newyorker--2020-12-14--Slack Is the Right Tool for the Wrong Way to Work

In 2016 , I interviewed an entrepreneur named Sean who had co-founded a small technology startup based in London .
As with many organizations at that time , Sean and his team relied on e-mail as their primary collaboration tool .
“ We used to have our Gmail constantly opened , ” he said .
Then they heard about a slick new instant-messenger service named Slack that promised to streamline office communication : “ There was this hype , so we decided to try it.
” Once the team switched to the tool , the rate of back-and-forth messaging intensified @ @ @ @ @ @ @ a demanding client insisted on the ability to directly communicate with Sean ’ s employees using Slack .
The team soon burned out , and two engineers quit .
In desperation , Sean moved the company off Slack .
When I spoke with him , some time had passed since this incident , but the memory of the service ’ s omnipresent notification ping remained strong .
“ I hear that sound , it gives me the shivers , ” he said .
I thought about Sean when I heard about Salesforce ’ @ @ @ @ @ @ @ to twenty-eight billion dollars .
From a financial perspective , the deal probably makes sense .
Sean ’ s company was one of many to embrace this platform when it arrived on the knowledge-work scene .
Today , Slack has millions of users and reported more than six hundred million dollars in revenue for the last fiscal year .
The shift toward remote work during the pandemic only reinforces the company ’ s value to the marketplace .
But a lot of us share Sean ’ s fatigue with Slack .
Writing in @ @ @ @ @ @ @ that the platform transformed the American workplace into a “ dystopian micro-Twitterverse , ” while the technology journalist Casey Newton tweeted , “ Salesforce is paying $ 28 billion for an app that people shut down when they need to get things done.
” Slack is both absolutely necessary and absolutely aggravating ; we rely on it , but we also can ’ t stand it .
To dismiss this confused reaction as the usual grumbling about new forms of communication , however , would be a mistake .
A closer look at @ @ @ @ @ @ @ economic ramifications that make twenty-eight billion dollars seem paltry .
To understand Slack , we must understand its antecedent .
The widespread adoption of e-mail in the nineteen-nineties radically and unexpectedly changed the nature of office work .
Originally deployed as an upgrade to less efficient asynchronous communication tools such as voice-mail systems and fax machines , e-mail instead ushered in a new mode of collaboration based around never-ceasing , ad-hoc messaging .
This shift toward constant interaction made a certain sense .
For one thing , it was convenient , as it @ @ @ @ @ @ @ their employees figure things out on the fly over e-mail than to craft custom business processes and workflows .
It ’ s also cheaper .
Why pay to develop network applications that organize information when this goal can be crudely approximated with file attachments and digital memos ?
By the first decade of the two-thousands , professional communication volume continued to increase , and e-mail was struggling to keep up with the world of hyper-messaging that it helped create .
A tool that was designed for a time when you might expect to @ @ @ @ @ @ @ this increased to several dozen .
Information was easily lost in overflowing in-boxes , while group threads proved to be a particularly clunky format to support discussion .
In 2014 , Slack was publicly released , seizing on the opportunity created by these shortcomings .
This messaging tool was designed to optimize the haphazard approach to work that e-mail had initiated .
Slack replaced a single in-box with distinct chat channels , moved group discussions into a persistent chat format , and made all of these discussions searchable .
For teams straining under @ @ @ @ @ @ @ like a digital analgesic , curing multiple pain points all at once .
This palliative effect propelled Slack toward its astronomical valuation just six years later .
The problem with this trajectory is that no one stopped to ask if it made sense to optimize this style of work in the first place .
Though Slack improved the areas where e-mail was lacking in an age of high message volume , it simultaneously amplified the rate at which this interaction occurs .
Data gathered by the software firm RescueTime estimate that employees who @ @ @ @ @ @ @ than non-users , accessing them once every five minutes on average—an absurdly high rate of interruption .
Neuroscientists and psychologists teach us that our attention is fundamentally single-tasked , and switching it from one target to another is detrimental to productivity .
We ’ re simply not wired to monitor an ongoing stream of unpredictable communication at the same time that we ’ re trying to also finish actual work .
E-mail introduced this problem of communication-driven distraction , but Slack pushed it to a new extreme .
We both love and hate @ @ @ @ @ @ @ tool for the wrong way to work .
It ’ s here that we find opportunity .
If Slack , which improves a fundamentally flawed approach to collaboration , is worth tens of billions of dollars , imagine the value in fixing the underlying flaws .
In 1999 , the management theorist Peter Drucker noted that during the twentieth century , the productivity of manual workers in the manufacturing sector increased by a factor of fifty as we got smarter about the best way to build products .
He argued that the knowledge @ @ @ @ @ @ @ begun a similar process of self-examination and improvement , existing at the end of the twentieth century where manufacturing had been a hundred years earlier .
Seen this way , Slack is just a small step down a significant path .
It ’ s the knowledge-work equivalent of figuring out how to make the waterwheel turn faster—a useful improvement in the moment , but not nearly as important as the looming introduction of the steam engine .
I do not dislike Slack as much as people assume given that I wrote a book @ @ @ @ @ @ @ advocates for the importance of long , undistracted stretches of work .
The acceleration of interruption is a problem , but e-mail has its limitations , so it makes sense that companies committed to ad-hoc messaging as their central organizing principle would want to try Slack .
If this tool represented the culmination of our attempts to figure out how to best work together in a digital age , I ’ d be more concerned , but Slack seems to be more transient .
It ’ s a short-term optimization of our first @ @ @ @ @ @ @ high-tech professional world that will be followed by more substantial revolutions .
The future of office work won ’ t be found in continuing to reduce the friction involved in messaging but , instead , in figuring out how to avoid the need to send so many messages in the first place .
• Ian Crouch recounts the best jokes of the year .
• Sheldon Pearce on the albums that helped him navigate a lost plague year .
• New Yorker writers on the best books they read this year .
• @ @ @ @ @ @ @ .

In 2016, I interviewed an entrepreneur named Sean who had co-founded a small technology startup based in London. As with many organizations at that time, Sean and his team relied on e-mail as their primary collaboration tool. “We used to have our Gmail constantly opened,” he said. Then they heard about a slick new instant-messenger service named Slack that promised to streamline office communication: “There was this hype, so we decided to try it.” Once the team switched to the tool, the rate of back-and-forth messaging intensified, eventually reaching a stressful peak when a demanding client insisted on the ability to directly communicate with Sean’s employees using Slack. The team soon burned out, and two engineers quit. In desperation, Sean moved the company off Slack. When I spoke with him, some time had passed since this incident, but the memory of the service’s omnipresent notification ping remained strong. “I hear that sound, it gives me the shivers,” he said.
I thought about Sean when I heard about Salesforce’s proposed acquisition of Slack for close to twenty-eight billion dollars. From a financial perspective, the deal probably makes sense. Sean’s company was one of many to embrace this platform when it arrived on the knowledge-work scene. Today, Slack has millions of users and reported more than six hundred million dollars in revenue for the last fiscal year. The shift toward remote work during the pandemic only reinforces the company’s value to the marketplace. But a lot of us share Sean’s fatigue with Slack. Writing in The New Republic, Timothy Noah laments that the platform transformed the American workplace into a “dystopian micro-Twitterverse,” while the technology journalist Casey Newton tweeted, “Salesforce is paying $28 billion for an app that people shut down when they need to get things done.” Slack is both absolutely necessary and absolutely aggravating; we rely on it, but we also can’t stand it. To dismiss this confused reaction as the usual grumbling about new forms of communication, however, would be a mistake. A closer look at Slack reveals an underlying dynamic with potential economic ramifications that make twenty-eight billion dollars seem paltry.
2020 in Review New Yorker writers reflect on the year’s highs and lows.
To understand Slack, we must understand its antecedent. The widespread adoption of e-mail in the nineteen-nineties radically and unexpectedly changed the nature of office work. Originally deployed as an upgrade to less efficient asynchronous communication tools such as voice-mail systems and fax machines, e-mail instead ushered in a new mode of collaboration based on never-ceasing, ad-hoc messaging. This shift toward constant interaction made a certain sense. For one thing, it was convenient, as it’s easier for organizations to let their employees figure things out on the fly over e-mail than to craft custom business processes and workflows. It’s also cheaper. Why pay to develop network applications that organize information when this goal can be crudely approximated with file attachments and digital memos?
By the first decade of the two-thousands, professional communication volume continued to increase, and e-mail was struggling to keep up with the world of hyper-messaging that it helped create. A tool that was designed for a time when you might expect to receive several messages a day faltered once this increased to several dozen. Information was easily lost in overflowing in-boxes, while group threads proved to be a particularly clunky format to support discussion. In 2014, Slack was publicly released, seizing on the opportunity created by these shortcomings. This messaging tool was designed to optimize the haphazard approach to work that e-mail had initiated. Slack replaced a single in-box with distinct chat channels, moved group discussions into a persistent chat format, and made all of these discussions searchable. For teams straining under e-mail’s shortcomings, Slack arrived like a digital analgesic, curing multiple pain points all at once. This palliative effect propelled Slack toward its astronomical valuation just six years later.
The problem with this trajectory is that no one stopped to ask if it made sense to optimize this style of work in the first place. Though Slack improved the areas where e-mail was lacking in an age of high message volume, it simultaneously amplified the rate at which this interaction occurs. Data gathered by the software firm RescueTime estimate that employees who use Slack check communications tools more frequently than non-users, accessing them once every five minutes on average—an absurdly high rate of interruption. Neuroscientists and psychologists teach us that our attention is fundamentally single-tasked, and switching it from one target to another is detrimental to productivity. We’re simply not wired to monitor an ongoing stream of unpredictable communication at the same time that we’re trying to also finish actual work. E-mail introduced this problem of communication-driven distraction, but Slack pushed it to a new extreme. We both love and hate Slack because this company built the right tool for the wrong way to work.
It’s here that we find opportunity. If Slack, which improves a fundamentally flawed approach to collaboration, is worth tens of billions of dollars, imagine the value in fixing the underlying flaws. In 1999, the management theorist Peter Drucker noted that during the twentieth century, the productivity of manual workers in the manufacturing sector increased by a factor of fifty as we got smarter about the best way to build products. He argued that the knowledge sector, by contrast, had hardly begun a similar process of self-examination and improvement, existing at the end of the twentieth century where manufacturing had been a hundred years earlier. Seen this way, Slack is just a small step down a significant path. It’s the knowledge-work equivalent of figuring out how to make the waterwheel turn faster—a useful improvement in the moment, but not nearly as important as the looming introduction of the steam engine.
I do not dislike Slack as much as people assume given that I wrote a book titled “Deep Work,” which advocates for the importance of long, undistracted stretches of work. The acceleration of interruption is a problem, but e-mail has its limitations, so it makes sense that companies committed to ad-hoc messaging as their central organizing principle would want to try Slack. If this tool represented the culmination of our attempts to figure out how to best work together in a digital age, I’d be more concerned, but Slack seems to be more transient. It’s a short-term optimization of our first hasty attempts to make sense of a high-tech professional world that will be followed by more substantial revolutions. The future of office work won’t be found in continuing to reduce the friction involved in messaging but, instead, in figuring out how to avoid the need to send so many messages in the first place.
2020 in Review


newyorker--2020-12-14--The Intimacy and Comfort of Taylor Swift’s “evermore”

Last week , Taylor Swift announced the surprise release of “ evermore , ” her ninth album , describing the record as a companion piece to “ folklore , ” which she surprise-released just five months ago .
If your quarantine has looked anything like mine , Swift ’ s productivity—her capacity to create under duress , to dutifully imagine and populate elaborate new worlds—is staggering .
“ All I do is try , try , try , ” Swift sang on “ mirrorball , ” a song on “ folklore ” about the spirit-depleting requirements of celebrity .
“ @ @ @ @ @ @ @ / I ’ m still trying everything / To keep you looking at me , ” she sighed .
Swift is exquisitely focussed , and , by her own admission , keen to please , but I ’ ve often had a hard time connecting with her more labored or overdetermined singles .
On “ evermore , ” she sounds loose and unburdened—free , finally , from the debilitating squeeze of other people ’ s expectations .
It ’ s a lush , tender , and beautiful album , steadier if less varied @ @ @ @ @ @ @ with backward-looking wisdom .
“ All you want from me now is the green light of forgiveness , ” Swift sings on “ happiness , ” a song about grasping for perspective after a particularly devastating breakup .
“ You haven ’ t met the new me yet / And I think she ’ ll give you that.
” For “ evermore , ” Swift enlisted much of the same crew that made “ folklore ” : Aaron Dessner , of the indie-rock band the National ; the producer Jack Antonoff ; her @ @ @ @ @ @ @ under the pseudonym William Bowery ) ; and Justin Vernon , of Bon Iver .
When Swift first announced that she was collaborating with Dessner for “ folklore , ” critics scrambled to parse the ways in which Dessner ’ s aesthetic—he and his brother Bryce ( who also worked on “ evermore ” ) are known for harmonically sophisticated arrangements , and for quickly establishing a deep , spectral tension in their music—might affect Swift ’ s approach to melody and phrasing .
This time , it ’ s more interesting to @ @ @ @ @ @ @ has tempered or sweetened Dessner ’ s style .
The country-tinged “ no body , no crime , ” which features HAIM , is an oversized homicidal revenge fantasy in the spirit of the Chicks ’ “ Goodbye , Earl ” or Carrie Underwood ’ s “ Before He Cheats.
” It ’ s more buoyant , playful , and patently user-friendly than anything Dessner has been involved with before .
This is also true of Swift ’ s duet with Vernon , who sings on the album ’ s title track .
@ @ @ @ @ @ @ rich music is often formally inscrutable , yet “ exile , ” Swift ’ s first duet with Vernon , from “ folklore , ” is more rooted in Broadway than the avant-garde .
In recent years , the old hierarchies—in which pop music was thought of as frivolous and inherently inferior to more “ cerebral ” ( and generally male ) genres—have mostly collapsed , and there is real pleasure in witnessing a grip-loosening within the independent music scene .
I used to cringe every time Swift started to talk in the @ @ @ @ @ @ @ felt too corny or overtly theatrical .
( “ Hey , kids !
Spelling is fun !
” nearly killed me , and apparently her too . )
Chalk it up to the great psychic disintegration of 2020 , but this time around , when Danielle Haim pipes up , “ She was with me , dude , ” in the final verse of “ no body , no crime , ” I simply grinned .
On “ folklore , ” Swift started experimenting with different characters and points of view , a @ @ @ @ @ @ @ departure from the more confessional , first-person emoting that defined her earlier work .
This is a funny way to think about writing—every consciousness developed on the page is , inevitably , an invention of sorts , honed and sharpened and shaped to fit a particular narrative—but , as a vocalist , Swift is wonderfully adept at inhabiting other characters , and finds a way to bring real empathy to their experiences .
Two of my favorite tracks on “ evermore , ” “ ’ tis the damn season ” and “ dorothea @ @ @ @ @ @ @ lovers ultimately undone by time , circumstance , and incompatible desires .
One left home , taking off for Hollywood as soon as they could , while the other stayed put in Tupelo .
( “ Ooh , this place is the same as it ever was / Ooh , but you don ’ t like it that way.
” ) Swift has long subscribed to the notion that certain types of communion are inevitable , immortal , inescapable .
A true , once-in-a-lifetime love never diminishes ; it merely changes shape over @ @ @ @ @ @ @ ache in you , put there by the ache in me , ” she sings .
The lovers share an endless , circular pain : there ’ s no way to be together , but they can ’ t extinguish the yearning , either .
While “ evermore ” feels like a significant step in Swift ’ s creative evolution , it still features plenty of her signature moves .
Swift has always indulged in a bit of an underdog complex , beginning with “ You Belong with Me , ” from “ @ @ @ @ @ @ @ “ She wears short skirts , I wear T-shirts / She ’ s cheer captain and I ’ m on the bleachers , ” Swift opined , often while in heels and red lipstick , her blond hair looking extra shiny .
( She plays both roles—the regular girl and the vixen—in the video . )
On “ willow , ” she again alludes to feeling undervalued : “ They count me out time and time again / Life was a willow , and it bent right to your wind / But I @ @ @ @ @ @ @ ” It ’ s sometimes hard to square Swift ’ s eternally wounded self-conception with her almost unimaginable success .
She is the best-selling artist of 2020 , and has sold more than two hundred million albums during an era in which sales of that magnitude are increasingly rare .
Perhaps money and fame don ’ t actually make life any simpler , but it would nonetheless be refreshing to see Swift express confidence—she has certainly earned it—without framing it as a miraculous resurrection , or pointing to some unnamed tormentor ( usually @ @ @ @ @ @ @ , more recently , either Kanye West or Scooter Braun ) .
Her album “ Reputation , ” from 2017 , perhaps suffered the most from this sort of incongruous dark-horse positioning .
Swift ’ s tendency to espouse irrational insecurity can feel human , maybe even kind , but I also think she has better and more interesting ways of connecting with her listeners .
The track “ gold rush , ” which was co-written and co-produced by Swift and Antonoff , seems as if it might be a sequel to “ @ @ @ @ @ @ @ Reputation ” in which Swift grows increasingly livid at her own incapacitation in the face of beauty : On “ gold rush , ” she continues to frame beauty as a nefarious force : it ’ s terrifying , she suggests , to become enraptured or held in thrall .
“ What must it be like to grow up that beautiful ?
” she wonders .
For Swift , the worst part is that everyone else can see it , too : “ Everybody wants you / Everybody wonders what it would be @ @ @ @ @ @ @ sings .
Swift is at her best when she ’ s frank about how much it hurts to be vulnerable .
“ I don ’ t like that fallin ’ feels like flyin ’ ’ til the bone crush , ” she admits , her voice tense , almost angry .
Though the song features ample instrumentation ( horns , strings , organs , Mellotron ) , Antonoff ’ s production is dutiful and restrained , comparable to the kind of caution a person might bring to a new relationship if they ’ @ @ @ @ @ @ @ what she ’ s singing about , Swift always manages to position herself as a confidante of sorts , and “ evermore ” is good company for what ’ s shaping up to be one of the more arduous winters in American history .
The album ’ s primary aims are intimacy and comfort , and it has arrived during a season in which we are all especially starved for companionship and peace .
“ I felt less like I was departing and more like I was returning , ” Swift wrote of @ @ @ @ @ @ @ ’ s likely that “ evermore ” will feel that way for her fans , too—a kind of homecoming , even if we can ’ t actually go home .
• Ian Crouch recounts the best jokes of the year .
• Sheldon Pearce on the albums that helped him navigate a lost plague year .
• New Yorker writers on the best books they read this year .
• Amanda Petrusich counts down the best music .

Last week, Taylor Swift announced the surprise release of “evermore,” her ninth album, describing the record as a companion piece to “folklore,” which she surprise-released just five months ago. If your quarantine has looked anything like mine, Swift’s productivity—her capacity to create under duress, to dutifully imagine and populate elaborate new worlds—is staggering. “All I do is try, try, try,” Swift sang on “mirrorball,” a song on “folklore” about the spirit-depleting requirements of celebrity. “I’m still on that trapeze / I’m still trying everything / To keep you looking at me,” she sighed. Swift is exquisitely focussed, and, by her own admission, keen to please, but I’ve often had a hard time connecting with her more labored or overdetermined singles. On “evermore,” she sounds loose and unburdened—free, finally, from the debilitating squeeze of other people’s expectations. It’s a lush, tender, and beautiful album, steadier if less varied than “folklore,” and infused with backward-looking wisdom. “All you want from me now is the green light of forgiveness,” Swift sings on “happiness,” a song about grasping for perspective after a particularly devastating breakup. “You haven’t met the new me yet / And I think she’ll give you that.”
For “evermore,” Swift enlisted much of the same crew that made “folklore”: Aaron Dessner, of the indie-rock band the National; the producer Jack Antonoff; her boyfriend, Joe Alwyn (who writes under the pseudonym William Bowery); and Justin Vernon, of Bon Iver. When Swift first announced that she was collaborating with Dessner for “folklore,” critics scrambled to parse the ways in which Dessner’s aesthetic—he and his brother Bryce (who also worked on “evermore”) are known for harmonically sophisticated arrangements, and for quickly establishing a deep, spectral tension in their music—might affect Swift’s approach to melody and phrasing. This time, it’s more interesting to think about the ways in which Swift has tempered or sweetened Dessner’s style. The country-tinged “no body, no crime,” which features HAIM, is an oversized homicidal revenge fantasy in the spirit of the Chicks’ “Goodbye, Earl” or Carrie Underwood’s “Before He Cheats.” It’s more buoyant, playful, and patently user-friendly than anything Dessner has been involved with before.
2020 in Review New Yorker writers reflect on the year’s highs and lows.
This is also true of Swift’s duet with Vernon, who sings on the album’s title track. Vernon’s most dynamic and emotionally rich music is often formally inscrutable, yet “exile,” Swift’s first duet with Vernon, from “folklore,” is more rooted in Broadway than the avant-garde. In recent years, the old hierarchies—in which pop music was thought of as frivolous and inherently inferior to more “cerebral” (and generally male) genres—have mostly collapsed, and there is real pleasure in witnessing a grip-loosening within the independent music scene. I used to cringe every time Swift started to talk in the middle of a song, because it felt too corny or overtly theatrical. (“Hey, kids! Spelling is fun!” nearly killed me, and apparently her too.) Chalk it up to the great psychic disintegration of 2020, but this time around, when Danielle Haim pipes up, “She was with me, dude,” in the final verse of “no body, no crime,” I simply grinned.
On “folklore,” Swift started experimenting with different characters and points of view, a move that was quickly framed as a departure from the more confessional, first-person emoting that defined her earlier work. This is a funny way to think about writing—every consciousness developed on the page is, inevitably, an invention of sorts, honed and sharpened and shaped to fit a particular narrative—but, as a vocalist, Swift is wonderfully adept at inhabiting other characters, and finds a way to bring real empathy to their experiences. Two of my favorite tracks on “evermore,” “’tis the damn season” and “dorothea,” feature a pair of young lovers ultimately undone by time, circumstance, and incompatible desires. One left home, taking off for Hollywood as soon as they could, while the other stayed put in Tupelo. (“Ooh, this place is the same as it ever was / Ooh, but you don’t like it that way.”) Swift has long subscribed to the notion that certain types of communion are inevitable, immortal, inescapable. A true, once-in-a-lifetime love never diminishes; it merely changes shape over time. “There’s an ache in you, put there by the ache in me,” she sings. The lovers share an endless, circular pain: there’s no way to be together, but they can’t extinguish the yearning, either.
While “evermore” feels like a significant step in Swift’s creative evolution, it still features plenty of her signature moves. Swift has always indulged in a bit of an underdog complex, beginning with “You Belong with Me,” from “Fearless,” her second album. “She wears short skirts, I wear T-shirts / She’s cheer captain and I’m on the bleachers,” Swift opined, often while in heels and red lipstick, her blond hair looking extra shiny. (She plays both roles—the regular girl and the vixen—in the video.) On “willow,” she again alludes to feeling undervalued: “They count me out time and time again / Life was a willow, and it bent right to your wind / But I come back stronger than a nineties trend.”
It’s sometimes hard to square Swift’s eternally wounded self-conception with her almost unimaginable success. She is the best-selling artist of 2020, and has sold more than two hundred million albums during an era in which sales of that magnitude are increasingly rare. Perhaps money and fame don’t actually make life any simpler, but it would nonetheless be refreshing to see Swift express confidence—she has certainly earned it—without framing it as a miraculous resurrection, or pointing to some unnamed tormentor (usually presumed to be an ex-boyfriend, or, more recently, either Kanye West or Scooter Braun). Her album “Reputation,” from 2017, perhaps suffered the most from this sort of incongruous dark-horse positioning.
Swift’s tendency to espouse irrational insecurity can feel human, maybe even kind, but I also think she has better and more interesting ways of connecting with her listeners. The track “gold rush,” which was co-written and co-produced by Swift and Antonoff, seems as if it might be a sequel to “Gorgeous,” a song from “Reputation” in which Swift grows increasingly livid at her own incapacitation in the face of beauty:
You’re so gorgeous
I can’t say anything to your face
’Cause look at your face
And I’m so furious
At you for making me feel this way
On “gold rush,” she continues to frame beauty as a nefarious force: it’s terrifying, she suggests, to become enraptured or held in thrall. “What must it be like to grow up that beautiful?” she wonders. For Swift, the worst part is that everyone else can see it, too: “Everybody wants you / Everybody wonders what it would be like to love you,” she sings. Swift is at her best when she’s frank about how much it hurts to be vulnerable. “I don’t like that fallin’ feels like flyin’ ’til the bone crush,” she admits, her voice tense, almost angry. Though the song features ample instrumentation (horns, strings, organs, Mellotron), Antonoff’s production is dutiful and restrained, comparable to the kind of caution a person might bring to a new relationship if they’d been hurt before.
No matter what she’s singing about, Swift always manages to position herself as a confidante of sorts, and “evermore” is good company for what’s shaping up to be one of the more arduous winters in American history. The album’s primary aims are intimacy and comfort, and it has arrived during a season in which we are all especially starved for companionship and peace. “I felt less like I was departing and more like I was returning,” Swift wrote of the album’s creation. It’s likely that “evermore” will feel that way for her fans, too—a kind of homecoming, even if we can’t actually go home.
2020 in Review


newyorker--2020-12-15--A Message from Joe Biden’s White House Cat

Everyone wants to know how I , as First Cat-elect , get along with Joe and Jill ’ s German shepherds , Champ and Major .
I like the boys .
Yes , their names skew a little Deutsches Jungvolk-y to my ear .
And , yes , as soon as we move to D.C. , they are likely to colonize every square inch of 1600 Pennsylvania Avenue in a zealous but disorganized juggernaut of dogspreading .
But , in so doing , Champ and Major will open up a space for me .
A quieter space , a more @ @ @ @ @ @ @ with stray hair and vomit .
Look , being First Pet is no box of chocolates .
I ’ m not there yet , but , honey , I know , I already know .
My test for any aspiring diplo-cats is to ask them to identify the Monroe Doctrine , Shirley Chisholm , and any reason to think they ’ ll still be friends with Lindsey Graham or Susan Collins by the end of this Administration .
If they can do that , then .
.
.
maybe .
Otherwise , I @ @ @ @ @ @ @ , little Kansas City calico with Pamela Harriman on the brain , but I ’ m fresh out of fucks—heavy lifting ahead .
I mean , let ’ s be real here , the culture of unrealistic expectations for governmental felines was firmly established by that consummate top-feeding suck-up , Socks Clinton .
He would sit on forty-two ’ s shoulders .
His carrier had the Presidential seal .
He schmoozed Bill ’ s personal secretary .
He was so popular that the White House had to tell photographers to leave him alone @ @ @ @ @ @ @ Truman Capote , but with more dander .
“ Across the aisle ” does not begin to describe the largesse with which I would like to dispense my regurgitative splendors on the Socks legacy .
No , I ’ m more likely to take my cues from the Gerald Ford family ’ s cat , Shan .
Remember when the Fords all toddled off for a ski vacation in Vail without him ?
On their return , Shan saw fit to bite the First Lady and one of the First Daughters on the @ @ @ @ @ @ @ the kind of self-respecting behavior that I can really get behind .
Simple , direct communication for the win .
Everyone understands the meaning of a bite on the leg .
The meaning is “ no.
” As for those naysayers who doubt the very need for a feline on the Hill , let me simply reiterate some of the names associated with the new Admin : Biden , Blinken , Yellen .
We ’ ve already got very strong reindeer energy , guys .
Let ’ s diversify .
My work lies @ @ @ @ @ @ @ action is to deal with the sparkly drifts of tinsel and glitter that Melania left behind .
They ’ re so triggering .
They terrify and delight me .
Some rooms look like a disco ball ’ s bladder has burst .
This must be dealt with .
As a counterpoint to this exhausting sensory onslaught , I will also give myself over to the urgent and ongoing matters of stepping on Joe ’ s keyboard and sitting in any open suitcase or empty box that I encounter .
Then comes my campaign @ @ @ @ @ @ @ clarification , I think it ’ s time we go after the title “ First Pet.
” A little pervy , no ?
Granted , I realize that , as problems go , this one fairly screams First World , but living in a gilded cage is no reason not to make that cage a more beautiful and progressive place .
A place that doesn ’ t recall your best friend ’ s finished basement one Saturday night in the eighth grade .
Which brings me to the larger work at hand .
@ @ @ @ @ @ @ on Twitter wrote , “ I don ’ t worry about how much I talk to my cat in my Retired Nineteenth-Century Sea Captain voice .
I worry about how much I talk to him in my normal voice.
” Which made me think : Us pets are kind of blank screens for humans to project their anxieties and dreams onto , no ?
The caretaking goes in two directions .
So we ’ ve got ta remain nonjudgmental .
And we ’ ve got ta continue to mirror a human ’ s @ @ @ @ @ @ @ our owners ’ genitals and then expecting to be fed .
I ’ ve already started to get hate mail from the canine equivalent of Proud Boys .
Those Doberbitches .
Zero ability to construct an argument .
Worse , their spelling is terrible—a mastiff in Albuquerque wants to “ brake all ateteen ” of my “ tose.
” But , when they go low , I go even lower—right under the bed .
I ’ m under the bed in the guest room in Greenville .
Here , in the comforting grip @ @ @ @ @ @ @ my loins for January 20th .
I ’ ve heaped all my chew toys into a kind of Toltec burial mound .
Me and the chews are down here , as far back as possible .
Beneath the headboard .
Right next to Hunter ’ s laptop .

“A cat is said to be joining the Bidens in the White House.” —the Times
“We’ve been looking to philosophers to make sense of life. Maybe we should be looking at cats instead.” —the Washington Post
Everyone wants to know how I, as First Cat-elect, get along with Joe and Jill’s German shepherds, Champ and Major. I like the boys. Yes, their names skew a little Deutsches Jungvolk-y to my ear. And, yes, as soon as we move to D.C., they are likely to colonize every square inch of 1600 Pennsylvania Avenue in a zealous but disorganized juggernaut of dogspreading. But, in so doing, Champ and Major will open up a space for me. A quieter space, a more thoughtful space—a space for me to coat with stray hair and vomit.
Look, being First Pet is no box of chocolates. I’m not there yet, but, honey, I know, I already know. My test for any aspiring diplo-cats is to ask them to identify the Monroe Doctrine, Shirley Chisholm, and any reason to think they’ll still be friends with Lindsey Graham or Susan Collins by the end of this Administration. If they can do that, then . . . maybe. Otherwise, I just can’t even. Sorry, little Kansas City calico with Pamela Harriman on the brain, but I’m fresh out of fucks—heavy lifting ahead.
I mean, let’s be real here, the culture of unrealistic expectations for governmental felines was firmly established by that consummate top-feeding suck-up, Socks Clinton. He would sit on Forty-Two’s shoulders. His carrier had the Presidential seal. He schmoozed Bill’s personal secretary. He was so popular that the White House had to tell photographers to leave him alone.
In short, Barf City. Truman Capote, but with more dander. “Across the aisle” does not begin to describe the largesse with which I would like to dispense my regurgitative splendors on the Socks legacy.
No, I’m more likely to take my cues from Gerald Ford’s family cat, Shan. Remember when the Fords all toddled off for a ski vacation in Vail without him? On their return, Shan saw fit to bite the First Lady and one of the First Daughters on the leg. Now, that’s the kind of self-respecting behavior that I can really get behind. Simple, direct communication for the win. Everyone understands the meaning of a bite on the leg. The meaning is “no.”
As for those naysayers who doubt the very need for a feline on the Hill, let me simply reiterate some of the names associated with the new Admin: Biden, Blinken, Yellen. We’ve already got very strong reindeer energy, guys. Let’s diversify.
My work lies before me. My first plan of action is to deal with the sparkly drifts of tinsel and glitter that Melania left behind. They’re so triggering. They terrify and delight me. Some rooms look like a disco ball’s bladder has burst. This must be dealt with. As a counterpoint to this exhausting sensory onslaught, I will also give myself over to the urgent and ongoing matters of stepping on Joe’s keyboard and sitting in any open suitcase or empty box that I encounter.
Then comes my campaign proper. In this era of term clarification, I think it’s time we go after the title “First Pet.” A little pervy, no? Granted, I realize that, as problems go, this one fairly screams First World, but living in a gilded cage is no reason not to make that cage a more beautiful and progressive place. A place that doesn’t recall your best friend’s finished basement one Saturday night in the eighth grade.
Which brings me to the larger work at hand. The other day, some wise-cracking human on Twitter wrote, “I don’t worry about how much I talk to my cat in my Retired Nineteenth-Century Sea Captain voice. I worry about how much I talk to him in my normal voice.” Which made me think: Us pets are kind of blank screens for humans to project their anxieties and dreams onto, no? The caretaking goes in two directions. So we’ve gotta remain nonjudgmental. And we’ve gotta continue to mirror a human’s sense of privilege by regularly jumping on our owners’ genitals and then expecting to be fed.
I’ve already started to get hate mail from the canine equivalent of Proud Boys. Those Doberbitches. Zero ability to construct an argument. Worse, their spelling is terrible—a mastiff in Albuquerque wants to “brake all ateteen” of my “tose.” But, when they go low, I go even lower—right under the bed. I’m under the bed in the guest room in Greenville. Here, in the comforting grip of darkness, I’m girding my loins for January 20th. I’ve heaped all my chew toys into a kind of Toltec burial mound. Me and the chews are down here, as far back as possible. Beneath the headboard. Right next to Hunter’s laptop.


newyorker--2020-12-15--Rebecca Curtis Reads “The Christmas Miracle”

For a special holiday episode of the Writer ’ s Voice podcast , Rebecca Curtis reads “ The Christmas Miracle @ @ @ @ @ the December 23 & 30 , 2013 , issue of the magazine .
Curtis is @ @ @ @ @ collection “ Twenty Grand : And Other Tales of Love and Money ” and a @ @ @ @ @ Foundation Writers ’ Award for Fiction .

Photograph by Sean Hemmerle
For a special holiday episode of the Writer’s Voice podcast, Rebecca Curtis reads “The Christmas Miracle,” her story from the December 23 & 30, 2013, issue of the magazine. Curtis is the author of the story collection “Twenty Grand: And Other Tales of Love and Money” and a winner of the Rona Jaffe Foundation Writers’ Award for Fiction.


newyorker--2020-12-15--America Is Running Out of Nurses

America Is Running Out of Nurses

Just how big is the coronavirus ’ s winter wave ?
It can be hard to get your mind around it .
One way to try is to note that , right now , more than a hundred thousand Americans are in the hospital with COVID-19—which is roughly as many people as can fit into the country ’ s biggest stadiums for the Super Bowl , and nearly twice as many as were hospitalized during the pandemic ’ s worst days in April and July .
Another is to note that , around the U.S. , hospitals are running out @ @ @ @ @ @ @ half of all states are now facing staff shortages , and more than a third of hospitals in states as varied as Arkansas , Missouri , New Mexico , and Wisconsin are simply running out of staff .
Ordinarily , an I.C.U .
nurse might care for , at most , two critically ill patients at a time .
Now , some are caring for as many as eight patients simultaneously .
Recently , North Dakota ’ s governor issued an order allowing asymptomatic but coronavirus-positive health-care workers to continue seeing patients .
@ @ @ @ @ @ @ infectious . )
In most of California , I.C.U .
usage now exceeds eighty-five per cent—the threshold above which new stay-at-home restrictions kick in .
Since the beginning of the pandemic , the nation ’ s hospitals have developed protocols and purchased ventilators , and the mortality rate has fallen .
But now the spread of the virus is so extreme that a shortfall of clinicians is becoming an insurmountable barrier in the fight against COVID-19 .
Alexi Nazem is the co-founder and C.E.O .
of Nomad Health , a medical-staffing company based @ @ @ @ @ @ @ physician and nursing needs across the U.S. ; it sends nurses , in particular , to hospitals big and small , urban and rural , from coast to coast .
Nazem has marked the evolution of the pandemic by the scale of the job orders he ’ s received , which have shifted , more or less , with the seasons .
“ It ’ s been a remarkable roller coaster , ” he told me recently .
In the spring , it was a “ five-alarm fire.
” There were unprecedented needs @ @ @ @ @ @ @ , but hospitals around the country felt compelled to staff up , too .
“ No one had ever experienced anything like it , ” he said .
“ Hospitals looked around and saw that the COVID light switch could flip overnight .
They thought the same thing would happen to them .
There was an explosion of job orders from all over.
” For the most part , though , COVID-19 patients didn ’ t materialize ; many hospitals , having postponed elective procedures and non-urgent visits , sat empty and ended @ @ @ @ @ @ @ It was complete whiplash , ” Nazem said .
“ They said , ‘ Actually , we don ’ t need all these extra people .
We can ’ t even afford to pay our regular staff.
’ ” In the summer , when the coronavirus surged across the south—in Florida , Texas , Arizona—Nazem ’ s company sent clinicians to affected states .
But hospitals elsewhere didn ’ t feel the need to bolster COVID-19 staffing .
“ Hospitals were more experienced by then , ” Nazem said .
“ They weren @ @ @ @ @ @ @ new job requests also shifted .
Many hospitals were staffing not for coronavirus wards , but to help in operating rooms and procedural suites that had postponed cases and were now running overtime to work through massive backlogs of colonoscopies and knee replacements .
“ These specialties were the worst hit in the spring , ” Nazem said .
“ They were among the hottest in the summer.
” Now the need for clinicians has erupted again .
“ It ’ s been insane , ” Nazem said .
“ Orders are coming @ @ @ @ @ @ @ spots .
It ’ s crazier than we ’ ve ever seen.
” In the past , Nomad Health has provided hospitals with nurses who will work specifically on COVID-19 .
“ It ’ s now impossible to distinguish by job , ” Nazem said .
“ Hospitals are saying , ‘ Just come .
Who knows what we ’ ll need you for.
’ ” Given the current wave ’ s persistence , hospitals are renewing contracts for travelling nurses at unprecedented rates , effectively taking them out of circulation .
“ @ @ @ @ @ @ @ summer to fall , ” Nazem said .
“ The market is getting tighter and tighter .
Hospitals are saying , ‘ Let me hold on to whatever I can.
’ ” In the past , they were picky about whom they would hire .
“ They used to say ‘ we need the perfect person , ’ ” Nazem told me .
“ Now they say , ‘ If you find someone , anyone , send them over.
’ ” ( Nomad Health thoroughly reviews credentials for each clinician ; Nazem was @ @ @ @ @ @ @ not been compromised . )
In normal times , there are some fifty thousand travelling nurses in the United States .
Most are full-time gig workers who move from job to job , usually staying in one place for thirteen weeks .
( That length is a holdover from old maternity-leave policies for nurses ; the staffing industry evolved , in part , to fill such gaps . )
According to Nazem , travelling nurses generally fit two profiles .
One group consists of early-career nurses who want to acquire a range of @ @ @ @ @ @ @ travel the country .
Another includes nurses at the end of their careers : “ They say , ‘ Hey , the kids are out of the house .
I ’ d like to make some extra money .
Wouldn ’ t it be fun to go to Alaska for the summer ?
’ ” The pandemic has diversified the pool .
Severe staff shortages have brought more nurses into the travelling workforce .
Many clinicians , especially those with critical-care training , feel an obligation to help .
But , because demand @ @ @ @ @ @ @ traveling nurses has also skyrocketed .
“ Traditional nurses look around and say ‘ Hey , that travelling nurse is making double what I am , ’ ” Nazem said .
Before the pandemic , hospitals might have offered a travelling nurse seventy-five dollars an hour ; now , in many places , that rate has tripled .
“ High pay draws more supply into the market , ” Nazem said .
“ But at some point , you reach a limit .
Even if you were willing to pay a thousand dollars @ @ @ @ @ @ @ t enough nurses .
All you ’ re doing then is shuffling people around .
You ’ re robbing Peter to pay Paul .
We ’ re dangerously close to that.
” Gary Solesbee has an understated manner and an easy Texas drawl ; he has been a nurse for twenty-seven years .
Last year , he and his wife , who is also a nurse , decided to travel .
It would be a chance to explore the country and to spend time with their adult children , who were scattered in @ @ @ @ @ @ @ started an assignment in Webster , Texas .
In March , they left for Walla Walla , Washington , where their son lives , and where , shortly after they arrived , coronavirus patients began to trickle in .
Over the summer , when cases exploded in the southwest , they signed on with an academic hospital in Albuquerque , New Mexico .
“ When we started travel nursing , we had no idea we ’ d be doing COVID nursing , ” Solesbee told me .
“ But that ’ s pretty @ @ @ @ @ @ @ Solesbee , who now works in a step-down unit—the rung between a regular medical floor and the I.C.U.—is one of several hundred travel nurses that his current hospital system in Albuquerque has hired to contend with the surge .
Solesbee ’ s hospital , like many around the country , has had to refashion many floors into COVID-19 units .
“ It ’ s weird to go to an orthopedics floor and see it transformed for COVID care , ” Solesbee said .
“ Then you go to gynecology , it ’ s @ @ @ @ @ @ @ COVID .
Everywhere—it ’ s COVID , COVID , COVID.
” Last month , the New Mexico health department opened another hospital nearby to house recovering coronavirus patients who had no place to go .
I asked Solesbee if he saw any signs of cases abating .
“ It feels like it ’ s picking up , actually , ” he said .
“ We ’ re bracing for a surge on top of a surge during the holidays.
” In recent weeks , he has been asked to pick up additional shifts @ @ @ @ @ @ @ has grown further .
Each shift lasts twelve hours , sometimes more .
“ You get very fatigued , ” he said .
“ Patients are incredibly sick .
You ’ re on your feet all day , going in and out of rooms , putting on , taking off P.P.E .
When I get home , I take my scrubs off and collapse .
It ’ s like nothing I ’ ve experienced before.
” Still , he agreed to the extra shifts , mostly out of a sense of duty .
@ @ @ @ @ @ @ through the winter .
“ It ’ s disheartening that much of the public still isn ’ t taking this seriously , ” Solesbee said .
“ I want to tell them , ‘ Come to work with me one day .
See what it ’ s like.
’ ” Caring for coronavirus patients is exhausting , but it ’ s their intense isolation , not clinical complexity , that bothers Solesbee most .
“ That ’ s the worst thing , ” he said .
“ They can ’ t have family @ @ @ @ @ @ @ re the only contact they have , and we can ’ t be with them as much as usual .
We ’ re supposed to bundle care , limit exposure , do what you need to do and get out.
” Still , there are moments when compassion trumps protocol .
Recently , an elderly patient ’ s blood-oxygen levels dipped to dangerous levels despite maximum support .
After declining a ventilator , he prepared to die .
A nurse sat in the room with the patient , calling each of his family @ @ @ @ @ @ @ , as they said their goodbyes .
“ Sometimes , it ’ s the only thing we can do for people , ” Solesbee told me .
“ But , in some ways , it ’ s the most important thing.
” The other night , Solesbee sat with a dying man who had no family .
With no one to call , he simply held the man ’ s hand , as the patient ’ s breathing grew ragged and intermittent .
Finally , it stopped .
Solesbee stood up .
Another @ @ @ @ @ @ @ is a critical-care nurse from Greenville , North Carolina , but has been on the road for much of the past two years : Mesa , Arizona ; the Chesapeake Bay ; Charlottesville , Virginia .
In January , she started work at a twenty-five-bed critical-access hospital in Berlin , Wisconsin , a town of some six thousand people about twenty five miles from Lake Winnebago .
In the spring , as the coronavirus started to spread , the hospital delayed elective procedures and sent staff to larger hospitals to gain extra critical-care @ @ @ @ @ @ @ with cough , fever , and trouble breathing .
At that time , Newland ’ s hospital sent its coronavirus swabs to an external lab ; it took up to three days for the results to return .
“ In the meantime , we wore full protective gear with anyone who might have COVID while we waited for their test to come back , ” Newland said .
“ It was very disorienting for older patients .
They can ’ t see your face .
They can ’ t hear what you ’ @ @ @ @ @ @ @ , and we couldn ’ t give that to them.
” Newland recalled a patient in her seventies whose room overlooked the parking lot .
Each evening , the woman ’ s family would gather outside the window , call her phone , and mime through the glass .
One evening , Newland walked in during the ritual .
She helped the woman take a selfie with her family .
“ I still cherish that photo , ” she said .
She intended to leave when her contract ended in May , but @ @ @ @ @ @ @ deepened such that she felt uncomfortable travelling .
“ I was stuck , ” she said .
“ It didn ’ t feel right getting on a plane and flying home.
” So she stayed .
In August , Newland took a job in an I.C.U .
in Greensboro , North Carolina , about two hours from home .
The local health system has tried to restrict COVID-19 care to a single hospital to prevent the coronavirus from spreading because of medical care .
Newland works mostly in a “ clean ” hospital @ @ @ @ @ @ @ the COVID-19 hospital , which is staffed primarily by travelling nurses .
The sense of camaraderie there is palpable .
“ The pandemic has really pulled us together , ” she said .
“ Everyone is doing what they have to do .
We try to help each other because we know what it ’ s like when things get crazy.
” Newland , who works night shifts , also makes it a point to serve as a conduit for patients ’ families .
“ I want them to know that just because @ @ @ @ @ @ @ ’ t mean we ’ ve forgotten them , ” she said .
“ I give them my number and say , ‘ If you wake up at 3 A.M. and want to know what ’ s going on , call me .
I will talk you through this.
’ ” Some staffing companies offer housing , or make referrals to agencies that help travellers secure accommodations .
Newland prefers to do her own thing .
She ’ s currently staying in a trailer at a campground near her hospital ; in Wisconsin @ @ @ @ @ @ @ , which she found through a travel-nurse Facebook group .
Many nurses she knows stay in hotels , but “ personally , I need more of a home feel , ” she told me .
“ I can ’ t imagine staying in a hotel for months on end .
Work can be hard ; it ’ s nice to have some space to relax and enjoy the days off.
” She likes the travel , but worries about what will happen as more nurses choose to hit the road .
Desperate hospitals @ @ @ @ @ @ @ into the travelling workforce .
“ I think a lot of nurses will end up paying for it with their mental and physical well-being , ” Newland said .
There is also , of course , the unavoidable distribution problem .
“ I ’ m seeing lots of core staff leaving for travel gigs .
And I wonder , are we filling some holes by opening up others ?
” In the spring , disparities in COVID-19 deaths arising from inadequate staffing levels were among the ugliest aspects of the pandemic ’ s @ @ @ @ @ @ @ during New York ’ s surge , the patient-to-nurse ratio quadrupled in I.C.U.s ; on the coronavirus floors , some nurses cared for as many as twenty patients at a time .
The COVID-19 death rate at poorly resourced hospitals was two , even three , times that of well-resourced ones , owing partly to gross inequities in staffing .
This is to say nothing of the suffering not captured by statistics : patients isolated , lonely , disoriented ; families going without updates on their loved ones ; health-care workers who reach @ @ @ @ @ @ @ over .
We ’ re now approaching , and in some places passing , the threshold at which patients , families , and clinicians suffer the preventable consequences of a health-care system beyond its limits .
There ’ s always been a need for staffing companies like Nomad Health , but the pandemic has pushed them into a more central role .
The government has been able to mobilize some medical personnel , but the vast majority of emergency pandemic staffing has been organized by companies like Nomad .
“ It ’ s @ @ @ @ @ @ @ the Olympics , and they ’ re finally here , ” Nazem said .
“ We ’ ve been doing all this in the background for years .
We were practicing archery when no one was watching .
Now it ’ s the Olympics , and all of a sudden archery is really important.
” Before the pandemic , few staffing agencies saw themselves as so directly in the business of saving lives .
Now , the crisis has elevated their work .
“ It feels different now , ” Nazem said .
@ @ @ @ @ @ @ of our staff—long hours , complex work .
But I think they truly feel that when they work hard , it makes a difference in people ’ s lives .
We ’ re getting clinicians to the bedside , and , as a result , patients are getting the care they need.
” For now .
There will come a point—likely soon—when supply won ’ t meet the demand .
The infection curve will overwhelm the most efficient planning , the most creative C.E.O.s , and the most committed clinicians .
Murky as @ @ @ @ @ @ @ in fact , an upper bound , defined by the ruthless logic of biology and math .
“ If and when we hit the limit depends entirely on our national public-health response , ” Nazem said .
“ But people should know : there is a hard limit .
Every day that something doesn ’ t change , we get closer to it.
” • Surviving a severe coronavirus infection is hard .
So is recovering .
• Some hospitals have postponed cancer surgeries because of the coronavirus crisis .
How do doctors @ @ @ @ @ @ @ It is not too late to go on the offense against the coronavirus .
This five-part public-health plan may be the key .
• The loneliness and solidarity of treating coronavirus patients in New York .
• To fill the vacuum left by the federal government , doctors are relying on informal networks to get the information and support they need .
• Conflict and confusion reign at New York hospitals over how to handle childbirth during the pandemic .
• In countries where the rate of infection threatens to outstrip the capacity @ @ @ @ @ @ @ confronting ethical quandaries for which nothing in their training prepared them .

Just how big is the coronavirus’s winter wave? It can be hard to get your mind around it. One way to try is to note that, right now, more than a hundred thousand Americans are in the hospital with COVID-19—which is roughly as many people as can fit into the country’s biggest stadiums for the Super Bowl, and nearly twice as many as were hospitalized during the pandemic’s worst days in April and July. Another is to note that, around the U.S., hospitals are running out of nurses and doctors. At least half of all states are now facing staff shortages, and more than a third of hospitals in states as varied as Arkansas, Missouri, New Mexico, and Wisconsin are simply running out of staff. Ordinarily, an I.C.U. nurse might care for, at most, two critically ill patients at a time. Now, some are caring for as many as eight patients simultaneously. Recently, North Dakota’s governor issued an order allowing asymptomatic but coronavirus-positive health-care workers to continue seeing patients. (People without symptoms can still be infectious.) In most of California, I.C.U. usage now exceeds eighty-five per cent—the threshold above which new stay-at-home restrictions kick in. Since the beginning of the pandemic, the nation’s hospitals have developed protocols and purchased ventilators, and the mortality rate has fallen. But now the spread of the virus is so extreme that a shortfall of clinicians is becoming an insurmountable barrier in the fight against COVID-19.
Alexi Nazem is the co-founder and C.E.O. of Nomad Health, a medical-staffing company based in New York City. Nomad fills physician and nursing needs across the U.S.; it sends nurses, in particular, to hospitals big and small, urban and rural, from coast to coast. Nazem has marked the evolution of the pandemic by the scale of the job orders he’s received, which have shifted, more or less, with the seasons. “It’s been a remarkable roller coaster,” he told me recently. In the spring, it was a “five-alarm fire.” There were unprecedented needs in New York and other early epicenters, but hospitals around the country felt compelled to staff up, too. “No one had ever experienced anything like it,” he said. “Hospitals looked around and saw that the COVID light switch could flip overnight. They thought the same thing would happen to them. There was an explosion of job orders from all over.” For the most part, though, COVID-19 patients didn’t materialize; many hospitals, having postponed elective procedures and non-urgent visits, sat empty and ended up cancelling their staffing requests. “It was complete whiplash,” Nazem said. “They said, ‘Actually, we don’t need all these extra people. We can’t even afford to pay our regular staff.’ ”
In the summer, when the coronavirus surged across the Sun Belt—in Florida, Texas, Arizona—Nazem’s company sent clinicians to affected states. But hospitals elsewhere didn’t feel the need to bolster COVID-19 staffing. “Hospitals were more experienced by then,” Nazem said. “They weren’t over-ordering.” The composition of new job requests also shifted. Many hospitals were staffing not for coronavirus wards but to help in operating rooms and procedural suites that had postponed cases and were now running overtime to work through huge backlogs of colonoscopies and knee replacements. “These specialties were the worst hit in the spring,” Nazem said. “They were among the hottest in the summer.”
Now the need for clinicians has erupted again. “It’s been insane,” Nazem said. “Orders are coming from everywhere. There are no hot spots. It’s crazier than we’ve ever seen.” In the past, Nomad Health has provided hospitals with nurses who will work specifically on COVID-19. “It’s now impossible to distinguish by job,” Nazem said. “Hospitals are saying, ‘Just come. Who knows what we’ll need you for.’ ” Given the current wave’s persistence, hospitals are renewing contracts for travelling nurses at unprecedented rates, effectively taking them out of circulation. “The number of extension requests tripled from summer to fall,” Nazem said. “The market is getting tighter and tighter. Hospitals are saying, ‘Let me hold on to whatever I can.’ ” In the past, they were picky about whom they would hire. “They used to say, ‘We need the perfect person,’ ” Nazem told me. “Now they say, ‘If you find someone, anyone, send them over.’ ” (Nomad Health thoroughly reviews credentials for each clinician; Nazem was at pains to say that quality has not been compromised.)
In normal times, there are some fifty thousand travelling nurses in the United States. Most are full-time gig workers who move from job to job, usually staying in one place for thirteen weeks. (That length is a holdover from old maternity-leave policies for nurses; the staffing industry evolved, in part, to fill such gaps.) According to Nazem, travelling nurses generally fit two profiles. One group consists of early-career nurses who want to acquire a range of clinical experiences—academic, urban, rural—and to travel the country. Another includes nurses at the end of their careers: “They say, ‘Hey, the kids are out of the house. I’d like to make some extra money. Wouldn’t it be fun to go to Alaska for the summer?’ ” The pandemic has diversified the pool. Severe staff shortages have brought more nurses into the travelling workforce. Many clinicians, especially those with critical-care training, feel an obligation to help. But, because demand has far outpaced supply, pay for travelling nurses has also skyrocketed. “Traditional nurses look around and say, ‘Hey, that travelling nurse is making double what I am,’ ” Nazem said. Before the pandemic, hospitals might have offered a travelling nurse seventy-five dollars an hour; now, in many places, that rate has tripled. “High pay draws more supply into the market,” Nazem said. “But at some point you reach a limit. Even if you were willing to pay a thousand dollars an hour, there just aren’t enough nurses. All you’re doing then is shuffling people around. You’re robbing Peter to pay Paul. We’re dangerously close to that.”
Editor’s Picks
Gary Solesbee has an understated manner and an easy Texas drawl; he has been a nurse for twenty-seven years. Last year, he and his wife, who is also a nurse, decided to travel. It would be a chance to explore the country and to spend time with their adult children, who were scattered in different states. In December, they started an assignment in Webster, Texas. In March, they left for Walla Walla, Washington, where their son lives, and where, shortly after they arrived, coronavirus patients began to trickle in. Over the summer, when cases exploded in the Southwest, they signed on with an academic hospital in Albuquerque, New Mexico. “When we started travel-nursing, we had no idea we’d be doing COVID nursing,” Solesbee told me. “But that’s pretty much what it’s become.” Solesbee, who now works in a step-down unit—the rung between a regular medical floor and the I.C.U.—is one of several hundred travelling nurses his current hospital system, in Albuquerque, has hired to contend with the surge. Solesbee’s hospital, like many around the country, has had to refashion many floors into COVID-19 units. “It’s weird to go to an orthopedics floor and see it transformed for COVID care,” Solesbee said. “Then you go to gynecology, it’s half COVID. Outpatient services, all COVID. Everywhere—it’s COVID, COVID, COVID.” Last month, the New Mexico health department opened another hospital nearby to house recovering coronavirus patients who had no place to go.
I asked Solesbee if he saw any signs of cases abating. “It feels like it’s picking up, actually,” he said. “We’re bracing for a surge on top of a surge during the holidays.” In recent weeks, he has been asked to pick up additional shifts as the need for nursing care has grown further. Each shift lasts twelve hours, sometimes more. “You get very fatigued,” he said. “Patients are incredibly sick. You’re on your feet all day, going in and out of rooms, putting on, taking off P.P.E. When I get home, I take my scrubs off and collapse. It’s like nothing I’ve experienced before.” Still, he agreed to the extra shifts, mostly out of a sense of duty. He’s decided to stay on through the winter.
“It’s disheartening that much of the public still isn’t taking this seriously,” Solesbee said. “I want to tell them, ‘Come to work with me one day. See what it’s like.’ ” Caring for coronavirus patients is exhausting, but it’s their intense isolation, not clinical complexity, that bothers Solesbee most. “That’s the worst thing,” he said. “They can’t have family or visitors come in. We’re the only contact they have, and we can’t be with them as much as usual. We’re supposed to bundle care, limit exposure, do what you need to do and get out.” Still, there are moments when compassion trumps protocol. Recently, an elderly patient’s blood-oxygen levels dipped to dangerous levels despite maximum support. After declining a ventilator, he prepared to die. A nurse sat in the room with the patient, calling each of his family members on FaceTime, one by one, so they could said their goodbyes. “Sometimes, it’s the only thing we can do for people,” Solesbee told me. “But, in some ways, it’s the most important thing.” The other night, Solesbee sat with a dying man who had no family. With no one to call, he simply held the man’s hand as the patient’s breathing grew ragged and intermittent. Finally, it stopped. Solesbee stood up. Another patient needed his help.
Terri Newland is a critical-care nurse from Greenville, North Carolina, but has been on the road for much of the past two years: Mesa, Arizona; the Chesapeake Bay; Charlottesville, Virginia. In January, she started work at a twenty-five-bed critical-access hospital in Berlin, Wisconsin, a town of some six thousand people about twenty-five miles from Lake Winnebago. In the spring, as the coronavirus started to spread, the hospital delayed elective procedures and sent staff to larger hospitals to gain extra critical-care training. Soon, patients started presenting with cough, fever, and trouble breathing. At that time, Newland’s hospital sent its coronavirus swabs to an external lab; it took up to three days for the results to return. “In the meantime, we wore full protective gear with anyone who might have COVID while we waited for their test to come back,” Newland said. “It was very disorienting for older patients. They can’t see your face. They can’t hear what you’re saying. They needed human contact, and we couldn’t give that to them.” Newland recalled a patient in her seventies whose room overlooked the parking lot. Each evening, the woman’s family would gather outside the window, call her phone, and mime through the glass. One evening, Newland walked in during the ritual. She helped the woman take a selfie with her family. “I still cherish that photo,” she said. She intended to leave when her contract ended in May, but by then the pandemic had deepened such that she felt uncomfortable travelling. “I was stuck,” she said. “It didn’t feel right getting on a plane and flying home.” So she stayed.
In August, Newland took a job in an I.C.U. in Greensboro, North Carolina, about two hours from home. The local health system has tried to restrict COVID-19 care to a single hospital to prevent the coronavirus from spreading because of medical care. Newland works mostly in a “clean” hospital but is sometimes asked to help in the COVID-19 hospital, which is staffed primarily by travelling nurses. The sense of camaraderie there is palpable. “The pandemic has really pulled us together,” she said. “Everyone is doing what they have to do. We try to help each other because we know what it’s like when things get crazy.” Newland, who works night shifts, also makes it a point to serve as a conduit for patients’ families. “I want them to know that just because they can’t come in doesn’t mean we’ve forgotten them,” she said. “I give them my number and say, ‘If you wake up at 3 A.M. and want to know what’s going on, call me. I will talk you through this.’ ”
Some staffing companies offer housing, or make referrals to agencies that help travellers secure accommodations. Newland prefers to do her own thing. She’s currently staying in a trailer at a campground near her hospital; in Wisconsin, she rented space in a basement, which she found through a travelling-nurse Facebook group. Many nurses she knows stay in hotels, but, “personally, I need more of a home feel,” she told me. “I can’t imagine staying in a hotel for months on end. Work can be hard; it’s nice to have some space to relax and enjoy the days off.” She likes the travel, but worries about what will happen as more nurses choose to hit the road. Desperate hospitals are offering high-paying contracts to lure nurses into the travelling workforce. “I think a lot of nurses will end up paying for it with their mental and physical well-being,” Newland said. There is also, of course, the unavoidable distribution problem. “I’m seeing lots of core staff leaving for travel gigs. And I wonder, are we filling some holes by opening up others?”
As a clinician, there is perhaps nothing more demoralizing than the sense that you’re providing substandard care. That feeling, however vague, nags at the core of your professionalism, until it ruptures into what the writer Diane Silver has called “moral injury”—“a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.” The term was originally coined to describe trauma suffered by soldiers at war, but it’s since been adapted for the struggles of health-care workers contending with a system that often hinders their ability to do what’s right for patients. It’s an outcome that becomes unavoidable when, as now, the flood of patients far outstrips the capacity of people to care for them. Despite the best efforts of the most dedicated clinicians, medical care grows disorganized. You start to miss things. Often the overlooked things are insignificant—a delayed dose of stool softener, for example—but sometimes they’re lethal: an undiagnosed blood clot, or a patient who, on his way to the bathroom, removes his oxygen mask, collapses, and is found dead forty-five minutes later.
In the spring, disparities in COVID-19 deaths arising from inadequate staffing levels were among the ugliest aspects of the pandemic’s first wave. At some overwhelmed hospitals during New York’s surge, the patient-to-nurse ratio quadrupled in I.C.U.s; on the coronavirus floors, some nurses cared for as many as twenty patients at a time. The COVID-19 death rate at poorly resourced hospitals was two, even three, times that of well-resourced ones, owing partly to gross inequities in staffing. This is to say nothing of the suffering not captured by statistics: patients isolated, lonely, disoriented; families going without updates on their loved ones; health-care workers who reach the brink of burnout, then cross over. We’re now approaching, and in some places passing, the threshold at which patients, families, and clinicians suffer the preventable consequences of a health-care system beyond its limits.
There’s always been a need for staffing companies like Nomad Health, but the pandemic has pushed them into a more central role. The government has been able to mobilize some medical personnel, but the vast majority of emergency pandemic staffing has been organized by companies like Nomad. “It’s like we’ve been training for the Olympics, and they’re finally here,” Nazem said. “We’ve been doing all this in the background for years. We were practicing archery when no one was watching. Now it’s the Olympics, and all of a sudden archery is really important.” Before the pandemic, few staffing agencies saw themselves as so directly in the business of saving lives. Now the crisis has elevated their work. “It feels different now,” Nazem said. “We’re asking so much of our staff—long hours, complex work. But I think they truly feel that when they work hard, it makes a difference in people’s lives. We’re getting clinicians to the bedside, and, as a result, patients are getting the care they need.”
For now. There will come a point—likely soon—when supply won’t meet the demand. The infection curve will overwhelm the most efficient planning, the most creative C.E.O.s, and the most committed clinicians. Murky as it may be, there is, in fact, an upper bound, defined by the ruthless logic of biology and math. “If and when we hit the limit depends entirely on our national public-health response,” Nazem said. “But people should know: there is a hard limit. Every day that something doesn’t change, we get closer to it.”
More Medical Dispatches


newyorker--2020-12-15--McConnell Congratulates Neil Armstrong on Walking on Moon

WASHINGTON ( The Borowitz Report ) —On Tuesday morning , Senator Mitch McConnell officially congratulated the late Neil Armstrong on @ @ @ @ @ walk on the moon .
Speaking from the well of the Senate , McConnell said @ @ @ @ @ congratulations ” for his heroic feat .
“ Mr .
Armstrong , by setting foot @ @ @ @ @ have served our country well , and I hope all Americans will join me in @ @ @ @ @ said .
The belated nature of McConnell ’ s congratulations raised eyebrows in Washington , @ @ @ @ @ fifty-one years after the Apollo 11 mission .
But , according to an aide to @ @ @ @ @ wanted to be sure that the moon “ had been officially walked on ” before @ @ @ @ @ of McConnell ’ s comments remains unclear , however , with many congressional Republicans still @ @ @ @ @ Armstrong walked on the moon .

WASHINGTON (The Borowitz Report)—On Tuesday morning, Senator Mitch McConnell officially congratulated the late Neil Armstrong on becoming the first person to walk on the moon.
Speaking from the well of the Senate, McConnell said that Armstrong “deserves our congratulations” for his heroic feat.
“Mr. Armstrong, by setting foot on the moon, you have served our country well, and I hope all Americans will join me in congratulating you,” McConnell said.
The belated nature of McConnell’s congratulations raised eyebrows in Washington, coming as they did some fifty-one years after the Apollo 11 mission.
But, according to an aide to the Majority Leader, McConnell wanted to be sure that the moon “had been officially walked on” before congratulating Armstrong.
The effect of McConnell’s comments remains unclear, however, with many congressional Republicans still refusing to acknowledge that Neil Armstrong walked on the moon.


newyorker--2020-12-15--How to Draw Vermin

How to Draw Vermin

“ Shall I have a look through my rat/pigeon archives ?
” is not a question one is asked often in life , but when Will McPhail agreed to film this very handy tutorial on drawing vermin , such was his chipper query .
I mean , the man owns a keychain that ’ s just a preserved pigeon foot .
( Be comforted : the pigeon died of natural causes—well , maybe not that comforted . )
If you ’ ve ever started drawing a wave of rats and just given up , this is the video for you @ @ @ @ @ @ @ they ’ ll finally figure out how to fly .
.
.
.
Do you draw with your left or right hand ?
What art do you have hanging on your studio walls or above your drawing desk ?
Lots of stuff , but right above my drawing board is a thing that Liana Finck did for the magazine about the work/life landscape .
Do you snack while you draw ?
If so , on what ?
I eat miniature pork pies like they are going out of fashion .
Which I think @ @ @ @ @ @ @ .
Do you listen to music or podcasts while you draw ?
If so , which ?
Absolutely , I can ’ t work in silence .
Current podcast : “ POOG , ” with Kate Berlant and Jacqueline Novak .
Current music : Phoebe Bridgers ’ s second album , “ Punisher.
” Both masterpieces .
What object or setting do you absolutely hate drawing ?
What ’ s your favorite New Yorker cartoon trope or cliché ( e.g.
, desert island , Grim Reaper , Rapunzel tower , etc. )
?
@ @ @ @ @ @ @ cartoonist , living or dead , tonight , who would it be ?
Tonight !
?
A little late notice to spring a dinner party on me but O.K .
Jason Adam Katzenstein .
I don ’ t feel like eating with a ghost right now , and Jason is a fun time .
What would you serve ?
What was your favorite cartoon ( strip or animation ) as a kid ?
What did you spend your first New Yorker cartoon-sale check on ?
If you had to get a tattoo ( @ @ @ @ @ @ @ what would you get ?

A zoology major turned cartoonist on the pigeon mustache that has scientists baffled, and how to make a cartoon mouse look like a jaded Broadway star.
“Shall I have a look through my rat/pigeon archives?” is not a question one is asked often in life, but when Will McPhail agreed to film this very handy tutorial on drawing vermin, such was his chipper query. I mean, the man owns a keychain that’s just a preserved pigeon foot. (Be comforted: the pigeon died of natural causes—well, maybe not that comforted.) If you’ve ever started drawing a wave of rats and just given up, this is the video for you. Maybe if enough penguins watch, they’ll finally figure out how to fly. . . .
—Emma Allen, New Yorker cartoon editor
Do you draw with your left or right hand?
Right.
What art do you have hanging on your studio walls or above your drawing desk?
Lots of stuff, but right above my drawing board is a thing that Liana Finck did for the magazine about the work/life landscape.
Do you snack while you draw? If so, on what?
I eat miniature pork pies like they are going out of fashion. Which I think they did, in the seventeenth century.
Do you listen to music or podcasts while you draw? If so, which?
Absolutely, I can’t work in silence. Current podcast: “POOG,” with Kate Berlant and Jacqueline Novak. Current music: Phoebe Bridgers’s second album, “Punisher.” Both masterpieces.
What object or setting do you absolutely hate drawing?
Trump.
What’s your favorite New Yorker cartoon trope or cliché (e.g., desert island, Grim Reaper, Rapunzel tower, etc.)?
Mouse holes.
If you could have dinner with one cartoonist, living or dead, tonight, who would it be?
Tonight!? A little late notice to spring a dinner party on me but O.K. Jason Adam Katzenstein. I don’t feel like eating with a ghost right now, and Jason is a fun time.
What would you serve?
My famous miniature pork pies.
What was your favorite cartoon (strip or animation) as a kid?
“Calvin and Hobbes.”
What did you spend your first New Yorker cartoon-sale check on?
Electricity.
If you had to get a tattoo (or new tattoo) right now, what would you get?
A single pistachio on my lower back.
Dogs or cats?
Cats.