r/dialysis Access Problems

Speaking of how dialysis can go badly, I saw this post on the r/dialysis subreddit:

I wrote a few times into this subreddit, but I have to share my problem with you. I started my journey in 2003. and as a kid I got a Catheter into my left side to try to help to my kidneys to work with plasmapheresis, because I have FSGS (this causes that I can’t get a transplant third time, because I had 2x tranplants and both failed in this disease). The catheter scarred my internal vein, so I got a stent. After I went through other diseases, I had a stomach perforation and a pancreas tumor (not cancer, but I don’t know the word), for 6+ months I was in the hospital, I had a permacath in my right side, when the doctors tried to save my life, they destroyed my veins on my arms (I don’t blame them). After they cured me (I was only 29 kg at this time, height 168 cm), they helped me to gain weight and I left the hospital when I was 17 years old and when I turned 18 they could make me a fistula, which worked 5 years, after it clotted the surgeon elevated my vena basilica, but my stent couldn’t handle the high blood flow (the previous fistula had lower flow) and my vein collapsed again and my hand was swollen, like a body builders hand, the skin never healed on that arm so my doctors closed the fistula. Permacath again for a short period, because they found a vein on my right hand and the surgery was successful and now it became its end. It worked 6 years and my surgeon told me there is no other option( no place for graft or anything ), only a Tesio Catheter: http://www.medcompnet.com/products/long_term/bio-flex_tesio.html , but I’m afraid, in my country there is no option for fistula on the leg, if my right vein fails, my life will be over, I mean they can put catheter into my groin, but what kind of life is that…
https://old.reddit.com/r/dialysis/comments/i9ah74/no_other_fistulagraft_options_im_only_31_and_on/

Holy shit. I know I complain a lot on this blog about how crappy my life is but I also admit that there are lots of patients who are worse off. My first catheter worked fine for 20 months. I had to go to the hospital to get it unclogged a few times but that’s just more sitting around. PD didn’t work eventually but I didn’t really have too many issues with the catheter or process, and did not get any infections. It’s been about 9 months now since I’m back on hemodialysis and again, the catheter is working great. My fistula is iffy but works when the needles are inserted correctly. Maybe we’ll find out more with the fistulagram next week.

I couldn’t imagine having all my access options fail. Dialysis sucks but short of a kidney transplant, there is no other solution to stay alive. I’d be freaked out if all the access points failed one after another. I think the original poster above thinks he is going to die and it seems like he’s in his late 20’s. Again, I didn’t start dialysis until I was 49 so at least I lived a semi-normal life until then.

I really think more resources should be spent on coming up with an implantable artificial kidney. Even the iHemo half-solution is better than hemodialysis today. Also, if the government would support PSA’s about live kidney donations as they did for drinking & driving and teen smoking, there would be a lot more live transplants and save a lot of patients from grief and risk of death. And we would save a ton on Medicare costs.

#700

700th post. During Divorce Care group meeting yesterday, someone mentioned they kept a journal of their healing process and it was very helpful. I guess this blog is similar. Originally I though it would be about peritoneal dialysis since there was so much to learn and do each night at home. Sometimes I would get home all tired, yet need to spend 30 minutes cleaning and connecting myself to the PD machine. Then the entire process took up close to 12 hours each day; half my life was dedicated to keeping me alive. Anyway, the blog helped.

Then I got emergency heart surgery and also switched back to hemodialysis. It was even more frustrating so this blog became an outlet. It didn’t matter that anyone I knew actually read the blog, just writing stuff down and venting was therapeutic.

So here we are, post #700. Again, a lot of the posts are pretty mundane: I walked this far, I weigh this much, no sleep again, and my foot hurts. I guess part of it shows that even with all these medical issues, I’m trying to live as normal as possible. Even with the pandemic and fear of serious harm/death, I still need to go to dialysis, get food or groceries, and breath “fresh” air once in awhile.

Actually, the weirdest part of this whole experience is dealing with mortality. I guess all these health issues puts me at higher risk of something more serious, and bad things happen on dialysis. I don’t know if other 50-year olds think about death but it’s hard to ignore for me. Some of it is watching fellow dialysis patients disappear from the clinic, and some of it is reading about complications from kidney failure, heart bypass surgery, diabetes, high blood pressure, and now COVID-19. I don’t have any brilliant thoughts or conclusions; I guess I’m still processing all this vs. how life was like 5-10 years ago.

Divorce Care Group #2

I went to the second out of four meetings for Divorce Care at church. This time, there was one more “guest” so we had six people. He took the came course two years ago except they went through 10 weeks instead of four this time. I believe he’s been divorced for about three years and he is about to get engaged again. The other two guests who also showed up last week met each other at a previous Divorce Care group.

The topic this time was on loneliness and the difference between being alone and lonely. I think I’m okay being alone since I’m more of in introvert. I don’t have to be out partying every weekend; actually I’m a bit uncomfortable at large social gatherings. I remember going with some friends to check out some student organizations at UCLA, probably ACA (Association of Chinese Americans) or CSA (Chinese Student Association). I found a bunch of pretentious people trying to impress each other and not a lot of fun. However, loneliness is different. Part of it is getting used to the missing person that was always there while you were married. I was married for seven years and during that time, we were apart only when I was on short-term mission trips, and when we separated of course.

I think it was good hearing other people share their experiences, though I keep thinking I should have adjusted better after 13 years of divorce. Still, how do you ever get over your first love? Just because they’re not part of your life anymore doesn’t mean it’s easy to forget about them.

Dental Appointment 8/14/2020

First day of year 53 was spent at the dentist. He wanted to crown the remaining upper teeth anyway so me losing part of the front tooth just hurried the process along. He prepped the front two tooth for crowns which means grinding them down then putting on temporary crowns until the permanent ones are ready. For both crowns and prep, they charged me $3,996. However, since I have dental insurance, even though I used up all my funds for this year, the adjusted price should have been $1,732 so I have a large credit on my account. This is the same with medical costs and insurance. Even though I’m paying myself, the price can vary wildly. If I didn’t have dental insurance, the I would have paid $2,265 more for the exact same service + crowns. That’s more than double. Plus usually people without insurance are those without good jobs so they double can’t afford dental work.

Anyway, due to the fistulagram quarantine next week, I can’t go back to the dentist until the following Monday. Instead of two temporary crowns, I have one large one covering the two front tooth. Weird but okay for a few weeks, though I can’t chew using the front until the permanent crowns are in.

Fistulagram

Just got a call from the vascular surgeon’s office. He wants me to get a fistulagram, which appears to be a dye-enhanced X-ray of the fistula. It’s scheduled for next Friday at 7:30 am which means be at the hospital by 5:30 am. I also have to do another COVID-19 test, this time in the hospital ER, then quarantine myself until the procedure by not going anywhere other than home and dialysis. I guess no follow-up dentist appointments next week.

As all this is going on, my fistula worked fine today. The tech used regular 16-gauge needles and was able to stick both needles in on the first try. They were also able to run at 350 mL/min without causing any error alarms for the entire four hours. In fact, they didn’t even hook me up with the catheter, and they even drew blood for labs from the fistula. It was a bit painful and itchy however.

I don’t think this is the last step yet. It’s just for him to go look at possible narrowing of the blood vessel and to see if there are clots. If not, there still a chance of more surgery. Dang it.

Hungry…

Ugh, my stomach is growling. As I mentioned in the previous post, I skipped breakfast and lunch, and only had about half of what my mom made for dinner. It’s a local Malaysian dish call laksa and it has a lot of spices. The flavor pack came straight from her hometown in Malaysia.

I’m afraid of drinking a pre-made protein shake (Nepro, Ensure, etc.) since the last two gave me diarrhea. Don’t want that to show up during dialysis. It’s monthly labs day so no disturbing the dialysis cleaning process. I have Honey & Bunches of Oats (HBO) cereal from Costco but I’m afraid that will mess up my chipped tooth some more.

Man, life is so complicated. Not sure what I’m going to eat for breakfast in a few hours so that I don’t pass out during dialysis. I may also need to skip my typical post-dialysis take-out lunch since I have to rush home to get on a work call. I picked a bad time to go “part-time” and lose part of my salary while seemingly doing the same amount of work.

Arm Shrinkage

I know where some of the weight loss I experienced in the past few months occurred. My left arm. I did notice that both arms seem skinnier than before but just now, I realized there was a huge difference between the two arms. There is much more flabby skin near the left armpit, and the circumference of the left arm at various points is smaller than the right arm. That’s kind of weird since I’ve been trying to not use the right arm as much due to the fistula. During cardiac rehabilitation, I didn’t notice the left arm being weaker than the right arm. I’m not sure how this discrepancy came to be.

Trying to find a tape measure…

Location	Left Arm	Right Arm
Wrist	6 3/4	7
Below Elbow	9 1/2	11 1/2
Above Elbow	10	11
Mid Bicep	10 1/2	12

Hmm, it’s actually difficult to measure your arm circumference by yourself. I didn’t measure myself previously but I think my biceps were >12 inches in circumference. The left arm is definitely smaller than the right arm. It’s kind of weird that the right arm gets a bit smaller above the elbow. I’m going to blame the fistula for swelling my arm and veins in the lower arm but 1.5 inch difference mid-bicep is strange.

I feel kind of stuck in limbo. I can’t eat well so I may not be getting enough protein and nutrients. This is leading to a continued gradual weight loss. Even with my dry weight down a few kgs, my ankles are still swollen so maybe there’s excess fluids somewhere? Even if I exercised more, will I pick up muscle mass even if I’m not eating enough? More protein shakes (they suck)? More Nepro? Feels like I’m going in circles with no way to break out other than a kidney transplant and we know how well that’s coming along.

==========

Heh! I can’t believe I got out of bed to measure my arms and blog about it at midnight. I was kind of busy with work today so didn’t nap very much, probably only from 11:30 am to 1:00 pm. I’m really tired and hungry (skipped breakfast and lunch, and had 1/2 of dinner due to chipped tooth) and need to get up in 4.5 hours.

Another COVID-19 Chart

This one is from the Orange County Business Journal. It shows a seven day moving average for several counties and when the original stay-at-home order from Governor Newsome was lifted. Pretty much 2-3 weeks after the order was lifted, the number of cases start increasing. Orange County is the orange line and kinda goes crazy in early June until mid-July.

*https://www.ocbj.com/news/2020/aug/12/covid-19-cases-down-peak/*

It does appear that we may have been avoid the spike in cases if we continued to stay home, or was better at wearing masks or keeping social distance. I don’t know how people think wearing masks is ineffective when you look at statistics across the world, especially in Asia. Do people really need to be infected and get super sick to believe that this pandemic is real?

COVID-19 @Work 8/12/2020

Heh, I feel kind of stupid. I’ve been reading the case statistics from work all wrong. The Intranet webpage lists cases-to-date by location, and the total number of recoveries. I just assumed the total number was adding up the individual cases. So today, the number of cumulative cases at our work location is 111 and 326 for the total company. However, 271 have recovered and cleared to return to work. So, there are only 55 active cases across the company out of 7,500+ employees. The number at our work location should be even smaller, likely in the range of 20-25. That makes me feel better. I thought there were 111 active cases. Hopefully that decreases the chance of having an asymptomatic employee show up to work.

Since almost no one shows up on Sundays, chances are very low that I’m going to encounter an asymptomatic carrier. I think it’s safe for me to run in the office, dump off some documents to shred, clean up my desk a bit, and steal my 30″ monitor on the way out. My coworker said a lot of people have taken IT equipment home recently and physical security seems to be okay with it. She walked out with her 24″ monitor recently and no one said anything. Maybe I’ll put that theory to the test this weekend and see if anyone grabs me coming out of the building with a huge (but old) LCD moniutor.

Work 1:1 Meetings

Even though I don’t have direct staff anymore, I still have several (6) one-on-one meetings on my calendar. One with my boss, two with peers, and three with ex-staff members. Our company asked all the managers to set these up weekly to improve internal communications. However, our CEO is a terrible communicator and we often have to check Twitter or Reddit for updated information on our own company.

Usually we hold these meeting in our lunch area or just at our desks. I typically try to talk about non-work related stuff since we’re a small department and I usually talk to my staff all the time. When we started working from home, these 1:1 meeting were held over the phone with is a very different dynamic. I also started skipping a lot of them since all my staff have become ex-staff. Anyway, I had two 1/2 hour meeting scheduled today and I spent almost 3.5 hours on the phone just catching up. I haven’t talked to anyone at work for about a month so it was good to talk to someone other than family or doctors for once.

Proposition 23

Another election means another dialysis related proposition on the ballot. This time it’s Proposition 23. Like Proposition 8 in 2018, this ballot measure is again sponsored by SEIU-UHW West, a labor union that is trying to organize at DaVita and Fresenius and their dialysis clinics. Proposition 8 was an attempt to limit dialysis center profits to 115% of costs. All I remember was that all the nurses and technicians at my dialysis center were opposed to it. My clinic is part of a non-profit hospital so they were not part of DaVita or Fresenius. I’m not sure if they are unionized as part of the hospital staff since sometimes they do cover at the dialysis unit in the hospital.

Reading through Proposition 23, it seems like the requests are reasonable, such has having a doctor on-site. However, having spent two and a half years on in-center hemodialysis, the proposal won’t matter much. We already have nephrologists doing rounds once a week, sometimes more often. There are several registered nurses on-site and if anything happens, it’s usually an emergency and the staff will call 911 for paramedics. Maybe it’s because we’re right next to a hospital, there is an emergency room 30 seconds away. I never felt medically neglected during dialysis sessions. The other requirement about reporting infections, I thought that was done already. Medicare has an entire website that compares the over 6,000 dialysis centers in the US.

In the end, this proposition, like Prop 8 that failed, is just SEIU trying to gain more members and more power. I don’t think they actually give a shit about the patients. Organizing and bringing in membership dues is their main priority. These propositions are aimed at lowering the profit margins for the commercial dialysis centers so they will negotiate with the union. It will probably hurt small or non-profit dialysis centers since many are not making money if they have a large % of Medicare patients. I’ll check with the nurses again but I’m pretty sure they will want me to vote no on this propositions too.

Peripheral Neuropathy 8/12/2020

I haven’t post about this in awhile, other to talk about the occasional pain episodes. However, the constant daily numbness is still ever-present. Each time I think about the neuropathy, if feels like it’s getting worse. I can’t blame the amiodarone I was taking early on anymore: it’s been eight months since I stopped taking it. Not sure if the other arrhythmia medicine (Multaq) contributed to the growing numbness, but I was on that for only a few weeks and stopped last month.

I mentioned that I purchased a shiatsu foot and calf massager. The few times I tried using it, the massager seems to make the numbness stronger. That may not be a bad thing since walking also increases the numbness for awhile. I assume it’s the increased blood flow in the the lower extremities. I need to be more consistent to see if there’s any real difference. However, sometimes I feel the numbness seems to be crawling up my legs, especially when I’m lying down. My new endocrinologist did say that anti-neuropathy medication are mostly ineffective and she would avoid them unless the pain/discomfort was overwhelming. I guess it is sometimes but most of the time it’s just there in the background, irritating but not debilitating yet.

Life is Like a Deck of Cards

Tomorrow I turn 52. If you asked me what life would be like in my 50’s when I was much younger, I would have never come up with this scenario. I never ate healthy or got enough exercise but I didn’t have any major health issues when I was younger. I know it’s a results of years of neglect but if feels like all these health issues hit me within the last five years.

When you say the number 52, I immediately think of a deck of cards. Not counting Jokers, there are 52 playing cards in a standard deck made up of four suites. Different articles have different explanations on the meaning of card suites:

Suite	Definition	Age Range
Hearts	Childhood; Love	1-13
Clubs	Youth; Education	14-26
Diamonds	Mid-life; Money	27-39
Spades	Old-age; Death	40-52

I mean 52 is not really old age. In the US, you don’t get a senior citizen discount until you turn 55. But since being on dialysis and looking at all the morbid statistics, it does feel like I’m in the end stage of my life. I’m trying to knock down each health issue as they come up but I get the feeling that I may be overwhelmed soon.

Anyway, if you look at the age ranges, it kind of fits my life until now. It probably easy to split anyone’s life into four periods, but humor me.

Hearts (1-13): This is the period up through middle school. I basically didn’t know anything and just followed my parents around. I was born in Asia but by age 13, was living in Canada.

Clubs (14-26): Education is right. I spent a lot of time in college and finally graduated when I was 27, so close enough. I wasn’t very social in college so it was like hiding out before entering the “real world.”

Diamonds (27-39): I probably made a lot of mistakes during this period but decisions here laid the foundation for the rest of my career. Also got married (31) and divorced (38) during this time. I didn’t think so at the time, but more and more I feel that life has been an empty shell post-divorce. Which leads us to…

Spades (40-52): Looking back, this period was mainly about trying to adapt post-divorce and now, not dying. Even though people keep saying that I’m still “young”, I feel terribly old. There’s also the persistent feeling that I’ve already lived my life, even though I didn’t accomplish anything big, and there not much left.

Usually people have three areas of concern in their life: health, relationships, and finances. I never had any real issues with finances: didn’t have a lot of money but always had enough to live on. The other two areas are a mess though. The health part we all know about.Post-divorce, I had two relationships. Again hindsight is 20/20; both were not right for me and failed. Now I’m too sick and tired to pursue any relationships. Just thinking about all the time and effort I spent dating and getting married the first time tires me out.

So what now? There are no more cards in a deck after 52 unless you count Jokers. Maybe I’m on borrowed time. In the 1920’s, average life expectancy in the Americas was still in the low 50’s. How did people plan their life accordingly? Nowadays, people talk about a “bucket list” of things to do during retirement (I guess before you “kick the bucket”). Sigh… if I was only so optimistic.

Dental Issues Again

I just noticed one of my front tooth has a huge piece chipped off, probably like 1/4 of the tooth from top to bottom. Also, it is a bit dark underneath so there’s probably a huge cavity there too. My dentist did say that he wanted to cap almost all the teeth in the top row of my mouth. At $1,500 per tooth, it’s going to cost a lot but now I have no choice. There is a huge gap between the front two teeth that needs to get fixed. I think the piece broke off when I ate something but what happened to the actual piece? Did I swallow it? It’s weird since the tooth is a bit sore when I blow air across the gap. How come I didn’t notice until I brushed my teeth just now?

These health problems just keep piling on. I have an entire list of stuff to go through. Maybe it’s time to review again since it’s been more than two months.

ESRD: I made several posts recently about waiting for UCLA to make a decision again
Dialysis access: fistula is kind of working half the time; waiting for vascular surgeon to call me back after an ultrasound scan of my arm last week
Cardiac rehab: still on hold but I probably won’t continue since UCLA already cleared me post-heart surgery
Atrial flutter: it’s been over two months since the ablation procedure and heart rate seems stable in the mid-50’s; still have some shortness of breath and some chest pressure but that may be more from the bypass surgery
Peripheral neuropathy: stopped all arrhythmia medication, including Multaq; also did not restart acupuncture; bought a large shiatsu foot and calf massager to see if that will help
Back pain and pressure in chest: about same; still difficult to sleep on left side
Minimal urine production: almost no urine output; maybe 50 mL per day?
Insomnia: still not sleeping more than 3-4 hours per night; just starting working part-time so taking lots of short naps during the day
Dental issues: dentist wants me in for teeth cleaning every three months; still fall asleep often without brushing first; see above for continued issues
Endocrinologist: saw new doctor; she prescribed a new (and expensive) drug since she wasn’t comfortable that I was not taking any blood sugar medications
Lump in left leg: no change
Constipation: not noticeable anymore; having pretty regular bowel movements
Ophthalmologist: need to make appointment; the one year exam deadline passed during the pandemic shutdown; probably also need to see the optometrist for new glasses again

Right now, the UCLA thing is taking up all my attention since we wanted two years and it seems we’re back exactly where we were. I’m very upset that UCLA deferred making a decision and I had to suffer two years of dialysis, including failed peritoneal dialysis which probably messed up my health even more. I know they’re being cautious but it’s not like I have a hangnail. A kidney transplant is night and day difference for a dialysis patient. My quality of life could have been so much better if we did the transplant two years ago. Seriously, I can’t believe were at exactly the same place we were two years ago and they still won’t make a decision.

It’s hard to have hope when looking at that huge list of problems. I don’t think I can work through everything in my remaining lifetime. Living with dialysis is already hard, plus trying to stay healthy enough for a transplant while your body is trying to kill you. Then I go and almost break a tooth. So many things to worry about and we’re basically stuck at home trying not to get infected with COVID-19.

I”m tired and just rambling now. It’s 12:34 am and time for sleep (for a few hours anyway). First priority is getting the tooth fixed before it gets any worse.

Work Project Update

I finally made some progress with my work project. Since agreeing to go to part-time status with my boss, I’ve been trying to get my one project off the ground. It takes a lot of coordination with the rest of the team even if everyone was in the office. With half the team working from home, it’s even harder to collaborate.

Anyway, I spent the last two weeks going back and forth between Purchasing and Information Security on my request for proposal document. I finally got it cleared up and received an okay to send it out. The document went out to ten suppliers so I had to send the same info ten times, making sure I have the right email address matched with the email contents. Nothing more embarrassing then to send an email to your intended recipient’s competitors.

I think I sent out the emails at 3:00 pm and already got a bunch of replies with questions and request for more information. Ugh. I think work will be a lot busier starting tomorrow. Good thing I’m now part-time and working for less money.

Long Donor Transplant Wait

My nephrologist was the one doing rounds today. I believe they have three nephrologists in the medical practice but one of them is my actual doctor, i.e., the one that I see if I go into their offices. I’ve been seeing her prior to starting dialysis so it’s been more than three years. She speaks Cantonese and Mandarin with an accent but we converse in English.

I gave her an update of the whole UCLA situation. She knows the rest of the story since she has been my nephrologist since I started the transplant process at St. Joseph Hospital back in 2016. She agrees that typically if you have a willing live donor, you should be able to get the transplant within months, not years. However, she did have a patient that had 4 volunteers to donate a kidney but for one reason or another, they were all eventually rejected. The patient ended up getting a deceased donor kidney after seven years on the transplant list. Ugh… that’s terrible. If UCLA rejects my sister, I don’t have any more live donors and can only look forward to 4+ more years of dialysis, waiting for a deceased donor if I stay listed in Southern California.

UCLA Committee Rehearing

My sister got a voicemail from the donor coordinator handling her case. Basically, she presented my sister’s case again to the committee yesterday; they meet every Monday. They modified their decision to include the possibility of getting a different scan for another look the legion. Otherwise they still want the biopsy. The coordinator is trying to get in contact with UCLA’s radiologist to get more clarification on the type of scan. Evidently, multiple scans and diagnoses from MemorialCare doesn’t count for much with them.

My questions is why another biopsy when they rejected our request for one two years ago? If the procedure was performed well before, then they’ll probably be unable to get a sample this time since the object has not changed much. If we go with another scan, is it new technology? Why wasn’t that an option two years ago when they messed up the biopsy? They do hundreds of kidney transplants each year. They must know the toll of spending two additional years on dialysis. Now there’s a chance all that suffering was for no reason at all?!

Very upset.

New Driver’s License

I got my new California driver’s license in the mail today. I already shared my story of my visit to the DMV. It turned out that the license did arrive before my birthday so in hindsight, I didn’t need the temporary license.

If you look at yourself daily in the mirror, you don’t notice gradual changes in your appearance. Then one day, you look closely at your reflection and wonder when everything changed. The photo on my current driver’s license was taken about five years ago. You can see that I’ve lost a lot of weight by looking at the two photos side by side. My face was pretty much round in the old photo; now, not so much. I guess that happens when you lose 50 pounds. It was also before my kidneys failed and dialysis so it was a better time even though I was fatter.

Let’s hope I have the opportunity to use the Real ID part of my driver’s license for boarding aircrafts.

Fistula Update 8/11/2020

The tech that’s been gone for three weeks was back today. I thought someone said medical leave but he told me he was on vacation. He went on vacation back in April; do dialysis techs get a lot of vacation days in addition to working only three days a week?

He came by at around 7:00 am to stick me. Originally I though my dialysis nurse was going to do it. At first glance, it looked like he was successful on both needles. However, once hooked up the machine, the arterial line had pressure issues. After adjusting it for awhile, he gave up and they used the chest catheter to pull blood from my body. He did say that he should have used the regular needle instead of the short one since my artery seems to be deeper down, though a huge blood vessel bulge is developing at the site. Someone else prepped the medical supplies this morning and I think he just used whatever was at my chair.

The only problem is that the arterial needle site is hurting, even three hours after dialysis. I don’t know if he poked around too much or what. At least I’ll get a break on Thursday since it’s monthly lab day and they like to use the catheter to make sure I get a good cleaning. He said he’ll try again this Saturday. Can’t wait…

COVID-19 @Work 8/11/2020

The latest count is 107 cases at my work site, and about 280+ across the entire company. That number seems to have steadied a bit, much like the rest of California, but it’s weird that is not decreasing. Is nobody recovering in the two months the company has been reporting the number? Or are new cases still greater than those recovering? If the pandemic is being contained, the total number of active cases should be dropping. Right?

I still think I should go into work at least one day a month to check if anyone left anything important for me at my desk. I do have another manager checking it periodically but I don’t know if she feels comfortable opening all my mail. I still have a ton of old bank statements that I want to shred and don’t want to do it four pages at a time with my home shredder. And there’s always the 30″ monitor on my desk that I want to bring home.