On spider bites, blood clots, and lions

Issue: BCMJ, vol. 63, No. 7, September 2021, Page 270 Editorials COVID-19

Loyal BCMJ readers appreciate that the worldwide outbreak of COVID-19 constituted a pandemic long before it was officially designated as such, and now tirelessly await confirmation of its conclusion. It is my pleasure to humbly answer their prayers with the following incontrovertible evidence, gleaned from the trenches of emergency medicine.*

Regulars have returned to the ED, including the spider-bitten

At the start of the pandemic, BC patients, as they have since the dawn of time, sustained spider bites daily. But COVID-19 fear drove them to shun the emergency department, instead electing to stay home and bang pots at 7 p.m. daily in tribute to health care heroes. The spider-bitten, no longer fearful of COVID-19, have returned to the ED alongside other regular patient cohorts constituting the ED faithful, on a scale recalling the annual Okavango Delta migration.

COVID-sick patients have given way to COVID-free patients fearing vaccine complications

During the various COVID-19 waves, many patients arrived with cough and some tested positive for COVID-19—strong evidence that the disease was rampant. But now we see only patients fearful of vaccine-induced blood clot complications. This is cause for joy and celebration. First, they do not have COVID-19 and are unlikely to get it by virtue of vaccination. Second, emergency doctors, even the lowest functioning cohort (e.g., the author), are expert in managing not only the fear that grips patients concerned about blood clots, but also the occasional clot we are able to confirm.§

The news cycle has moved on

COVID-19 topped headlines for over a year. But in journalism the old inevitably makes way for the new, never to return (i.e., The Mov­ing Finger writes; and, having writ, Moves on). For example, in the May/June CPSBC College Connector, the pandemic has lost top billing to antiracism, including the decision to retire the College’s 135-year-old colonial crest. Distinctly medieval, the crest features a crowned lion standing on a larger crown. The crest was in fact emblazoned on the BC flag from 1871 to 1906. The noble lion is balanced on all fours, with its head turned left facing the viewer (in heraldry the statant guardant attitude). This heraldic lion motif is a feature of the royal crest of England.

I wish each of you health and happiness as we and the public we serve emerge from a time of prolonged suffering.
—David J. Esler, MD

*Opinion expressed is solely that of the author. No endorsement by the BCMJ or Doctors of BC expressed or implied. Variant strains and fourth wave exempted. Applicable in BC only. Other conditions and exclusions may apply.

Other ED faithful include patients concerned about hypertension (cura elevatum pressura sanguinem) and those in need of work notes (litteras excusationem ab opereor) or prescription refills.

The spider-bitten are well known to BC’s emergency doctors. They present with red spots/blisters inflicted by the many species of BC’s nocturnal human-biting spiders (BCNH-BS). These remarkable arachnids bite only at night when the unsuspecting victim is asleep. On waking, the spiders have retreated to camouflaged web-sites, there to rest weary legs and fangs in joyful anticipation of the next busy night of human predation. Only suffering is left in their wake.

§Recently one of my EP colleagues sustained a serious head injury while mountain biking. On waking from a prolonged coma she was unable to speak or recognize her husband and children, yet immediately and accurately reproduced the Wells blood clot algorithm. Now free of family responsibilities, she continues to mountain bike and scour the ED for blood clots.

The “Hat on a Cat on a Hat,” (i.e., coronam super leonem super coronam).

Barbary lions, cited by British monarchs for their virtues—nobility, royalty, strength, stateliness, and valor—did not lead fulfilling lives as guests of the Crown at their official residence in the Tower of London menagerie. Notwithstanding their royal status, they would doubtless have preferred chasing Barbary sheep and stag over the sunny sands of North Africa to languishing in a damp, dreary, and wretched British prison/zoo.

David J. Esler, MD, CCFP(EM). On spider bites, blood clots, and lions. BCMJ, Vol. 63, No. 7, September, 2021, Page(s) 270 - Editorials, COVID-19.

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