my people, doing their job

Readers of this blog who are in my phone contacts and see my WhatsApp statuses already know I'm super excited about the news from Penn State Health this week! It's been a noteworthy week for pharmacy employees. First, a pharmacist coworker was spotlighted in the Penn State Health news. If you're interested, here's the article on Darryle Tillman, whom I work closely with. The picture that was chosen is a perfect snapshot of a daily scene in the pharmacy. 

Karla Rivera-Rodriguez is the lead tech who keeps everyone in line. Rare is the day when she hasn't set Darryle straight at least once! I love her body language and the look in her eyes here. It looks like she's getting ready to deliver her famous line, "Darryle, get your **** together!" 😆 

The next event was the arrival of our covid vaccine, which made local news (article here). I'm so excited our hard-working team is getting some recognition and it makes me happy to share a glimpse of my world with you! 

A day later the first vaccinations were given to front-line employees, again making news (link here). There are several great pictures accompanying the article, but I think this one is the best because it shows the clean room and hood where we make our sterile products. (Click to enlarge).

I've spent many hours in that hood. Just imagine Megan is me and you'll get a precise visual of a day in my life! Darryle seems to have a knack for making headlines. Here's Kelsey again, too.

My excitement is mostly because I'm so proud of these people! The vaccine is not so much my focus, but I've been asked by several people if I'm getting it. The short answer is no, but I'll also give the long answer. 

We received 975 doses of the vaccine, which is a first dose. The second dose will arrive later and be given after a few weeks. At this time it is not mandatory for hospital employees, like the flu shot is, but if we want the vaccination it will be administered using a tiered plan. Those who work in CCU and covid units will get it first. Our department would be on a tier below those who directly interact with patients, and by the time it comes around to us I'll be moving on to my new job. I don't know what LVHN's policies are, but expect it to be similar. Although I don't plan to get vaccinated at this time, I want to make it clear I am not against it and have no use for the conspiracies being spread by people who are ignorant. Sorry if that offends you, but that's how I see it. However, I'll admit I'm slightly reluctant about something that is so new and would like to see its long-term effects before I get it. If it meant I didn't have to wear a mask anymore, I'd get it tomorrow, but that's not going to be the case. Those who get vaccinated will still need to wear a mask because they could have no symptoms but carry the virus. My knowledge is limited as to how long it will be before that changes, but it's not likely to happen soon. Yet I do think those who haven't had the virus or are vulnerable because of other health issues should get it as soon as it becomes available. 

I hear opinions from both the far left and far right about covid, drugs, the vaccine, and other hot topics and as someone who hates conflict it honestly makes me cringe. What would Jesus do if He was here? Thinking that way sometimes helps me find the path of peace. After all, He's the gentle man who calmed the storm, ate with sinners, and lived His life loving and healing. What an example!

work challenges

After working the 3:30 pm to 12:00 am shift five days in a row, I'm still wide awake at midnight. I've been slightly frustrated lately with working full time. It seems I'm constantly trying to get things done at home but never quite reach a point where things are caught up. I never have time for anything extra, like sewing or having company. A good part of my time at work is spent in a small enclosed area making IV's. Lately it's been so hot and uncomfortable in there and I'm tired of sweating inside all the sterile garb. I sometimes miss going to a job where I can dress up and wear nice things. Schools are starting and the beginning of a new term always brings back memories and part of me longs to be there again. I'd like to wish away those feelings because it doesn't seem like the way is open for me to teach. That's probably enough sharing of the ugly, discontented thoughts I've been having.

Last night I made an IV drug I've never done before -- antivenom for a patient who got bit by a copperhead. I wasn't at work when the patient came in (sometime during the night) and this was a follow-up dose of the drug. It's amazing how often the unusual, crazy stuff happens on the evening and night shifts. I also had to make TPA (massive dose of a clot-busting drug for patients who are having a stroke) at least twice while working evenings last week. It is of utmost importance to quickly get TPA to the patient who is having a stroke because "time is brain". Every minute counts when blood flow to the brain is being blocked. In those kinds of emergencies, I don't stop to think about how someone's life might depend on the drug I'm making and how quickly we can get it to them. If I did, I'd probably stab myself with a needle or make some kind of mistake while compounding the drug. Staying calm is the best thing to do.

Last week we were so short of technicians a couple days that a pharmacist had to step in and do the work we techs usually do. I found it amusing that the pharmacist who was covering had a mini meltdown after a couple days of doing the hands-on work because it was too much to handle. 😄 Especially now, while our IV room is under construction and one person is responsible for making all the IV's in a 2 foot area, it does get to be too much sometimes. It takes mental and physical strength to keep your cool. 

I'm trying to have a relaxing weekend to prepare for next week's 5:00 am schedule. That is actually my favorite shift, but after working evenings for a week, I feel a little out of sync. Recently I had my yearly performance eval and felt encouraged by what my manager said about me. Knowing I'm a valuable team member helps me put up with some of the challenges and give it my best.

impressions and observations

Working in healthcare in the midst of a pandemic leads to many impressions and observations. Our number of COVID patients is slowly decreasing, but deaths are still rising. One bright spot is the 38 year old patient I mentioned in this post. Although many patients in similar situations haven't survived, it looks like this one might pull through! Then there's the patient who has been hospitalized since the beginning of April. He was on a ventilator for weeks, but finally began to recover. He was eventually moved out of critical care, but because of altered mental status and other complications was recently brought back to CCU. As lately as two days ago he'd been agitated and trying to climb out of bed. Today I heard he'd passed away. I don't have full access to patient information so I don't know what the actual cause of death was. To see someone near death fight for so long, gain ground, then regress, is disheartening. 

I mentioned in this post that we were using the anti-malarial drug hydroxychloroquine even though it hadn't been proven effective. President Trump has touted it as a cure for coronavirus and claims to be taking it. However, further studies have shown it to be ineffective against COVID-19 and because of potential harmful side effects, doctors are no longer recommending it. The most recent "miracle drug" for treating coronavirus is the antiviral Remdesivir. Currently the federal government controls which hospitals get this drug, based on data such as number of COVID cases and number of ventilated patients. We got our first supply last week, but it was only enough for one severely ill patient. Our hospital command center along with doctors involved in treating the sickest patients, decided who would get it. Again, this drug has not yet been proven effective although some studies have shown hopeful signs. The patient who received our first supply of Remdesivir did not improve or get worse for the first few days. He eventually began to further decline though, and passed away yesterday. In the meantime we received a larger shipment of drug and now have several patients on it. Time will tell if it actually works.

There was an incident in the ER on Sunday that made it into our local paper. A combative patient punched a nurse aide in the face, knocking him down and breaking his glasses. The patient was charged with assault, although the aide was not seriously injured. You can read the article here. I'm glad action was taken to protect the caregiver, because they often put up with abuse from patients. 

The weather has been delightful this week and I'm looking forward to being off all next week! We get two weeks of vacation every year, and I like to choose the end of May because it's one of the most beautiful times of the year in my opinion. I hope to spend lots of time outside, puttering around in my flowerbeds and soaking in the sunshine!

weekend work race

Today I nearly reached my breaking point. I was mentally prepared for a very intense weekend, but it still took a toll.

Last week one of the pharmacists who has been at St. Joe's over 20 years said he's never seen our IV room as busy as it's been the last while. During the week, a pharmacist and tech are in the clean room making IV's, but on the weekends it's just one tech. Yesterday and today it was my responsibility to make IV's for the entire hospital. The pharmacists helped by sending back drips before they were due so they'd be ready when the nurse requested them. We currently have 7 patients on a ventilator, and as I mentioned before, these patients are on multiple IV's for sedation. Some of them run at high rates so one bag might only last an hour or two. I have no idea how many drips I made over the last two days, but it was enough to give me blisters from manipulating a syringe! By lunchtime today I had almost more than I could take and a few tears were shed, but after a 30 minute break I was ready to tackle the rest of the day! When you're making drips as fast as you can but there's always more to do, it starts feeling like no matter how hard you try, you haven't accomplished anything. The second shift tech came in at 3:30 and helped out, and I stayed over an hour late. Finally I asked a pharmacist to take over so I could leave.

When making IV's, one thing that's very important is that no foreign objects or particles somehow get into the drug. One way this can happen is when you "core" a vial. Sometimes a small piece of the rubber stopper of a vial is sheared off as the needle passes through. These pieces can be very tiny and almost unnoticeable. The pharmacist who checks the final product may not see it. At two different times today I happened to notice a vial had been cored. Once it was after 200 milliliters of propofol had been injected into a bag. The way to fix this problem is to drain the entire contents through a filter needle. A drug flows very slowly through a filter needle and in the time it takes I could've probably made a whole new bag. Very likely I could have let it go and the pharmacist wouldn't have seen it. You simply cannot cut corners when a patient's safety is at risk, though.

Thankfully I'm off tomorrow so the weekend stress can be forgotten by the time I go back to work on Tuesday!

of drugs and dying

Things continue to be much the same with the COVID situation at work. Our IV room has experienced a huge surge in the amount of stat IV's made, and at times can hardly keep up with the demand for sedatives for vented patients. To make one bag of fentanyl, for example, nine 2 mL vials have to be opened and punctured. Just taking a guess, we probably make at least 25 bags in an 8 hour shift.

This is the type of vial we are currently using. Before the cap can be snapped off, the perforated top part of the wrapper has to be peeled off. Those little details are time consuming and slow down the process. The clean room workers appreciate when the ante room tech peels the stickers off before sending the drug back. Today I was the ante room tech, and at one time I peeled off the stickers on 108 vials to make 12 bags of fentanyl.

This is another type of vial, called an ampule, we had. They are also time-consuming to open and draw the drug from. The ampule is glass and since the tops are snapped off, there is potential for glass shards to be in the drug. We use a filter needle, which traps particles, when drawing out of an ampule. The needle is then changed before injecting the drug into an IV bag.

In the last week we've had several patients who work at the same local facility admitted with COVID. This is alarming and shows what can happen in workplaces once someone gets the virus. One of those patients, who was only 58, passed away today. Hearing that saddens everyone. We prepared many IV's for her in the short time she spent in critical care. I have full confidence in the elderly pulmonologist who is the intensivist (doctor who provides care for critical patients). I've seen respiratory therapists and nurses doing their jobs with their best ability. Yet all that effort can't save a life. There's another patient in critical care (employed by the same company) who is only 38 and in very grave condition. You can tell once certain drugs are being used that an all-out effort is being made to keep someone's body from shutting down. For example, when someone's kidneys are failing, they might be put on CRRT (continuous renal replacement therapy) a type of 24 hour dialysis which does the work of the kidneys. I can't remember anyone who recovered after being on CRRT.

The tone of this blog has been negative and I don't want it to end that way so I'll mention some more uplifting events. These things brighten a work atmosphere!

• Seeing a brand new baby on a trip to the birthing center
• Same baby announcing a set of strong, healthy lungs to anyone within earshot 
• Helping a patient get their meds quickly
• "Thank you" from a tired, hardworking nurse 
• Support from the community in the form of drive by's, donations, and food for healthcare workers

a glimmer of light

In the blog I wrote on New Year's Eve I felt excited about 2020. It seemed like a year full of possibilities and experiences waiting to be lived. Now, four months into this new decade, we've experienced things we never would've imagined! You can look at it as a disaster or an adventure to be living in a year that will be written about in the history books.

In the last few weeks the numbers of sick people in our hospital have continued to rise. It appears we may have already reached the peak of the curve. If you're interested, here's a tracker that is updated daily on COVID-19 statistics for St. Joe's and Hershey Medical Centers. St. Joe's is one-fifth the size of Hershey but has experienced the majority of cases. Unfortunately we've had 5 deaths and it looks like that number will continue to rise based on how many patients we have on ventilators in critical care. On the bright side, we are discharging people every day. When a COVID patient leaves, it's announced over the loudspeakers and a bit of music is played to celebrate another recovery! 

It's been interesting seeing what drugs are given to positive patients. We are using the anti-malarial drug hydroxychloroquine, even though it's still being studied to see if it's actually effective for this virus. Vitamin C and zinc are flying off the shelves, and the antibiotic azithromycin is also very popular. Albuterol inhalers are in high demand as well. For ventilated patients, we're making hundreds of fentanyl and propofol drips.

Some caregivers have gotten sick from the virus, but so far everyone in the pharmacy has stayed well. We've all been practicing precautions, but from what I've observed, some of my coworkers are much more obsessed with it than I am. I haven't been washing my clothes as soon as I get home or otherwise doing anything out of the ordinary. I'm pretty convinced I already had the virus back in February when I was sick for 2 weeks and off work for a week. My symptoms were very similar, and I really haven't worried about getting sick again.

Yesterday it was announced that Reading Hospital furloughed 1,000 employees. St. Joe's is also experiencing financial stress since overall admissions have been lower in the last few months due to the quarantine and the additional cost of caring for COVID patients. Who knows what ramifications this pandemic will cause. I'm just glad I don't have to worry about figuring out where to cut costs. We've all been told to conserve and only order necessary supplies, volunteer to take time off, and work no overtime. 

It seems like we might be seeing the light at the end of the tunnel. Until then, everyone keeps plugging along.

carry on

I think most everyone is tired of hearing about COVID-19 by now. We've become more adjusted to the "new normal" and if you're staying at home and avoiding the news, you could probably forget about it! That's not my situation though, and it's very much at the forefront when I go to work.

We've seen a surge of sick people in the last week and hospital leaders say we haven't reached the peak yet. The units that were set aside for COVID-19 patients are nearly full, and if cases continue to rise as predicted, another unused area of the hospital will be opened. Since the OR is only doing emergency cases, nurses from the areas associated with surgery are being deployed to assist with patient care. Every time I have to deliver meds to an area where the COVID patients are housed, I want to stop and just take it all in! It's fascinating to see history in the making.

I'll try to describe the scene when I walk into the critical care unit. This is where the very sickest COVID patients are located; there's another whole floor elsewhere of more stable patients. Many of those in CCU are on ventilators, which means they're getting dozens of IV meds. The IV poles are kept outside the patient's room in the hallway, so that the nurses can access those meds without going into the room. Hallways are cluttered with equipment and people in sterile scrubs, masks, and goggles. Nurses in patient rooms communicate with those outside by writing messages on the glass door. It looks like a disaster zone.

These images are from Google, but very similar to what I see at work.

Ventilated patients go through an
astonishing amount of sedatives like propofol (that's what Michael Jackson overdosed on), narcotics like fentanyl and dilaudid, and paralyzing agents such as precedex and nimbex. We are kept busy in the pharmacy getting those drugs made and trying to send them in a timely fashion. Sometimes the nurses let something run dry, then they call us in a panic requesting another bag. If it's something we have to make, it can take a couple minutes, which to them seems much longer! We sometimes get multiple calls while the drug is being made. We do our best but unfortunately the pharmacy is usually too slow for the nurses. Since I worked on a nursing unit before, I've seen it from both sides and can sympathize with nursing and the pharmacy! Many of the drugs that are being used to treat COVID are on shortage, specifically the paralytics. Backup plans and drugs are being investigated, and we try to not waste what we have. Too often patients end up dying (not necessarily COVID patients, but any vented person) after being given high doses of these drugs for several days and it feels like those scarce meds were used for nothing.

IV pole with multiple drips, similar to
those outside COVID patients' rooms 

The general atmosphere at work feels somber. It doesn't help that everyone wears a mask and you can't see smiles and facial expressions. That in itself can be dispiriting. The ear loop masks make your ears hurt after wearing them awhile, and if you wear glasses they're constantly fogging up. I've seen some innovative ways of getting around the ear pain by attaching the loops to buttons on a headband, or using paper clips to hold the loops together and put around your neck instead. I've tried some of those ideas myself, but haven't found anything too satisfactory.

On the bright side, Godiva donated chocolate to Penn State Health workers and we all got to enjoy something delicious! It's wonderful to see the community helping to support those on the front lines.

Earlier this year I requested four days off over this weekend, and it's proving to be just the right time for a break. Even though it won't be an Easter for getting together with family and friends, this too shall pass and we'll look back and say, "Remember when we couldn't go to church on Easter Sunday?" Hopefully we'll be more thankful for the simple things we all took for granted when this is over!