Saturday, October 14, 2006

The Phlegm and the Fury

As a nurse, I absolutely dread the advent of flu season. Obviously, I personally dread getting the flu myself. It's debilitating, demoralizing, and seems to take forever to recuperate from. It necessitates lost days at work, eats up my earned time for future vacations, and can set me back physically for weeks.

Aside from my own selfish reflections vis-a-vis the flu, I loathe the inevitable confusion and rancor over flu vaccine stocks. First, we usually hear that last year's problems with inventory and distribution have been solved and that "this year will be different". Not long after that pronouncement, we generally learn that the clinic has not received the number of doses ordered from DPH, and that our affiliate hospital system is having problems obtaining its full allotment. Aside from that, tainted vaccine and factories failing inspection always seem to make the evening news.

As the patients' panic calls begin to pour in, I do my best to quell fears, subdue the masses, and fight to get my hot little hands on enough vaccine to inoculate the thirty or forty most vulnerable of my caseload. Failing my ability to adequately meet my patients' needs, I punt, sending them to any and every flu clinic that I can locate in the city.

For people with AIDS, cancer, hepatitis and COPD, a year without a flu shot seems unthinkable, although I try to also educate them that a vaccine will not protect them completely. It's also hard for them to understand that a bunch of scientists basically takes what amounts to an educated guess as to which strain will snake its way across the US this year. They've been wrong before, and sometimes you just have to get sick.

Aside from the struggles over the vaccine and its relative lack or abundance, the sick calls then begin. Patients with the flu---even though it's definitively a virus---inevitably want antibiotics. While some protracted viral illnesses will indeed manifest secondary bacterial infections in some part of the respiratory system, we try to assist our patients to "tough it out", weather the storm, soothe the symptoms with NSAIDS and fluids and rest, and call us in the morning. This tactic is the most difficult to finesse, especially when our patients are used to using medicines to eradicate symptoms. Sometimes, I tell them, you just have to slog through the phlegm and the fury to get to the other side. They're generally not amused.

So, as October winds up into the middle of the month, Flu Vaccine Fever will soon spread like TB on a hermetically sealed city bus. The symptoms: frequent calls as to when the shipment of vaccine will arrive; requests for prophylactic antibiotics; requests for prophylactic Percocet (why not?); and panicked calls with fears that the dreaded illness has finally struck pay-dirt in the patient's home. My mantra: fluids, Tylenol (Ibuprofen if any liver disease is present), more fluids, sleep, more fluids, more sleep, and still more fluids. And don't forget to sleep. And, oh, did I mention the fluids?

The Flu Vaccine Fever will soon be upon us. May compassion fill my heart, may patience be my guide, and may vaccine supplies flow like champagne at a wedding.
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