November 8, 2021

Patient, Provider, Immunocompromised, and Unvaccinated.

Central, Clinical Partners, Rural Health

Essay by Stephanie Grahek, Physician Assistant with Trauma & General Surgery

Life was going according to plan, even in the middle of a pandemic.  My husband and I celebrated our 25^th anniversary.  Our boys were healthy and doing well in school with one investigating different colleges.  I loved my job in Trauma and General Surgery at CentraCare.  Then last fall I started developing some pain radiating down my left leg.  It seemed a lot like the sciatica I had many years ago.  The symptoms progressed and physical therapy didn’t help.  In January, my doctor recommended an MRI that changed my life forever. The imaging showed a tumor in my sacrum.  Biopsy confirmed that it was a plasmacytoma.  Further testing led to a diagnosis of multiple myeloma. 

I started radiation to shrink the tumor and control the pain.  Then came surgery to stabilize my pelvis and several rounds of chemotherapy to get the disease under control.  Finally, an autologous stem cell transplant at Mayo—which is a bone marrow transplant where my own stem cells are harvested for the donor cells. The goal of the stem cell transplant, along with continued chemotherapy, is to put my disease in remission for as long as possible.

Immunocompromised

The cells of the bone marrow are the precursors to the cells circulating in our blood.  They create the oxygen carrying red cells, the disease fighting white cells, and the platelets that stop bleeding.  Multiple myeloma is a disease of a specific type of white blood cell called a plasma cell.  Our plasma cells produce the antibodies that fight infections.  The stem cell transplant wiped out my immunity and I’m basically starting over with the immunity of an infant.  All my childhood vaccines, all those colds and flus, my COVID vaccine…all of it was wiped out making me immunocompromised.

All my childhood vaccines, all those colds and flus, my COVID vaccine…all of it was wiped out making me immunocompromised.

Physically, I feel great. I’m young. I was healthy before all this. I’ve done remarkably well through all treatments. I no longer have pain. I don’t feel sick. I feel like I could return to the life I had before my diagnosis. However, when I was discharged from Mayo in August, the vaccination rate of Stearns and Benton counties was under 50% and the vaccination rate at the hospital was too low for me to return to work.  The team at Mayo felt it was too risky for me to return to the hospital. Yet.

In November, I’ll be one hundred days post-transplant and eligible for my first dose of the COVID vaccination series.  While the vaccine will undoubtedly help, I will always be immunocompromised because of the multiple myeloma. It’s an evil disease and a constant battle to keep in remission. I’ve wrapped my head around it, done a lot of research and I’m taking it day by day. Plus, I have great providers at Mayo and here at CentraCare.

Family and Work Family

CentraCare is a wonderful place to work, and I am proud of the work we do every day. The outpouring of support I’ve received from my work family – the nursing staff, physicians, other APPs and staff in general has been amazing. Absolutely amazing! Amazing beyond words! It feels really good to have a work family that is so supportive.

Families and work families need to be honest with one another. I know there is a lot of angst right now over the vaccine requirement. From my perspective as an immunocompromised patient, I have a great deal of anxiety over entering our healthcare facilities.  Patients like me do not do well when infected with COVID.  I need to balance the risk of exposure to unvaccinated people, whether in the general population or CentraCare employees, with the benefits of being seen.  Like many other patients, I have put off some of my general care. As an example, I’m due for a mammogram, but I don’t feel it’s worth the risk of potential exposure to unvaccinated staff and patients given the current vaccination rate. 

Our colleagues in the ER and ICU see it every day. These are our coworkers, friends, and medical teams we’ve trusted with our healthcare. Their message has been consistent. The vaccine works!

As a provider, I respect all my colleagues and CentraCare staff, but there’s something I don’t understand. To work at CentraCare, you must be vaccinated for mumps, measles, rubella, hepatitis B, hepatitis C, etc. Yet, in the midst of a global pandemic, some are refusing to get a vaccine that is proven to be effective against COVID. I have heard the argument about the vaccine technology being too new or rushed through the process. Or the objection to fetal stem cells in the research. Yet, if infected, many of these same people want the monoclonal antibody treatment.  Was it not also rushed to market? Can it be traced to fetal stem cells?  Or, do the rules or ethics change once you’re infected? Personally, I choose to believe the science. I believe what the vaccine has already shown in our own patients at CentraCare.  Our colleagues in the ER and ICU see it every day. These are our coworkers, friends, and the medical teams we’ve always trusted with our healthcare.  Their message has been consistent.  The vaccine works!

While we are all trying to make our way through this, I have learned a great many things about being a patient that I know will make me a better provider. Feeling safe is at the top of the list. If you are not yet vaccinated, please reconsider your position. It is the best protection you can give yourself, your family, and your patients.  

I have learned a great many things about being a patient that I know will make me a better provider. Feeling safe is at the top of the list.

More than anything, I look forward to December 15^th.  That is the day that I will be fully vaccinated for COVID (again). Then, I’ll be back at work in the hospital rather than working from home.  I’ll be with my work family doing what we all do best — taking good care of others. 

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