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The Dimming of the Shining City

By Jason Terk, MD

Published by on October 20, 2021. You can read the original article here.

In March 1630, John Winthrop delivered the treatise “A Model of Christian Charity” at Holyrood Church in Southampton, England, prior to leading the first settlers of the Massachusetts Bay colony on their to journey to the New World. In his address, he referred to the new community they would found as a city upon a hill with the eyes of all people upon them. This reference to a portion of Jesus’ Sermon on the Mount underscored the importance of committing the colonists to brotherly love and unity, setting the needs of others and the community above one’s own needs.

I first heard this reference to a shining city on a hill at the moment of my political awakening and at the close of Ronald Reagan’s presidency in his farewell address in January 1989:

I’ve spoken of the shining city all my political life, but I don’t know if I ever quite communicated what I saw when I said it. But in my mind, it was a tall, proud city built on rocks stronger than oceans, wind-swept, God-blessed, and teeming with people of all kinds living in harmony and peace; a city with free ports that hummed with commerce and creativity. And if there had to be city walls, the walls had doors, and the doors were open to anyone with the will and the heart to get here. That’s how I saw it and see it still.

I was never much a fan of Reagan but did recognize his desire to lead all of us as a nation of different people who had unique talents to share and whose commonality of purpose exceeded partisan divisions. I also recognized that this vision was as aspirational as the source that inspired it. North stars have their role if only we faithfully chart our course by them.

As Reagan’s farewell words washed over me, I looked ahead at my immediate future and recalled my recent past. I would graduate from college a few months later and start medical school. I had just completed an idyllic nine months of study in Hamilton, New Zealand, an experience that still influences me today. I witnessed a nation of diverse people that cared about each other meaningfully. The Kiwi culture is exemplified in their national sport, rugby, emphasizing the team over the individual.

That promise of the shining city seemed more tangible as we witnessed the close of the 1980s and experienced the bliss of the 1990s. I and my contemporaries moved through those years, getting married, starting families, starting jobs, and acquiring mortgages. The demons of our nation still seemed to be suppressed by our angels for the most part. We could not know that the seeds of the cataclysm that was 9/11 and the divisions that would follow were germinating beneath us.

The number of years since that horrible day has verily seen the transformation of who we are and how we are. No longer do we have a presumption of goodwill toward those who are politically, religiously, or philosophically different from us. Yes, we have always borne the demons of racism and intolerance through our nation’s shared history, but there was almost always the patina of unity among us save for the years of the Civil War. Rather, we are now in a season of distrust and tribalism where each partisan seeks to win leverage for the sake of power alone only for those of like mind and mission.

The most insidious part of this darkening of our nation is the democratization of truth and the obfuscation of our understanding of reality. A lie told a million times on social media becomes fact. No longer can we count upon rationality, logic, and evidence to be the measures we employ to discern truth. Truth has been abducted to serve the mission of elevating influence, gaining advantage, and exercising power. It is a rot that is destroying us and creating many victims. The internet, formerly and quaintly referred to as the information superhighway, has become our road to perdition and the chief means of the purveyance of agenda-driven disinformation coming from both extremes of the political spectrum. The algorithms move us into our demagogic poles and obliterate the common ground where consensus suffocates from lack of oxygen.

This organized perpetration of deception has taken on more meaning as we have faced the last century’s most critical public health threat. Freedom which was once defined as something that required a personal sacrifice of individual concerns in deference to the needs of others and the community has now become rebranded as solely within the province of individual liberty. The simple acts of individuals wearing masks or getting vaccinated to protect all of us and ending the pandemic for our towns, cities, states, nations is too much for many among us who have distilled their catalyzed grievances into refusals to sacrifice their “personal freedom.”

Indeed, as I write these words, state legislatures, including our own in my state, are codifying this movement into law with bans on companies including hospitals, nursing homes, and medical facilities from requiring COVID-19 vaccination for their employees. And, those legislators are doing it not because of some sincerely held principles, but because they know which way the wind blows and cynicism Trumps all other considerations in getting reelected.

The victims of this now distorted concept of liberty are ones that we physicians encounter every day. The one that inspired this essay for me is an 11-year-old boy that I saw three weeks ago. He is a patient of mine in my pediatric practice who came to see me with typical respiratory symptoms that led to a diagnosis of COVID-19. While he recovered uneventfully, his father got sick the next day and died from the same illness five days later. Like the vast majority of people who die from COVID-19 now, he was unvaccinated, believing that getting vaccinated was unnecessary and part of a greater effort to undermine his personal liberty. His son is now dealing with the unimaginable grief of losing a parent at such a tender age and asking his mother if he killed his father by getting sick and causing his death. This happens every day now in our communities across our nation. These are wounds that will never heal for this generation of kids.

We have no hope of exiting this pathway to darkness unless we can collectively rise above our manufactured grievances and reductive individualism to truly witness and love each other. We must recognize and reconcile the real harms done to each other in the evil pursuit of purely selfish interests. Only then can we renew and rekindle the true light of a successful community and our city on the hill.

Tarrant County COVID-19 Activity – 01/18/22

COVID-19 Positive cases: 454,638

COVID-19 related deaths: 5122

Recovered COVID-19 cases: 374,926

Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County updated Tuesday, January 18, 2o22. Find more COVID-19 information from TCPH here.

*These data are provisional and are subject to change at any time.

Deaths and recovered cases are included in total COVID-19 positive cases.

Volunteers Needed for Arlington COVID-19 Testing Site

Tarrant County will be activating a COVID-19 surge testing site in Arlington. The Tarrant County Office of Emergency Management requests volunteers to assist with line management and other miscellaneous duties.

Volunteers will work 3.5-hour shifts with three volunteers per shift. This work will be outside and require standing for long periods. Volunteers will not be involved with the testing procedure. Water will be provided. Face coverings are recommended.

Dates:  January 20, 2022 – February 10, 2022

Time:     9:00 a.m. to 7:00 p.m.

Location: Globe Life Field, Parking Lot M 1205 Pennant Dr, Arlington, TX 76011

Volunteer Sign-up:

  1. Link:
  2. Select one or more shifts and then click the Submit and Sign Up button at the bottom of the screen.
  3. Fill in your information. Please include your phone or email address. We will use this information to keep you informed of updates.
  4. Click the Sign Up Now button.
  5. You will receive a confirmation email with more information.

If you have any questions, please contact:

So-Called “Mild” Omicron Still a Serious Threat, Physicians Warn

By Brent Annear

Published by the Texas Medical Association on January 14, 2022. Read the original article here.

As the massive spike of COVID-19 cases continues, the degree of infectiousness and lack of the best and most available treatment worries Texas Medical Association leaders about what the next few weeks will bring. They say important medical advice bears repeating with patients

The omicron variant’s illness has been described by some people as “less severe,” but physicians urge their colleagues to help patients keep their guard up. In addition to making people sick enough to miss several days of work and school, the virus remains a serious threat to people at high risk for severe illness. Some physician practices have had to close due to COVID-19-related staff shortages or have gone to 100% telehealth visits.

“This illness may seem mild to some, but right now we don’t have enough effective treatment if too many high-risk patients get sick all at the same time,” said John Carlo, MD, a TMA COVID-19 Task Force member.

So far, only a single monoclonal antibody treatment (sotrovimab) is effective against the omicron variant. Supplies are extremely limited.

“On top of this, the omicron variant is incredibly infectious, even more so than previous variants,” Dr. Carlo added.

The Texas Department of State Health Services has reported more than half a million cases since Jan. 1.

“The good news is we know how to protect ourselves,” Dr. Carlo said. “Vaccination with a booster, diligent and effective mask-wearing, and avoiding poorly ventilated indoor settings are effective.”

Physicians also worry about Texas hospital beds filling up too quickly, as area hospitals already face staffing shortages due to sick workers. “We want to make sure we have the space for every patient who needs care,” Dr. Carlo said.

TMA’s COVID-19 Task Force recommends reiterating to patients the following protective measures:

  • Get vaccinated against COVID-19: Get the booster shot as soon as eligible, too.
  • If you must leave your home: Physically distance yourself, wash your hands frequently, and wear your mask anytime you need to be near someone when outside your home. Wear the best mask you can get: N95 masks are best, followed by KN95 masks, then surgical masks, then multi-ply cloth masks that fit snugly around your face. Wear masks if you can’t socially distance, even if outside, and even if everyone attending is vaccinated and boosted.
  • If you must gather with others from outside your home: Choose an outdoor or well-ventilated space.
  • If exposed to someone who has tested positive for COVID-19 (you were within 6 feet of him or her for at least 15 minutes in 24 hours): Quarantine away from others for at least five days and get tested after five days even if you do not develop symptoms. 
    • Watch for symptoms. If you have no symptoms after five days, wear a well-fitted mask for the next five days anytime you’re near anyone and avoid being around people who are at high risk.
    • If fully vaccinated or you have had a confirmed case of COVID-19 within the past 90 days, it is not necessary to quarantine, but you still should wear a well-fitted mask when around others for 10 days and get tested after five days even if symptoms do not develop. 
  • If you test positive for COVID-19 or have mild symptoms, regardless of vaccination status: Isolate for at least five days and until you are fever-free and your symptoms improve (stay away from other people, including people in your own household). (This applies to mild-symptom or zero-symptom cases.) After five days’ isolation, wear a well-fitted mask for five more days whenever you’re around others, avoid travel, and avoid being around those who are at high risk.
  • If you have severe symptoms: Isolate for at least 10 days and consult your doctor before ending your isolation. If you develop any serious symptoms, such as trouble breathing, seek emergency medical care immediately. 

“This current wave is spreading faster than ever before, and the only way to slow this down is for everyone – not just some people, but everyone – to be vigilant,” said Dr. Carlo.

Project Access Tarrant County

Growing into the future

by Kathryn Narumiya

This piece was originally published in the January/February 2022 issue of the Tarrant County Physician. You can read find the full magazine here.

Isn’t it great when a business has more clients than they know what to do with? Of course! It’s a problem most business owners would beg for unless they are providing critical medical services to those in need. 

At Project Access Tarrant County, we are honored to have the opportunity to provide surgical treatments to our client base. While PATC can always use more volunteer general surgeons, gynecologists, and orthopedists, lack of volunteers is not the main issue. Many of you have eagerly and graciously given of your time and expertise to these patients. We are all grateful for your time and efforts. 

Unfortunately, the number of patients far exceeds the volume that Tarrant County hospital partners can provide on a charity basis.  For us, having clients on long wait lists or undergoing emergency surgery because PATC is unable to coordinate their surgeries is heartbreaking. We don’t want these outcomes to become normalized or acceptable. 

In 2020, we began working toward reducing our wait times. While progress has been slow, we have made significant strides in this direction. After considerable research into alternative services offered by peer organizations across the country, we have identified an opportunity to strengthen the number of patients we can serve through an additional lane to our current panel of services. To be clear, Project Access Tarrant County as it currently exists is not going away.

Introducing – Access Surgery Partnership. 
Based on Surgery on Sunday, a medical nonprofit organization in Lexington, Kentucky (, Access Surgery Partnership will host surgery days in a separately leased surgery center on a periodic basis on a day when the facility would traditionally be closed. The surgery center partner(s) will receive compensation for use of the facility. The surgery center staff will be comprised of teams of volunteer surgeons, nurses, and ancillary staff, both medical and non-medical.  The united surgery center staff will perform multiple outpatient surgeries and procedures in one day, effectively eliminating long surgery wait times. 

The traditional PATC model will still exist as we realize that not all procedures are appropriate for an outpatient setting, and not all physician volunteers will participate in the new model. We will still need our current hospital partners in order to serve our client base. 

We are not doing this alone. We are building a strong foundation for this new service line by collaborating with Brittain-Kalish Group and Dynamic Development Strategies to complete a proforma, business plan, timeline of milestones, and a long-term development plan. Several funders have shown interest in backing this initiative, and we are continuing to cultivate and update those parties as we progress. In fact, the Sid Richardson Foundation has singlehandedly funded the “discovery phase” of this project as we research and plan. 

A lot of work remains to be done with various challenges to overcome. Our primary and most imperative challenge is finding a surgery center partner. Additional challenges include recruiting volunteer medical non-physician staff and obtaining our own surgery center license. 

 This is where you come in. We need your help!

1. CONNECTIONS to Leaders!

    o Do you know leadership at a Tarrant County surgery center? 

 Please make an introduction to PATC!

2. Staff VOLUNTEERS! Talk to your medical staff about volunteering. 

3. STEP UP YOURSELF! If you have not been able to volunteer previously due to conflicts, this new model may be more conducive to your schedule.

      o Contact me and we can discuss options!

As other opportunities to help arise, we will let you know about them. We will also keep you apprised of our progress towards making Access Surgery Partnership a reality. With the Tarrant County Medical Society membership, we know we are well on our way. 

The Last Word

By Hujefa Vora, MD – Chair, Publications Committee

This piece was originally published in the January/February 2022 issue of the Tarrant County Physician. You can read find the full magazine here.

The medical students were sent into hiding.  We chose not to risk their bodies to the unknown illness.  Instead, most of them sat alone at home in front of computer screens.  They attended lectures virtually.  Physical contact became taboo.  Learning turned into rote memorization of presented facts, with little opportunity for the hands-on training of our time.  

In our clinics, we went into hiding as well.  Our appointments became virtual.  We too hid behind these computer screens.  Physical contact became taboo.  To start a visit note, we would write that the patient had consented in an informed fashion to participate in a virtual visit, utilizing a platform with audio and visual capabilities.  Patients would take their own blood pressures using their automatic home monitors.  Often, they would not only create their own objective findings, but also their own interpretations of their subjective history.  When we no longer touch our patients, when we can no longer hold their hands, we become severed.  The patient-physician relationship is powered by the force of our connection to our patients.  

A story that needs to be told.  I had a patient who smoked incessantly.  He was referred to my office by his cardiologist, who explained his worsening shortness of breath by saying it is not his heart.  He came into my office for the first and last time in March of 2020 just prior to the lockdown.  We spoke of his three packs a day habit.  We talked about how for the last month, he was unable to walk across his living room without becoming short of breath and coughing until it felt like his heart would pop out of his chest.  Fearing the worst, I sent him out to get a chest x-ray.  Those fears were confirmed with the finding of a complete white out of the right lung.  A CT scan confirmed the presence of malignancy in the setting of emphysema.  We couldn’t get a biopsy right away because the lockdown happened.  Many of you will remember that elective surgeries were put on hold.  Biopsy of a mass which I was sure was cancer was not necessarily elective, but getting the procedure done became nearly impossible.  I had to present the case to our surgical review board at the hospital in a Zoom meeting.  They authorized my procedure and scheduled the next available interventional radiologist.  As the day of the biopsy approached, we were informed that the patient would not be admitted without a negative COVID PCR result.  In the early days of the pandemic, PCR results took sometimes one or two weeks.  We had 72 hours, and it took about that long to actually get the test done.  Upon finding that we were not going to get the biopsy done, I spoke to the patient and his family over the telemedicine platform my office had just installed.  If we admitted him to the hospital, we might be able to get things done more efficiently.  The patient’s daughter refused this option.  We will be surrounded by COVIDI can’t risk that.  The patient continued smoking his cigarette pensively, deliberately.  The patient was offered a pulmonary consult instead and possible bronchoscopy.  It took another three weeks to get the patient in front of the computer screen of the pulmonologist, and then another two weeks after that to get the bronchoscopy done.  Ten days later, a pathologist called me to let me know that the patient had waited too long to quit his smoking habit and now had squamous cell carcinoma of the lung.  This is the kind of news that needs to be conveyed in person, not something to be said over the phone.  The patient refused to break his lockdown, so that meant the phone was how this would happen.  Unfortunately, the patient’s daughter was unavailable, so we were unable to establish the video component of the virtual visit.  I told my patient he had cancer over the phone, unable to reach out and make any physical contact, not even something as simple as a handshake or a pat on the shoulder.  I couldn’t see his face to read his thoughts, get some signal of the inner turmoil he might be experiencing.  I did my best to follow his verbal cues.  We talked about the plan.  He wanted to know our next steps.  Well, it took another month to get the patient onto a Zoom call with an oncologist.  Another three weeks got us into the virtual room of a cardiothoracic surgeon.  The surgeon agreed that the patient would need surgery to remove the tumor and at the very least improve his quality of life by making it so he could breathe.  The patient was referred back to our original cardiologist for cardiac clearance prior to surgery.   In order to get his stress test, he was subjected to another PCR test for COVID-19.  This came back a little quicker than expected, negative as was expected.  The patient underwent his stress test and was negative for inducible ischemia.  He was cleared for surgery.  At his preoperative evaluation for his scheduled surgery, the patient was told he would need another COVID-19 test.  He refused, as he had the PCR just two weeks prior at his stress test, and he was tired of the runaround.  Unfortunately, this assertion of control, this blatant attempt by the patient to avert further procrastination, further delays of his surgery, backfired.  In the meanwhile, I had been following the patient’s progress for the past six months with monthly phone visits or Zoom calls.  And so, I tried to take control of the situation.  I spoke to the surgeon, questioning why it had been necessary to delay surgery for a cardiac clearance in a patient with known cancer.  We would not have delayed the procedure for CABG had this been necessary.  So we had lost more time.  I produced the records of three COVID testing results over the past few months.  I again met with the hospital’s surgical review board.  We worked out a plan of care.  I brokered a deal.  The patient would go for surgery as soon as the surgeon scheduled.  We had one last meeting before surgery.  It was now September.  The patient asked me if he would be recovered by November 4th, election day.  I told him that I was not sure.  He informed me that he would not schedule his surgery until after election day, because he needed to vote in the election.  The surgeon reluctantly agreed to schedule him for surgery on November 5th.  The oncologist interceded and demanded that another PET CT be done prior to scheduling the surgery.  Another PCR was ordered and refused.  Another deal was struck.  The patient’s PET CT showed progression of the disease – not a surprise.  On November 5th, the patient finally went for his surgery, 249 days after our opening salvo. Ten days in the ICU.  I didn’t see him because we were in the heart of COVID at this point.  You know this patient though.  He was too stubborn to let this cancer beat him, too tough and thick-skinned to allow even COVID to get through.  He survived all of this.  The oncologists offered him chemotherapy and radiation treatments, but he refused.  He went back home to his couch and his cigarettes.  Behind the scenes, I continued to coordinate his care with the surgeons, his oncologists, the cardiologist, and the pulmonologist.  To him though, I was just another voice over the phone, a talking head disrupting his existence.  Molasses.  Quicksand.  COVID testing.

Our patients went into hiding.  Their trust of the medical establishment is broken.  Our relationship with them, though we looked out for their best interests, is broken.  We have socially distanced ourselves into a corner.  It is time to come out of hiding.  It is not taboo to touch our patients’ lives.  It is what they expect.  With this new year, we must wake up.  We must remind our patients that we will always fight for them, whether we are fighting against cancer, against COVID, against politicians, against ignorance, against fear.  Never against them, but always with them.  My patient survived, thrived, but I have never seen him again.  This is the Last Word.

Tarrant County COVID-19 Activity – 01/13/22

COVID-19 Positive cases: 441,134

COVID-19 related deaths: 5111

Recovered COVID-19 cases: 373,903

Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County updated Thursday, January 13, 2o22. Find more COVID-19 information from TCPH here.

*These data are provisional and are subject to change at any time.

Deaths and recovered cases are included in total COVID-19 positive cases.

Project Access Patient Spotlight

Melanie was the one suffering with a hernia, but it was hurting her entire family

by Allison Howard

All too often, struggles with our health bleed into other areas of our lives. “Melanie’s” hernia did not just cause her stomach pain and inflammation – it stopped the mother of three from playing soccer with her children. It made her struggle with depression and lack of motivation. It made her worry about the future.  

Melanie had to go to the ED several times because the pain became severe, and she worried that her condition would become worse. Her children were anxious about their mother’s health, and she was concerned about them – her youngest is only one year old.  

She sought care at Cornerstone Health Network, and it was there that Melanie was referred to Project Access. At that point she was relived – there was hope for the future. Melanie knew she would receive the care she needed, the care that she could not otherwise access due to lack of resources.  

Melanie was referred to Project Access volunteer Dr. Mohamad Saad, who agreed that she needed surgery to repair the hernia. Dr. Saad performed her surgery at Harris Southwest Hospital, and anesthesia was provided by US Anesthesia Partners – Southwest Division.  

Now, Melanie is again playing with and taking care of her children without pain. She is grateful to everyone who made this possible – from Project Access to Dr. Saad and his staff – because it has given her the opportunity to live a better life.  

One of the things that makes Melanie happiest is knowing that it doesn’t stop with her – that many other people have also received critical care through these services. She shares her thanks for the help and genuine care that is extended to Project Access patients. 

President’s Paragraph

Terrible Twos

By Shanna Combs, MD

This piece was originally published in the January/February 2022 issue of the Tarrant County Physician. You can read find the full magazine here.

Welcome to 2022! This is going to be our year. Things are going to be better. So long, COVID . . . Oh wait, maybe not. Doesn’t this all sound a little too reminiscent of the start of 2021? As I write this, we are in the beginning stages of a new variant, Omicron. There is still much we do not know about this variant, and hopefully, by the time you are reading this, it will have turned out to be not as bad as the last one. 

Thinking back to the start of 2021, we were elated to have new vaccines to fight off and end the COVID pandemic. Many of us in healthcare were racing to sign up to get our shot and show it off on social media. We finally had some armor to protect us in this fight, and soon enough it would be available to protect our families, friends, and patients. Yet the conversation quickly turned to, “It was made too quickly,” “You can’t mandate that I get the vaccine,” “I am healthy; why do I have to get the vaccine?” or “It is all fake news.” So now, here we are, entering the “terrible twos” of the COVID pandemic. If there is one thing that has been demonstrated during the COVID pandemic, it is that the innate trust in physicians, medicine, and science is, unfortunately, no longer so automatic. We as physicians must continue to be voices for science and for medicine who, at the end of the day, want the best health outcomes for our patients.  

As we enter the terrible twos of the pandemic, I encourage my physician compatriots to be the voice that our patients and our society need to hear. Whether that is in your day-to-day interactions with patients, conversations with family and friends, or in public venues, we must continue to be the voice of medicine. Ways to amplify that voice exist within our own county, state, and national medical society. Those of us in medicine often focus on what makes us different, but now more than ever we need to focus on what brings us together. 

We are all tired and exhausted from this fight, and more than once I have heard others as well as myself say, “Can’t we just go back to how it used to be?” Unfortunately, I hate to say, COVID is with us for the foreseeable future. Yet, those of us in medicine went into this field for a reason. For me, that reason always comes down to my patients. I want to provide the best care to optimize the health and well-being of my patients. During these terrible twos, I call on my colleagues to remember why you embarked on this journey of medicine, and when you see a colleague struggling, help them to remember why they came to this profession. Not only can we be the voice of medicine to our patients, but we can also be the voice of support and camaraderie for our fellow physicians.

As we embark on this new year, I want to say that I support you as a fellow physician, and I look forward to the amazing work that you all contribute to your patients and to our society. Thank you for what you have done and what you will continue to do.