Night Shift: I Could be Wrong

11 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.


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“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.

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.”


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“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.”

“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.”


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“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?”

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.

11 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.

  3. I have always enjoyed and respected Mark’s column, but I must say I was disappointed in this one. It is our our duty as a professional to use our knowledge and training to guide our patients to the best treatment options that our scientific evidence supports. I use shared decision making with my patients all the time, but only in the context of when there is NOT clear evidence for what I should recommend. I don’t expect other professionals I hire such as an electrician to discuss other service options that are not supported by his knowledge base. This is why we hire and consult with others that have the education and training to guide us properly.

    I am all for setting up good scientific studies to evaluate the potential for benefit of therapies or drugs such as Ivermectin, but we need to leave politics and social media influences out of our practices. The only patients I have taken care of who want to be given these drugs, are people who refuse to accept other scientifically proven therapies such as Monoclonal antibodies or Remdesivir.

  4. Despite being a “fictional” story, it is still reasonable to offer criticism of its disingenuous tone. I was fully immersed in the back and fourth of the “expert” husband and the layperson wife. Laypersons are not stupid as using the term worm medicine instills a level of supercilious engagement that it also seen in the media and everyday intellectual discussions. If you were to get a group of doctors, of all specialities, with full transparent outward thinking, and propose this question “What can we do to better treat this illness?”- you would get either dead silence or data-driven diarrhea. What I mean is that intellectual curiosity has reached an all-time low that people (and doctors) today have resorted to lazy data regurgitation and headline experts. Instead of saying ‘the experts’, instead you should grow a pair, and say, “We are the experts, and let’s figure this out ourselves.”
    That’s right, I am calling my colleagues cowards for not standing up for their patients. Hard stop.
    To conclude, I am not advocating any particular treatment (including iseemectin). I am calling for a line of thought that challenges exactly what the layperson wife asks “Is THAT your standard of care?”

  5. Adam Costarella MD, FACEP on

    Mark, I have been reading your articles faithfully the past few years or so. I find them intriguing and sound like my own stories I have had over 40 years of ER practice (recently retired). However, there was an article debating mask usage that I have to say stirred my angst. I recently came from a vacation in Hawaii, where everybody there wears a mask, required by the state law. In a state of 1.7 million people only about 1 thousand deaths from COVID. In the 3 counties surrounding me in Ohio with a population of 500 thousand we have over 1700 deaths from COVID. In those same 3 counties less than 50 percent are vaccinated and most of the people I see in stores , etc refuse to wear masks. I agree there are many factors affecting spread of disease. However, the article on mask debates is wrong! Every knowledgeable doctor agrees masks help prevent the spread of disease. That is why we have a CDC to give the doctors guidance. There are many studies done by doctors and Phd’s showing that masks prevent the disease whether N95 ore even simple face masks, by preventing the spread of droplets, particles, etc. To debate the subject may lead to the ill informed spreading a false thesis. On Ivermectin it would be hard to get any Infectious Disease expert pushing for its use, anecdotes aside. Your wife remarking everyone who dies with delta variant had the vaccine is absolutely wrong and can mislead less knowledgeable people (I hope not doctors). Actually the statistics to those working in the ER’s will point out that those who die in the hospital are 26 times more likely to be unvaccinated. These are reported in almost every hospital in the country. The lay person does not know these common facts and it discourages me when I try to tell people to get vaccinated, that they come back and say a doctor said the opposite. I would encourage you to keep a keen eye to the truth as this may save lives in the long run. I enjoy reading your monthly, I do not know how you can maintain your sanity working only nights. Take Care. Adam Costarella Md, FACEP

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