Night Shift: I Could be Wrong

8 Comments

I could see that my wife was troubled by something as I entered the house after coming home from work. I just assumed it was something I’d done or said so I wasn’t anxious to open that can of worms before trying to go to sleep.

Finally she blurted it out.

“I didn’t know whether to tell you this before you went to bed, or after you woke up, but I just couldn’t take it any longer. Jerry died.”  I could see her eyes welling with tears.


ADVERTISEMENT

Jerry was a long time friend of the family who had only recently been diagnosed with COVID.

“Damn,” I moaned bowing my head. “He went down fast.”

“He was diagnosed just three weeks ago in the ER at St Augustine,” she said emphasizing the time line. “They sent him home and told him to come back if he got short of breath.”


ADVERTISEMENT

“That’s awful. He was healthy,” I recalled. “Had he been vaccinated?”

“He was only 45 years old, Mark. He has three teen aged girls. And yes, he had been vaccinated,” she spat out changing from sorrow to anger. “I talked to Edie. She wants to sue the ER doc who sent him home.”

“That’s not going to help anybody,” I said shaking my head plaintively. “Besides she’s not going to get anywhere with a suit like that. If he wasn’t hypoxic there is nothing to do.”

“That’s the standard of care?” she said looking at me with a mixture of frustration and anger. “Do you send people home with those kinds of home-going instructions, ‘Come back if you can’t breathe?”


ADVERTISEMENT

I could only give a helpless shrug.

“Over 99% of people do fine, honey. At least they don’t die.”

“Yeah, well Jerry died. He must have been more fit than most, or he didn’t want to admit he was having trouble. Because when he came back to the ER he was in such severe distress that he went straight to the ICU.”

“Do they know who he contracted the infection from?” I said trying to move the discussion away from the ER.

“A friend of a friend. Everyone was vaccinated and wearing masks, except when they weren’t,” she shrugged. “So now you want to blame the friend for not wearing those stupid masks that you even say don’t really do anything?”

“I’m not trying to blame anyone. It was probably the Delta variant.”

“And the vaccination doesn’t stop the Delta, huh? Great,” she said bitterly. “Then why are we getting the damn shots?  Aren’t they just effective on the Alpha strain?”

“It does seem to have cut down on the disease in the elderly.”

“Then why are they now telling us we have to have a booster. And maybe another. And another?”

“Well, it seems like the vaccination’s protection isn’t lasting as long as they once thought.”

“And what about the people who actually got COVID?  I’ve read that their immunity is lasting a lot longer…and broader. I don’t think they are getting the Delta as much as people like us who got the shot.”

I hated trying to argue the merits of various research reports with my wife.

“I read a Harvard epidemiologist say that maybe only the elderly should get the shots and younger people should get the disease and develop natural immunity. But it seems like the policy elites are trying to get everyone vaccinated, even little kids. Won’t that just protect us all from Alpha and make everyone susceptible to the Delta?”

“I don’t know,” I said. My fatigued mind was foggy and not really wanting to engage in this argument. “But people like Jerry are still going to catch the virus,” I mumbled softly before immediately regretting it.

“Exactly,” she came back even more determined.  “I heard that people like us, who have been vaccinated are 27 times more likely to get the Delta variant than someone who has had the infection.”

I was familiar with the research she was referring to, but not wanting get into the details. I was actually just as frustrated as she was.

“And why don’t you treat patients like Jerry when they are first diagnosed?”

“With what? Ivermectin? Worm medicine?” I blurted out.

“Why not?” The question hung in the air. “I’ve read some reports from some pretty smart people that things like that helped. I’ve even heard your guys on the editorial board arguing it back and forth on your monthly calls.”

“Well,” I began, “Ivermectin, just like every other drug, has side effects. And people can take too much and get sicker.”

“Oh, do you think I believe that stupid story about the ER out in Oklahoma that was supposedly jammed Ivermectin overdoses. That turned out to be a bald faced lie.”

Inside I was chuckling cynically at the idiots at Rolling Stone who believed and printed that baloney.

“‘I’ve seen you hand out Ivermectin like candy to the patients we were treating on our missions trips to the jungles along the Amazon,” she said. “It’s not ‘dangerous’ and you know it. If I got COVID,” she said looking deep into my eyes, “would you try something as harmless like worm medicine, just on the odd chance that it might help?  Or would you wait until I was turning blue and then try to save me?”

“The chances of you needing anything at all is really slim,” I explained.

“Jerry died, sweetheart, and they didn’t offer to treat him with anything until it was too late. Whatever happened to the ‘shared decision making’ I hear you talking about all the time?  What about just telling him that you are aware of studies that suggest a benefit from various treatments, but you don’t have confidence in their statistical accuracy?  Just be honest with the patient about the controversies among the so-called experts. And let him weigh in on the decision.

“I’m not sure the pharmacist would fill the prescription if I wrote for Ivermectin for COVID,” I mused.

“Oh, I know you, you would tell the pharmacist that I was eating dirt from the garden and got worms. That’s not it. You’re afraid of telling your colleagues, especially the younger ones, that you prescribed Ivermectin, worm medicine, for COVID.”

“The randomized control trials don’t suggest any benefit,” I said coldly.

“I know I’ve heard you say that about a lot of things that I know you have offered routinely to your patients. You let them know your doubts, you let them ask questions, and you let them decide, if there isn’t something really dangerous. You know, no one said anything to me about the risk of getting Guillain-Barre when I got my vaccination. I’m sure it was in the literature that I signed, but there was no discussion. I was just told to get the shot.”

“So you think we are wrong to not discuss all the various treatments that are available to patients with early COVID.”

“I think that there are a lot of reasons you don’t discuss treatments with patients. And to your young colleagues that discussion is…purely clinical, academic and probably not very personal. But for me, and certainly Edie and Jerry, that discussion would have been very personal. And they might have seen it very differently if they had been given an opportunity.”

“So, can we just agree to disagree,” I said wishing to end the conversation.

“Yes,” she said, “if you will grant me one concession. Say what our counselor told us to say when we had tough disagreements. And mean it.”

“Ok,” I said with a warm nod. “I could be wrong.”

ABOUT THE AUTHOR

FOUNDER/EXECUTIVE EDITOR Dr. Plaster has been an emergency physician for more than 30 years, working exclusively night shifts for the past 20 years in emergency departments across the country. During that period, he joined the U.S. Navy and served two tours in Iraq. Dr. Plaster is the founder and executive editor of Emergency Physicians Monthly and the founder of Plaster Publishing.

8 Comments

  1. Charles Kutner on

    No vaccine, no medication is guaranteed to work 100% of the time. The fact that it does work is in the data. That ivermectin does not work is also in the data. That is what one should follow. otherwise we might as well be prescribing vitamin c and zinc for covid. Could it help someone? Absolutely. Is it worth it? absolutely not. If we don’t follow the data we have we might as well go back to the 16th century before the scientific method pulled us out of the dark ages. Then you could have a priest bless your loved ones and watch them die in droves as every family did with their children. I am sorry for the loss of your family friend. yet the scientific method of testing reality should always guide us. Yes you could be wrong but your wife was definitely wrong.

    • David Schulze MD on

      I’m not sure what to think of the results from the state of Utter Pradesh India where initially vaccinations where rare in 2020 and early 2021 and mortality was high. The Indian government started giving out blister packs with Ivermectin 12mg along with Vit D 5000IU and Doxycycline 100mg in Spring 2021. My understanding is that by Sept 21 the state is virtually free of COVID-19. The vaccination rate has increased but not enough to explain the decrease in Covid-19. Where is the intellectual curiosity that once defined the medical community that now unquestionably follow media talking points. What’s happened to us? Doesn’t such data compel us to go outside the usual sources of information to explore the possibilities. What are we afraid of? That we’ll be accused of quackery? Please explain the phenomena of 241 million people prescribed Ivermectin including children in Utter Pradesh. I’m open to knowing more after 30 years of practicing medicine it wouldn’t be the first time I’ve been humbled.

  2. Glad I haven’t had this vitriol from my spouse. If I had to come home and defend myself after 12 hrs of frustration, misinformation, anger and the regular ED drama… I really would lose my mind, and soul.

Leave A Reply