Month: March 2020

stay home stay healthy

We are 10 days into our local stay home order, and a week into our statewide order.  I had to cancel my trip to the midwest to visit my mom, who is elderly and 2 years out from open heart surgery.  She lives alone with my sister nearby and is doing great by the way.  This meant I had 6 nights off before going back to my ED nursing job.  I was faced with a choice; do I pick up extra shifts because our department always operates short staffed even before the pandemic started, or do I take advantage of nights off at home, to rest up and eat well and get outside in the sunlight. I spent time reading the emails from my manager and the hospital administration, I read posts from colleagues about nurses being quarantined, I read about the PPE situation in the department and, the posts from my union rep about actions to take and I realized that this pandemic is going to be a marathon so I decided to take the time off as a gift.  I rarely stay home when I am off from work more than a few nights, we usually travel somewhere, so this time at home feels like a gift.  I have been spending the time doing spring cleaning and reorganizing the kitchen. I am working on a project clearing out 32 years of stored stuff that I have been avoiding for the last 5 years.  I have had time to snuggle on the couch in front of movies, do a little cooking and play my guitar.

I find myself reading studies about SARS trying to understand the truth about what we actually know.  Nursing is my third career and my first one was as a research microbiologist.  I know how to look at data, and read research studies, and I understand infectious diseases and how they spread.  I question every headline and statement I see in the news or on social media, how do they know that? what studies are they basing that statement on?  I follow the CDC, WHO and other data driven websites and make my own conclusions about what the data seems to be telling us.  I try not to post statements that I can’t back up with facts, and I don’t apologize for being a nerdy science type. Because of this background I am usually  calm and don’t freak out at every little thing because I can look beneath the sensationalism and find the facts.  This virus is new however, and we have little history about it’s behavior.  We can extrapolate and predict based on the behavior of similar viruses, we can model systems of transmission and study how to protect ourselves. The truth is, we are not far enough into this pandemic to have the data we need to make some of the decisions we need to make.  It is going to take time and trust in the scientific community (not the political or corporate community) to do the experiments; studying the epidemiology, developing a vaccine, and developing antivirals that can mitigate course of infection and maybe even act prophylactically.  We have not seen anything like this on a global level before.  Other novel infections have been contained in certain locales long enough to develop ways to fight them with vaccines or medication protocols. The time for containment of this virus is long past; we must self isolate, be meticulous with hand washing and take care of our immune systems.

So what is the good in this?  Many people get to spend more time with their families, focused on each other and what is important to them.  We as a community are finding ways to help each other with errands, check ins, and support.  We are all learning more about technology and how we can connect virtually.  There has been an outpouring of music on the internet from artists all over the world.  In the long run our healthcare system will have to improve, as this pandemic is exposing lots of places where we are grossly unprepared for a pandemic or other kinds of disasters.

I tend to look at the world though a healthcare and science lens, and rely on others to take care of the economy.  I don’t have talent or much interest in deeply understanding how the economy works, however, I  have been forced to learn a lot in the last five years  since becoming a single parent and putting a child through college on a single income. I am grateful that I have a good, stable job (that I happen to love) with great benefits. But not all are so lucky. Two of my 3 young adult children are without income right now. I am supporting one and the other is managing on savings and scrambling to create new income streams. It is a scary time for everyone,  and I am quite aware that my family is privileged. My kids will be ok in the long run, they are resourceful, smart and generous, and I am in a place to help them if they need it.

My heart aches for those without safety nets.  Without income, or most of all without people to lean on. I try to end each day with gratitude.

Pandemic

When I came back to my blog last week I had something entirely different in mind to talk about.  However in light of the global health crisis, I want to talk about THE VIRUS.  Yes SARS-CoV-2 that causes COVID-19 disease.  I work as a nurse in an emergency room at the only trauma center in a large west coast city. We are busy on any given day with traumas, strokes, heart attacks, drug overdoses, stab wounds, gunshot wounds, falls, alcohol withdrawals, psychiatric emergencies….. I could go on and on.  Since we are  the county hospital we also take in our share of homeless seeking shelter and sandwiches, patients in custody, and sexual assault cases.  This time of year we are geared up to handle people with the flu and other respiratory infections.

When I first started hearing about this novel virus, I thought, as many did that it was going to play out just like the flu, but maybe just a little worse because it is new and we don’t have a vaccine yet.  We already had a protocol for masking people with coughs and fevers, we assumed that would be enough.  Fast forward to the last couple of weeks as the data started rolling in from around the world showing that this virus is more deadly and likely more contagious than the flu. We watched as China, Italy and Seattle shared their experience and their data.  Each day I would go to work and be briefed on the current status for handling patients and testing, and what we should be doing to protect other patients in the ER and ourselves.  We rearranged triage areas, changed workflow, brushed up on higher level PPE. Every day we were told that the tests are limited, with very strict criteria for testing patients. At first the samples had to be sent to the CDC for testing, then much later we got the capability to test in our state, but still limited quantities. As I write this we are still not testing health care workers in my hospital.  As far as I am aware, though  several nurses are out on quarantine for having been exposed, some have symptoms but since tests are scarce none have been determined to be positive for Covid-19.

Earlier this week all our local counties were asked to shelter in place, and yesterday the governor initiated a statewide order. Only essential workers can go to work and only essential activities are allowed outside the home, such as grocery shopping and medical appointments.  Schools, theaters, restaurants, bars, gyms, all closed.  My days have not changed, no Netflix and chill for me, I am still going to work.  My family has been instructed to wash hands when they walk in the door, and watch for fevers or coughs.  College is online and graduation is cancelled for one of my children, two of them have little or no work. We are a multigenerational household with some concern for bringing the virus home so we are all being vigilant.

It is hard to keep up on all of the data coming out, but it has become clear that two  significant assumptions we made have to be adjusted.  First, a study came out showing the viability of the virus on surfaces and in aerosols. Now that we have more information, actual data that shows the virus behaves more like the SARS-CoV-1 (from 2002) with persistence in aerosols, this information makes me more concerned.  This requires higher level of isolation and precaution similar to that of TB.  If we get a surge of patients testing positive, we are not prepared to maintain that level of isolation on many patients.   Second, we have been thinking that this new virus does not affect young people that much, that they would only suffer mild symptoms.  Two studies have shown this not to be true one from China and one from United Kingdom, while young people (under 60) still have a significantly lower risk of death from Covid-19, many do get hospitalized and some even need intensive care.  What this says to me is that young people still must be careful and not assume they will not get sick.

Some other sobering news came out of UCSF Infectious disease meeting, more than half of the US population will likely get the virus and with a 1% fatality rate that means 1.5 million Americans may die.  We will need 1 million ventilators, we have about 160 thousand.  It is time to mobilize manufacturing in this country as we did for WWII; build ventilators, produce masks, gowns, gloves and sanitizer.  We haven’t seen the likes of this since 1918 with the Spanish flu.

This brings me to being a canary.  Those of us who work with sick patients, are 4 times more likely to get the virus, it is imperative that we have adequate protection.  Enough PPE, support of hospital leadership, cooperation of the population to do their best to shelter in place and minimize the spread of the virus.  We are crazy dedicated to our work and often put caring for our patients before our own safety. I don’t want to face the decision of do I care for my patient or not because I don’t have the necessary PPE.

Every day we learn something new, about the virus and about ourselves in a global state of crisis.  Our lives are changed, our priorities reordered and gratitude for the small things we overlooked becomes our focus.  Stay positive, stay connected (virtually) and remember all of us have an important role  in slowing and eventually halting this pandemic.  Step up and lean in with a smile, check in with people, and if someone is struggling, be present with them through the fear even though we don’t know all the answers. STAY HOME AND WASH YOUR HANDS.

Jennie

PS some links

josh lerner MD

aerosols

Atul Gwande

Larry Brilliant

SF Chronicle on nurses at SFGH

young people

maria shriver

Up from the ashes

Out of suffering have emerged the strongest souls; the most massive characters are seared with scars. Khalil Gibran

Helloooooo out there! I feel like I have come out of the dark, risen from the ashes after five years and I want to participate in life again.  I have missed blogging,  I want that connection with people to share stories as well as work through my growth and changes.  Five years ago I went through a traumatic explosion of my marriage that shook me to the core. There were multilayers of betrayal, lies and secrecy and at the time I really didn’t think I could go on.  I want to get to the point of being able to share the story, to have conversations and maybe even help others who feel as isolated as I sometimes do.  However, right now there is still too much shame and anger that gets triggered that leaves me wanting to hide under the covers with my cat.  It is my goal to break free from that. At the time I rallied for my kids, grateful for a job that was my refuge and a posse of friends that helped me piece my life back together. My life became small for a long time, I focused on surviving. Take care of my kids, get myself to work and pay the bills.  I really didn’t do much else. Slowly I started healing thanks to my devoted family, passage of time and the burning desire to get out of pain and feel happy again.  Now five years later my kids are grown, I am in a new relationship and I am feeling more optimistic. I am ready to reengage. Five years ago this blog was a place for notes about my knitting and other crafting, kitchen creations and a little about my nursing adventures.  I am not sure where I want this blog to go now, I still want to talk about creativity and about nursing but I also want to explore who I am on the other side of trauma.   I have done so much therapy, read so many books, gone to so many workshops; journaled, meditated, and cried gallons of tears.  I guess I thought that somehow I would get back to the confidence and stability that I had before. But no, the innocence of that former time is not coming back. I may be a stronger more compassionate human, but I will forever have a dent in my trust and a scar on my heart.3B12B943-26FE-4CC4-9B1E-73DF5B4686E4