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.