Dr. Nykki's mom and granddad
Two people who are excited about this vaccine – my mom and her dad – from my 2017 archives

Introducing Mom…

Today, my mom called me to let me know that she had received her first shot of Pfizer’s vaccine. She’s a pretty healthy not-too-much-over-70 woman who assured me that the biggest symptom she has had so far was a feeling of amazement and dawning relief. 


We are all carrying around a lot of stress and anxiety — for so many reasons — and I think it’s important that we continue to acknowledge that. It’s okay to feel anxious! It’s also okay to be tired of living under a burden of constant vigilance, because that is emotionally and physically exhausting, and we have been living under COVID vigilance since roughly March of last year to varying degrees. 


Take care of yourself, if you can, this coming weekend. Go outside if that’s feasible for you, and take some time to breathe fresh air (if you are quarantining or isolating, then take appropriate precautions to avoid others breathing your freshly-exhaled air, but get some fresh of your own). Write a letter to yourself or so  meone you care about (It’s okay! Wash or sanitize your hands after handling your mail because that’s good practice any time you handle something a zillion people and machines have been touching, but the risk of getting COVID from your friend’s letter is minimal, if any). Make some tea, if you enjoy tea. Take a long bath. Get dressed in nice clothing if you have been living in sweats. Exercise if you have not been (exercise outside if you can): exercise triggers your body’s natural antidepressants. 


None of this is going to make it okay that we’re living lives of vigilance and separation. But the really amazing thing about human beings is how good we are – when we let ourselves – at finding creative ways to solve our problems. Give yourself permission – because I am giving you permission – to be your most amazing self this weekend. I’m interested to know what that looks like, if you decide you want to share.

Mom had a vaccine question for today’s diary: 


What happens if I don’t get my second dose right at 21 days (or 28 days)? What if my second shot is late?  


Short answer: 


You’re still considered to be fully vaccinated, even if your second shot is waaaay after your first, although we don’t have data to give you a definite answer beyond 6 weeks yet. That’s consistent with our recommendations for all the routine vaccinations you’re likely to get — we don’t generally restart shot series. 


Long answer: 


Most vaccines – regardless of the trick they use to do it – work by invoking your immune system’s short-term defenses and long-term memory cells. For vaccines that are given in a series (like your childhood shots are), each shot builds on the memories of the one before it, reinforcing the protective responses of your immune system to create long-lasting defenses. 


Let’s look at tetanus as a great example. The idea behind tetanus vaccination is to protect you from Clostridium tetani infection, which causes tetanus (cheerfully known as lockjaw to some folks). C. tetani lives in dirt and makes a toxin that causes serious muscle spasms, and getting tetanus naturally does not protect you from future infection (yikes!). Fortunately, we have an extremely effective set of vaccines to help your body protect itself against tetanus. We measure that protection by checking levels of tetanus antitoxin. 


The first dose of a tetanus vaccine creates almost no protection — but it primes your immune syste for the next; after the third dose nearly every vaccine recipient has high enough levels of tetanus antitoxin to safely step on a dirty nail without getting lockjaw (I don’t recommend stepping on nails regardless). That protection lasts for about 3-5 years, so we give a booster shot to kids who are entering kindergarten, and another one in the early teenage years. At that point you may be protected to some degree for 20-30 years because your immune system remembers – but we still currently recommend a booster every 10 years to keep the memories fresh, and if you happen to encounter a dirty nail we’re going to give you a booster dose to make extra sure you stay safe.


If you happen to miss out on one of those childhood doses, we don’t make you restart the series – because we’re counting on the long-term memory cells (remember the memory B and memory T cells? We talked about those a couple of weeks ago) to pick up where they left off with the next vaccine in the series. For almost every vaccine on the market (exceptions: certain cholera and typhoid vaccines), that remains true; we recommend a minimum time to wait between vaccine injections in order to let your body finish round one of recognizing and remembering so it can launch its best response to round two, but there is no maximum time. 


The data we have at this point is only good for a delay of about six weeks between vaccines, and only on the Pfizer vaccine. Because Moderna’s vaccine is so similar, we are making an educated choice to treat it similarly, and as we continue to vaccinate more people – and make difficult decisions about how to distribute a limited vaccine supply – we may learn more (scientists love data! Even if it’s not in a controlled experiment) and be able to expand that information. 


For now, if you have gotten two doses of the Pfizer or Moderna vaccines – spaced at least 21 (Pfizer) or 28 (Moderna) days apart (the CDC says you can have a grace period of up to 4 days early), then you are considered to be fully vaccinated. 


And thanks for asking the question, Mom!


Memory Care

Quick update tonight: I had a headache this morning, but I went to the gym anyway and by the time I was done doing a ridiculous number of squats it had gone away. One of my partners had to call out sick today after their second dose, though. Your mileage may vary. 


Today’s everyday superpower I have manifested: being home in time to say goodnight to all three of my children. 


I’m unlikely to get to a full Vaccine Diary tonight;  on Tuesdays I come home late, eat dinner while my shower warms up, and then go back to all of the less-urgent messages I didn’t answer during the day.  So here is a vignette instead. 


Tuesdays are nursing home days, and no matter how much time I spend there these days, it’s never enough. I find myself holding hands in the memory care wing, carrying on conversations born in Wonderland, finding graceful ways to exit a never-ending loop of unlost memories.  


We had a coronavirus outbreak in this facility. Many of the patients whose hands I am holding today are survivors of it. They are more fragile than I remember them being before; less fragile than they were when I came – clad in disposable gown and gloves, surgical booties and bonnet, face shield and N-95 mask – to see them on the isolation ward. 


None of them are the same as they were. 


And neither, really, am I.



This is our shot

Do I look delighted? Because I am excited! Second dose of Pfizer’s coronavirus vaccine is in.

Now it is a waiting game, as my body replicates, recognizes, and remembers. I’ll pick back up with my #covidvacccine diaries as long as I can carve out time to.

Today, IDoH opened vaccination to all residents over the age of 80. 33,500 Hoosiers over 80 registered for their shot between 9:00 and 11:30 today.

Right now, my arm hurts and my heart is light.


An empty room in black and white

Empty Beds

I made nursing home rounds today. 

I am working through unpacking “long covid”, and also unpacking the reports of folks who did not sail through vaccine administration as smoothly as I did, but the absence of people for whom I was as familiar a face as their own families hit me unexpectedly hard, and I don’t have the words today. 

This is not a post about COVID vaccines, and it is a post about COVID vaccines.

I am thinking about my friend spending twelve and fourteen hours at a time in a moon suit, striving desperately to save people I can no longer manage as outpatients, whose tired eyes reveal the truth when she tells me “I’m fine.”

I am thinking about calling families to ask them if they want to come say their last goodbyes, or if they want me to keep fighting, knowing that if they choose to keep fighting then their goodbyes may have to be said by video chat, a long way from home. 

I am thinking about my office staff calling people every day at home. “How is your fever? Are you short of breath? Can you check your oxygen level?” and about the way sometimes we are the only contact people have in isolation. 

I am thinking about video chats from my living room late in the evening to decide whether a baby is sick enough to need admission, because life doesn’t happen during office hours, and about drive-by lung examinations the next day, just so we will both sleep better. 

I am thinking about life, and death, and about the glimmer of hope this vaccine represents to so many of my patients, who have lived their lives in isolation since the first thaws of spring this year.

They are counting on me. On us. On science. On the infinite ingenuity of humanity. 

There are too many empty beds already. And all we can do is all we can do.

A Brief Update


Last night I went to sleep and didn’t get up until the next morning (h/t Arlo Guthrie). I still have no superpowers, other than the perfectly ordinary superpowers I’ve always had. I feel good physically.


It’s been a long day of catching up on things I’ve meant to do and it’s late. I’m going to keep this update short, because I haven’t had time to do my research properly. 


Questions for today, being pushed to tomorrow: 

  • If I have had Guillain-Barre syndrome in the past, is it advisable that I get the COVID-19 vaccine? 
  • If I am a COVID “long hauler”, is it advisable to get the vaccine? What if my early antibody tests were negative?



Dr. Nykki in her mask