Pause

Pause:

noun: 1. a temporary stop

            2. temporary inaction especially as caused by uncertainty.

verb:     1. to stop temporarily

2 : to linger for a time

The pause heard round the world came to our front door this week, when the Johnson & Johnson vaccine was put on hold after 6 people developed blood clots, one of them dying. As 7 million J & J vaccines have already been administered, this represents less than 1 in a million but it was enough of a potential risk to give the CDC reason to pause all shots.

V was among the millions of people scheduled to receive this vaccine; his appointment was for Monday. It was hugely disappointing for us, as it surely was for others, especially in underserved communities in which the J & J vaccine is particularly effective: it can be kept in a refrigerator and brought to people in rural and other hard to reach areas; it is easier to schedule with no follow up appointment, making it more user-friendly for many who might have difficulty getting to a vaccine site or for homeless people who might be hard to track down. For someone like V, who has a very difficult time with a shot, blood draw or any other medical procedure, the single dose is a game changer. Given past experience, he will be momentarily surprised and upset when he gets the shot, but if he had to get two shots he would be panicked and inconsolable upon entering the lab or pharmacy where the first shot took place and likely not be able to go through with it.

Pauses in the medical field are hardly unusual – there are often pauses we don’t even know about prior to the roll out of new medications, times when scientists and public health officials had to stop and weigh risk against benefit, possibly retooling or tweaking a formula before it reaches the public.

Pauses in general are so commonplace we often don’t even think about them. We pause to say grace before a meal, to give thanks when receiving a gift or good news, to catch our breath when exercising, to take a break in the workday. During the trial in Minnesota I’ve been watching pauses are frequent, whether it’s lawyers stopping to gather their thoughts, or a few minutes for the judge and jury to use the bathroom. There is now a pause until Monday when both sides will give final arguments and the jury will deliberate.

Pausing can be helpful as I’ve found during this past trying year.  To stop between activities or in the middle of them. During the darkest days of winter I often would pause and make myself a cup of tea, putting a hold on whatever I was doing or not doing to engage V and sip, smell, taste what was in my cup, pause and be transported for a few minutes, to feel grounded and centered and have a moment of joy in a dreary long day.  I would stop and take a few deep breaths before getting back to whatever was going on.   

I have been back on my bike this week and I realize how much I pause on the way to get anywhere. I shift gears, take a sip of water, look behind me to check on traffic since my rear view mirror fell off. I go on the sidewalk when there are too many cars parked on a street. There are no bike lanes where I live so like considering a vaccine, I need to balance between risk and safety, to keep moving and yet stop when needed. These pauses can be annoying yet they keep us alive. I also pause for flowers and dogs and other things that draw my attention away from the road.

I pause frequently while writing, I try to get into a flow and then it gets interrupted by phone calls or my own distraction as I obsess about things on my to do list that remain to be done. I call the pharmacy to ask about when the vaccine will be back. The NYTimes estimates 7-10 days, do they really have any idea if that’s accurate? Is it possible they won’t bring it back at all, that it won’t in fact be a pause at all? Will it play havoc with public health since it’s only heightened the fears and doubts among those who are leaning against getting vaccinated? How do we plan ahead?? It’s not the temporary inaction as much as the uncertainty that makes this pause so difficult to take.

The woman at the pharmacy says that we can get the Moderna vaccine on Monday or keep calling back to see if and when they will have J & J. They don’t know if they will carry it again. The pause may be more than that, we don’t know. It may lead to longer term disruption of the rollout that has been so successful to date. I pause to curse, to feel frustration that V is back to being unvaccinated for now, that once again we are in a large underserved minority, one of millions of disappointed people. And then I put the kettle on and take a deep breath.