Published September 21, 2021 by Nan Mykel


There’s a new pill out and it’s called

Psychosis. It lets your cell walls

melt and you become as one mix.

No pretense of striving, no

effort to see light of day

by light of the moon, for all

too soon you will search for rock

bottom and find it gone.


The droning of drums siphons you

into the drip drip of the coffee maker

at the church tea.  Better put on

your clothes.  Your clothes, your clothes,

better put on your clothes.


Image: Pinterest


Published September 20, 2021 by Nan Mykel

Image:  Nancy Roman

Big discovery, thanks to Ruth Scribbles who tried to download my free book.  She got nothing but a blank.  I tried and I got it.  My helper suggests my pdf needed a special link which was missing.  Turns out it wasn’t really missing (maybe), it was just hiding under the next paragraph heading, if you click on it first:


Altho I earlier said I was going to remove this page, apparently it never got opened, so if you’re interested in a free pdf of the whole book, the link is either the semi-heading maybe in blue, or what you get after clicking on it.

Please tell me if you can’t see it by clicking on the preceding capitals.   This is what we get for being born too late to groove internet.  The  “page” to try and blast off from  is one of several at the top of this blog.

I’m another OOPS–saying this all wrong.  Go to the list of pages at the top of the blog, go to Free book and then go to FALLOUT PDF INTERIOR and click. Then either click on a link which may appear or maybe the book will appear.  Grump grump–don ‘t know why I can see it and others can’t–or couldn’t, the other day.  Or just tune in every Wednesday for chapters in order.  (Boy, all that was hard for me to say–I mean write).


Published September 20, 2021 by Nan Mykel

I resonated to Wislawa Szymborska’s poem Wonderment which I happened upon in the bookcase next to my chair, in Sounds, Feelings, Thoughts, Princeton Paperbacks 1981Since I’m not clear on all the flavors of the copyright law I’ll only share a portion, for your education:


Why to excess then in one single person?

This one not that?  And why am I here?

On a day that’s a Tuesday?  In a house not a nest?

In skin not in scales? With a face not a leaf?

Why only once in my very own person?

Precisely on earth?  Under that little star?….

(The poet was the winner of the 1996 Nobel Prize for Literature).

Another Ravitch Winner

Published September 19, 2021 by Nan Mykel

You have probably read about the gymnasts who testified before Congress last week, complaining about the failure of the FBI, the US Olympic Committee, and others had ignored their reports of sexual abuse by the doctor for the gymnastics team.

Like me, you probably never read the FBI report describing its own failure to take their reports seriously.

This CNN story has a link to the report. It is horrifying.

While Wandering Through the Life Issues page:

Published September 19, 2021 by Nan Mykel

I’m Still Alive  from the Mental Chronicles – In 2013–Still Alive?


To be honest, I’ve mostly been thinking. The end of the month I’ll go back to campus for another two semesters of classes, which I enjoy, but this was supposed to be a break and it has turned into me just feeling numb.

I wish I could just focus on things that are going right in my life, but I can’t. I quit going to my psychiatrist several months ago, and I got the letter fairly recently warning me to schedule an appointment or be discharged. Followed by the letter officially stating that I have been discharged from psychiatric care at this place. I had just held that letter and stared at it, and thought about how I had been doing well for a while after leaving. Then I thought about how I refuse to go back to medication because I never want to deal with side effects again.

I had thought studying psychology would be good for me. I thought maybe it would help me understand myself, and maybe people in general.

I’m beginning to think nothing can help me. A lot has to do with my understanding of the world. The world is a terrible place because of humans and humans are terrible because of human nature. There is no refuge in religion because I see through most established religions. Why would I believe there is a god when all I see in news is foreign genocides and political assassinations and six years old rape victims? Or, if there is a god, why would I want to worship something that could end misery but allows genocides and assassinations and the rape of six-year-olds?

Then I wonder if I am facing the true shape of things or if I am disillusioned. To be honest, I want so badly to be wrong. But I can’t make myself believe that it’s true.

The state of the world so deeply bothers me, and yet I feel there’s nothing I can do. No one can clean all the world’s filth, and if someone did, it would just re-accumulate–because that’s how people are.

I’ve heard often the counter-argument, of course, that if you can make a difference to even one person, that’s a huge deal in that person’s life and that’s one less person suffering. I just can’t see it that way. No, I do not just turn my head, I do try to help. But in my head, it makes no difference. Yes, I helped the homeless woman on the corner. But who is there to help the man being dismembered or the child soldier or the bullied student or the woman being brutally raped in some guy’s basement?

There is no one to help them, and they will suffer.

And there is no end and no cure because we would be our own shot at salvation but we are too busy being the devil to care.

I just find it difficult to deal with and I tend to think maybe, maybe it is a trend going downward and maybe someday our world will become too heavy from the weight of its crimes and it will all fall down and collapse in on itself, and maybe that is the outcome humanity deserves.

All of this is condensed in this frustrating nebula that lives in the back of my head and taints nearly everything I think and do with meaninglessness.

I apologize for my first recent entry being so rant-like and dark, it’s just that this is what I’ve been thinking about.

I just don’t know.


WHO AM I?–Wednesday FALLOUT Continued

Published September 15, 2021 by Nan Mykel

I’ve lived a long life…an incest survivor talks to incest offenders

The most striking characteristic of sex offenders, from a diagnostic standpoint, is their apparent normality. —Judith Lewis Herman, 1990

The good news is that the incest offender is usually not psychotic, retarded or senile and seldom uses physical force against his victim. Although it is not completely known what creates a sexual predisposition toward children on the part of an adult—what bio-psycho-social components, what developmental events, at what points, in what combinations and in what intensities are critical—we do know
that a wide variety of individual differences do exist. (Groth 1982, 226)

You may qualify for a diagnosis; you decide. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (2000, 572), known in the profession as DSM IV, defines
a “Pedophile” as follows:
A. Over a period of at least 6 months, recurrent, intensely sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally 13 years or younger).
B. The person has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.
C. The person is at least age 16 years and at least 5 years older than the child or children in Criterion A.
NOTE: Do not include an individual in late adolescence involved in an ongoing sexual relationship with
a 12-or 13-year old.

Specify if:
Sexually Attracted to Males
Sexually Attracted to Females
Sexually Attracted to Both

Specify if:
Limited to incest

Specify type:
Exclusive Type (attracted only to children)
Nonexclusive Type

Salter (1988, 51) has written, “It is this author’s opinion that, while many incest offenders are closet pedophiles, incest offenders exist who are not.” Apparently offenders against boys are more likely to meet the criteria for Pedophilia than offenders against girls (Herman 1990, 181-82).

You may also be a stepfather. Children who live in stepfamilies are unusually vulnerable, which means that stepfathers are at increased risk to offend. You may be an alcoholic or possess one of the disinhibiting factors discussed later in the book. It’s also likely that you tend to be a little suspicious of the motivations of others and haven’t completely embraced the adult role in society. As with the other diagnostic features, this may or may not describe you. You probably had fantasies about molesting your family member long before doing it and then “groomed” her—like in a courtship—to woo her trust. This process is described in more detail in Chapter 6.

It’s quite possible that you have also molested non-family members at some point in your life, as suggested by one study in which twenty-three (34%) of the men known only to have molested outside the home also perpetrated incest, and 9 of the 18 known incest
offenders admitted to undetected abuse of a child outside the home (Weinrott and Saylor 1991, 292). A large study by Abel and Rouleau found that 131 individuals (23.3%) had offended against both
family and non-family victims (1990, 16).

The response to the query “who am I?” may be “your own abuser.”  This statement needs to be read carefully, because many victims fear an assumption that if they were victimized they will inevitably become an offender. This is not the case.

Sometimes, however, the offender was a victim himself, and dealt with his abuse by identifying at some level with his molester, consciously or unconsciously. In fact, when a child starts molesting other children it can often serve as an alert to the possible existence of an additional sexual abuser in the background. This is a controversial topic in the literature. A number of incest offenders admit to having been molested as children. Some do not, and some falsely claim to be victims of childhood sexual abuse, presumably in order to gain sympathy from treatment staff (Hindman and Peters 2001). It appears that males, with their testosterone, macho culture and possible genetic influences, may be reluctant to disclose that they have been abused. I realize now that admitting that they have been damaged by sexual abuse is tantamount to admitting vulnerability, a trait not in keeping with the offender’s self-image.

Briere (1989, 154) observes that “the developing male child may
strive to reaffirm the power or masculinity he believes was compromised by his abuse—potentially leading to high levels of sexual aggression against others.”

Clarke and Llewelyn (2001) suggest that men and women cope with their abuse experiences differently, that male survivors are more likely to become abusers, females to be re-victimized. Carmen, Reiker, and Mills (1984, 382) report that in their sample of physically and sexually abused psychiatric patients, “the abused females directed their hatred and aggression against themselves. … In comparison, the mainly adolescent male victims, although experiencing many of the same feelings of self-hatred, more often directed their aggression toward others.”

Since a great many victims dissociate or otherwise block the memory of having been sexually abused as children until years later, why would this not also be true of victims who become abusers? The puzzle and controversy continues. During one therapy group session I had occasion to witness a child molester regain the memory of having been sexually assaulted by his priest. How much do you remember? That could be part of who you are.

Marshall and Barbaree (1990a, 259) have observed that human males are biologically prepared for sexual aggression, citing the same sex steroids for both sexual arousal and aggression. “In our view, then, biological factors present the growing male with the task of learning to appropriately separate sex and aggression and to inhibit aggression in a sexual context” (260). This developmental
task can be impacted by childhood experiences, cultural influences, pornography, and situational factors.

Smallbone (2006, 99), addressing Marshall and Barbaree’s theory, writes that “the fact that normal adult males are typically most attracted to youthful and beautiful sexual partners suggests that it is
the exploitation, rather than the recognition of young people’s sexual appeal that characterizes sexual offending behavior.” In this sense sexual offending against children is much more like theft or robbery than it is like non-criminal sexual deviations like fetishism or transvestism. The question of why most men do not sexually exploit children and young people is not all that different from the question of why most do not rob banks. (Ibid.)  It should not be puzzling, therefore, that there are many more male sexual aggressors than female.

Another possibility lurking in the background is the concept of sexual imprinting. According to this theory, one is imprinted by his first pleasurable orgasmic experience, and although he may repress may always carry the possibility of being sexually aroused by another male, although married and in love with a woman. William
Prendergast shared this theory during a 1987 training presentation
in Chillicothe, Ohio. Various aspects of that first physically pleasurable molestation may also be imprinted, as was the case with one
of the men in our program who had been molested in a movie theatre. He became an offender, and the site of his offending was always in a movie theater, with one exception. The offense for which
he was incarcerated involved him sitting beside his victim, in the
front seat of a car.

Hunter has observed that “a large percentage of those who identify
themselves as sexually compulsive or addictive also report experiencing childhood sexual abuse” (1995, 61).

In response to the incest offender’s query “who am I?” another answer may be “someone vulnerable to acting out the adult-child sexual paradigm, either by having experienced it or knowing of its existence within the family.” Mrazek (1981, 104) suspects that previous incestuous experience or knowledge of it within the family
may be the most significant factor in the continuation of incest with
new family members. It appears, as she reports, that once the incest
taboo is broken within a family, it is quite likely to be broken again.

Courtois (1988, 26) agrees, stating that once the incest barrier is breached, there is little to disinhibit additional incestuous activity; incest becomes
the ‘normal’ way to interact and seems to become unconsciously embedded within the family, even though
the abuse is commonly kept secret. There are differing findings and opinions in the literature about the
importance of this transmission, however. Williams and Finkelhor
(1990, 238) state that “although intergenerational transmission
may be a factor for some incestuous fathers, it does not come close
to being universal.”

Finkelhor is concerned that the popularization of the “simpleminded intergenerational transmission theory” terrifies victims,  who fear they are destined to become abusers. Moreover, “because
the intergenerational transmission explanation relies exclusively on a childhood experience that we cannot return and change, it breeds cynicism that we can be effective in prevention” (1986a,

On my father’s side, my grandfather molested me and several others in the family. Over the generations, at least seven members of the family line have been tainted by incest, as offender and/or victim. My father told me my grandfather also made sexual advances toward my mother.

Soon after my father first molested me, he said that some experts maintain that “it” is damaging, but he didn’t believe it.
So—back to the identity question: What do you know about your own family? That, of course, is part of who we all are.

Are you vulnerable to child pornography? You know you are.  At one of our training seminars the presenter described a case in
which a juror, along with the other jurors, was required to view  child pornography as part of the evidence. Shortly thereafter the
juror—who reportedly had never previously assaulted a child—began molesting children.

Child pornography appears to carry with it the potential, then, to ignite fires due to erotic vulnerabilities that were formerly under control. Both viewing child pornography and having fantasies of offending can be precursors to the act, especially when utilized while masturbating. A number of recovering molesters wisely  avoid the Internet, due to reasonable concern about a possible relapse. Warning: on the Internet, pornography can pop up when you least expect it. After retirement I Googled “sex offenders” and got pornography, to my chagrin.

Watch out. Not infrequently, hearing that a child has been sexually abused precipitates sexual fantasies in an adult. Quick, change the subject before you are led astray! As much as I regret it, before we leave this topic, I need to mention that a small minority of “healing professionals” take sexual advantage of clients who share their history of incest during therapy.  Presumably their fantasies get stirred and disinhibit them.

So far we have looked at the possibilities that the potential incest offender has a tendency to follow in the footsteps of his own abuser, has been sexually imprinted at an early age, may know of incest within his family, and may be vulnerable to the effects of child pornography and to fantasies ignited by learning of a young victim’s sexual abuse. He may also be that invisible intruder who  visits sorrow upon his own family.

When speaking of behavior rather than a physiological state, the usual term is compulsion rather than addiction. In our program we used Carnes’s Out of the Shadows (1992), still a classic in its field. For specific criteria see “The Sexual Addiction Assessment Process” by Carnes and Wilson (2002). They define compulsivity as “the loss of the ability to choose whether or not to stop or continue a particular behavior” (4–5).

One reason for the public’s reluctance to accept the “sexual addict” label is that it smacks of excuse making. But the alcoholic who gets a DUI is not excused because of his physical vulnerability to alcohol, any more than a sexual addict should be excused for acting out his compulsion. Nevertheless, the fact is that just as some people have more difficulty staying sober than others, it’s more difficult for some sexual abusers to avoid molesting children than it is for most of the population.

It was known in my community that I treated sex offenders, which is how I came to be contacted by a local Crisis Line in response to an emergency call from a child molester in another city. He had recently been released from prison for sexual crimes against children and was reoffending. He wanted to know if the judge would be lenient if he turned himself in. My answer had to be “no.” As a second time offender his sentence would probably be harsher. His modus operandi was to pick up children from bus stops, take them and molest them and return them to the bus stop. Apparently one child’s shame and her fear response was so great that it touched him, and he became aware of the wrongfulness of his behavior at the visceral level and wanted to stop, but without living the rest of his life behind bars. Fortunately, I happened to have referral information to an emergency clinic that offered medical treatment for compulsive sex offenders. The clinic was in our state, and only several hours away. I don’t know the end of this story, but was thankful that I could offer him one possible solution. Others interested in medical help for sexual addiction will want to consult a specialist about the most current treatment possibilities, as well as their side-effects.

One man, a grandfather in our program, reported that he used to lock his front door in order to keep his granddaughter out, so that he would not molest her again. He became suicidal prior to incarceration. Again, in the midst of scorn for child molesters, it may put things into perspective to remember that most of us do not have to struggle against an urge to molest children. Salter said that the hair on the back of her neck stood up when she interviewed an obviously earnest and troubled minister with a conscience who molested his grandchildren. Salter realized that if a man who truly believes in hell would be willing to
go there in exchange for the chance to molest a child, this problem had a persistence and compulsiveness that few outside the drug addiction world could appreciate. (2003, 76)

If you have had to repeatedly struggle against urges to commit sexual abuse, you may in fact be on the brink of a sexual compulsion.  Once breached, the inhibitions are weakened, and with repetition over time develop into patterns and then into habits (Hunter 1995, 57).  If you have already become sexually compulsive “much of the emotional material that is fueling the behavior is not conscious” (57). “By the time someone has developed a psychological addiction to an act, it has taken on a life of its own. The actions are so automatic that the addict will report that they ‘just happen’ as if he or she played no role in the action” (60).

While some individual offenders may try to use the concept as an excuse, there are a great many cases in which having a sexual compulsion is a statement of fact rather than a cop-out. Recognizing and owning that you have a problem can be a first step to taking the problem seriously and working toward recovery.  As Herman (1990, 187) says:  “Addiction interferes with normal maturation and destroys social relationships. These problems remain even after the compulsive behavior has been given up.  … Once an addiction has become established, it must be considered a lifelong process. An addict may achieve abstinence; he does not achieve cure,” and “Highly structured group treatment and self-help programs appear to be the most successful modality for the social rehabilitation of addicts, including sex offenders. … A new source of self-esteem is provided by the structure of a program which requires acknowledgment of the harm done but offers an opportunity for restitution and service to others. (Ibid., 186) (See also discussion of Circles of Support and Accountability in chapter 12.)

Sexual compulsives are welcome at AA meetings, but they must be circumspect in details that they divulge as they work on their problem. Although a confidential group, felonious conduct is sometimes reported to authorities by other members. There are other groups specifically for these men and women, including Sex and Love Addicts Anonymous, Sex Addicts Anonymous, and Sexual Compulsives Anonymous. Most apparently follow the 12-step program developed and utilized by Alcoholics Anonymous. Local chapters of the above groups vary in their commitment to working on the problem, but a visit to any such self-help meeting should offer an idea of the support available from that group.

This may be an appropriate place to repeat that child molesters are never cured of their attraction to children, but with support and sufficient motivation they can strengthen their inhibitions and continue their struggle to never reoffend.

Although quality treatment can decrease recidivism to some extent, men who molest children can never be trusted alone around children again, nor should they want to be. In most cases continual self-monitoring is required. The future is more hopeful for the man who is in recovery and constantly working the steps of his treatment program or relapse prevention plan, instead of denying that he really has a problem. One of the most dangerous thinking errors of sex offenders is, “I’ll just put it out of my mind.”

A hopeful note lies in the fact that we are discovering that the brain is still plastic and capable of change. For example, a new conceptualization and treatment of obsessive-compulsiveness has been developed that may be helpful in treating the recurrent deviant thoughts that usually precede sexual assault. While description of this treatment, which was pioneered by Jeffrey M. Schwartz, is beyond the scope of this book, it can be readily accessed in Norman Doidge’s The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science (2007).

Psychopaths are not addicts or compulsives. They have no inclinations or inhibitions to struggle against, since they lack a conscience (Hare 1999). If having committed one or more sexual offenses does not bother your conscience, you may in fact be a psychopath. The psychopath’s diagnosis is Antisocial Personality Disorder, described on page 706 of the DSM IV.

What’s a man to do if he has to stay away from the people he prefers? What is his alternative? His choices are killing himself, abusing (and harming) the same or another child, or exploring other avenues, including support groups, medical therapy, psychotherapy,  12-step programs, and establishing friendships and activities with other adults. It is recommended that sexual involvement with anyone be postponed until an alternative pattern of meeting needs is developed.  Killing oneself bestows a heavy burden on anyone who cares about you, including the victim. Having a family member who commits suicide is a risk factor for future suicides in the family.  We are all part of the web of life with its interdependencies, and there is no escaping the fact that a single behavior can have ever expanding effects, for better or worse.

No friends; emotionally and physically isolated from other adults; lonely; unaware of the effect of your behavior on your family (perhaps your drinking, excessive self-focus, etc.); a talented manipulator; non-assertive; obsequious outside the family; lack of respect for your wife; socially ill at ease; feelings easily hurt; morally somewhat strait-laced; lack empathy; some feeling that you deserve more than life has given you; distrustful of the motivations of others. This is an apt description of my father. Can you relate to any of these descriptors?

You can’t. Let go of her. Let her be free of you. More about this difficult and painful topic in the Trauma Bond chapter, where snipping the trauma bond is discussed.


A story I don’t know that isn’t mine to tell

Published September 14, 2021 by Nan Mykel

Amen, brother!

Welcome to infinitefreetime dot com

Many years ago I had this young man in my classes, we’ll call him Johnny, which isn’t his name. Johnny was in an all-boys’ class, the only one I’ve ever taught, and a group that, in general, drove me insane, because temperamentally I am not very well suited to teaching large groups of boys. I had him in 6th grade. He was a pretty good kid, as it went, but he was prone to getting dragged into shit if shit was nearby to get dragged into. I have described this type of student to parents before as a “kindling kid”– he’s not going to do anything on his own, but if there’s fire, he’ll burn.

Anyway, I was describing his behavior to his mother at parent teacher conferences once, and she was reacting quite a bit more strongly than I really felt like she ought to have, and at one…

View original post 647 more words

Keith’s Suggestion

Published September 14, 2021 by Nan Mykel

Nan, we need to reach out to GOP legislators and note concerns over the party and beseech them to help return the party to viability. We need a GOP party that is based on truth and right now it denounces the truth tellers and praises the liars.

They could begin by telling the former president to get over it, stop the bogus election fraud claims and accept your loss like a grown-up. He has probably the worst litigation record on this issue, winning one case out of well over 60. And, GOP election officials continue to disagree with his claims.

The 2020 election was one of the most secure in history per Chris Krebs, who led the effort. But, he was fired for saying so. These attacks on the voting process led by Texas is a solution looking for a problem. Jim Crow has been alive and well in Texas and other states.

So, we need to pass the national legislation to make the process better, seek term limits on Congress and Senate and shorten the election process. If we can get more of the money out of the process, that would be great, but that may be a pipe dream The term limits would at least restrict the ROI on funders of candidates. They do want something for their funding.


Keith Wilson

(Musings of an Old Fart)


Published September 14, 2021 by Nan Mykel






I am, I was, I will be…


I sing, I sang, I will sing again



The path out of the forest

disappears too soon into the hills,

corn popped, husks dropped.


Is there a me to be?

Or a time to count?  If there

is more than a dream


what dreams it?  A second chance

at what?  Caught in something’s

game show, DNA in shreds?


Bird on the wing is migrating maybe?

Biscuits in the oven pethaps, but

is anybody home?  Who wrote this?

Another Ravitch Winner

Published September 14, 2021 by Nan Mykel

This is an arresting article that was written by respiratory therapist Karen Gallardo and published by the Los Angeles Times. I wish it was compulsory reading for everyone who refuses to wear a mask or to get vaccinated.

She writes:

I’m a respiratory therapist. With the fourth wave of the pandemic in full swing, fueled by the highly contagious Delta variant, the trajectory of the patients I see, from admission to critical care, is all too familiar. When they’re vaccinated, their COVID-19 infections most likely end after Stage 1. If only that were the case for everyone.
Get vaccinated. If you choose not to, here’s what to expect if you are hospitalized for a serious case of COVID-19.

Stage 1. You’ve had debilitating symptoms for a few days, but now it is so hard to breathe that you come to the emergency room. Your oxygen saturation level tells us you need help, a supplemental flow of 1 to 4 liters of oxygen per minute. We admit you and start you on antivirals, steroids, anticoagulants or monoclonal antibodies. You’ll spend several days in the hospital feeling run-down, but if we can wean you off the oxygen, you’ll get discharged. You survive.

Stage 2. It becomes harder and harder for you to breathe. “Like drowning,” many patients describe the feeling. The bronchodilator treatments we give you provide little relief. Your oxygen requirements increase significantly, from 4 liters to 15 liters to 40 liters per minute. Little things, like relieving yourself or sitting up in bed, become too difficult for you to do on your own. Your oxygen saturation rapidly declines when you move about. We transfer you to the intensive care unit.

Stage 3. You’re exhausted from hyperventilating to satisfy your body’s demand for air. We put you on noninvasive, “positive pressure” ventilation — a big, bulky face mask that must be Velcro’d tightly around your face so the machine can efficiently push pressure into your lungs to pop them open so you get enough of the oxygen it delivers.

Stage 4. Your breathing becomes even more labored. We can tell you’re severely fatigued. An arterial blood draw confirms that the oxygen content in your blood is critically low. We prepare to intubate you. If you’re able to and if there’s time, we will suggest that you call your loved ones. This might be the last time they’ll hear your voice.

We connect you to a ventilator. You are sedated and paralyzed, fed through a feeding tube, hooked to a Foley catheter and a rectal tube. We turn your limp body regularly, so you don’t develop pressure ulcers — bed sores. We bathe you and keep you clean. We flip you onto your stomach to allow for better oxygenation. We will try experimental therapeutics.

Stage 5. Some patients survive Stage 4. Unfortunately, your oxygen levels and overall condition have not improved after several days on the ventilator. Your COVID-infested lungs need assistance and time to heal, something that an ECMO machine, which bypasses your lungs and oxygenates your blood, can provide. But alas, our community hospital doesn’t have that capability.

If you’re stable enough, you will get transferred to another hospital for that therapy. Otherwise, we’ll continue treating you as best we can. We’re understaffed and overwhelmed, but we’ll always give you the best care we can.

Stage 6. The pressure required to open your lungs is so high that air can leak into your chest cavity, so we insert tubes to clear it out. Your kidneys fail to filter the byproducts from the drugs we continuously give you. Despite diuretics, your entire body swells from fluid retention, and you require dialysis to help with your renal function.

The long hospital stay and your depressed immune system make you susceptible to infections. A chest X-ray shows fluid accumulating in your lung sacs. A blood clot may show up, too. We can’t prevent these complications at this point; we treat them as they present.

If your blood pressure drops critically, we will administer vasopressors to bring it up, but your heart may stop anyway. After several rounds of CPR, we’ll get your pulse and circulation back. But soon, your family will need to make a difficult decision.

Stage 7: After several meetings with the palliative care team, your family decides to withdraw care. We extubate you, turning off the breathing machinery. We set up a final FaceTime call with your loved ones. As we work in your room, we hear crying and loving goodbyes. We cry, too, and we hold your hand until your last natural breath.

I’ve been at this for 17 months now. It doesn’t get easier. My pandemic stories rarely end well.

Karen Gallardo is a respiratory therapist at Community Memorial Hospital in Ventura.

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