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!

pros and cons

In my last post I mentioned feeling discontented with my job and experiencing nostalgia for teaching. It caught me by surprise because I thought I had finally put that to rest and no longer missed teaching. Sometimes I wonder why I can't be more settled with where I'm at in life. I know I sound unstable and wishy-washy. I'd like to be more steady and anchored, but don't believe in trying to be something I'm not. Being fake is too exhausting. At 35 years old, I still don't know what I want to be when I grow up! Part of me would like to settle down and stick with one thing, but the other part of me sees so many opportunities and begins to question if I want to stay in the same place. I'm also realizing how quickly time moves on and how soon we age. Am I using my time in the best way possible, or will I look back in 20 years and say "I should have taken that opportunity!"? This quote has been an inspiration to me many times, although I don't know exactly what it means for me.

What are the bowlines keeping me in the safe harbor? Could the safe harbor actually be the place I should stay? So many conflicting thoughts leave me feeling a little topsy-turvy. In an attempt to make sense of it all, I decided to make a list of pros and cons of being a teacher versus pros and cons of my current job. It helped to see it spelled out, but didn't completely clear it up. Here's a condensed version of that list. The items are not listed in order of importance.

Teaching: Pros

• Challenging and rewarding
• Involvement with church people, co-teachers
• Teaching subjects that inspire me
• Always opportunity to gain expertise
• Scheduled time off, summer vacation
• Exposure to the outdoors, not confined 
• Dress up, wear nice things
• Decorating a classroom
• Time moves quickly
• Introduce children to wonders in history, science, books, etc. That excited look when they learn something interesting.

Teaching: Cons

• Constant scrutiny
• Criticism
• Weight of responsibility
• Enforce rules, discipline
• Never done at work, work follows me home
• Difficult situations with students or parents
• Not financially compensated on the same level as effort put in
• Poor work/life balance

Pharmacy: Pros

• Work can be left at work
• Steady income, affordable health insurance
• Challenging
• Being a part of the medical field
• Time to read, write, do puzzle, and other hobbies
• Work/life balance
• Feel appreciated, valuable as an employee 

Pharmacy: Cons

• Little involvement with church people
• No routine schedule 
• Mandatory weekends, evenings, nights, holidays
• Rules, regulations, policies
• No exposure to the outdoors - work in a confined area
• Difficult co-workers, managers

I'm pretty certain I know what the "safe harbor" is and what makes the most financial sense by considering these points. Is work/life balance more important than being involved with my church family? I know there will never be a "perfect" job and every situation has advantages and disadvantages. I can accept my present job and it's not like I have to make a decision between the two. So unless some other door opens, I'll keep plugging away!

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.

A collection of living

Writing inspiration has been scarce the last while. It seems like I only wrote about work for the last four months and I thought it might be getting monotonous. My job is a major part of my life though, so it will probably continue to come up.

At the end of May I had a week of vacation at home. It was so wonderful to not have a schedule or any place to go! By the end of vacation, I was ready to quit my job and stay at home. However, working does bring a sense of satisfaction and expands my life. I've felt more appreciated at my job the last three years than any other job I've had. Pharmacy seems to be a good fit for me, although I'm still wondering if I want to stay in the same position for the rest of my career. 

During the week I was off I spent a lot of time working in my flower gardens. Digging up rocks for flower bed edging, mulching, and fertilizing plants in the warm sun was just what I needed after weeks of mask-wearing and being around sick people. I got a recipe from a friend for a most delicious drink that hit the spot on those hot days. The recipe comes from Southern Living. If you like tart, sweet, slightly fermented drinks, you'll probably enjoy this raspberry shrub. 

Here's my take on a book I read recently. Station Eleven by Emily St. John Mandel is a work of speculative fiction about a flu-like plague that wipes out most of humanity. Some of the language used, like quarantine and unprecedented, was eerily like the times we've been living in. In the book, the world as we know it quickly becomes obsolete. Survivors rely on horses for transportation and hunt deer for food. People die from infected cuts and easily treatable diseases because there are no doctors or medicine. If you are a fearful person who worries about things like this happening, reading Station Eleven is probably not a good idea. Others I know would enjoy this book.

Since I can't seem to blog without mentioning my job, here's what's been going on at work. Our COVID numbers have steadily dropped off over the last few weeks. Now we're down to 3 or 4 positive patients, surgeries have resumed, and we're trying to get back to normal as much as possible. We still get our temperature taken every time we come to work and wear masks at all times. I think some of the changes we've seen because of COVID are here to stay, and we might never go back to life exactly how we knew it. It's likely there will be waves of this virus in the foreseeable future, and maybe times of quarantine again. Not to sound negative, but if we accept that's the way it will likely be, it might be easier to adapt.

Changes are happening in the pharmacy, too. A construction project has been in the works for the last several years, and after many delays, it finally started. The project has taken away our IV room and a large chunk of pharmacy space, and we all try to work around loud noise and blocked off areas. Our director and manager spent a huge amount of time figuring out how to operate in these circumstances. A space that was an office has been turned into a segregated compounding area, where we have a two foot hood to make any IV's that have to be made on demand or can't be ordered pre-made. There is also a fairly large freezer in this small space which stores all the IV's we normally batch but are now getting frozen pre-mixed. It puts off quite a lot of heat, combining with little ventilation and full sterile garb to create a toasty, slightly claustrophobic situation. There is a fully garbed person in the segregated compounding area (SCA) from approximately 5:00 am - 3:30 pm. I've been spending around four hours a day in there. After a whole week of that, I was SO ready for the weekend! I've had the luxury of more than one nap today, 😊 even though there's much I could be doing around the house. 

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!

telling the truth

Tonight I'm "living the dream." At home on a Friday night sitting by a warm crackling fire, with the choice to read, set puzzle, or blog. Nothing could be more comfortable for an introvert.

Life has been fairly uneventful the past few weeks, which is actually a blessing, but doesn't generate much writing inspiration. Something did happen today that I thought I'd write about. To tell what happened, I first need to give some background information.

We pharmacy technicians are scheduled to do a nursing unit review once a month. Each tech has a specific area assigned to them with a checklist of tasks. Every nursing floor has two medication rooms and a supply room. Most of the nursing unit review is focused on these areas. Supply rooms have hundreds of items, such as lab tubes, IV supplies, toiletries, dressings and bandages, and other nursing necessities. Medication rooms each have a Pyxis machine where drugs are dispensed and cabinets stocked with supplies used for giving meds, such as needles and syringes. We go through all these items, looking for any expired products. The Pyxis machine needs to be cleaned and code carts opened and searched for expired items. We also randomly check approximately 4 patients to make sure IV tubings are tagged properly and antibiotics and other drugs given on time. 

The nursing unit assigned to me is one of the smaller ones, so I volunteered to take on another one when someone recently quit. February was the first time I did the new unit, and it took me quite a long time since it's one of the messiest and I did some extra cleaning. We are only scheduled one day to do our review, so I ended up getting only one of my two nursing units done. Today our lead technician asked me if I had done my second unit, and when I told her I hadn't, she said, "We're just going to make it look like you did and fill out the paper." When she brought me the paper to sign I said I couldn't do that because I felt like it was lying. By her reaction, I couldn't quite tell what she was thinking but it seemed she was slightly disgusted. She said, "Can you do it today then? How long do you think it will take?" It was around 11:30, I hadn't had lunch yet, and was only working till 3:30.  I told her I could probably do it 1-2 hours, and thankfully there were enough other techs working that someone could take over what I was doing in the pharmacy. 

I didn't have much time to think of how to respond in this situation, and it was my superior asking me to falsify information, so I wasn't quite sure at first what to do. When she wanted me to sign the paper though, it became quite clear to me I couldn't go along with it. There's been other times when I wondered if I had been completely honest, or just being tormented with doubt. I'm glad it was so obviously wrong to me this time.