I hate 2020. It\’s the worst year I can remember. Between the pandemic, the shutdown, the plunging economy, the overloaded medical system, the mask debate, and the looming elections, I can\’t remember a worse one.

And it\’s not over yet.

From doctors to politicians, all those who know what they\’re talking about, and some who don\’t, think that the coming winter will be worse. And, unlike the calendar, winter doesn\’t end with December. We\’re talking months of the 2020 misery compounded by short days, bad weather, and socially isolated winter celebrations.

How will we stay alive and slightly sane until it\’s over?

That\’s what I asked myself as I listened to the news while struggling to zip my raincoat to take the dog out in the nasty rain – after cleaning the puddle in the dining room.

Organized as always, I made a list you may find useful. If you happen to be one of those who don\’t need a social life, don\’t worry about money, and don\’t long for spring, feel free to share your recipe with us, the humans. We\’ll all think of you lovingly. As for me, this is my list.

1. Accept reality. No matter how much you wish, it wasn\’t so, this is the reality we all live in. Denying it won\’t make it go away. It will just make it harder to deal with it.
2. Get ready for more shutdowns. That\’s what happened to France, Great Britain, and others. It may happen here. Stock what you\’ll need, besides toilet paper. A generator? Your medications? Batteries? Hair dye?
3. Behave like you may have the virus, even at home. Don\’t share your cutlery, your glass, your toothbrush. Wash your hands often, and don\’t lick the kids\’ ice-cream.
4. Make a plan in case you get sick. How will you self-isolate? Who\’ll care for the kids? Walk the dog? Speak to those who\’ll have to take over.
5. Start a project and set deadlines. Whether it\’s cleaning the pantry, training the cat, or becoming vegetarian, committing to a project will make time go faster. And give you something to brag about.
6. Rest. Tired people make mistakes, get compassion fatigue, and lose touch with the joy in their life. Say no to that extra shift. Health trumps money.
7. Learn a new skill. The internet is full of online courses. You can learn anything, from dog training to poker, as you sit on your sofa. Whether it\’s photography, knitting, or getting a degree, use this time to enrich yourself.
8. Do something you enjoy every day. Watch a movie, quilt, take a hot bath. Doing something you love will lower your stress and help keep you sane.
9. Work out every day. Whether it\’s kickboxing, chair yoga, or walking the dog, working out will make you healthier, stronger, and happier.
10. Do something to make others happy. Bake a cake for your coworkers, grab some groceries to help your neighbor, or call Grandma, even if she\’s not sure who you are. Making others happy will give you purpose and joy.
11. Watch your weight. Few say it, but obesity is a substantial COVID risk factor. Not great for your heart and joints, either. If you\’re overweight, losing weight will help keep you healthy.
12. Connect with people. Call your high-school buddies, look up your old friends, send a birthday card to your ex. Connecting, even virtually, will help keep you grounded.
13. Make a plan for the winter celebrations. Avoid large gatherings. Look for alternatives: a Zoom Thanksgiving dinner, mailing stocking stuffers, meet for a hike. But if you must meet in person, don\’t go if you\’re sick, social distance, and keep the windows open.
14. List your happy memories: Your first time fishing; your son\’s graduation; your wedding (or your divorce). Make a list and put it on the fridge for those pesky low days.
15. Stay in touch with your doctor. No matter who says what, your doctor wants you to be well. If for no other reason, because they\’re already overworked. Follow their instructions, take your medications, and call them if you\’re having trouble.
16. Take time for yourself. Find a couple of hours every week to check on your inner self. Are you hanging from a thread? If you\’re losing it, seek help. It\’s not wimpy. It\’s smart.
17. Turn off the news. No matter what, half of us will feel broken after the elections. There\’s no point in rubbing salt in the wound – yours or others\’. If you lose, remember that that\’s democracy. Everybody\’s vote counts. In four years, you\’ll get a redo. If you win, remember that so many are mourning. Don\’t be a sore winner. Let them grieve.
18. Wear a mask. It will protect you not only from COVID but also from the flu and pesky colds. The flu season is here, and the flu sucks. You\’ll be even more miserable if you get sick.
19. Be kind to others. Most people aren\’t evil. Their mistakes are born of ignorance, anger, or hurt, and we can all use some learning.
20. Finally, remember that this too shall pass.

Good luck, stay safe, and stay sane. As always, I can\’t wait to hear from you.

Rada

Rada Jones is an ER doc in Upstate NY, where she lives with her husband and his deaf black cat Paxil. She is the author of three ER thrillers, Overdose, Mercy and Poison, and “Stay Away From My ER,” a collection of medical essays.

I miss Thailand and my Chiang Mai friends. I miss the spices, the heat, and swimming before the pool opening time. I miss the orange-clad monks collecting alms as I returned from the market loaded with fruit, vegetables, and the meat-du-jour: anything from beef tongue to pig head via fried chicken. I miss the jasmine leis around my neck and the orchids, an armful for one dollar. I miss always trying something new: spiky fruits, stuffed bitter cucumber, crispy golden triangles with a spicy-sweet sauce. It took me months to learn they were fried tofu. I miss the back massages at Kad Suan Kaew, coffee with Steve, and chatting to my writer friends. I miss Thailand.

But that was then, and this is now. We got back for the last golden days of the fall, the final lawn mowing, the last hauntingly beautiful kayak trip before fall falls apart into winter.

We hugged our son that we hadn\’t seen in a year, petted old Paxil, who looks younger thanks to his care, found friends we missed. We raided the wine shop, I savored my best burger in a year, and I got back to Instagramming the sunrise. I try to focus on the things I missed: Cheese. M*A*S*H. Our cabin in the woods.

But nothing is the same. Gone is our Sam\’s membership. Gone are my ski pants. Steve dispoed them with most of my clothes. Gone are my skis, my pots, even the San Marzano peeled tomatoes.

I wasn\’t pleased, and we had a few rough days. It was hard to forgive and compromise, but we did. We had to. It looks like we\’ll be here for a while.

So much happened. COVID 19 – the mourning and the hoax. Fighting over masks. The economy. The elections. Neighbors fighting neighbors. The hate.

We try to make sense of it, and we struggle to deal with it, whether it makes sense or not.

We have to. Thailand is closed because of Covid. So is most of the world these days. Between the growing anger and raising Covid rates, Steve isn\’t into RVing, and I can\’t disagree.

Many have it worse. The sick. The mourning. The jobless. The mentally ill and isolated. The health workers, living in fear for their families. We are lucky, even though it doesn\’t feel that way.

The news suck. Struggling to close my raincoat around the new curves I gained, feasting on Turkish Delight isn\’t as much fun as eating. Looking at the skunks hunting for grubs in the back yard makes me wish they smelled better. Or not at all.

Instead of a birthday party, I took a 20K walk to think about the future. What should I do with myself?

I could spend my time writing a book, reading, watching old movies. Wait for the world to come back to its senses. After all, a year is no big deal.

But there\’s no guarantee. Even less these days. This year may be the last we can still enjoy life. How can we make the most of it?

We\’ll get a dog. We\’re dog people. We\’ve been orphans since Gypsy died two years ago. A dog will fill our hearts and our lives.

We adopted Guinness. She was born to a Mennonite family in Pen Yan twelve weeks ago. She LOVES people, dogs, and cats, but walking? Not so much. She\’d rather be carried. She has a taste for horse manure, grubs, and dead fish, but she\’ll eat whatever she can find, from crocs to carpets—anything but her food.

Gone are the days I wondered what to do with myself. Thanks to Guinness, I ran out of time to watch the news and complain.

So we go on, hoping that once the elections are over, we can be a nation again. Like all of you, I know that my choice is the best. And I hope we win. But, whoever wins, remember we\’re all in the same boat. Bragging, shaming, and humiliating the others, is uncool and unAmerican. Let\’s get ourselves together and move on.

Remember that love trumps hate, kindness trumps judging, and we\’re stronger together.

I wish you health, safety, and love. See you on the other side.

Rada

Rada Jones is an ER doc in Upstate NY, where she lives with her husband and his deaf black cat Paxil. She is the author of three ER thrillers, Overdose, Mercy and Poison, and “Stay Away From My ER,” a collection of medical essays.

My honeymoon with Thailand ended yesterday.

We live in a condo in Chiang Mai, Thailand. Signs on every door warn: No Mask, No Entry. Most people comply. Some don\’t. I ignore them unless they try to join me in the elevator. If they do, I wave them away. \”Not without a mask, please.\”

Yesterday, a tall farang (white person) I know well did the same. The man wanting in went berserk. He burst into the elevator punching and kicking. The farang responded in kind. Security came, then the police. Since it turns out that legitimate defense is illegitimate in Thailand, they got both got fined 100 baht each – about $3.

The good news:

1. The farang  was able to afford the fine.
2. Getting punched beats getting shot.
3. Being fit is always a plus.
4. I have an excuse to start learning Muay Thai.

This incident – flabbergasting in a country where 95% of people wear masks – got me thinking. What about wearing a mask drives people insane to the point of shooting others and accusing doctors of crimes against humanity?

It\’s hard to understand, especially for somebody working in healthcare. Even before COVID, OR folks wore it every shift. We, in the ER, wore it for the immunocompromised, the flu-like patients, and whenever we got the sniffles. We double-mask for stinky affairs like fecal disimpactions or trench foot.

Do we enjoy masking? Hell no. We enjoy breathing just like you do, and masks don\’t help.  Wearing them for hours isn\’t fun. Nor is wearing bras, helmets, seatbelts or high heels, but people wear them to protect themselves and fit in society. Masks are more critical: we wear them to avoid killing others by breathing our germs over them.

Masks are uncomfortable. I know. Health care workers choke under so many layers of hot, heavy PPE that they can barely recognize each other. They get bruised from wearing masks for too long, and they get blisters behind their ears. To help with that, savvy businesses invented gadgets to protect them. And I won\’t even mention lipstick, my favorite morale booster, that I had to give up. But we still wear masks, at work and out in public. Why don\’t the others, even though all health care experts recommend them?

To understand, I asked my Facebook friends: Why would you NOT wear a mask? I unleashed a deluge of anger and insults. How dare I even ask?

\”Use your degree to stand firmly and unilaterally in the message that we NEED our citizens to wear masks in public, all citizens, all the time. Otherwise, you look STUPID and irresponsible. Any opinion other than \”everyone should wear a mask\” is STUPID. Get on the right side of history. STRONGLY CONDEMNING people who do not wear masks is the first step. We don\’t have TIME to understand people\’s backward illogical uninformed reasoning.\”

I don\’t know about you, but I don\’t enjoy people calling me stupid. I question their smarts  and common sense. I also feel the urge to do the opposite of what they want, just to piss them off. Does that sound familiar?

Being yelled at may be one reason that people don\’t wear masks. I think a civil conversation may accomplish more.

The inconsistent message is another.  At the beginning, it was: \”Masks don\’t help, and we don\’t have enough of them. Leave them for the healthcare providers.\” Months later, after stumbling through bandannas and thick scarves, by the time the message became: \”Whenever you\’re in public, wear a mask, \” people had lost trust in the messengers.

Even now, there is no unified message. The American government disregards its own health experts\’ guidance on masks and social distancing. Every state and every county has different rules that change every day. People no longer know who to believe.

Unlike many adopters of national mask policies, who value discipline and conformity, Americans hate being told what to do and feel the mask is an assault on their freedom. Unfortunately, that contributed to our high COVID numbers. Thailand – who had the first COVID case outside China –  had a total of 3185 cases, 58 deaths, and no community transmission in weeks. Compare that to the US numbers.  2.9 mil cases, 130K deaths and 58K new cases on July 3rd. Yes, Thailand has 70Mil people, while USA has 328 mil. Still.

Wearing a mask has a lot to do with who we are. The average mask wearer is older, urban, female, high earning, and Democrat. The mask haters are the opposite. They are also less concerned about getting sick. Remember:  You don\’t wear a mask to protect yourself; you wear it to protect the others: The old, the frail, the immunocompromised.

Masks can be uncomfortable and hot and interfere with breathing, especially when working out. And while CO2 accumulation is a myth – otherwise no surgery would ever happen since everybody in the OR would pass out – masks do increase the breathing effort of those who already have trouble breathing and may cause hyperventilation in those prone to anxiety. To that, I say: Not all masks are created equal. You don\’t need an N95 to walk the dog. Use the mask you can breathe in. A mask is better than no mask.

Sadly, the mask has been weaponized into a political symbol that deepened our national divide. Despite the pictures of refrigerated trucks full of dead bodies, some still believe COVID is a Democratic hoax propagated by the media, unless it\’s a Chinese ploy to destroy America. The president thinks that only people who dislike him wear masks, therefore not wearing a mask is a pledge of allegiance.

Some think masks are ineffective. Then why bother wearing them? It took time for the medical community to learn about COVID and its transmission. And we\’re still learning. But experiments,  studies, and guidance indicate that masks, social distancing, and hand hygiene curb the virus spread.

As per BMJ, \”in the face of a pandemic, the search for perfect evidence may be the enemy of good policy. As with parachutes for jumping out of airplanes, it is time to act without waiting for randomized controlled trial evidence. Masks are simple, cheap, and potentially effective. They could have a substantial impact on transmission with a relatively small impact on social and economic life.\”

A few quotes from my friends:

\”How would a non-mask wearer feel if they came into an operating room to have their knee replaced, and the surgical team WASN\’T wearing the super-duper space suit attire used to prevent the devastating complication of an infected prosthesis? What if no one had a mask on?\”

\”In years gone by, we weren\’t bombarded with all these ideas, recommendations, etc. I am spent with the effort it takes to go out. Do I want to go out and expend the effort of a mask, having hand sanitizer and the 6 ft rule to purchase a plant, a loaf of bread…?\”

\”One problem is the random enforcement of mask-wearing and social distancing rules. Protestors and rioters were allowed to violate every rule without the threat of fine or jail.\”

\”Some don\’t wear masks because of communication problems. They can\’t hear well. It makes people feel unseen and unheard. We all want to be seen and heard. The mask feels like a gag.\”

\”The conspiracy nuts that think the government is trying to control us and take over. What dystopian society will allow citizens to walk about their day with their identity hidden behind a mask?\”

\”It\’s difficult for a deaf person who needs to read lips to understand what people say… American sign language includes body language and facial expressions….\”

\”Masks are to PPE like frosted flakes are to a balanced breakfast. Alone, they\’re about as useful as that proverbial screen door on a submarine (or, to farmers like me, tits on a bull). Masks are an added safety measure like the Nader pin in a car. It won\’t protect you when you hit a tractor-trailer but can help keep the door from opening during a rollover and ejecting the passengers.\”

Bottom line: Masks work. Recent studies show that masks, social distancing, and hand hygiene help curb the spread. I hope that a unified message, education, and a vaccine will stop the spread. But remember that your right to not wear a mask doesn\’t preclude your responsibility to not infect others. If you don\’t wear a mask, stay home. Everybody\’s health depends on all of us.

That brings us back to the beginning. The man who assaulted the tall farang could have used a mask, take the stairs, or wait for another elevator. He chose to fight instead. Why?  It\’s not all about the mask. It\’s about the anger. He got so angry that he was denied access to \”his\” elevator that he failed to see the other \’s right to not be exposed.

Sadly, these miserable days that holds true for all of us. We\’re so angry that we refuse to see the others\’ point of view. Blinded by our anger, we make bad choices. Recognizing how our anger poisons us is the first step to managing  it and be able to communicate and work together.

Rada Jones is an ER doc in Upstate NY. She lives with her husband and his deaf black cat Paxil. She authored three ER thrillers, Overdose, Mercy and Poison, and “Stay Away From My ER,” a collection of medical essays.

PPE is a generic name for the protective covers professionals use to do their job, healthcare workers included. Welders use gloves and welding masks. Electricians use protection goggles, rubber boots and fall protection harnesses. Construction workers use helmets. Adult movie stars use condoms. For all, using PPE is mandatory, otherwise safety officers will throw them off the job.

Healthcare workers have their own specific PPE. Gloves and gowns, sometimes sterile, prevent contact transmitted diseases, like scabies and C. Diff. Diarrhea. N95 respirators are unique masks preventing the spread of airborne germs like TB. Surgical masks prevent droplet-transmitted diseases like the flu.

What\’s the difference between droplets and airborne? Droplets are heavy and fall to the ground, though a sneeze can project them up to sixteen feet. In church, that\’s about four rows away. Airborne germs are smaller, lighter, and they can float in the air for hours. If your neighbor sneezed in the elevator before breakfast, you can still catch it after dinner. Surgical masks will prevent you from projecting droplets, but not from breathing airborne germs. Your surgical mask will mostly protect others.

A few weeks ago safety officers all over the US guarded Code Rooms, denying access to those lacking appropriate PPE and healthcare workers were getting fired for providing patient care without adequate equipment. Patient safety was paramount.

No longer.

The worst pandemic of a century slammed the earth like a freight train striking a wagon of hay, and PPE became a luxury. Instead of changing PPE not only after each patient, but even between encounters with the same patient, healthcare workers were told to reuse equipment for multiple patient encounters.

By \”healthcare workers\” I mean everybody in contact with patients and their stuff: Nurses, doctors, EMTs, CNAs, RTs, Radiology techs, environmental workers, etc.

All of a sudden, it\’s OK to use the same PPE for this possible COVID patient to that one with Norwegian scabies, then the other one with CD diarrhea, before holding grandma\’s hand.

Surgical masks don\’t do much for COVID. As per this study in The Annals of IM: \”both surgical and cotton masks seem to be ineffective in preventing the dissemination of SARS–CoV-2 from the coughs of patients with COVID-19 to the environment and external mask surface.\”

Let\’s talk scarfs. Some bright political minds opined that they\’re better than PPE, since they\’re thicker. Not really. You should go for a good quality pillow case, or a coffee filter instead.

Driven away by the scarcity of PPE, concerns about patient safety vanished. It\’s OK, required even, for masks to hold for a whole week. That\’s a lot of patients, even on slow days, and these days aren\’t slow. It\’s OK to wash your hands with your gloves on and reuse them, patient after patient. For pelvic and rectal exams too, I wonder?

To put things into perspective, just imagine what would happen if condoms became scarce. What would porn stars do? Wash condoms between encounters to reuse them for a week? Staple them if they fell apart? Craft home-made condoms out of utility gloves and glue, and tie them around their waist so they won\’t come off? Duct tape maybe, since that can fix anything?

People got creative. The ingenious crafted masks out of old sheets and lined them with toilet paper, since that\’s the one thing we have plenty of. Grandmas knitted masks; grandkids glued them for craft. These days, home-made masks are hotter than home-made bread. Scientists got on the band-wagon too. There\’s how you can make a mask out of a vacuum cleaner bag.  Or masks from elastomers respirators.

Hospitals didn\’t like it. How professional would your hospital look if the surgeons sport home-made masks with Sponge Bob and Dora? They banned them.

\”No asymptomatic HW should wear a mask to see an asymptomatic patient.\” As in, unless you\’re coughing and sneezing like you got hit with chlorine gas, you shouldn\’t wear a mask, even if you brought it from home.

Healthcare workers got angry. They know that sending them to care for patients without appropriate PPE is like asking adult stars to perform without condoms. Worse, really, since HIV takes many years to kill you. COVID will kill you in days. They complained and shared their concerns through social media.

Hospitals fired the whistleblowers.

Healthcare workers got sick. Some died.

In New Jersey, Dr. Frank Gabrin, 60, was the first Emergency doc to die from COVID. So did Kious Kelly, a 48-year-old nurse in NY, Israel Tolentino, a 33-year-old EMT in NJ and Chris Firlit, a 37-year-old PGY6 Maxillo-Facial surgery resident in Detroit, who died three months before his graduation, leaving behind a wife and three kids.

They\’re just the tip of the iceberg. A disproportionate number of COVID victims are healthcare workers, since they\’re sitting ducks. They are stressed, overworked and they can’t socially distance. They see nothing but sick people every shift.

They live in fear of getting sick. Even worse, they are worried of infecting their families. Many quarantine themselves from their loved ones, adding to their burden of suffering and loneliness. Some can\’t, since they are single parents or caretakers.

Infected HW infect patients. To those coming for reassurance, a sprained ankle, or a med refill: If your nurse has been wearing the same mask for a week, you may be safer staying home.

If that wasn\’t bad enough, the same people who work with inadequate PPE and are supposed to make it last, got accused of stealing it. How else can you explain this exponential increase in PPE use?

Try Pandemic.

By the same logic, NY morgues are overfilled because of people bringing bodies from home.

For some, the penury of PPE is an opportunity. They hoard it to sell it to the highest bidder, setting states against each other and the Federal government. Others manufacture fake N95 respirators and sell them to the public. The buyers think they are protected, but they aren\’t. They get sick and infect others.

What do healthcare workers say?

\”Why are we expected to just accommodate to what\’s available? Because \”we knew what we were getting into being a healthcare worker\”? Bullshit. The best two things EMS taught me are BSI and Scene Safety. If they are aren\’t both in place…peace out. I\’m always the priority.\”

\”In a broken health care system, the lack of PPE in this situation magnifies two things for me. 1: the corporate greed is now coming to fruition, and 2: that greed has been successful on the backs of caring professionals that are now being sacrificial lambs. Millions are being spent, but the money is not going to medicine. It goes to those managing it.\”

\”Why aren\’t we deciding the PPE we need versus administrators with no medical background?\”

\”As a healthcare worker, you are a force multiplier. Your training and experience are invaluable in this crisis. You have to put your needs first. I\’m speaking about PPE and your safety. If you become infected, not only are you out of the game, but your replacements could be people without your expertise. When short-staffed, your co-workers are more likely to make mistakes and become ill. You stop being a force multiplier and start using resources. You may save that one patient, but you can\’t save any patients as you lay in the hospital using a vent yourself. People are going to die.  Do not become one of them. There is no emergency in a pandemic. During the Ebola outbreak, people were dying. But at no point did we rush in. We took the 10 minutes to put on our PPE with our spotter. If we didn\’t have proper PPE, we did NOT go in. There is no emergency in a pandemic.\”

Your doctors, your nurses, and all the other healthcare folks work hard to keep you alive. They forgo their sleep, their food, their safety and their families to serve you.

Some die for you.

What do they want you to do?

1. Stay home.
2. Wash your hands.
3. Don\’t buy N95s. They\’re either fake, and they won\’t protect you, or real, and they belong in the hospitals.
4. Don\’t use the PPEs that they need more.
5. Don\’t go to the ER unless you must.
6. Listen to the experts.

I\’ll end with one exhausted doctor\’s words:

\”Hold your cheering. I don\’t need it. Just think long and hard before you vote.\”

Rada Jones is an ER doc in Upstate NY. She lives with her husband and his deaf black cat Paxil. She authored three ER thrillers, Overdose, Mercy and Poison, and “Stay Away From My ER,” a collection of medical essays.

Saying NO is hard. Even harder if you happen to be kind. You want to help, to make people smile, you want them to like you. Saying NO doesn\’t come easy.

We’ve never been taught to say no. Ever since we were toddlers, we\’ve been conditioned to say yes. Rolling on the floor in a temper tantrum to express our NO was a NO-NO. People don’t like you if you say NO. Say YES if you want to have friends.

In cultures that treasure harmony above all else, saying NO is perceived as rude and avoided. Japanese, for example, will say \”Chotto\” – a little bit – instead of NO. Say you\’re in Kyoto, trying to buy tickets for the 3:05 to Osaka, and there\’s none left. The clerk will smile, fret, fake a complex seizure, rub his hands in distress, look at the Emperor\’s picture and mumble: Chotto, then disappear rather than say NO.

What he\’s trying to say is: there are no tickets for the 3:05 to Osaka. Not a little bit, not a few of them, nothing. Zilch. But he can\’t bring himself to say it, because he doesn\’t want to be rude to you. That’s nice, but that won\’t get you a ticket. Nor will it tell you there\’s no ticket, so you can book a hotel room and try again tomorrow. Or go to Tokyo instead. Nope. I mean Chotto.

Saying no is even harder for us doctors, since healing and helping is our whole raison d\’etre. Saying NO, especially to patients, feels like we’re abdicating our responsibilities.

For me, as an ER doc, saying NO may be easier than most. First, I don\’t have long-term relationships with most of my patients, to make me feel like refusing a friend. Plus, we\’re often tired, overwhelmed, and frustrated enough to lose some of our need to please. Our priorities are clear: 1. Keep them alive 2. Make it to the bathroom before it\’s too late. 3. Move the meat.

Still, saying NO comes with consequences.

Your patients won\’t like it. Nor will their families.  As soon as you say NO to that Percocet script, that unwarranted admission, or that non-urgent MRI, they\’ll question your judgment, ask for another doctor or burst out in four-letter words. They’ll threaten you with a lawsuit. They may key your car, or become violent putting your staff in danger.

They may ask for the patient advocate. That will buy you a tete-a-tete with your boss, drop your Press Ganey\’s and ding your compensation. All in all, no good news.

Saying NO to friends, neighbors, and staff is even harder. They need advice on that pain in their knee. They need somebody to look at their rash. They want you to write a Z-pak script for their cough. You\’d love to help them, but you know better. Your malpractice won\’t cover you, and if things turn bad, you\’re screwed. You don\’t want to do it, but you hate saying no.

There are volunteer activities. Your kids need a chaperone for their field trip. The EMTs need a medical director. The library needs a speaker. You want to help, but you\’re overbooked. You know you’re burning the candle at both ends.

The hardest of all is saying no to a colleague who needs help. They ask you to cover their shift to visit their sick friend. They need you to come in early so they can take the dog to the vet.  They request a switch that takes away your only free weekend that month, to attend their daughter\’s violin concerto. So, for the most part, unless you\’re one of those assholes, you do it, whatever it costs. And it costs a lot.

It costs your peace at home. Your spouse made plans for that weekend months ago. He won\’t be happy. You promised the kids to take them skiing. They\’ll be stuck with their cellphones instead. You told your mom you\’d drive to see her. She\’ll have to wait for another month.

It costs your well – being. You’ll have to skip your workout, forgo the beer with your friends or cut your time between shifts. You’ll have to give up the things that keep you sane.

Eventually, it costs you your self-respect. Saying yes again and again, at a cost to your family and yourself, will make you feel used. And maybe you are. You\’ll feel taken for granted and disrespected.

Saying yes is expensive. It comes at a cost to your time, your peace of mind, to your family, and your self-respect.

How about saying no? Everybody does it all the time. Why not you?

It’s uncomfortable. But then, so are many other things you do every day. From pediatric codes to fecal disimpactions, from debriding wounds to performing pelvics on bariatric stretchers, none of them is fun. But you do it because it\’s your job. Liking has nothing to do with it.

How about saying NO as another uncomfortable but necessary procedure in your arsenal? Accept that it\’s unpleasant, steel yourself to do it, then do it. Nicely. Just like you smile politely and do that pelvic, debride that wound or open that abscess, you smile politely and say no. Unlike most other procedures, you can practice in the mirror.

\”I\’m sorry, but my malpractice insurance won’t allow me to write that script.\”

\”Our policy is to not prescribe opiates for chronic pain.\”

\”My family is counting on me, so I can\’t take that shift.\”

How to say no?

1. Firmly. No \”I\’m afraid that I might have to decline\” or \”I\’m not sure.\” Just say NO.
2. Briefly. Don\’t go into lengthy explanations. \”NO\” is a sentence.
3. Honestly. You don\’t need to explain, and you don\’t want to lie.
4. Suggest alternatives if you can. \”Motrin works great for back pain.\” \”Your doctor will order the MRI if they deem it necessary.\” \”I\’d be happy to look at some three-way shift that will help you, but I can\’t do that day.\”

Then smile, nod, and walk away. You did the best you could: You performed the uncomfortable procedure of saying NO. Nobody died. Your family will be glad. You\’ll get more respect from those who take you for granted, and you may find yourself under less pressure.

Rada Jones MD is an Emergency Doc in Upstate NY. She lives with her husband Steve and his black deaf cat Paxil. She authored three ER novels: OVERDOSE, MERCY, and POISON, and Stay Away From My ER, a collection of medical essays. A previous version of this article was published on Doximity.com.

I roll in my bed, unable to sleep. I listen to BBC talk about the craziness that took over the world, preoccupied with this one question.

What question?

It’s not: “Why, Corona?” For that, I already have more answers than I want.

Scientists say that COVID19 is an animal virus. It spread to humans from bats or pangolin due to close proximity in a seafood market, much like its older siblings SARS and MERS. Some well- informed people on Facebook told me that COVID19 is biological warfare sent by the Chinese to bring down the US. My Trump supporter friends think it’s all a hoax invented by the Democrats and perpetuated by the media. Others think it’s a virus sent by Gaia to save the Earth to stop overpopulation, global warming, and overconsumption.

It\’s not: “What’s going to happen?”

Better minds than mine have tackled the issue. They predicted the virus will peak, then stick around to join the other viruses plaguing us every winter: Flu A, B, and others I won’t get into. Other bright minds disagree.

Nothing to do with the markets. They already fell into disrepair, and they’ll take years to recover. Recover they will, eventually. It’s all good unless you need your money now. But, since you can’t go anywhere, can’t meet anyone, and can’t buy anything, you should be safe.

It\’s not even about the US elections. These days, the right and the left are so far apart that the middle vanished. Between “Make America Great Again” and “Make America Socialist,” the center is only there for the rest to attack. We’re not purist enough. Not white enough. Not feminist enough. Not angry enough. Not young enough. Not whatever enough. These days, compromise is a dirty word. But I digress.

The question that keeps me up at night is: Why toilet paper, out of all things?

You may think that’s funny, and maybe it is. But I’m serious. This is happening everywhere in the world, from the US to Japan, the UK, and Australia. Even Thailand. People clean out store shelves like the apocalypse is coming, for a disease with no digestive manifestations. As in, you won’t over-poop.

Why? Because people are stupid? I don’t think so. If so, they’d buy stocks, cruises, lottery tickets, or life insurance from companies that are about to go bust.

Some experts say that people need to feel in control. That makes sense. But then, why TP? Why not toothpaste? Chocolate? Pizza? Ice-cream? Wine? Heating fuel? Gasoline? Canned goods? All gone, of course, now that the TP is gone.

For full disclosure, let me tell you: I’m an expert in stockpiling. I’ve lived in Communist Romania. Our phone would ring at 6AM: \”They’re bringing toilet paper this afternoon. The corner of Republicii with Armata Rosie. I’ll hold you a place. Half an hour, no more. They’ll rip me apart.”

Other times it was sugar; lemons; pork trotters – we called them “sneakers”; laundry detergent. If you think you’re an expert in stockpiling, I can out-expert you most days of the week. I take Mondays off. I hate them. That’s a sore remnant from my ER days.

Back to my point: why toilet paper? That’s what I came up with. Feel free to add.

1. It serves a basic need. People poop and pee. In our society, keeping clean is a must. Our cave-dwelling ancestors pooped too, even without toilet paper. I know that for a fact. Chinese started using paper for this purpose in the 6th century. The west took its time: Joseph Gayetty invented toilet paper in 1857, but splinter-free toilet paper didn’t come until 1935.
2. People need to feel in control. Buying TP checks off one thing off a long, scary list.
3. Toilet paper takes a lot of room. You feel like you got a lot for your money. One pack will fill a cart, and make a dent on that shelf. Things like tuna, coffee, or string cheese won’t look like much.
4. It’s affordable. A family can stock up on six months of toilet paper for $40. Think about what it costs to stock up on six months of wine, ice-cream, steaks, or gas.
5. It doesn’t need refrigeration. That’s good, since the fridge is already full.
6. It has so many uses. Cleaning your privates, but also blowing your nose, cleaning after the dog, cleaning the kid’s paintbrushes, or using it as napkins, like many Thai people do.
7. It doesn’t go bad. If this pandemic ever goes away, you can still use it next year.
8. If you have to be stuck inside for months, you’d rather be stuck with companions sporting clean assets.
9. You can trade it. A roll of TP may be worth a case of beer or a gallon of ice-cream these days.
10. It’s almost gone since everybody has stocked up on it. You don’t want to be the only one using newspaper. Let alone having your kids share that with their friends. So, you buy that last pack.
11. We’re social creatures. We’re inclined to do the same thing the others do. What if they know something you don’t? You yield to the wisdom of the crowd, to keep safe.

So, there are many good reasons for intelligent, decent people to fight for toilet paper. They try to do what’s best for their loved ones in these scary times of extreme uncertainty. Most of them would trade you. Even give you some if you really need it.

Remember: We, humans,  survived through millennia without toilet paper. And, believe it or not, some still do. Many people use sprays to clean themselves – you could make do with a vessel of warm water and soap. You’ll end up cleaner. If you have more than you need, give away a roll or two to somebody in need. It’ll feel good. Plus, you never know when they’ll come back and return the favor with something you really, really need. Like blood, or bone marrow, or Netflix.

Rada Jones MD, is an Emergency Doc in Upstate NY, where winters are long, people are sturdy, and the geese speak mainly French. She lives with her husband, Steve, and his black deaf cat Paxil. She’s the author of three ER thrillers: OVERDOSE, MERCY, and POISON, and a collection of tongue-in-cheek medical essays, Stay Away From My ER. Find more at RadaJonesMD.com.

1. Take it easy. The worst part of all this is the fear. More people die from the flu, car accidents, or guns. As of Saturday, March 7th, 19 Americans had died from Covid19, compared to 1177 every week from the flu, 746 from car crashes, and 294 from gunshots.

2. Wash your hands like your life depends on it. Because it does. Not only for Corona, but for the many germs you’ll acquire from touching elevator buttons, doorknobs, or somebody else’s hand. Or the dirtiest thing on earth: money: Everybody handles it, and nobody washes it. Except for the mob. And me, when I forget it in my pockets.

3. Stay home if you’re sick. Same with your children.

4. Disinfect frequently touched surfaces: Shared pens. Door handles. Water taps and toilet flushes.

5. Avoid meetings and crowded spaces, especially those hard to leave from, like planes, conferences, and churches.

6. If you want to chill with your friends, go outside: go skiing, hiking or skating rather than bowling, clubbing or the movies. More fresh air and fewer germs.

7. Cough and sneeze in your elbow or shoulder or in a tissue, not in your hand.

8. Stay away from those who sneeze, cough, or look sick.

9. Vaccinate. There’s no vaccine for Corona yet, I know. Still, more people have died from flu this year than they did from Corona all over the world.

10. If you have a fever and body aches, take Motrin or Tylenol, stay home and call your doctor.

11. Don’t touch your face or pick your nose. It only contains what it always does, boogers. But if you must, at least wash your hands first. And after.

12. Keep well hydrated with water, Gatorade, or the fluid of your choice. Note: Corona beer isn’t named after the virus, isn’t infused with it, and it won’t give you the disease. Unless you share the bottle with somebody who’s sick.

13. Remember that, unless you’re old and ill, you’ll likely recover fully, even if you catch it. Better odds than for bike crashes, bad investments, and fights with your spouse.

14. Make sure you have advanced directives. This isn’t about Corona. It’s about being prepared and in control of your life no matter what happens.

15. Rest, relax, and live healthily. Stress, lack of sleep, poor nutrition, and poor hygiene will weaken your immune system. Get enough sleep, eat well, and wash your hands. Again.

Don\’t: 

1. Don’t shake hands. You don’t know where their hands have been, and you don’t want to get whatever they acquired there. Smile instead.

2. Don’t eat, drink or scratch your face if you haven’t just washed your hands really well with water, soap, and enthusiasm. Wash them like the toilet paper was too thin.

3. Don’t visit all-you-can-eat buffets, and don’t try food samples. Remember the celebrity who licked a doughnut then put it back? She’s not the only one. Sitting by the table of a buffet dinner cured me of buffet dinners. The things people do when they think nobody’s watching will make you shudder.

4. Don’t share masks.

5. Don’t go visit grandma in the nursing home if you have the sniffles. Call her instead.

6. Don’t go to the ER unless you’re deathly ill, immunocompromised, or really bored. You’ll spend a long time there, get loads of rotten looks, get irradiated, and get a hefty bill to pay, plus everybody else’s germs. The one thing you’re unlikely to get is a straight answer since testing kits are still hard to come by.

7. Don’t eat things that aren’t supposed to be eaten. Avoid pangolin, bats, civet cats, and bush meat. Avoid socializing with them too.

8. Don’t expect a Corona vaccine before next year. Vaccines take a long time to develop, because: 1) They need to work. 2) They need to be safe. That takes time and testing.

9. Don’t have unprotected sex. Not Corona specific, other than sharing body fluids, but it’s good advice. Other viruses like HIV and Herpes, also Syphilis, Chlamydia, and their other friends are looking for a loving host. Don’t let it be you.

10. Don’t call the ER to ask if they’re busy. They’re busy. Even if they weren’t, they wouldn’t give medical advice by phone. Call your doctor, and wait for them to call back. They will, as soon as they catch up with the sick and the many worried-well.

11. Don’t rub yourself all over with garlic. That’s not for Corona, that’s for vampires. Though, if you eat raw garlic, most people are likely to keep their viruses away from you.

12. Don’t share an ice cream cone, water bottles, or cutlery. Don’t let people taste your food, and don’t try theirs, no matter how good it looks.

13. Don’t drink bleach. It won’t help. Unless you inhale it, bleach goes to your stomach, while the virus targets your lungs. It will hurt, A LOT, as it burns your throat.

14. Don’t believe all the stuff you read on social media. Misinformation has become an infodemic.

15. Don’t share it either. Prayer is good for the soul, but it’s unlikely to destroy the virus. Corona is not a hoax, a democratic ploy, or a biological weapon released by the Chinese. It’s not invented by vaccine companies to make money. Otherwise, they’d sell it to you now. Elderberry, vitamins of any persuasion, or getting exorcised are unlikely to help. Wash your hands.

Rada Jones MD is an Emergency Doc in Upstate NY, where winters are long, people are sturdy, and the geese speak mainly French. She lives with her husband, Steve, and his black deaf cat Paxil. She’s the author of three ER thrillers: OVERDOSE, MERCY, and POISON, and a collection of tongue-in-cheek medical essays, Stay Away From My ER. Find more at RadaJonesMD.com.

Like all doctors, I’m a lousy patient. My doctor is a lovely man, but going to see him? That\’s right there with weighing myself, getting a flu shot and doing my taxes, and behind celebrating Thanksgiving with the in-laws and getting a root canal.

And I’m not the only one. If I had a dollar for every patient who told me they hate doctors (no offense), I\’d be long retired.

If you’re like us, I have a tip for you. Choose a woman doctor.

Why? 

1. You\’ll be more likely to survive a heart attack. Female doctors have lower patient mortality and readmission rates. To me, that matters. I hate hospital food and I detest funerals.
2. They don’t wear ties. Ties are relics. They belong with the dinosaurs. They indicate that the wearer is somebody. In doctors, that\’s somebody covered with germs. A tie is Noah’s ark for germs looking for a home. Don’t let that home be you.
3. They listen longer. Today\’s doctors are too busy to listen to their patients. The average male doctor interrupts a patient after 47 seconds, but female doctors will let you speak for three whole minutes.
4. They tend to be more thorough. Whenever my husband cleans the kitchen, there\’s stuff left for me to do. He’s good with the big picture – but the details? He doesn’t see the breadcrumbs. I do. Women doctors are more likely to deal with every detail and leave no loose ends.
5. They\’re better at multitasking, just as men are better at compartmentalizing. Your woman doctor will remember your blood pressure, your work note and the script for Viagra even if her pager goes off, the Patriots won, and she\’s late for dinner.
6. They follow guidelines. That\’s good. Guidelines are evidence-based and meant to improve your medical care.
7. They communicate better, providing patient-centered care. Instead of telling you what to do, they\’ll work with you to get you the care you need.
8. They\’re more likely to include your family in your care.
9. They have smaller hands. Why does that matter? Try getting a pelvic or a rectal exam from somebody built like a linebacker, and you’ll understand.
10. They\’ll counsel you on your health behaviors. They’ll work with you on stopping smoking, losing weight or drinking less. You don’t want to hear that. Neither do I. But a healthy lifestyle will help you live longer and improve your quality of life.
11. They provide better quality of care in diabetes.
12. They provide emotional support. So do men doctors, of course, but it\’s not the same. I hug my patients when they need it. My male colleagues give fist bumps. That works with toddlers, but not when giving bad news.
13. They always wash their hands after they pee.

Rada Jones is an Emergency Doc in Upstate NY where she lives with her husband, Steve, and his black deaf cat Paxil. They are in the (slow) process of moving to Thailand. She authored three ER thrillers,  OVERDOSE,  MERCY,  and POISON.

My friend the hospitalist was livid as he came from meeting the administration. “They said doctors cost too much!” he sputtered. “We’re an expense. An expense the hospital can no longer support. WE are an expense!”

He turned purple. Nice color, like a good Bordeaux. I worried about his blood pressure. He can\’t have a healthy lifestyle! None of us does. Seven twelves in a string will do a number on your workout routine, your family life, and your sanity.

“I wanted to ask: Why do you think patients come here? To see you? To see what you concoct while sitting in your office popping M&Ms? They are here to see doctors. We care for the patients. We make you money. It’s OUR work that gets YOU paid! And we cost too much?”

To that I’ll add:  When was the last time YOU saved a life? It still matters a little.

Medicine changed. Remember the family doctor driving his horse-drawn buggy for home visits? Delivering children, letting blood and getting paid in chickens and honey? Neither do I.

That was BOE. Before our era. Before hospitals, insurance companies, EHR, and Obamacare. Those doctors are dead, lucky them.

You and I, we live in the Provider Era. We are no longer doctors. In our sick healthcare system, we became providers.

“Code 99. Provider Jones to Room 3. STAT.”

Cows provide milk. Pigs provide bacon. Farmers provide corn. What do I provide? Percocet? I&Ds? Work notes? How about you? And BTW, which provider school did you go to?

Downgrading doctors to providers was a coup. It trimmed our aura, downsized our hubris and reduced our influence. Our expectations and our pay too. It helped bend us to the regulations administrators exist to enforce. Unless it’s the other way round. Regulations exist for administrators to enforce. After all, they need to do something. And they aren’t into touching patients!

We are blessed with administrators for every taste. CEOs. COOs. Quality coordinators. Facility planners. Compliance officers. Human resource managers. Risk managers. Trauma coordinators. Patient care advocates. Coders. Education specialists. I\’ll keep it short since some of us actually have to work.

They wear suits. We wear scrubs. They smell like aftershave and cologne. I smell like patients and stress sweat. They talk Medicalese. I talk ER. Their job is to tell us what to do. Like:

• Fill out ALL forms.
• Check ALL the boxes on ALL the charts.
• Obey the latest genius rule hatched by CMMS.
• Give antibiotics even before we know if somebody’s sick.
• Kiss JCAHO’s cheeks.
• Have no drinks at the desk. Coffee, I mean. What were you thinking?
• Give drugs to those who say they have pain.
• NO! STOP! Don’t give them drugs! You\’ll make them all into addicts!
• Be nice to patients. They’re always right, even when they bite.
• Any spiritual beliefs we need to be aware of? Do they need a shaman? Get a shaman.
• Do they need a translator? They speak English? So what? Ask anyhow.

Thanks to the administrators\’ care, no patient with a stubbed toe fails to get his religious beliefs recorded, his drinking habits evaluated and his spiritual needs cared for.

We are the Touchables. Nurses, Doctors, PAs, NPs, CAs. We touch patients. We touch their bodies. We touch their lives. We touch their deaths. We tell them that their mother died, their kid has drowned,  their husband will never walk again. We tell them they’re dying. We put a stethoscope on their chest, a finger in their rectum, a tube down their throat, a hand on their shoulder. We hug them if they let us.

Sometimes they touch us. They touch our souls. We spend nights wondering if another doctor could have saved them. They touch our bodies. They hug us. They punch us. They cut us with the blade in their bra. Our scrubs and our minds are forever stained with their blood, their poop, their sorrow. We inhale their smells, their viruses, their misery.

We’re touchable. Expendable too. We’re the foot soldiers in the healthcare war.

Administrators are a different breed. They don’t touch patients. They don’t draw blood, they don’t clean poop, they don’t get hurt. They don’t lose their jobs when things go bad. They have scapegoats. Us.

They proliferated like mushrooms. Or like cancer. So did healthcare spending. Any relationship, you think?

You can’t swing a dead cat without hitting an administrator. That would be comforting as long as you have enough dead cats.

As for doctors? Unless you’re bleeding to death, you\’ll wait for months for an endoscopy. Same for neurology, urology, ENT, ortho, and any other specialty.

We got far away from those touching patients making decisions for their care. We’re ensnared in a net of rules and regulations compiled and enforced by untouchables who would do anything to keep their job. Anything but touch a patient.

Something\’s rotten in America’s healthcare.

Rada Jones MD is an  Emergency Doc in Upstate NY. She lives with her husband Steve and his black deaf cat Paxil. She authored three  ER thrillers OVERDOSE MERCY, and POISON.

I work in the ER. It’s not an easy job. Not glamorous either. At least not as glamorous as my Mother-in-Law used to think.

Years ago, when I declared I was going into Emergency, she looked at me askance. She didn’t ask why. She looked at me with her wise old eyes. “Let me tell you about ER,” she said. “I know all about it. I watch every show.”

She was politely dismissive and actively unimpressed. Worried about the staff having sex in the closets maybe? Or she didn’t think that my hair or my style could stand up to the job.

She was right. Not about the sex. I don’t know how the folks in the movies find the time. Or the interest. I struggle to find time to pee. And the closets? Really? You get turned on by dirty mops and bleach perfume? She was right about the hair. It’s still not worth mentioning. And my style – what style?

I eventually got used to people questioning my career choice. Patients ask me when I’m going to specialize. My best friend – a computer maven – asked me why I choose to work triage. “Can’t a nurse do that? Shouldn’t you be treating people, instead?” I tried to explain. She smiled and changed the subject. I got even by questioning her choice of husbands. Years later, we’re still friends. I still work ER, but she dispoed her husband. Advantage home.

Still, every once in a while, somebody asks me a question that catches me off-guard. “What’s the hardest thing about your job?”

I stumble. I mumble. I try to say something intelligent. I fail. They try to help.

“Is it people dying?” they ask.

No, it’s not, even though I feel defeated every time someone dies on my watch. Even if there was nothing I could do. I feel inadequate and powerless. I always wonder if a smarter doctor, a faster doctor, a better doctor, could save them. I agonize about it, looking for my failing. But that’s not the hardest part of my job.

“Is it the abuse? Is it people swearing at you, throwing feces at you, keying your car and threatening to rape your daughter?\”

I don’t have a daughter. These days, I don’t even own a car. I got used to the swearing and being called the c-word. I don’t like the feces or the spit, nor being bitten or kicked, but I use protection equipment. I stay out of the fray. When everything else fails, IM Succinylcholine works. I’ve never had somebody spitting at me with a plastic tube in their throat.

“Is it your accent, since these days immigration has become a dirty word?\”

No. People would spend their last hard-fought breath to find out where I’m from. Romania, I used to say. That was the end of the conversation. I stopped telling them. If they insist, I say Beekmantown. My nurses love it. They can’t wait to get in on the game. If I say Transylvania, patients think I’m kidding. We laugh and get back to what matters – what they’re there for. Once only, my Dilaudid-deficient patient asked for an English-speaking doctor. I think she meant American. My English isn’t that bad.

“Is it telling families that their loved one died?”

No. It’s never easy, even if they lived to be a hundred, but it’s part of the job. I try to make it easy on them. I wash my hands of their loved one’s blood. I borrow a clean coat, even if I have to cover somebody else’s name with my badge. I lie. I pretend it didn’t hurt them, and it didn’t hurt me. I try to give them hope or solace.

“Is it being a woman? Having to deal with the glass ceiling?” 

Not really, though it’s frustrating when patients call you nurse, after introducing yourself as their doctor. I didn’t suffer much from the glass ceiling. I didn’t aim high enough? A perk of age? By the time I got to be a doctor, I was past maternity leave. And handling angry surgeons is easier than dealing with macho men in Communist Romania.

“Is it the human tragedy? The drunk drivers, the sexual assaults, the children with broken bones and cigarette burns on their belly? Is this the hardest part?\”

No. These are all things I can do something about. I treat, I advocate, I educate. I struggle to prevent it from happening. I try to make a difference.

“What is it, then?” they ask.

It’s making decisions. Choosing winners and losers, when I don’t know who should win and who should lose. Every shift I make decisions with limited information, limited resources and limited time. Decisions that can mean life or death.

Some are big: Do I scan this back pain, looking for a dissection, and possibly destroy his kidneys, or do I send him home to die.

Some are small: Should I first discharge Room 9, who’s desperate to get her kids off the bus, or see the chest pain in Room 3, which may be having a heart attack?

Some I don’t know. This woman, here for the third time this week, is she a drug seeker? Or is she sick? Should I scan her again, spending thousands of dollars on her third workup? Or should I have security escort her out?

This smiling infant with a bruise on her neck. Is she an adventurous explorer, or an abused child that I’m about to send home to die? Should I call CPS, destroying the peace of this family, or should I trust her sobbing mother telling me she stumbled and fell on a toy?

And of course, they all come at the same time: the chest pain, the baby, the fire drill, the EMS call, the floor code, the radiologist calling about the brain bleed, the administrator barking at me for being behind on my charts.

I can’t do it all. Not at the same time. But maybe a smarter doctor, a faster doctor, a better doctor, she could.

The hardest part of my job is the guilt. I never, ever, do everything I should. Not well enough, not fast enough, and never perfect.

Rada Jones, MD, works in Upstate NY, where winters are long, people are sturdy and the geese speak mainly French, Eh? She lives with her husband, Steve, and his deaf black cat Paxil. You can find her ER thrillers OVERDOSE and MERCY on Amazon. Find out more at RadaJonesMD.com.

First published on Doximity.com on Aug 29, 2019, as \” What\’s the hardest part  of  practicing Emergency Medicine?\”