#overthinking #outofmydepth

It's Christmastime, which means that la p'tite, who lives a ludicrously pampered first-world-plus existence at baseline, is bang in the middle of an eight day stretch of truly mindblowing indulgence, as the trifecta of her birthday, Christmas, and a contentious co-parenting relationship convene to (transiently, one hopes) stamp out any vestiges of moral fibre, restraint, and humility that may have developed over the preceding 12 months. 

For her birthday/Christmas this year, the present she has most consistently requested whenever the subject has come up is, I am not making this up, 'shackles.'  Rather than go deeper into what she would plan to do with shackles, should Father Christmas decide he's down with this (because I really, really don't want to know), I have been trying the Good Mummy diversion tactic of "what presents are you excited to make/give other people?" which turns out doesn't really work if you have the kind of kid who wants shackles to begin with. 

When I was little, I wanted a Barbie for Christmas; my mother, like any self-respecting hippie feminist child of the 60's, was horrified, but she squared it with her soul, and stayed up late the night before Christmas sewing Barbie outfits. Thus I awoke on Christmas morning not just to a new Barbie (with a plastic panel in its back which you pushed to get a kissing noise eeeeeuw) but also to a whole wardrobe of tiny Liberty-print floral hippie smocks, all ready for Barbie to start boiling her own soap, dipping her own beeswax candles, and putting on her wellies to go out to the pea-patch to harvest her curly kale to make a bulgur salad. I do remember a slight pang of disappointment at the time that my Barbie did not have more flashy outfits as-seen-on-TV, but I now think of my Barbie's flower child/Mennonite wardrobe as an act of tremendous beauty and sweetness by my mother. (By the time I was la p'tite's age, my mother had taught me to sew myself, and there was no looking back: all my teddy bears had reproduction Elizabethan ball gowns for regal functions, executive suits for work, and chintz floral prints for casual daywear while on tropical vacations: truly the gift that has kept on giving through the decades.) Neither my Barbie (unless you count her lurid pink plastic high heels) or my teddybear, however, went in for BDSM, so I don't have much in the way of parenting precedent to lean on, here.

La p'tite's interest in sewing is cursory, but her interest in dominatrix gear has been pretty consistent since the age of about six, long enough to not really be a phase, I think. (Favourite superheroines are without fail the baddies, the ones who dress in skintight black leather, carry whips, and have fangs). There are plenty of things I make her do that she's not into (piano lessons, chewing with her mouth shut, math) so I should honour her other interests when I can, right? So: shackles. I stopped by JoAnn Fabrics this afternoon and picked up a yard of chunky plastic silver chain and a strip of black leather with silver studs, and I made the girl her shackles. (All her other presents, scouts' honour, are entirely virtuous, innocent, and focused on self-improvement: art supplies, musical instruments, books, etc.... with the possible exception of a pair of socks which say "Fuck off, I'm reading" which I couldn't resist.) 

I am going to wrestle in private with the murky question of whether I should have indulged this particular whim at all BUT here's the question for the wide reading public: is it creepier to receive your gift shackles from an weird old semi-magical dude you've never met who sneaks into your room at night to leave stuff at the end of your bed (Santa)... or from your mother? 

Kafka in times of COVID

So yes, big long gap there for a minute, but I have not had anything more notable happening in my life than anyone else on the planet has (masks, long lines to buy food, child at home, obsessive checking of IHME stats), but there's a wee gap in patient care duties and a situation which is just so, so indicative of how completely stupid the medical system is that I can't resist; it is truly a self-sustaining industrial monster at this point, absolutely definitely not set up to serve any actual human beings other than possibly the corporate  overlords. To wit: 

1. I work several different jobs. 

2. Each job requires that I get fitted for the particular type of N95 mask that they stock.

3. I have been successfully fit-tested for multiple types of N95 mask without difficulty. 

4. The one exception was for my one un-busy job, which already has presented me over the last year with a number of bizarre and surreal situations, not the least of which is insisting that I physically come in to clinic at the height of the pandemic to see exactly zero patients. At the fit-testing for this job, (outsourced to an outside company), the technician seemed unsure of herself, saying it was her first time fit-testing someone. She had trouble decanting the saccharin into the test sprayer gizmo, and when she sprayed it, I couldn't smell anything. I suspected that she had just done it wrong, but I also have had a stuffy nose since March because of wearing an N95 all day every day, so who knows. I therefore failed that particular fit test; I wasn't terribly worried because there was another provider at that job who was willing and able to see any/all potential COVID patients and the total number of patients seen is very low, and I have other N95's from other jobs that I can wear to help keep myself safe. 

5. Fast forward six months, we got a fit-testing kit to actually have at the clinic so it seemed reasonable to have another go. I filled out the preliminary questionnaire, marking 'no' to every question about symptoms other than 'Have you ever had difficulty getting fit-tested because of inability to smell?" The medical assistant sprayed saccharin at me, confirmed I could smell/taste it, and successfully fit-tested me. 

6. I got an email from the clinic manager saying that before I could _wear_ the N95 mask I had just been fit-tested for to see actual patients with actual COVID symptoms I would need to get signed off by the medical director, because bureaucracy.

7. This is the waking-up-as-a-cockroach part: the medical director, who is a doctor, declined to sign off on my using the N95 mask I had been fit-tested for because I had marked 'yes' in answer to the question re: smell above, and told me I needed to get signoff to use the mask from... a doctor. (At my own expense, they made a point of telling me).  Full disclosure: I am a doctor. I have no idea how I would evaluate someone's fitness to wear an N95 mask other than asking them if they'd passed their N95 fit test. I asked the medical director (a doctor whose job it is to provide other doctors with medical advice) this, and he has thus far declined to answer. 

9. I now have a telephone appointment with my own lovely doctor, to ask her to write a letter either clearing me (or not) to wear the N95 mask I have been fit-tested for. She is way smarter than I am, so if there is some other way of determining fitness to wear an N95 mask other than doing an N95 fit test, she may know about it, but am I cynical to think this is more about keeping lawyers happy than about keeping me or patients safe? Hmm. 

10. What I will likely ask my own lovely doctor to write (and what she will likely write): "Clearance given to wear N95 mask." What I want to ask her to write: "ARRRGHGHGHGHHGHGHGHGH what the FUCK this is a ridiculous farce if your own N95 fit testing procedure is not enough to guarantee someone's ability to wear an N95 mask, you shouldn't bother doing it; what the hell additional objective criteria is someone supposed to apply - over the phone, mind you - to determine this? I hereby grant permission for the patient to hide under a rock until the pandemic is over, at time-and-a-half pay." 

Note that this is the same institution that, back in April (remember April? widespread asymptomatic transmission, no tests, completely overwhelmed Public Health... eerily similar to December except for the test part...), was instructing providers to "rule out COVID-19 over the phone" and to refer anyone for whom we could not magically, telephonically and definitively rule out COVID to, yup, Public Health, that same Public Health not answering the phones or website inquiries because they were at max capacity just trying to figure out how to test people with both symptoms AND recent travel history to Wuhan. 

Can someone just make Atul Gawande God already? 

Day 29 of shelter-in-place: ten anticipated adaptations for return to real life in a Zoom-habituated world.

1. As well as a well-fitting N95, it will be considered gauche to go out in public without a small rectangular mirror glued to your forehead, so that anyone you interact with can surreptitiously adjust their posture and facial expression to be maximally flattering.

2. Pass codes will be required in order to prevent racist amateur pornography trolls from crashing family dinners.

3. An enterprising tech-savvy school teacher will make a fortune with an app that allows teachers to instantly "mute all participants" in a real life classroom; meanwhile students will have to paint their palms blue in order for the teacher to notice them when they raise their hands.

4. 'Business casual' will be redefined as wearing pyjamas rather than nothing at all.

5. When get-togethers become boring, it will be acceptable to entertain yourself by picking people up and arranging them all just the way you like them on your wall. Also, if you're the host, you can swap out their real names and assign your guests more amusing names at your discretion. 'Peanutbutter Dragon' is good.

6. If you need to go to the loo during a work meeting, it'll be totally normal to just squat down in the middle of the conference room and go, as long as you turn the lights out first and don't make any noise while you do it.

7. Six-foot distancing will be automatically maintained by the portable green screens which everyone will walk around with strapped to their backs. The curated background images being continually projected onto these screens will give the subtle impression that everyone else is way cooler than you, and probably spent their SIP time training for marathons and writing devastatingly well-researched & intensely clever nonfiction, and definitely did not bother with inane blogs or YouTube videos of Comedians In Cars Getting Coffee (start at 2:45 if you're going to watch the Obama episode, which will make you nostalgic for the days when we had a sane person with a sense of humour and humility in the Oval Office).

8. If you go out to a restaurant with a group of three or more, you will be kicked out after 40 minutes and will have to come back in again to finish your food, unless it's a fancy restaurant that charges more than $15 per entree.

9. Children will be flabbergasted at the ease with which their parents are able to maintain ongoing conversations without tech support.

10.  Your sex life will -------- and the---- n----- rhinocer-------  --sn't ------- ---- --- - Anderson Cooper's vacation home------- ---- ----- several million yen ---- ------ back of the sofa --- and that of course will be the definitive solution to climate chan-- ---- -------- -----  ---- sorry, I appear to be cut--------- ----- --- think I'm ---- connection problems ----

Day 19: dragon table completed (except for varnish)

Artistic collaborations with la p'tite always seem to involve way more work for me than for her. Clearly I am doing this all wrong. Chairs next (if I can face them); she's already done her bit by drawing individual chair dragons in Sharpie on the backs. one corresponding to each family member.

We invented a whole series of new words to be extra posh yesterday which consist of adding the ending 'aviar' (as in caviar) to the end of whatever you are talking about, which at the time happened to be dingoes and the song "Supercalifragilisticexpialidocious;" I am more than a little worried that after 12 days straight with no one but each other for company that our language will drift so far from standard English that we will actually lose contact with the mainland and our loved ones will have to send in a team of crack forensic linguists to help decipher the squeaks, grunts, giggles, and references to dingoviars if they want to be able to communicate. Linear B's got nothing on us.

Day 17-18: oy.

The shelter in place order just got extended until May 3rd in Alameda County, with tighter restrictions than the previous one; I have been advised to keep my work badge with me so that I can prove I am 'essential' if I get stopped by the police while on my way to work... so it is getting serious down here. Luckily, the Daiso store in El Cerrito Plaza is still open, presumably so that the brave and overworked ICU staff who need to keep their hair off their faces as they perform bronchoscopies on COVID patients will have access to crucial life-saving plastic sushi- and cat-shaped barrettes; JoAnn Fabrics likewise has a sign on the door saying that they decided to stay open "in order to help with the grassroots effort to donate home-made face masks to hospitals." (If you don't know anyone who sews this might sound convincing, but please trust me that anyone capable of sewing a facemask also has a gigantic fabric stash which they should have gotten rid of a long time ago, and needs JoAnn's like an addict needs their dealer, i.e. like a hole in the head.)

Meanwhile, I worked a positively sepulchral Urgent Care shift on Monday; I was scheduled to work a second shift on Tuesday, but it got cancelled because they can't justify paying two doctors to be there, so instead I spent the day in a mighty orgy of semi-productive procrastination. I am scheduled to teach an art class for three weeks in July to fifteen 10-11 year olds, a job which I got on the strength of a conversation with the director of the UW Early Entrance Program at a Bay Area fundraising mixer (which truthfully I only went to because it was at a really nice tapas restaurant in SF), and I have been putting off finishing the syllabus for the class (due April 1st) for weeks 'n' weeks 'n' weeks, initially because I thought, whatevs, I have weeks to do it! and then more recently because the world has been getting cancelled and it seemed unlikely that art classes would be any exception. I talked to Trophy BF in the morning and we both agreed we were going to get right down to our various plans for the day, and then we both engaged in what can most kindly be described as meta-faffing. I successfully nailed everything in the bottom two squares of my Eisenhower box (walking to a closed hardware store to attempt to buy varnish for the dining room table, e.g., which is how I know that Daiso & JoAnn's are still open), but did not actually get down to syllabus-writing until (squirm) nine o'clock at night; meanwhile Trophy BF put together a binder of his planned schedule for the next few weeks of staying at home in which he actually scheduled his daily shits. 

I got to have a long chat with my delicious one and a half year old godson, who doesn't so much chat as provide performance art pieces (live motion-sickness-inducing tours of the lowest two feet of the cabin in the woods where his family is holed up, with particular detail to the cabinetry in the kitchen and occasional random glimpses of the ceiling; the soundtrack is not-hugely-comprehensible-but-impressively-polyglot squeals), and had virtual dinner with a friend who is considering 'going on retreat' during this time, which means upping her usual meditation practice of 1.5 hours a day to six hours a day. I have tried meditating for fifteen minutes at a time for the last couple of days and both times was ready to crawl out of my brain by about minute six; I think probably safest for the world if I stick to painting dragons and playing Lego with p'tite. We have one more day of 'distance learning, and then twelve days of 'extended spring break', just her 'n' me; watch this space to see if I'm still standing by the end of it.

Day 16: Substantial silver linings

P'tite decided she wanted to sleep in my closet last night, in a nest she had made herself out of cushions from the sofa, a bean bag, and blankets, happily surrounded by stacks of her books and wearing a set of headphones unconnected to any jack in the existing mundane universe, but apparently streaming wonderful sounds from the mothership in the parallel universe she actually comes from. I woke up early and decided to go to the Monterey Market while she was still dozy and (I hoped) the lines were less awful, as we were overdue for a megashop. (I love that it is now the responsible thing to do to leave your child unattended at home while you go to the grocery store...)
The line was both awful (I arrived at opening time and there were already fifteen people ahead of me, dutifully spaced six feet apart - Berkeleyites are SO conscientious - plus I'd failed to take into account the first half hour of opening times being reserved for the 60+ crowd) AND totally worth it: once I actually got in, I whizzed around a gloriously empty Monterey Market and was back less than an hour after I'd left home with $350 worth of groceries, which I would never have believed possible given the preCOVID Piccadilly-Circus style gridlock which chronically constipates the aisles of the MM. (They had everything on our list except for AP flour, which suggests that more than one family is dealing with quarantine boredom by baking; we're going to survive coronavirus only to die of diabetic complications.) I hope they continue the policy of limiting number of people inside the shop at any one time postCOVID because overall it is totally faster, but sadly, I suspect they will not. Lines look great outside posh nightclubs, but uncomfortably Soviet outside grocery stores.
I recently got sent an article by the astronaut Mark Kelly - who should know - suggesting that routines are very important when you're stuck for long periods of time in confined quarters, but here's a word in favour of not planning: we made a list of the stuff that absolutely had to get done (seedlings, piano practice, exercise), p'tite put arbitrary times next to them, and then she went into Lego ecstatic flow state on the living room floor for the next four hours while I went into gold chalk paint ecstatic flow state on the dining room table (needs varnishing, and the chairs & middle table leaves still need ('need' is used loosely) painting, but first phase of Mission: Dragon Dining Experience is now complete):

An hour of ABBA Just Dance videos (she is always Benny, I pick Agnetha or Bjorn) qualified as our exercise for the day, followed up by a couple of hours in the garden (late-afternoon sun, seeds & weeds & overenthusiastic akebia vines), a ginger cake in honour of Grandpa's birthday (celebrated remotely via Zoom), a hot bath, the Oxford Children's History (plus fart jokes) read aloud while snuggled on the sofa under a blanket, then blissful bed at 8:30 for both of us. A similarly peaceful and unstructured day would have been unthinkable pre-social distancing, but like the line outside the Monterey Market, sometimes you need a crisis to show you there's a better way of doing things.
Oh! and my COVID19 test from last week came back negative...

Day 15: Public health medical quiz, aka this is what I get for refusing to write prescriptions for family members

The following exchange happened on family chat yesterday. The names have been changed to protect the innocent and/or insane. Ten points for each correct diagnosis (hint: almost all can be found in the DSM IV; none are COVID19).

Family Member Without Medical Training But a Propensity for Self-Diagnosis No. 1 (FMWMTBPSDx1):
BTW, don't panic; I have a sniffly cold, but a robust sense of smell, so I'm afraid the common cold is also doing the rounds. I and [Family Member Who Ignores Any Medical Problem Including Skull Fracture with Traumatic Brain Injury (FMWIAMPISFTBI)] are completely exhausted and not feeling great. I've got a stinking cold. No fever, no cough, just sinusitis. xxx

Family Member Without Medical Training But a Propensity for Self-Diagnosis No. 2 (FMWMTBPSDx2): Oh no! How do you think you picked it up?

FMWMTBPSDx1: I whizzed out to buy wine three days ago (mask, latex gloves, social distancing, sanitizer, etc) but yes, I was meeting an essential need! But don't worry, this definitely not the dread c., just sinusitis which is very different.

FMWMTBPSDx2: If you can pick up an arbitrary virus being as careful as possible, please don't go out again! It's too risky.

FMWMTBPSDx1: I figured out that - duh - this week FMWIAMPISFTBI has been sawing wood all week in the house, and I've been living in all this dust and doing the sweeping up. I'm having a strong allergic reaction, scratchy eyes and runny nose. Absolutely no other symptoms, no sore throat or anything. Not taking Benadryl because I don't want to put any drugs in my system because of the Advil news. Definitely allergy. Streaming nose!

FMWMTBPSDx2: Hooray!

FMWMTBPSDx1: I sent off for 6 bottles of red online this afternoon!

FMWMTBPSDx2: Medical family members [i.e. me + Trophy BF] - turns out I fractured a knuckle. I have an appointment with the doctor next week, and would like to stabilise the joint in the meantime. Do you know if bent vs straight is better? I've been wearing a splint that keeps it fairly straight. I bought plaster wrap so can also easily stabilise it in a more bent position.

Helpful Trophy BF Who Has Yet To Fully Gauge the Depth of Insanity of Which My Family Is Capable Despite Having Been Immersed In It For Nearly 5 Years (TBFWTF5): You poor dear. How did you manage that? Can you call so I can ask some questions? Easier to evaluate and instruct by phone.

FMWMTBPSDx2: Eep, sorry, was just peeing and crawling into bed. Can I ring tomorrow?

TBFWTF5: If you can call before 9 am one of us can talk you through making a gutter splint in the right position - important to get position right.

FMWMTBPSDx2: You're so kind - thank you! I hate to waste your time though, so if it's on YouTube I can also just look there. But I can probably catch one of you.

TBFWTF5: It's your ring finger most proximal knuckle?

FMWMTBPSDx2: It's my fuck you finger. OK zzzzz now I love you!!

TBFWTF5: Here's a decent video. Note the finger position; making a radial gutter splint is a two-hand job so you'll need help. Don't try it unless you're sure that you can do it; not that easy a splint if you've never done it. In addition to the correct bend at the MCP joint and the relative straightness of the fingers, note the slight backwards angle of the wrist. There should be no tension on the tendons on the front or back.

FMWMTBPSDx1: Explain to your dear family how you broke your knuckle

Me: Wait, wtf, sorry to be late to the party here. How the hell did you break your hand? Around now - ring anytime.

FMWMTBPSDx2: Thank you! That video is great. Did not break hand! Tiny tiny hairline fracture in knuckle when using drill. Read this hilarious Economist article!

Me: fracture = break, silly

FMWMTBPSDx2: I know, just clarifying the magnitude so that FMWMTBPSDx1 doesn't report to FMWIAMPISFTBI that I've shattered my entire right arm. Are there splinting competitions? After watching three YouTube videos I now feel like I can splint any mangled MCP joint you throw at me.

Me: Where did you end up going to get an xray? Urgent care? I hope nowhere you could have picked up COVID.

FMWMTBPSDx2: I am mistrustful of urgent care since [a completely different provider at a completely different UC in another city] mishandled my broken foot a couple of years ago

Me: Right, because all urgent care doctors are identical. So where did you get your xray?

FMWMTBPSDx2: I've got an appointment for one next week.

Me: I begin to smell a self-diagnosis based on YouTube videos, unless you McGyvered an xray machine out of old laptop parts and some radium you found in the basement.

FMWMTBPSDx2: I've had enough joint breaks to know what they feel like vs other joint injury.

Me: How about at least jumping on video chat to show me where your hand hurts?

FMWMTBPSDx2: Thanks, but all outcomes are taken care of! I'm already bored of it. Read the Economist article!

So to sum up: we're apparently a family of allergy-prone alcoholics, but at least one of us has Xray vision, which is totally better than average. I'll take it.

Day 14: junior hackers, preoccupied slugs, sex dolls

We got an email from the teachers yesterday saying that some kids are playing video games on their computers during virtual classtime and that the kids are expected to stay focused etc. etc. - I don't think we are quite that naughty, but I did open up my laptop to discover that my home screen wallpaper had been changed and the icon representing la p'tite in her Google classroom had been changed to a dragon, and she hasn't had access to the laptop except for during official distance-learning activities, so clearly a somewhat beadier eye is required. I also caught her yesterday going through the kindergarten level of Chinese flashcards supposedly because she couldn't figure out how to access the third grade ones - hmph, a likely story - but I gave her a pass on that one because I was feeling smug: I had only caught her because I was hearing words that _I_ recognised. Anyway. The point being: digital native. I think my best hope of not having every account I own hacked and used for nefarious purposes is for her to get religion, preferably some hideous old world religion that involves a very strict all-seeing & fierce deity, who has stayed current and issues specific edicts about not using your parents' Amazon account to order stuff they've refused to buy you or read their email when they're not looking.
 A moment of discord in the afternoon when she DID NOT WANT to go out to exercise, but it was a beautiful day and we needed to get outside for a wee rollerskate/run up the greenway as far as the El Cerrito Plaza BART station: we pissed and moaned and clung to the back of my shorts all the way there, and then literally the moment we turned around to come home, all was once again sweetness and giggles and funny stories and pretending to be various animals: we got a lot of mileage (literally) out of 'preoccupied slug', 'despondent puppy,' and 'obstreperous hyena').
I know that there are people out there who live alone who have no physical touch with another human for long periods of time normally, but that is, if not by choice exactly, at least something that you theoretically could do something about: get a pet, pay for a massage, make a friend who will hug you, hire an escort, whatever. I had a conversation with K. - an avid tango dancer and massage therapist who lives by herself: she has gone three weeks with not a sausage, and there must be a lot of people like her out there who _are_ used to casual, frequent, affectionate touch from humans who are suddenly not getting it, which has got to be very hard. I was a bit horrified when I read recently about the hyperrealistic robotic sex dolls now available, but if social distancing is the future, we should consider making taxpayer-financed regular-to-slightly-dowdy-but-very-good-company dolls using the same AI technology available to anyone living alone. (The government can start buying hot nubile  sex dolls for anyone who wants one only _after_ it starts paying for food, housing, health care and higher education for anyone who wants it). Meanwhile, I am getting my quota of cuddles from madam, who fell asleep last night demanding 'tighter hugs,' and sleepily announcing, "if my knickers aren't pulled up high enough, I can't sleep. That's a quote from Shakespeare."

Day 13: Masks, doom, stage-combat.

While la p'tite did her online distance learning in the morning, I spent the morning sewing surgical facemasks, which was fun and felt very wartime - sort of like knitting socks for Our Boys At The Front, except they were actually for my parents (my mother was wanting something more stylish than the grotty sawdust-covered all-purpose masks that have been hanging on a nail next to my dad's table saw for the last twenty years, can't think why). I did feel very proud of my pre-COVID reduce-reuse-recyle mentality, as I was successfully able to scrounge up enough garbage twisty-ties to successfully make nose-pinchy inserts for all the masks. I made a mask out of octupus and squid-print material lined with grey - for the business cephalopod look - since la p'tite wanted one as well, so we are all set, at least fashion-wise, for the apocalypse. Oh, the irony that I taught a class in monster mask-making just last summer, with no inkling that I would be mass-producing surgical masks less than a year later... Trophy BF has requested a Batman N95, which is above my paygrade but which I am sure will be one of the first things to start getting produced once the factories in Wuhan are up and running again; I secretly hope that the experience of having lived under actual clear blue skies for the last couple of months while everything's been shut down will result in some converts to the environmentalist cause in the mainland Chinese powers-that-be. Dare to hope... 

In the afternoon we went out for a run/rollerskate; passing through the Westbrae we passed two grocery stores both with lines out the door and multiple smaller food shops which were allowing only one customer in at a time. The shops are, thankfully, starting to limit people as to how much of any one item they can buy in order to prevent hoarding, but it does mean that we will need to go out to buy food more often and spend longer doing it than before, which is somewhere on the frownyface/smileyface pain scale between tedious and possibly dangerous. Video chat with auntie D. over dinner - she is on the lam in Utah camped out in a vacation rental in a closed-down ski resort, and likely to remain there for the duration, working online by day and teaching her co-fugitives 'how to find the beat in a piece of music' (yes, for real) by night - and then we watched Song of the Sea, which I think is up there in my top ten favourite movies ever. I love, love, love the artwork in it, plus I just read that the whole thing was drawn by hand. Wow. I wish Tomm Moore would make more films already. 

I am trying not to worry about money. Quite apart from only being able to work halftime while the schools are closed down, furloughs and layoffs and reduced hours are happening, even in the doctor world. As locums physicians both trophy BF and I are, we are finding out, very, very vulnerable - as the outpatient clinics reduce their services and go down to unreimbursed phone visits, the locums are the first to get the chop, and credentialling as a hospitalist/ER triage provider will (a) take time (b) not be guaranteed either and (c) put us more in harm's way with regards to getting sick ourselves (I am grateful la p'tite and I are both in a low risk group, and was very reassured by Atul Gawande's level-headed recent article in the New Yorker, but I could still bring it home to other, more vulnerable family members). 

I fell asleep and dreamt that I got into a stage-fight with some woman in a cafeteria while waiting for our plane to leave for South Africa for the medieval bookmaking art class I'd registered for, and our fake fight was so convincing that someone called the cops on us and we ended up missing the flight. I have no idea what it means. 

Day 12: tech support, baby ninjas

Someone said to me around the time that la p'tite was born that when you have a baby, the baby itself is the most amazing wonderful thing ever, but that it will make the non-baby rest of your life speed off to hell in a handbasket in a most expeditious fashion, and, you know, it is kind of true still even though we are nearly ten years in. I am feeling a pang of sympathy for all the hapless IT helpdesk employees I have inflicted my forgotten passwords on over the years: literally every time that I got on the phone to start a phone visit with a patient yesterday, something would go wrong with the digital school setup and I (me! ha! the universe is laughing at the thought) would have to provide tech support. There's also the random injury factor (we were playing Baby Ninja Training Academy out in the garden, as you do, and I added a couple of really pretty spectacular exemplars to my bruise collection), the cooking factor (a pot of chili will feed me for the whole weekend; however, when she's around, I feel this inconvenient compulsion to provide somewhat varied nutritious meals, which turns out takes some time and effort), and the chore factor (I wanted to get laundry and seed starts done, she wanted to play Baby Ninja Training Academy; I got the clothes into the washer but not out of it, and half the seeds done, so I'm counting it as a draw).

She is, however, good for a laugh, which is nothing to sneeze at in these trying times: as we were falling asleep last night (I know the Good Mummy Handbook says that kids should sleep in their own beds, but you know what? fuckit, coronavirus) she was telling me jokes.

Q. What goes on and off and on and off?
A. An on-and-off machine.

Q. What goes on and off and up and down and sideways?
A. An on-and-off-and-up-and-down-and-sideways machine.

etc.

Speaking of tech support, she also had a virtual playdate with another child from her class, who is not quite the alpha-dragon that madam is, and the conversation went like this:
Her: Let's play Ninja Academy.
Other kid: How do you be a ninja?
Her: You spin your stick around like this, then you do ninja-y things.
Other kid: What's ninja-y things?
Her:
Other kid: Are you just going to read?
Me (shouting from other room): Don't read when you're on a playdate with another kid! That's rude!
Her: OK, OK, OK, OK, I said OK.
Other kid: Have you ever noticed how many letters sound like ay? K, J... may, play, day, lay, say...
Her: Do you want to draw dragons?
Other kid: I used to be really good at drawing dragons. Now I'm terrible. How do you want to do it?
Me (off-camera): do you want some paper and pens so you can draw, and then you can hold the drawings up to the camera and show each other?
Other kid: can we use whiteboard?
Her: What's whiteboard?
Other kid: Here, share your Zoom screen with me, and then at the bottom of your screen you can see the whiteboard icon, then you click on whiteboard, and then you can use whiteboard to draw...

We had Zoom dinner with grandparents & trophy BF last night, which was a little bumpy to get going but ended up being very successful and I think we will do it again soon, and then madam had another chess game with her grandfather snuggled up with the computer next to the fire, which was all kinds of cute, and I fell asleep with my cup of tea and my book on the sofa.

It feels a little bit like a long-haul trip via steamboat from Victorian England to some farflung colonial outpost, this coronavirus thing: steamships are safe enough that you are mostly assured that you will arrive at your destination, but there could well be some crocodiles along the way, and it will take months to get there, during which time you are stuck with just the other people on the boat with you, and there's not a lot to do but wait, and for those of us lucky enough to be travelling second-class, play tiddlywinks or shuffleboard or shipboard cricket or whatever the hell they used to play, and go for walks along the deck and hang over the prow of the boat singing "The Heart Will Go On," at least until the hospital gets back to us about working  the shifts in the Emergency Department once the storm really hits.

Day 11: swabs up my nose & more Wagner

So, phone visits with patients all day, punctuated by an exciting ten minute visit to clinic in the middle of the day to get a Q-tip stuck deeper in my nose than I've ever had a Q-tip go before. I am still not sure whether I did the right thing requesting a test, given that I've had none of the classic symptoms (cough, fever, shortness of breath) and there are loads of people out there sicker than me, but since I was out in the world seeing patients this whole last week without realizing I was 'symptomatic' (insofar as -not- being able to smell counts as a symptom; as M. pointed out, it's not like I went blind and failed to notice it) and it does appear that anosmia is weirdly correlated with COVID19, perhaps it -is- the responsible thing to do... urgh. I don't know. But I am now officially a Person Under Investigation, which means that I am staying completely home for the next few days, which is what I was going to do anyway since madam is back with me for five days starting today and we have digital school to manage.

Trophy BF very gamely offered to watch the first bit of Das Rheingold with me in the evening, and we ended up watching THE WHOLE THING. I have never seen any of the Ring before, and boy, is it ever the silliest plot, even for a genre renowned for silly plots. But it was really fun to watch, and the singing was great (especially Freia and Loge, and except for one of the giants) and I really liked the crazy rotating plank contraption in the set, as well as the discofabulous lighting design, and I am kind of tempted to power through the rest of them over the next three days, just because apparently we're all going to be stuck at home not doing a lot of anything for the next however long, and why NOT spend Armageddon watching opera.

I am looking forward to la p'tite coming home. It will be nice to have human contact that I don't have to stay 6 feet away from. Also, we have dragons to paint.

Day 10: anosmia, chili, opera

I just found out last night that the lovely friend with whom we had brunch two weeks ago subsequently got sick and tested positive for coronavirus; then I read in the NY Times that loss of smell is in many people the only symptom of COVID19 and hey! guess what? last weekend I couldn't smell or taste anything, which I attributed at the time to having had gum surgery a few days earlier, but now of course I'm adding it to the constellation of phantom psychosomatic symptoms I have also been having since the whole bloody thing started, and thinking, well, shit, I think I need to try and get tested. So, instead of going to work today, I'm going to ask if I can do all my telephone visits from home (daft not to be doing this anyway, really) and in between phone calls see what I can do to get myself tested. Getting past the fierce barrier of triage nurses to get a test is going to look a little bit like this I suspect, but following the standard public health testing formula of
legit specific symptom + known positive contact + healthcare provider = asymptomatic NBA star
I totally deserve a test, and, if there's any justice, a spot in next season's draft as well.

My shift yesterday was slow, slow, slow - everyone without respiratory symptoms is staying home, and anyone with respiratory symptoms is being turned away at the door by the Urgent Care Sphinx and sent to the coronavirus triage tent, which I haven't worked in (yet) but imagine as being kind of like the tent in the Great British Baking Show, where you have to compete in front of a judging panel made up of Paul Hollywood, Mary Berry, and the head of your county's Public Health Department to see if you deserve the accolade of this week's Star Convincing Coronavirus Patient.

Afterwards, I came home and finished the pot of chili which has got me through the last weekend (had madam been with me she could have helped me determine whether my sense of smell has completely returned or not...) and watched the first half of Tristan und Isolde courtesy of the New York Metropolitan Opera, which is streaming a different opera from their archives every night for free. It is the first time I have ever felt properly sad about not having a huge bloody great flat screen TV, because it was fantastic - they had set it in a very dark and gloomy modern naval ship/submarine, with black & white waves tossing outside & a huge glowing green submarine sonar hanging over the stage endlessly circling in a way that suggested CERTAIN DOOM - and the singing was seriously luscious. At the risk of sounding like an uncultured slob, I gotta say I have trouble with Wagner; it can get a bit soupy, and it's not always obvious what the melody is, but still, absolutely great and I might well watch another one tonight, since my music-making date got cancelled due to impending inclement weather. Fiddle-playing friend and I have coined the term "active social-distancing": we were going to sit six feet apart playing our respective string instruments so badly as to actually repel anyone who might be in the vicinity. If the police get overwhelmed in the coming weeks trying to enforce shelter-in-place orders, they could use us to dispel inappropriately-gathering crowds. It's a public service we're providing, people.

Day 9: wtf

It has been two weeks since I last got to see trophy BF, but it feels like a million years, and I MISS HIM. I took him to the airport for his regular Monday morning flight back to Seattle - we were worried enough about COVID19 then that I didn't want him taking BART to the airport - but we didn't have any sense that it was going to be a really long time before we saw each other again, whereas now... months? who the hell knows. I do not want me or la p'tite to be the one to get him sick, however, so I don't know if I even want to try to see him. Urgh. He sent out a very articulate precis of what's needed w/r/t data collection to a data guru friend yesterday, which made me feel very proud of how smartypants he is, but also made me miss him more.

Anyway. So the people who are taking all this seriously here, scrupulously following all the 6' distancing & shelter-in-place rules and sewing home-made facemasks to donate to hospitals are me 'n' my hippie lefty friends and neighbours, whereas Trump & co are busy squashing cheek to well-fed jowl onto stage at press conferences while his supporters frolic on beaches by the thousands in Florida, organizing themselves into flashmob middle-finger formations pointed at the CDC. I am curious as to whether this has played out along political dividing lines in other countries as well - in the US, at least, it seems that until enough people of all walks of life and political ideologies get sick and die and make it obvious that this virus is not picky, the self-reinforcing tribal identities of the two camps seem likely to continue to diverge; from what I have read, this has not happened (at all) in Italy, Spain, or South Korea, but is happening (a bit) in the UK; the us v. them lines are apparently drawn strongly enough here that even a 1% threat of death isn't enough to shift them (yet). I don't know whether this has to do with
a) size - it's hard to maintain a cohesive sense of national identity when there are 250 million of you spread over thousands of miles
b) relative youth as a nation - it's hard to maintain a cohesive sense of national identity with very little in the way of shared history & accumulated culture - or
c) chronic intractable bloodymindedness - it's hard to maintain a cohesive sense of national identity when the only shared culture that we do have is apparently an unshakeable belief in every-maverick-for-himself.

Off I go to urgent care shift with my cute new fabric surgical mask over my reused N95 mask. La p'tite has days-of-the-week undies; I've got days-of-the-week N95's. At least hers can be washed...

Day 8: The emperors are cashing in on the burning of Rome

Oh, I am now angry angry angry. Airlines and cruise ships are going to get huge bailouts, average citizens are going to get barely enough to help through a week or so of being off work, and those at the very bottom are being kicked to the curb so egregiously I can't stand it - children in foster care, apparently, are en masse getting kicked out of their foster home placements because no one wants to deal with having foster children actually under their feet all day long while the schools are shuttered. Trump downplayed the expected impact of the coronavirus while Republican lawmakers were busy selling off their stocks right before the crash. 

And meanwhile, I have an MD and I spent the day at home painting my dining room table, chatting with friends on video hangouts who want to sew me home-made surgical masks out of cute print fabrics, and thinking I should probably go out for a run at some point... I am going to write to the medical staff office of the local hospital and see if they are planning to loosen the requirements for ER/hospitalist work; it has been over seven years since I did any inpatient medicine (aside from the odd labor & delivery patient with an internal-mediciney issue) so I am rusty, but since so many outpatient clinics are shuttering and the hospitals are exploding, it just feels like that is the place I should be right now. They were pretty desperate for hospitalists when I applied for my L&D privileges several years ago. Ooh, I can wear one of my cute new surgical masks. It'll make up for the fact that Richard Branson, who already has a net worth according to Google of about $3.5 billion, is about to walk off with, not just the cost of my cancelled flight to the UK in April, but also several million dollars in bailout money.

Day 7: psychosomatic coronavirus

The writers of ICD-10 diagnostic codes, whose praises we have had good reason to sing in previous blog entries, have, bless their cotton socks, once again risen magnificently to the occasion, this time providing a off-season urgent addition to the codebook, so that doctors can officially diagnose COVID19. The variations include 'confirmed COVID19,' 'suspected COVID19,' 'contact of person known to have COVID19' etc. They have yet to create the ICD10 code, however, for 'psychosomatic delusions of COVID19 in healthcare provider,' which I think is an oversight, as both trophy BF and I have come down with this, and more data need to be collected with regards to prognosis and morbidity of this. For the last few days I have been increasingly convinced that every time I swallow or take a deep breath, it's _going_ to hurt; meanwhile the only symptom of actual COVID19 that I have currently is fatigue, and that might have more to do with the fact that I'm up at 3:30 in the morning writing a blog and trying not to scratch my poison oak than any phantom viral infection.
The very beloved clinic where I worked for years burned down four and a half years ago, and I cannot help but feel that there is a parallel between what happened then and what is going to happen on a much, much, much larger scale now. I found out about the arson in the middle of the night, when one of my colleagues rang me, and over the two and a half years between the fire and eventually leaving the job, the emotional landscape unfolded as follows;
- initial surprise - whoa that's crazy, but why did I need to be woken up to get told about it?
- over the next few days - things got easier and more fun: we didn't have to do any actual work, because there was nowhere to do it, and when we did have to do something, it was mostly sitting around in meetings getting told about what the plan was going to be, which (again), way easier than actual work, plus people were really nice to us and we got a lot of cake and sympathy.
- over the next few weeks - an enjoyable sense of solidarity and Rosie-the-Riveter-iness as we mucked in and started seeing patients again in a tiny trailer parked next to the smoldering ruin of our clinic. The Germans probably have a better word for it, but until then, I'll bookmark it with auto-preschadenfreude: the pleasure in the drama of one's own's misfortunes before the full impact of those misfortunes has really hit you.
- over the next few months - deep, deep tedium, as the computers in the trailer continually crashed due to dodgy internet, and patients were bad-tempered with us because trailer, and the summer was really hot, and the trailer smelt like a sewer because something was up with the plumbing in the microscopic loo, the nurses and front desk staff were in different buildings so we never got to see each other anymore, plans to put together a new building were stalled out, and the administration moved into spiffy new digs in Sebastopol and yet somehow we were still in the shitty trailer.
- over the next 1-2 years - a profound drop in morale despite having moved into a fairly reasonable prefab building as a temporary space; meetings in which everyone was pissed off, and bitter, and tired, in which we were asked to do more and more with less and less, and the administration gave peptalks about preventing provider burnout without actually doing anything of the things that have been shown to decrease it, etc. etc until
- 2.5 years later I quit and started doing all locums.

I think a lot of health care providers are going to leave medicine over this, and a lot of young people who might have gone into medicine will not, and telehealth will become the new normal in primary care, which in some ways is great (no infection risk sitting in waiting room, more convenient for patients, doctors get to work from home, etc) and in some ways is terrible (it's harder to love a patient that you are looking at on a screen than one you are sitting with in real life, and harder to really understand what's going on with them). We'll see. But right now, at least at several of my jobs, we're in the everything-is-ironically-easier phase: with everything on lockdown, most nonessential visits have been cancelled; those that remain are happening by phone, and we're just waiting for the other, much heavier, shoe to drop.

Day 6: zebra/teabag jokes, doing the dishes, bookclub, and dragon painting

Surrealist joke of the day, courtesy of the nine year old (it is possible that the isolation is starting to affect her sense of logic, which is shaky at the best of the times; however I can report that this joke genuinely cracked both of us up for a full five minutes):

A zebra said to a teabag, "Hey, what are you doing?" The teabag said, "Mind your own business."

Second day of distance learning went slightly more smoothly, although there was one moment of panic when it turned out I didn't have the right packet printed out prior to the Zoom group class (humiliation! bad parent! with the whole class watching!). Seeing all the little kids on their Zoom meeting is VERY FUNNY, as if they were the executive board of directors of a company (consultants for zebra/teabag based humour?).

There is a sign over the sink at my sister's communal living space that has a picture of various Arctic/Antarctic fauna joyously gambolling on the ice, with a caption that reads something like "Civilisation is a thin layer of ice over an ocean of chaos; do your dishes"; we will not contemplate right now the larger ramifications of that sentiment with regards to all the people who are apparently responding to this by buying guns and ammunition (God bless America), but instead confine ourselves to considering the immediate home environment; I have surprised myself by becoming an immediate, but immediate, washer and dryer of dishes after meals (the dishwasher is on the fritz), in addition to a slavish adherent of the school schedule, since it is obvious that the other way darkness lies...

I don't think it has dawned on la petite that she is literally not going to get to play in person with another child for probably months. We held our quarterly mother-daughter book club yesterday afternoon via Zoom as well; discussion of the book was negligible, and it was mostly a chance for the mothers to commiserate and the daughters to type poopie poopie poopie in the chat window to each other. They were so insanely happy to be typing poopie poopie poopie to each other that after half an hour or so, the mothers signed off, and I let madam take the laptop into her room so that she could giggle and type poopie poopie poopie to her friend in private. The psychic aftershocks of this experience are going to be felt in her generation for years to come, I betcha.

Meanwhile, dragon!

Day 5: school via webcam, piano gruesomeness, chess match

Yesterday was a ludicrous illustration of the human (or at least my) brain's ability to completely misprioritise threats. It was the first day of 'distance learning' for la p'tite, and we'd received boatloads of instructions through the school with regards to schedules and links to packets of work for the kids and on-line tutorials for stuff, and in my head I was thinking I'd be able to set her up in front of the computer at the beginning of each hour, press go on whatever activity she was supposed to be doing, and then get on with what I was supposed to be doing (which was telephone visits with patients; I set her up in the other provider's empty office, meeting requirements of both social distancing AND HIPAA, so there). However, it wasn't quite as seamless as I'd imagined; every few minutes she would somehow manage to click out of the Zoom meeting with her teacher, or the online tutorial thing she was supposed to be doing, or she would accidentally hit mute, or (etc. etc. etc.) and would distress-yip for rescue; so much for her being a digital native - perhaps I have done her a disservice by previously insisting on limited screen time, since apparently, even though the revolution will not be televised, we'll be spending 98% of Armageddon on the internet. She even complained at the end of the day that it had been "very screen-filled." But here's the stupid part: I was more stressed out physiologically (elevated blood pressure, constricted pupils, sweaty palms) at the thought of not getting her logged in on time and successfully to the Zoom meeting with her Chinese teacher (we were four minutes late) than I was on reading the new update from the CDC that people in their 40's infected with coronavirus are way more likely than previously realised to require hospitalisation; my autonomic nervous system is seriously crap at threat triage.
In any case, I can see that I am going to need to rethink my romantic notions of enjoying homeschooling, since we somehow have more to do schoolwork-wise than we usually do during regular school. B. reports from Barcelona that school there is just straight-up cancelled and they are spending their days playing video games, working out on the stationary bike, playing with the cat, etc., and occasionally doing some reading, so I'm grateful for the structure that school is providing.
In the afternoon we had virtual piano lesson, which was hideous - while she's routinely low-grade horrible about practising, usually she pulls it together quite well for piano lesson in person, and sits up and plays properly and doesn't race through stuff and is more or less polite to the teacher. Yesterday for virtual lesson, however, she was frankly vile, lolling around on the piano bench, being offhanded with the teacher, racing through everything at breakneck pace with frequent excruciating collisions into wrong notes that she made no attempt to pretend to care about, etc., and I kind of wanted to murder her. (Wait, not 'kind of'. I wanted to murder her). But! It is a truth universally acknowledged that it is my choice to inflict piano lessons on my unwilling kid, so I decided my penance was to suffer in silence (although, ha, after the lesson was over she kept playing on her own for half an hour without any prompting). Mostly I am putting it in writing so that, if we all survive this, twenty years from now when she comes back and says thank you for making me take piano lessons, I can feel smug.
After that I let her bugger off to her room and play Lego while I sanded down the dining room table in preparation for dragon fabulousness, then dinner online with trophy BF (who should by rights have arrived on the plane last night and be lying next to me while I type this, but coronavirus), and then a chess game with Grandpa by phone while I (eek) ran back to clinic to rescue my laptop charger without which (see above comments re: Armageddon happening online) we are screwed. I returned in time for the last half of the chess game, which was pretty great: we'd labelled the board A-H and 1-8 down the sides so they could describe their moves to each other down the phone, and by the time I came back they had developed a large-animal variation on the military phonetic alphabet, and madam was gleefully calling out 'Queen to crocodile 2! Knight to gruffalo 8! MUMMY, come look how badly I'm beating Grandpa!" I am hoping to institute a regular weekly chess game, if only for the comedic relief.
They finished while I watched a helpful video sent by E. (hello, E!) on, exactly as requested, vent-settings for dummies in the event that primary care doctors get drafted to help in ICUs, and I also texted and emailed various friends, and generally felt that so far, coronavirus has provided some fairly seriously ironic silver linings in terms of connection with others. And then to bed, with an icepack for my poison oak rash.

Day 4: urgent care shift

An eerily quiet day at urgent care; I had arrived early, expecting for it to be absolutely bursting, and that I would need to be briefed on whatever new policies and procedures were in place as of the last time I was there... and it was empty. Anyone with any respiratory symptoms whatsoever was being diverted to a special testing tent at one of the other sites, and anyone without respiratory symptoms was, for the most part, staying put at home. I saw five people in the whole shift - a lady with an ingrown toenail, a lady with a possible ectopic pregnancy, a guy who needed his stitches taken out, a guy who needed a TB test placed, and a young woman with a bruised thumb (whose bruised thumb did not, hilariously, stop her from texting the whole time I was trying to talk to her; while I was examining her thumb I snuck a peek into her lap to look at her phone screen to see what it was that had her so engrossed: "I never kissed him or made out with him u have to tell her that it aint me i dont even like him that much..."). The rest of the time I sat and read the internet - often good things, about how the canals in Venice are actually running clear, with fish, and with the bottoms visible for the first time in decades, and how the skies above China are already clearing with all the factories shut down, and about all the kind things that neighbours are doing for each other and the creative ways people are finding to help each other and fill their time while self-isolating.
I suspect that, just as my phone calls with students from Friday do not require really any specialised knowledge (otherwise healthy person + fever/cough = stay home and self-quarantine), having a patient on a ventilator for coronavirus is not going to be hugely medically complicated for the bulk of them compared to what the average pulmonary/critical care doctor is used to, and that with a minimum of additional training it should be possible to get family practice doctors up and running to take care of some of the really sick people, leaving the really really really sick people for the pulmonologists and ICU doctors. Can someone please write the Idiot's Guide to Vent Settings for a Coronavirus Patient Who Otherwise Doesn't Have That Many Medical Problems?
I fell asleep while listening to a Margaret Atwood lecture on creating believable dystopias. Hm.

Day 3: Bay Area officially on lockdown.

I had a dream last night that I went to a medical conference and there was an ER doctor there who brought the heads of two accidentally-decapitated patients that she had been trying to reassemble, which is pretty much a metaphor for how a lot of the day went (example: right before I got home I managed to drop a tin of exploding paint on myself; don't ask).

On the plus side, wheels are turning at work to try and make the clinic flow slightly less insane with regards to keeping patients and staff as COVID-free as possible (although at this particular job there is a layer of head-games from the administration that is getting bizarre, along the lines of not trusting the providers to wipe our own arses and then providing us with live porcupines as the officially-approved material for arse-wiping).

I did a bunch of telephone visits with patients that all went the same way:
Me: Hi! So tell me what's been going on?
Patient: I've had several days of a cough, some fever, some sore throat, and chest tightness.
Me: I'm so sorry to hear that. Any recent travel or known exposure to a COVID+ person?
Patient: no.
Me: OK, well, you're going to need to self-quarantine completely for two weeks, and we'll give you a ring in the meantime once we're up and running with COVID testing for patients who don't meet travel history criteria. Wash your hands whenever you touch a doorknob, your face, or anything else, wear a mask, stay at least 6 feet from every other human, and in your room if at all possible. Call if your symptoms get worse and we'll try and help you decide whether you actually need to go to hospital.
Patient: Supercalifragilisticexpialidocious.
Me: Byeeee.

Then I went to get fit-tested for the type of N95 mask that we have in clinic... and possibly thanks to recent gum surgery, or the medications I am taking for poison oak (opportunities for self-pity are thick on the ground at the moment) I couldn't smell the testing chemical thing, which means I still have not been fit-tested for the N95 masks we have at that clinic which means I still can't see anyone who has any respiratory symptoms at all. Except for invariably what has happened with the patients that I have been seeing who supposedly have already been screened and confirmed not to have respiratory symptoms is that those conversations go like this:
Me: Hi! So tell me what's been going on?
Patient: Well, I've had a sore finger ever since I jammed it in the door last week.
Me: I'm so sorry to hear that. Anything else going on?
Patient: I've had several days of a cough, some fever....

At which point I ask them to go outside, I don my ridiculous space outfit, including the mask that hasn't been properly fit-tested, and we go finish the conversation sitting on the bench outside the clinic, making sure that no one else is listening because HIPAA compliance! I swear, the world could actually be ending, and we're all so twitchy about HIPAA we'd still be requesting that people sign to get their medical records sent over so we could see whether they'd discussed with their previous provider their plans for the afterlife.

I think not infrequently of the most shocking experience of my career in medicine, as a third year student on my surgery rotation, when a young man pretty much exactly my age came in with what turned out to be a ruptured aortic aneurysm. I scrubbed in on the surgery, at one point taking over for the scrub tech, frantically handing instruments to a monosyllabic and clearly stressed surgeon, and it was a bloodbath of the most horrifying gothic proportions. At one point near the end when the anesthesiologist realized that she was having trouble ventilating the young man's lungs because his chest was literally filling up with blood, the surgeon ripped the sterile drape off the patient's chest, threw it to the floor, and slashed his chest open with a scalpel to release the accumulating blood, which sloshed all over the floor. I had a little prissy moment of wait, you can't DO that, what about infection risk if the operation isn't kept sterile?? and then realised, oh god, of course, he's going to die anyway, infection risk is meaningless.  So. Let's hope that we continue to have the luxury of prissily worrying about HIPAA regulations, since that will mean that Coronageddon isn't all _that_ bad.

Day 2: last social contacts

Sunday. No cannibalism yet. We were more social than is probably advisable - P's godmother came for a very disorganized lunch, and we ended up having dinner with the M's, who are currently camped out in our back garden en route from Argentina to the wilds of northern California. It would be very helpful if someone who knew something about viral spread and computer modeling could provide some guidelines w/r/t 'social distancing': I know that being within six feet and more than a few minutes increases your risk of respiratory exposure, but in terms of fomite spread from surfaces - what if you remain at least six feet from each other but moving around the same house? using the same tea-towels to dry your plate? who knows.
It is hard, I am finding, not to consider the more meta-view: a virus that removes up to 10% of the human population (mostly sick and elderly) relatively quickly and painlessly, discourages casual air and large cruise ship travel, and takes developed-world hubris down a serious notch or two, sounds like it would start to address the one problem we have that's even bigger than coronavirus, i.e. environmental damage and climate change. However, the cruise companies and airline industries will get bailouts at taxpayer expense, and Jeff Bezos will profit enormously from everyone doing all their shopping from the coronavirus-free comfort of their homes rather than braving the outside the world, and more and more people will become homeless because they can't go to work because they're sick or their kid's school is closed or the small business they work for folded or any number of reasons, and on and on until end times actually come. (Incidentally, I can't find easily isolatable mortality statistics for homelessness, but I'd bet on average it's more lethal to be homeless than to have coronavirus, since in California average life expectancy for a homeless person is, according to a Kaiser study I just found, age 48 (women) and 51 (men) respectively.) So there's that cheerful thought to start the day with.
Today I am headed back to clinic, to see if the nonsensical policy of Friday has been replaced with any less nonsensical policy. I would much, much, much rather stay right where I am, which is tucked up on the sofa in the dark with my lovely girl warmly snoozing next to me (we had a living room campout last night, mainly an excuse for cocoa and to sleep by the fire), dreaming of the dragons I have promised her we can repaint the dining table with later this week when we are home together on Thursday.

Coronavirus day 1

Of course it's not actually day 1 of coronavirus, but it feels close enough to the beginning of our personal mini-Armageddon that I have decided to call it day 1: school is officially closed as of yesterday, and so la p'tite and I are now holed up at home, shunning contact with the plague-ridden outside world as best we can (sort of). Next week starts home-schooling, or something approximating it; for now it is a question of embracing our cabin fever and making the most of it.
I am secretly looking forward to the home-schooling aspect of things - madam, it should be said is most definitively _not_, but we have at least managed to make a list of 'things we want to learn about while at home together next week': we are going to
- do a report about volcanoes,
- do a calligraphy project
- learn about the American revolution, and
- write a story each. Her writing prompt is, 'what if a kid found a bomb under the teacher's desk?' prompted by an exhaustive, disorganized, gleeful, improbable search for bombs throughout the house this morning, mainly, we suspect, in an effort to avoid the family meeting. Trophy BF attended the meeting remotely (note to self: buy stock in Zoom; it will be the only stock not in freefall at the moment) and was very game: he too was given a writing prompt ('what if a sorbet jumped into the pool while crying?' which he will doubtless manage to do something brilliant with), participated in the long-distance gym lesson organized (I use the term loosely) by madam, and suggested a science project for us to do, which we may or may not get to (we are currently reading a book while hiding inside the massive furniture-and-blanket fort that dominates the living room, and have shown no interest in coming out). I am not totally sure how exactly I'm going to convince her that we should sit up at the table Learning About Volcanoes, but this feels like an opportunity to try out what home schooling would be like, so I'm tentatively excited. We have gotten as far as making ourselves a plaster of Paris volcano, which needs painting before we do the vinegar and baking soda trick on it; the kit came with a geode (which we dutifully cracked open) and a pumice stone (which I will use to scrub my feet in the bath tonight).

The interesting thing is that as long as I leave her alone to get on with her projects, she's perfectly content: she's been reading in her fort (quote: "I love books! the reason books are better than screens is that the batteries never give out") in her pyjamas most of the day, and has been quite lovely, without apparently any need for external input. She has come up several times requesting food, hugs, or, twice, 'a tango competition,' but otherwise she's been quite self-entertaining.

(As have I: I have dug out a monster load of crabgrass and oxalis from the front garden, cooked meals for the next three days, and re-read the first half of La Sombra del Viento, actually looking up the words I don't know this time round; the majority of the vocabulary I am pleased to report is gratifyingly obscure and I am learning some English words along with the Spanish. Google gave me 'groyne' as the English translation for 'espigon,' for example, which turns out to be a low sea wall constructed to check erosion; likewise 'sortilegio' is 'sortilege,' which (duh, if you didn't know) is the historical practice of fortunetelling by drawing a random card. So there.) I should also say it's been chucking it down rain all day today; it's not just coronavirus.
Anyway. A moment to reflect on the whole coronavirus thing: I understand that the point currently is to slow down transmission so that we can avoid overwhelming the health care system's capacity with a huge dramatic peak in cases and possibly, maybe, give the CDC time to develop a vaccine for this thing before too many people die of it, but given that the healthcare system can't actually do much about it except for Tylenol, oxygen and a ventilator if it gets really bad, it's hard not to wonder whether we should be concentrating our efforts on getting everyone in the country a home O2 sat monitor and a thermometer so that they can just call the oxygen delivery company when they are ready for home O2, and 911 when the home O2 isn't enough and a ventilator is in order; ditto Tylenol. Likewise, despite all the efforts to develop a PCR test for viral RNA to figure who has live virus, a test for COVID19 antibodies - which would identify both who has an ongoing infection plus who has recovered from it and therefore can go out into the world and do their work - might ultimately be of more utility.  
The situation at work feels ludicrous: the official word on Friday was 'phone triage all patients; if there is anyone you can't rule out COVID19 by phone, then refer them to public health,' which is deeply, deeply nonsensical on several levels. (The only way, given that we know there is community transmission in asymptomatic people, to 'rule out' COVID19 is with a lab test, not a phone call, ergo if we followed this policy, we would be sending literally every patient to Public Health, and Public Health would be sending them right back to us because they are still completely overwhelmed and therefore only testing people with known exposures plus symptoms; therefore the policy makes zero sense, but all the administrators keep repeating it as if it does make sense and I am apparently just being difficult and unhelpful). It is very, very tempting to just quit my job and sit at home and wait this whole thing out, except for I need to go out there and pretend there is something we can do about COVID19 in order to earn money to pay for the house to which I would dearly love to just retreat).
We do not (no surprise) have anywhere near enough N-95 masks at work (five, at last count; they are technically meant to be disposed of between patients, ha, no news on when more will be forthcoming), and the fit-testing didn't happen until yesterday (finally organized by the medical assistant, NOT the administration), so our pants are well and truly down. What I have done is filch one N95 from each place I work thus far plus a small one for la p'tite should the need arise, seal each one in a ziploc bag labelled with each day of the week, and I will reuse each mask weekly for the whole day at work, covered with a surgical mask (or a plastic face shield, if I can get one, since there's limited evidence to suggest that this might prolong the life of an N95, but of course these are also not available for love or money in any of the places I work), and then reseal them in their ziploc baggies, leaving 7 days for the virus to hopefully die until the next time I need to reuse the mask. It's a faff, and it's far from perfect, and I will doubtless get sick with this eventually, but hopefully I will not take anyone down with me. On the plus side, the lack of air travel is probably brilliant for the environment...