A Glimmer of Hope

It might be weird to admit it aloud but I’ll go ahead and say it: I like poking people with needles. Which was my first thought when I saw the call for volunteers to give the new COVID-19 vaccine, and so I didn’t hesitate to sign up.

Since December 16th, the Occupational Health department has taken over the back classrooms of the first floor in the Medical Sciences building, transforming it into a clinical space: We have a security team, a row of check-in stations, an ad hoc pharmacy, and a surprisingly efficient workflow.

The clinic itself is an inter-disciplinary collaboration unlike any I’ve participated in at UCSF and includes students from the schools of dentistry, pharmacy, medicine, and nursing, volunteering together to carry out the vision of the Occ Health heroes behind this massive effort — in particular, LVN Julian Villanueva and administrative director Tisha Bertlow.

I was at SF General when the pandemic hit and we were quickly excused from our rotations. Despite an intense desire to be useful, my status as a student and relative inexperience prevented me from jumping into the fray.

Over the last two weeks of administering first the Pfizer and now the Moderna vaccine, I’ve had an incredible opportunity to give something back, and also to discuss the pandemic, the vaccine, and healthcare during this crisis.

Sitting across from each of our revolving door of vaccine recipients each day, I’ve talked to a true cross-section of the UCSF community. Ranging from discussing workflow strategies with an ER resident working on opening Moscone Center for an expanded vaccination campaign to the recounting of an ICU fellow who first worked on the East Coast during the pandemic’s early days and now is seeing a familiar scene in the current surge.

I’ve talked to weary attendings, NPs and RNs, their exhaustion palpable.

I heard from a researcher the story of the day they shut down the campus labs and were forced to “sac” the lab mice.
I made the mistake of asking what “sac” meant and, unfortunately, it is totally what you think it is.

I’ve heard stories from techs and managers working behind the scenes and maybe left out when the media reports on our “frontline heroes” but no less indispensable or exposed to the work being done in our EDs and ICUs.

I’ve listened to some who seemed bewildered to have been called so early in the vaccine priority list and who wondered aloud whether or not others should’ve gone first.

I am also bearing witness, of course, to the rumors and gossip: jealousy on the units when some people were called for the vaccine earlier than others.

Murmurs that the Presidio hospital is going to soon be opened for overflow. That the Moderna vaccine is preferable or less preferable to the Pfizer vaccine.

Everyone is speculating, even these giants of health care. Everyone is wondering what comes next.

I have a standard series of questions I have to ask before I administer the shot: Do you have any questions about the vaccine?

They all look at me like, “Don’t we all?” When I ask, “Do you have any allergies to the components of this vaccine?” recipients often reply with a smile of resignation, like, “How would we know?”

My last question always feels a little silly. “Do you consent to receive the vaccine?” UCSF is not forcing anyone to take this vaccine.

Overwhelmingly people have run — not walked — when their time has been called. I’ve vaccinated people who had received the email invitation 20 minutes earlier and immediately jumped into the car.

The mood in the vaccination room is often jubilant — people are excited. Despite the unknowns, for many, this vaccine offers the first glimpse of an end to the pandemic in nearly a year.

On our first day of vaccines, one of my first patients tentatively took her phone out and asked,

“Would it be weird if I took a selfie?” I smiled. “Of course not,” I told her, “Here, let me take the photo for you.”

This has become part of my patter with every person at my station.

We do the consent questions and then I also tell them, “Please feel free to take a picture.”

Many people do, and some don’t out of respect for those who can’t access it yet. We are so lucky to be at UCSF at all.

As of this writing, I have not been invited to receive the vaccine but, as members of the UCSF community, we will all be far ahead of many people who are also at high risk.

The initial reaction from the general public to the vaccine has been a mix of relief and distrust.

Standing in the Moffitt cafeteria the other morning, I saw a TV news report that only 42% of Black Americans are willing to receive the vaccine — a fair and understandable distrust, given the history of medical abuse perpetrated against that population.

Meanwhile, BIPOC people are being sickened and dying from COVID-19 at disproportionate rates.

There is privilege inherent in receiving the vaccine so relatively early and I think the concern that it is in poor taste to broadcast that privilege is valid.

I also understand wanting to share how big this moment feels or the desire to help ease fears so that our most vulnerable populations are less likely to hesitate to receive their own.

I’m not sure there is a single, right choice — it is a menu of inadequate options in a time when everything we do, to some degree, feels inadequate to address what this pandemic has laid bare for all to see: the harsh fact of the inequity in our economic and health care systems and how it causes harm, and the frank enormity of what has transpired in the last year and what is still yet to come.

Everyone is asked to wait at least 15 minutes after receiving the vaccine so they can be monitored for any kind of adverse reaction.

It gives us time to chat. It gives people time to sit, scroll, work a puzzle, to do nothing. I have wondered how often during the day many people in this room actually have time to just take a moment and breathe.

It occurred to me that we should bring in therapists to just sit down with people and give them a mini session, tacking a few important inquiries after my more fatuous consent questions: How are you holding up? What are you doing for self-care? Are you eating? Are you sleeping?

Sometimes when I look across the table at these souls, I am not so sure.

This disease has profoundly impacted us all -as students and workers in the health care field, as human beings, as a world community.

I think about the ways we will one day be able to pick this thing apart retrospectively and highlight all the mistakes we have made and what we could have done better.

But, in this improvised clinic, with its scrappy team of volunteers and participants patiently sitting out their quarter-of-an-hour across from me, I see evidence of our resilience.

And I am allowing myself to feel the hope that this vaccine will give us the fighting chance we need, to regain some ground, to get back to our classrooms, to plan better for the next crisis, to spare some lab mice.

I also hope that soon, mundane moments of pawing at our phones, simply waiting, won’t feel so novel — excuse me for that word choice, it is too soon — won’t feel so RARE, once again.