hurt, vulnerability, and love

I'm afraid this post is going to be a tough one. Usually there has to be some kind of inspiration before I write. Sometimes the words come flying out and other times it's a struggle because of how personal the inspiration is and how vulnerable I become when I share it. That vulnerability is especially hard because I try to lock up and forget past hurts. Along with that I'm determined to never allow myself to get in a position of being hurt again. The downside is that resolve makes me a numb, hard, uncaring person who doesn't want to get too close to anybody. I become even more walled in and bitter. It happens gradually without notice, then one day I realize what I've become. Now I have a choice  - continue with a cold, proud heart immune to hurt and become someone I never wanted to be, or let the ugliness out and be healed, realizing that will again make me vulnerable to hurt.

Love. Such a beautiful word, but so difficult to understand. This week, 1 John 4:8 was part of my reading. "He that loveth not knoweth not God." No question. Just the plain, easy-to-understand truth. And it describes me. I don't fully understand why or how I became that person, and maybe don't need to figure that out. But now that I know I'm one who "loveth not", what should I do about it? There's no chance of remedying it on my own. I'm defeated before I even try. That leaves one answer - only from God. With my own determination there's no way I could like, never mind LOVE, that coworker I can't stand. And in all reality, I probably never will like him. But despising, avoiding, and talking unkindly about him is certainly not Godly love. 

So that's the real, ugly truth. Satan is trying to tell me I'm a hypocrite for saying these things, because it sounds righteous and preachy and I fall so far short. My proud, selfish nature is always going to be there. But by God's grace, I won't be that miserable, unhappy, uncaring person whom I never wanted to be. 

adventures fill your soul

Taking time off and getting away from the daily routine of work and home life almost always refreshes me. I feel new inspiration and can somehow see the big picture better when I take a step away. Home is still the best - there's no other place where I feel as comfortable - but traveling is important to expand the edges of our world. 

This past week was the time we were planning to go to Ireland, but those plans were smashed because of the pandemic. I still hope to go someday, but for now I'll continue to dream. Half the fun is in planning and looking forward to a trip, anyway! Instead of Ireland, we went to Tennessee, where we spent a few days with Shelby & Kait and two nights in the Smoky Mountains on the way home.

I have visited only a few national parks, but consider them one of the best places to travel. There's nothing like seeing the vast Grand Canyon for the first time, or the rolling peaks shrouded in mist of the Great Smoky Mountains. We go to the Smokies as often as we can, and this year we were fortunate enough to visit twice! Cade's Cove, a picturesque valley nestled in the mountains, has always charmed me. The carefully preserved log homes, churches, and a mill from bygone days can be visited while driving along an 11 mile loop, which we've done several times. 

We wanted to bike the loop this time, and made it a priority on our trip. Experiencing it that way added another dimension of awe. I'm easily moved by emotion, and feeling the atmosphere of Cade's Cove on a closer level than riding in a car was exhilarating. The bike ride was tougher than I expected, but so worth it! 

Stories about events and curious happenings in national parks always interest me. I've collected several books from my visits, and this time I bought Into the Mist - tales of death and disaster in Smoky Mountains National Park. Another favorite of mine is Over the Edge: Death In Grand Canyon. This book is down the same line and is very interesting so far. 

I saw a children's book about national parks called You Are Home at a shop we visited and loved the illustrations and poetry. I added it to my collection also.

Going back to work and daily life after time away is sometimes discouraging. I like this quote, "Jobs fill your pocket. Adventures fill your soul." 

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.

Summer Prose

She said, "Summer is overrated."

And I thought

Well.

Fall is beautiful too

But each year

I

Fall

A little more in love

With summer.

Summer

When the sun shines hottest 

Is when I feel the most alive

And 

My exuberance 

Tries to express itself

In a poem

That doesn't rhyme.

In August

The Sunday of summer

I feel the end

Is coming too soon.

And

I want to spend

More time

In the sunshine.

Nurture my flowers

Soak in 

The colors

And sounds 

of summer.

More time

Away from work

Slow down

Take a walk

Go to the mountains

Ride bike

Visit the lake

Sit on the deck

Go out for ice cream.

There is beauty

In every season

And I 

Enjoy them all.

But

Summer

Is never long enough

For me.

Hudson River weekend 2020

Last weekend we took our annual summer trip to the Hudson River Valley. I blogged about our trip last year here and wasn't sure I would give a report again, but several people have asked about it. 

We love going to this area of New York because it's only a 2 - 3 hour drive from here (depending where you stay) and it's beautiful natural scenery. The towns are really not that great... kind of run-down and old. This time we stayed in a basement apartment in Newburgh that I booked through Airbnb. The place was very nice but in a super sketchy part of town. I would not have felt safe being out at night on that street! Loud music, groups of people congregating on front porches and sidewalks, abandoned buildings, graffiti... get the picture? While I'm writing on accommodations, I will recommend a place we stayed at the first time we went to the area. The Gilmor Sloane House in Stony Point is an 1856 Victorian mansion with 11 bedrooms each uniquely decorated with antique furniture. It was an interesting place to stay! I couldn't find a place to book online; I think you have to call for reservations. Here's a link to the website. 

We like the Stony Point area best of all the places we've stayed. Once again we partook of burgers and fries at The Filling Station in Haverstraw and went to the Stony Point lighthouse for a lazy afternoon taking in the view.

The Filling Station - amazing burgers and fries!

Stony Point lighthouse is located at the Stony Point Battlefield historic site.

Earlier this summer we each bought a bike and have been rediscovering how much fun it is to ride! We got a carrier for the car and are now officially bike-toting Subaru drivers. 😊 They rode along to New York with us and we decided to bike the Walkway Over the Hudson in Poughkeepsie. 

Walkway Over the Hudson 

We've been on the Walkway before and it's impressive every time. There's a paved trail on an old railroad bed extending several miles from either side of the bridge. We rode over the bridge a couple times and took the trail on both sides for a total of 20 miles (not the whole length of the trail - we didn't reach the end). It was fantastic! The trail is flat, easy riding. It was a warm, sunny day perfect for feeling the wind as we rode. Sometimes I have the urge to ride fast and it's thrilling to zip along, feeling like a kid again. The bike ride was definitely the highlight of this trip and I highly recommend it to anyone who enjoys that sort of thing.

I think we might make it a tradition to take a similar trip every year for our anniversary. We've always gone in the summer, but I'm sure fall would be wonderful too. I'm already looking forward to next time!

winds of confusion, lessons from a tree

Is anyone else completely confused about life these days? Has there ever been a time before when so much conflicting information is being shared? How can a tiny germ cause such chaos, but more important issues are ignored? I have no answers and don't know what is truth anymore. News articles are published every day with one site stating a "fact" while another site states a "fact" that is the polar opposite. I don't spend a lot of time reading the news but skim headlines and hear other people's conversations. It seems like conspiracy theories, which I automatically mistrust, are everywhere, and I've finally concluded you can't believe anything. You can call me cynical, I know I am. Thank God this is not my permanent country! Unfortunately I can't bury my head in the sand, though. Somehow we have to cope with these accusations, recommendations, theories, movements, divisions, and riots that are swirling like dark clouds around us.

Maybe the reason this is on my mind is because I went back to work today after a two week quarantine due to a member of our household who was COVID positive. Cooking, cleaning, working outside, and being a homemaker was such a simple life. I never got bored, although I did get tired of cooking! Now I'm back to wearing a mask for 8 hours and following hospital regulations. I hugged a coworker and got reprimanded. (COVID! Social distance!) Another coworker still gets on my nerves. While driving to work this morning I purposed to be tolerant and kind. Unsuccessful. After two weeks of being around people who don't make a big deal out of COVID, going back to the high alert level of healthcare was kind of exhausting. On the bright side, more than one person told me I was missed and they were so glad to have me back. Maybe I am needed more than I realize! I need to focus on doing my small part instead of the restrictions and unpleasantness. 

Last week we went to Ohio to be with Chad and Keela and kiddos for a couple days. It was one of those spur of the moment decisions... I was quarantined and Cliff could get off, so we went! We spent part of a day at Lake Erie and I keep remembering something we saw there. The coastline is rocky, but at one place where we walked along, trees were growing in the boulders. At some places the roots were exposed on top of the rocks, then there were cracks and crevices where the roots snaked down to the water. I think there's life lessons to be learned from that. Overcoming obstacles, thriving in adverse circumstances, and staying strong when heavy winds are blowing were some of the inspirations that came to me. That's what I want to focus on instead of the turmoil around us!

still waters run deep

I've been asking myself a question in regards to this blog and haven't figured out an answer. 

Recently I was told (again) that I live a life that's "all about me" and I know it's true. It seems so repugnant to be that kind of person. I haven't yet found a way out and feel this is just part of the journey I'm on right now. In taking stock of everything I do that is self-centered, I've wondered about this blog. It truly IS all about me. Yet some have mentioned it's a way of giving myself to others by sharing my life and thoughts. Writing is the easiest way for me to communicate, and maybe this is how I can connect with people. The downside is that I write things I'd probably never say, thereby opening myself to criticism. As a side note, I do appreciate constructive criticism and know I need to learn how to better handle all types of criticism/reproof. 

Maybe one of the reasons I find it hard to talk is because I have low tolerance for "fluff" but it seems you need a certain amount of it to carry on a conversation. When I write, I can talk about "real" things and be honest with my thoughts. I love it when people are real and aren't just putting out a culturally acceptable version of themselves. The above quote and title of this blog reflect my thoughts down that line. But where is the balance between accepting who you are and trying to blend in? 

Since writing is how I process my thoughts and feelings, maybe I should do it solely for my own benefit and stop blogging. I'm not necessarily looking for input, just stating my thoughts so others will understand if I decide to permanently delete this.

this summer evening

It doesn't get any better than this: sitting on my deck as the sun goes down, watching fireflies and listening to the birds. The air is warm, the flowers are brilliant, and it's complete contentment. How I love summer evenings! If I had to choose one favorite out of all the above, I'd pick the fireflies. Watching hundreds of them rise flickering above the grass is so lovely!

Working inside a windowless, sterile environment is a trial I resent in the summer. Since I'm also taking some online college courses, most of my non-work time is occupied studying. I was going to work on some assignments just now, but stepped outside and realized how lovely it was and decided it would do my soul good to just sit on the deck and write. 

I have been enjoying studying, although I'm realizing it's not as easy to learn when your brain is 35 years old! I'm taking biology this summer and plan to take several more classes in the fall semester. I don't have a definite plan, but for now I want to build up health sciences credits that will be useful if I decide to go to pharmacy school or any other healthcare field. Nothing will happen fast since I plan to keep working full time.

It's certainly been a stay at home summer, but that's fine with me! I honestly can't remember when the last time was that we traveled outside of the state (or maybe even the county!). Tonight we actually WENT TO A RESTAURANT AND DINED IN! That hasn't happened in at least four months. We want to do our usual summer Hudson River Valley trip over a weekend in August. I don't have to leave home to take a mini vacation, though. When sitting on my own deck on a summer evening is the best place to be, life is good!

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. 

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!