Louisville Medicine Volume 69, Issue 8 - Page 27

AUTHOR John David Kolter , MD
the vaccine-hesitant , that these toxins do not leak out . Instead , we try to let it out , to let it go , in other ways .
Sudden trauma upends your life . How you define yourself changes abruptly : you have this huge new thing to add in . The meaning you ’ ve invested in your life may just become unrecognizable . Collective , prolonged trauma - experienced in varying degrees by all sorts of us - changes the meaning we attach to almost everything . Going to the grocery at 0600 in the winter of 2020 became a shield , a grab at safety . Going to vaccinate people in January 2021 became striking a vengeful blow at COVID , and a healing chance to work again in gleeful camaraderie . Over and over , the message that “ Nothing is certain except death and taxes ” has been driven home .
There are many ways to deal - forgetting is not what I prefer . I prefer remembering , in great detail . I prefer honoring the memory , distilling the meaning of it , and letting it soak in . But then - then ! Then is the time to go gaze at the stars and hug your dogs and your sweeties and scream for your Cardinals ( from home , it ’ s safer ).
DOCTORS ' LOUNGE
Then is the time to be grateful for living , for yet another Inspector Troy mystery , for your best pot of chili yet and a Stiegl grapefruit radler - and for the giants of science who have got us vaccines and are guarding us as best they can .
May the Force be with them .
Dr . Barry is an internist and Associate Professor of Medicine ( Gratis Faculty ) at the University of Louisville School of Medicine , currently retired and mulling her next moves .

SANGUINE HANDS , SANGUINITY LOST

My patient was admitted with COVID-19 this morning and sits in a precarious situation . While her infection could not entirely be avoided , her immediate peril could have been . Yet , the last time I saw her , I tried my damnedest to prevent this reality . Diagnosed three days before , she ’ d been set up for a monoclonal antibody infusion . Prior to her infusion , she declined rapidly , before her caretaker ’ s eyes , and was admitted , hypotensive , to the hospital shortly thereafter . The details of the story can otherwise be predictably filled . My response today , the day of admission , is anything but pure empathy ; more than anything , my response is rage . In the moments after I first got word of her septic admission , it was unfettered .

I last saw my elderly patient months ago , in the early vaccine days , when vaccine appointments were allotted for the highest risk . There was still a level of scarcity and novelty to the vaccine . I saw her in those days through the lens of hope when the potential to rapidly achieve mass vaccination still existed . Oh , how nobly optimistic we all were ! However , at the time of our visit , I saw this patient with
AUTHOR John David Kolter , MD
her son , who assists in her care at home . My patient has early dementia and speaks few words . Her absence of verbosity in the clinic is hastened by the fact that English is her second language , and she prefers her native Farsi . Regardless , I pushed the conversation about obtaining her COVID-19 vaccine , with undoubtedly a high-risk patient sitting before me . I reviewed the benefits , the rationale , the need to achieve herd immunity , the risk of not getting vaccinated . Her son was having none of it and was simply belligerent in his refusal of my entreaty . My patient sat , seemingly oblivious , with a pleasantly demented grin on her face , juxtaposed with her son who sat heedless to my pleas . Undeterred , I pushed , and I pushed hard . I pushed well past our visit time . When her son told me that his friends in Sunday school had taken the vaccine and , “ He respected them , but …,” I leaned in harder . I presented vaccination clearly as not only a duty to himself but also to those around him , a rationale that I thought surely would resonate to anyone versed in Sunday school prose . Though my patient ’ s son could not present any specific or evidence-based reason for refusing the vaccine , he refused it , nonetheless , for his mother .
I lost the argument that day . We reached only a stalemate . Sadly there was not a willingness for my patient ’ s son to listen and learn
( continued on page 26 ) JANUARY 2022 25