Monthly Archives: March 2020

ventilate, from the latin ‘ventulus’ meaning ‘a breeze’.

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Comrade President Donald Trump is, of course, the worst possible leader in any sort of crisis. Because he views everything through a transactional lens, he’s singularly inept when it comes to a medical crisis. I mean, I understand he dislikes criticism, even (or especially) when it’s deserved. But to delay or withhold critical medical equipment from a state because that state’s governor was mean to you? Jesus suffering fuck, what a petty-minded, vindictive thing to do.

But here’s Trump:

I don’t believe you need 40,000 or 30,000 ventilators. You go into major hospitals sometimes, and they’ll have two ventilators. And now all of a sudden they’re saying, ‘Can we order 30,000 ventilators?’

I have some experience with ventilators. This is how old I am: I was a medic when the military first began developing specialized respiratory therapy units. I was assigned to the first RT unit at the medical center where I was stationed. There were only six medics in the unit, two of whom were senior NCOs whose duties were largely supervisory. The other four of us did the actual work — which meant we worked 24 hour shifts. One day on, two or three days off.

Sometimes we were busy, sometimes we spent most of a 24 hour shift sitting around waiting for an emergency. For the most part, we spent our shifts giving positive pressure breathing treatments, nebulizing patients with asthma, checking on patients getting oxygen through nasal O2 tubes. For critically ill or ICU patients, we also set up and managed the ventilators.

The Bennett PR2, our primary volume ventilator back in the day.

There are basically two types of mechanical ventilators — pressure ventilators and volume ventilators. The ventilators you hear about on the news are volume ventilators, which allow patients with incapacitated lungs to breathe. It’s that simple. Without the aid of a ventilator, patients with badly damaged lungs will probably die.

We had a total of six volume ventilators. We rarely needed more than three. But ‘rarely’ means we sometimes needed more. And there were times during my career when we needed seven.

Bird Mk7 — this is what it used to look like.

You can see the problem. When you have six volume ventilators and seven patients who need them to breathe, somebody has to go without. Somebody dies. The doctors make that decision. They decide that Patient A has a better chance of survival than Patient B.

But it’s the technicians who do the work.

Nobody tells you how do that. Remember, this was a new unit. There was no written process — no manual detailing what to do about unhooking a living person from a ventilator. And the first time we got the order, we didn’t have time to consider how to do it. Patient A needed the ventilator. So we winged it.

I unhooked the ventilator from Patient A, the supervisor moved the ventilator to Patient B, and I stayed with Patient A. Until his damaged lungs stopped working. Until his body stopped struggling to draw air. Until he stopped gasping and making sucking noises. Until his heart stopped. Until he died.

After the first time, that became the process. We felt somebody needed to stay with the patient until the patient became a body. We felt the person who unhooked the patient was the person who should stay. If you’re going to kill somebody, you have some sort of an obligation to stay with them until they’re dead.

I’ve had to do that five times.

Patients die. Sometimes even with the assistance of a volume ventilator, the patient dies. That’s part of the job and you accept that. But it’s one thing to have a patient die; it’s another thing to kill them. Even if you’re following a doctor’s orders, even if there’s logic and reason behind the decision, the fact remains that you’re killing somebody.

What it looks like now.

I’m sure things are different now. That was a long time ago in a military hospital and military hospitals operate under slightly different rules than civilian hospitals. As a medic I was allowed — and sometimes even required — to do stuff that wouldn’t be allowed in a civilian hospital. I’m sure now there are medical ethicists who get involved in the process, and there are detailed written procedures outlining the circumstances under which a patient can be removed from a ventilator. I’m sure it’s a lot more regimented and orderly and lawyerly now.

But when it happens, there still going to be some poor bastard doing the ugly work.

Like I said, it was a long time ago and I haven’t thought about this very often over the last few years. I mean, you see something in a hospital scene on television or in a movie and it comes immediately back. But the sad fact is that killing those five people isn’t even in the top five of my most common ugly memories.

At least it wasn’t until recently. Now, because of the news, I remember those five people a few times every day. I remember sitting or standing by their beds, holding their hands, watching and waiting for their bodies to give up and die. And when I hear Trump say nobody needs thirty thousand ventilators, I think about that thirty thousand and first patient. And I think about the poor bastard who’s going to have to kill somebody in order to try to save somebody else.

relax guys, trump is dealing with the pandemic by bringing in carnival cruise ships

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Legit question: why are news media still covering Comrade Trump’s Covid-19 briefings? They know he’s going to spread misinformation; they know he’s going to lie. It’s bad enough that Trump misinforms and lies about political stuff, but when it comes to public health his misinformation and lies actually endanger lives.

Another legit question: IF the news media feel the MUST cover Trump (because he’s the president, after all), why do they have to clean up the nonsense he spouts? When he says something incomprehensible, which he does all the time, they edit it so that it appears to make sense. Why?

“I’m hearing good things on the ground.”

Here’s an example. Yesterday the network evening news accurately reported this part of Trump’s statement: “I also just invoked the Defense Production Act to help facilitate distribution of essential supplies if necessary.” That makes Trump sound reasonable, proactive, presidential — none of which is true. They did NOT report his responses to some of the questions asked about the Defense Production Act.

Q: You “enabled” — I guess, is probably the best way to put it — the Defense Production Act yesterday, but you didn’t pull the trigger on it.

A: No, because we hope we’re not going to need that.

So he invoked the DPA, but he hasn’t actually used it. The entire point of invoking the act is to require manufacturers to produce material needed in a national emergency. Like a pandemic.

Here’s another question.

Q: Under what conditions would you put the Defense Production Act into action?

A: Well, if we were desperately in need of something — and we, frankly, will know about that very shortly. We want to be ahead of — we don’t want to do it as it happens but before it happens. We’re going to know a lot over the next two or three days. We’ll know a lot.

“We don’t want to do it AS it happens, but BEFORE it happens.” We’re going to wait a few days to see if we’re really as desperate as every doctor and every nurse in every hospital and clinic in every state claims we are. Then we’ll act before it happens. Trump fails to comprehend simple causality. He doesn’t understand you can’t wait until AFTER an event to act BEFORE the event.

“No, really, I’m the president. I’m NOT a shipping clerk.”

But wait, there’s more:

Q: I wanted to just follow up on John and Kaitlan’s question. So it’s not just masks. Doctors are saying now that they are desperate for other personal protective gear — gloves, other equipment. Governors are saying that they don’t have access to respirators, and they’re terrified. What is your reticence about invoking the Defense Production Act?

A:  Governors are supposed to get it. The states are supposed to get it. But we’re helping the states.

Q: But people are saying there’s nowhere to buy them, that there aren’t enough in the country.

A: Well — look, for years, they bought them, and now, all of a sudden, they’re coming to the federal government.

Q: They need more now.

A: We are working with the states. We’re working with the governors. We’re working with everybody. The relationships are great. One of the things that happened this morning: I spoke with Micky Arison of Carnival Cruise Lines, and he’s going to make ships available.

He’s invoked the Defense Protection Act because it’s a national emergency, but it’s up to the governors of the individual states to get the equipment — the equipment that isn’t being rushed into production by the DPA. Besides why do they need this stuff ‘all of a sudden’? Why aren’t they prepared? Good news, though. Micky is going to provide cruise ships — I guess because of their stellar record public health record.

“Yeah, I don’t know where the buck stops. It’s got to stop someplace. But it’s not stopping here. We’ll see how it goes.”

But wait again, there’s still more.

Q: But, Mr. President, what is your reticence about invoking the Defense Production Act?

A: I’ve done it. I’ve done it.

Q: But you said that you don’t want to invoke it yet.

A: Yeah, if we find that we need something, that we will do that. And you don’t know what we’ve done. You don’t know whether or not we’ve ordered. You don’t know if we’ve invoked it. You don’t know what’s been ordered, what’s not been ordered.

Did you wash behind your ears? Yes, I did. But your ears are still dirty. I’ll wash them if they need washing and you weren’t there so you don’t know if I washed them or not stop picking on me.

None of that was seen on the evening news. None of the wildly contradictory claims, none of the childish tantrums. Just ‘Trump said something that sounded presidential’.

But wait one more time, there’s still more.

Q: Could you explain the gap in — for the American people — in what you’re saying here today about there being tens of thousands of tests available, about how there being a huge amount of masks available and what we’re seeing on the ground, which is really the opposite of that? People are — people are saying that they can’t get tested even when they have symptoms. People are saying that they — doctors are telling us they don’t have access to vital equipment. Can you explain that gap?

A: Well, I can’t. I cannot explain the gap. I’m hearing very good things on the ground, and we’re dealing with — look, they had to ramp up. They had an obsolete system, and they had a system, simultaneously, that was not meant for this. It wasn’t meant for this. Nobody knew there’d be a pandemic or an epidemic of this proportion.

He can’t explain why people are saying they don’t have necessary equipment because he’s hearing very good things about people having equipment, but whatever the problem is, it’s not his fault. Who knew there might be a pandemic?

“Nobody knows the trouble I’ve seen. Nobody knows my sorrow. Nobody knows the trouble I’ve seen. I blame it on Obama.”

I know the evening network news doesn’t have the time to include news segments that take more than a couple of minutes. They can’t show six or seven minutes of the president blathering like a nincompoop; they have advertisers to please, and there’s a sports team scandal, and there was severe weather someplace, and of course they need to have final feel-good segment about a high school play that got canceled but the kids did it anyway on Skype and boy you just can’t hold back American spirit, can you, no sir.

But Jesus suffering fuck, surely the American people need to know their president is a bonehead without a gram of compassion and entirely lacking in the skills necessary to deal with an interoffice squabble let alone a national crisis. Don’t they? Shouldn’t that be newsworthy? Shouldn’t the news media report the actual news?

trump, burr, and the missing worldwide threat assessment

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Here’s a curious thing. Last month Senator Richard Burr (R-North Carolina) spoke at a luncheon sponsored by the Tar Heel Circle (which is more formally known as The North Carolina State Society of Washington DC). That’s not the curious thing; members of Congress routinely meet with ‘important’ people from their home state — business owners, social leaders, local politicians.

This smarmy fucker knew.

The curious thing is what Burr told those ‘important’ people. He warned them about a virus coming to the U.S. He told them it was “much more aggressive in its transmission than anything that we have seen in recent history. It is probably more akin to the 1918 pandemic.” You know, the pandemic that killed millions of people worldwide. He talked about travel restrictions and schools closing. He talked about how the military might need to be mobilized.

Here’s another curious thing. At the same time Burr was giving his speech, Comrade Trump was assuring the public that “the coronavirus is very much under control in the USA.” He acknowledged a small number of US citizens had become ill, but “they’ve gotten very much better. Many of them are fully recovered.” We know, of course, that wasn’t true.

Had we been told the truth, the butcher’s bill wouldn’t be so high.

Here’s yet another curious thing. Every year in January or February, the US intelligence community provides the House and Senate intelligence committees with a briefing on global threats. That briefing is usually accompanied by a public hearing and the publication of an unclassified report called the Worldwide Threat Assessment. This year, the public hearing for the 2020 Worldwide Threat Assessment was canceled. It hasn’t been rescheduled. The report, which is usually unclassified, was suddenly classified.

One more curious thing: Senator Richard Burr, who issued that dire warning to the ‘important’ people of the Tar Heel Circle, is the chairman of the Senate Intelligence Committee. The committee that first learns the details of the Worldwide Threat Assessment.

More curious things. In 2017, the Worldwide Threat Assessment said this about the threat to public health:

“A novel or reemerging microbe that is easily transmissible between humans and is highly pathogenic remains a major threat because such an organism has the potential to spread rapidly and kill millions.”

The 2018 WTA:

“A novel strain of a virulent microbe that is easily transmissible between humans continues to be a major threat, with pathogens such as H5N1 and H7N9 influenza and Middle East Respiratory Syndrome Coronavirus having pandemic potential if they were to acquire efficient human-to-human transmissibility… a severe global influenza pandemic could cost the equivalent of 4.8 percent of global GDP—more than $3 trillion—and cause more than 100 million deaths.”

The 2019 WTA:

“We assess that the United States and the world will remain vulnerable to the next flu pandemic or largescale outbreak of a contagious disease that could lead to massive rates of death and disability, severely affect the world economy, strain international resources, and increase calls on the United States for support.”

We can, I think, safely assume the now-classified 2020 Worldwide Threat Assessment repeated what the last three WTAs said. We can, I think, assume that what Senator Burr reported to the ‘important’ people of North Carolina came directly from the 2020 WTA. We don’t have to assume that information was kept from the general public for at least six weeks; we know that’s true. Six weeks during which the US government failed to respond to a health threat they knew was coming. Six weeks in which the Trump administration could have prevented needless sickness and death.

We can’t blame every Covid-19 death on folks like Trump and Burr. But we can hold them responsible for a lot of them.

They knew. They knew it was coming. These fuckers deliberately downplayed the threat to the public while warning the ‘important’ people.

We need to see the 2020 Worldwide Threat Assessment report. We need to know what they knew. We need to hold all of these fuckers accountable. We need to toss them out of office. We need to publicly name them and shame them. We need to hang the scope of this pandemic around their necks and make them wear their shame every day for the rest of their miserable lives.

we’re talking the fomite, y’all

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Okay, there are facts and there are suppositions based on facts. It’s a fact that the Renaissance painter Titian (who actual name was Tiziano Vecelli, which takes a lot longer to say) made a portrait (seen below) of Girolamo Fracastoro. It’s also a fact that Fracastoro was a poet, an astronomer, a physician, a geographer, and a mathematician (because back during the Renaissance everybody seemed to do everything). But it’s just supposition that Titian painted this portrait in exchange for Fracastoro (in physician mode) treating him for syphilis.

Girolamo Fracastoro (also known as Hieronymus Fracastorius because everybody in the Renaissance had like half a dozen different names).

You guys, Fracastoro invented syphilis. Not the disease (which apparently came from the Americas, brought back by a crewman on one of Columbus’ ships — I know, irony, right?), but the name of the disease. In 1530 he wrote an epic poem (we’re talking a trilogy — seriously, a three-book poem written (and I am NOT making this up) in dactylic hexameter; when these guys decided to do something, they didn’t fuck around) about a shepherd boy who insulted the god Apollo, who responded the way gods always seem to respond: he gave the boy a horrible disease. That unlucky boy in the poem was named…wait for it, wait for it…Syphilus.

The foul Infection o’er his Body spread
Prophanes his Bosome, and deforms his Head;
His wretched Limbs with filth and stench o’er flow,
While Flesh divides, and shews the Bones below.
Dire Ulcers (can the Gods permit them) prey
On his fair Eye-balls, and devour their Day.

Yikes, right? Three books of this. So many different forms of torture. Anyway, our boy Fracastoro made his bones (so to speak) by treating communicable diseases. He came up with the concept of fomes, which is the plural of fomite.

Syphilus being warned against yielding to temptation (temptation in the form of that chick with the lute — I mean, just look at those ankles).

So you’re probably thinking “Hey, Greg, old sock, what the fuck is a fomite?” Well, I’m going to tell you. And stop calling me ‘old sock’. Actually, I’m going to let Fracastoro his ownself tell you.

“I call fomites such things as clothes, linen, etc., which although not themselves corrupt, can nevertheless foster the essential seeds of the contagion and thus cause infection.”

In other words, he’s talking about the way disease can be spread. Fracastoro was a proponent of the notion that epidemics were caused by “spores” — transferable tiny particles — that could infect people (or animals) by direct or indirect contact, and that was how diseases moved over long distances. This was 300 years or so before folks came up with the idea of germs.

Oh, and fomes? That’s the Latin term for kindling or tinder — the material you gather together in order to start a fire.

Makes sense now, doesn’t it. Now you’re thinking of Covid-19, right? Now you’re thinking of all those anti-bacterial wipes you can’t find on the store shelves. Now you’re thinking about all those doorknobs you touch every day, and about the handrails on stairways and escalators, and about the handle of the coffee pot at work. Now you’re thinking about the table at the diner where you put your cell phone while you eat your salad, and how maybe the person who sat there before you touched an infected doorknob before sitting at that table and left ‘spores’ on the table that are now transferred to the back of your cell phone case, which means it’s now on your hands. And you’re thinking “Lawdy, my cell phone is a goddamned fomite! And that table, a goddamned fomite. And I’m surrounded by goddamned fomes!”

Which is exactly what you should be thinking. All those things you touch during the day? That’s kindling. You spread that kindling, you create a forest fire.

That’s fact, no supposition. Keep Girolamo Fracastoro in mind everywhere you go. I’d suggest you get a tattoo of Fracastoro on your forearm, except the tattoo gun is a goddamned fomite.

Wash your damn hands, people.

joe biden = comfort food

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Like a lot of folks, I went to bed last night (and woke up this morning) thinking this: Joe Biden? How did we end up with Joe Biden? I mean, almost every Democrat over the age of thirty was running for POTUS, and several of them were really good candidates. And here we are with Joe Biden? Joe Biden?

But I think I understand it now. Joe Biden is comfort food. You know — a dish that holds some nostalgic and maybe cultural significance for you. We’ve all got at least one comfort food. It’s not necessarily good food, not necessarily food that’s good for you, not something you’d likely order at a decent restaurant, and certainly not anything that’s complex. It’s what you want to eat when you’re feeling down, or anxious, or needy, or sentimental.

Joe Biden

My comfort foods are mostly what some folks would call ‘Southern white trash’ food. I love a simple perlow, or something from a box with a Little Debbie label, or a peanut butter and mayo sandwich on white bread. If the weather is chilly, I’ll go with grilled cheese and a bowl of tomato basil soup. Comfort food.

For you maybe it’s poutine, or mashed potatoes and gravy, or chocolate mint ice cream, or pierogi, or a green bean casserole with those french-fried onion things on top, or udon, or chicken and waffles. It doesn’t matter what your comfort foods are; what matter is that they’re safe and put you at ease and don’t require a lot of thought.

Joe Biden

That’s Joe Biden. He’s safe, he can put you at ease, and he doesn’t require much thought. Biden is pretty predictable; we know who is and what he is. Yeah, we’re all a wee bit creeped out by his weird habit of touching folks, but nobody suspects him of paying off hookers and porn stars. He doesn’t require us to think a lot, because we’ve already dealt with him for eight years.

Joe Biden

He’s not somebody you’d order off the menu of a good restaurant. But after three years of eating rancid garbage and flaming hate, it seems a LOT of people just want some mashed potatoes with butter. Or a Hostess Twinkie.

Anyway, that’s my current thinking on the unexpected success of Joe Mac and Cheese Biden.

now what?

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Well, here we are. The Democratic Party presidential race is down to two septuagenarian white guys. It’s a sad day when we have to admit the most capable candidate was largely erased from the contest through media bias and because of the cowardice of voters who were afraid other people wouldn’t vote for a woman.

It wasn’t just her energy, it wasn’t just her willingness to stand for four hours so everybody could get a selfie with her, it wasn’t just her intelligence and clear thinking, it wasn’t just her goofy but charming and sincere pinkie-promises with young girls, and it wasn’t just her ability to articulate complex issues in ways that made sense to ordinary folks; it was her essential honesty and decency that made Elizabeth Warren such a compelling candidate. But now she’s out.

Now what are we supposed to do? I’m talking to those of us who supported — and still support — Elizabeth Warren. Now who do we support? The old cranky white guy whose policies are closest to our own? Or the old cheerful white guy whose policies are more modest but more likely to be implemented? Do we support the guy who promises major structural change? Or the guy who just wants a return to normality? The guy whose followers include a vocal group of misogynistic assholes? Or the guy whose supporters include the usual big money donors? Which old white guy do we choose?

I like Bernie. I also like Joe. I like them in different ways. I like Bernie because he’s consistent and stubborn. He’s an old school structuralist, and he’s never going to change because of popular opinion. He plants his flag and stands by it. I like Joe because he’s flexible. He gets along with people and is a genuine deal-maker. He understands the need to accommodate other perspectives, to compromise when necessary, to bend to some degree to get what he thinks is important. I like Bernie because he doesn’t budge when he believes he’s right. I like Joe because he’ll budge a little to get a little.

At this point, I’m trying to balance pragmatism with emotion. Here’s my pragmatic view at the moment. I think Bernie’s positions are right. I also think being right isn’t enough. Being right isn’t as important as improving things. Bernie’s been right for his entire career in Congress, but he hasn’t been able or willing to work with others to get things changed. Joe hasn’t always been right. In fact, he’s been pretty godawfully wrong about some stuff, like the war in Iraq. But he’s also worked with others to accomplish a lot, like pushing President Obama to support marriage equality.

Here’s my emotional view at this moment. I don’t have any clear view of Bernie’s interior life. I can’t imagine what he does when he’s at home with his wife. I can’t see him watching a television show, or playing with a dog, or reading fiction, or going to a baseball game, or having a glass of wine while cooking supper. I’m sure he has an interior life, but I can’t picture it. I can picture Joe doing all of that, and having a good time of it. I fully recognize that’s a shit reason for preferring one candidate over another — and it won’t be my deciding factor — but I’d be lying if I said it didn’t matter.

It may sound like I’m leaning toward Joe. I’m not. At this moment, I really don’t know which candidate I’m going to support. There are valid arguments for each of them. There are valid reasons to oppose each of them. I’ve spent the day walking and thinking and all I know for sure is that at this momrnt I can’t support either of them with any enthusiasm. Not with any passion. Not with the deep sincerity and clarity I felt in supporting Warren. So I don’t know who I’m going to support. Maybe neither of them.

 

But I DO KNOW THIS. I know we need to burn the patriarchy to the fucking ground. Because this shit HAS to end. We need to burn it to the ground because we had several women candidates equal to — and in most cases very much better — than these two old white guys. We need to burn the patriarchy to the ground, then burn it again. Then drive a stake directly through the ashes where its heart used to be, and then burn the fucker one more time. And keep burning it, over and over.

Then nuke the entire sit from orbit. You know the reason why.