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B and I have an ongoing discussion.

He says people aren't working because they have been given too much money by the stupid gummint. Also now he's reading that the younger folk are just saying, yeah, I ain't gonna work for the boomers. Working for the boomers does enrich the Waltons or whoever. It's kind of annoying. I am in total sympathy with not working for Walmart. I hear Costco treats their employees better, but still. Just another cog in the machine.

I think people are unenthused about dying of Covid-19. The medical assistants abandoned clinic first, as I've watched the articles. The nurses quitting is pretty obvious. Lots of them died and a job where tons of your patients die and then tons of them die while refusing vaccination and refusing to believe they have Covid-19, well. Wanting to help people becomes more difficult when people are being spectacularly stupid and stubborn. Why they will take cow ivermectin or an experimental antibody prep instead of a vaccine, I have no idea. Well, that isn't quite true. I think this is terminal "You can't tell ME what to do." The US is awash in humans who value independence most and doing it themselves. A lot of the most stubborn are dying and then taking down friends and strangers and family with them. This is pissing off the nurses and doctors who are burning out, dying, fleeing and quitting medicine. When the hospital has all beds full of Covid-19 patients, the heart attack patients die in the emergency rooms because there is no where to transfer them to. I am in a Facebutt group where I am hearing about people calling 60 hospitals trying to transfer a patient. One limiting factor is Ecmo: extracoporporeal membrane oxygenation. An external lung, essentially. The blood is circulated through it to be oxygenated. We use this for cardiac surgery and for heart and lung transplants. Now some people are on one for days or weeks or months, but many still die. And there aren't very many ECMO places and it is nurse intensive, two nurses at a time to monitor one patient.

Our 25 bed hospital is currently capped at 14 beds because we are limited by the lack of nurses. Nurses are also quitting and going to travel nursing. I was making $110 an hour as a Family Medicine temp doc. For an ICU travel nurse, they were offering $180 per hour in the midwest and now other places. But if you are a nurse making your regular salary and you find out that the travel nurse is making $180 per hour, you might quit and travel too. So the surgeons have to limit what they are doing, general surgery and orthopedics, and they are still scheduling things but with the caveat that anyone can get cancelled at any moment for anything elective. Hip replacements, knee replacements, colonoscopies, it's all backlogged. Heads down and doing what they can. I live four blocks from my county hospital and the helicopters have been buzzing like little bees. Since we are two hours away from the big hospitals in Seattle, it's usually a helicopter transfer. We don't send ambulances out of county because then we don't have ambulances. Ambulance transfer requires getting an ambulance sent from somewhere else. Rural medicine is interesting. It's the absolute best IMHO.

I am feeling lucky that I got whatever I got in March. Otherwise I'd probably have gotten Delta and be dead. My lungs are that vulnerable. I may have had a mild cold. This time I barely coughed at all but I couldn't breathe and a heart rate of 135 and oxygen dropping below 87% does feel terrifying and like shit. Yea for oxygen. Not being able to breathe is an awful way to die. Kidney failure is way preferable, the rising creatinine shuts down pain receptors and then puts you in a coma. If you get a chance to pick, pick renal failure. I get short of breath talking when my whatever-it-is is at its worst. The stupid antibody baseline appears to rise as you get older so looks like I will wear a mask on planes, trains and in stores for the rest of whatever life I got left. I had a phone appointment with the Infectious Disease Specialist that I saw in 2014. He basically said, yep, still don't understand your lung vulnerability, and yeah, you may BE the expert in adult PANDAS in the state, I don't know anything about it. He said try a pediatric provider and I said, yeah, they don't return my calls. He said, well.... good luck.

I wouldn't want to work in a restaurant right now. Or a store. I thank people who ARE working in stores. I thanked a checker at our local grocery store for working. She has worked there for 20+ years. She sighed and said that they have people who just start shouting at them because the lines are too long, but there is no one to hire. She says people are crazy. I still have unvaccinated friends. Unvaccinated crazy people, but really I think everyone is crazy. That was my conclusion in medicine. It's not just that all of my patients were interesting and weird, everyone is interesting and they are all way weirder than they appear on the surface. And it's the most normal I've-got-it-together ones who are hiding the most shit, really. Holy moly.

I still think the phase after Covid-19 is gone enough to come out of our bunkers will be another roaring 20s. You are just hoping it's a roaring 20s and not a roaring 30s. Masks when someone has a cold are here to stay and Covid-19 won't go away either. Hopefully by the end of this winter it will die away into less terminal viral versions, just as influenza did in 1919. Any sensible doc has been expecting an influenza pandemic for most of their career, at least I have been, and the only surprise was that it was a corona virus, not a flu virus. Flu is still around though. Hopefully it won't morph into a killer this winter, because that would really be cat among the pigeons.

I think that the US gummint did a pretty good job with the money to keep people going. I don't think that money is why people aren't working. I think it is terminally stupid to evict everyone now. They are not going back to work if they are homeless. Want to see crime go up? Evict people. Families were the rising group of homeless before Covid-19 and it's going to get worse fast. Ah, well, if I ran the world. Where is that 4 million dollars? If people had health insurance in the US, single gol damn payer, we'd see small businesses bloom like flowers. We are anyhow, because people don't want to work for the man. The man can suck it, frankly. The man has been treating people like widgets for a long time and is getting exactly what he deserves.