First day of school

My emotions are all over the place today. I desperately needed some time in my house, without my fabulous but sometimes a little smothering, children. I don’t use the word “desperately” mildly. At the same time, I feel like I’m sending my children into battle. The enemy, a tiny microscopic set of nucleic acids disguised as obnoxious, ignorant, and often petulant flag waving deniers who care more about their “freedoms” than health and the science that we know works. I did not send them into battle unarmed though.

Double masked, goggled, and sporting sanitizer, my kids have the privilege of being vaccinated and highly knowledgeable about everything that we know will protect them. I just hope that it is enough.

Military State

This morning as I arrived at work, I was literally greeted my an Army National Guard in full fatigues. The significance of his presence was not lost on me. It means that we are loosing the war. It means that my six months of extra shifts to administer COVID vaccines, failed to protect lives and end this thing. It means that my day will be more exhausting and my family more endangered just because they are my family. It means that more lives are being lost and forever changed by a virus that we could have stopped. COVID 19, today, is a PREVENTABLE disease.
My eyes welled up as I rode the tram up. Not going to lie about how this moment made me feel. It hurts in so many ways.
I feel like I’ve seen this movie, I can’t really believe that we are at this part. What next?
I haven’t asked in a while, but please, can you take your loved ones and go get vaccinated? If not for me and all my fellow health caregivers, then for our children who can’t yet?

1Year Ago

A year ago yesterday was the last time that my kids spent a day in a classroom. For them, this was the beginning of this nightmare. COVID 19 became a real part of their vocabulary. Life as they knew it completely changed. I could count on my two hands the number of times since then that the kids have left our home.

The prospect of beginning in person hybrid learning next month comes with fair amount of anxiety for them. It’s not quite like I think you might imagine it to be. The kids have finally found a place where they know what to expect from CDL and they have a routine. The idea that we should uproot all of that now, when the end of the school year is just two months away, is not being met with welcome arms from anyone in our home. Our school district has been pretty tight lipped about what to expect from this “hybrid learning” too. What we learned just a few days ago is that they will go either Monday and Tuesday or Thursday and Friday from 8:45 to 11:45, and then are expected to complete those days in CDL. The logistics of figuring out how to get them there and home alone is pretty ridiculous. We have decided that we will drive Ava, Liv and Tay who all attend the same school now. In theory they will be in the same “cohort” having in-person learning on the same days of the week. Wes will have to take his bus. We thought there was low risk here since he already takes a special bus for kids with special needs. But this means that Wes will be on a bus for at least 60 minutes, probably more depending on how many stops the bus has. All for a 180 minute school day. I have a lot of reservations about this plan. It seems pretty ridiculous to me at this point.

Jon calculated it out, with hybrid learning starting on April 12th, our kids will have a maximum of 16 days of school for the whole year. At three hours a day, well that is 48 hours in class and 16 hours on a bus.

As I reflect on this last year, I am still in shock by how little we now “know”. It feels like so many big questions still hang around every corner. I spend my weekends “off” volunteering my time at the airport mass vaccine clinic. I think I vaccinate about 12 patients an hour give or take. At that average, I vaccinate about 50 people every shift. So far, I have completed 5 shifts, so 250 patients. I feel really good about that. I had one known “moderate exposure”, where I cared for a patient without sufficient PPE due to PPE shortage and inadequate recommendations. It happened on April 3rd. I was so angry about it. It was my second shift back to work after my medical leave. I spent my whole leave worrying about how I would protect myself (and more importantly my family) from this horrible new virus. So part of me was angry that I wasn’t successful, but more was angry that compromises were being made by the health care industry. My safety was calculated against predictions about what might come and how much PPE supply was available. This was clear early on, but with the CDC under what amounted to gag orders by 45, technically speaking, the hospital was protected under the context of “following guidance”.

Most of the last year, I have spent feeling angry. First at the hospital for keeping PPE from me while I came to work every day exposing myself and my family to whatever might have been there. Then at people around who ignored social distancing and masking, and at 45 who spewed out so much shit information that emboldened those who ignored recommendations, slowed our understanding of the virus and its spread, literally spread it with their ridiculous rallies, and I could go on. At least now, I feel like my small role in vaccinating approximately 250 Oregonians, is something moving towards beating this virus. I’m finally doing something to fight back. Not that I haven’t been doing so all the long. I have shared information that I found reputable and trustworthy, I have led by example, and I have treated many patients in hospital with known COVID infection. Not to mention that I voted that a*******e out of office. I have been fighting for the better part of year, and combating misinformation. But only now do I feel a little bit like its working.

Calmness Whispers

This afternoon (on my coast anyway) I tuned in as the President and the Vice President commemorated the lives this country has lost to COVID 19. The tears that rolled down my face were my body’s way of releasing the toxins of the last four years. I felt a calming as all the pent up fear, turmoil, and stress literally leaked out.

I am reminded though, that I am adaptable and resilient. Though I have never ever wanted to test these traits, this moment in history has nonetheless provided opportunity. I believe that America too will show its resilience. I won’t sugar coat the reality, however; the divide in this country is vast. I do worry about how or if unity is possible.

Numero dos

I did another thing! Five days and I can enjoy up to 95% immunity! Now I will be deployed to give the gift of immunity to others!

Vaccination

I did a thing today!

I never imagined myself being excited to get a shot on Christmas Day, but it is 2020. A year like none other. My number was picked as I was able to step off the unit and receive the Pfizer vaccine.

More than once in the last week I have shed tears over this moment. The weight of this time, the pandemic, the death-suffering-loneliness, all of it has started feel pretty hefty. In my few moments of quiet, sometimes it just overtakes me.
I mourn many things… the loss of everyday life, my kids graduations from middle and elementary school, vacations, visits from family and friends, a feeling of safety and security, feeling valued in my work, connecting with my patients in the moments when it really matters in the close human way that my work requires at times, dining out, the quiet of my house when the kids are at school and Jon is on a run, the tidiness my house once had when it sat at 1/3 capacity 2/3rds of the day, the laughter of my kids on the playground or socializing with friends, meandering in a store just to linger a little longer, the joy on Wes’ face when we went to a mall with an escalator or rode the Max… so many things.

This little thing I did today (which is making me tired, sore, and a bit woozy) is the beginning. It is a gift of science and exhaustive hours of hard work. I want to take a moment to let sink in the full meaning of this moment.

I know that there is a lot of hard work still to do. Tomorrow I will see more COVID positive moms and try to help them give some immunity to their babies, but I get to do it knowing that my body is hard at work trying to build some protection for me too.

Best Christmas miracle ever!

Merry Christmas 🎄!!

Vaccine

The long anticipated roll out of the first vaccine to prevent COVID 19 is underway at my hospital. It hasn’t gone without controversy though. Like many institutions, they stated that frontline workers would be among the first to get the vaccine. Of course there are thousands of frontline healthcare workers just at my institution, and only a small fraction of doses available at this time. It begs the question, who should get it first?
I think it was sold that doses would be prioritized to those workers who are at most risk by both most exposed and most vulnerable (age, ethnicity, and chronic health). While this sounds totally reasonable to me, the process of identifying who is in fact the “most exposed” hasn’t been very transparent. The administration announced several “phases” or “waves” with vague titles such as “acute care”, “ICU” or “support staff”. They have not clarified what specific units fit into these broad categories. Our L&D nurses, for example, serve as a triage point for all pregnant women. We see a lot of COVID positive patients, who are allowed to have a COVID positive support person and to remove their masks in active labor. These nurses are at the bedside for their entire shift in very close contact for their entire labor. They support these moms through aerosolizing procedures, active labor and delivery. Their risk is extremely high. Their vaccination opportunity falls in the second “phase/wave”… this was unsettling to learn, but it was much worse when stories of medical students (who don’t have patient contact), residents, and physicians (who spend little time at bedside in contact generally speaking) are receiving vaccines ahead of bedside staff such as our L&D nurses.

As far as who might be at more risk from a demographic/ overall health standpoint, there was no systemwide survey conducted. So there is no transparency around how these decisions are being made.

I know that my risk is lower than many nurses at my hospital, maybe even several physicians and residents, but surely not medical students! I can wait for my turn, I can absolutely appreciate that there people whose age and/or health requires more immediate attention, but it is all an easier pill to swallow when the process of decision making is transparent. I think I have a right to know the process and understand where I reasonably stand, given the sacrifices that I have personally made over the last nine months. Please respect me enough to offer this small curtesy!

And yes, when you are offered a vaccine, you should take it (unless your medical doctor has outlined specific risk factors that are contraindicated)! COVID is a public health issue. It doesn’t know republicans from democrats, race, sex, gender… etc. Healthy people who get vaccinated protect those who can’t, and eliminate horrible deadly diseases from our communities. See Polio, Smallpox, and Measles for more understanding.

Waiting … for my number to protect those I love, and you and those you love!

Baking Merry

The last month FLEW by! I have wrapped up my first term of my graduate program! It feels really good to be able to say that and still feel firmly on my feet! It was a lot of work, and I neglected several preferred things, but its in the bag! Now as we turn our sights towards the holidays, making merry and bright, and saying goodbye to the year… I’m finding myself with a wee bit of time again.

While I was working after Thanksgiving, Jon and the kids kicked off our holiday season by putting away fall and brining out our holiday favorites. Interestingly there where a lot of things that didn’t make their way out of boxes. It felt like the spirit of 2020 had seeped in and dampened everyone’s hustle and bustle.

So slowly I have been ordering, receiving, and wrapping holiday (and birthday - at the Stanis house) gifts. I’m pretty proud to say that I have everything wrapped that is here, though I am still waiting on a few stragglers to come in.

Jon baked bread to share with our neighbors, a holiday tradition from his childhood. It somehow seems like the right time to bring those traditions back in a year when so much feels wrong.

Yesterday I whipped up some sugar cookie dough, and the kids helped roll it, cut it, and bake it! They did it with pretty much only verbal cues. Which was great. I always remember feeling so physically tired after making cookies in the past! Tonight we will apply icing and sprinkles to bring them full circle. Should be equally messy, right!?!

For me, it doesn’t really feel real that it is Christmas time. My body is still quite full of anxiety over the state of our government, the state of public health, my children’s mental and social health, the questions that remain unanswered about the near and distant future. I feel fortunate to have built in avenues of reliable and supported information, the ability to have stable housing and income, a spouse who always works from home, and lots of technology and knowledge to help my kids through distance learning; just to name of few things I am thankful for. I still live with an endemic level of anxiety and concern for our world.

The weight of this year has been hitting me a little harder in the last few weeks, probably as things have slowed down a bit for me.

My experience on the front line:

I set out two biohazard bags and two clean gloves. Then I tied on a scrub cap. Next I removed a clean disposable gown which I placed over my head, threaded my thumbs through and tied around my waist. Then a pair of clean gloves that slip over the gown at my wrists. I removed my regular surgical mask that I wear all day, and placed my plastic disposable container, with my N95 mask suspended in it, over my mouth and nose. I pull the lower strap up over the container and then my head down to my neck, then the second strap. I cover the container and set it aside. I pinch the metal strap over my nose and breath in and out deeply and slowly, testing the seal. I place my goggles that I wear in every room on next. I test the seal again. I adjust the metal strip when my goggles fog a little. Test a few more times until I am satisfied that the fit is right and the seal is solid. Finally I place the strap of my plastic face shield over my head.

This process has already taken me nearly ten minutes. I’m thinking through every step carefully. I don’t want to screw this up. One error at this moment brings this thing home. It puts my family at risk. I’m not thinking about myself in this moment, I am totally thinking about my kids.

I am hot as I walk into the room. The family on the other side of the door is pleasant. They look tired, like all the moms and dads I see. She has a mask sitting just below her nose covering her mouth and chin. Her baby is swaddled and laying on her lap in the bed. His mask covers most of his face. A bushy beard breaks around the edges on the sides and bottom.

I wonder what they think of me as I introduce myself and explain my business in their room. What would I think if someone walked into my room looking as I do now? They are happy to have me there, they have a lot of questions. The baby is completely asleep. I’m relieved in one sense, I will not have to spend a prolonged period of time within six inches of this mother’s face, but I might have to don everything again and come back. My mind sighs. I start describing the expected feeding behaviors of their baby, and the mom interrupts me to share that her baby is special and already exceeding all of these expectations. Of course she is. I spend about 45 minutes talking and answering questions. My face is sweaty. The shield, or maybe the goggles, or both, are starting to fog up.. my mind focuses on that for a second and I think it’s time for me to get out.

As I finally exit the room, I can’t seem to pull hard enough to break the tie of the gown. I curse in my head as I struggle to pull in the right place. I take a breath and slow down, careful to wrap the gown into itself so as not to shake around any droplets. I get one hand out, then with some effort, the other. I mindfully place the ball gently in the waste bin at the door. As I exit, I hit the sanitizer bottle squirting a huge glop into my hands. It takes a bit for the sanitizer to dry enough that I can put on the clean gloves I had laid out before I went in. As it dried, I thought about the order of doffing what was left. Once my gloves were on, I grabbed a new cavie wipe from the bottle and carefully remove the face shield so as not to touch the mask or my cap. I clean the shield and place it in my paper bag. Next I do the same with my goggles. Then I uncover my plastic Glad-wear. I place it over my face. I reach back for the lower strap and bring it up over my head and around the entire container. Then I repeat with the second strap. I place the cover on and press it tightly to seal. Months ago I drilled three holes into the container for ventilation to allow anything in it to dry. I’m grateful today that I prepared this so long ago. Finally I remove my cap with one hand, while holding the bio bag in the other. I am careful to try not to touch the sides or the edges. I compress the bag a little to let out some air and seal it as well as I can with one hand. I take off the gloves, sanitize and put on clean gloves again. This time I open the second bio bag and invert it, pulling it right side out with the other bag cleverly contained with in. I seal it, doff gloves, and sanitize again.

Its been about 90 minutes since I started, but I think I did a good job. I grab a new surgical mask that I will wear the rest of the day. I store my PPE and place the bio hazard bags in my bag to take home to wash. Disposable hats (bouffon caps) are on low supply so the hospital doesn’t recommend using them for routine care of COVID positive patient.

I sent Jon a text to have my house robe waiting for me when I get home. Its our code for “I’m somehow interacting with someone who is or is suspected of being COVID positive”. He places my house robe in the laundry room that connects our garage to the house. When I pull in the garage, he opens the door. I step in and use the heal of my shoe to close the door. He opens the washer. I give him my phone, lunch box, drinking cup which he will wash right away. I strip down and everything goes in the washer, including the scrub cap that I remove carefully from the bags, avoiding touching the contaminated insides. I put on the robe and make my way to the shower. I scrub and douse in soap and water. My robe and towels go into the washer next, and everything is washed immediately on sanitize. I leave my shoes there for several days when possible.

I don’t get to know if these measures are enough to keep us safe, but the routine is the best chance we have to keep COVID at work. I want so desperately to protect my family, that I take the time to think through it, to plan my moves with intention. This patient experienced only mild symptoms, but many on our unit have been quite ill. A few are lucky to have made it. COVID is devastating to pregnant women. Most of them who have been so ill, also delivered prematurely. This has turned out to be somewhat protective for me as a lactation consultant. When they deliver prematurely, I don’t end up needing to spend time at their bedside, I can provide education on the phone and through bedside staff. Still, it’s heartbreaking to watch this play out on the sidelines. I am grateful for the vaccine that is now being administered to the most at risk of our ranks. I don’t know when my number will come up, nor when my family will be able to receive it. I don’t love that it had to be rushed, nor that long term effects can’t be studied. I don’t love having to be one of the first to get it, but I will get it, and I will take these unknowns. Because the alternative is to let this virus continue to ravage the world. When healthy people get vaccinated, it protects the most vulnerable among us.

May 2021 bring us all peace and humility once again.

Clorox

Before the pandemic, approximately every six months, I received a shipment of Clorox wipes as part my subscribe-n-save subscription on evil Amazon. I know it’s evil, but I live on a budget on borrowed time, so some evils are necessary. I found if I purchased my cleaning products this way, with a reoccurring replenishment, then I was better at using them. Thus, my bathrooms were clean with sparkling toilets and showers/tubs. And with a big child whose potty skills are less than apt, well we find an abundance of need for the use of harsh wipes! Of course I never used as much as I had, so I found myself at the beginning of a pandemic of a novel virus overstocked with Clorox. Who could be happier!?!

Fast forward about three months of mad daily cleaning, and my stockpile was nearly gone (and not as much stockpiled as I had thought). I decided to leave the Clorox on my list, even though I was fully aware that it would be quickly out of stock for awhile. Every month it told me it was out of stock and I deferred it to the next month. Well, today it came!!! I got three fresh new bottles of disinfecting bliss!!!

Our COVID routine has transformed with knowledge, social distance, and lack of access to abundant Clorox, so I will likely continue with Lysol spray and reusable cloth in favor of saving these wipes for Wes’ messier accidents. I sure am grateful to have them again!

I haven’t tried to reload in gloves yet. We still have a little more than half a box, but that need will come soon. Fingers crossed 🤞🏼 that they will be in stock when we need some. That thin glove is often the only think that keeps us from loosing our lunch! There is a really good reason that most almost 12 year olds are potty trained!

Sp.ed. and other ramblings

I forgot to post photos of the waffle cakes… So here are a couple.

I have three sped (special education) children. One is pretty high functioning with support, one is just getting her feet wet and supports haven’t been well identified yet, and one is low functioning even with all the support they throw at him. I use “support” here in the way that the school and federal/state education boards use the term. To me, accommodation is a better term. My kids are assessed and have goals established and evaluated constantly. Still, all three of my sped kids are pretty behind when compared with their peers. There are good reasons not to compare kids, and I try not do so either, but once in a while I sit back and think, “how would my life look differently if these three kiddo were more typical?” The honest answer is that something else would take the place of my current worries/troubles/challenges, but sometimes I think it might be nice to worry about those things instead of the things that I do.

Just a little bit ago Jon was sitting with Wes on a zoom call that was meant to serve as a math assessment. It was painful for me to set over at my desk and watch, and it was painful for Jon to sit next to Wes powerless to aid in any way. The teacher certainly couldn’t say, but I would bet my life on the fact the he might use the word “painful” to describe the interaction also. Wes, however, was gleeful as he jabbered on about anything that came to his mind. Inadvertently he answered a couple questions right, he did demonstrate a few skills that he actually has, and his “jabbering” was on topic - mostly number songs that he made up. Every 30 seconds the teacher tried in vain to reestablish Wes’ attention, which mostly failed until Jon intervened. Usually with a physical and verbal cue about where his attention needed to be. Many things that Wes actually does know, were not demonstrated because who could stay on topic through all of that to get down to what it means to subtract two numbers. (He can subtract basic 0-9 numbers, sometimes. But I don’t think he really understands what it means to “take away” or “subtract” or “minus”.)

So far, comprehensive distance learning has meant hours (4hrs in increments of 55 min) of Wes sitting in front of his iPad while the world zoomed (literally) in front of him. The speaking in these classes goes so fast that Wes cannot seem to keep up with what is being said. By the time he has heard, then interpreted, then prepared a response, the class is onto something else. When he is called on to answer a question, it takes 3-5 minutes for him to articulate his ideas. Sometimes because it took that long for him to get the courage to speak, and often because it takes that long for him to form the thought and the language to express it. When he does finally speak, he needs to be taught how to turn on the microphone over and over, and he speaks so quietly that almost no one, even us sitting next to him, can hear it. My boy who is often outspoken and inappropriately loud, is completely shy and intimidated by the concept of speaking on the computer.

For my other kids, I keep them on schedule, but they are able to find and log into their classes on their own. They need me to ask about what homework they have and if it is done, or guide them in determining how their time should be used. But Wes, he needs someone to take him to his work area, turn on and navigate the device, listen to the class and redirect his attention every minute or so, engage him IRL in the topics that are being discussed online. He needs to be prompted to listen to what is being said, and begged and rewarded to sit up, not mess around with the screens, and stop talking (to the aid, because he won't talk to the class). On a good day, this is all that is required, he might even try to answer some questions, but most days are not so easy. He screams, cries, throws his body down, lays his head on the table and covers it with a blanket. When I say “aid” I mean parent or PSW (Keaton- who is amazing and patient and I don’t know what I would do without her!!)

Our school district identified early that in person school would not be a reality at the start of this year. Jon and I support this concept, as most students should not be in school while the pandemic remains out of control. At the same time, Wes is not learning in this environment. We do not have the resources to maintain this level of support at home, and our district seems deaf to the difficulty. I attended three Zoom meetings before school started around services for students with special education needs. I had countless emails with Wes’ teachers to voice my concerns. I see them doing everything that they can within the confines of the directives from Oregon department of Education. It’s just not enough.

Ava has not had any contact from her special ed supports beyond an email with instructions for setting up audiobooks from he library… which we already a have three audiobook applications where she can get books for leisure reading. What she needs is support around organizing her work and figuring out how to complete things. She needs remediation in math and practice using her reading skills that her tutor has been working on.

Taylor needs much of the same support as Ava, but in a way that will make him a successful high school student. He needs someone to highlight how that is different from being a middle school student. He needs some guidance around how to navigate this and how to keep up. Taylor has had no communication from his supports. I have no clue how anyone is “supporting” Taylor as outlined in his IEP.

In CDL, the concept of support is foreign. There is no special education, there is just one kind of education, and it presumes a lot of skills. It also presumes a lot help from parents. It is not hard for me to see how this education exposes disparities for all sorts of children.

More cake, cause this topic got deep real fast… sorry….