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!

mounting pressure

When I last wrote I was feeling quite positive about coping with the pandemic we're experiencing. Although I'm not worried or afraid overall, the strain at work has intensified. Last week everything seemed to be going smoothly, but by the weekend the atmosphere had become much more stressful. While working Saturday and Sunday I got outside of the pharmacy more than usual since I wasn't scheduled to make IV's. I felt the tension in the air when I made deliveries to areas where suspected virus patients are taken care of. The nurses seemed harried and short-tempered. I had a hostile interaction with one nurse in particular who was demanding meds. Sometimes I think the nurses don't realize the pharmacy serves the whole hospital at once and their requests aren't always as important as others.

While making deliveries this weekend I saw some very sick people. I wonder if they have worried family members who are unable to visit? I've been reading stories of people who can't be with their dying loved ones during this time. It's hard to imagine how painful that would be. But it's also true that far too many people die alone during normal times.

The turnaround time for COVID-19 testing is at 10 days now because labs are so overrun with specimens. Hopefully a more rapid method will be developed soon. This is just another reminder of how relatively new this strain of coronavirus is. Personally I am very skeptical of those who claim drug X is the cure or treating with X method is the answer. Enough time will show the truth, but right now all these drugs and methods are not proven. Touting their supposed benefit is a little premature.

As of today, employees are required to wear a mask in the hospital at all times. We are supposed to use the mask for 7 days to conserve supply. It's no fun to wear it for 8 hours a day, but I'm thankful our leadership is trying to protect us. Doctors and nurses are undergoing much more cumbersome garbing to take care of patients. Those who provide direct care are real heroes. I found out Wawa is giving free coffee to healthcare workers, which is wonderful! Little gestures like that mean a lot.

I pass a Harley Davidson store when I stop at Wawa for my coffee, and their sign says. "This sucks! Screw it. Ride on!" A little cloud of darkness comes across my day when I see it. I decided to leave an anonymous message saying I don't appreciate their sign. It doesn't give a good feeling and we need positivity during this time. If there's others who feel the same, maybe you can encourage them to change it also!

I'm on day 5 of a 7 day work schedule and definitely feeling the need for a break. It's nice to be needed, but it's also important to get away and refocus.

Every now and then the funny side of all this strikes me. Today when I looked around and saw everyone wearing a mask looking like beaked aliens, I wanted to laugh! Let's not get caught up in fear and gloom over this pandemic. Take precautions and follow the rules, then look for things to spark joy!

another week down

Well, we've definitely been seeing the uphill part of the COVID-19 curve here in Berks County this week.

According to numbers taken from the PA Department of Health website, 90% of people who get tested are negative, even though overall numbers are rising. This is proving true at work. Patients who are suspected of having the virus are put in isolation as if they are positive until their test results come back. The vast majority end up not having it. And some who were positive never had to be admitted.

In the midst of all this, we are surprisingly not that busy. The overall hospital census is down quite a bit from usual. The pharmacy director has called off one pharmacist every day this week, and we techs were strictly told "no overtime!"

I visited the quarantined area of the hospital and it looked as if everything was running like a well-oiled machine. It's amazing how much donning and doffing of PPE, hand washing, and coordination between nurses has to go into the care of one patient who is only presumed to be positive.

Beginning Monday, all employees have to get their temperature taken when coming in to work. As of today, our county is under a "stay at home" order, so hospital workers were given a letter to carry with us stating we are an essential employee.

There are some wonderful things to come about because of the quarantine. Roads are wide open and I've cut almost 10 minutes off my daily commute. More people are spending time outdoors. Life has finally slowed down like we said we wished it would. Teachers are becoming even more appreciated (I hope! 😄)

Besides, how can you be blue when all nature is ringing with spring?! With robins chirping early in the morning and spring peepers providing lovely music at night, bright yellow forsythia, daffodils, hyacinths, and pansies blooming their hearts out... feast your eyes and fill your lungs with the delicious clean air and everything starts looking up!

this week in the hospital

This has been a most unusual week, yet I feel lucky that my daily life is much the same. The most outstanding change has been all the new policies and procedures put into place at work. Maybe some of you would find it interesting to hear what hospitals are doing to prepare for a pandemic.

One of the first changes to take place was limiting visitors to 1 per patient (2 for pediatrics). Then the main hospital doors were locked and all patients and visitors had to go through a screening to get inside the building. A tent was set up at the ER entrance and those who showed symptoms like fever or shortness of breath were taken aside for further examination. Early in the week a new employee travel policy was put in place. One of the things it stated was if you had traveled to an amusement park, been on a cruise, or in one of the areas with a high incidence of COVID-19, you would be quarantined for 14 days. This applied to one of my coworkers, who had been to Disney the week before and already come back to work. She's perfectly fine and has no symptoms, but has to stay home until 14 days past the date of her return. Since she had come back to work before this new policy took effect, those who were in close daily contact with her have to wear a mask and take their temperature twice a day. The travel policy is very restrictive. Basically you can't travel outside of the state without notifying your manager.

Leaders were encouraged to give access to their staff for working remotely. Management is working on getting some of our pharmacists set up to work from home. Since we technicians do the actual hands-on part of the job, that's not a possibility for us.

Some very noticeable changes were happening in the cafeteria. Tables were cleared of salt and pepper and ketchup bottles and we're now using packets. We're no longer allowed to serve ourselves at the salad bar or help ourself to bagels, etc. Personal drink cups are not allowed; to get coffee, water, or ice you have to use a single use cup. We can use our badges to pay for food, but the cashier can no longer swipe them for us. Half of the tables and chairs were removed to allow for social distancing. Employees are encouraged to not eat in the cafeteria since it's considered a public area.

By the middle of the week, all non-essential surgeries were called off. Later this week the gift shop was closed and a "no visitor" policy was enacted with exceptions for labor and delivery, pediatrics, and end of life.

Drive-through testing is offered in the parking lot from 8 am to 4:30 pm. This prevents potentially sick patients from entering the hospital. You must have a doctor's order to get the test done.

Our leaders are doing an excellent job preparing for a potential influx of patients and trying to protect employees from exposure. Even though many changes are happening, the atmosphere is calm and people are going about their jobs as usual. It's actually been less busy than normal since people are staying home and surgeries are cancelled.

Maybe with all the strict guidelines the government has put in place we'll weather the COVID-19 crisis without much disaster. That is the point of isolation and precaution, after all. I know some people might find the quarantine frustrating and boring, but this too shall pass! And it may pass sooner if we all take it seriously. However, there is no need to panic. Now is the time to put our belief into practice and trust that God will take care of us. And with spring arriving early, it's a great time to get outdoors and work on those projects we've been putting off! Here's a quote I often think of and agree with 100%. There's no reason to be bored in a world as wonderful as this!

One last plea: if you are healthy and able to donate blood, please consider doing it. Many blood drives have been cancelled and inventory is low. It is estimated the nation has only a 2 day supply presently. I believe blood donation centers remain open. Google "blood donation near me" to find a location.

the world turned upside down

According to legend, the British army sang "The World Turned Upside Down" when they surrendered to General Washington at Yorktown in 1781. Each stanza of the song ends with Yet let's be content, and the times lament, you see the world turn'd upside down.

Has COVID-19 turned our world upside down? If you've gone grocery shopping or read any news this week, it looks like people are preparing for the apocalypse. Personally, I just can't get worried about it. It is necessary to take precautions (hand washing, hand washing, hand washing!) but healthy people shouldn't fear this virus. As with the flu, it's the elderly and immunocompromised who are at the greatest risk. For a little perspective, look at these facts: the CDC estimates 22,000 people have died from the flu this season, and so far there's been around 40 deaths in the United States from COVID-19.

At work, all our masks have been locked up in the safe. We use masks, gowns, gloves, and sterile alcohol on a daily basis for compounding sterile products. We have enough supply for a limited time, but are having a hard time getting more of these necessary supplies. The hospital has established a command center and town hall meetings are being held. In the event we have cases of COVID-19, an empty wing of the hospital has been set aside to keep those patients in isolation. Even though we are taking all precautions, I haven't seen anyone become panicked about the situation.

I keep thinking this feels like the end of the world. I have seen nothing like this in my short life (with the possible exception of Y2K). It makes me wonder, would all this preparation be happening if it was announced Jesus will return sometime next week? Somehow I think not.

Avoiding media, if possible, would be a good idea. Making lists of things we are thankful for, playing with children, cuddling a baby, or taking a walk in the fresh air are all ways to lessen the tension. Most of all,

STAY CALM

WASH YOUR HANDS