COVID-19 Narrative (2): Chris Matthew Sciabarra

This is the second in my series of COVID-19 Narratives, by my dear friend Chris Sciabarra, sheltering in place in Brooklyn, New York. Though the series is primarily about what I called the “supply side” of the health care equation during this crisis, I wanted to run some posts that described the “demand side” as well, that is, what it’s like to be a patient during the pandemic. Particularly valuable about Chris’s post is how it illustrates the implications of the COVID-19 pandemic for people with serious medical conditions whose previously scheduled medical procedures have now been deemed “elective.” “Elective” in this context doesn’t mean “optional.” It means downgraded to second or third priority out of sheer, dire necessity: hospital beds, equipment, and personnel have to be left vacant or unused to absorb the overwhelming crush of COVID-19 patients we expect to see. And even at the center of the pandemic, we haven’t yet reached the peak of that crush. Continue reading

Coronavirus Diary (17): Geriatric Oncology during COVID-19

Here’s a press release from an old friend that I’ve mentioned here a couple of times before, William Dale MD, the Arthur M. Coppola Family Chair in Supportive Care Medicine at the City of Hope in Duarte, California. William specializes in geriatric oncology, the treatment of cancer in older patients, which for obvious reasons presents severe challenges during an event like the COVID-19 pandemic. His pushback against the repulsive ageism that has recently come to the surface of our discourse is an enormous relief to read. Continue reading

God Bless the Child Who’s Got His Own Epi-Pen

I don’t like to pre-judge a legal case before it’s been adjudicated. So instead of pre-judging this case, I’m going to wonder about it out loud in as non-judgmental fashion as I can muster, playing the role of a chatty, colloquial, self-appointed investigator tasked with getting “to the bottom” of the matter, but in a sense of that broader than the narrowly legal.

Suppose that you’re a pre-school given the responsibility of caring for a child with a severe dairy allergy–severe enough to kill him if he eats the wrong thing. Death, I assume, is a serious matter, and merits being taken seriously. So I’d assume that you’d take measures to flag the child during lunch or snack, and make sure he doesn’t eat the wrong thing. If his dietary restrictions were merely a matter of finicky tastes or even religious dogma, you could afford to slip a bit. But if the restriction is a matter of life and death, you couldn’t. So I would make sure that someone was tasked with giving him a non-dairy meal. Or something like that.

But suppose that you do slip, and feed a severely allergic child a grilled cheese sandwich. The child now shows signs of going into anaphylactic shock. Preliminary question, not meant to be rhetorical: do you know what anaphylaxis is? Continue reading

D.F. Kripke on the Use of Sedative-Hypnotics: A Query

Here’s a question for any PoT readers who are physicians or who otherwise have experience prescribing sedative-hypnotics (aka, “sleeping pills”):

I’ve been working through D.F. Kripke’s paper “Mortality Risk of Hypnotics: Strengths and Limits of Evidence,” which claims that “hypnotics cause huge risks of” premature death in those who use them. In many ways, the paper strikes me as a methodological disaster area (here’s a cogent critique), but I’m curious what any physicians/prescribers out there think about two of the anecdotal claims Kripke makes about physicians who prescribe sedative-hypnotics. Continue reading