If you\’re in healthcare, this is probably your worst winter ever. Between the COVIDs, scarce resources, shutdowns, homeschooling, bureaucracy, hoaxers, and checking the in-laws\’ rashes online, you must feel cooked.

You\’re frustrated. Your patients die calling COVID a hoax. People refuse to wear masks. So many loved parents die alone. Bureaucrats don\’t prioritize people\’s lives. Even some of our own sold their soul for fame or money.

You\’re tired of being strong. You care for others\’ families, while your own must fend for themselves. You\’re tired of fighting COVID, ignorance, administrators, even your relatives over the Thanksgiving virtual table. You\’re tired of the mask burning your face, filthy gloves, people shrinking when you hug them. You\’re tired of being treated like a pariah whenever you stop to get coffee at the gas station. You\’re tired of your scrubs shrinking since the gym\’s closed and you live on junk food.

You miss your parents. But they\’re old, frail, and COVID-prone, so you avoid them. So much so that Dad asked if that new Ancestry test taught you something he should know about, and Mom apologized for mentioning your ex that last time you visited.

You love your kids. You\’d die a thousand deaths for them, but homeschooling? Oregon Trail and core math? Having them home every hour of every day? They don\’t know you need to sleep after your nightshift.  And you just can\’t watch Frozen three times a day.

Your spouse?  Things weren\’t that bad when you both worked and the kids went to school. Family time was sacred but limited. Now, you struggle to bite your tongue and stick those fists in your pockets. No more date nights to rekindle a flailing relationship, no more vacations to break the monotony, no more nights out with your buddies to blow up steam.

How can you survive this winter holding on to your temper, family, and job?

Look out for #1.

That\’s you. To care for others, you must care for yourself first.  Like the in-flight safety videos say: \”Put on your own mask before you help others.\” You won\’t save anyone if you run out of oxygen. To care for those who need you, you must keep afloat. You\’re everybody\’s keeper. If you get sick, they might too. If you go crazy, your family will suffer. If you fall apart, who\’ll care for your elderly parents?

That\’s not selfish. That\’s smart. To protect those who need you, you must stay healthy and sane.

How? These are my tips.

1. Set rules for others and for yourself. Your sleep should be sacred. So should whatever time off you can schedule.
2. Enlist help. There are so many grateful folks who want to help the healthcare workers. Your neighbors may be glad to walk your dog, run some errands, or grab a gallon of milk.
3. Prioritize yourself. Pay someone to plow, buy groceries online, hire a housekeeper to save time for the things that really matter.
4. Schedule time for yourself. To exercise, meditate, pray, journal –  whatever helps fill your well.
5. Shut off the TV. Whether you\’re Democrat or Republican, you won\’t enjoy the news. Watch Hallmark, the nature channel, or the food channel. Watching food is fun, and it won\’t make you fat.
6. Go outdoors. There\’s magic in nature and sunlight, whatever\’s left of it. Hike, snowshoe, and allow your lungs to breathe real air instead of the reconditioned germs they allow you in the hospital.
7. Say no. That\’s a survival technique. Say no to parties, to hugging strangers, to doing things you shouldn\’t, in order to protect other\’s feelings. Let them take care of their feelings. You take care of yourself.
8. Cut yourself some slack. You aren\’t perfect. Nobody is. You\’ll make mistakes, gain a few pounds, step on some toes, maybe even lose it at times. So what? Just do the best you can.
9. Read a book. Remember those things made of paper? You turn a page and land in a new world? These three always make me happy: The art of Racing in the Rain, Holes, and Because of Winn Dixie. What works for you? Please share.
10. Be careful with alcohol and substance use. They may feel good at the moment, but you\’ll be worse off in the long run.
11. Watch old movies that make you laugh. My favorites: A fish called Wanda, Hopscotch, and Naked Gun. And MASH. It\’s on HULU. How about you?
12. Take a break from social media. Picking fights with random strangers won\’t help your mental health. Sadly, not everyone posts sunrises and puppies. Cut off those who hurt you.
13. Get a cat. They have nine lives; That\’s why they are masters of survival. They ignore all unpleasantness, from dogs to COVID, and they\’ll show you how to do it too. And they\’re the best nap helpers.
14. Communicate. Ask your coworkers how they handle the stress. They may teach you something, but even if they don\’t, sharing the burden will help you both.
15. Seek help before you lose it. Check out the CDC resources below.
16. Pat yourself on the back. You\’re a darn hero! In recycled PPE instead of shining armor you saved fair maidens of all genders, ages, and persuasions. With a vaccine in sight, there\’s a light at the end of the tunnel.

Wishing you all health, joy, and happiness. See you all on the other side.

Rada

Rada Jones is an ER doc. She lives in Upstate NY with her husband Steve, Paxil, his deaf cat, and a tsunami named Guinness who loves brushing her teeth.

Rada authored three ER thrillers, Overdose, Mercy and Poison, and “Stay Away From My ER,” a collection of medical essays

Free confidential resources: 

• National Suicide Prevention:  1-800-273-TALK (1-800-273-8255
•  Lifeline Crisis Chat, free, will connect you to a counselor in your area.
• Domestic Violence Hotline: 1-800-799-7233 and TTY 1-800-787-3224

If you\’re in healthcare, this is probably your worst winter ever. Between the COVIDs, scarce resources, shutdowns, homeschooling, bureaucracy, hoaxers, and checking the in-laws\’ rashes online, you must feel cooked.

You\’re frustrated. Your patients die calling COVID a hoax. People refuse to wear masks. So many loved parents die alone. Bureaucrats don\’t prioritize people\’s lives. Even some of our own sold their soul for fame or money.

You\’re tired of being strong. You care for others\’ families, while your own must fend for themselves. You\’re tired of fighting COVID, ignorance, administrators, even your relatives over the Thanksgiving virtual table. You\’re tired of the mask burning your face, filthy gloves, people shrinking when you hug them. You\’re tired of being treated like a pariah whenever you stop to get coffee at the gas station. You\’re tired of your scrubs shrinking since the gym\’s closed and you live on junk food.

You miss your parents. But they\’re old, frail, and COVID-prone, so you avoid them. So much so that Dad asked if that new Ancestry test taught you something he should know about, and Mom apologized for mentioning your ex that last time you visited.

You love your kids. You\’d die a thousand deaths for them, but homeschooling? Oregon Trail and core math? Having them home every hour of every day? They don\’t know you need to sleep after your nightshift.  And you just can\’t watch Frozen three times a day.

Your spouse?  Things weren\’t that bad when you both worked and the kids went to school. Family time was sacred but limited. Now, you struggle to bite your tongue and stick those fists in your pockets. No more date nights to rekindle a flailing relationship, no more vacations to break the monotony, no more nights out with your buddies to blow up steam.

How can you survive this winter holding on to your temper, family, and job?

Look out for #1.

That\’s you. To care for others, you must care for yourself first.  Like the in-flight safety videos say: \”Put on your own mask before you help others.\” You won\’t save anyone if you run out of oxygen. To care for those who need you, you must keep afloat. You\’re everybody\’s keeper. If you get sick, they might too. If you go crazy, your family will suffer. If you fall apart, who\’ll care for your elderly parents?

That\’s not selfish. That\’s smart. To protect those who need you, you must stay healthy and sane.

How? These are my tips.

1. Set rules for others and for yourself. Your sleep should be sacred. So should whatever time off you can schedule.
2. Enlist help. There are so many grateful folks who want to help the healthcare workers. Your neighbors may be glad to walk your dog, run some errands, or grab a gallon of milk.
3. Prioritize yourself. Pay someone to plow, buy groceries online, hire a housekeeper to save time for the things that really matter.
4. Schedule time for yourself. To exercise, meditate, pray, journal –  whatever helps fill your well.
5. Shut off the TV. Whether you\’re Democrat or Republican, you won\’t enjoy the news. Watch Hallmark, the nature channel, or the food channel. Watching food is fun, and it won\’t make you fat.
6. Go outdoors. There\’s magic in nature and sunlight, whatever\’s left of it. Hike, snowshoe, and allow your lungs to breathe real air instead of the reconditioned germs they allow you in the hospital.
7. Say no. That\’s a survival technique. Say no to parties, to hugging strangers, to doing things you shouldn\’t, in order to protect other\’s feelings. Let them take care of their feelings. You take care of yourself.
8. Cut yourself some slack. You aren\’t perfect. Nobody is. You\’ll make mistakes, gain a few pounds, step on some toes, maybe even lose it at times. So what? Just do the best you can.
9. Read a book. Remember those things made of paper? You turn a page and land in a new world? These three always make me happy: The art of Racing in the Rain, Holes, and Because of Winn Dixie. What works for you? Please share.
10. Be careful with alcohol and substance use. They may feel good at the moment, but you\’ll be worse off in the long run.
11. Watch old movies that make you laugh. My favorites: A fish called Wanda, Hopscotch, and Naked Gun. And MASH. It\’s on HULU. How about you?
12. Take a break from social media. Picking fights with random strangers won\’t help your mental health. Sadly, not everyone posts sunrises and puppies. Cut off those who hurt you.
13. Get a cat. They have nine lives; That\’s why they are masters of survival. They ignore all unpleasantness, from dogs to COVID, and they\’ll show you how to do it too. And they\’re the best nap helpers.
14. Communicate. Ask your coworkers how they handle the stress. They may teach you something, but even if they don\’t, sharing the burden will help you both.
15. Seek help before you lose it. Check out the CDC resources below.
16. Pat yourself on the back. You\’re a darn hero! In recycled PPE instead of shining armor you saved fair maidens of all genders, ages, and persuasions. With a vaccine in sight, there\’s a light at the end of the tunnel.

Wishing you all health, joy, and happiness. See you all on the other side.

Rada

Rada Jones is an ER doc. She lives in Upstate NY with her husband Steve, Paxil, his deaf cat, and a tsunami named Guinness who loves brushing her teeth.

Rada authored three ER thrillers, Overdose, Mercy and Poison, and “Stay Away From My ER,” a collection of medical essays

Free confidential resources: 

• National Suicide Prevention:  1-800-273-TALK (1-800-273-8255
•  Lifeline Crisis Chat, free, will connect you to a counselor in your area.
• Domestic Violence Hotline: 1-800-799-7233 and TTY 1-800-787-3224

Some say 2020 is the year of disasters. Others say it\’s the year of change. To me, 2020 is the year of rage. In 2020, rage overtook the world, consuming us and hurling the leftovers against each other.

The right is angry with the left. The social distancers are angry with the beach-goers. The mask wearers are angry with the mask haters. The protesters are angry with the system.

Like a lid on a boiling pot, the lockdown intensified the pressure. The upcoming elections turned up the heat, spurring strangers to feud on social media, destroying old friendships,  and making loving families spew hate over the dinner table.

What does that mean for us, the healers, who already struggle with a failing medical system, COVID, the lockdown, the lack of PPE, the racism, and the riots?

First, we must recognize that we are not immune. Whether you\’re black or white, Democrat or Republican, female or male, and whether you see it or not, you are likely infected with the rage devouring us all. Denying your anger won\’t make it go away. It will only make it harder to manage. Whether you see it or not, the endless string of bad news shortened your fuse too.

And unlike others who may have the luxury of time, you and I live and work on the front line. We can\’t retreat to consult our inner wisdom and get in touch with our feelings before we act. In our line of business, we need to be ready for whatever comes through the door, whether it\’s codes, traumas, or angry people.

Patients are anxious and worried. They hate to wait; they loathe the mask; they become impatient, unreasonable, sometimes violent. They want their family. They ask for a COVID test for their sprained ankle. They request hydroxychloroquine with the Z-pak they need for their cough.

Nurses are angry. They\’re exhausted. They go home to home–school after their shift, instead of sleeping. Their spouse got furloughed, their mortgage is due, and they worry about their mom in the nursing home. They\’re tired of dealing with angry patients. And it\’s just so damn hot under all that PPE.

Doctors are angry. They\’re exhausted by fighting COVID and reusing their PPE; they\’ve had enough of avoiding their family for fear of getting them sick; they\’re enraged by seeing their hours cut, the unpaid mandates piling up and their vacation plans fall apart.

Your family is angry too. They\’ve had enough of social distancing and being cooped in the house. The kids got the heebie-jeebies and want to be out with their friends. Your spouse is tired of home-schooling them, watching bad news on TV, and eating in.

So, in this world consumed by anger, how can you manage to stay calm and professional and keep everybody safe?

1. Recognize your anger, so you can manage it before it blows up on the floor, taking your career and your reputation with it.
2. Get enough rest. It\’s hard to be professional with the patient asking for a Viagra script in the middle of a code when you\’re tired.
3. Don\’t postpone your bathroom breaks. Rushing to see patient after patient on a full bladder will make you resentful and shorten your fuse.
4. Don\’t go \’hangry.\’ Plan ahead. Smoothies, fruit, string cheese–whatever you can manage. Not coffee. Coffee is not food. It\’s life, but not food.
5. Take a time-out when you feel you\’re losing it, even if it\’s taking a two minutes walk to the furthest bathroom.
6. Don\’t say yes to unreasonable requests, like bad shift changes, giving medical advice in the elevator or writing scripts you know you shouldn\’t. Decline, and move on, otherwise your frustration will catch up with you.
7. Practice circular breathing, meditation, or relaxation.
8. Work out—the harder, the better. Kickboxing works for me, but running, hiking, or biking will do. Get rid of that adrenaline.
9. Laugh. Laughing diffuses tension and softens lousy situations, and not many situation are so bad that you can\’t laugh at them. And it\’s good for the soul.
10. Talk to a friend, a spouse, or a coach. Investing in a career/life coach can be cost-effective. A few years ago, when I struggled with burnout, I hired a coach. I paid for six sessions, but I only needed four. Work got easier, life got better, and I recovered my smile.
11. Do things that nourish your soul. Not the news or violent movies. Make a date with yourself: visit a museum, plant a tree, play the violin, take a photography class, go parasailing.
12. Play. With the kids, the dog, your significant other. Playing brings back the child in you and brings light to the darkness inside.
13. Practice compassion and gratitude. Remember how lucky you are to be who you are and have what you have.
14. Recheck your malpractice. The time of healthcare workers being heroes is about to be over. Before long, we\’ll be talking about how the medical system failed us. Cynical, I know. But bad things happen to good people. Be prepared.
15. Ask for help before it\’s too late. Healthcare professionals, especially women, have high rates of divorce, substance abuse, and suicide. Yes, it\’s the stress of the job, but it\’s also because we\’re so bad at asking for help.
16. Cut yourself some slack and reward yourself for good behavior. Be proud for keeping calm, and don\’t berate yourself for losing it. Learn something and move on.  You\’re only human, after all.

Finally, remember that this too shall pass. Hold on to the things you cherish: your family, your career, your sanity, and wait for the times to change. Because they will.

Rada Jones is an ER doc in Upstate NY. 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.

A version of this essay was previously published on Doximity.com.

Somewhere in Wuhan, somebody ate undercooked bat soup, and the world as we knew it was over. (Note to self: never have your bat below medium, and avoid bat tartare like the plague.)

Kids stayed home. So did their parents. They started talking to each other, instead of watching their phones while rushing from soccer games to ballet rehearsals, via McDonald\’s.

Sports got suspended, and millions of rabid sports fans remembered that their home team is right here, in their home.

Avid shoppers forgot about the latest fashions to fight over PPE and toilet paper.

Salons closed. Haircuts, manicures, and even lipstick fell out of favor. Couch potatoes got an irrepressible urge to go out. Stair haters started hiking. People who hate being touched became huggers, and fat dogs got slim by walking their extended family.

On TV, ER and ICU action replaced live sports. Dr. Fauci\’s wrinkled face outsold Kim Kardashian\’s derrière in everything from men\’s socks to prayer candles. ER docs, the Cinderellas of medicine, became hotter than Dr. Pimple Popper, and people stopped asking when they\’ll finally specialize, since COVID put Emergency Medicine on the map.

More good news: clean air, empty animal shelters, and not a single school shooting. The pandemic kidnapped our normal life, reset our priorities, and got us thinking. It also reminded us that medicine is not retail.

For years now, administrators struggled to mold medicine into a customer-driven business. Patients became customers, doctors became providers. The art of medicine was out, the patient experience was in.

Paper-pushers whipped healthcare into Disney\’s religion of customer satisfaction, bowing to customers and managing expectations. Their Holy grail tool? Press Ganey.

For those who don\’t know, Press Ganey is a standardized survey rating patients\’ hospital experience to correlate it with hospital revenues. It\’s widely agreed that, by imposing pain as a vital sign Press Ganey contributed to the opioid epidemic.

Regardless of their subjectivity, low response rate and lack of relationship with patient safety, PG surveys have become the way to assess medical care. For more on the relationships between PG and quality of care, check out \”Death by Patient Satisfaction.\”

To put that into perspective: Say you have a hot date at a nice restaurant. You order a nice wine, a steak with fries, a salad with ranch dressing and a Sundae.
The waiter looks at you and asks:
\”How much do you weigh, sir?\”
\”Two-fifty,\” you lie, crossing your fingers under the table.
\”How tall are you?\”
\”Six feet three,\” you say, though you know damn well you\’re only five eight.
The waiter tightens his mouth disapprovingly and says.
\”I\’m sorry, sir. That\’s not good for you. You can have one glass of dry wine, and a skinless chicken breast with steamed kale. Green salad with balsamic vinegar, no oil, and a sugar-free baked apple. That\’s all I can do for you. You need to lose a lot of weight.\”
He turns to your hot date, who\’s watching with her jaw on her knees, and adds: \”As for you, madam, you can have fries with your chicken, but I recommend using a mask and ditching this smoker. He\’s a heart attack waiting to happen.\”

How would you rate your experience?

Press Ganey measures the pleasurable experience of being in the hospital. But suddenly, thanks to COVID, staying alive became more important than being comfortable and more relevant than waiting times, Percocet, and turkey sandwiches.

Patients are still upset, and for good reasons. They want tests telling them if they\’ll live or die, and they can\’t have them. If they do, the results take days. They want to feel safe. They don\’t want people coughing on them or touching them, not even medical providers unless they\’re wearing PPE, and they\’ve been tested.

The regulars, the \”pain in the elbow for 6 years\” and the \”I couldn\’t keep anything down since January\” and the \”I need a note for work for last week,\” are gone. They don\’t think they\’re sick enough to risk their lives with the sick people out there. And they\’re right.

Unfortunately, that also goes for the indigestions that are, in fact, heart attacks, the weak and dizzy that are, in fact, strokes, and many others who need care but are afraid to go to the ER.

Still, for once, patients and medical professionals found themselves on the same page. We all agree that staying alive matters more than waiting, discomfort, and privacy.

It\’s an entirely different world in the not-hot spots, where medical professionals are getting fired or they get their hours cut. As the pandemic of the century unplugged the US, our unprotected and overworked medical professionals cared for patients while risking their lives, endangering their families and getting fired if they spoke up.

Covid19 did a lot of harm to many people: Patients, families, healthcare workers. But there\’s a silver lining. This pandemic reminded us that medicine is not retail, and patients are not customers. After years of kowtowing to Press Ganey, we remembered that there are things more important than patient satisfaction, like patient safety and saving lives.

These are some comments from  my healthcare friends. Not PG rated.

\”Press Gainey is just one more vulture picking at the remains of the US healthcare system.\”

\”The Tool is designed to sell more of itself.\”

\”I like the airline comparison. Did the plane get you there? Did you live? Did you take your bags with you? (important body parts that you weren\’t there to have removed).

\”COVID19 life is a true war zone. Press Gainey is life at the office paintball match.\”

\”Press Ganey has no place in medicine. The business model of medicine needs to be put to sleep (I hear a propofol/etomidate/potassium combination satisfies the humane aspect). We need to restart taking our practice back from CPA\’s and MBA\’s.\”

\”The pandemic exposes how useless P-G is. Most people care if they are treated kindly and if they f***ing live or die. I\’ve never been thanked more by family members. It\’s weird. I had a cantankerous guy last night, and it was almost a relief that things seemed more normal…\”

\”Pre-Covid value: rectal exam at an ophthalmologist\’s office. Post-Covid value: wearing a steak thong in an alligator pit.

\”We started calculating 95% CIs on PG scores at my shop. I highly recommend this. You can be about 95% confident that an individual is either amazing or terrible. Or in between.\”

\”The only patient satisfier question should be \”Did you die?\”

Stay safe, and see you on the other side. Hopefully both of us wiser.

A previous version of this essay was published on Doximity.com.

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.

1. Both masks and underwear exist to contain badness. Neither works 100%, but they\’ll curb the worst of the spill.
2. Don\’t borrow someone else’s, no matter how cool they look.
3. Keep them on around strangers, unless you’ve both been tested.
4. Cotton breathes better than polyester.
5. If they don\’t fit well, you\’ll be chaffing.
6. Wear them both when you visit grandma.
7. They stink at the end of the day.  They need frequent washing.
8. They\’re affordable and a worthwhile investment.
9. The lighter they are, the better you breathe.
10. Adjusting them in public is a no-no.
11. They\’ll cover your cold sores and droopy assets, making you more attractive.
12. Taking them off counts as foreplay.
13. They\’ll cover the drools and the drips.
14. You shouldn\’t stick your nose out of either.
15. They won\’t silence you. From MAGA to BLM, they help with your self-expression.
16. They cover revealing body language: your mask hides your smirk, your underwear hides it whenever your flag rises to salute foreign territories.
17. If you\’re looking for extra excitement, you can get them see-through.
18. They help block bad smells.
19. It\’s always a good plan to have a spare.
20. For both: cleaner is better.
21. They showcase your personality. Granny’s whites are to red lace thongs what an N95 is to a gauzy rainbow.
22. They only work if you wear them.
23. In extreme situations, you can switch.
24. In 2020, they\’re both highly recommended.
25. It feels wonderful to take them off at the end of the day.

BUT: 

1. While nobody cares about your undies, everybody cares about your mask.
2. Mask are more effective than undies as fashion statements.
3. Your undies never saved a life.
4. It\’s hard to make a political statement by underwear alone.
5. Your undies are for yourself, but your mask is mainly for the others.

Rada Jones is an ER doc in Upstate NY. She authored three ER thrillers, Overdose, Mercy and Poison, and “Stay Away From My ER,” a collection of medical essays.

1. Both masks and underwear exist to contain badness. Neither works 100%, but they\’ll curb the worst of the spill.
2. Don\’t borrow someone else’s, no matter how cool they look.
3. Keep them on around strangers, unless you’ve both been tested.
4. Cotton breathes better than polyester.
5. If they don\’t fit well, you\’ll be chaffing.
6. Wear them both when you visit grandma.
7. They stink at the end of the day.  They need frequent washing.
8. They\’re affordable and a worthwhile investment.
9. The lighter they are, the better you breathe.
10. Adjusting them in public is a no-no.
11. They\’ll cover your cold sores and droopy assets, making you more attractive.
12. Taking them off counts as foreplay.
13. They\’ll cover the drools and the drips.
14. You shouldn\’t stick your nose out of either.
15. They won\’t silence you. From MAGA to BLM, they help with your self-expression.
16. They cover revealing body language: your mask hides your smirk, your underwear hides it whenever your flag rises to salute foreign territories.
17. If you\’re looking for extra excitement, you can get them see-through.
18. They help block bad smells.
19. It\’s always a good plan to have a spare.
20. For both: cleaner is better.
21. They showcase your personality. Granny’s whites are to red lace thongs what an N95 is to a gauzy rainbow.
22. They only work if you wear them.
23. In extreme situations, you can switch.
24. In 2020, they\’re both highly recommended.
25. It feels wonderful to take them off at the end of the day.

BUT: 

1. While nobody cares about your undies, everybody cares about your mask.
2. Mask are more effective than undies as fashion statements.
3. Your undies never saved a life.
4. It\’s hard to make a political statement by underwear alone.
5. Your undies are for yourself, but your mask is mainly for the others.

Rada Jones is an ER doc in Upstate NY. She authored three ER thrillers, Overdose, Mercy and Poison, and “Stay Away From My ER,” a collection of medical essays.

1. Both masks and underwear exist to contain badness. Neither works 100%, but they\’ll curb the worst of the spill.
2. Don\’t borrow someone else’s, no matter how cool they look.
3. Keep them on around strangers, unless you’ve both been tested.
4. Cotton breathes better than polyester.
5. If they don\’t fit well, you\’ll be chaffing.
6. Wear them both when you visit grandma.
7. They stink at the end of the day.  They need frequent washing.
8. They\’re affordable and a worthwhile investment.
9. The lighter they are, the better you breathe.
10. Adjusting them in public is a no-no.
11. They\’ll cover your cold sores and droopy assets, making you more attractive.
12. Taking them off counts as foreplay.
13. They\’ll cover the drools and the drips.
14. You shouldn\’t stick your nose out of either.
15. They won\’t silence you. From MAGA to BLM, they help with your self-expression.
16. They cover revealing body language: your mask hides your smirk, your underwear hides it whenever your flag rises to salute foreign territories.
17. If you\’re looking for extra excitement, you can get them see-through.
18. They help block bad smells.
19. It\’s always a good plan to have a spare.
20. For both: cleaner is better.
21. They showcase your personality. Granny’s whites are to red lace thongs what an N95 is to a gauzy rainbow.
22. They only work if you wear them.
23. In extreme situations, you can switch.
24. In 2020, they\’re both highly recommended.
25. It feels wonderful to take them off at the end of the day.

BUT: 

1. While nobody cares about your undies, everybody cares about your mask.
2. Mask are more effective than undies as fashion statements.
3. Your undies never saved a life.
4. It\’s hard to make a political statement by underwear alone.
5. Your undies are for yourself, but your mask is mainly for the others.

Rada Jones is an ER doc in Upstate NY. She authored 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.

This is the Thai\’s government daily Covid update for May 20 2020 (2563 in Thai, since not only are they forward thinkers but they use the Buddhist calendar.)

Loose translation: On May 20, 2020, for a total population of almost 70 million people, Thailand had 3034 confirmed cases (+1 since the day before), 2888 recovered (+31 since the day before), 56 deaths (no change). The new case is a repatriated Thai citizen in state quarantine, like most new cases for weeks.

Per the European CDC, that brings Thailand to 44 confirmed cases per million, and 0.8 deaths per million. For comparison, the US has 4838 cases/million and 290 deaths/million. Sweden, (who never locked down) has 3249 cases/million and 389 deaths/million.

Steve and I spent the winter in Thailand. We were here when the pandemic exploded in Wuhan, when Thailand diagnosed the first case outside China, and when the world shut down. We weren\’t yet ready to leave in March, then flights became scarce, until they disappeared. International flights to Thailand are closed until July. And it\’s a long walk home.

The first sign that things were getting funky came in February: the Chinese tourists crowding the streets and malls disappeared almost overnight. All of a sudden, traffic started flowing, the restaurants turned quiet and the shops uncrowded. The locals loved it. Until the restaurants and shops started closing due to lack of business.

Then people started wearing face masks.

Ignorant, we thought. But, out of respect for the locals, we started wearing them too, even before the government made them mandatory.

Then came the Emergency Decree and the 10 to 4 curfew. Nonessential business, from malls to massage parlors, were closed, including all restaurants, public pools, and entertainment venues. That put the last nail in the coffin of tourism, and bankrupted many cash-poor businesses. Flights got cancelled, schools closed, city buses stopped.

But Thai being what they are – flexible, pragmatic, and funny – most non-essential businesses, from IT stores lo lingerie shops, made themselves essential overnight by offering face masks, safety glasses or hand sanitizer.

The biggest event of April is Songkran, the Thai New Year – an alcohol-fueled week-long street party celebrating rain. Passers-by shoot water guns and douse each other with water. Businesses sell ponchos, safety glasses and booze, and offer barrels and hoses with free water for refueling. Songkran is the time of wet t-shirts, phones wearing zipper bags, and drinking with wet strangers for young people of any age.

This year, Songkran was cancelled. To encourage compliance, the government declared a week-long alcohol ban making Thailand go dry. The ban was announced two days early, so everybody got to stock up, and the hospitals were notified to get ready for the inflow of new cases – not of Covid, but of alcohol withdrawal.

To encourage compliance, the government provided daily updates on the state of COVID, including summaries in English detailing the number and provenience of new cases and deaths, and insisting on social distancing, masks and hand hygiene. They organized field hospitals. They are now stockpiling Favipiravir, (Avigan) to prepare for the second wave.

But for now, they\’re letting loose. After the number of new cases went down to single digits, the economy slowly restarted. Mom-and-pop shops, then small outdoor restaurants, now parks, malls, gyms and hairdressers. Still closed: Bars, cinemas, entertainment venues, muay-thai arenas, bull fighting, fish fighting, and massage parlors.

I expected the pent-up demand to explode everything into opening on day one, like a piñata. Not exactly. Businesses are taking their time. The famous Chiang Mai walking streets, always choking with food, shopping and entertainment, are empty. The Saturday Night Market street was a post-apocalyptic scene on Saturday night, empty but for the ghosts of Saturdays past.

Thai adopted the idea of social distancing. So much so that passers-by will give you ugly looks if you walk without a mask, restaurant owners will send you to wash your hands before serving you, people will wave you away rather than share an elevator, and bikers will wear a mask even when they don\’t wear a helmet – both required by the law.

Most Thai support the closure of entertainment venues, even though many struggle: the bar-girls in Loh Kroh, the elephant sanctuaries, the massage parlors, the tuk-tuk drivers. The Phuket airport is closed. Drones patrol the Pattaya beaches, keeping sun worshippers away. Chiang Mai hasn\’t had a new case in weeks, but our pool is still closed.

Even beyond the government\’s requirements, the opening is slower than we, expats, would like. Very cautious too. Before allowing you in, malls check your temperature and take your phone number, for screening and tracing. Thankfully, they use forehead thermometers, otherwise we\’d be hurting.

After a successful trial on mice, Thai researchers are testing a new vaccine on monkeys. Another step towards normal, even though the new normal won\’t be like the old. That\’s not all bad. If I had my say, the days of hugging and kissing casual strangers would be over. So would overcrowded highways, rat-sized cubicles, sardine-packed planes, air pollution and two hour commutes.

Thinking of you all. Missing you, and missing life as it used to be. Don\’t know when we\’ll be back, but we\’re OK. I hope you are too.

Stay sane, stay safe, and see you on the other side.

Rada Jones is an ER doc in Upstate NY. She lives with her husband and his deaf black cat Paxil. She\’s the author of 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.