I normally arrive at the hospital thinking about protecting my patients. Today it was all about protecting me.
Getting the Covid-19 vaccine had been a hope that sustained me through many of these last months of caring for patients hospitalized with Covid-19. I was looking forward to getting vaccinated, marking the beginning of the end of my worry about my own health in relation to this pandemic. I would be moving on.
“They’re advising that you get the shot in the nondominant side,” the nurse administering the shot told me. “My arm was sore for days.”
“I’ll take a better immune response over pain,” I replied, and held out my right arm.
My right side is my dominant side. I use my right arm more than my left, meaning more blood pumps through it when its muscles squeeze. Injecting a vaccine into the dominant arm is supposed to hurt for a shorter period of time because the vaccine gets distributed more effectively, possibly with a better immune response.
I took my selfie and waited the requisite 15 minutes. During that time, I began the shift from anticipation to watchful ministration. I was now the gardener who had planted the seed and now must water and tend it.
I rode my bike home, knowing that exercise after vaccination can improve the immune response.
When I got there, I was ready for a drink. But wait! Alcohol is an immune suppressant. I couldn’t take the risk. A dark stout, though — surely that would be healthful. I thought of how it was touted in my breastfeeding groups as a tonic to boost the supply of breast milk. I looked up the health benefits: stout is packed with antioxidants (though it probably doesn’t increase milk supply). I had a sip, but no more.
I cooked, chopping garlic cloves and letting them rest to maximize their allicin content and associated health benefits.
I know that chronic stress can blunt the immune response. So I had to put aside everything that came before the vaccine — the fear of moral injury, the sticky heat under my personal protective gear, the cold tears, the phones held to the ashen faces of patients lying in ICU beds.
My husband and I had an after-the-kids-are-in-bed video call with some friends, comparing notes on quarantine life, cackling over old jokes. “This is perfect,” I thought. Laughter is great for the immune system.
I had trouble falling asleep that night. I pinched and pressed ineffectually at my achy neck and shoulders — which long predated any arm soreness from the vaccine —since massage enhances immune function. I considered taking a naproxen, but didn’t want to dampen the vaccine’s action with an anti-inflammatory agent. I tossed and turned, ribosomes and receptors dancing in my head, until I fell into a restless slumber.
My husband let me sleep in the next morning, taking our son downstairs for milk and cartoons. I think he knows, even as a non-medical person, that sleep is what the immune system really needs to make a durable antibody response.
When I got up, I ate my typical breakfast — fried eggs with nutritional yeast — and took my regular dose of vitamin D. Maybe that would be my ticket to a neutralizing immune response.
I took a hot bath, resisting the urge to rise above the water’s surface. The heat would help my immune system’s enzymes function at maximal capacity, just like a fever does.
As I lay there, steaming, I thought back to everything I knew about the immune response to vaccines, and the immune system in general. When I studied it in medical school, I was both lost and fascinated. The PowerPoint slides on specific receptors in our bodies that naturally homed in on foreign invaders had me on the edge of my seat.
I thought of all the changes that had come to my life because of the pandemic. Worries of becoming infected, spreading it to my family, getting sick or possibly dying. Even worries about worrying. I thought of ending all in-person social functions, aside from the occasional backyard chat. Taking showers before and after leaving the hospital. The whole world grieving at once. I thought of the comforts I had found in routines: a preferred beer, an uncluttered table, a sweater shaver, a calming ritual of staring into our 4-year-old’s fish tank while he splashed with my husband during his pre-bedtime bath.
Strength has an odd meaning when applied to the immune system. An immune system that’s too strong or active can cause allergies and autoimmune disorders. What you want from the immune system is temperance: strike the right balance, respond but don’t injure, let the fever run its course.
I had fallen into the trap of thinking that a hot bath or sleep or vitamins or other things would help the vaccine protect me. I realized it was foolish to think I could craft a specific immune response through force of will. It made me feel as kooky as I thought were the people who talked about “boosting their immune function.”
I’ll never know if any of the things I did would make a difference immunologically, but I’m pretty sure getting worked up about it wasn’t helping my T cells and other immunologic protectors. What will truly protect me is when we are all vaccinated and then before, during, and after that, when we all act in ways that show we care and love each other.
I get famously sleepy when I’m sick. I once slept 72 hours straight, waking only to drink orange juice and go to the bathroom. On the third day, when I felt able to get out of bed, I went and sat on the door step, closed my eyes against the thin Vermont sunshine, and marveled at the body’s ability to heal itself.
I have to do the same now. Be at peace with the vaccine. Wait for the next dose. And let my body do the work.
Sharon Ostfeld-Johns is a pediatric and adult hospitalist with Yale Medicine, and an assistant professor in the Department of Pediatrics and voluntary clinical instructor in the Department of Internal Medicine at Yale University School of Medicine.