Physician immunizer

Well, it all started when I was complaining about Canada’s slow vaccine roll-out. “Ten million doses—maybe by Christmas.” And a certain amount of frustration that we, as a nation, were dependent on the output of Belgium and India for our survival. Whatever happened to Connaught Labs? With limited supply of vaccine, and small patient volumes being processed, I felt the most important threat to our species was being dealt with—gently. Such is the Canadian way, with a surfeit of politeness and deference. Other countries had the military vaccinating en masse. Elsewhere there were drive-through clinics and supermarket immunizers. I felt I should stop complaining, and DO something useful. So, I asked my Public Health Clinic if I could vaccinate on night shifts, weekends and holidays. “Do the online training modules, and we’ll let you know.” I did four modules, but heard nothing. Then I found four more on how to use the clinic computer system, and bingo—I was a going concern. I did a shift the following day. Sheepishly, I strolled past a long lineup outside, and said to the security at the door “I give shots.” I was ushered inside, and met great staff, Red Cross workers, volunteers and nurses. My daughter had just finished a stint for the CRC over the summer, at this vaccination site. I was acutely aware of my naivete as a public health worker. The last time I had an intra-muscular shot was when I slipped on the ice (there was a ball-point pen in my trouser pocket). I never got to practise injecting an orange. I prayed I wouldn’t faint. I mean, I can put in central lines, intubate, float temporary pacemakers, and tap chests—but needles? Hmmm. The first person I recognized was a radiology colleague, Rob. “What are you doing here?” I was thinking he must be either very dedicated or lost. Like me, he felt the need to participate in the process, and move the dial forward. Good on you, Rob. I sat beside him as he chatted with the public, smooth and reassuring, ticking all the boxes. I took notes. I was assigned a computer workstation. The head nurse sat beside me as I processed my first patient. Pass. Magic. Then I was flying solo—no one to correct my glitches, hold my hand, set me straight on computer protocols. My first patient sat down, looked me straight in the eye, and said, “I am severely anaphylactic.” When I asked for a more detailed description, she said she turned pink with strawberries and chocolate. I assured her that, as far as I could tell, there were no strawberries or chocolate in the Pfizer shots we were using today. I said she could wait longer in the observation area post-injection, but she bolted after 15 minutes. A pianist would have been a great addition to the auditorium waiting area—patients might have hung around longer. The second lady was puffing before she got to my desk. She was over 300 pounds and way too short to justify the weight. “Can I get the shot standing?” she said. “Sure,” I said, hoping she wouldn’t collapse in my direction if she had a vasovagal. The third patient was already on a Laz-y-Boy recliner, and I got the heads up she “fainted with every vaccination.” By this time, I figured out someone was sending all the tough stuff my way . . . . In three hours, I vaccinated 22 patients. Most of it was chit-chat (vaccine types, potential side-effects, latest stats). I vaccinated a 12-year-old Kevin, who was a soldier from start to finish. Of course, his dad went first, so Kevin could memorize the answers to all the tricky questions (“Are you pregnant? Immune compromised?” etc.). At the end of the day, I had failed to register one patient (but got instructions on how to fix that lapse). I drove home excited, somewhat exhausted, and happy to have made a small difference. As vaccine supplies started to ramp up, I could see a growing demand for immunizers for second shots, for children, for latecomers. The Red Cross Volunteers, the Public Health nurses and some other doctors all reassured me that the system was credible, albeit a bit slow. I followed up with a full Sunday, this time arriving at 8 a.m. For the first hour, we drew up vaccines into insulin syringes, and made sure to get every last drop! I immunized 42 patients that day. One mother brought two daughters in with her. “Aileen’s brought her EpiPen, she’s asthmatic and dreadfully allergic—and Dana always faints with needles.” Of course, neither misbehaved. A day full of kids, ages 12 to 18. One guy with a wonderful eagle tattoo on his biceps (guess where the needle went). Everyone joyous to be vaccinated, and safe at last. All keen to get their second jab eight weeks later. I left tired but satisfied. Since then, I’ve done 10 more clinics. I’ve seen the patient offered Moderna but wanting Pfizer. I’ve seen the 12-year-old too terrified to even look at me, but who thought nothing of it afterwards. I met familiar faces (“Hey, you did me last time”), and the process became routine. Computer documentation can slow the process, but the paperwork can’t be overlooked. I’ve never seen anyone faint or go anaphylactic, although we were prepared for such excitement. Last week, I started my shift at noon. I saw mostly second-dosers, and kids. The head nurse approached me at 1:30 p.m. and said, “Well, you’re done.” What on Earth? I had vaccines to spare and time to give them. But the clinic had no patients waiting in line. So, I was sent home. What have I learned this summer? • If you complain about a system, try and fix it first, you will feel better about yourself. • There are a lot of well-meaning nurses and doctors willing to immunize our population, but next time the military might figure out a way to do it faster. • I worry about those who don’t want a vaccination. They will be the fermentation tanks for the variants—they will perpetuate this and future pandemics. • I know a bit more now about vaccines, administration, what to ask and how to reassure. It is tough to understand the philosophy of “me” over “we.” Vaccination saves mankind, your neighbour and your grandkids—and the most vulnerable amongst us. When one of my patients, 82 with heart disease, said, “I don’t need a shot, I have an immune system,” I told her that 700,000 people in the U.S. with immune systems had died from COVID infection. That didn’t persuade her. I asked if she remembered polio, a dreadful disease, which has been almost completely eradicated by vaccination. She quickly switched topic. Persuasion will come from restrictions: restrictions on travel, employment, restaurants and shops, insurance coverage and public gatherings. It is tough to turn naysayer opinion: They are truly victims of internet misinformation and a lack of critical appraisal skills. Popular internet sites (you know the ones) do nothing to reign in the torrent of lies, to edit the propaganda, to restrict usage by nutbars. This is a huge, and probably culpable, misuse of public trust. Readers will believe nonsense (nanochips, QAnon and government interference). These sites, and their readers, fail to see beyond self-interest. One day, when the inconvenience becomes huge, patients may realize their folly, and take the shot. And social media will be held accountable for their action/inaction. And mankind will be spared—for now. Here is some further reading on online misinformation.

Casebook of a Community Internist

Physician immunizer

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Blog Author

Hector Baillie

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