Yes, one day I'll get back to the writing posts. The light and breezy posts that make folks giggle.

But not today. I need to process this night. Couldn't tell my parents because they are already horrified and I'm only telling them about 20% of what I'm dealing with. I told hubs, but he's already doing a lot to support me and doesn't need to be my counselor as well. Didn't make sense for a Twitter thread or Facebook post. (Knowing FB, the deniers will come out and try to explain why none of this is real.)

Trust me. It's real. And it's terrible.

Within the past week, I had the worst hospital call night ever. That's saying something, considering I have written posts about delivering stillborn babies at 3am. But this recent night was as bad if not worse but in a different way.

I had taken a 24 hour of extra call from my colleague who had gone on vacation (including Vegas (???WTF???)) a few weeks prior. Surprise, he was sick with COVID and couldn't take his call. So a partner of mine and I had to split his call days. I only had 5 patients in the hospital. Of that, 3 were in the ICU. But still. 5 patients should be easy. Right?

At 1am the hospital called. "We need you at the bedside now." I shoved on clothes and drove the few minutes to the small rural hospital. One of my admits from earlier in the day had deteriorated quickly, and now needed more fluids, oxygen, and drips. He had COVID and some other bad things going on. I spent two hours resuscitating him, calling his family to update them, arranging transport for a higher level of care than we could provide in a rural hospital. Only...we couldn't transport. No EMS availability until after 8am later that day because all crews were out on far-away transports due to regional hospitals not having any beds because of COVID patients filling all the beds. And because the patient was very large, he required special equipment that only 1 EMS outfit had. We had to keep this guy alive until 8am. Oh my god.

A few hours later, as I wrapped up the stabilization plan for this gentleman, the nurses ran over to me. "We need you in 130. We're about to start bagging her." ("Bagging" = starting CPR) This COVID patient had responded well to remdensivir + dexamethasone + convalescent plasma over the past few days. All of a sudden she needed way more oxygen, her chest XR looked like a white-out in a blizzard, and she was struggling to breathe despite maximum levels of oxygen. She was on maximum blood thinners so it wasn't likely an embolism. It was just COVID. Shitty, capricious COVID.

It was then, at 3am, that I had the terrible conversation you hear about in news articles about COVID. You know, the conversation where you hold the cell phone up on speaker, and then patient gasps for air as they try to say goodbye and I love you to their family. You clarify code status -- ventilator or not/CPR or not -- and answer questions with little data -- yes I think if you go onto the ventilator it's not a great chance you'll come off of it. What's "not great"? I don't know. I just know that there are so many other factors going on that most survival calculators put it around 10% for this particular person. So much of what we're doing is guesswork.

You know what isn't guesswork? The plan to keep this patient comfortable and make sure they're not suffering as they gasp for each breath and their lungs become edematous. I could reduce suffering. It was a terrible conversation, and I laid my forehead on the bed railing, trying to be unobtrusive as I held the phone inches away from this lady's gasping breaths. Somewhere in the back of my mind, I had the fleeting thought that if N95's, goggles, gowns, and gloves didn't work, then I would 100% get COVID based on the fact that this patient room was swimming in it with all the high flow oxygen and enclosed space and lady coughing right on my head while I held her phone. I finally wrapped up this patient's care at around 4:30 am, squeezed the nurse's arm because we can't hug because of stupid COVID, removed my own PPE, and took myself into an empty conference room to cry in private for a bit.

Then a page came in. A man with COVID in room 134 has suddenly taken a turn, can I come right away? Heart aching, eyes burning from tears, I blot with Kleenex and put on my mask and goggles as I run down the hall. Another patient struggling to breathe despite optimal treatment. Another conversation to clarify last wishes. Another terrible phone call between patient and family. I am so tired physically and emotionally, that I can't even put up the half-walls that protect me from these times. I can't hug the patient. I can't hug the family because they need to stay out of the hospital for their own safety. We do everything on the phone and it's terrible and necessary. I finish up at 6:30 am and text the oncoming physician to meet me in the ICU so I can hand off care in person. I'm too exhausted to cry. I fall asleep sitting in front of a computer, barely registering the nurses whispering their own check-outs at the next desk over.

7am. My partner arrived for check-out. All three patients had survived the night. I could walk away, having handed off care for the next day. But I couldn't function.

The dream-like blasts of images from that night have stuck with me and go on replay over and over at the worst times. One patient has recovered well, one is still critically ill, and one is on comfort care as they are actively dying. It's debilitating how I can be both sad and numb at the same time. This scenario is happening all over the country in every single hospital multiple times per day. I cannot imagine the collective injury to patients, families, and to healthcare workers. It defies the ability to visualize.

I'll leave this post with my PSA, and it's based on how one of those patients got COVID after staying home for months and months, only to have a visitor for the first time who stopped by for half an hour. That was enough for them to get COVID. I'm not going to tell you which patient it was. But keep any gatherings small and within your family unit/household. Please. It could mean the difference between your life or the life of someone you love.

As some of you know, I have been knee-deep in COVID doctor-y stuff since the beginning of March. I'm one of the physician leaders at my hospital, and the non-hospital clinic has been crazy pants. And over the past several weeks we've had a lot more sick patients -- things are starting to heat up. And the meetings just keep coming. My brain has had one setting and it's: COVID COVID COVID 24/7.

So for months, the only writing work I've been able to successfully accomplish involved not CREATION but only REVISION. These are not equal activities. I can tell a big difference between CREATION which takes a clear, uncluttered mind and longer periods of blank, free time -- versus REVISION, with I can do in short snippets and in between non-writing activities. (And while on call, true.)

I have two different books out on submission right now. (commence the nail biting!) That means waiting and doing ... something. So, the best activity is to write the second books to follow each of those submitted ones. Mission accomplished on one of them (I wrote book #2 a few years ago, thank goodness!). But the other book/series? I turned in the 2nd book for submission in June and immediately started thinking about a sequel. Every day, think, think, think. Come on, sequel. No words would come out. Weeks went by. I'd hit a terrible wall. Then came a little kernel of idea. A snippet of dialogue. A scene paragraph. But that was it. Nothing more would come.

The more I fretted about the lack of words, the less the words came. A vicious dive down a black hole that kept getting worse and worse.

I even managed to come up with a very rough outline. It was ... meh. As they say in My Big Fat Greek Wedding, "...dry like toast."

Then I did what any good doctor -- I mean writer -- should do. I took a dose of my own medicine!

Why was I starting with a plot point or a need to write a sequel? Why, when every other book I've written has started with the tiny kernel of idea and ... CHARACTERS.

You see, I had committed a key writing sin. One that I did years ago on my most difficult book to write so far. I didn't create my characters first. Didn't do the 10-page character interviews. Didn't use character motivations to generate conflict or plot. I had skipped a big step. Tried to jump straight to the drafting stage, which I know is quick and relatively painless for me. In short, I GOT GREEDY. Or lazy. Pick which word suits.

Here's what I realized -- the reason the drafting process had been relatively quick and painless in the past had to do with the fact that I had done my homework: character interviews, events/plot points, outline, and a super detailed outline. Then -- and only then -- came drafting. Come on, writer, you know better than to take shortcuts!

What do you know? Those detailed character interviews and insights led me to the conflict and plot. And bingo, bango -- we've got a book to draft.

Moral of the story: 1) don't take shortcuts and 2) when you find a process that works, don't mess with it!

It's not often I talk about one of my avocations: trail running. 

Now, before you think that it's glamorous or that I'm like those models in Runners World, trim and womanly yet exuding gentle strength, while decked out in sleek tech gear and  bounding down the trail like a graceful gazelle...that's nothing like my reality.

Imagine if you will a deranged oompah loompah who appears to be on the verge of a coronary, careening off rocks and roots all while muttering profanities as though f$%k is the only word in her vocabulary. (TBH, it IS one of my favorite words and I don't get to use it nearly enough.) What I do in the woods can barely be defined as athletic -- much less photogenic.

Have I mentioned that my ability to sweat buckets would put a Serengeti water buffalo to shame? It's impressive. As are my cankles. Hey, there's nothing wrong with sturdy legs. (Note to self: never wear skirts and heels.)

Every so often, in between barking my toe on a rock, then using the word f$%k like a verbal paintbrush and the world around me is a Jackson Pollock blank mural, I get kind of philosophical. And then I trip again.

But in those moments of clarity, I've learned a few things about my life and how the running reflects it. You might find a bit of yourself in here, too.

1) It's a marathon not a sprint. Or, in my case, it's a 50K not a sprint. (50K is 31 miles, because doing a marathon is silly enough, why not tack on another 5 miles because by golly I paid good money for All Of The Pain.) Mind you, I do a 4 month ramp-up training plan to get prepared for each race. 4 months of structured running 4-6 times/week and then put it all together in a 7 hour blaze of insanity.

I think about this concept of a marathon not a sprint a lot with my medical career, those long blocks on call, and my writing world. I've learned firsthand what happens in medicine if I don't meter out my energy and time carefully: burnout. Another way I look at it: You can eat an entire elephant...if you just eat it one bite at a time. Ok. Ew. I'm a vegetarian. And elephants are super cute. Anyway.

2) If you can't keep going at this pace or your legs are burning, it's okay to walk for a while. It's okay to dial back the effort and switch from anaerobic back to aerobic activity. It'll save time and legs later. Same with career or writing life. It's okay to take a break. Sometimes doing so means you can run faster and longer, later. Or work through that writer's block, or better edit that book after a break.

3) There are ups and downs in every run and every race. A wise ultra runner (it wasn't me, it was someone legit) said that every race has one or more low points -- places where you'll want to quit or you'll lose sight of why in the world you're doing this crazy thing. The folks who succeed are the ones who figure out how to work through the difficult times and continue.

4) RFP. I learned this one during a hot trail marathon where the wheels on the proverbial cart were just coming off that day. Bugs were biting. My clothing was 100% soaked in the humidity, and I still had 12 miles to go. It wasn't looking good. This spry runner zipped by, said "good job" (though how someone could conclude that from the mess I presented, who knew), and he quipped, "RFP!" I asked him what that meant and he said "Relentless Forward Progress." If you can't run, jog. If you can't jog, walk. If you can't walk, crawl. I almost made it to "crawl" that day, but I did finish.

5) Snack frequently. For ultra distances, it's important to condition the body to take in food throughout the activity. If not, you bonk hard and frankly it's a disaster. It's hard to recover from exhaustion due to total lack of calories. It's way better to be pro-active and take in small amounts of food throughout the race. Same in other activities. Keep the tank filled, at least partway. Writers, we can take breaks to read an article, take a course, or chat with writing buds. Never let the tank get too empty -- it's so much harder to fill back up from zero.

6) No one person is a trail runner. All sizes, shapes, and backgrounds are welcome at races. Same for writing, same for medicine. Anyone can do something. Maybe not everyone will run a 50K -- maybe they'll run a half-marathon. Maybe not a half-marathon -- maybe they'll walk a 5K. That's fine. It's all about each person's journey within themselves.

Writers have certain behaviors and activities associated with stages of the writing process. Some folks drink wine or go out to eat. Others buy a fun book and get lost in the pages for a while. Then there's yours truly.

In honor of my 10th book going out to an agent/publisher for consideration, I bring you: What I Do After Completing a Manuscript

1) Sigh happily with a dreamy expression on my face.

2) Dust the entire house. You heard me. This house doesn't get dusted but maybe 4-5x yearly which interestingly enough, corresponds exactly with me finishing either my first big draft of a new manuscript or the final product of a manuscript. Domestic goddess, I am not. But when the dust bunnies achieve sentience, I need to do something or they'll start unionizing.

3) A treat. Today, hubs got me some kind of magical Gelato that has cookie dough and fudge stripes in it. Makes me want to write another book, just to get more!

4) All the stuff I have been putting off because I need my brain to stay in creative/fiction mode for a while. There's a list. It waits for me. Tomorrow I will work on my doctor resume and a physician leadership application that's due. Talk about switching gears, huh?

5) Clean out the closet and/or bathroom. See item #2. Don't know why the closest gets picked, but this activity is a thing. I go through and throw out clothes I haven't worn in over a year, and tidy up a lot of book stuff that is stored in there. After every manuscript. And the bathroom gets an industrial cleaning.

6) Write a blog post. Voila!

7) Buy something fun. I used coupons + a sale and got a few skin products for the amazing price of $14.29 when it was all said and done. (I do like a good deal!)

What rituals or rewards do other folks enjoy when they finish a draft or a complete manuscript? Let me know -- I might pick up some good ideas to use after my next book!

As I suggested in my 5/1/20 post, the news is confirmed: I will not be attending any of the planned summer book signings...

Romance Rendezvous Book Blast
Royal Readers at Mall of America
Mayhem in the Midwest

Bummer. Big stinking bummer.

The request is that this healthcare organization's employees not travel until the end of summer unless it's absolutely necessary, and if folks do have to travel that they not do activities in groups more than 10 people. For about a second, I had considered doing the signings but not letting my employer know. But in good faith, I cannot do an action that might put my family, my patients, and myself at undue risk of exposure. I am a front-line healthcare worker, seeing patients in the clinic, labor/delivery, and the inpatient medicine/ICU floor. While I take every precaution with PPE and have (knock wood) remained healthy, my job does put me at a higher risk of exposure. Even if I had no symptoms, I could still pass an illness along to someone if I was not taking the precautions like when I'm in the hospital -- and I don't think anyone wants me to do a book signing in full PPE.  :)  (Though I suppose it would be a unique conversation starter!)

Big thanks to the organizers of these events and their understanding. And readers, stick with me -- when I can do book signings again, we are going to have such an amazing time!