Epilogue

As I review my flu clinic schedule copy printed out by the agency on 4-October-2004, I realize that the vaccination clinics came to closure prematurely. Dates for 20-October, 26-October, and 03-November have all been cancelled due to vaccine shortage. My vaccination clinic scheduled in my hometown on 15-October, Friday, was cancelled as well. All nurses scheduled for clinics after last week have heard the same story.

There remains a memory embedded in my mind. And it's not from any digital camera or video or internet article. It is a picture I have seen with my own eyes. Seniors, sitting on weaved lawn chairs in October waiting for their flu shot.

I can't stop thinking about those weaved chairs filled with people. Perhaps if they were folding chairs like catering halls provide it might be easier to forget. But the weaved chairs strike a chord somewhere from the past. They summon up a parade of memories all their own. Barbeques and summer parties, outdoor concerts and picnics in the park, softball games with a parked weave chair on the grass.

Weaved chairs are a season. They are summer. These chairs are not seen in droves in October. This is an unnatural occurrence. Halloween is just around the corner. When little witches and ghosts come to my door for a treat I'll feign appropriate shock and horror. That will be easy to do this year. Because I've seen seniors in mall strips on concrete in lawn chairs in October who weren't able to be vaccinated.

Fourth Clinic

14-October-2004, Thursday, 1:00 pm to 7:00 pm
Pathmark, East Rockaway
(last clinic assigned, all rest would be cancelled)

In terms of time, this clinic would be the only one I was scheuled to work six hours. Revved up from Audrey's clinic and our four hour total, I was ready to break records. But it was not to be. Allotted only enough vaccine for between 100 to 110 injections, clinic would be over before 7:00 pm.

Arriving to the pharmacy, I met Lenore, the nurse assigned with me. Lenore told me it would be her first vaccination clinic. We gathered supplies, handed out forms and had approximately 30 people waiting for us before beginning. Lenore was recently married, a newlywed of three weeks. Her husband was a handsome gentleman who stopped by soon after we began the clinic to ask his bride if she could get away for lunch. Basically, she told him if she left her station we would most likely be mobbed. They both ended with " I love you, I love you too." This seemed to calm down some of the seniors. They must have been reminiscing about the early days.

And then the reality of the vaccine clinic came around to bite us again. "This is Disgraceful!" cried one senior. I remember her name was the same as a precious stone, Ruby or Opal because I thought she was a real gem. And I had to agree with her. It was disgraceful. This is the United States for God's Sake. Why are seniors lining up in lawn chairs taking a chance like a lottery for a flu vaccine?

Ruby/Opal didn't know what I had seen. Yes, I had to agree. But Ruby/Opal, I'm not responsible for the shortage. Still, I have to admire your spunk. You made a point of telling us it was a disgrace at least 6 or 7 times in a half hour period. I'm listening. Then Ruby/Opal added "I am going to call Newsday and tell them what's going on here!" Ruby/Opal, I think they may already know. In fact, I'm keeping my own little diary of the outrage. I was only thinking this.

Lenore and I kept working, at the same time telling her we would do our best to see that she received the vaccine. The seniors on line became irate at her continued interjections. Our pharmacist, Christina and her staff came through once again to provide us with more syringes. The staff also made sure we had a beverage and a snack and they couldn't have been kinder to Lenore and me. After this experience, I must say: A rose to all employees who work with the public on a day to day basis. Congress should supply you combat pay.

And Lenore, may your marriage be forever. When you look back after 50 years, remember you participated in vaccinating 108 patients three weeks after you were married in 2004. Clinics may be over, but the memories are forever.

Third Clinic Scheduled

13-October-2004, Wednesday 3:00 pm to 7:00 pm
Eckerds in Plainedge, NY

As I drove into the parking lot of the shopping center where construction has been ongoing for the last several months I thought maybe the new craft store was finally opening because there were so many people on line. Maybe a grand opening with a complimentary gift? In retrospect, I realize this was my brain's way of protecting me from immediately coming to the conclusion that the line was for VACCINATION.

Because it took another millisecond for me to process the fact that the line began at ECKERDS front door. Actually it began inside the store at ECKERDS pharmacy.

This would have been a good time getting out of the car to leave my lab coat in the back seat. But that actress in the video had her lab coat on at all times and her hair was perfectly coiffed. And after I put my hands though my hair and did the silent scream I looked like I had been standing outside starboard on a very fast cruise. And would someone please tell me why there were patrol cars in the parking lot? As soon as I was spotted I heard the crowd. There she is! With the first box of supplies, my pocketbook and my temperature controlled vaccination pack a circle began to form around me and the questions/comments began commencing in rapid fire: How may vaccines do you have?

"Let her through, she's important!" "Can I just ask you ONE question? Do you think you have enough?" "How many did she say she had?" "Move over and let her through!" "Nobody can go in the IN door! You have to go through the OUT door to get in!"

So as I went in through the OUT door, 4 police officers from the 8th precinct were there to help clear a path and escort me inside. As I neared the pharmacy I was hoping for a comrade, another nurse to do a reality check with. And there was Audrey, from the agency and I was never happier to see another nurse. As I went to retrieve the rest of our supplies the officers asked if I needed an escort to the car. I declined, telling them I'd just wave if I needed any assistance. It looked as though they were needed directly in front of the crowd to maintain law, order and control. I kept wondering about the timeliness in announcing a vaccine shortage when vaccine clinics had just started last week. Was it all about supply and demand? Was it a lot of hype? Was this same scenario playing out in other towns and other sites for vaccination? WHY? I would have to ponder these questions like everyone else. But later. Now we had to start this clinic. Audrey and I were going to do this together, with police presence for the duration of the allotted time. We had a system. We didn't identify the system that evening; there wasn't time. And police presence was part of the equation in this system. I was unaware of that until I reviewed my four clinic experiences.

In all clinics even though organized, we still had to deal with questions as we were doing other tasks relating to work. I would like to give you a flavor if you have not been in the trenches with the nurses for a vaccination program.

Imagine trying to complete required paperwork, draw up vaccine and answer a dozen people less than a foot away from your workspace (smiling is a prerequisite) about proper form applications relating to their needs, who is/isn't a priority for vaccination and maintaining your concentration for clinic standard protocol? Its challenging. It is not impossible for a nurse. Just challenging. You go with the flow. You are aware that seconds and minutes are ticking and time waits for no one, not even in your important vaccination clinic. You ask the police officers to check for line for any patients on portable oxygen and/or in wheelchairs. You know who your priority patients must be. The CDC made quidelines for vaccination after the shortage was announced. But it is not the law. They are guidelines. So do you ask a patient who is 50 years old on line stating an Asthma history to move on along? I didn't. But I did inquire about any current medications to confirm an asthmatic hx. And I realize that is no guarantee either. Almost everyone has access to an internet, thereby an internet search. If you are savvy enough, you can learn anything with a click. But I'm a nurse, not a detective. I'm sure many if not all the nurses participating in the clinics this season came across the same quagmires, namely the ethics guiding us in vaccinating those most in need of vaccination. By the way, who controls the distribution of the current vaccine? And if you're price gouging you have your own date with Karma.

I've digressed. Back to clinic. I only know this. That Audrey and I need to do our best. And I believe we did. Before you look at that number I would like to say thank you.

To the store manager Al, who checked in at all times, to the men from the 8th precinct who stood only steps away as we operated the clinic, and who checked the line and helped us bring in patients on oxygen and wheelchairs, to the pharmacy who once again came through in a pinch with extra syringes for our clinic. You all made it possible to record our best clinic as far as vaccinations in the 4 hour time span.

Many thanks from Susan and Audrey and I'm sure, the Public.

Total Vaccinations: 157

Second Clinic Scheduled

7-October-2004, Thursday, 3:00 pm to 7:00 pm
Eckerds in Woodmere, NY

Prior to this clinic the agency apologized profusely, promising there would be another nurse present for my second clinic experience. I was very happy to meet Nicole; we would be working together towards a common goal, vaccinating persons at high risk, completing our public health nursing assignment together. At this clinic more patients were present and lining up earlier. To save time I had pre-filled 50 syringes and labeled the date, time and lot number on front of the sealed plastic bags which held, by now, precious flu vaccine.

The manager at this store, Mr. Rose, gave us all that we asked for and managed crowd control like a seasoned marine sergeant. Organized and efficient; very important to run the clinic properly. There were no untoward incidences. As we neared the end of clinic we again required more syringes than the allotted amount in our supply box. Explaining this to the patients who were waiting on line, one man asked "How many more do you need?" (the pharmacy didn’t have the required needle size.) When we told him he left the store promising to "be right back." He returned a few minutes later with the required amount to complete our clinic. He was a podiatrist. I am sorry to report that I do not know his name. But I would like to tell him that because of his gesture, everyone left on the line received their vaccination. So thank you to our Podiatrist and store manager Mr. Rose from Susan and Nicole.

Total Flu Vaccines administered: 113

First Clinic Scheduled

5-October-2004, Tuesday, 3:00 pm to 7:00 pm
Waldbaums in Lawrence, NY

Procedure states to arrive 1 hour prior to set up equipment, introduce yourself to store personnel, begin required paperwork, answer questions asked of your potential patients.

Before I am leaving to drive to my destination the phone rings. The agency states they are having difficultly reaching the 2nd nurse. Well, that won't be a real problem, I thought. I've been in tougher situations before. I'll go with the flow, just like all the rest of my nurse friends and colleagues. I switched gears to the Nurse mantra: Expect the unexpected.

Several moments into the drive, 1010 WINS News Radio announced a flu vaccine shortage. Chiron operations had been suspended in the UK and the U.S. would have its vaccine supply cut in half. I wondered what effect that would have upon the scheduled clinics? Every nurse scheduled for these clinics, as well as the agency would soon find out. Arriving at the clinic, only 3 patients were waiting for the 3pm start time. Not too bad. No other nurse followed, so I began. The first half hour was similar to the video I had seen only a few days ago. After that, the best way to describe the situation was synchronized pandemonium.

As more of my potential vaccine patients arrived, some in the crowd became, well, let's just say "Rowdy." One man demanded to know why the clinic wasn't staffed with another nurse. Another man began arguing with two ladies letting them know in no uncertain terms that he was BEFORE them. Some of the group began defending my lone position in front of the pharmacy. "Leave her alone! Don't you see how hard she's working?" Gee, that video I had seen? It was a tropical vacation compared to this reality. However my priority was vaccination, paperwork and collecting the monies for private fees. Nurse, secretary and treasurer. Crowd control would need to be handled by someone else. And it was.

The store manager, John and one of his employees, Diane were so much help in this area I can't begin to thank them enough. Clinic progressed at a rather rapid pace; soon my manila envelope where I placed 20 dollar bills for private pay looked like the tissue paper surrounding presents in boxes under the Christmas tree, overflowing without rhyme or reason. (The actress in the video did not seem to have this problem.) More potential patients streamed in, by now many had heard of the shortage and were commenting as they received their injections. I continued vaccinating, collecting fees, filling out paperwork. And on and on it went. Work continued taking on a factory resemblance; but these were human beings, not parts. I was amazed at the masses.

And responsible for them. Close to 6pm, Kathy the pharmacist came to my table with a quart of Orange Juice. It was the best Orange Juice I have ever had. By 6:30pm I counted the remaining syringes. There were 10 left. And then I counted the line. There were 17 patients remaining. I asked Kathy if she could supply 7 more syringes to complete the clinic. She was able to accommodate the request. At the same time a woman on the line told me she worked for a surgeon in Garden City and offered to help with any paperwork to finish clinic. I was so grateful. I asked her to pull up a chair. This part wasn't in the video either but desperate times call for desperate measures. Her name was Linda.

Clinic had to be completed. Patients had to be vaccinated. We ended officially at 7:20 pm. Everyone on line that evening received their vaccines. It would be the only clinic I worked where that would occur. So I would like to thank John, Diane, Kathy and Linda for what you did not HAVE to do, but did anyway. You made those 5 hours and twenty minutes which went by in a flash, bearable. And I send you my eternal gratitude.

Total vaccines administered: 112

Prologue

As a seasoned nurse with past experience in Epidemiology and Immunogenetics, signing on for part time work during flu clinic season seemed to be a good match. Performing a public service by vaccinating was a tour I was looking forward to.

Eight clinics were given to me when I visited the agency all dependent upon my own schedule. Some were local, maybe I would even get to see neighbors or friends. I would only be able to do a total of four after media announcement of the Vaccine Shortage.

My first day at the agency consisted of regular screening protocol, test taking and viewing a video of a well run, synchronized Flu Vaccine Clinic location. In the video the actress was filling out required forms, drawing up Vaccine doses, answering questions (one at a time) and screening patients with regard to any contraindications after the patients answered 7 questions on the Immunization form. She reached out to other patients waiting in line (about 5) assuring her public they were doing their best to move everyone along the line as efficiently as possible. As I watched I thought, I’m really going to enjoy doing this. Besides, I’ll use this time productively until I decide to accept new employment in a full time position.

I aspired to run any clinics assigned to me with the same standards I had just seen in the video presentation. Yes indeed, this was a perfect match coupled with my past experience in Nursing.

It would take only the first clinic experience for those rose colored glasses to fall off my face.