What a Mother

Today is Mother’s Day where we honor perhaps the most complex human and relationship we will ever have in our lifetime.

I cannot nor will go into the complex tragic, joyous, frustrating relationship I had with my Mother. She has long been dead now over 35 years and what is passed is just that in the past and nothing can change what transpired but I can change how I manage my emotions with regards to her and our relationship. My Father is now just over 10 years dead and with him I will always have complex tragic memories and with that tucked among them some good as he too was equally complex and tragic figure whom, like my Mother I never really knew or understood. That carries forward into all my relationships, past and present, as I do not trust, understand the nature of what they need and what I need from them in which to make it whole and fruitful so I choose to not pursue any. I have run from job, to home, to persons in which to avoid conflict and drama that seems to define almost ALL relationships, be they personal or business. Anyone who thinks otherwise needs to watch more, listen more and say less. Observing the interactions of others can be quite telling even when little is said.

Needless to say I will not be attending any Brunches today or well any other day. Actually I cannot think of anything more boring and the late Anthony Bourdain was quite dismissive of the practice and many Chef’s have been quite honest about how they are often cost prohibitive for their Restaurant and yet are dependent upon them. In other words – Lose/Lose. And that pretty much sums up my own feelings about the experience of sitting en masse and trying to connect to others whose commonalities seem to be either work or family related. It has become almost to near impossible for individuals to make friends not related via work or familial, be that through birth or marriage. It explains why people are so pro finding a mate as it secures a “friend” for life without all the daily effort in which to maintain it; thus explaining the high divorce rates as well.

I am rarely if ever lonely; however, I can find myself bored of my own company. I attend a great deal of Arts and Entertainment but I do so alone. And upon occasion I have had random encounters that were fulfilling and gratifying in which to alleviate the boredom and bring me positive reminders of the goodness of humanity. I am afraid that has happened less and less and with that I feel it has accelerated that once dormant push to extricate myself and move on. I came to Jersey City with great hope and expectation that this would be my forever home. I could not be more wrong and largely it came in the same way it did in Nashville, over time and spending time observing and learning and attempting to make effort into building community. And that comes from the most central of all community building, the public education available. And with that I did what I did in Nashville and found the history behind their system despite most of New Jersey having a superior system across the State, excluding largely poorer faces of color and those who English is not their first Language. A reality that is across the Nation and this story in the New York Times discusses how Climate Change is another factor in how that diaspora is the most affected by decisions and lack of funding parallel another human kind of disaster. I can assure you that it will not get better and it is clear that our lessons have never been learned. It is also why I want to leave the area, as even NYC costs of living there has now exceeded the worth. When you examine what the simple payback is, you realize it is all output with very little in return. Lack of affordable housing the primary one and the focus on youth. (Again the youth means 21-35 not the actual youth of the City who have equally atrocious segregated schooling) This seems to be the standard bearer when it comes to all relationships and it also tells you that it may not be worth it. I see the City different now that I am inside and looking through the window that being outside looking in. It is not aging well in any sense. Covid took a life and strangled that city in ways that will take decades for it to recover. The aged population that is the largest cohort (Developers believe otherwise and with that the costs of living regardless of age is absurd) and with that I find the aging not aging well in the City. It should not be Sex and the City it should be Old in the City. I see hunchbacks, stoops, walkers, canes, wheelchairs, mobility issues, hearing problems and yet youthful skin and faces and expensive clothing on bodies that are falling apart. It is not pretty in the least. We all want to age and die in dignity and what I see in the streets, in the theaters, the bars and shops are elderly who can afford to die at home but there is nothing dignified by any of it.

And to think that young people are going to relocate there and live in micro units pay well over half their salary in rent to experience this is absurd. The geriatric set cannot support the Arts and while every now and then I see full houses at the Phil, Carnegie Hall or the Metropolitan Opera it is largely White, well over 65 and the few that are privileged enough to go upon occasion, but not season ticket holders who have large purses for large donations. These orgs are bleeding money and desperate for a new Audience who simply do not have the means. And that is across the Country but here if you can make it here you better have a lot of money and be able to burn it if not spend it.

And that is what Mother’s Day is about birth, rebirth and family. If you have none as I do then it is about the self and self care. I find that in the cultural options in Manhattan, the NY Phil was amazing this Friday with a set of Mozart along with an altered Beethoven piece thanks to the second time around termination of two players accused of sexual assault. That is one thing that also never seems to get old. And a finale of the Met Opera’s Madam Butterfly. The story of a young as in 15 years old young, orphan girl ofa once good family sold off to marriage to an American Soldier. She embraces his culture and beliefs much to the chagrin of her own remaining family and in turn gives birth to a Son whom the Sailor never met as he left shortly after consummating his marriage and his “Bride” to return to the States. Three years later she awaits his return in desperation and once again near poverty when he arrives with his American wife to see what was his past and now his destiny. The production was full on Met and it was cast with two amazing Singers whose range and Chemistry was not unlike the powerful Romeo and Juliet I saw last month. The Met has its clunkers as I once again saw Fire in the Bones and yep it still was a mess, the Second Act an improvement on the first but despite the presence of a much better Baritone in Ryan Speedo Green it still was to say the least underwhelming. I have much to compliment Terrance Blanchard for tackling this but there needs to be a stronger editing hand to much of the new Opera as it lacks a cohesion, see the Hours as an example of that and the term “hot mess.”

But we all need more to fulfill us and when you see check after check be written and you walk on the streets and see shit (both Human and Animal) literally everywhere. The failures of our infrastructure and the adjacent bodies of Government simply failing to provide basic services (well its tough when everyone from former Presidents to current Senators being on trial and Mayors and others fighting investigations) you can see where the money is being spent, and none of it good. And all of them had Mothers who wanted it better for their Sons and their Daughters and that is not always the case anymore. We can only ask for what we need and want and hope we can reconcile the two. That will take a hell of an Accountant I believe. I am not sure we can afford even one of those.

Maybe we all want Better Mothers who can fix all of this.

Watch Out for the Better Mother

May 10, 2024

By Pamela Paul Opinion Columnist The New York Times

Sometimes, particularly in a public parenting setting, I will play the Better Mother. This is the mother who stands attentively outside a music audition, serenely listening to the notes emanating from within. She realizes the parent next to her said “Haydn,” not “Biden.” When her child emerges, the Better Mother isn’t sprawled on the floor playing Spelling Bee but instead greets him with encouraging commentary on the second movement. Also, she has brought a snack.

The Better Mother understands the lacrosse match (game?), cheering at appropriate moments in ways that hearten rather than humiliate. She knows the coach and chats amiably with team parents about various maneuverings on the field, nimbly expanding the conversation to school committees and after-school events. She did not bring a book.

The Better Mother ensures her kids have dress shoes that aren’t two sizes too small. She bakes. She reads official emails from school and camp from beginning to end. She knows which teachers your kids are supposed to get and whom to email if they aren’t gotten. She always brings a water bottle.

She is not the mother who didn’t know there was a school concert and has to sneak in as the lights go down. She knows which side of the field her child is playing on and possibly which position. She never texts at a stoplight with her child in the car.

She is empathic but not overbearing, affectionate but not treacly, wise but not smug, concerned but not anxious. She is the mother who knows danger but never checks in on a child for the wrong reason.

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The Better Mother is, by definition, a better mother than I am.

She can be a total stranger spotted at the museum or a familiar face at a birthday party. Either way, she is a natural star in the play for which you haven’t quite memorized your lines.

Most mothers — and fathers — probably have a personal vision of their own competition, depending on one’s skill set or lack thereof. For me, it depends on the context, my mood, the child in question and the spectrum of parental figures in the vicinity, even sometimes on which TV show I last watched or what book I’m reading.

For a period, I decided that a better mother than I was Mary-Kay Wilmers, a former editor of The London Review of Books, a woman I’ve never met but read about in “Love, Nina,” a memoir by Nina Stibbe, who served as a nanny to Wilmers’s two precocious sons. Wilmers surrounded her children with clever British eminences like the playwright and novelist Alan Bennett and the biographer Claire Tomalin, as well as the critic John Lahr. Raised among brilliance, her boys became sharp wits themselves, biting and slightly wicked in their humor.

As I didn’t have any storied literary figures lighting up my dinner table, I simply let loose all my own most caustic comments, the kinds of uncharitable thoughts you usually reserve for like-minded adults. Alas, without elegant British companions, I was merely encouraging a rude sarcasm. My error was highlighted in the presence of another Better Mother, my friend Robin, whose children looked strangers in the eye upon meeting, shook hands firmly and managed civilized niceties.

No one is suggesting you have to be the Better Mother — merely that you can play her in public at your discretion. When you’re surrounded by a bunch of slacker parents or all-out bad moms or you’ve had a busy week and need an extra boost, you can simply slip on the role, ideally in public, for a Sunday afternoon. Yes, I am saying you can fake it.

Mother’s Day brings forth the Better Mothers in droves, when they accept all due adulation. On such occasions, regardless of what kind of mother you are in reality, you can damn well play the part.

And who’s going to be the wiser? The ones we think of as Better Mothers could be big fakers themselves, women who shove unevenly microwaved Trader Joe’s items before their kids for dinner and call it a night. They could be the ones who post about their teenagers on TikTok or slap their toddlers in Target when an iPhone camera isn’t in the vicinity.

Or they could just be like most parents, occasionally too tired to read aloud, not hugely interested in seventh-grade algebra or simply not in the mood to play.

It is possible the Better Mothers are no better than the rest of us. Only our children know the truth.

Here we go again….

Yesterday the videos of the beating and ultimate death of Tyre Nichols of Memphis, TN was released. Of course the death loop and endless watching of this will accomplish little to nothing but will be used as evidence in the criminal trials of the four Officers who individually at some level contributed to his death, including clubbing him in the skull, tasing him, kicking him repeatedly and punching him then dragging his unconscious body to sit against the police vehicle and waited over 20 minutes for Medics to arrive. Ah those first responders that we so idolize right?

I write often about Nashville and my negative views of the State and that city in particular. I do want to say that Memphis is not a perfect city and there is immense poverty and of course there have been some hideous crimes that made the news, a serial shooter and the abduction, rape and murder of a Teacher on an early morning jog, but the reality is it is a city like many I have visited, both in the South, the North and the Midwest. And with that I have met amazing people and difficult people and come away with stories and a sense of a place that often is maligned and misrepresented in the media. And Memphis is one. It is a place of SOUL and much like the city down the river in Louisiana, New Orleans, it is complex polynomial. And I have found that in almost all my travels of said cities… Louisville, Cleveland, Baltimore. For the record Detroit has often been portrayed as such, but for the wrong reasons. I will never return there as there is nothing there.

I just returned from a day trip to Philadelphia and with that visited the Barnes Foundation and their Museum of Art to see two exhibits at each; Modigliani at the Barnes and Matisse in the 30s at PMA. Amazing venues, packed to the rafters with lovers of art and amazing individuals who were working the crowds that again lean to largely old white folks with varying ailments, disabilities and overall angst about being in public. A fun crowd. Okay but there were some younger and people of color at the PMA and they were expressing deep curiosity and interest at the art and the stories Matisse was telling in his work. The Barnes.. no. I am not sure that Modigliani was an artist that spoke to them in the way Matisse does in the popular culture. Sad really as he died at age 30 and his work is much more lush and complex than a simple viewing allows. The Barnes had taken X-Rays, Thermal Imagining and used other technologies to uncover a wealth of info and material on the artist. He reused other Artists canvas and painted over their work, he used cardboard and was also a painter who sketched and painted directly on the work only to revise it. Amazing exhibit and brilliant curation. My love of Matisse was only expanded by this exhibit at the PMA but it did not change my adoration that the MOMA accomplished with their amazing exhibit of the Red Studio last year. That will always be my most treasured exhibit as it was a “Where’s Waldo” moment to spot the art and the way the artist used a signature in all his works that at times is obvious and others less so. I learned a great deal so that knowledge came to use when someone asked what a yellow blob was in one work, and I said: “Flowers, Matisse loved flowers and they are in almost all his work these are just an Impressionist view.” And sure enough there were photos of the scene in the studio that showed the vase of flowers in their natural state. I owe that to MOMA.

The day in Philly was cold and I wandered the city and like many metro centers it was dead and many shops and businesses closed. I rode a largely empty subway to familiarize myself with their transit but basically it was an easy walk back to the Station after lunch at a recommended pub in the area. As always the people I met were charming and friendly and the food was well as most – average and expensive. I am becoming disappointed of late with the options of food and the lack of quality with regards to price. I see why the restaurants at the two Museums were packed and required reservations, as again options were few. But walking through Philly I saw charming blocks with restaurants and shops, not yet open but were there giving an indication that there are as always, pockets of activity tucked into corners worth exploring. I look forward to returning.

And I truly did not want to ruin that day with the images in that video, so this morning with my coffee I did and all I really did was focus on the sounds. The young man crying for his Mother, the Cops ranting and breathing heavily, their rage and ramblings and of course the last breaths of Tyre as he begged them to stop and they kept on beating him until there was nothing but silence. You see the red lights and hear the conversations between the Officers debate the condition of the man they have beaten to near death and with that you see others standing around watching, for who or what I am not sure but again it is very reminiscent of the Floyd killing only this is by five men of color repeatedly assaulting a man of color. They use every tool in their arsenal other than a gun, their feet, their hands, their clubs and their tasers. Did they think it was less severe or that a gun shot would be the final nail in THEIR coffin?

I leave it at that. I have little more to add and my rage, anger and sheer confusion about why this continues is not surprising. The protests will be less intense and fewer and we will go back to our homes, to our places of business, our places of congregation and we will do what we always do. Rage and rant and offer thoughts and prayers and nothing will change. Why? We simply cannot get guns out of the equation. No guns were found, nor shots fired and yet here we are, another death by the hands of the Police. They constantly complain they were in fear. I see none of that on display in that video, I see a man being yanked from the car, he being pushed to the ground, him managing to get up and run and they pursue him determined to find him and in turn determined to bring him to his knees. I saw the same video last week with the young Black Teacher on Wilshire in Los Angeles. And I will see it again in another city with another young Black man in the future. America we are a violent dangerous nation, obsessed with crime, obsessed with guns and in turn we see anyone as the enemy. I see the Police as mine but I have for years. I have been the victim of lies by Cops, their pursuit of lies and a Medic who enabled and assisted them in doing so. First Responders are the agents of death not of saviors. They can all go fuck themselves.

The Next Pandemic

The next pandemic will be one with regards to mental health. We already do a piss poor job on that count serving the needs of those seriously mentally ill, let alone those who have struggles with other disorders from Anxiety to Depression. Now that the Mental Industrial Complex have added Grief as a mental health problem more will follow with regards to being handed medications and given little else to find the coping skills needed to manage. Grief is an emotion different for each individual and given the numerous articles and books about how many Children, now adults, are glad that their parents are dead as it shows we have a long ignored the realty of how Parents continue to fuck us over in ways that carry on long past childhood and that exemplify the failure of most parents to be, well parents. Ask Davie Sedaris about that one, or this woman whose essay is quite similar in nature to David’s own.

For the record my Parents sucked and they didn’t. I have long worked past the rage and disappointment and still focus on being grateful that whatever they did wrong or right enabled me to survive this very unconventional life I have been fortunate to lead. I know now I struggle with intimacy and tried too hard and then when I checked out as I always do it is not handled well or I am dumped early on because of it and rather than give a shit I packed my shit and left leaving the mess tidely packed in designer bags and placed in storage until I finally could no longer do so. And with that I know am a one and done and will be super company for a moment, an hour, a minute but I will call it a day and live with that. We all do what we have to to survive, be a day, a week, a month, a year or a pandemic. But the toll is there and there is always that which must be unpacked, tossed or given away in which to fully function.

There is no one size fits all when it comes to how to diagnose and treat mental health. It is why we have so many confusing issues when it comes to understanding the mind, treating the patient and in turn actually “fixing” it in a way that enables an Individual to adjust, adapt and function in a productive manner with regards to society’s expectations on what is “normal.” I have to avoid going off on a tangent about this as frankly it is another definitive that means a specific “type” of behavior, attitude and manner that allows for little deviation by the one providing the definition. Again, who provides the definition controls the narrative and with that the ability to conform or manage falls to those who agree what is “normal” or not. Think about how Gay people were defined? Women defined? People of Color defined? Yeah.

There was an article in the Washington Post about the crisis in public education that has finally realized there is an extensive mental health problem not on the horizon but in fact now. I do feel that more is coming as Children born during the pandemic and are about now two years old should be included as these were born in a panic mode, have witnessed nothing but panic and given the evidence I have seen from 946 below me we have major problems with their parents mental health so their daughter will equally reflect some of that. And with that they are not alone, as many primary caregivers are primary breadwinners, despite the presences of two parents but more critical only one, few other family members active in care, and the pressure to work from home full time, yet maintain education or basic training all while trying to offer organized play. all under this whole mantra of “STAY SAFE” will produce a generation of children, I believe, to be truly mentally unstable. I see the evidence in the Schools, the Streets, in Public, at the Parks how undisciplined and confused they are with regards to order and managing their own behavior and expectations. Those parents who are succeeding are doing so I believe as they simply have worked double time to get their children back on track and usually those are people who have worked in Education or in some type of Medical Care as they are aware of developmental benchmarks and what those mean as Children age.

The privileged set have always had Nanny’s and Private Schools that did not close and with that their children will be as always, privileged. That said the diversity and inclusion issues will not happen as the ways they do so, via sports, music and other extracurricular activities declined and with that the social isolation only furthered that with more and more families relocating, going to home school or again relying on the biggest segregation method – Religion. Churches have understood this dynamic and weathered many a plague and this is no different. The rise in more dogmatic and conservative faith has been noted – particularly among Families of Color. Gimme that old time religion! And why? Because again the lack of AFFORDABLE mental health counselors is a massive issue. And with that the Post article states that both funding and available trained staff are an issue.

****

In many areas, even when money is in hand, hiring is not easy. As this school year opened, nearly 20 percent of schools reported vacancies in mental health positions, according to federal data. Schools often said they employed too few staff to manage the caseload but also complained about difficulties finding licensed providers, the data showed.

“We simply don’t have enough people in our profession to meet the need,” said Kelsey Theis, president of the Texas Association of School Psychologists. When families seek private therapists, “sometimes there’s a wait list of months and months before they get help,” she said.

In Maine, waiting lists grew so long last year that school counselor Tara Kierstead began looking out of state for therapists who had openings — a solution that was not practical for many families.

Surgeon General Vivek H. Murthy called out the “devastating” effects of the pandemic on youth mental health in a public advisory last December. Earlier that year, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association together declared “a national state of emergency” in children’s mental health. They pointed out that young people of color were especially affected and linked the struggle for racial justice to the worsening crisis.

A year later, this October, they sounded the alarm again. Things are not getting better.

***

And with this let’s discuss the mental health crisis that is being played out on our public streets. From coast to coast we are hearing about an immense housing crisis and with that many who are working but living paycheck to paycheck are finding themselves not out pacing inflation and the rising rents thanks to the housing market which rising interest rates have led to more renters, and with that more renters as the multi family market has never struggled to build, one look at Jersey City should confirm that, where as single family housing has. And with that when you struggle to pay bills and support your family the strain shows on all members regardless of age. I do believe that some of the better survivors are those with extended family members and multi age generations sharing a home. From an economic standpoint it enables a stronger base to afford housing and associated costs but also responsibility between the members regarding care and emotional support. It is not always ideal but there has to be ways to look at this and see what we can do to improve it (aka size of home) and in turn how there are ways to encourage access and availability to those without extensive community/family ties. The New York Times has been very active in writing articles about living alone and aging and the risks associated with that, that they had their former writer, Frank Bruni, do an essay on that issue to counterpoint the idea that being alone and aged is detrimental to one’s physical and mental health.

To truly see what is like to age in place there is nowhere better than New York City.  This is a city awash with varying levels of wealth and industry and yet I have never witnessed so many individuals within my peer group age so badly.  It is distressing to note that while all these supposed sophisticates living in the greatest City in the world they do so in simply poor physical and mental health.  I have met few that are mobile and independent without some type of assistance and those that are seemingly independent not functioning at high order.  They have access and availability to attend events, go to varying places in the City and yet getting therapy of some kind is either ignored or manipulated.   The body and the mind are connected folks and there are real problems here with the aging population.

This weekend I attended two Operas, The Hours, based on the book/movie and was created for the Soprano Renee Fleming to return to the MET and Rigoletto, the story of a sad clown which is by far more of a story of being alone and afraid despite the tone of the subject The Hours is about. I cannot say that The House is a complex story as it is and if you have no seen the movie or read the book, the Opera would be a loss. And fo the two this weekend, I adored Rigoletto, hada better seat and was besotted with the cast, they were PERFECTION; Despite the Hours stellar cast, the same could not be said. the story was missing, a theme which through a song would have shown the connection between the women, a use of lyrical hook perhaps may have worked. Again if you had not sen the movie or read the book the story was odd, you have Virginia writing the book, The Hours about Mrs, Dalloway; another woman jokingly called that by her friend and writer as she plans a party for him, and another reading said book while struggling with being a Wife/Mother in search of a “room of one’s own” all in different times in history and place. As they say it is complicated. And while I loved all the women, , they were beautiful and immensely talented there was no emotional connection to any of it. Rigoletto on the other hand… Reviews were mixed and not one person I spoke to liked it. The women in my row left at intermission, there were two men who hated it and raged all the way out, another who did not like a single piece and felt it lacking, and the woman crying on the subway informed me that it was garbage and should never have been made! At least the two women just left without incident, the need to stay throughout not one but two intermissions, and to rage all the way out, on the subway seems to have a a problem with emotional restraint and management. In other words – mental health. And this is visible everywhere, which explains the burst of violence (not just guns but in both verbal and physical assaults.

Texas and Florida have been front and center in the culture wars when it comes to education and with that, I read about Brevard County in Florida and the mass exodus by Teachers and other Staff in the district due to Students uncontrolled behavior.   From masturbating in class to utter disregard and abuse to Teachers during class does not shock me in the least.  I saw similar acts of excess in Nashville when I lived there and I can only imagine the state of the schools now.  I am exhausted trying to explain to Teachers here the way the District alone disrespects Substitutes it is only a part of the reason the Students do.  They model the expectations and behaviors which sends a message to Students to do the same.  I welcome the day when proper introductions are made and I am greeted by name, but that is beyond reach in most schools but it is possible.  Try to imagine coming into someone’s home or they into yours and not being formally introduced or acknowledged.  I guess that is what these people do, just ignore strangers, and hope they take care of the formality.  The reality is that we are invisible and with that it greatly affects my mental health in ways that harken back to the days when I had Traumatic Brain Injury, it is that serious and traumatic.  I have spent days contemplating my mental health and long-term wellness and with that it affects how I see myself and my relationships to others.

During the pandemic being a loner paid off, and I thrived.  Today when out and about I am exhausted being in the company of others.  The endless sense of entitlement you once saw in New Yorker’s has now doubled down.  The extreme rudeness and paranoia are on overdrive.  I have experienced it one time too many in the Theater and until Saturday managed to avoid it at the Opera.  The reality is that many went to see the acclaimed star, they arrived in walkers, wheelchairs, with canes, hearing aids and other disabilities that are so prevalent I cannot imagine why they did not go to a theater to view it on HD simulcast or listen to it on the radio simply for that reason alone.  The man behind me at Rigoletto was stoned eating edibles the entire performance, his friends had never been and were clueless, about the protocol, and they were not young.  They expressed amazement at the seat shuffle that took place, not realizing as the Opera began many were moving seats as now is customary and that many open seats were being sold at a flat $50 dollars to anyone willing to come as the MET day of, as its online site had been cyber attacked so empty seats were for the taking.  It is why I moved immediately once the lights went down and my row did as well to much better views.  I informed them that this is the new Met, sit anywhere and come late they hold the doors for at least 15 minutes for that reason.  Nothing starts on time.   The boxes are equally empty and if you know how to handle that area no one would notice you slipping into one.  Frankly the sight range is poor but the sound is better so it is a tradeoff.  And these two demanded to go to a box immediately.  Dear God. This is common to any coffee shop or bar of late, the endless demands and orders as if they are at home and this is simply an extension of it.    But sadly, this behavior is not confined to New York by any stretch.

Mental health is a problem, the depth and breadth are not fully realized as in reality many have employed coping skills and strategies to make it work, as do I, but this long-range problem is not anywhere near resolution.  Look at Twitter the cesspool of idiocy and hate.  Look at Washington Post comments and see a miasma of cranks, bots and morons writing their brain farts as if they have just composed a modern version of Great Expectations. Do you honestly believe the progeny of these individuals will be mentally sound and capable of handling a crisis let alone daily living?  I do not. And I point to the precious snowflake in  Apt 946 and her psychotic parents as an example of unhinged idiots.  The Mother a massive Karen and her spouse an abusive asshole who threatened me.  These are not model parents in any way. Nor are the ones storming the gates of schools, threatening Board Members, Teachers and Administrators.  I am not alone in the abuse but I am alone and I am having none of it.  And with that I pick and choose my battles but I soldier on. But I am afraid, very afraid. And I agree with this essay from this EMS Tech we are nowhere near fixing what is now, let alone what is coming.

I’m an N.Y.C. Paramedic. I’ve Never Witnessed a Mental Health Crisis Like This One.

Dec. 7, 2022 The New York Times Guest Essay

By Anthony Almojera

Mr. Almojera is a lieutenant paramedic with the New York City Fire Department Bureau of Emergency Medical Services and the author of “Riding the Lightning: A Year in the Life of a New York City Paramedic.”

There are New Yorkers who rant on street corners and slump on sidewalks beside overloaded pushcarts. They can be friendly or angry or distrustful. To me and my colleagues, they’re patients.

I’m a lieutenant paramedic with the Fire Department’s Bureau of Emergency Medical Services, and it’s rare to go a day without a call to help a mentally ill New Yorker. Medical responders are often their first, or only, point of contact with the chain of health professionals who should be treating them. We know their names and their routines, their delusions, even their birthdays.

It is a sad, scattered community. And it has mushroomed. In nearly 20 years as a medical responder, I’ve never witnessed a mental health crisis like the one New York is currently experiencing. During the last week of November, 911 dispatchers received on average 425 calls a day for “emotionally disturbed persons,” or E.D.P.s. Even in the decade before the pandemic, those calls had almost doubled. E.D.P.s are people who have fallen through the cracks of a chronically underfunded mental health system, a house of cards built on sand that the Covid pandemic crushed.

Now Mayor Eric Adams wants medical responders and police officers to force more mentally ill people in distress into care. I get it: They desperately need professional help and somewhere safe to sleep and to get a meal. Forceful action makes for splashy headlines.

People with mental health challenges can be victims of violence. I’m also painfully aware of the danger people with serious mental illness and without access to treatment can pose to the public. Assaults on E.M.S. workers in the New York City Fire Department have steadily increased year over year. Our medical responders have been bitten, beaten and chased by unstable patients. A man who reportedly suffers from schizophrenia has been charged with fatally stabbing a colleague of mine, Capt. Alison Russo-Elling, in Queens on Sept. 29.

But dispatching medical responders to wrangle mentally disturbed people living on the street and ferry them to overcrowded psychiatric facilities is not the answer.

For one thing, the mayor is shifting more responsibility for a systemic crisis to an overworked medical corps burned out from years of low pay and the strain of the pandemic. Many E.M.S. workers are suffering from depression and lack adequate professional mental health support, much like the patients we treat. Several members of the Fire Department’s Emergency Medical Services have died by suicide since the pandemic began, and hundreds have quit or retired. Many of us who are still working are stretched to the breaking point.

I’ve gone down the road of despair myself. The spring and fall of 2020 left me so empty, exhausted and sleepless that I thought about suicide, too. Our ambulances are simply the entrance to a broken pipeline. We have burned down the house of mental health in this city, and the people you see on the street are the survivors who staggered from the ashes.

Those who are supposed to respond and help them are not doing well, either. Since March 2020, the unions that represent the Fire Department’s medical responders have been so inundated with calls from members seeking help that we set up partnerships with three mental health organizations, all paid for by the E.M.S. F.D.N.Y. Help Fund, an independent charity group founded and funded by medical responders and the public through donations to help us out in times of crisis.

We need to sift through the embers and see what we can salvage. Then we need to lay a new foundation, put in some beams to support the structure and start building.

What New York, like so many cities around the United States, needs is sustained investment to fund mental health facilities and professionals offering long-term care. This effort would no doubt cost tens of millions of dollars.

I’m not opposed to taking mentally ill people in distress to the hospital; our ambulances do this all the time. But I know it’s unlikely to solve their problems. Hospitals are overwhelmed, so they sometimes try to shuffle patients to other facilities. Gov. Kathy Hochul has promised 50 extra beds for New York City’s psychiatric patients. We need far more to manage those patients who would qualify for involuntary hospitalization under Mr. Adams’s vague criteria.

Often, a patient is examined by hospital staff, given a sandwich and a place to rest for a few hours and then discharged. If the person is intoxicated, a nurse might offer a “banana bag” — an intravenous solution of vitamins and electrolytes — and time to sober up. Chances are the already overworked staff members can’t do much, if anything, about the depression that led the patient to drink or take drugs in the first place.

Let’s say a patient does receive treatment in the hospital. Mr. Adams says that under the new directive, this patient won’t be discharged until a plan is in place to connect the person with ongoing care. But the systems responsible for this care — sheltered housing, access to outpatient psychiatric care, social workers, a path to reintegration into society — are horribly inadequate. There aren’t enough shelters, there aren’t enough social workers, there aren’t enough outpatient facilities. So people who no longer know how to care for themselves, who need their hands held through a complex process, are alone on the street once again.

A few days ago, I treated a manic-depressive person in his late 30s who was shouting at people on a subway platform in Downtown Brooklyn. The man said he’d gone two years without medication because he didn’t know where to get it. He said he didn’t want to go to a shelter, and I told him I knew where he was coming from: I was homeless for two years in my early 20s, and I slept in my car to avoid shelters; one night at the Bedford-Atlantic Armory was enough for me.

I persuaded the man to come with me to Brooklyn Hospital Center and made sure he got a prescription. Whether or not he’ll remember to take it, I don’t know.

While I don’t know how forcing people into care will help, I do see how it will hurt. Trust between a medical responder and the patient is crucial. Without it, we wouldn’t be able to get patients to talk to us, to let us touch them or stick needles filled with medications into their arms. But if we bundle people into our ambulances against their will, that trust will break.

Also, medical responders aren’t equipped to handle standoffs with psychiatric patients. In my experience, police officers are not keen to intervene with the mentally ill. They don’t have the medical knowledge to evaluate patients. So who is going to decide whether to transport them? What if we disagree? Protocol has been that the E.M.S. workers make the decision. Will the police now order us to take them? I can only imagine the hours that medical responders and cops will spend debating what to do with patients.

Rather than look for a superficial fix, Mr. Adams should turn his attention to our neglected health care apparatus. We must heavily invest in social services, housing and mental health care if we want to avoid this ongoing tragedy. We need this kind of investment across the United States, where there has been a serious mental health crisis since the pandemic began. My contact with New York City’s mentally ill population over the years and my own brushes with depression and homelessness have taught me we are all much closer to the abyss than we think.

Dumber and Dumber V19

The endless stories of the should of, would have, failed to and help me I think I’ve fallen and can’t get up stories of those who have contracted Covid, become violently ill, died, failed to get vaccinated in time, rejected said vaccine or simply are just members of the Doomsday Cult. Why do all these people seem to reject expert testimony, from their own Physicians, Medical experts or people in the field of Science. Suddenly they are all these armchair Jeopardy contestants who seem to be experts on viruses, vaccination development and of course all things complicated like Science. I am sick of this shit and not in a Covid way and this and these people are a sad lot; Not sad in a sympathetic or empathetic way, just sad in that they are all part of our failed attempt at Democracy by providing public education that failed them and us as a country. I once again blame the Voodoo President Reagan for this as we are now bypassing his era and moving into cool retro Joe Biden era of the late 60s and all that came from that time in history.

So to recount the current sad sack stories I read the story printed below in the Washington Post today, and over 1K in comments were posted, to the point they are closed; to note, few if any were supportive, let alone compassionate. I turned it into a joke forum about Christian Dating Sites as clearly those are ones to not only socially distance from but like the Churches they populate, physically distance from. Name a church that has not been involved in a plague of some kind throughout history. And of course more jokes about how I like my truth, negative as I have been told, and yes the truth hurts, not like a tube shoved down my throat. But hey, I like “my truth” like I like my Covid tests – NEGATIVE – much like I like my booze, ice cold and a double shot. But even the dogs were not willing to touch that body, they say they can detect Covid, clearly a little late on that one. But hey they don’t have it so no human to animal transmission, yet. Do they have a rabies like shot for them only for Covid? Dog bites no one but the owner sure bit it. And like Ron DiSantis, Trump, Condos, Jeffrey Epstein, all things in Florida eventually do bite it. Care for an orange slice?

**thank you I will be here all weekend, tips are always welcome**

As Mr. T used to say, I pity the fool. Here are two fools minus one.

Wife hospitalized for covid gets home to find husband dead from the same virus: ‘It was like walking into a horror movie’

By Andrea Salcedo The Washington Post August 27 2021

Lisa Steadman could not wait to go home to her husband.

The nail technician had spent more than a week in a Central Florida hospital recovering from a serious case of covid-19 while Ronald Steadman, who had also contracted the coronavirus, battled a milder case from home.

During many of their check-in phone calls, she relayed to him how scared she was of dying alone in the hospital.Her health was improving and so was his, he reassured her. Soon, they’d be back together at the Winter Haven, Fla., home they were in the middle of renovating.

But Ronald, 55, did not appear to be home when Lisa returned Aug. 11.

“Ron? Ron?” Lisa,58, yelled while searching for him throughout the house.

Eventually, the barking of their three dogs led her to their bedroom.

When Lisa cracked open the door, she found Ron unresponsive on his side of the bed and their three dogs in distress. By then, his body had already begun decomposing, she told The Washington Post. The dogs looked as if they had not been fed or given water for at least two days, she said.

“I just went hysterical,” Lisa said. “It was like walking into a horror movie. That’s what I see now when I think of him.”

Neither Ron, who died of covid-19 complications, nor Lisa had been vaccinated, Lisa said. Both had agreed they would wait longer to schedule their shots. Lisa rarely got sick and left her house only for work, and Ron, who was in charge of running the couple’s errands during the pandemic, always wore his mask and stayed away from large crowds, Lisa said.

“Both of us thought that [the vaccine] came out so fast. How could they have done so much testing on it? I was just cautious about it,” she said. “It’s not that I was against vaccines.”

The couple, who met through a Christian dating website after losing their previous partners, were part ofthe tens of millions of Americans who have not yet received at least one dose of a coronavirus vaccine, which are available free to anyone 12 and older. Like the Steadmans, many people remain reluctant about the shots. Others have put off getting inoculated.

Nearly 52 percent of Floridians are fully vaccinated, according to data compiled by The Post. In the past week, new daily reported cases and deaths in the state rose nearly 10 and 66 percent, respectively, The Post’s coronavirus tracker data shows.

Health officials continue to stress that the vaccines significantly lower one’s chance of becoming severely ill or dying of the virus as the highly transmissible delta variant spreads across the country.

Ron, a mechanical and electrical engineer, was the first one to test positive Aug. 1, Lisa said. Doctors at the urgent care site he visited sent him home with medications and asked him to return if his condition worsened. Two days later, Lisa, who had gone to the emergency room because she started exhibiting symptoms, also tested positive. She was sent home, only to return days later after her oxygen levels dropped to 80 percent and she lost consciousness at home.

The couple kept in touch throughout much of her hospital stay, Lisa said. How are the dogs doing? How do you feel today? Have you called your family? Lisa said the couple would ask each other. After nearly a week in the hospital, Lisa reported feeling better. Ron was also improving, she said.

Days before she was expected to be discharged, Ron told her that his phone was not working properly. At one point when Lisa could not reach him, she called the Winter Haven Police Department to go check on him, she said.

Police called her back to report that her husband was doing fine, which the department confirmed to The Post. So when her phone call went straight to his voice mail Aug. 10, Lisa didn’t think much of it, she said. After all, Ron had said his phone wasn’t working and was known for being a deep sleeper. Police had already reassured her that he was doing okay. She told herself they would be reunited the next day when she was discharged.

“I thought he was just going to be fine and that his phone wasn’t working,” she said.

Local authorities later told her that he was likely already dead.

Lisa, who would have celebrated her fourth wedding anniversary with Ron on Oct. 28, said she expects to get vaccinated in September — a decision she had already made before leaving the hospital.

She has been hurt by comments on social media criticizing her decision not to get the vaccine earlier.

“I did what I thought was best for me,” Lisa told The Post. “Even if you don’t agree with me that I didn’t get the shot earlier, you don’t say, ‘I bet you wish you would have gotten the vaccine so your husband wouldn’t be dead.’ ”

She added: “We wanted to make sure [getting vaccinated] was safe.”

She plans to finish the home the couple were remodeling in honor of her husband. That’s what he would have wanted her to do, she said.

“That was Ron’s dream,” Lisa told The Post.

4 Stars****

This is the symbolic rating number we often assign to people, places, or things that have some how excelled with service by design or by nature. We love rating systems and it allows us all to be judgemental reviewers without recourse or requirement in which to substantiate our opinion. We can lie, we can exaggerate, we can tell the truth but again it is only our own completely and totally objective belief that we are right and this is deserved, be it good or bad. Okay, that is why I never use YELP or any other review system as who the fuck are you and how do I know this is legit. For years we have faced that same bullshit on Amazon and just for laughs I ordered a light bulb from one company on Amazon and another on Light Bulbs plus. The one on Amazon was 60 bucks, the one on Light Bulb was 20. They were identical. To return it I had to jump through many hoops in which to do so as the vendor in Amazon was well not legit in the least. I showed Amazon the bulb, photos of them, links to Lightbulb plus and that was that. Not the first time not the last, well maybe, I hope.

So reviews unless they are in valid sources of information such as newspapers and journals I have no time for. Your Uncle Williams love of the BBQ joint down the street is great but I can make up my own mind. And I have disagreed with many professional reviewers in my day but that is what free minds do, they don’t think alike. And I have often disregarded reviews to find that I may or may not agree but again, free will, free choice. However there are times when you realize that this rating system may be gamed and when it applies to Nursing Homes I have to wonder who is rating them? Well it appears they are doing it themselves. It may explain a lot. They did not need Andrew Cuomo at all to send the sick in there to die, they were managing quite well on their own.

This article, Maggots, Rape and Yet Five Stars: How U.S. Ratings of Nursing Homes Mislead the Public, from the New York Times goes into questioning the practice of the rating system to assist those in finding a home to shove Granny right after you get that conservatorship taken care to make sure the money train is not going the wrong way! If they don’t manage to kill her then a cruise is always available.

And because of that investigation the State of California is suing Brookdale Homes. Gosh it took this thing called a newspaper to do what the State should have been doing all along. And to think you folks hate mainstream media. Do you love it less than your Grandmother?

The article states: The lawsuit is among the first of its kind to accuse nursing homes of submitting false information to Medicare’s ratings program. The system assigns stars — one being the worst, five being the best — to the nation’s more than 15,000 nursing homes.

The system is powered by largely unaudited data submitted by nursing homes, including the amount of time that nurses spend with residents, and in-person examinations by state health inspectors.

And this is not the first time such institutions have faced similar investigations, largely for Medicare fraud as killing old people is good money. Philip Esformes, who operated a chain of nursing home facilities in South Florida, was sentenced to 20 years in prison Thursday after he was found guilty of defrauding Medicare and Medicaid through a scheme of kickbacks and money laundering in what the U.S. Department of Justice​ said is the largest healthcare fraud case in U.S. history.

Or this nursing home:

Owners of a nursing home chain with ties to Beaver County will pay nearly $15.5 million to settle claims the company provided needless rehabilitation in an effort to meet financial goals.

Guardian Elder Care Holdings, based in Jefferson County and owned by Peter Varischetti, settled with the federal government last week following whistleblower complaints it provided unnecessary rehab therapy to residents – some with dementia or in hospice care – to make money, overlooking clinical needs of patients.

The company owns more than 50 nursing homes in Pennsylvania and neighboring states, including Beaver Elder Care and Rehabilitation Center in Hopewell Township.

Or how about these whistleblowers who told on their bosses:

Between January of 2010 and April of 2012, Benjamin Monsod was a nurse assessment coordinator at Longwood’s Montrose Healthcare Center. In this position, also known as MDS coordinator, he was charged with designing care plans for residents; a task that likely allowed him to detect fraudulent billings based on inappropriate care plans and unnecessary rehabilitation therapy sessions.

According to the lawsuit filed by Monsod and Boyce, “Through his employment at the Montrose facility, Mr. Monsod gained first-hand knowledge of the fraudulent scheme.” Monsod is currently an MDS at the Casitas Care Center, a California-based SNF.

A Kansas, resident, whistleblower Judy Boyce worked at the Golden Living Center in Cottonwood Falls, Kansas, between 2004 and 2010, first as a Social Service Director and later as the facility’s Executive Director. 

The Cottonwood Falls Golden Living Center is owned by Aegis, a company that is also a defendant in the lawsuit. Aegis provides skilled nursing services for many Longwood operated facilities. According to the Boyce-Monsod lawsuit, “Through her employment at the Cottonwood Falls facility, Ms. Boyce gained first-hand knowledge of the fraud.”

Whistleblower Keith Pennetti has been the Director of Operations for California at RPM Rehab since 2012. A physical therapist by training, Pennetti was described by one of his employers as “an industry leader in rehabilitative medicine for over 20 years,” and an expert in “compliance training.” Undoubtedly, Mr. Pennetti, was also in an ideal position to detect fraudulent behavior by the defendants. 

Or here:

A secret internal investigation of fraud at Indiana’s largest nursing home system alleges more schemes, more conspirators and far greater financial losses than anything previously disclosed.

After the FBI raided the office and Carmel home of then-American Senior Communities CEO James Burkhart in 2015, Burkhart and four associates were charged. They pleaded guilty in 2017.

Federal prosecutors said the five men set up shell companies to inflate costs and pay themselves kickbacks on vendor contracts for landscaping, food, medical supplies and more. In all, $19 million was stolen, prosecutors said.

From the Washington Post:

For-profit nursing home providers that have faced accusations of Medicare fraud and kickbacks, labor violations or widespread failures in patient care received hundreds of millions of dollars in “no strings attached” coronavirus relief aid meant to cover shortfalls and expenses during the pandemic, a Washington Post analysis of federal spending found.

More than a dozen companies that received federal funding have settled civil lawsuits in recent years with the Justice Department, which alleged improper Medicare billing, forged documents, substandard care and other abuses.

The companies repaid the government a total of more than $260 million and nearly all are under active corporate integrity agreements with the inspector general of the U.S. Department of Health and Human Services — the same department that distributed the payments under the Coronavirus Aid, Relief, and Economic Security Act, or Cares Act. The five-year agreements require independent audits, employee training and other enhanced reporting protocols.

This story in the Guardian tells how the quest for profit is what is killing the industry and your Grandmother. Largely it is due thanks to the Vulture Capitalists who seem to think flipping homes is another great way to make money, fuck the old.

Flipping, or the buying and selling of nursing homes with the purpose of turning a quick profit, is exceedingly common. Once dominated by individual, family-owned non-profits, over the past few decades the industry has experienced the penetration of for-profit corporate ownership leading to an increase in facility sales and contributing to the overall uptick in closures across the US – more than 550 nursing homes (out of a total of 15,600) have closed since June 2015.

Again in that blog post I wrote about Women and Aging we are the group most likely to end up fucked and in the cold. If we live that long. And nursing homes are not just for old but for those who need assistance in living and caring for themselves after surgical procedures. What many families do is think it is temporary and that their family member can get the care and rehab they cannot provide at home, not realizing that few if any staff are available, capable and able to provide the care and service one needs. And that there are services now with Nursing associates who can come to your home and do so. I hired one after my surgery and in many cases this is covered under insurance plans and Medicare. Staying home is the best revenge, you live. But then again who wants Granny living with them, she’s old and shit.

Mother’s Day

As we acknowledge or celebrate Mother’s Day we have to remember that not all of us commemorate or even recognize the woman who was our Mother for many they lost her early in life, she chose to give you to another family and offer that celebration to another and those whose mother was not present even when they were in the same room, this day has many meanings.  But perhaps this story illustrates the reality of neglect and abuse by the Medical Industrial Complex who has proven during this pandemic to be ill prepared let alone well equipped to handle the onslaught of patients and the demands upon a system that is about access and availability. And for many they have neither. This is one Mother’s Day story about just that.

New York mother dies after raising alarm on hospital neglect

Amber Rose Isaac died less than four days after tweeting that she should write an exposé on ‘dealing with incompetent doctors’

Alexandra Villarreal in New York
The Guardian
Sat 2 May 2020 12.39 EDT

Amber Rose Isaac tweeted on 17 April about how she would write an exposé on “dealing with incompetent doctors” in the Bronx while pregnant with her first child.

Less than four days later, she was pronounced dead after a caesarean section went wrong. She died alone as New York City battled with coronavirus.

“All of this was 100% preventable. All of it,” said Bruce McIntyre III, Isaac’s partner. “I feel like she would have got more attentive care if she was a white mother, to be completely honest with you.”

In an interview with the Guardian, he described a pregnancy riddled with neglect by rude and unprofessional staff at the Montefiore Medical Center, who he said ignored Isaac – a 26-year-old black, Puerto Rican New Yorker – even as she reached out to them during her final weeks.

“We know she did all that she was supposed to do, right?” said Dr Joia Crear-Perry, founder and president of the National Birth Equity Collaborative. “And she’s not the only one. That’s the story of the black maternal mortality issue across the United States.”

The City, an independent, nonprofit newsroom, first reported Isaac’s death. Spokespeople from Montefiore did not return the Guardian’s request for comment.

In New York City, black women are nearly eight times more likely to die from pregnancy-related causes than white women. Latinas in the metropolis – especially Puerto Ricans – also face higher risks of life-threatening complications during childbirth.

“Unfortunately, what I see when I look at Amber Rose’s case is a beautiful young woman who fell through our big, gaping hole of a healthcare system,” Crear-Perry said.

Maternal care has continually failed all women in recent years, with maternal mortality rates devastatingly high compared to similarly well-off countries. But the crisis has disproportionately burdened black mothers, who are exponentially more likely to die from conditions related to or aggravated by pregnancy than their white and Hispanic counterparts nationwide. And, as Covid-19 overburdens already under-resourced hospitals and complicates how women give birth, experts fear pre-existing problems may get worse.

Isaac died in the same hospital where her mother has worked for 25 years, after switching Montefiore facilities because she felt so mistreated at her original branch, under the care of a doctor she had known since she was a teenager.

“Implicit bias, racism, being very dismissive of people that look like Amber, making assumptions,” said Angela D Aina, interim executive director of the Black Mamas Matter Alliance. “This is the result.”

Isaac developed HELLP syndrome, a pregnancy-related condition that only proves fatal for “a small number of women” – if they go without treatment, according to March of Dimes, a nonprofit focused on mothers and babies.

“It’s definitely not something that people in the United States generally die from,” Crear-Perry said. “If you are a person who has been receiving prenatal care and people are aware that you have something going on, it’s not a surprise, you’re able to manage it with treatment.”

Around 60% of pregnancy-related deaths are preventable, according to the Centers for Disease Control and Prevention.

As early as February, Isaac knew her platelet levels – which help blood clot – had started to drop. But because of the pandemic, her routine doctor’s visits turned into conference calls over Zoom, where she answered a few screening questions and checked her blood pressure.

Isaac got updated bloodwork because she decided she wanted to hire a doula or midwife for an at-home delivery during the pandemic, partially because she felt so neglected by the system, McIntyre said. But she was labeled too high-risk and needed a surgeon after she discovered her platelet counts were still falling.

Isaac tried to raise the alarm and figure out what was happening, but her medical team at first ignored her calls. When she finally had blood work done and was later admitted to the hospital, she entered scared and alone – neither her mother nor McIntyre was initially allowed to join her.

She died on 21 April, after being induced more than a month early, then rushed into an emergency C-section. The surgeon she had been assigned wasn’t present.

Aina said there has been an uptick in C-sections during the pandemic, after years of advocacy campaigns against the invasive surgery’s rising rates.

Now, Isaac’s newborn Elias will live in an apartment that was meticulously planned for him by a mother who will never get to be a part of it.

“It’s very hard being in this home and imagining her here with us,” McIntyre said. “She never got to even meet him. She never got to see him. And she was just so thrilled about having hi

The Winning Ticket

Everyday the crazy daily lottery announcements by Cuomo in New York and Murphy in New Jersey has become at one point de rigueur watching then loathing by many who have become immune to the daily Colbert show graphics, the scolding and of course the sibling Cuomo rivalry.  From the absurd threats and faux tears over deaths of citizens that on a daily basis these men would give two shits about is now passed the point of absurd. This is now in month two, entering month three and the jig is up. You are fucked and you know it. What they believed that it would somehow move or compel the federal government to finally step up and take leadership has failed, then it went into a way of insuring compliance by scaring the public shitless, has now become a type of cheerleading performance art.  This is another way of manipulating the public into believing they are the reason and are heroes due to their social distancing aka home imprisonment as they have nothing else.   Basically it is men doing what they do best – coercing compliance and consent in order to fuck you.

I was led to an article about the Jersey City Mayor who is opening the city up for no other reason that he needs to get business and in turn money into the city coffers.  If they stay closed much longer there is less likelihood they will ever reopen and in turn those closures will kill more lives than Covid in the long run.

The true measure of what this pandemic is is about the death rates and how they are in relation to normal death rates at any given time and what extrinsic factors contribute to rises and falls in a population due to any number of variables.    Chicago could use shooting deaths or say Ohio Opioid related ones that affect a cohort in higher numbers over another.  AIDS was perhaps the largest one I recall in my generation but we have had others such as 9/11 that led to an uptick in death  long after the attack due to deaths by illnesses suffered by first responders, including suicides.  And Covid appears to share that but in this case may cities are counting all dead as Covid related and that artificial count is somehow to include those who died but were not confirmed as that as cause of death and those who for whatever reason died and is believed may not have, but due to Covid and the push at hospitals, led them to die sooner than expected.  Sure that is a good idea, not at all.

And lets talk briefly about testing. Again in the article with Jersey City Mayor there is a requirement that front line Municipal workers must be tested every two weeks, there is no given number of how many that is but each week that must be a significant number which in turn is counted again and again against overall tests and the negative and in turn positive numbers that never seem to die off (pun intended) which means that it is front line “essential” workers contributing to the large number of positives as few are tested without meeting criteria otherwise. Then add to that any retests and follow up tests for those who did test positive and have to return to verify that they are now past the contagion stage which also means 14 days following recovery.  How many of those are tested and what are their results? Are they finding them all negative now or are they still positive?  And in turn what percent/proportion of those allocated tests given to them.   So again how many people in need or desire of wanting to be tested regardless of symptoms are being tested again that are not municipal employees or follow ups?

As we move on with this disease that is clearly problematic we are going into the unknown but again the data lovers can rely on one number that cannot be denied – total deaths.  Regardless of the way the  individual died we have a total death number for a period so that may be the clue in what it means to move forward.  If I hear one more comparison to fucking 1918 I will throw on my suffragette gown to rally for women to vote.  We are in the 21st Century with much more effective means to communicate, a robust global medical field of scientists, universities and companies that have this virus/drug thing as a full time occupation and in turn we are also supposedly better educated and in turn aware of our surroundings and long term needs so I don’t get why we are still talking about 1918. Even I wasn’t alive then.  So lets work with what we have – FACTS. Oh those are the real problems here we don’t have those but we do have the dead, so they do tell tales.

The metric that could tell us when it’s safe to reemerge

May 4, 2020
The Washington Post

By:  Jeremy Samuel Faus, an emergency physician in the Division of Health Policy and Public Health at Brigham and Women’s Hospital in Boston and an instructor at Harvard Medical School. Carlos del Rio, a professor of medicine and global health at Emory University. The views expressed are solely their own.

There’s a metric that can indicate when it is safe to reopen society that does not depend on politics or guesswork. It’s called excess mortality.

Excess mortality is the number of deaths from any cause that both occur in a given time period and surpass the expected number. Deaths in the United States have been carefully counted for more than a century. These “all-cause mortality” numbers are extraordinarily stable. We know to a remarkable extent how many Americans are expected to die every day.

As The Post reported Saturday, there were an estimated 37,100 excess deaths across the United States in March and the first two weeks of April — nearly 13,500 more than are currently attributed to covid-19. The number of such deaths can be useful in indicating when the coronavirus threat may be less potent.

Remember, excess mortality is a metric that does not depend on the number or percentage of positive SARS-CoV-2 tests. Those statistics depend on policies: How many tests are being done, and on whom? Similarly, the “case fatality rate” of confirmed or suspected cases of covid-19 is subject to forces resulting from testing decisions.

Excess mortality does not depend on counting the number of covid-19 deaths, which ultimately relies on the subjective opinion of physicians and medical examiners proffering their best guesses on death certificates (and whose minds might be understandably steered by the day’s news — “Did this patient with advanced cancer die of the coronavirus, or with the coronavirus?”).

In graphs that track the number of deaths per week, month and year, entire generations blend into the next. For years, nothing much seems to happen. Then there’s an unusual rise in deaths, say, among young men in the 1990s. It tapers off by the end of the century. There’s a sudden spike in New York and New Jersey in September 2001. Mostly, though, the death counts drone on with the march of time, without much deviation and without fail.

These graphs make visible the mundane reality that death is a part of life, quantified. They also show when something unusual is happening. In Massachusetts, for example, the week-to-week data show that this year began like usual. Then, on the week ending March 29, there was a blip: 10 percent more deaths than the usual number. Nothing unprecedented, but it looked like a fluke. Rates returned to normal the next week.

Then history began to unfold in the graphs. The following week, 11 percent more deaths occurred than expected. The next week, 35 percent more. The week after that, there were 73 percent more deaths than normal. Then the number climbed again, to 119 percent more deaths than expected. By April 19, there had been 2,946 more deaths than expected since the beginning of March. By then, the state had reported 1,800 deaths from the coronavirus.

Now, are these undercounted deaths directly caused by covid-19? Did they occur indirectly due to covid-19, because patients who needed medical attention were scared to seek it?

The reliability of excess mortality lies in eschewing this question. Put another way, using excess mortality as a barometer of this pandemic involves being deliberately agnostic to such questions. Excess mortality cares not why anyone died. It simply observes the fact.

This is also why excess mortality presents an unusual opportunity. By closely monitoring excess mortality, which is occurring all over the United States, it is possible to determine when it is safe to reopen the economy and when is too soon.

As long as excess mortality rates are observed, the effect of SARS-CoV-2 remains too substantial to return to normal. Conversely, as excess mortality abates, it’s possible that physicians will continue to observe that some people who die have also tested positive. Even so, if death rates remain at expected levels, the virus is not posing an unusual threat to our normal way of life.

This will be especially potent if new cases spike in several months. Many cases may occur in people who — knowingly or not — already had the virus. If this coronavirus behaves like other respiratory illnesses, second exposures should be milder. If most people who test positive in the coming months have already had the virus, the death rate will be very low — assuming that our immune systems behave as expected. Excess mortality rates would therefore be indispensable in helping health officials to contextualize future spikes in covid-19 cases.

Excess mortality should form the core of evaluation around reopening the economy. Excess mortality can, however, lag behind caseloads because covid-19 deaths start cropping up a couple of weeks after infection, so comprehensive testing is still necessary. Without tracking excess mortality closely, there is a risk that officials might see the results of universal testing and interpret a handful of new cases as bigger threats than they truly are. This could paralyze society for too long.

While excess mortality information in the absence of adequate testing could inform policymakers that another shutdown is necessary, such information might come too late to prevent another major outbreak. Employing these tools together, however, would allow us to determine whether this pandemic has subsided — and likely detect any resurgences.

Really? I know

I have never heard more histrionics about anything like Covid and all of it from men other than Dr. Bix who basically did what I have done all along, blame Millennials. Their sheer lack of understanding, grasping that actions have repercussions led to a larger spread and in turn contributed to ultimately some of the draconian lockdowns that have occurred. And that also goes for the larger non-secular communities of Orthodox Jews that have had over the years been plagued with varying problems resulting from being so insular, so prohibitive of modern science including vaccinations and  tolerating any Governmental interference yet willing to exploit it in the running of their communities and doing so without regard to many laws that are outside of their beliefs.  And today they struggle with the current restrictions relating to the pandemic.  Then there is the reticence to do so as the fear of being declared Anti-Semitic has apparently more weight than compliance to the law.  And in turn they are a community being hit hard by the virus. 

As a result to not appear as such we all suffer and it goes for the areas of Newark and Brooklyn in New York that have had repeated parties and larger gatherings broken up and again as they are communities of color it is even more disturbing to realize how few heed the message and reject it because of the history of repression and violence by law enforcement which contributes largely to this.

In the meantime we are being warned, scolded, reprimanded and told repeatedly to stay safe. Okay then I got it I really did so no matter what I do to change my behavior it is never enough unless I go into full on lockdown and rely on strangers to do what I can do for myself and then what? Wait and wait some more?   We don’t know shit and we can live in respect and in caution but we need to do so with knowledge not fear.  Fear prevents us from knowing Strangers who once could be friends.

Newsweek
Why the COVID-19 Death Forecasts Are Wrong
Hannah Osborne
April 21, 2020

Models forecasting death tolls are inaccurate, but they are good to help inform policymakers about resources needed and when lockdown measures could be reduced. Forecasts predicting the total number of deaths from COVID-19 may be wildly inaccurate because we do not know key information about the virus. This includes how many people have had it, whether people who recover will develop lasting antibodies to protect from it, how well people are observing social distancing measures—and how long they will be willing to do it for.

“Even though there’s a huge amount of resources being poured into modeling… [the forecasts are] going to be wrong,” said Irwin Redlener, Professor of Health Policy and Management and Pediatrics at the Columbia University Medical Center, who is currently working on the coronavirus pandemic.

At the start of April, Deborah Birx, the response coordinator on the White House Coronavirus Task Force, said models indicated the U.S. would be facing between 100,000 and 240,000 deaths from COVID-19—even if mitigation guidelines were followed. It was not clear where this figure came from, and shortly after reports emerged that a number of White House officials had questioned this death toll. In an interview with the radio station KVOI, Robert Redfield, director of the U.S. Centers for Disease Control and Prevention, said this forecast had assumed only around 50 percent of the public would observe social distancing recommendations, when actually most were adhering to them.

On April 9, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said the total death toll would likely be far lower than the initial White House estimate. “It looks more like the 60,000 [figure] than the 100,000 to 200,000,” he told NBC’s TODAY Show. “But having said that, we’d better be careful that we don’t say, ‘OK, we’re doing so well we could pull back.'”

This figure from Fauci is more in line with the widely cited forecast from the University of Washington’s Institute for Health Metrics and Evaluation (IHME). At present, this model suggests that by August 4, there will have been 60,308 coronavirus deaths in the U.S.—with a range of between 34,063 to 140,145. At time of writing, the Johns Hopkins University tracker has recorded 788,000 cases in the U.S., with 42,364 deaths. The IHME model says the country is six days past the peak number of deaths.

Redlener said that the issue with models is they come up with an answer to a question, such as what the fatality rate is, or when the apex of cases will be. “The problem is forecasting is increasingly inaccurate because of the variables,” he told Newsweek. “[They] come up with an answer, but the answer does not necessarily reflect specificity, because of the assumptions that go into the formula. If you put in uncertain numbers and assumptions that can’t really be proved, the conclusions are not necessarily accurate.”

There are many uncertainties with COVID-19. One of the big uncertainties is whether people can be reinfected with the virus. Anecdotal evidence appears to suggest they can. South Korea’s Centres for Disease Control and Prevention said 163 people who had recovered from the coronavirus had retested positive, although this may have been the tests picking up on the remnants of the virus, rather than a new infection. Another preliminary study that had not been peer reviewed found a third of people who had recovered from the virus had low levels of antibodies, potentially highlighting a risk of reinfection.

Research on the virus itself is also raising more questions than are being answered. Scientists at the U.K.’s University of Cambridge say they have identified three different types of the virus—A, B and C. A was the type closest to the coronavirus found in bats. B was the predominant variant in Wuhan, China, where the virus was first identified. C was the “daughter” of type B and was mainly found in Europe. A number of pre-print studies have also suggested the virus can and is mutating.

“This is a new virus that people haven’t been exposed to before,” Redlener said. “There’s a lot about its behaviour that we don’t know, and a lot about the way humans react to it. People will develop antibodies, but we don’t know for how long those antibodies will be viable and will protect people from getting reinfected. If we don’t know that, it’s very hard to predict when and if we’ll get a second wave and resurgence.”

There are also huge questions about how many people have been infected. It is thought many people who get COVID-19 are asymptomatic, but are still able to spread it. One pre-print study from Stanford scientists suggested the rate of infection may be 85 percent higher than is being reported. The true number of how many people have been infected can only be determined with large-scale testing.

It is this incomplete information that is being used to feed the models. “You may make an assumption today but you’ll get more data in a couple of days that will change the assumption,” Redlener said. “The input data for the models are really inaccurate—or at least incomplete and that creates a problem for the conclusions reached by the modelers. It’s extremely complicated and I don’t know what’s going to resolve this except more modeling and more following trends. The predictability of where we’re going is extremely complex and inaccurate.”

Jeffrey Shaman, Professor of Environmental Health Sciences at Columbia, who works on developing COVID-19 models, said one area where data is lacking is the way people are practising social distancing and how they have changed their behavior. Another problem is more systematic: “I think the biggest frustrations are the inherent delays in the system—transmission today results in confirmed cases 10 to 16 days later—and the lack of a coherent, identifiable national approach to control,” he told Newsweek. “This makes the situation very fluid and hard to pin down.”

He continued: “The projections are used to suss out possible outcomes—the full range of possible outcomes—provide context for current actions and a frame of reference for guiding ongoing policy decisions.”

Shaman also says models need to be better understood. “They are projections, not forecasts; they are done for a continually evolving situation for which there is little information on transmission over the last two weeks, limited information on changing social distancing compliance within communities, and no sense of how society will increase or relax its controls in the future.”

Redlener said an important aspect of modeling away from death tolls is to understand how long the outbreak will last. This will allow for a better understanding of how overcrowded hospitals will get and for how long, meaning plans can be put in place to facilitate the surge in patients. Eventually, they will help policymakers decide how and when to start easing lockdown measures, to let people get back to work and, ultimately, to recover the economy.

But for forecasting how many people will die, models cannot provide accurate answers.”It’s very frustrating for people,” Redlener said. “I know you want answers. But you’re not going to get one that’s very satisfying.”

Nobel laureate Michael Levitt, a professor of structural biology at Stanford University, proposes another way to think of death forecasts and what the ultimate toll on a given country will be. Levitt told Newsweek he was reading a Medium post by David Spiegelhalter, a statistician at the University of Cambridge, when he started thinking about death tolls differently.

Spiegelhalter was considering how many people who have died from COVID-19 would have died anyway from other, “normal” risks. The risk of dying, generally, increases with age, and COVID-19 follows a similar trajectory—death rates for those above 70 are much higher for younger adults and children. His calculations suggested that COVID-19 deaths account for about a years’ worth of death risk.

“I thought it was a very clever way to express numbers,” Levitt said. “People don’t think people die normally. And people get upset by every death. But in the world 150,000 people die every day, so you need to normalize that.” However, he thought that a years’ worth of deaths was too high, so he used this principle and applied it to the Diamond Princess—the cruise ship that was quarantined off the coast of Japan towards the start of the outbreak—and then to Wuhan, the city in China where the virus was first identified.

Through his calculations, Levitt accurately predicted the total cases and deaths in China during the country’s outbreak. “What I noticed was if you actually look at the places that are heavily hit, what you discover is for each of these places, the fraction of population—total population, not cases—that are dying is very similar. It’s around 0.2 percent.”

He suggests the number of deaths from COVID-19 in a given country equates to around a month to five weeks worth of excess deaths. He added that it is important to remember that some of the people who have died from COVID-19 might have died over this time from something else.

Levitt said that while there is a huge amount of uncertainty, if you look at how many people die in the U.S. every year and calculate what that would be per month, the number of COVID-19 deaths could be around 300,000. “But that could be over two to three years,” he added.

Levitt said what is important is learning from the pandemic and applying this knowledge to future challenges, such as climate change. “Our artificial intelligence is developing so quickly that maybe, in the next outbreak, we’ll be able to say ‘hey Siri, Alexa, Google—should I panic?'”

Meanwhile, Redlener says much of how the country will move forward over the coming months will depend on how the virus is contained and how authorities go about testing until a vaccine becomes available. “It’s a very complicated agenda—complicated formulas with no clear answers,” he said.

“I think it’s inevitable that there will be a second wave because there’s a lot of motivation to get back to normal, for people to get back to work. But if we don’t have the testing capabilities to test for presence of the virus and or presence of antibodies, we won’t have an idea of who exactly is ok to go back to work, go back into public. That’s a real problem.

“If we know a large proportion of the population has immunity, even if we don’t’ know how long it’ll last, we could start to relax the restrictions. But right now, without the testing, I don’t know how and when we’re going to have the models to properly advise the policy makers.”

Vent This

The histrionics over ventilators is because the hospitals need quick fix and bandaids to treat numerous patients at a time with minimum effort and expedite them through.  When you read of the Doctor in Seattle who contracted COVID and his overall care it was extensive and intense. They won’t be doing that for anyone or everyone.  It is is neither cost nor labor efficient.

Want to be intubated.. fuck you no.  Say no.

Why Ventilators May Not Be Working as Well for COVID-19 Patients As Doctors Hoped

By Jamie Ducharme
Time
April 16, 2020 7:00 AM EDT

New York City emergency-medicine physician Dr. Cameron Kyle-Sidell sparked controversy when, two weeks ago, he posted a YouTube video claiming that ventilators may be harming COVID-19 patients more than they’re helping.

“We are operating under a medical paradigm that is untrue,” Kyle-Sidell warned. “I believe we are treating the wrong disease, and I fear that this misguided treatment will lead to a tremendous amount of harm to a great number of people in a very short time.”

Weeks later, claims from Kyle-Sidell and like-minded doctors continue to spark impassioned debate within the medical community, with some doctors moving away from the use of ventilators and others defending the current standard of care. What’s clear, though, is COVID-19 patients on ventilators aren’t doing as well as doctors would hope—and health care experts are scrambling to fix it.

Mechanical ventilation always comes with risks: a tube must be placed into a patient’s airway to deliver oxygen to their body when their lungs no longer can. It’s an invasive form of support, and most doctors view it as a last resort. Under the best of circumstances, up to half of patients sick enough to require this type of ventilation won’t make it.

But for COVID-19, the numbers are even worse. Only a small portion of COVID-19 patients get sick enough to require ventilation—but for the unlucky few who do, data out of China and New York City suggest upward of 80% do not recover. A U.K. report put the number only slightly lower, at 66%.

Doctors like Kyle-Sidell (who TIME could not reach for comment) argue these numbers are so high because physicians are ventilating patients as though they have a condition called acute respiratory distress syndrome (ARDS), when they in fact have a different type of lung damage that may not respond well to mechanical ventilation. A group of European physicians submitted a letter to the American Journal of Respiratory and Critical Care Medicine, published March 30, detailing COVID-19’s discrepancies from typical ARDS and calling on doctors to avoid jumping to unnecessary mechanical ventilation. Other physicians say mechanical ventilation can help some patients, but doctors are jumping to it too quickly, potentially subjecting patients to unnecessary traumatic treatment when they could use less-invasive respiratory supports like breathing masks and nasal tubes.

But Dr. David Hill, a pulmonary and critical care physician who treats COVID-19 patients in Waterbury, Conn. and serves as a volunteer medical spokesperson for the American Lung Association, says arguments against COVID-19 ventilation have been over-simplified. It may be less that ventilators aren’t the proper treatment for coronavirus, and more that they’re not a panacea for a pandemic that has pushed the health care system to its breaking point, Hill argues.
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“You have really sick people, [while] the people who have the best training are in short supply and ventilator management is not simple,” Hill says. If a dedicated lung specialist were available for each patient, he believes, outcomes would probably be better. They could make the subtle adjustments required for effective long-term ventilation, or try less-invasive options and only move to intubation when absolutely necessary. But with many hospitals nearly at capacity, last resorts can become first resorts.

High ventilator mortality rates in New York City suggest “a health care system failing, and not a ventilator hurting people,” Hill says. (He says telehealth consultations with pulmonology experts could provide stop-gap support for emergency-room doctors.)

Few doctors are saying COVID-19 patients should never be ventilated, but there is a growing subset that thinks it’s happening too quickly. Dr. Nicholas Hill (no relation to Dr. David Hill), chief of pulmonary, critical care and sleep medicine at Tufts Medical Center in Boston and a past president of the American Thoracic Society, says he’s avoiding mechanical ventilation when he can, and finding success with some non-invasive options like flipping patients onto their stomachs, which can trigger better blood flow to the lungs.

He says some doctors are intubating early because they fear that less-intensive forms of ventilation, like high-flow nasal oxygen, can aerosolize a virus, putting health care workers at risk of getting sick. “This is more theoretical fear than a real fear,” Hill says, since there’s not strong evidence that COVID-19 spreads this way.

Tufts’ Hill also points out that patients sick enough to require intubation tend to be those who are older and have underlying conditions. These patients are not only the most likely to experience COVID-19 complications, but also the least likely to do well on an invasive form of support. “That raises the question of whether we should think more about intubating a patient who is very unlikely to do well on a breathing machine,” he says.

Then there’s the issue of how to treat patients who do end up on ventilators. Tufts’ Hill agrees that COVID-19 patients do not behave exactly like they have ARDS, a type of respiratory distress that occurs when fluid builds up in the lungs’ air sacs. The lungs usually get stiff when a patient has ARDS, requiring high-pressure ventilation to support them. But that’s not happening with many COVID-19 patients, Hill says, leading some doctors to fear that the extra pressure is actually damaging the lungs.

Even stranger, some COVID-19 patients who show very low blood oxygen levels still appear to be breathing fairly comfortably, raising even more questions about how much support they need.

Dr. Ken Lyn-Kew, a pulmonologist at National Jewish Health in Colorado, agrees that there are some differences between classic ARDS and COVID-19, but he emphasizes that there’s a lot of variation among COVID-19 patients he’s treated. He says most still meet the criteria for an ARDS diagnosis. In his view, coronavirus patients likely have ARDS plus other issues, but they still have ARDS. With so much unknown, and with treatment protocols being updated on the fly, he thinks it’s too soon for doctors to go off-book and avoid conventional protocols like mechanical ventilation.

“The world is not a dichotomous, black-and-white place, but a lot of people are having trouble with that,” Lyn-Kew says. “We might be able to do better, but in the absence of data on the way to do that, we need to follow our societal guidelines and 25 years of research.

Laughter the Best Medicine

Excuse/Justification or just wrong. You decide.

Nurses make fun of their dying patients. That’s okay.

The Washington Post
By Alexandra Robbins
April 16, 2015

Alexandra Robbins is the author of “The Nurses: A Year of Secrets, Drama, and Miracles With the Heroes of the Hospital,” which was released this week.

The laughter of the ER staff echoed down the hall as Lauren, a nurse in Texas, talked about a patient who had ingested “a thousand ears of corn,” requiring her to repeatedly unclog kernels from the oral-suction tubing. The episode had earned Lauren surprise gifts of corn nuggets from a respiratory therapist and a can of corn from an EMS technician. But not everyone found the story so funny. When Lauren entered a patient’s room nearby, the patient said to her: “I hope you’re not that insensitive when you’re telling your friends about me later.”

Although patients typically don’t overhear it, a surprising amount of backstage joking goes on in hospitals — and the humor can be dark. Doctors and nurses may refer to dying patients as “circling the drain,” “heading to the ECU” (the eternal care unit) or “approaching room temperature.” Some staff members call the geriatric ward “the departure lounge.” Gunshot wound? “Acute lead poisoning.” Patient death? “Celestial transfer.”

“Laypeople would think I’m the most awful human being in the world if they could hear my mouth during a Code Blue,” Lauren told me when I was reporting my new book on nursing. (I agreed to use only her first name, so she could speak freely about behind-the-scenes hospital life.)

Indeed, while people may readily excuse gallows humor among, say, soldiers at war, they may have a lower tolerance for it among health-care professionals. “Derogatory and cynical humour as displayed by medical personnel are forms of verbal abuse, disrespect and the dehumanisation of their patients and themselves,” Johns Hopkins University professor emeritus Ronald Berk contended in the journal Medical Education. “Those individuals who are the most vulnerable and powerless in the clinical environment … have become the targets of the abuse.”

I strongly disagree. The primary objections to gallows and derogatory humor in hospitals are that it indicates a lack of caring, represents an abuse of power and trust, and may compromise medical care. But in my reporting, I found that nurses who use this humor care deeply about their patients and aren’t interested in abusing their power. Their humor serves to rejuvenate them and bond them to their teams, while helping to produce high-quality work. In other words, the benefits to the staff — and to the patients they heal — outweigh occasional wounded feelings.

Nursing, while noble and rewarding, can be a physically and emotionally exhausting career. Many nurses are overloaded with more patients than the safe maximum. They’re on their feet constantly, moving heavy equipment or lifting patients — in an eight-hour shift, a nurse lifts an average of 1.8 tons. Nurses routinely observe tragedies and traumas, and perform futile care on critically ill patients. Yet through it all, they must demonstrate mental composure, physical stamina and alert intelligence, even if they are berated by patients and visitors, bullied by doctors or shaken by their cases.

Doctors and other hospital personnel are also exposed to death and suffering, but nurses may be more susceptible to the lasting emotional impact. Nurses spend the most time with patients individually and have a hand in every level of their care. A Maryland hematology nurse told me: “If they die, it’s very hard; you have lost someone you became close to very quickly, someone you were cheering to beat the odds. As a nurse, you can’t dwell on your loss. You have other patients who need you. One might think that you would build a tough exterior that doesn’t let the hurt in, but to be truly effective, you can’t.”

One of the nurses I followed for a year lamented that there’s no downtime or debriefing after traumas. “People die on our shift — sometimes several people in one day — and then we just go back to work,” she said.

It’s no wonder that nurses have relatively high rates of depression and anxiety related to job stress. An Emory University study found that intensive care unit nurses experience post-traumatic stress disorder at a rate similar to that among female Vietnam veterans.

While gallows humor may seem crass amid patients who are coping with illness or injury, many nurses depend on it so they aren’t overwhelmed by sadness. A Texas nurse practitioner explained: “Sometimes when something happens that is so awful you want to cry, instead you use black humor to keep from crying.” A Mid-Atlantic nurse told me that while attending to a massive-trauma case, she likes to “take note of the cheery toenail polish color of a patient, or remark that they picked a great day to wear clean underwear for the car accident.” In California, an ICU nurse persuaded a patient with a fake leg to help her prank a new doctor; the nurse pretended the leg was real and shouted that she couldn’t find a pulse.

The nurses I interviewed maintained that situations and symptoms, more often than patients, are the targets of jokes. I learned that some units have a dedicated “butt box” for items retrieved from patients’ rectums — glass perfume bottles, an entire apple, etc. — though after Indiana nurses pulled out a G.I. Joe, the real unfortunate hero assumed pride of place in the nurses’ station.

Researchers at Northeast Ohio Medical University say the patients most likely to be joked about are the ones perceived to have brought on their own medical problems. The California nurse told me: “We all play a game called Interesting Things I Have Found in Obese People’s Rolls of Fat. So far I’m sitting in third with a fork, second place is an ICU nurse who found a TV remote, and the winner is an ER nurse who found a tuna fish sandwich.”

But even when patients do become subjects of derogatory humor, we shouldn’t rush to criticize medical professionals for using it. Bioethicist Katie Watson suggests that kind of humor may result when health-care providers feel powerless to heal. “Derisive joking does the unspoken work of reframing physicians as blameless for their inability to help,” she wrote in 2011 in the Hastings Center Report.

Or it may be about doctors and nurses trying to distance themselves enough to be able to help patients to the best of their abilities. Better that patients are mocked and healed than, well, about to take a dirt nap.

Humor has been shown to decrease health-care workers’ anxiety, create a sense of control and boost spirits in difficult moments. This is important because they must get through traumas intact so they can be fresh and focused for the next patient and the next.

Humor also strengthens the connections between members of a medical team. As Lauren, the nurse who encountered the corn, put it: “It’s a byproduct of being placed in situations where death is common and unimaginable horrors are just another day at work. Gallows humor helps to deal with some of the horrible things we see in a way that bonds us together as a team against the bad stuff.” It lets them express their feelings more easily and say things that otherwise could be difficult to say — which leads to better patient outcomes.

That’s not to excuse all humor by health-care professionals. For example, mocking disabilities and using racial, ethnic or other cruel epithets go too far.

Consider the case of a Virginia colonoscopy patient who says he set his cellphone to record post-procedure instructions and ended up recording his doctors making fun of him while he was under anesthesia. The patient claims that his doctors called him a “retard” and joked that he might have syphilis or “tuberculosis in the penis.” He is suing for defamation and seeking more than $1 million in damages.

“Tuberculosis in the penis” is funny because it makes no sense. But “retard” is an unacceptable word under any circumstances. If the patient’s claims are true, his doctors crossed a line.

Of course, it’s an odd case, because the humor was supposed to be private. Doctors and nurses usually make every effort to ensure that backstage humor stays backstage. But even if occasionally an unintended witness misinterprets the joking as insensitivity, the misjudgment is worth the trade-off. Ultimately, laughter is a useful medicine.

Humor has a place in hospitals, even if it’s dark, even if it’s derogatory — as long as it isn’t cruel. We ask extraordinary things of our nurses and expect them to face horrors and grotesqueries that we cannot. They should be permitted to resort to whatever non-destructive coping measures they need in order to provide the best possible care, even if those methods might seem unprofessional outside of the health-care setting. Humor is a way for nurses to empower themselves and to unite with one another, determined and defiant, against disease and injury. Above all, it is a way for nurses, who are overworked and underappreciated, to locate hope amid hardship — which is exactly what we need them to do.