In Memoriam: For Lillian On Her Birthday (July 9, 1925 – December 31, 2016)

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Prayer card from Lillian’s memorial service

This year I had planned to be in Savannah, Georgia at Bonaventure Cemetery spending today with you and Grandpa, preferably with my parents or one of my siblings.

You convinced me to keep writing when I wanted to give up.

You told me I could succeed.

You would have been 95 today. We celebrated our birthdays together: yours today and mine tomorrow.

At the time I thought it was weird that I didn’t have normal birthday parties. Instead, we had a big family dinner together on July 9th and then we’d do something together on July 10th. Sometimes whatever we did involved whatever children my family could scrounge together.

It wasn’t until adulthood that I realized this was a birthday party, just not the kind of birthday party most American kids have.

What I hadn’t realized was that every year you celebrated me being your birthday gift.

I was your surprise baby. Your impossible baby.


Impossible Baby

The story goes Mama was sick
Mama didn’t know I wasn’t the flu
A five month flu
Impossible flu

Two kids to chase
Two kids to follow

Too Sick, Too Tired
Mama didn’t know I wasn’t the flu

Doctor came in the room
Test Results Read
“Impossible”
She said

Ultrasound
Boy’s Name
Father and Grandfather
Dreams Come True
Finally
The fourth with their name

Grandmother’s Birthday
Too Early
Don’t Be Born
Baby — But
Mama can’t stop me
Born Just After Midnight
July Tenth
Belated Birthday Gift

But
That’s Not A Boy

No One Agrees:
Laraleigh – Laura
No,
Lo


Being born premature in 1989, my mother did not want to take baby pictures of me in an incubator where she could not hold me. She did not want to have pictures reminding her of what I looked like hooked up to a heart monitor and a ventilator with various IV bags flowing into me. She did not want to remember the hours and hours where she wandered around a hospital screaming because the nurses lost track of where they put me and forgot to tell her anything about my condition.

Seriously, you kids born premature after 1990 had way higher survival rates. One of the reasons my mom didn’t take baby pictures was because she was advised not to in case I didn’t live. That’s the sort of stuff women were told would be psychologically better for them in the 1980s. I swear my mother is one of the strongest women on this planet.

Because of this, I didn’t see a baby picture of me until I was 30 years old – this past February/March while visiting my parents. In the picture, I am almost 6 months old and my grandparents are holding me after my christening service at St. Matthews Church.

Christening

I didn’t see the photograph
Until age 30
Grandmother and Grandfather hold me
[The red brick of St. Matthew’s Church]
Smiling-
Laughing so hard
Their faces blur

The only baby picture

Mama didn’t want to remember:
Wires, tubes, monitors, screens

I don’t remember them either.


In my early twenties, I asked my grandmother for a picture of her and my grandfather for my birthday. I’m terrible at asking for anything, especially if it is something the logical part of my brain has deemed superfluous. What I didn’t expect was this.

It’s a picture of my grandmother and grandfather at Armstrong College in Savannah, Georgia. At the time, my grandfather, having just returned from World War II, was finishing up a Bachelors of Science in Meteorology. My grandmother taught chemistry. They fell in love with teaching, scientific progress, and each other.

They were the types of people that had trouble sitting still.

My grandmother was academically fascinated by her heritage. She honored her connection to the Douglas clan, but I would not call her proud. Often, she focused more on the deep connection it provided her to faith. Her expressions of spirituality changed so much even over the 27 and half years I knew her that it’s hard to say what she believed. What I can say is that she believed in showing endless love, patience, and understanding. We selected her favorite prayers and passages to include on the prayer cards.

Prayer cards from the memorial service for Lillian

What I want every person reading this to know is that though I have only spoken of a few moments, 91.5 years is a long time on this planet. Lillian danced through those years with a love of music, chemistry, objectivity, compassion, education, and love.

The last two gifts she gave me were her engagement ring and her last words.

My grandmother wanted to experience everything there was to experience on this planet. She liked to say, “Heaven Is Here On Earth.” She did not live an easy life – in fact, quite the opposite. Her life was by far full of emotional hardship.


The Last Memory

Restless loblolly pines
We sit
Dry docked green aluminum jon boat
He laughs with goofy faces
Old spice arms envelope me
Binocular eyes

“That’s the Hale Bopp Comet”
His voice is shimmering moonlight on bay water
His presence is my father’s smile

He still wears that 1970s brown and tan puffer jacket
A flare orange dog whistle on a braided leather cord
I taste fried fish tails
Bay water drains off the hull

My fathers hold me together
The child meant to be the fourth with their names
For that moment I belong

Together they point to stardust
Teach me constellations
How to find my way home
If I am ever lost at sea


My grandfather died in 1997 in the doctor’s office while getting dressed after a physical. He wasn’t feeling well and in between classes he managed to get seen. He didn’t make it to his afternoon lecture. In October, he would have been 100 years old.

She never remarried, but she was not broken. She mourned the loss of her best friend and celebrated his memory every chance she got. My grandfather loved fill-in-the-blank style Hallmark cards and writing her love poems. What I didn’t realize until I was a teenager was that she kept all of them and read his words every time she missed him.

Now, I find myself doing the same thing, even with her final words. My birthday buddy can never be replaced. I will celebrate her 150th birthday in 2075 just as I celebrate her 95th.

Terminal Lucidity

They said she’d never play piano again
Hematoma
Right side
CAT scan looks bad

We came to visit at the wrong moment
Right moment
The nurses couldn’t find the cell phone number
They wouldn’t let us in the room

We’d spoken to her that morning
We said we’d see her soon

You were out on the boat
Knee high in male bonding
Falling in love the only way
Our family knows how

We finally got you on the phone
But you never hung up

At 91 and a half
You and I argued
You insisted she was clear

We moved her to hospice
We prayed she’d tell us that we were wrong

Later that night
I sat alone with my other mother
She squeezed my hand
“I’m not ready”

She never spoke again.


As I conclude this memorial, I thank you for taking the time to be here with me. I recognize that it is not easy to be with someone in mourning. I recognize that it is increasingly unusual in America for people to grow up in a multi-generational child rearing situations where they and their siblings form these close bonds. Because of this, real family, the family that sticks by you and unconditionally loves you, will be my first priority in life for as long as I live. That’s what we were taught by our grandparents and our parents. I hope that this is a legacy my siblings and I can carry on.

With that, I close this with love to all members of my family.

“A good name is to be chosen than great riches, and loving favor rather than silver and gold” – Family Motto / Proverbs 22:1

Is the US flattening the curve? Yes. Significantly? Who knows.

How do you describe that feeling of watching numbers climb and realizing that you’re watching in real time the most global example of what you’ve studied and taught your entire adult life?

Dread? Excitement? Existence?

When teaching about pandemics we teach students to look retrospectively at the numbers of those that have recovered versus those that have died. We make estimates on the numbers of those that were actually infected based on documentation available (or more recently – on documented confirmation). At about 6:00PM on 27 March 2020 twice as many people had died of covid-19 in the United States as have recovered. Seeing those numbers broke my heart for a moment, so I had to talk it out to myself somewhere.

https://coronavirus.1point3acres.com/en as of 6:26 PM MST 27 March 2020

It’s too early to call what it will look like in the United States in terms of our final numbers with covid-19. At this time these numbers are skewed by post-mortem testing and testing criteria that limits test accessibility to those already in need of medical intervention over home care.

Things might look scary, but don’t give up hope. Update 30 March 2020: and reporting started coming in of recoveries! Part of why this reporting may have been delayed is due to stringent testing criteria.

https://coronavirus.1point3acres.com/en as of 12:47 AM MST 30 March 2020. The criteria most are going by: 2 negative covid-19 swabs with a minimum of 24 hours separation.

The reason for this standard is that there is a very high false negative rate with the rt-PCR based test. If anything goes wrong along the way – say there’s a bad reagent, too low of a sample of viral particles, or something goes wrong that invalidates the test it will come back negative. This is the bane of every graduate student that has ever done rt-PCR. They will tell you their horror stories, especially if they were from poorly funded labs.

For some additional hope.

There’s this amazing power of graphs. We can look at growth of reported cases overtime to project the number of cumulative reported cases in the United States in the future.

I started keeping these to track the projection if we stayed on an exponential number of cases reported (aware of typo – did not plan on using this graph for anything originally)

Even as we have expanded albeit limited testing across the United States the overall rate of growth of total cumulative cases is slowing. While this hope is based on very limited data, could it be that we may actually be flattening the curve?

Equation is changing – are we flattening? I’m not sure. We added a zero. [Does some math]. I don’t know if that’s significant yet.

We’re able to see the slope change as the day to day numbers change. Thus, we can see when our efforts are working. (See below)

Source: https://coronavirus.1point3acres.com/en has the ability to build graphs showing how the US has slowed growth from 28% to 25%. That 3% isn’t much, but it’s something.
Source https://coronavirus.1point3acres.com/en But remember that our reporting is primarily coming from one place right now. Go to the website and visit this graph – it’s actually a movie!

This is part of why we need accurate reporting above anything else. The numbers that only require home care matter. In order to accurately understanding the danger of a disease we have to know how many people have it and are acting as asymptomatic or low symptomatic carriers. This influences anticipatory healthcare planning decisions for patients and facilities. I will address this a bit more later in regards to the limitations of cultural understanding around death, dying, and disease.

Update 30 March 2020: Exciting New Graph! If we start looking at the growth in the number of reported cases since improved surveillance across the United States started around March 19th – Yes, the US is kind of flattening the curve. But not enough. We’re also not far enough in to predict the peak.

We can be hopeful. As of 30 March 2020 we were set to diagnose our 500,000th case on 4 April, 2020. Flattening the curve is succeeding in different parts of the country. I will be addressing this in a new post. As a brief update as of 12:01AM 1 April, 2020, we have moved that projection out to 5 April, 2020. My model is limited by not knowing what the current daily max testing capacity of the United States is yet.

Update 5 April 2020:

Hey, look! We didn’t hit 500,000 cases. That’s incredibly comforting and is a fantastic sign. That said, we still have a backlog of COVID-19 tests, an untested positive population acting as a reservoir to continue infecting our healthy population, and we have no control over this. At this point, it is believed that SARS-CoV-2 will become a seasonal illness in the United States.

Source: Same as before

Remember how I said before that the 500,000th case had been pushed out to 5th April? Now, that’s 6th April, 2020 if only looking at the cumulative cases since the 15,000th case in the United States. What if we look at since 23 March? On this day we had approximately 46,000 confirmed cases, with the next day climbing to 55,000 confirmed cases. This is the date we should look at to consider since 50,000 cases reported.

Source: same as before

It’s not changing. There’s enough growth in of confirmed cases in parts of the country that any flattening is being overwhelmed right now. America’s current check up isn’t doing so hot.

A website for further seeing how your area is doing with flattening the curve. It is grading the United States with a D, and I agree.

PPE Shortages

It’s not the fault of our healthcare workers and everyone needs to show gratitude. The United States is facing extreme PPE shortages, resulting in healthcare workers being put at risk for infection and at risk for being vectors of covid-19. Hospital acquired infections have long been a problem in the US due to poor hygiene practices among staff and invasive devices used in hospital settings such as catheters, PICC lines, and IVs. While this has been combatted over recent years by the installation of improved educational programs and the implementation of disease control specialist positions in hospitals and clinics, these measures are useless without sufficient PPE. Washing hands and hand sanitization does only so much. We dedicate a lot of research time and money to this topic.

Diagnostic Testing Has Barriers

Point of Care rapid testing is a luxury afforded us over the past ten years (and toward the end of the 20th century) for strep throat, influenza, drug screenings, and other common “ailments” that bring you in to say hello to someone like me (only using quotes because I included drug screenings). The fact that we have this soon to be available for the coronavirus at all is incredible. Not only will this help with disease surveillance, but we have the ability to accurately study a pandemic in real time on a scale like never before. We could have the ability to intervene and institute true quarantine measures assuming we roll out extensive Point of Care screening for everyone.

But until then, can I even trust this data?

Rituals Around Disease, Death & Dying Complicate Things

How many people are dying at home untested? Remember that across America we have incredibly diverse customs about death and dying.

I recently spoke with friends in New York City and she mentioned that she knew members of certain cultural communities that though they were symptomatic were not getting tested. Part of why this happens is because of cultural beliefs around illness and dying. It’s going to be scary and everyone is reacting in ways that may deter them from getting tested. This will limit our surveillance and will also result in transmission within communities.

In the American South (where I’m from) families conduct home hospice even during severe illness out of pride and the cost of healthcare. Once the family member has died they will contact the local mortician. While it might no longer be legal to do home embalming and many states have prevented home burials, this has never stopped families from caring for the dead. Caring for the ones we love as a final act is one of the most essential acts as a family member that is often robbed of Americans elsewhere across the United States. In twenty to fifty years will we need to do go all paleovirology/anthrovirology (actual fields!) on disinterred bodies to get the actual numbers? Or will we go the route of China with incinerating covid-19 presumed bodies without testing? Will we go the route of the US during 1918? Will we burn it all?

Another thing to consider with any pandemic is how the rituals around death in the home contribute to the spread of a disease. This paper regarding the Ebola pandemic addresses why it is important to understand how we culturally handle death in times of pandemic in order to appropriately control spread.

Future Questions We Will Hopefully Answer:

As we look into ways to protect our healthcare workers with limited PPE we should be reminded that there are other ways we control the spread of disease.

Are healthcare workers on PReP faring better?

Many of the antivirals in PReP and PeP are being tested in the treatment of covid-19. Healthcare workers in Emergency Medicine have recently started turning to PReP and PeP to prevent the spread of HIV as a result of blood born pathogen exposure. Are these healthcare workers faring better than those not on PReP? Only time will tell since the number of workers on PReP reporting is still rather low.

What percent of the population needs to participate in social distancing in order to flatten the curve?

There’s isn’t actually an exact percent. What’s critical is that those at highest risk of being effective vectors for covid-19 during the transmission period of infection while shedding virus are able to infect as few other people as possible. This is a complicated question I’ve broken down into a couple parts.

Who actually needs to be on a stay-at-home order / essential workers only order for us to flatten the curve?

Go Fill Out Your Damn Census So I Have A Better Map

On the U.S. Census map above population density is shown in dark areas. Are you in that darker half? Stay. The 🦆 Home unless you are an essential worker.

Are you NOT in the darker half? Then you should be worried if you hear that there’s community transmission in your county. At that point practice social-distancing.

But you’re not out of the woods yet my friends. I have some more criteria for you:

How far away does your closest neighbor live? If you live in an apartment building – you should stay home. Live out in the country? Congratulations you lucky son of a gun! We’ve shown those city slickers that living in the underserved parts of America with crappy, dying economies that have been sputtering out and suffering at the hands of a global economy and evil corporations ain’t so bad, now is it? Or is it.

How far away is the closest interstate, highway, airport, train station, and other means of connection? Ever go to the gas station close to those things? May want to rethink that. Those are going to be your highest risk areas.

There’s a certain percentage of the population that can’t participate in the Stay at Home orders. It’s not their faults and they should be treated with the utmost kindness. They are taking huge risks. If you are a member of this population there are ways to assess how high risk your workplace is (if you’re interested). The actions of everyone else helps to make up for that by creating distance and reducing the number of people available for transmission at all. I know that’s a little messed up, but that is part of the theory behind it.

Source: https://www.census.gov/library/visualizations/interactive/2014-2018-median-age-by-county.html#

What is the median age of your area? Serious question though. Also, how old are you? Yes, this disease is affecting young people and those with conditions that make them more vulnerable. But I want you think about what kind of threat you are posing to the other people in your area by being a vector. If you live in a dark blue area, even if there hasn’t been a reported case in your county yet – staying home or social distancing is protecting this vulnerable population. You don’t want to have helped transmit the first.

source: https://www.unacast.com/covid19/social-distancing-scoreboard

(Update 5 April 2020) What Is Your Social Distancing Score?

You have thought about population density. You have thought about your median age group and how that plays into susceptibility of your area. The actions of those around you also put you at risk. In the flattening the curve check ups on New York, Pennsylvania, and New Jersey I talk about how important social distancing is right now and how big of an impact it is going to have on what we see in the future, such as the one vs. two peaks in New Jersey. But remember that not everywhere can social distance. Pay attention to the areas graded “F” as we address poverty below and in this post here.

Source: https://www.census.gov/library/visualizations/2019/comm/family-gatherings.html Do you live in a multigenerational household or live close by to family and see each other often?

Do you live in a multigenerational household or live close by to family? Do you see them often?

You absolutely need to be trying to stay home. These stay at home orders are critical to you. Illnesses like this can spread through families like wildfire. We love our families, right? Keep our families safe. If you are an essential business employee, it is even more important that you protect your family and isolate from them if possible. In many cases there is caregiving. This is addressed more in this post.

Source: https://www.census.gov/library/visualizations/interactive/2014-2018-poverty-rate-by-county.html#

Do you live in an area that is severely impoverished?

I hate asking this question because it is loaded. Click here for further reading on an additional opinion regarding race and healthcare inequality relating to poverty. Problems with the wealth and resource gaps in America demonstrates the huge gap between the way we treat people and I’m from a deep blue dot on the Chesapeake Bay where those resources aren’t available.

Disease outbreaks are worse in areas where poverty is not appropriately addressed. If you live in an area like this, you need to take stay at home orders seriously and the problem is, you can’t. And it’s not your fault. Our government and humanity are failing you.

I made a new post to address this more. Point is: stay home if you can, but be compassionate with yourself if you can’t.

What is determined to be essential and how do they determine what percentage of the workforce can be considered essential?

Oh. See, here’s the fun part. They don’t. They think of essential services, not the total number of employees this prevents from participating in social distancing. The state governments will figure out why this is really really dumb pretty fast, especially since many are now seeing hiring booms in those fields (like gas stations and weed delivery). I’m not an economist or a business person. People need to eat. This will be a strain on efforts that has to be monitored.

If people are interested in hearing me rant about the topics I’m actually an “expert” (by degrees and academic research/teaching background only) in let me know. If you are I’ll actually go back and edit this rant and dress it up a bit.

Thank you to anyone reading this. Without you this is just a shout into the ether.