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?

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.

Catching Up

Yesterday I spent all day catching up on class work that I neglected while I recovered from my cyst removal and made headbands to cover the wound while my hair grows back there. My point is, I was pretty distracted too much this week and I had to hunker down and really hit the books (well screens), I actually only have one book, which I read first on audible but found difficult to cite. So I broke down and purchased a used hard copy. I can’t really remember the last actual textbook I purchased. Mostly I rent digital copies. I have a pretty sweet set up with my old IPad Pro and Apple Pencil. Jon also set me up with a monitor and laptop mount so I can essentially have all three screens working for me at any given time.

Today I worked. It was a busy lactation shift. Right now we are working without a contract. I haven’t been through this process yet, so I’m not really sure what to expect, nor how normal this is. It’s been 2 months already and the updates that we get from both sides sing very different tunes. I’m trying to trust the process, but it’s not easy in a global pandemic during the most divisive election in my lifetime.

Exhaustion

Peppermint Patty knows what I am talking about! I’m so tired, I should just go to bed! I think going back to work after an extended vacation is highly over-rated… even when the “vacation” is as stressful and cumbersome as mine was!

It was a nice work weekend, not too slow, not too busy, but I am impossibly tired.

This could be my culprit… my arm was pretty darn sore this morning, but I barely notice it now. Its amazing what the human body can endure! In two weeks it will have made an army to protect me from this nasty invader. In an unprecedented year… “BUILD ME AN ARMY!” body! One thing I know for certain is that I do not need to contract COVID 19 AND influenza!!!!

Ok, seriously, I’m going to bed. Tomorrow is sure to be another grueling day!

Pronouns

Many years ago when Wes started ABA therapy one of his goals was to learn pronouns and prepositions. I thought this was fine, even useful for a four year old to understand what it means to have something on, under, or next to something else. Equally I thought it was useful to understand what was meant by he, she, him, her, etc. Fast forward a few years, and I can say without much doubt that Wes understands on, under, and next to, but he still can’t always use them properly when trying to describe where objects are. Likewise, I think he understands the concepts of -he verses she- in our general cultural context, but he rarely gets those right either. We used to spend a lot of effort correcting him every time he misgendered people, but recently, say the last two to three years, I no longer see the point.

Liv helped me see that pronouns have meaning, even if I used them as just words. I think there are many words in our language that if thought of in this way, we might stop using. My Pronouns is a link to another website that has a really good explanation about why it matters that we use more care when addressing people with pronouns. I have become pretty good at using they/them when referring to people whose preferred pronoun is unknown to me.

I am very fortunate to work at a company that values these types of conversations, and gives me a lot of practice outside of my home too. As a parent, my gender non binary or transgender child gives me plenty of worry, especially with a shifting political environment that is prone to injustice and inequality, but it also gives me a lot of perspective. I am forced to look at our world through the lens of this child and their challenges. Maybe we could all spend a bit more time doing that.

Happy Monday

Today was super busy. It is the first day of my first term in graduate school. Ahhh!!! This probably will sound weird to some, but grad school is a bucket list item for me. It’s an achievement that I have dreamed about since high school in the way that some people decide that they want to become a medical doctor. I didn’t know that I would end up in nursing and it took me a few years to determine which direction in nursing it suits me to be.

I’m a little intimidated as I look out at the long list of work ahead in this term, let alone the whole program. However, I know that I can do this, and I’m stubborn as a mule, so the saying goes. So, one day at a time, one page at a time.

I get the privilege of traveling down this road with an awesome MBU colleague too! Maria shared initial sentiments about the load and journey ahead. How cool is it to travel alongside another!?! A fellowship!

Anyway, I feel pretty tired after that long Zoom orientation. My mouse croaked in the middle of it, so Jon and I took an impromptu date to the Apple store. Where we only allowed ourselves to purchase one (rather expensive) but awesome trackpad to replace my mouse. Anybody want to give me a all I can grab sweepstakes at Apple? No? Hurmph!

We grabbed some sandwiches from a street vender and sat in the warm breezy courtyard while we ate. That is as close to dinning out as we have been since January. It was so nice to be away from the kids for a minute and just enjoying the quiet of each other’s company. I’m not sure how I can properly emphasize my need for those moments. Wes had an awful morning. He was screaming and melting down constantly. When he wasn’t, he laid his head on the table and covered it with a blanket. It seems that it is not just “going” to school that he dislikes. At lunch he started slapping his face over and over. When Jon tried to restrain him, he actively and vilolently resisted. Jon ended up walking him to his room where he was screaming and hyperventilating. It was a demonstration like we haven’t seen in a long time. Eventually I replaced Jon so that he could eat, and I used my Apple Watch Breathe app to help him find calm. I suggested a long time ago that Apple turn that into a phone or IPad app for kids like Wes, but I don’t know that it has happened.

Finally, Coco has been licking and gnawing a lot recently. I noticed an area above is right front leg that he won’t let me see very well. It’s yellowish and crusty and sensitive that he nips when I even touch the hair around it. We took him to the vet hospital because his vet wouldn’t see him, no appointments available. I was right, he had three infected areas. They think it’s allergies, so now he is getting antibiotics and an antihistamine. Hopefully this calms things down!