Kentucky Moon

I grew up in what I believe to be one of the most friendly places in the country, a rural area of south-central Wisconsin. Very early in my education, I was one of the gifted and talented students.  I understood math so well as a first-grader; they asked me to help third graders when my first-grade classmates got their addition and subtraction lessons.  I graduated with honors from high school.  I remember informing the high school counselor I wanted to attend the University of Wisconsin – Madison.  He advised I should consider one of the smaller University of Wisconsin schools such as Eau Clare or La Crosse.  He knew my high school education was not equivalent to the other students I would encounter and compete with at UW-Madison.  He seen a history of prior students attending Madison, drop out, and not graduate from the prestigious university.  I admit, when I got to Madison, some of the things he warned me about were true.  On day one of my calculus class, the professor asked how many of us had calculus in high school.  Eighty percent of the two hundred students in the auditorium raised their hands.  I did struggle with my studies at the UW-Madison, but eventually proved my guidance counselor wrong and graduated with a professional degree as a Physician Assistant.

I met people from all walks of life at the University.  In my first year, I shared a dormitory room with a brilliant man from Cypress who spoke seven languages. His uncle was a professor at MIT and helped invent specific tiles to protect the Space Shuttle so it would not burn up on re-entry into our atmosphere.  My sophomore roommate was an African American man who grew up in Oakland.  He and I also grew up in such different environments.  He often said I trusted everyone.  He didn’t trust anyone until they earned his trust.  Where he grew up, he could not trust others, for risk of being shot and killed.  It never crossed my mind during my entire childhood that I could become a victim of homicide in my hometown area.  In my junior year, I  became a House Fellow working as a resident assistant with other students.  In addition to my studies, I worked as a live-in with two men with disabilities. I donated my time to gain experience at a local community clinic for people with no health insurance. I volunteered at the UW-Hospital Emergency Room and spent time at local homeless shelters.  I learned a lot outside of class by integrating with students who were different than me and with other people on campus who came from diverse backgrounds.  In my first year of college, I signed up at my church for a week of service at a young men’s retreat, helping people in rural Kentucky.  The experience opened my eyes to a different rural culture and my expanding awareness of others’ needs.  

I ended up being the only one from my church who signed up. I told my family about my plans and took a Greyhound bus from Madison to Chicago.  When I got off the bus in downtown Chicago, I found myself let off after dark, in a station full of unsavory characters.  Thankfully, I didn’t wait long until two local men picked me up and brought me back to their residence. The young priests in training fed me dinner that night as well as breakfast the next morning. Then the three of us drove in their vehicle from Chicago to Cincinnati.  When we arrived at a large church in Cincinnati, we joined young men from all over the country who flew or drove there as well.  After several hours of orientation about the week we volunteered for, we loaded up our luggage into two large vans and made the drive to Vanceburg, Kentucky.  

I will never forget the most bright, full moon I viewed when we drove around some foothills just outside of Cincinnati and crossed the state line into Kentucky.  The moon was unusually large and low on the horizon.  At first, the moon hid behind the peaks of the rounded hills and sandstone rocks.  The earth was dark and covered in evergreens.  The curvey country road not easily navigated.   We came around one corner, and I was in awe of this unusually beautiful moon.  I had been to the mountains of Colorado and Wyoming before and never saw such a magnificent moon.  At that moment, I felt my soul speak.  I was heading to a place I had never been before, I trusted that I was going to be ok, and naively agreed to participate in a retreat that I, in reality, was unprepared to experience.  

Image by Steve Buissinne from Pixabay

We arrived at the remote farm where we would be staying for the week.  The church vans safely navigated by the two drivers brought the two priests in training and eighteen college men.  Half of us got a bed in the main house, the other half of us assigned to the barn.  I was fortunate to get a bed in the house as I got to stay in the house all week. One of the two priests in training also got a bed in the house.  We bunked together.  I didn’t get the best sleep that night, sleeping in an unfamiliar place with many strangers.  One of the guys snored, and sharing a cramped room with five other men made it difficult to get comfortable.   The next morning after some hot breakfast, we had another session on what to expect.

We met a volunteer carpenter.  I don’t recall his name, but he was skilled and a patient instructor.  He spoke of how he was the man in charge of the leading project for which we were going to double the size of a local family home.  Our goal was to build an addition onto their home.  The foundation of the project was already down; we would make the walls and roof this week.  The next group of volunteers would eventually finish the interior.  He informed us the family paid for the material.  Not all of us could work the site at once, so we would take turns.  Some of us would do other projects or go to different places until it was our turn to work on the home.  On the day I got help, the carpenter told us the family would offer us drinks and cookies.  We were informed to politely turn down their offer as the local water was not safe to drink.  Thus, we ported in drinking water and food to eat on the site.  At the end of our volunteer week, I finally got my turn.  My job ended up shingling the roof.  The work was hot, tedious, and not very gratifying.

We took a muddy, no gravel road around a few hills and through woods before arriving at a valley where the home was situated.  The house was a trailer, and it was in rough shape.  It was worn, grey, with thin walls and windows.  It had rained the night before, so the enitre site was challenging to walk around.  Two unkept dogs were roaming freely on the property.  One of two dogs was friendly, the other barked and barked – keeping a safe distance away from us.  When we did meet the owners of the home, I was surprised to meet a young couple, likely in their late 20’s and their newborn son.

The man of the home did all of the talking.  He was soft-spoken and incredibly humble.  He probably thanked us five or six times for coming to help his family.  They offered drinks and cookies exactly as the project manager said.  The project manager accepted their offering and took the plate of cookies and pitcher of iced tea from them and then excused us so we could start working.  He showed us what to do, and it was surprisingly easy.  I remember it being a long morning until we broke for lunch.  A more painful and hot afternoon followed.  When we got back to the farmhouse where we were staying, I had no choice but to go down to the creek to get cleaned up.  All week we did not have access to a hot shower.  It was still May so the creek water felt ice cold!!! Yet, despite the conditions, I hung in there.  The priest in training who got a bed out in the barn was not as gracious.  He complained daily about the sleeping conditions, lack of bathing facilities, and he couldn’t get WAIT for the week to be over so he could return to civilization.  He longed for his bed in Chicago, and to work with the homeless at the soup kitchens where he was more familiar and comfortable.

On one of the days, we went to a local funeral.  I found that odd, not sure who decided we ended up there.  I felt uncomfortable about that day.  I didn’t want to participate, and it was incredibly awkward.  I felt like I was a spectator, not a sympathizer who could relate to the families and friends that gathered to mourn the death of their loved one.  However, years later, I was grateful for the experience.  One of the other days, I worked at the local church.   One day I stayed at the farm and worked on a project there.  One of the more memorable nights, we drove a few miles down the road to a modern barn.  This barn freshly painted, clean, and inviting.  Inside were bails of hay arranged theater-style along with a raised stage and colorful lights.  We experienced an authentic Appalachian evening complete with banjo, fiddle, harmonica, and guitars.  It added to my love of the week, and I discovered the talents of the local people that before that evening, I didn’t realize came from the area.  What little I knew about bluegrass I saw on the television show, Hee Haw.  Bluegrass in a barn was one thousand times better than anything I ever saw on television.

Image by Ryan McGuire from Pixabay

When my week was over, I gained so much in a short time.  My heart grew and filled with experiences that remain with me thirty years later.  I am grateful for knowing I contributed an insulated room and warmer bed for the parents and their newborns.  I knew their firstborn child was going to have a better upbringing from having a friendlier environment in the winter.  He would be less prone to ear infections, bronchitis, and other respiratory conditions that find vulnerable infants during the winter months.

I stepped out of the comfort I knew growing up, and I am forever grateful I did.  That week in Kentucky would eventually lead to another critical decision in my life.  The choice to begin my PA career in a medically underserved region.  After graduation from the University of Wisconsin – Madison, I moved to Huntington, West Virginia, and started my career working in a rural clinic.  For years I was asked, “where are you from.”  People were curious about why I moved there.  The minute I started talking, my midwest accent would give me away.  Everyone who met me for the first time knew I was not local.  These types of greetings continued for many years.  The work and environment were great for me, and I was an asset to the community.  I thrived there for eighteen years.

I provided direct care for people of all ages.  After a generation passed, I moved to Florida, where I currently reside.  I now correct people who speak poorly of Appalachian people.  I inform them the people of Appalachia are hard workers.  When I hear someone use a derogatory term, I challenge their perception.  I advise why the stereotype is wrong and inappropriate. I also give my account of how the majority of people in Appalachia are very generous and loving people.  They are gifted as evidence of the bluegrass, country music, and famous voices who grew up in the region.  Why do I bother to speak up?   Because it is the right thing to do.  Our country must move beyond derogatory stereotypes of all kinds. 

As a health care provider, I come into contact with people from different backgrounds: taking into consideration their ability, age, ethnicity, gender identity, health status, intelligence, occupation, race, religious belief, sexual orientation, and unique health history.  I have to approach each person as an individual and treat them with dignity and respect.  When I learn about their health history, it starts the process to use my critical thinking skills and ask specific questions.  Based on their answers, I tailor further questions to discover and pick up on clues that may help to make a diagnosis. In doing so, I then use my evaluation skills to decide what treatment I am going to recommend.  I usually explain to patients why I feel the way I do and then allow the opportunity to ask questions.  If they agree with the treatment, I proceed.  If they need time to research or contemplate their options, we will schedule a follow-up appointment.  Not all treatments are pharmacological.  Sometimes the advice is prevention, exercise, nutrition, or I might give my viewpoint and then encourage them to seek another medical opinion.  I am an advocate for my patients in the best way I know-how.   I try to understand what it is like to be in their shoes, and I treat them the way I would treat my sister, father, grandmother, nephew, or spouse.  The golden rule has worked well for my patients and me for twenty-five years.   

 

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Thirteen Years of Training For A Pandemic

electrocardiogram heart

Powerful Words of Wisdom:

Thirteen Years of Training For A Pandemic

Why I Created MyMedicInfo

I’ve been a physician assistant for 25 years.  I have worked in family medicine, internal medicine, addiction medicine, and orthopedic surgery.  I have seen patients struggle with remembering the specific names or doses of their medication.  I know the questions your health care providers ask when you see them in the clinic, urgent care, emergency room, hospital, and ambulances.  I’ve seen patients in agony trying to answer my questions when they had migraines, chest pain, abdominal pain, or shortness of breath.

When the encouragement from changing from paper charts to electronic medical records developed, it was sold to us as ways to improve patient care.  There would be fewer medical errors, better communication, and improved outcomes for patients.  Over the years, the government enforced electronic medical records by reducing medicare reimbursements year after year on those hospitals and clinicians who did not use electronic medical records.

Your medical information is encrypted and protected on those web servers.  However, all of your medical treatments and information are probably on different systems.  If you have a primary care physician, a cardiologist, and an endocrinologist, the odds that they are all on the same electronic medical system is low.  To get access to all of that data is cumbersome and often complicated.  MyMedicInfo simplifies access to your medical history by using Trusona for user authentication and no password to remember.   Plus, you control your medical information—highly sensitive and confidential information you can omit.  For example, if you have a history of a sexually transmitted infection, simply skip that information.  An emergency room physician or paramedic is more interested in your allergies, medications, and what diagnosed conditions you have.  MyMedicInfo will enhance your medical care.

As a health care provider who has worked in a variety of clinics and environments, I can get frustrated with the technology intended to make things better.  I’ve worked at a hospital where the health care providers had to take classes to use the hospital’s electronic medical records.  Health care electronic systems should not be so complicated that you have to take classes to navigate through them.

I developed this website to keep your information secure.  It has three levels of security.  First, it has the highest level of SSL encryption available.  A firewall is frequently scanning and preventing unauthorized access: Additionally, it uses a password-free two-factor authentication login to verify your identity.  The service does not allow a user to upload files to protect the website.  I know that with any medical care, you need to trust the people involved to protect your information and promote your health. 

You probably have received medical treatment from a physician assistant.  You know they are highly skilled, knowledgable practitioners.  I am proud of my career and my chosen profession.  Physician Assistants are sometimes called patient advocates.  We have a reputation for explaining complex medical terms in a way that is easier to understand.  We have a reputation of spending more time with patients, especially when doctors are pressured for their time.  Physician Assistants tend to be thorough in their evaluations and have a high rate of patient satisfaction.

I’ve included a link to a video clip of one of my recent discussions on the COVID pandemic. Watch it if you want to learn more about me.  I want to earn your business.  I wish you wellness and continued excellence in medical care as you interact with professionals in the future.

Pandemic Fatigue

stress

In the United States, many of the recent news reports are focusing on trying to find a new normal.  Merely using the word normal implies that things can go back to the way it used to be before COVID-19.  Unfortunately, we know that is not going to happen.   

One definition of fatigue is a person lacks the energy to perform tasks.  It is also known as exhaustion, feeling run down, lethargy, listless, malaise, or weakness.   Fatigue may be due to mental stress.  It may be due to physical demands.  Sometimes it is a combination of both psychological and physical.  Pandemic fatigue is feeling these symptoms as a result of adjusting our daily routine due to the COVID-19 pandemic.  We in the United States are suffering lives lost, unemployment, business disruption, and financial burden.  How the pandemic affects individual Americans varies considerably –  the contrasts can be as different as night and day.

Lives lost due to COVID 19 – over 90,000 Americans.  Australia – lives lost 98.  Iowa State has more COVID related deaths than the country of Australia.   Lucas county of Ohio has more COVID related deaths than the country of Greece.  The city of Chicago has more COVID associated deaths than the country of Poland.  In the United States, we have a stark difference between places that have lost a significant number of lives vs places that have significantly less.  Albany in Georgia, Baton Rouge, Bridgeport in Connecticut, Boston, Buffalo, Cedar Rapids in Iowa, Chicago, Detroit, Farmington in New Mexico, Flagstaff in Arizona, Greely in Colorado, Greensburg in Indiana, New York City, New Orleans, Philadelphia, Salem in Ohio, Sumter in South Carolina, Trenton in New Jersey, and Washington DC are among the hardest-hit cities with higher total death rates per capita.  Some metropolitan areas with low infection rates per capita include Portland, Sacramento, San Antonio, and Tampa Bay.   Another contrast is the percentage of African Americans who died in comparison to other races.  Theories as to why the African American population has suffered more include higher rates of pre-existing conditions, less access to health care, housing disparities, and a higher percentage of essential workers cited as probable causes.  Globally, the United States has one of the higher death rates per capita.  Countries with higher infection rates per capita should logically have higher numbers of COVID related deaths.   However, Singapore has a high number of infections per capita but is not among the top 15 countries in COVID related deaths.  It could be explained by how they define COVID related deaths.   Other undetermined factors could be reasons why they are not seeing as many deaths per capita.

Staggering unemployment is the new normal.   According to the Bureau of Labor Statistics, the unemployment rate for April 2020 spiked to 14.7% as 20.5 million workers lost their jobs.  Those facts do not include May unemployment figures.

Unemployment Rates for the World’s Largest Economies 

The unemployment rates for the world’s largest economies were generally low at the end of 2019.

  • Japan: 2.4%
  • India: 3.5%
  • Germany: 3.6%
  • United Kingdom: 3.9%
  • United States: 4.1%
  • China: 4.8%
  • Canada: 5.9%
  • France: 8.6%
  • Italy: 10.4%
  • Brazil: 11.6%4 

Source: https://www.investopedia.com/articles/personal-finance/062315/unemployment-rates-country.asp

In contrast the unemployment of the same countries in April 2020:

  • Japan: 3.0%
  • India: no data
  • Germany: 3.9%
  • United Kingdom: 4.8%
  • United States: 14.7%
  • China: 4.3%
  • Canada: 7.5%
  • France: 10.4%
  • Italy: 12.7%
  • Brazil: 14.7% 

Source: https://www.imf.org/external/datamapper/LUR@WEO/OEMDC/ADVEC/WEOWORLD/JPN

The United States Unemployment rate is now equal to Brazil.  Other countries who have faced COVID lockdowns such as Germany and the UK have not had as much of a change as the US.  China is the only country to decrease the unemployment rate.  People who still have employment are either essential workers or jobs that accommodated them to work from home.  1 in 5 Americans who had employment, lost it due to coronavirus. Some positions terminated while some companies forced to put their employees on hold, and when the weeks turned into a month, the anger was palpable.  People protested, wanting to return to their jobs or owners fighting for the survival of their business.   We as Americans have invested years of blood, sweat, and tears into our livelihoods, and we realized that we had to return to work.   The problem remains, how to make that happen without allowing the virus to spread out of control.

Finances – While the United States has been the most exceptional economy for more than a decade, we could lose that status. Increased national debt and the loss of employment will have an impact on the GDP.  The actual financial burden with the pandemic and its effect on the US has only begun.  At the beginning of the year, our economy was strong.  Business experts are talking about a recession that could rival the great depression.  One billionaire believes the United States will suffer an economic depression if the lockdowns last for a year.  The United States was already trying to balance saving lives and saving the economy back at the end of March.

Meanwhile, two professors at Northwestern University predicted the costs of not closing down non-essential businesses and allowing the virus to spread unchecked would have been more expensive than closing non-essential businesses. They were not alone in their predictions.  In the US and abroad, experts weighed in on what the best course of action would be. Investors are now predicting a 3.9% fall in U.S. GDP in 2020.

All this stress creates mental fatigue from the pandemic.  The kind that disrupts sleep and changes your appetite.  Psychological stress affects your ability to concentrate and contributes to other symptoms like headaches, muscle aches, and abdominal pains.  It is new stress, and our country unprepared.  Our food banks are in high demand, the unemployment offices that process payments unable to keep up, and the federal government was providing a stimulus intended to offset the financial strains are giving away money to corporations and institutions that do not need it.  While some large chain restaurants and sports franchises have already said they will return the money, one educational institution has already declared they will keep the money and use it for students.  If you don’t acknowledge the mental strain, you are in denial.  Denial itself is a psychological mechanism to try and protect oneself from facts.  When facts are too painful to admit, denial is a coping mechanism to allow you to continue to function, to move on.

Front line health care professionals are working extra hours – the physical demands of caring for more patients in hot zones day after day contributes to fatigue.  The post-traumatic disorder is already presenting in some of them from witnessing more deaths than usual.  It also gives a risk of suicide as we learned of one emergency room physician who got COVID, recovered, returned to work, and ultimately took her own life.  Nonessential workers are also affected.   They are at home, getting restless and weary as they watch the news, interact on social media, and worry about the safety of their loved ones.   In some hot zones, they are returning to work.  They now have to worry about how they can do their job safely and must plan a new work environment to reduce the chances of spreading infection.

 

What follows are some of the lives lost or changed due to COVID-19.  The loss of these heroes affects their loved ones, their neighbors, the communities they served, and our world:

Police officers – https://www.lawenforcementtoday.com/senior-detention-officer-officer-of-23-years-man-of-faith-dead/

Paramedics – https://www.ems1.com/coronavirus-covid-19/articles/covid-19-ems-deaths-jk5zWFziwYVYUaM4/

Store workers – https://www.eater.com/2020/4/7/21212135/grocery-workers-are-dying-from-coronavirus-trader-joes-walmart

https://www.kcra.com/article/he-was-a-healthy-man-family-mourns-safeway-worker-who-died-of-covid-19/32179508#

Meatpackers – https://www.usnews.com/news/healthiest-communities/articles/2020-05-01/cdc-nearly-5-000-meat-plant-workers-infected-by-coronavirus

Doctors – https://www.nbcnewyork.com/news/local/new-jersey-er-doctor-dies-one-week-after-exhibiting-covid-19-symptoms/2354084/

Nurses – https://www.usatoday.com/story/news/nation/2020/04/21/us-nurses-who-died-coronavirus-honored-white-house-protest/2996839001/

Physician Assistants – https://www.military.com/daily-news/2020/03/31/guardsman-who-died-covid-19-remembered-1st-responder-passion-serve.html

Nurse Practitioners – fortunately, no deaths reported https://www.11alive.com/article/news/health/coronavirus/georgia-nurse-survives-covid19-battle/85-37c7b703-fe2f-41d3-b62f-f4a6ee2a838d

Nurse Anesthetists – thankfully, no deaths reported – https://www.nola.com/news/coronavirus/article_25b835c0-7b65-11ea-ab5c-67ceca2dba77.html

Respiratory Therapists – https://www.local10.com/news/local/2020/04/24/partner-of-fallen-healthcare-worker-says-they-need-more-protection-from-coronavirus/

Journalists – https://www.cnn.com/2020/03/29/us/maria-mercader-death-trnd/index.html

The journalists and colleagues we’ve lost to the coronavirus

https://www.voanews.com/covid-19-pandemic/dozens-journalists-have-died-coronavirus-march-1-group-reports

Politicians – https://www.forbes.com/sites/jackbrewster/2020/04/07/these-34-us-lawmakers-have-tested-positive-for-covid-19/#378ee12d46d9

https://www.newscenter1.tv/south-dakota-state-representative-bob-glanzer-dies-at-74/

TSA employees – https://www.khou.com/article/news/health/coronavirus/fifth-tsa-employee-dies-of-coronavirus-as-more-than-500-have-tested-positive/285-8910f312-fd8e-418a-acc6-6ca303474a05

Overall Medical workers:  https://www.businessinsider.com/healthcare-workers-who-died-with-the-coronavirus-2020-4?op=1#douglas-linn-hickok-57-a-physician-assistant-and-new-jersey-national-guardsman-became-the-first-us-military-service-member-to-die-from-the-coronavirus-7

Overall memorials: https://www.cnn.com/interactive/2020/health/coronavirus-victims-memories/

When does the pandemic improve?  It could dramatically improve with successful treatments.   Finding effective antiviral medicines would allow for less severe outcomes.  A successful vaccine would prevent illness.   Herd immunity.  Even the possibility of finding a post-exposure prophylactic medication that is mostly safe and lessen the severity of disease would dramatically change things.  Until then, defense remains our best strategy.  Good luck in avoiding exposure to coronavirus in America.  Recent data shows you have had it with the shelter in place recommendations.  The latest guidelines implemented by the CDC to safely return us to work suppressed by the White House task force.  Some Americans are unwilling to wear masks when out in public but eager to protest and visibly display assault weapons to make their voices heard.  The concept of comprehensive testing before Americans returned to work seems to have lost traction.   America is suffering, and it will continue to do so in the unforeseen future as we will are unwilling to help stop the spread.  What we do here in the US has implications for others all around the globe. Our actions as a country will not only affect our economy but will have a ripple effect on other countries that rely upon the US for their country to function.  Many innovators and scientists are finding solutions to these complex problems.  Keep them in your prayers, for they are the ones who will save lives and decrease the suffering.  Our government had the opportunity to prevent the devastation of this pandemic, but that window of opportunity closed a long time ago.  At this time, our politicians can only react as prevention was not enough of a priority.

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Published 5/17/2020 at 8:30 am EST