People frustrated with lockdowns need to read this ER doctor's COVID-19 journal entries

With protests around the country over pandemic lockdowns, it's clear that many Americans are frustrated—and understandably so. We're in a frustrating situation, where leaders and public health officials have to make impossible decisions based on constantly changing data, with terrible consequences resulting from every choice.

But some folks seem to be a bit unclear on exactly what these lockdowns have been preventing. In areas that haven't been hard hit, the measures feel like an overreaction. That's why we need to be reminded of the real, dire human toll this virus will take if allowed to spread. And not just in numbers, which are too easy to dismiss, but in stories that describe the reality of what can happen anywhere the virus is allowed to take hold.


Jason Hill, an ER doctor at New York Presbyterian Hospital in New York City, shared some of his personal journal entries during the peak of New York's outbreak. They offer a painful but beautifully crafted window into why we've been locking down and must continue to do what it takes to keep the spread to a minimum.

Jason Hill www.facebook.com

Dr. Hill wrote on Facebook on April 15:

"Thanks for all the bday wishes. Several people have asked me about what it's been like in the ER with Covid. I'd done some journaling the last couple weeks. As I turn forty this is how my head, heart, and soul have been occupied.

Covid at 40.

The eyes stay with you. In peace time most of those we intubate are chronically ill, or profoundly confused, or unconscious and unaware of the world around them. Covid has changed the equation. Most of my patients now remain awake and alert until the end. These days the ER is permeated with frank conversations about death and dying and what a chance to live entails. It is a hard thing to tell a healthy and functional person who felt fine and well six days ago they may be dead in a day or two and humbly ask how aggressive they want us to be. A chance to live comes with the risk of dependence on life support and pain. The alternative is the guarantee of an imminent but peaceful death. I have never had more harrowing, more frequent, more brutally honest, more meaningful, more exhausting conversations in my life. Complete strangers open up to you in profound ways during such times and you can only hope both your expertise and your humanity serve them well. And the eyes stay with you.

For those I intubate, those who choose intubation, I often find myself having a final stare. After all the words are spoken, the decisions made, the medications drawn, the bed positioned, the tubes and drips and ventilators readied, there is a final stare. It is a stare of intention. It is a moment of humanity. It is a shared space, a hallowed space, the final moment of someone's awareness, possibly forever. It is a space where fear and hope mingle, where autonomy fades into trust, uncertainty into acceptance, and all they have left is placed firmly in your gloved hands. It's brief, and you're busy, and time is essential, but you find a few seconds to share this final breath. That stare lasts a moment. That stare lasts a lifetime. And the eyes stay with you.

I see them often in my mind, and although haunting I am glad to keep them with me. I warm my hands on the raw humanity inherent in such moments and they empower me to carry on. For carry on we must because the room is full of agony and sickness and fear that must be attended to quickly and humanely.

//

I am asleep before a long night shift. I awake to the sound of cheers and yells. To hooting and hollering. To the clanging of cow bells and the banging of drums. They yell and shout and scream to honor us. They shout from rooftops and ground floors and all the windows and balconies in between. I am asleep before a long night shift. It wakes me up. I am scared shitless. I think the building is on fire. I run around panicked and confused for several minutes. Why do the fire sirens sound like drums and cowbells? Do I even have a fire escape?? WTF is going on?? Oh. Ohhhhhhh. Ok. I get it now. My heart is still racing, but now I'm grinning. Thanks. I feel grateful…mostly.

//

Oxygen Rounds is a new term we have become all too familiar with. I have a hospital full of medications. Antibiotics and anti-virals and sedatives and vasopressors and steroids and opiates. But the only truly effective medicine we have is Oxygen. We blow it at high flow rates into people's mouths and nostrils, a crutch to help the lungs that are struggling and staggering. And it's in a shorter supply than I'd like. It flows forever from spickets on the walls, but we have many times more patients than spickets and even fewer rooms so an ever increasing number of patients on stretchers line hallways further and further from the spickets on the walls. We place portable tanks next to stretchers, but the tanks run out and we can't refill them fast enough. Once per hour, sometimes twice, I walk the halls, hunting for gauges approaching empty and hoping the cabinet holds a replacement. Invariably I find empty ones and hope it hasn't been empty long. Invariably someone is turning blue. It's no one's fault. it's everyone's fault. it's Covid's fault. And there just aren't enough eyes and hands to keep up. I mutter a promise to check three times next hour. I pull a step ladder from the utility closet and string plastic connecters end to end to end threading them from wall spickets through corrugated ceiling tiles to drop down above patients' heads in the hallway so they aren't reliant on a tank. It's hard to tell which knob goes to who, but at least it doesn't run out. It's a strange time when a step ladder becomes a more useful tool than a stethoscope.

//

I admitted four of my colleagues today. Four of them. They had the usual symptoms. A week or so of cough and chills, fever and body aches, fatigue and loss of smell. They stayed at home and took Tylenol and sipped chicken soup and wondered which patient they had gotten it from. They stayed inside and washed their hands and waited to feel better. But better never came. The cough worsened, they had trouble walking around their home without getting winded, and they knew all too well what that meant, so they came, each of them, not knowing the others were doing the same. I'm in a room with four chairs housing four colleagues with oxygen flowing into their four noses. I'm used to seeing strangers, people I care about because they're human, but a stranger still. I can maintain a detached distance. This is different. These are my friends and colleagues. These are the people I suit up with and go to battle beside. This is my team. I've had harrowing experiences beside them for years. They keep me sane and effective and capable. Together we've saved lives and lost lives and everything in between. But now they are on the other side of the curtain. Their coughs hurt my ears more, their fear becomes my fear, I check on the them to the point of harassment, can't help it, can't fix it, they're on a path I can't cure, can only support through. Can only stand beside them and hope. They try to reassure me, a strange role reversal that belies their strength. I well up with a deep respect. I well up with tears. The front line really feels like the front today.

//

The makers are my favorite people this week. Several days ago I intubated without a face shield. It was three in the morning and we had run out. There were simply more intubations than face shields and we had burned through the stash. But a patient came in and was suffocating in their own lungs and needed a breathing tube, so they got one, and they got one from me, and I did not have the proper armor. Today I stand in a room with hundreds and hundreds of face shields. They are pulled hot off the 3D printers like newspapers off a press. They are arranged on tables by volunteers who add elastic bands and attach shields to complete the ensemble. In the background the gentle hum of a dozen printers working around the clock is an echo of the thousands of engineers and designers, seamstresses and manufacturers, cooks and delivery workers and writers all contributing to the cause. Each shield is a person protected. Each volunteer is a soldier in the fight. I feel less alone.

//

Oxygen means something different in this new reality. In peace time an oxygen level below 95% is bad. An oxygen level below 95% on a non-rebreather face mask is terrifying. That's a no-brainer. That gets fixed quickly or that gets intubated. Everything is different now. We hang facemasks of oxygen on people with 85-90% saturations for days. They are on the edge of the cliff with one foot dangling and there they stay. Will they inevitably fall off? Are we helping or merely delaying? No one knows. Ventilators are in short supply, ICU beds are full, and ICU docs are tired. We're all tired. So we temporize, hoping a few will sneak by and not get intubated. Hoping someone doesn't fall off the cliff when we aren't looking. The monitors don't help. They are all beeping and blaring all the time from every direction. The background music of a pandemic. They only tell us what we know, everyone is sick. Only our eyes and experience can help us now. I take another lap around the ER to check the cliffsides.

//

I'm baking a mask tonight. My single use N95 has been on my face for days. The backs of my ears are raw from the rubbing of its straps and my nostrils are filled with the scent of fibers mixed with my coffee flavored breath. My mask bakes and bakes, sterilizing it and killing any viral hitchhikers that attached themselves today. I wish I could do the same for someone's lungs. It comes out warm and toasty and clean. It comes out safe. I set it on the windowsill to cool, like an apple pie from easier days. Worst desert ever.

//

All hands were on deck today. Elective surgeries have been cancelled and the surgeons and anesthesiologists and neurologists and orthopedists and urologists and rehab specialists and pediatricians have been deputized as ER and ICU docs. Urology attendings and shoulder surgeons are rounding with ICU teams, adjusting ventillators, and drawing blood gases. Pediatricians are seeing adult patients and monitoring oxygen levels. Outpatient docs are working in tents in front of the ER to decompress volume. General surgeons are going from room to room to room putting in Central lines and Arterial lines on our sickest patients. Anesthesiologists are running in to intubate. It remains busy. It remains overrun with sickness and suffering. But today we have more help. Today we have reinforcements. Today we feel like one big army devoted to one fight. Today it feels like maybe, just maybe, we can keep up.

//

Es El Fin. Today I'm a palliative care doc. This man is not doing well. This man needs intubation to survive. He's 67 and only speaks Spanish. He's healthy. He's dying. His oxygen is very low. His respiratory rate is very high. He's getting tired. He's suffocating in his own body. He needs to be intubated. He doesn't want to be intubated. He doesn't want to be on a machine. We ask if we can help call his family to say goodbye. He looks at us puzzled, somehow still not fully understanding. Esta Muriendo senior. Es el fin. This is the end. He gets it. He's stoic despite the tears. He's strong. If this disease attacked character instead of lungs he would have a fighting chance. We set up a video call with his family. He says goodbye. They say they love him in a dozen different ways. He touches the screen. A digital hand hold in a pandemic age. We make him comfortable. He's still drowning but he can't feel it. He says thank you before his eyes close. I can't help but wonder if he would have survived had he been intubated. The odds say no. The sense of defeat within me screams maybe. I try to remind myself this is what he wanted. That this is for the best. I quickly forget.

//

I give out more juice and blankets than I ever have. In peace time the ER is busy, always busy, but most people are not dying. Very few are dying, and even fewer are acutely and actively dying. The scourge of Covid has rewritten those rules. Everyone in the ER tonight is too sick to go home. Many are dying. Many will never leave the hospital. Many will never have a meal or a juice box again. In peace times I often can't be bothered to bring someone juice. It's not a priority. Tonight anyone asking gets juice. Even those not asking get juice. Often it's the only comfort I can provide. A small ease of suffering. A brief distraction from the fear. It may be the last juice they ever drink. Some nights it's the best medicine I have.

//

We had a patient tonight that impaled her hand with a crochet needle. Right through her hand. Simple stuff for us. Easy to take care of. Three of us ran over. Two more than was necessary. An orthopedist playing ICU doc was walking by. He ran over. He was excited. We were all excited. This was not Covid. This was something we could fix. We did it together. Eight hands to do the job of two. We removed the needle, help it up like a trophy, washed it off and gave it back. Our patient smiled, said thank you, and went home in one piece. It was the best we'd felt in days.

//

My colleagues are tired. The patients keep coming. The ER is wall to wall misery and mayhem. Only five people died on me today. Only five. But everyone there is dying to varying degrees and at various rates. The ER is a cross section of the disease. The well who will stay well. The well who will come back much worse. The sick who are stable. The sick who are crashing. It's all around us. It keeps coming in through the front door. It keeps coming in through the ambulance bay. And my colleagues are tired. We give oxygen. Everyone staying gets oxygen. Needs oxygen. We try antibiotics. We try antivirals. We try hydroxychloroquine. This week we use steroids. This week we limit IV fluids. This week we give blood thinners. Does anything work? Are we saving anyone or just supporting them as they go along a path pre-determined by the virus coursing through their insides? Is the inevitable inevitable? Some days we just feel like spectators, front row observers going through the necessary motions of a play whose final act has already been written. So much death. So much dying. And my colleagues are tired. We're all tired. And yet somehow, for some reason, I find there's no place I'd rather be. I leave the ER, the sun has come up and I walk around enjoying its warm tendrils. Its quiet. Stores are shuddered, streets are empty, and sidewalks are bare. It seems peaceful. Its an illusion. But I appreciate it. Time to go home. Time to recharge. Tired won't last forever. Covid won't last forever. And there is still plenty of fight in us."

Imagine this being your current reality, then imagine what it must be like to see people protest the measures that are keeping that reality out of other communities. We're not doing all of this for nothing. Yes, it's frustrating, but we face nothing but frustrating options at the moment.

Thank you, Dr. Hill, for sharing your experiences and for doing your best to save lives. Let's hope people see the warning in your words and act accordingly.

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Judy Vaughan has spent most of her life helping other women, first as the director of House of Ruth, a safe haven for homeless families in East Los Angeles, and later as the Project Coordinator for Women for Guatemala, a solidarity organization committed to raising awareness about human rights abuses.

But in 1996, she decided to take things a step further. A house became available in the mid-Wilshire area of Los Angeles and she was offered the opportunity to use it to help other women and children. So, in partnership with a group of 13 people who she knew from her years of activism, she decided to make it a transitional residence program for homeless women and their children. They called the program Alexandria House.

"I had learned from House of Ruth that families who are homeless are often isolated from the surrounding community," Judy says. "So we decided that as part of our mission, we would also be a neighborhood center and offer a number of resources and programs, including an after-school program and ESL classes."

She also decided that, unlike many other shelters in Los Angeles, she would accept mothers with their teenage boys.

"There are very few in Los Angeles [that do] due to what are considered liability issues," Judy explains. "Given the fact that there are (conservatively) 56,000 homeless people and only about 11,000 shelter beds on any one night, agencies can be selective on who they take."

Their Board of Directors had already determined that they should take families that would have difficulties finding a place. Some of these challenges include families with more than two children, immigrant families without legal documents, moms who are pregnant with other small children, families with a member who has a disability [and] families with service dogs.

"Being separated from your son or sons, especially in the early teen years, just adds to the stress that moms who are unhoused are already experiencing," Judy says.

"We were determined to offer women with teenage boys another choice."

Courtesy of Judy Vaughan

Alexandria House also doesn't kick boys out when they turn 18. For example, Judy says they currently have a mom with two daughters (21 and 2) and a son who just turned 18. The family had struggled to find a shelter that would take them all together, and once they found Alexandria House, they worried the boy would be kicked out on his 18th birthday. But, says Judy, "we were not going to ask him to leave because of his age."

Homelessness is a big issue in Los Angeles. "[It] is considered the homeless capital of the United States," Judy says. "The numbers have not changed significantly since 1984 when I was working at the House of Ruth." The COVID-19 pandemic has only compounded the problem. According to Los Angeles Homeless Services Authority (LAHSA), over 66,000 people in the greater Los Angeles area were experiencing homelessness in 2020, representing a rise of 12.7% compared with the year before.

Each woman who comes to Alexandria House has her own unique story, but some common reasons for ending up homeless include fleeing from a domestic violence or human trafficking situation, aging out of foster care and having no place to go, being priced out of an apartment, losing a job, or experiencing a family emergency with no 'cushion' to pay the rent.

"Homelessness is not a definition; it is a situation that a person finds themselves in, and in fact, it can happen to almost anyone. There are many practices and policies that make it almost impossible to break out of poverty and move out of homelessness."

And that's why Alexandria House exists: to help them move out of it. How long that takes depends on the woman, but according to Judy, families stay an average of 10 months. During that time, the women meet with support staff to identify needs and goals and put a plan of action in place.

A number of services are provided, including free childcare, programs and mentoring for school-age children, free mental health counseling, financial literacy classes and a savings program. They have also started Step Up Sisterhood LA, an entrepreneurial program to support women's dreams of starting their own businesses. "We serve as a support system for as long as a family would like," Judy says, even after they have moved on.

And so far, the program is a resounding success.

92 percent of the 200 families who stayed at Alexandria House have found financial stability and permanent housing — not becoming homeless again.

Since founding Alexandria House 25 years ago, Judy has never lost sight of her mission to join with others and create a vision of a more just society and community. That is why she is one of Tory Burch's Empowered Women this year — and the donation she receives as a nominee will go to Alexandria House and will help grow the new Start-up Sisterhood LA program.

"Alexandria House is such an important part of my life," says Judy. "It has been amazing to watch the children grow up and the moms recreate their lives for themselves and for their families. I have witnessed resiliency, courage, and heroic acts of generosity."

Researchers at Harvard University have studied the connection between spanking and kids' brain development for the first time, and their findings echo what studies have indicated for years: Spanking isn't good for children.

Comments on this article will no doubt be filled with people who a) say they were spanked and "turned out fine" or b) say that the reason kids are [fill in the blank with some societal ill] these days are because they aren't spanked. However, a growing body of research points to spanking creating more problems than it solves.

"We know that children whose families use corporal punishment are more likely to develop anxiety, depression, behavior problems, and other mental health problems, but many people don't think about spanking as a form of violence," said Katie A. McLaughlin, director of the Stress & Development Lab in the Department of Psychology, and the senior researcher on the study which was published Friday in the journal Child Development. "In this study, we wanted to examine whether there was an impact of spanking at a neurobiological level, in terms of how the brain is developing."

You can read the entire study here, but the gist is that kids' brain activity was measured using an MRI machine as they reacted to photos of actors displaying "fearful" and "neutral" faces. What researchers found was that kids who had been spanked had similar brain neural responses to fearful faces as kids who had been abused.

"There were no regions of the brain where activation to fearful relative to neutral faces differed between children who were abused and children who were spanked," the authors wrote in a statement.

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Images courtesy of John Scully, Walden University, Ingrid Scully
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Since March of 2020, over 29 million Americans have been diagnosed with COVID-19, according to the CDC. Over 540,000 have died in the United States as this unprecedented pandemic has swept the globe. And yet, by the end of 2020, it looked like science was winning: vaccines had been developed.

In celebration of the power of science we spoke to three people: an individual, a medical provider, and a vaccine scientist about how vaccines have impacted them throughout their lives. Here are their answers:

John Scully, 79, resident of Florida

Photo courtesy of John Scully

When John Scully was born, America was in the midst of an epidemic: tens of thousands of children in the United States were falling ill with paralytic poliomyelitis — otherwise known as polio, a disease that attacks the central nervous system and often leaves its victims partially or fully paralyzed.

"As kids, we were all afraid of getting polio," he says, "because if you got polio, you could end up in the dreaded iron lung and we were all terrified of those." Iron lungs were respirators that enclosed most of a person's body; people with severe cases often would end up in these respirators as they fought for their lives.

John remembers going to see matinee showings of cowboy movies on Saturdays and, before the movie, shorts would run. "Usually they showed the news," he says, "but I just remember seeing this one clip warning us about polio and it just showed all these kids in iron lungs." If kids survived the iron lung, they'd often come back to school on crutches, in leg braces, or in wheelchairs.

"We all tried to be really careful in the summer — or, as we called it back then, 'polio season,''" John says. This was because every year around Memorial Day, major outbreaks would begin to emerge and they'd spike sometime around August. People weren't really sure how the disease spread at the time, but many believed it traveled through the water. There was no cure — and every child was susceptible to getting sick with it.

"We couldn't swim in hot weather," he remembers, "and the municipal outdoor pool would close down in August."

Then, in 1954 clinical trials began for Dr. Jonas Salk's vaccine against polio and within a year, his vaccine was announced safe. "I got that vaccine at school," John says. Within two years, U.S. polio cases had dropped 85-95 percent — even before a second vaccine was developed by Dr. Albert Sabin in the 1960s. "I remember how much better things got after the vaccines came out. They changed everything," John says.

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