Over the years, especially since starting this blog, I’ve kept notes on what we were seeing, experiencing, thinking, feeling, reading, even eating, as well as where we were going, who we were meeting, visiting, and traveling with, trying to keep the rush of modern live from blending into a giant amorphous blur. When the world began to be so dramatically upended by the coronavirus threat, with day by day changes happening so fast it was hard to keep up, I began dictating daily notes to myself. As the pandemic accelerated, requiring businesses to shut down and engendering wide-spread unemployment, I realized that, impacted as we were, both as healthcare workers and personally, we were seeing the unholy mess from the safety of a giant bubble of a privileged life.
Steve and me, cowering in our protective bubble? (Bubble coral buddies (Vir philippinensis shrimp), Anilao, Philippines)
Sunday, March 1, 2020
Sedona red rock panorama on a hike from the house.
The strangeness started even on our return trip home. We drove to Scottsdale in time for a mid-afternoon flight home to San Diego. Cindy and Gerry returned from their bicycle ride just in time for us to visit for a few minutes in front of their condominium, where we keep our car, before we summoned an Uber to take us to the airport. They were sweaty from the ride and the warnings against close contact and hugging had already penetrated our consciences enough that we refrained from embracing as we usually did.
We arrived to an unusually empty San Diego airport, especially for a Sunday afternoon. Also unusual, there was no one ahead of us in the Uber line.
New York’s first confirmed case of coronavirus infection was today.
Monday, March 2, 2020
At the end of the day, I had just enough energy to bike ride home.
By evening, it was clear this was not allergies. I felt bad enough that I sent our department head this text:
“hi Nik, I am looking at the schedule for tomorrow because I am feeling like absolute hell at the moment. chills, coughing, tachycardia. I had my temperature taken today and it was normal. I am thinking I may have to be seen in urgent care tomorrow morning. Symptom onset was Sunday evening after a flight from Phoenix. I felt great last week and the week of Presidents’ Day, as well as the three weeks we were in Indonesia. Steve and I passed through Narita, on a one hour layover, exactly 2 weeks ago, coming from Jakarta. We were in a practically empty business class and no one appeared to be sick, but who knows what this is. In all probability, just an ordinary cold. It looks like all of the nukes people are working tomorrow but appears that you are splitting the day with Jeff G. Just wanted to give you a heads up.”
Nik was off the schedule for the afternoon, but had meetings with MD Anderson scheduled, so there was no one who could substitute for me if I felt worse the following day.
Tuesday, March 3, 2020
I worked in nuclear medicine, alone in a locked reading room, with no through traffic. I made it through a relatively light day, but felt absolutely terrible. I alternated reading cases with putting my head down on the desk or lying down on the carpeted floor. My primary care physician and I texted back and forth. She consulted the county with my symptoms and travel history and they responded that I didn’t meet the criteria for Covid-19 testing.
Increasingly frantic emails began circulating among our group, laying the groundwork for minimizing our exposure by retooling and having more people work from home, as well as concerns about having adequate personal protective gear (PPE). Soon, this acronym will be standard lingo.
Wednesday, March 4, 2020-Friday, March 6, 2020
I end up taking three full days off of work. Although I never had documented fever (Steve and I discovered that neither one of us can read a traditional mercury thermometer anymore and ordered a digital one), I have day after day of nonstop chills. My pulse, normally between 70 and 80, is consistently above 100, day after day. I have no energy. I am coughing, some, with nasal drainage but strangely, never had a sore throat.
Steve develops a milder, but similar set of symptoms, with diarrhea intermittently thrown in on top. He is scheduled to undergo spinal stenosis surgery the following Monday and has arranged two weeks leave of absence. We worry that his surgery will be canceled or postponed.
I had wished to have my 60th birthday off. It was Thursday, March 5, but being sick at home was definitely NOT what I had in mind. Steve had planned a special birthday dinner at home, scallop risotto, but by afternoon, it was clear that he was really not feeling up to cooking. His younger sister, Sarah, called with birthday greetings during the day. Learning we were sick, she texted me afterwards and told me chicken soup was on its way. A delivery man in the driveway startled me when I went up to get the mail. He was bearing a sack full of food from the Crack Shack, including chicken matzoh ball pozole soup, coleslaw and deliciously buttery miniature biscuits.
We had to miss a Friday dinner party planned by Tatiana. This had started out as Steve and I having dinner with Miles and Tatiana and had morphed into a birthday celebration dinner for me, including Ralph and Gail, Ron and Lucille, and Ellen and David. After Miles circulated a pathologist’s advice for coronavirus contact avoidance strategies, the email discussion during the week included whether elbow bumps would be the preferred mode for greetings.
Saturday, March 7, 2020
I had made an appointment at the La Mesa Costco to have Mama’s hearing aids checked out. One of her rechargeable battery seems to have failed, as Clarissa learned in Singapore. However, I am still really bogged down and low on energy, so I postpone to the following Tuesday. Steve and I had been scheduled to go to the VIP opening of a new contemporary Chinese photography exhibit at the Museum of Photographic Arts (MOPA), but neither one of us felt well enough to go or mingle.
Sunday, March 8, 2020
We recover just enough to attend a performance at the Old Globe, the 2 PM matinee of Hurricane Diane. We arrive in Balboa Park early enough to be able to visit MOPA and see the contemporary Chinese photography show, which we both think is excellent. At the theater, I chat with my seat mate, whose husband is a playwright. As we make each other’s acquaintance, our conversation acknowledges that we should not shake hands. Although I don’t know it at the time, this will be the last live theater performance we will see for quite a while.
Monday, March 9, 2020
We had been mentally preparing for this day for years. Both Steve’s parents had surgery for spinal stenosis and we have known for at least two decades that Steve has it as well. Over the past few years, this has increasingly limited his walking and even influenced us to choose bicycle trips over city vacations requiring a lot of walking. Walking from our apartment through Central Park to the theater district was still possible, but required many pauses for Steve to find a bench every few blocks to stretch out his back, bending over an elevated leg. In December and January, he consulted with 3 spine surgeons, including one orthopedic surgeon and 2 neurosurgeons. His MRI showed a tight constriction at one level and we hoped he could get away with relief of the stenosis at that level. Neither of us was enthusiastic about a more extensive surgery or hardware. He finally decided on the least invasive version of a decompression surgery, performed through a series of tubes to gain access, with the least downtime. He arranged 2 weeks leave of absence. He was scheduled to be the first case and amazingly, before noon, he was ready to be released.
I had swapped assignments in order to be working at the same site as Steve, thinking his procedure and recovery would take most of the day and I would drive him home when I was done for the day. Patients can’t drive themselves after anesthesia and must be released into the charge of a family member or friend. I brought the car around to the back of the hospital and “picked up” Steve and drove him as far as the parking garage and waited with him for an Uber.
Tuesday, March 10, 2020
This was a rare day off for me in the middle of the week. I had planned to take Mama to Costco in La Mesa for a hearing aid check over the weekend, but still felt ill enough the Saturday before that I rescheduled it to today. I hate to go to Costco for just one thing but the store seemed crowded and I just didn’t have the energy to negotiate the crowds just to replenish our depleted stores of dried mangos. In retrospect, this was probably panic buying in action, with shoppers scooping up toilet paper or other “essentials”. That is one supply we are not concerned about, as we installed a Toto washlet in our bathroom after our last trip to Japan. True luxury=a warm toilet seat, and the washing function definitely cuts down on the use of TP.
Wednesday, March 11, 2020
The WHO declared Covid-19 a pandemic today. To date, there are 118,000 cases worldwide. Stump suspended air travel between the US and continental Europe.
I worked at Carmel Valley, on breast imaging. At lunchtime, I have a manicure and pedicure at Nails on 56, the little shop inside the gas station complex next to this site. Strangely, although it is lunchtime, I am the only one in the shop and my manicure and pedicure are actually done concurrently and I am in and out in 40 minutes. The following week, this type of business will be closed by mandate of the governor, having been deemed “nonessential”. Being in healthcare, we are “essential” so this will not be much of a holiday for us.
In the afternoon, I did an ultrasound-guided biopsy on a patient who had already been proven to have breast cancer, but had another lesion in a different quadrant, suggesting multicentric disease. I explained the procedure to her and her husband. Apparently, she has mild dementia, although this is not readily apparent to me. These are the last patients with whom I shake hands. Even as I do it, I thought “Woops, I really shouldn’t have done that.”
Thursday, March 12, 2020
This is my first day working from home. The prior year, Scripps offered the radiologists home reading stations. Steve came up with the clever idea of building a desk into the guest room closet, which was underutilized. Up until now, we’ve only used our “office in a closet” station sporadically, mostly Steve reading musculoskeletal or neuro cases on the weekend for extra pay and to keep Monday from being disastrously overloaded.
Steve is three days post-surgery and is on leave of absence, recuperating from his spinal stenosis decompression surgery on Monday. I have never worked a full day from our home work station, so this is something new for me. I am paired with Joe, one of our locums physicians, who is working at Carmel Valley. I like the 30-second commute from upstairs to downstairs. I also like wearing jeans and UGGs to work.
The Broadway theaters were shut down today, the final death kneel to our plans for a trip to New York at the end of the month. Today is the 3rd anniversary of the opening of Come From Away. The profit checks, which had been coming like clockwork, come to a halt.
Friday, March 13, 2020
A transformed workplace: a new name (Geisel Pavilion, formerly Anderson Outpatient Pavilion), new embellishments (Cat in the Hat sculpture) and new temporary Covid-19 screening tents outside of Urgent Care.
A parking lot between the outpatient pavilion and the doctor’s parking garage is transformed into a drive-up Covid-19 screening center.
This is the first day I start following San Diego County’s confirmed Covid-19 case count. Today’s total is 11.
Saturday, March 14, 2020
I had long-standing plans to see my friend Susan Kanfer, a fellow photographer and traveler. Initially, we planned breakfast, but I had pushed it to lunchtime in order to make my ikebana class, which ultimately was canceled due to the coronavirus concerns. In the meantime, Steve had our house’s architect, Wally, come over late morning, to discuss what color to repaint the house. I don’t think we realized at the time this would be the last of these type of “non-essential” appointments for quite a while. I still had an occasional cough residual so sat at the opposite end of our long dining room table from Wally.
Susan and I discussed by text whether to keep our plans for lunch and end up deciding we will eat outside at Bushfire, but will keep our distance from each other. Steve comes along. There are very few people at Bushfire at lunchtime, maybe two other tables. In normal years, we would’ve attended the La Jolla Playhouse annual gala in the evening. We had not committed to it this year because of Steve’s back surgery earlier in the week and it was canceled ultimately because of the pandemic.
Sunday, March 15, 2020
New York City’s mayor announces the school system will close. We are relieved on behalf of Sarah, Steve‘s youngest sister, who works as a school nurse in lower Manhattan. They don’t close soon enough, as within 10 days she comes down with fever, cough and aches. Even though she’s a nurse, she couldn’t be tested for Covid-19 (not sick enough) and received a presumed Covid-19 diagnosis via a video visit. (She recovered uneventfully and with schools closed, is redeployed the following month screening children of essential parent workers on the Upper East Side).
Monday, March 16-Friday, March 20, 2020
Steve is in his second week of leave of absence from his spinal stenosis surgery. He decamps to Borrego Springs, to the empty house of our friends John and Elena. We have done multiple exchanges with them and they used our house in Sedona recently for the annual mountain bike festival, a week after we were there for the film festival.
I am home alone for the week and worked from home several days.
Every day after 4 PM, I am on the San Diego County website, looking up the number of confirmed coronavirus cases. For this week, the doubling time is about every three days, from 55 on Monday, to 60 on Tuesday, to 80 on Wednesday, 105 on Thursday, 131 on Friday and 159 on Saturday.
Everyone I know is already voluntarily staying at home when Governor Newsom issues a statewide stay at home order on Thursday night, March 19, becoming the first state to do so. The highest Level 4 travel advisory is issued on the same day by the State Department advising suspension of non-essential travel.
Steve returned from the desert on Friday evening. He is refreshed and relaxed and has been quite productive photographically, getting up for the sunrise and flying the drone. He has some beautiful images to show for it.
First light and a rainbow at Font’s Point, Anza Borrego Desert State Park (by Steve).
Aerial view of the Borrego Badlands, more back surgery convalescent work by Steve.
In the evening, we have our first virtual hour hour, with Dave and Rasa in Seattle, which does us both some good.
Saturday, March 21, 2020
The original plan for this day included dental cleaning appointments for both Mama and me. I have mine every three months and she has hers monthly. However, the transformed landscape ultimately led me to decide to cancel hers, after text discussions with Ohana and the dentist’s office.
I do go through with my dental cleaning. I find the office procedure is transformed. The ultrasonic cleaning has reverted to hand scaling. The hygienist does not floss my teeth at the end of the procedure as they usually do. No fluoride rinse is provided at the end of the cleaning. I’m advised to do a fluoride rinse at home. The hygienist herself is clad in a gown and a full face mask, similar to what we wear to perform breast biopsies. Of course, we wear a gown mostly to protect our clothes. The full face mask is just in case one accidentally hits an artery. It’s a rare occurrence but can happen.
I also have a hair appointment. When I arrive, the shades are drawn. The salon is on the second floor and it turns out hair salons were included in the shut down of nonessential businesses and so technically, we’re not supposed to be there. I had texted Mayling a few days before to see if we would be alone in the salon on Saturday, as we usually are. She said no. When I arrive, Carrie is there with a client. Carrie and Mayling are concerned that if they carry-on with business, someone will report them. Apparently, there are fines for flouting the business shutdown order.
As it turns out, I have perfectly timed this hair appointment for the last possible opportunity to have it professionally done. Of course, that’s a coincidence, as I make 6 months of appointments once our 6 month vacation schedule is set.
I had plans in the afternoon to see House of Joy at San Diego Repertory Theatre with Vivian, but theatre being nonessential, it was canceled only days after opening.
Ellen and David hosted a Fuck Coronavirus virtual dinner party in the evening. In attendance were Miles and Tatiana, Ralph and Gail, and Ron and Lucille, the same cohort whose company we missed back on March 6 when we were sick with the flu. A few days before, Steve and I discussed whether to have Berta, our long-time housekeeper, continue to come on Fridays. We decide to have her continue, as long as she and her family are healthy and that we will pay her whether she comes or not. We are still working and the psychological lift of weekly house cleaning still feels necessary. Ron and Lucille have kept their housekeeper on, with the stipulation that she move into their guesthouse. Ellen and Tatiana have the same housekeeper, who lives in Tijuana and cannot now cross the border, so they are managing themselves.
Sunday, March 22, 2020
On a gorgeous sunny morning, we rode north on our bicycles along the coast. Down the hill from us, we found the rail trail heading north from Chesterfield a bit too crowded for proper social distancing, with families with children and dogs. Pretty quickly, we decided to jump off and head north along Vulcan., which runs parallel to Highway 101. Ordinarily, it is too narrow for me, without much of a shoulder, but since it was early and traffic is so markedly reduced, it was fairly pleasant. Our turnaround point was the Buena Vista Audubon Society center, which has a short, but nicely done, system of boardwalk nature trails right off Highway 101.
Buena Vista lagoon, a peaceful spot with head-high reeds.
A scene from a short nature walk at Buena Vista Audubon Center, our usual South Oceanside turn-around spot for a North coastal bike ride.
It is a peaceful spot. When we have visited before, there’s been few if any visitors and today we only encountered a single woman, who steered clear of us as we did of her.
In the afternoon, we were supposed to have seen Little Women at the Old Globe, but that was canceled weeks ago due to the outbreak. The California state shelter in place mandate went into effect Thursday night, March 19, although most of the people I know were voluntarily staying at home prior to that time.
I heard from Patricia, my American friend living in Paris. She had been traveling for weeks in South America, birdwatching in the Atacama desert, the lake district and Patagonia. She and her friends were planning an Antarctica cruise, leaving from Ushuaia. However, it was canceled when they reach the end of the world. Argentina ejected foreigners and there were few flights out, so she had to hopscotch from airport to airport, including Buenos Aires, San Paulo, and Madrid, to make it home to Paris. Her description of quarantine confinement in Paris as living in a “gilded cage” plays in my mind when I spy a back-lit rain-droplet weighted spider web on our gate, seen in the feature image opening this post.
I spoke to Clarissa and Jason in the afternoon. They were so lucky with the timing of their trip to Riga, Latvia and St. Petersburg, Russia. They even managed to have dinner with their friends in London on their return. Later, all of them developed symptoms, probably the flu. Jason recovered quickly. Clarissa mentioned profound muscle aches. They returned to a transformed New York of shortages and panic buying.
3.3 million Americans filed for unemployment last week, an astonishing figure.
Monday, March 23, 2020
It has been two weeks since Steve’s minimally invasive decompression surgery for spinal stenosis and one week since such a surgery would have been indefinitely postponed as nonessential.
I woke up to the news that San Diego County has had its first death from Covid – 19. The good news is that the institution of stay at home orders seems to have had an effect this week, with the doubling time for new diagnoses increasing to five days this week, compared with three days last week.
Over the weekend, our work assignments were rejiggered to staffing with 14 radiologists per day, versus 18 radiologists a day. This is a work in progress, but last week made abundantly clear that our volumes have dropped dramatically since elective surgeries and non-essential studies like screening mammograms were postponed.
Steve received an unexpected day off, as we are furloughing people on occasional days during this period. I also received an unexpected half-day off. I worked in breast imaging with Rebecca in the morning, doing one cancer biopsy, a handful of diagnostic work-ups, read only one breast MRI and a handful of other studies and no screening mammograms.
It was pouring in the morning, so I decided not to bike to work, but it was sunny by the time I left work just before noon.
Steve and I walked from the house to San Elijo Lagoon for a late afternoon stroll. They were a handful of other people, not so numerous that they were difficult to avoid. I wore a buff around my neck to serve as an emergency mask.
We FaceTimed with Jon and Mayde in Florida, comparing notes on our new reality. Mayde is assembling face shields for distribution to health care workers.
A comment from a former partner to a New York Times article I posted on Facebook, about the rise in racism against Asian-Americans in the wake of the Covid-19 crisis and the racist in chief’s role in promulgating this by insisting on calling it the Chinese virus, prompted me to block him as a friend on Facebook, the first time I’ve done that since the 2016 election.
Today’s case count for San Diego County is 230. Yesterdays‘s was 205. The day before that it was 159.
Tuesday, March 24, 2020
Today was Steve‘s first day back at work, after his spinal stenosis surgery just over two weeks ago. He was on MSK, or musculoskeletal, which over the weekend had been transformed into a joint rotation with CT, staffed with two radiologists instead of three. I had to go into work physically as well, to Rancho Bernardo. Although I was on breast imaging, I was the only radiologist physically present there. Normally, we staff with three people, two doing general radiology and one doing breast imaging. Our volume is so reduced (60%?) that Brandon working from home and I were often competing for cases.
Today’s San Diego County case count is 242, including 45 hospitalized.
We received a surprise in the mail today, a check for each of us for $400, a thank you from Japan Airlines for attending to that desperately ill man in late January on our flight from Tokyo to Jakarta. I’ve often thought of him since, wondering if our diagnosis of pulmonary embolism was correct. Reports are now emerging that Covid-19 also affects the heart and kidneys and is implicated in thrombotic cerebrovascular events. There is so much that is not known about this disease.
I canceled our plane flights to and from Phoenix for next week. We are now planning to drive to Arizona.
Jessica, the daughter of our friends Rick and Sandy, wrote a very moving essay about her wedding, which had to be canceled this last weekend. I was brought to tears.
My friend Barbara, who normally works three days a week in another San Diego radiology group, is now working one day a week. In the meantime, she is busy sewing up colorful fabric masks. A diving friend in the Bay area posts on Facebook that she too is sewing masks.
Wednesday, March 25, 2020
Steve and I drive separately to work, even though we are working on the same campus. I am on nuclear medicine and likely will have to stay most of the day as much of my work is done on specialized workstations, which I do not have at home. He is again on MSK/musculoskeletal and can finish his day at home.
I notice I am making subtle changes to my work habits. Nuclear medicine tech Chris calls me in the morning to come down to perform a sentinel lymph node injection for a breast cancer patient who is going to surgery tomorrow. Until recently, I would have reviewed the case downstairs, after introducing myself to the patient. It only takes a minute or so of glancing at their mammograms, breast ultrasounds and breast MRIs to get a handle on which quadrant of the breast their tumor is, giving me direction for where to introduce the radioactive material under the skin of the breast. Today, I review the patient’s studies upstairs in order to minimize how much time I spend in the room with the patient. I also don a mask which I saved from a breast biopsy performed the past week. It’s a special type of surgical mask, which incorporates clear eye protection. So far, there seems to be adequate protective gear but the directive from administration is clear: conserve if possible.
Ordinarily, I take a central set of stairs down and walk through the x-ray department in order to reach nuclear medicine. I prefer these stairs because they are carpeted. Instead, I head to the back stairs, which are cold and metallic but don’t require me to open and close doors with my hands and take the back, more direct door into the department, in case there are waiting patients in the halls.
Tapping My Apple Watch to bring up the timer to steep my tea I encounter a disconcerting message: No more events. I see this message regularly in the ensuing weeks.
I hope that won’t always be the case. We now have so few appointments to remember that I don’t even bother to write them down on the calendar anymore.
San Diego’s case count today is 297, a big jump from yesterday’s 242.
Thursday, March 26, 2020
Bicycle commute: Dog Beach in Del Mar, ordinarily never empty, is deserted late March in the early weeks of state-wide quarantine.
Steve worked from home today, doing general radiology and musculoskeletal imaging remotely for our Carmel Valley site. I cycle to work, for the first time in over three weeks. I am paired with Amy, one of my most imperturbable and pleasant partners, in breast imaging. I have not seen her since Monday, March 2, the day I was coming down with the flu. I was starting to cough quite a bit that day in our shared reading room and so I am relieved to see her and to learn that she did not become ill. Her son, in his junior year at Berkeley, is home and her high school student daughter Jacqueline is also doing her school work from home.
Our workday is quite transformed from normal. We have no screening mammograms, very few diagnostic mammograms, and double the normal number of biopsies. We’re trying to clear out the pipeline of already scheduled procedures so that we can consolidate services and close some sites a few days/week. I end up doing three biopsies, two stereotactic biopsies in the morning and one ultrasound guided biopsy in the afternoon and Amy does a total of four ultrasound guided procedures by day’s end. There is so little for us to do otherwise, that we both leave an hour early.
I notice, not for the first time, that wearing a mask interferes with the iPhone’s face recognition capability.
Rob and Jeff lunched together out on the patio behind the cafeteria, in a sunny spot. The table is too small for my comfort, so I take a seat at an adjacent table, close enough to talk to them, but far enough for physical distancing.
San Diego’s confirmed Covid-19 case count is 341 today.