By Le Bui
The pandemic has impacted and changed billions of lives. The way we think, feel, and interact has been irrevocably altered, for one cannot cross a river without getting wet. And yet, we lack understanding of what happened to those who swam deepest in those depths–the countless numbers of medical workers burning the candle to let others breathe another moment. My sister was one of those medical workers–and interviewing her, a clinical pharmacist, was an exercise in the joyful familiar and the terrible unfamiliar. “Of Sickness and Strength” is a look behind a pharmacist’s eyes during the Omicron wave of the COVID pandemic, and the will to keep on keeping on.
Photo by Dr. Vy Bui
Doctors are not the only medical workers to swear oaths of service and office. Many others do – physician assistants, nurses, and of course, so do pharmacists. They swear to put the concerns of patients first, to alleviate suffering and to heal the sick. At the end of the autumn of 2021, my sister, a first-year resident clinical pharmacist fresh out of school, was truly not prepared for how heavy that oath would become.
My sister is a lot of things. She’s finishing up her residency at Johns Hopkins as an Investigational Drug Services Resident, soon to finish up her qualifications to oversee drug trials. But she’s also a pianist, who occasionally plays for our local parish despite the constraints on her own time. She’s become a pretty talented cook, having learned from our mother from a young age how to bring the best tastes from bargain ingredients. She was on the high school tennis team, and still plays today. I know that she isn’t invincible and she certainly can’t do everything, but it’s difficult for me as her younger brother to potentially foresee myself in her shoes – especially when she shares heavy stories about frontline healthcare.
“It depends on the rotation, but for my SICU rotation, I’d be up and at it at 5 AM, pre-rounding with the patients, reviewing their charts, and preparing for their treatments,” she began, describing a day in her life within the Surgical Intensive Care Unit. As her day went on, important duties abounded, each one urgent, each one something that needed to be personally taken care of. “I would clean up medication lists that could’ve had duplicate therapies, adjusted medication doses for everything between renal and hepatitis function (kidney and liver, respectively) to insulin in response to blood sugar changes–the list could go on.” Endless and ever-changing during that autumn SICU rotation, the list of duties seemed only to increase in size from shift to shift, keeping a continual train of care for patients churning forward. It’s supposedly why residency hours can be so ridiculous at times, up to 80 hours a week, and oftentimes doctors work shifts that are measured in days rather than hours despite the risks of sleep deprivation. It’s necessary to keep a seamless line of care, and avoids the risks of interrupting care via handing patients off to another team. This grueling work schedule reflects itself to other healthcare workers – including pharmacists like my sister. “After I’d finish up that, I would have to quickly make note of these interventions and review them with my preceptor about fifteen to twenty minutes before rounds.”
And then naturally after all that preparation, she would have to actually attend to her patients. She would attend urgent rounds from early in the morning to lunchtime, and then follow up on less important patients afterward. Some days even eating wouldn't be a guarantee until she left the hospital – bureaucracy stops for no one, and meetings are necessary and commonplace in order for administrators and hospital leadership to be in touch and to know how to schedule shifts and reallocate resources. The latter would become depressingly relevant in recent years. To keep up, oftentimes she needed to skip her meals and remain on the clock until late in the afternoon, until she could drive through the Baltimore neighborhoods to cook and eat her dinner within her townhouse near the hospital – it’s necessary to have a short commute.
COVID, naturally, altered things. Johns Hopkins is a prestigious hospital, renowned as one of the greatest in the world. A teaching hospital and a biomedical research facility, the Baltimore medical institution has a long history behind it. As one of the earliest American medical institutions, many medical specialties found their origins there, from pediatrics to neurosurgery. It has over a thousand beds and retains a Level 1 Trauma Center – a facility that can increase your chances of survival in an emergency by 25% compared to care without one. Yet even even so, Hopkins was struggling to handle the pandemic and the corresponding massive increase in critical patients. Matters worsened as surges beyond the baseline occurred due to travels from the holidays, as restrictions loosened and variants began to evolve, each finding new ways to overcome countermeasures. Beds continually filled up with long-term care recipients, needing hospital equipment to even gasp another breath. Even if they were well enough to leave the hospital, so-called “long COVID,” a broad spectrum of detrimental health effects long after the initial symptoms ease, would often bring patients back. Finding motivation day after day was a struggle for everyone in the hospital, patient or family or worker, yet my sister did not shy from the challenge.
Perhaps it was having already gone through a long journey to make it to where she was that made her refuse to flinch from such challenges. In her words, “I’ve dreamed of hospital pharmacy since high school, after a summer program, and I’ve never doubted that it was the right place for me to be.” She graduated high school in the top 10 of her class, and went to college at UNC-Chapel Hill, finishing three years but not graduating due to being accepted at the Eshelman School of Pharmacy in her junior year. “I got really into Investigational Drug Services because it was my favorite rotation at Duke Hospital, combining my interests of clinical pharmacy and research. It’s what inspired me to pursue residency at Johns Hopkins, and I wouldn’t trade it for anything.”
Indeed she did not, and fortunately for my sister, her rotations weren't canceled or made virtual like many others’ were. Whether it was confidence in Johns Hopkins’ safety measures or a sheer need for manpower to keep the hospital running, day in and day out she entered the hospital, ready to work. The need for more coworkers to keep afloat was ever-present, unfortunately – a recurring topic within my sister's weekly phone calls was that even in a place as acclaimed as Hopkins, it felt that the staffing shortage was a persistent problem.
Her surgical intensive care unit rotation was slammed yet again as the holiday season began, heralding another variant: Omicron. Things changed – they had to change. Even though Omicron was less likely to cause severe disease – and the definition of "severe" was quite broad – it spread with even more frightening ease than its earlier compatriots. Swaths of beds within the SICU were forced to change to COVID patient beds.
The already harsh reality of COVID was crushing, but as Omicron added more weight, plenty of other landmines lie in front of healthcare workers, causing an already-desperate balancing act to teeter dangerously close to collapse. Early on in the pandemic, many clinical workers were isolated even as they worked themselves to the bone, unable to share their burdens except through distance or virtual screens, fearing taking home diseases to their friends and family. Certainly, life got better as time passed and people adapted – vaccines and medications were released and distributed, testing became commonplace, and hygiene habits improved.
Yet, even as COVID became combated and other diseases were dealt with, another kind of contagion was spreading, ones not so easily dealt with by medication. News articles abounded of anti-vaccination sentiment, of some denying the vaccine or even COVID’s existence on their deathbeds. Hostility against medical workers arose among certain portions of the public, with stories and reports of death threats filtering daily into the rumor mill, deeping the already-present pallor at the hospital. Burnout and quitting became increasingly common topics, even at Hopkins. Many medical workers continued isolating, keeping themselves and their families safe, and my sister followed suit. She didn't have much choice, though. She was a resident, out-of-state. She only had her roommate, dead-tired colleagues, and a home that she could only visit through calls.
“There was a nonvaccinated, critically-ill pregnant patient who was admitted for COVID pneumonia. The team had tried various methods to improve her status but she remained on mechanical ventilation,” my sister reported grimly. Despite Johns Hopkins’ prestigious reputation, they had few options. The only real option was to deliver the child as soon as the mother came to term, in order to try to save both the life of the mother and child, or else they would rapidly soon have to choose between one. “It was hard to watch, sometimes, because the patient's family was loving and attentive. They often came to visit, but they had to deliver that care and love through a glass window.” Safety protocols were paramount, necessary for the situation not to worsen even further. One sick member of the family was bad enough.
“A lot of choices were considered, and presenting these options to the patient and family was perhaps one of the hardest duties I had to undertake,” my sister said, a response that weighed even heavier due to me knowing about her titanic daily schedule. “Thankfully, the patient improved after several courses of diuretics and was able to come off of mechanical ventilation without having to prematurely deliver the baby.”
She smiled – a happy ending for once, in a forest of sad and ambiguous ones during the pandemic. But in medicine, you learn to take those, or else you're not going to be able to keep on keeping on–for decades on end. Because when you can’t, that’s when you burn out, and you have to stop. That’s what it means to shoulder that burden, to heal the sick and alleviate their pain. That’s what it means to live the Oath.
Photo by Le Bui