Julianne Nicole: This is our grief, NY ICU RN

I am a Covid ICU nurse in New York City, and yesterday, like many other days lately, I couldn’t fix my patient. Sure, that happens all the time in the ICU. It definitely wasn’t the first time. It certainly won’t be the last. What makes this patient noteworthy? A few things, actually. He was infected with Covid 19, and he will lose his battle with Covid 19. He is only 23 years old.

I was destroyed by his clinical course in a way that has only happened a few times in my nursing career. It wasn’t his presentation. I’ve seen that before. It wasn’t his complications. I’ve seen that too.

It was the grief. It was his parents. The grief I witnessed yesterday, was grief that I haven’t allowed myself to recognize since this runaway train got rolling here in early March. I could sense it. It was lingering in the periphery of my mind, but yesterday something in me gave way, and that grief rushed in.

I think I was struck by a lot of emotions and realities yesterday. Emotions that have been brewing for weeks, and realities that I have been stifling because I had to in order to do my job effectively. My therapist tells me weekly via facetime that it’s impossible to process trauma when the trauma is still occurring. It just keeps building.

I get home from work, take my trusty companion Apollo immediately out to pee, he’s been home for 14 hours at a time. I have to keep my dog walker safe. No one can come into my apartment.

I’ve already been very sick from my work exposure, and I’m heavily exposed every day that I work since I returned after being 72 hours afebrile, the new standard for healthcare workers. That was after a week of running a fever of 104 even with Tylenol around the clock, but thankfully without respiratory symptoms. I was lucky.

Like every other healthcare worker on the planet right now, I strip inside the door, throw all the scrubs in the wash, bleach wipe all of my every day carry supplies, shoes and work bag stay at the bottom of the stairs.

You see, there’s a descending level of Covid contamination as you ascend the stairs just inside my apartment door. Work bag and shoes stay at the bottom. Dog walking shoes next step up, then dog leash, then running shoes.

I dodge my excited and doofy German shepherd, who is bringing me every toy he has to play with, and I go and scald myself for 20 minutes in a hot shower. Washing off the germs, metaphorically washing off the weight of the day.

We play fetch after the shower. Once he’s tired, I lay on the floor with him, holding him tight, until I’m ready to get up and eat, but sometimes I just go straight to bed.

Quite honestly, I’m so tired of the death. With three days off from what has been two months of literal hell on earth as a Covid ICU nurse in NYC, I’m having an evening glass of wine, and munching on the twizzlers my dear aunt sent me from Upstate NY, while my dog is bouncing off the walls because I still don’t have the energy to run every day with him.

Is it the residual effects of the virus? Is it just general exhaustion from working three days in a row? Regardless, the thoughts are finally bleeding out of my mind and into a medium that I’m not sure could possibly convey the reality of this experience.

There’s been a significant change in how we approach the critically ill covid-infected patients on a number of different levels over the last two months. We’re learning about the virus. We’re following trends and patterns. We are researching as we are treating.

The reality is, the people who get sick later in this pandemic will have a better chance for survival. Yet, every day working feels like Groundhog Day. All of the patients have developed the same issues. This 23-year-old kid walked around for a week silently hypoxic and silently dying. By the time he got to us, it was already far too late.

First pneumonia, then Acute Respiratory Distress Syndrome (ARDS), essentially lung failure. Then kidney failure from global hypoxia and the medications we were giving in the beginning, desperately trying to find something that works. Then learning that it doesn’t work, it’s doing more harm than good in the critical care Covid population.

Dialysis for the kidneys. They are so sick that your normal three-times weekly dialysis schedule is too harsh on their body. They’re too unstable. So, we, the ICU nurses, run the dialysis slowly and continuously.

They are all obstructing their bowels from the ever-changing array of medications, as we ran out of some medications completely during our surge. We had to substitute alternatives, narcotics, sedatives, and paralytics, medications we’re heavily sedating and treating their pain with, in an effort to help them tolerate barbaric ventilator settings.

Barbaric ventilator settings while lying them on their bellies because their lungs are so damaged that we have to flip them onto their bellies in an effort to perfuse the functioning lung tissue and ventilate the damaged lung tissue.

Lungs that are perfused with blood that doesn’t even have adequate oxygen carrying capacity because of how this virus attacks.

Blood that clots. And bleeds. And clots. And bleeds. Everything in their bodies is deranged. Treat the clots with continuous anticoagulation. Stop the anticoagulation when they bleed.

GI bleeds, brain bleeds, pulmonary emboli, strokes. The brain bleeds will likely die. The GI bleeds get blood transfusions and interventions.

Restart the anticoagulation when they clot their continuous or intermittent dialysis filters, rendering them unusable, because we’re trying not to let them die slowly from renal failure. We are constantly making impossible treatment decisions in the critical care pandemic population.

A lot of people have asked me what it’s like here. I truly don’t have adequate descriptors in my vocabulary, try as I might, so I’ll defer to the metaphor of fire.

We are attempting to put out one fire, while three more are cropping up. Then we find out a week or two later that we unknowingly threw gasoline on one fire, because there’s still so much we don’t know about this virus.

Then suddenly there’s no water to fight the fire with. We’re running around holding ice cubes in an effort to put out an inferno. Oh yeah, and the entire time you’ve been in this burning building, you barely have what you need to protect yourself.

The protection you’re using, the guidelines governing that protection, evolved with the surge. One-time use N95? That’s the prior standard, and after what we’ve been through, that’s honestly hysterical. As we were surging here, the CDC revised their guidelines, because the PPE shortage was so critical.

Use anything, they said. Use whatever you have for as long as you can, and improvise what you don’t have.

As we’re discussing medication and viral research, starting clinical trials, talking treatment options in morning rounds for your patient with the team of doctors and clinical pharmacists, suddenly, surprise! Your patient developed a mucous plug in his breathing tube.

Yes, that vital, precious tube that’s connected to the ventilator that’s breathing for them. It’s completely plugged. Blocked. No oxygen or carbon dioxide in or out. It’s a critical emergency.

Even with nebulizer treatments, once we finally had the closed-delivery systems we needed to administer these medications and keep ourselves safe, they’re still plugging. We cannot even routinely suction unless we absolutely have to because suctioning steals all of the positive pressure that’s keeping them alive from the ventilator circuit. One routine suction pass down the breathing tube could kill someone, or leave their body and vital organs hypoxic for hours after.

Well, now they’re plugged. We are then faced with a choice. Both choices place the respiratory therapists, nurses, and doctors at extremely high risk for aerosolized exposure.

We could exchange the breathing tube, but that could take too long, the patient may die in the 2-3 minutes we need to assemble the supplies and manpower needed, and it’s one of the highest-risk procedures for our providers that we could possibly carry out.

Or we could use the clamps that have been the best addition to my every day carry nursing arsenal. You yell for help, you’re alone in the room. Your friends and coworkers, respiratory therapists, doctors, are all rushing to get their PPE on and get into the room to help.

You move around the room cluttered with machines and life sustaining therapies to set up what you need to stave off death. You move deliberately, and you move FAST. The patient is decompensating in the now-familiar and coordinated effort to intervene.

Attach the ambu bag to wall oxygen. Turn it all the way up. Where’s the PEEP valve? God, someone go grab me the PEEP valve off the ambu bag in room 11 next door. We ran out of those a month ago, too. It’s all covid anyway, all of it is covid. Risk cross-contamination or risk imminent death for your patient, risk extreme viral load exposure for you and your coworkers, and most certain death for your patient if you intervene without a PEEP valve.

You clamp the breathing tube, tight. The respiratory therapist shuts off the ventilator, because that side of the circuit can aerosolize and spray virus too if you leave it blasting air after you disconnect. Open the circuit. Respiratory therapy attaches the ambu bag. You unclamp. Bag, bag, bag. Clear the plug. The patient’s oxygen saturation is 23%. Their heart rate is slowing. Their blood pressure is tanking. Max all your drips, then watch and wait while this patient takes 3 hours to recover to a measly oxygen saturation of 82%, the best you’ll get from them all shift. These patients have no pulmonary reserve.

All of our choices to intervene in this situation risk our own health and safety. In the beginning we were more cautious with ourselves. We don’t want to get sick. We don’t want to be a patient in our own ICU. We’ve cared for our own staff in our ICUs. We don’t want to die. Now? I’ve already been sick. I am so, so tired of the constant death that is the ICU, that personally, I will do anything as long as I have my weeks old N95 and face shield on, just to keep someone alive.

I’ve realized that for many of these patients in the ICU, it won’t matter what I do. It won’t matter how hard I work, though I’ll still work like a crazy person all day, aggressively advocate for my patients in the same way.

My coworkers will go without meals, even though they’re being donated and delivered by people who love and support you. Generous people are helping to keep local restaurants afloat. We can always take the meal home for dinner, or I can devour a slice of pizza as I walk out to my truck parked on the pier, a walk I look forward to every day, because it gives me about eight minutes of silence. To process. To reflect.

I’ll chug a Gatorade when I start feeling lightheaded and I’m seeing stars, immediately after I just pushed an amp of bicarb on a patient and I know I have at least five minutes of a stable blood pressure to step out of the unit, take off my mask and actually breathe.

Every dedicated staff member is working tirelessly to help. The now-closed dental clinic staff has been trained to work in the respiratory lab to run our arterial blood gases, so that the absolutely incredible respiratory therapists who we so desperately need can take care of the patients with us.

Nurses in procedural areas that were closed have been repurposed to work as runners. To run for supplies while the primary nurse is in an isolation room trying to stabilize a patient without the supplies they need, runners to run for blood transfusions.

Physical therapists, occupational therapists, speech and language pathologists being repurposed to be part of the proning teams that helps the nurses turn patients onto their backs and bellies amidst a tangled web of critical lines and tubes, where one small error could mean death for the patient, and exposure for all staff.

Anesthesiologists and residents are managing airways and lines when carrying out these massive patient position changes. Surgical residents are all over the hospital just to put in the critical invasive lines we need in all of our patients.

The travel nurses who rushed into this burning building to help us are easing a healthcare system. The first travel nurse I met came all the way from Texas. Others terminated their steady employment to enlist with a travel agency to help us. Every day there are more travelers arriving.

A nurse from LA came to me after she found out I was part of the home staff, in my home unit, where this all first started in my hospital what feels like a lifetime ago, and said, “I came here for you. For all of the nurses. Because I couldn’t imagine working the way you guys were working for how long you were working like that”. During our surge and peak in the ICU, we were 1:3 ratios with three patients who normally would be a 1:1 assignment. And they were all trying to die at the same time. We were having to choose which patients we were rushing to because we couldn’t help them all at the same time.

The overhead pages for emergencies throughout the hospital rang out and echoed endlessly. Every minute, another rapid response call. Another anesthesia page for an intubation. Another cardiopulmonary arrest. A hospital bursting at the seams with death. Refrigerated trailers being filled.

First it was our normal white body bags. Then orange disaster bags. Then blue tarp bags. We ran out of those too. Now, black bags.

The heartbreakingly unique part of this pandemic, is that these patients are so alone. We are here, but they are suffering alone, with no familiar face or voice. They are dying alone, surrounded by strangers crying into their own masks, trying not to let our precious N95 get wet, trying not to touch our faces with contaminated hands.

Their families are home, waiting for the phone call with their daily update. Some of their loved ones are also sick and quarantined at home.

Can you even IMAGINE? Your husband or wife, mother or father. Sibling. Your child. You drop your loved one off at the emergency department entrance, and you never, ever see them alive again.

Families are home, getting phone calls every day that they’re getting worse. Or maybe they’re getting better. Unfortunately, the ICU in what has quickly become the global epicenter for this pandemic is not a happy place. We are mostly purgatory where I work, so this snapshot may be more morbid than most.

These people are saying goodbye to their loved ones, while they’re still walking and talking, and then maybe a week or two later, they’re just gone. It’s like they disappeared into thin air.

That level of grief is absolutely astounding to me, and that’s coming from a person who knows grief. I was there at the bedside, I held my young husband’s hand when I watched his heart stop beating. I was there. That grief changes you immeasurably.

But this grief? This pandemic grief? It’s inconceivable. These families will suffer horribly, every day for the rest of their lives. They might not even be able to bury their loved one. God, if they can’t afford a funeral with an economic shut-down, their loved one will be buried in a mass grave on Hart Island with thousands of others like them. What grave will they have to visit on birthdays and holidays?

Yesterday, I was preparing for a bedside endoscopy procedure to secure a catastrophic GI bleed in this 23-year-old patient.

It was a bleed that required a massive transfusion protocol where the blood bank releases coolers of uncrossmatched O negative blood in an emergency, an overhead page that, ironically, I heard as I was getting into the elevator to head to the fourth floor for my shift yesterday morning; a massive transfusion protocol that I found out I would own as a primary nurse, as I desperately squeezed liters of IV fluids into this patient until we got the cooler full of blood products, and then pumped this patient full of units of blood until we could intervene with endoscopy.

Before the procedure, I stopped everything I was doing that wasn’t life-sustaining. I stopped gathering supplies to start and assist with the procedure.

I told the doctors that I would not do a required “time-out” procedure until I got my phone out, and I facetimed this kid’s mom because I didn’t think he would survive the bedside procedure.

She cried. She wailed. She begged her son to open his eyes, to breathe. She begged me to help her. Ayudame. Ayudame. She begged me to help him. She sang to him. She told him he was strong. She told him how much she loved him. I listened to her heart breaking in real time while she talked to her son, while she saw his swollen face, her baby boy, dying before her eyes through a phone.

Later in the day, after the procedure, his mom and dad came to the hospital. He survived the securement of the bleed, but he was still getting worse no matter what we did. He’s going to die. And against policy, we fought to get them up to see their son.

We found them masks and gowns that we’re still rationing in the hospital, and we let his parents see him, hold him. We let them be with their son.

Like every other nurse would do in the ICU here, I bounced around the room, moving mom from one side of the bed to the other and back again, so I could do what I needed to do, setting up my continuous dialysis machine, with the ONE filter that supply sent up for my use to initiate dialysis therapy. This spaceship-like machine, finicky as all hell, and I had one shot to prime this machine successfully to start dialysis therapy to try to slowly correct the metabolic acidosis that was just ONE of the problems that was killing him as his systolic blood pressure lingered in the 70s, despite maxing all of my blood pressure mediations.

Continuous dialysis started. You press start and hold your breath. You’re not removing any fluid, just filtering the blood, but even the tiniest of fluid shifts in this patient could kill him. But you have no choice.

His vital signs started to look concerning. I could feel the dread in the pit of my stomach, this was going south very quickly. Another nurse and the patient’s father had to physically drag this mother out of the room so we could fill the room with the brains and eyes and hands that would keep this boy alive for another hour.

She wailed in the hallway. Nurses in the next unit down the hall heard her cries through two sets of closed fire doors. We worked furiously to stabilize him for the next four hours.

Twenty minutes before the end of my shift last night, I sat with the attending physician and the parents in a quiet and deserted family waiting room outside the unit. I told his mother that no matter what I do, I cannot fix this. I have maximized everything I have, every tool and medicine at my disposal to save her son. I can’t save her son.

The doctor explained that no matter what we do, his body is failing him. No matter what we do, her son will die. They realized that no matter how hard they pray, no matter how much they want to tear down walls, no matter how many times his mother begs and pleads, “take me instead, I would rather die myself than lose my son”, we cannot save him.

We stayed while she screamed. We stayed until she finally let go of her vice grip on my hands, her body trembling uncontrollably, as she dissolved into her grief, in the arms of her husband.

This is ONE patient. One patient, in one ICU, in one hospital, in one city, in one country, on a planet being ravaged by a virus.

This is the tiniest, devastating snapshot of one patient and one family and their unimaginable grief. Yet, the weight is enormous.

The world should feel that weight too. Because this grief, this heartbreak is everywhere in many forms. Every person on this planet is grieving the loss of something.

Whether that’s freedom or autonomy sacrificed for the greater good. Whether that’s a paycheck or a business, or their livelihood, or maybe they’re grieving the loss of a loved one while still fighting to earn a paycheck, or waiting for government financial relief that they don’t know for certain will come. Maybe they’re a high school senior who will never get to have the graduation they dreamed of. Maybe they’re a college senior, who won’t get to have their senior game they so looked forward to. Maybe they’re afraid that the government is encroaching on their constitutional rights. Maybe it’s their first pregnancy, and it’s nothing like they imagined because of the terrifying world surrounding them.

Or maybe they lost a loved one, maybe someone they love is sick, and they can’t go see them, because there are no visitors allowed and they’re an essential worker. Maybe all they can see of someone they love is a random facetime call in the middle of the day from an area code and a number they don’t know.

Everyone is grieving. We’ve heard plenty of the public’s grief.

I don’t blame anyone for how they’re coping with that grief, even if it frustrates the ever-living hell out of me as I drown in death every day at work. It’s all valid. Everyone’s grief is different, but it doesn’t change the discomfort, the despair on various levels. We are at the bottom of Maslow’s hierarchy of needs. Basic survival, physiological and safety needs. I’ve been here before. I know this feeling. How we survive is how we survive.

Now that I’ve had the time to reflect and write, now that I’ve let the walls down in my mind to let the grief flood in, now that I’ve seen this grief for what feels like the thousandth time since the first week of March as a nurse in a Covid ICU in New York City, it’s time you heard our side. This is devastating. This is our reality. This is our grief.

Spring Migraines and patient abandonment

Sunday night migraine… 13 days late on #BotoxforChronicMigraine because of COVID19 Shutdown and my neuro’s decision to close the office. 13 days ago at my telemed appointment, my neuro said she’d write me a script for the new migraine abortive med Ubrelvy. It’s still stalled at Austin Neurocare for prior auth and has been for over a week. 🙄 I’m starting down the familiar emotional road of feeling ABANDONED by my neurologist. #abandonedpatient This is an uncomfortable and upsetting feeling.

Never in 9 years of Botox have I even been ONE day late for injections. Botox is cumulative. So there’s a nagging question… with all these delays in treatment, will botox require a few treatments “to catch up” to therapeutic levels? I vacillate between moderate pain and symptoms to desperate despair to embarrassment to glimmers of hopefulness to runaway anxiety to resolve to horrific levels of pain and symptoms where my head is on fire, my teeth are brittle and raw nerves and my jaw feels like steel that might snap. I’m not really “myself.” Just a very solid shadow hanging on by fingertips.

My husband and I just had an interesting exchange tonight…

Me: I was in so much pain before, crying and moaning.
Marc: when was this?
Me: After dinner. Just about an hour ago. I was laying here in bed in so much misery, rocking, goaning, crying, not wanting to go on, but now the medicine is helping a bit. Did you not HEAR me? You are right there next to the bed!
Marc: (scoffs) Oh… I thought you were just moaning in pain… like you used to do when you were in labor.

Me: 😶
Me: Yes… well I’m glad we cleared that up. Sorry again.

(Like I used to do in labor!? Childbirth labor, as in the most PAINFUL experience in the world? And that didn’t alert you that I might be in incredible pain? Or trigger something inside you… like, Idk, an emotion of concern… or care? Just… wow. Okay. Nice.)

If I just died here tonight… it wouldn’t be a bad thing. Migraine at a 5-6 but my jaw and teeth… omg, they are so brittle and in so much clench pain. My head is a thousand degrees. And my sacroiliac is having a tantrum.
This is a day I break my own rule and ask… WHY. Why. Why. Why. Why.
T storms tomorrow. My roots grow deep here in bed.
Love to all❤

#ChronicMigraine #MigraineAwareness #SpeakYourMigraine #BotoxforChronicMigraine #CMA #CMAware

The storm

“There is peace… even in the storm” Vincent van Gogh
A new day… a familiar neurological storm.
There is no cure.

Day after day. 9 days late on botox. Yesterday the migraine was manageable… I attended a telemed doc appt with rheumy and ran an errand to UPS. Today’s migraine has decked me. Every medicine is failing. Even my muscles are cramping in my legs.

#ChronicMigraine #MigraineAwareness #SpeakYourMigraine #BotoxforChronicMigraine #CMA #CMAware

An open letter to my NEUROLOGIST on their decision to refuse BOTOX treatments during COVID19 shutdown

I’m writing this Thursday night. Attaching information from our county’s covid information update site.

It’s been an awful 2 months. I’m not in status migrainosis and I’m not in rebound. My migraines keep pace with even minor weather fluctuations as well as this added anxiety and stress over the many losses (my childrens, my own) and difficulties re covid shutdown. My migraines follow the migraine pattern just perfectly: prodrome, attack, postdrome – they don’t last longer than 3 days but they are triggered incredibly frequently. For instance, I was in very bad shape this Easter weekend (tornado warnings Sunday at 04:30), but found a mild reprieve when the weather was stable for over 24 hours early on in the week. Wednesday was my son’s 22nd birthday and I migrained all day but still videocahatted with him. Thursday I woke up in decent shape, attended a GYN office appointment, came home, collapsed and slept all day in a wicked prodrome pathologic lethargy. I woke up in terrible migraine in the evening. Looks like there is some more weather expected tomorrow. I took my abortive medication with some relief. My head is plastered with ice packs. I’m nauseous, my head is so hot and my feet are freezing (thermoregulation disorder symptom). It feels like a crevasse is opening in my right side of my brain. My jaw is instinctively trying to clench to help with the pain. I’m actively forcing it to relax. I’m focusing on breathing and applying counter pressure and ice. I’m only opening my right eye slightly, and trying to keep my body and head as still as possible (movement makes everything worse). This is Chronic Migraine in all its glory – especially since my preventative has run dry and I’m white knuckling life.

“We all have to be patient during this time,” you said. But… do we? How can I help but ask? What else is there to think about when you have a right-sided crevasse in your skull?

This leads me to my other point. I don’t foresee me being able to wait for botox. Right now stay at home is extended. And frankly I’m not at all clear about what model Austin Neurocare is following and when they’ll be willing to start helping patients with office visits. It seems you’re on your own timetable.

Sadly, I’m feeling forced to utilize another option which we spoke about – a pediatric neurologist in the area who is continuing to treat patients who need botox. Hopefully you can share information with the practitioner who treats and helps me, if she needs it.

Doctor, I know you spent a good amount of time explaining the “presidential mandate” reason (during our telemed appt) for closing the office, but my husband and I surely didn’t feel it made complete sense, because Presidential mandate or whatever, it appears doctor offices have a tremendous amount of individual authority over their own practice. Independently, they are making their own decisions on treating OR refusing to treat their patients.
For instance, the GYN appt I attended today: no problem! I was thermal checked at the door, we all wore our filtered masks, and nothing was all that far from ordinary. My husband has seen his podiatrist 2-3x during the shutdown – and in truth, these visits haven’t even been remotely essential! As his foot issue is not a big deal. But, there has been absolutely no change in procedure. The allergist continues to see patients… their office has changed procedure a bit with face coverings and even treating patients with their allergy shots in their cars! And of course there is no change in primary care providers for ourselves or our children – besides the thermal check and masks. All my other doctors: endocrine, rheumatology, pain medicine, psychiatric NP – have given me the option of telemedicine. But I could have opted for office visits, if I chose. Our dentist has closed his doors and is referring emergencies to an oral surgeon (but I think he may be on a mission trip).

I’ve read the healthcare “mandates” with covid and I completely understand where it says “non essential surgeries and day surgeries are canceled” … that makes a tremendous amount of sense as the hospitals are needed to treat covid patients. But I can’t find any documentation FORBIDDING essential healthcare office visits – or even non essential healthcare office visits! Nor can I find information where full hazzard and contact PPE is required or even suggested for physician’s offices. You explained your staff would need N95s and face shields to treat patients. Why would face shields be needed for botox injections? That doesn’t even make any sense. Certainly just eye protection would be ample… unless an unmasked ill patient was actively coughing on your face.

Like I mentioned, I have a new medical bag of surgical masks (20) that I’m happy to donate to Austin Neurocare! They are yours for the taking! If you really think face shields are necessary, I know several local citizens in our town who are donating 3D printer created face shields and I’d be overjoyed to arrange a donation to Austin Neurocare. I’m not really sure Austin Neurocare is a covid hotspot of treatment though… which is why full contact PPE is so baffling. 

Like I mentioned, my other in-person appointments went amazingly smoothly with masks alone.

Why am I so focused on my neuro treatment (besides the fact that [1] botox is essential for me and has been the only preventative that actually helps me, [2] I plan my entire life around that one day every 12 weeks, [3] I’m essentially abandoned by my provider)? Mostly, I’m kept up at night thinking about the dozens of Austin Neurocare chronic migraineurs who’ve been abandoned as well. This is so absolutely appalling. And what’s worse… there doesn’t seem to be a valid reason for it. Hospitals should be kept free of non essential procedures. Physician offices? They have their own autonomy to perform essential procedures. I can’t even imagine a neurologist or headache specialist that wouldn’t agree that for many chronic migraineurs, botox procedures are absolutely essential. ESPECIALLY because NOT receiving this particular essential treatment can absolutely send the patient to the EMERGENCY ROOM – covid hotspot! This refusal to treat is 100% counterproductive

I would love to think that other migraineurs of the practice would be able to benefit from my questioning this decision, my donated PPE, or anything else I could provide. When you told me about the other migraineur who frequents the emergency room, it really upset me. Just imagining the other chronic migraineurs in the community who look to you in desperate help to provide essential treatments in order to have some shred of “life”…. when I think of them feeling the same shock, abandonment, loss, hopelessness… trying to hang on through a pandemic (difficulties obtaining groceries, job loss, homeschooling their children, caring for their childrens’ emotional needs, trying their best to keep their family safe and address all the mental aguish) without even a basic migraine prevention medication! When I think of this, it’s so clear that this is NOT a just me problem! And as an advocate of people living with migraine disease, I am compelled to speak out for those who cannot.

Please. Please don’t abandon your patients in need. 

I don’t think I’m a serial complainer, I don’t think I’m a noncompliant patient, I don’t think I’m a difficult patient. But I am an advocate. And I’m also in a very dark place.

I realize my words will probably offer very little change… it will probably just be something we have to agree to disagree about. But on behalf of we living a recluse chronic migraine life, I am glad to have said it.

Please stay healthy! Praying for your husband on the frontline battling this virus and saving lives! Please let him know how grateful we are for his sacrifice  – for all your family’s sacrifice! And thank you for taking the time to read this.

#ChronicMigraine #MigraineAwareness #covid19 #covidquarentine #covidshutdown #botoxforchronicmigraine #austinneurocare #chronicillness

UPDATE Monday (4 days later):

Dr Westgate called me today – after receiving my letter. She was distraught to hear I felt abandoned and she has me at the top of the list for botox … she said they may open May 15. Which is still… far away. I believed her completely that she didn’t want me feeling forgotten and they were very willing to try different medications… they just cannot open the office due to covid safety concerns and the AMA recommendations.

She has no problem sharing my treatment plan with another provider in town who can get me in earlier – a pediatric neuro who is continuing to treat patients during shutdown (as their practice considers migraine treatments essential).

I admit that I do not understand the large discrepancy in care I’m seeing with independent doctor offices. It is absolutely baffling to me. And, today Gov Abbott made changes in restrictions as TX’s covid “peak” is supposed to occur this week. Nonessential procedures and surgeries are allowed now and our hospitals are definitely not near capacity.

Of the chronic migraineurs all over the country I’ve heard from, greater than 50% have had no interruption in botox treatment. Baffling.

I am now only 7 days late for botox. The new provider Dr Kate Labiner anticipates she can get me in by next week.

Today was a tearful day… 1) so many days of pain and symptoms are soul crushing, 2) I could sense my physician’s concern and care and feelings of helplessness, 3) the fact I’ve been connected to an incredibly kind and supportive provider who can help is overwhelming. Words fail me – a friend with her own trials has helped me.

I’m always surprised how many tears there are in my head. It seems I’ve cried an ocean. It’s my superpower 🦸‍♀️

Thank you all for your support.


COVID quarantine negative decisions & abandonment

There are people dying during this pandemic. I get that. And I should be grateful for our health…. so writing this has been difficult for me.
At first the nurse told me it was because they didn’t “have PPE for themselves and their patients.” When I offered to supply their office, she said they just “weren’t seeing patients.” And I should “call if my head got worse.” Is this a fucking joke?
I’ve never missed a treatment in 9 years. I plan life events around that ONE DAY every 12 weeks. It is the ONLY treatment that has helped with Chronic Migraine in 12 years. When the medicine starts to wear off at 8-10 weeks I begin a mental countdown to the sacred appointment.
Home Depot is open. Liquor stores are open. Even gun stores are considered essential.
The past couple of days I was stunned, despondent, heartbroken… yesterday I moved on to morbidly resolved. I write this post because I can’t even talk about it without falling apart. Absolutely horrible migraines this past month. There is this part of me that doesn’t understand the cruelty behind this decision and alternates between wanting to die and wanting to punch someone in the throat. Mostly I’m just a puddle of tears. I am abandoned by my medical provider. This is what medical abandonment feels like. Mariah instructed me to make sure and contact her if I needed help. “There are things we can do; medications we can call in.” I have a one way to contact … through the office nurse who can be an utterly horrible human. I feel like I’ve been fed empty words and been abandoned.

Meanwhile, my husband’s allergist office and podiatrist have no issues continuing appointments.

#ChronicMigraine #MigraineAwareness #SpeakYourMigraine #COVID19 #covidquarentine #botoxforchronicmigraine


Please sir, just a drop of Botox. Please do not abandon me.
Migraining like mad; the weather keeps changing.
Please sir, might I have some more.


• Coronavirus lockdown for one week
• Unstable weather patterns
• Uncertain times: are we overreacting or under reacting?
• Why is toilet paper selling out?

• Massive migraine action for me… the worst started Thursday and ruined all of today (Saturday) too.
• Thursday every medication was failing and I finally turned to my shots. An expired Sumatriptan injection helped.

• I finished the 11 seasons of MASH on Hulu and had to say goodbye to Hawkeye and Houlihan, goodbye to creative comedy and OR scenes that first stirred my interests to become a nurse.

• Friday was procedure day at APC… back injections into the lumbar area for some sacroiliac relief (its been bothering me like crazy since the DC trip). All the staff was masked and I was thermo checked and screened at the door. Marc wasn’t allowed into the building – only patients.

• Bless their hearts, not all the staff were using protective equipment correctly. The medtech who took me back, had an N95 mask on but kept sticking her fingers between her mask and face by her mouth because “it was hot.” The office worker wore her mask below her nose. Everyone else was fine. Doctor Michaud came to check on me before procedure and he was not wearing a mask. No one tells Dr Michaud what to do!😂😍

• Tried to rest all day… but there was an El Arroyo margarita ZOOM party at 8 with the neighbors. I could only stay about an hour. Then there was more migraining to do.

• This morning my migraining was exploding … out of the back, the sides, the front of my head. Medications, rest, Cefaly. I couldn’t get out of bed. I lay in bed… barely moving… just dying. One of those migraines where I can’t believe how bad it is… one where I don’t bother hiding from my family – because I’m too too sick. Completely ruined day. One where I remember: “Wow, I really DO have migraines – don’t I?” Omg, it hurts so much.

• Finally a dose of butalbitol and phenergan helped. That phenergan… it can really be a blessing when migraine has shut down my gut.
• Sunday I felt some relief. Amazing. Truly amazing. But I was too tired to really get anything done. I folded a load of laundry and cleaned the birdcage. Huzzah.

• Watching the tv series the Dead Zone with Anthony Michael Hall cuz it’s a bit of reminiscence.

• Prepping our world for continued Coronaquarantine remote online learning. The world is indistinguishable; never has this happened before. No word on how long it will be like this. Everyday is a little weirder. The situation is fluid. Very fluid. Unprecedented times.

• Watching the Normals have an apoplexy from quarantine is a little funny… watching the general public misuse medical equipment is amusing as well. There is great loss: both Robyn and Nick have lost their jobs (put on temporary leave). Schools have shit down: the kids will continue UT (Ken) online, TAMU (Corey) online, LTHS (Nick and Robyn) online. No word on prom or graduations.

There is also great kindness and beauty: our community tries to help local businesses with take out restaurant orders and someone need only post an ‘ISO’ post and there are offers to help.
• This will be a time to remember for certain. A time when people will ask “Where were you when…” All because of a funny little bug: the COVID19.

My first migraine

Migraine has always been a part of my life. So when I was asked about my first migraine experience, I had to think a bit. When was my first memory of this neurological “storm?”
And then I stumbled across a vivid one. I must have been 6 because I was at a YMCA summer morning camp. I didn’t need or usually attend summer camp – my mom was a stay at home mom. So I must have wanted to attend, or even joined with a friend.

I don’t remember all the particulars, but camp ended with all the children meeting in the YMCA gymnasium before it let out at lunch time. In my memory, the room was huge and echoey – in that way school gymnasiums are, hundred of kids on wooden bleachers, singing or shouting and stomping a camp song together. It was loud. I remember sitting with my group and trying to participate in the activity. I could not perform well; I couldn’t sing along, just stare and go inward. The entire episode was intolerable. There were too many people and it was too damn loud and I felt sick to my stomach and… there was something quite wrong with my whole head. It vibrated and throbbed as if it’d been struck like a gong. I wasn’t having fun at camp; I wanted out. I was “spaced out” and confused and I wasn’t able to think of what to do….except wait for camp to be over and wait for my mom to pick me up. I wasn’t scared and I tried to keep up with the activity.
When I got in the car, I was quiet. And since the loud echoey noise was left in that gymnasium, it was easier to handle my gong-head and nausea.
I must have looked pale or distant or like something was wrong and I must have been able to verbalize some of what I was experiencing. And my mother really saw me and had no hesitation diagnosing, “You are having a migraine,” she said.
Some people wait years and years for their diagnosis. I was diagnosed in a few minutes.
How did my mom know? Because she was an episodic migraineur. She struggled with hormone and stress triggered migraines one to a few times a month. She described them as 3 day crescendos, with the pain becoming it’s highest level on the last day. Then she described the postdrome as feeling “bruised all over the day after.”

She did not have aura or visual aura. And neither do I. And for many many years, she did not have anything for treatment but aspirin, until the 1980’s when ibuprofen became available. And by the time my mom went into menopause, her migraines nearly ceased to exist. My dad would also occasionally get “weekend migraines” from stress letdown from his work. I’m told even my grandparents had episodic migraines. It’s clear I have a very strong genetic predisposition for Migraine.

So on that day… that YMCA camp day with my migraine, my mom took me home, gave me some yummy chewable aspirin and some food and drink, and put me to bed.
And I recovered.

I also remember another migraine when I was older… probably age 10-12. I was in bed in my dark room, miserable with throbbing head pain and light sensitivity, and waiting for the ibuprofen to start working. My dad came in to check on me and he started to massage my head. He was used to doing this for my mom and her migraines. He massaged my head, found where the pain was worst and applied pressure. I remember it as one of the most amazing feelings of my life… like my dad was expelling the migraine from my brain.
For so many years, I was in good control of my migraines. Ibuprofen and rest was my effective treatment. I never doubted it would be a part of my life, but I didn’t have any idea it would be so much more.

Why Chronics need other Chronics…

I’m still me. I’m still in here. But there’s this strange and ridiculous chunk of my life that is this other thing.

What would my “normal” friend say if I told her I’d been wearing pajamas for 5 days? What if she saw my freezer drawer with 15+ ice packs? What if she saw my medication drawer?
She might run screaming. And understandably so… my Chronic life is so far from what my Normal life was. I wouldn’t have understood it back when I was a Normal. And I’m a nurse; I should have understood! But nowhere in school or clinicals did they discuss chronic pain.

Which is why my Chronic friends are so critical. Some of our correspondence through Facebook messenger, Instagram direct messages, and texts are freaking hilarious. Hilarious in a dark, wacky, weird way. My Chronic friends are people I can vent and connect.

When we ask each other how we are… we don’t smile and lie and answer “Fine.” We lay it out honestly: “I’m still in bed and it’s 1pm! My head is a bastard and I’ve got a heater on my sacroiliac nonsense. How are you?” Sometimes we talk in Pain Scale: “My head is only a 4 but my RA is a 7 and I can’t keep my eyes open.”

We all have matching night tables with a pharmacy drawer chockful of medication bottles, “Big Bertha” pill organizers, an unusually large amount of icing and heating instruments, drug-free treatment mechanisms, massage gadgets, and other tools that poke, prod, stab, flatten, relax, bruise, knead, manipulate different areas of our body.

Our houses are not like other homes… we have a “nest” or a “perch” where we crawl to when the hurting is too much. It’s our Spot. Mine is my bed… in my bedroom where I haven’t opened the blinds in over 5 years. It’s where my kids and my husband look for me first when they come home. My Spot is surrounded by everything I need: many pillows and blakets, heating pads, my nightstand with it’s medication drawer and the second drawer full of topicals – Biofreeze, Voltaren, Arnica, IcyHot, essential oils, numbing sticks and more. And always a lip balm. Because lip balm is an amazing thing that is both critical for dry lips and can make us feel a little more alive!

Chronics need distraction. While we are in the nest, we can watch tv sometimes. It can be a helpful distraction from pain… during attacks computer screens and books are difficult, but Netflix… we can sometimes handle that! And we’re Netflix experts and we can talk show shop. “Did you watch that series?” “It was pretty good.” “Oh I liked that one a lot!”

We keep our phones nearby… it’s great to connect through Facebook support groups or text each other. We understand when it takes awhile for another Chronic to respond as they may be busy with very difficult task of SHOWERING. Or they may be too sick to open their phones. If they can respond, sometimes their responses might not make sense if they’re in a bad way. It’s hard to spell and autocorrect is a jerk when you’re hurting. Aphasia and brain fog certainly don’t help writing and communicating coherently.

Chronics don’t call or Facetime each other. We wouldn’t dare. That’s just altogether too intrusive. The other Chronic may have 3 day bedhead, drool marks on their face, ice or cups attached to their head. It’s a definite possibility. And that would be awkward.

Our calendars look the same: often littered with many doc appointments, therapy, treatment, and lab appointments, and the like. We may have a busy day with obligations of “Normal living”… those days usually have rest prep days and rest recovery days worked in – if we know what’s good for us.

Many of us have “furry caregivers”… our dogs and cats are Chronic comforts. They are so important and I know as much about my Chronic friends’ animals as I do about their children. We might try to hide some of our illness from our families, but our pets see it ALL.

We know how to celebrate the big things: “I did a load of laundry today!” “I cleaned the cat box!” “I made dinner!” And we applaud each other with celebrating emoticons and hearts. ❤😍💪😃👏🎊

We have found each other, we understand each other, we don’t have to pretend. And there’s an empathy and recognition that only other Chronics get… we care deeply for each other… we share pain and burdens and blessings. And we are always there to support and encourage.

Actual Chronic A, B, C conversation:

A: “I’d go but I’m in the worst shape: migraine everyday.”
B: “g*d da** it! It’s no f***ing fair!”
C: “I’m so sorry, I can’t believe how sh*t it’s been.”
A: “I feel like THE biggest loser.”
B: “I was saying exactly the same thing today.”
C: “No one gets it but you guys.”
B: “Me. Complaining everyday about something insane. Yesterday I couldn’t believe how bad my back was. Then today my arm! Yesterday my head was insane!”
A: “Seriously this all embarrasses me. I’m like only out of bed to go to the bathroom. My SI is giving me searing pain from my a** to the instep of my foot. What the actual f*ck???”
C: “And the weather! It’s been rain and more rain. There’s no way I can function with the s*it!”
A: “I took my son to the doctor today and found out they have an online scheduling portal, so I’ll never have to operate a telephone to schedule him in!”
B: “Golden!”

#ChronicMigraine #MigraineAwareness #SpeakYourMigraine #ChronicIllness #Automimmune #invisibleillness