Dr. Vincent Peyko: Battling Hard Daily Against a New Virus
Dr. Vincent Peyko, a clinical pharmacy specialist in emergency medicine at Mercy Health in Boardman, is hanging tough. You can learn more about Dr. Peyko at his LinkedIn profile.
How has the COVID outbreak changed your work life?
Healthcare, in general, is always a battle on many fronts. COVID-19 did not eliminate these fronts, but certainly became nearly the entire war. We had this new enemy that very little was known about. This new disease required an all-encompassing focus, an obsessive focus, because new information, new studies, new treatments, new everything comes nearly every day. With a new disease and new therapies, hyper-vigilance is mandatory. Clinical pharmacists are often the people other clinicians seek out to help answer the questions they may not have answers for. Working around the clock, I and other clinical pharmacists at St. Elizabeth Boardman and Youngstown hospitals, St. Joseph Warren Hospital and the entire Bon Secours Mercy Health enterprise respond and remain agile to the ever-changing dynamics of this virus. This includes meetings, discussions, evidence reviews, pharmacology and work with physicians and specialists to develop algorithms and further optimize therapy.
I did my residency and worked in New York City for more than five years prior to coming back to the Valley in 2016. Every day I was talking to former colleagues in New York and others throughout the country to try to gain an edge on this virus — trying to figure out what can work. Reading the never-ending literature… What, if anything, worked in China, Italy, Spain, Germany?
With new therapies come new monitoring. Our clinical pharmacy team reviews every single patient every single day under an absolute microscope to assure that any therapies for COVID without years and years of evidence will not cause adverse reactions to the patient.
New therapies, around the clock discussions with providers, day after day, week after week, with no days off. Everything became COVID, all the time! I was even dreaming about COVID.
The emergency department at Mercy Health Boardman was no different. COVID has become a great focus. A simple intubation has now become every healthcare professional wearing full PPE, but so have little things. Protecting patients and ourselves has now become our day to day. But we are beginning to see the light at the end of the tunnel.
How about your personal life?
My personal life is only just a little bit different. My wife, Meagan, has the patience of Griselda. Everyone in the hospital knows they can call me 24/7 for any issue, so my wife is used to me getting called all the time in the pre-COVID era; she is used to me reading and writing and getting little sleep. COVID has only put that a bit more into hyper-drive. Getting home and eating but then talking and texting with other colleagues and reading until I fall asleep. Waking up at 4 a.m. to read more and work more on potential solutions. And on any day I was not in the hospital, I was logging in from home to review my full list of patients to assure their safety. With a two-year-old daughter and five-month-old daughter and working full-time, Meagan certainly shouldered more of her share of the parenting than normal in order to enable me all the time to work, so no doubt she has been stretched by COVID.
Missing out on time with my parents, family, and friends has been a big change, too. Sure, we FaceTime and text. You never feel entirely isolated because technology keeps you in communication. But with a vivacious two-year-old, I just feel bad that her grandparents don’t get to come over and play with her or that she cannot play with her cousins.
The whole social distancing thing has my friends busting my chops. They laugh at me saying I gave up shaking hands two years ago. With my infectious diseases background, once I had my first daughter, I gave up shaking hands a while ago — not entirely, but I am always conscious of my hands and touching my face. It’s funny, with my daughter being born in November during such a devastating flu season for kids, I have been so vigilant about social distancing and hand hygiene among friends and family every day since November. So all of this focus on hand-washing is nothing new in my home. Meagan will tell you there were three different times pre-COVID that I had a little sniffle and every time I fed the baby, I had my face covered!
What steps are you taking to hang tough?
It’s trite but I hang tough just by taking things one day at a time. You will certainly be a better clinician when you take each patient one at a time. And when you take each day, one at a time, you reward yourself with the little things. The day-to-day routines of waking up my two-year-old, MacKenzie (although she is almost always waiting for me at the door when I come up the steps). Playing in her room until my wife grabs my five-month-old Stella. As we walk down the steps together, Meg getting Stella’s bottle, me putting together MacK’s breakfast and getting that 30 minutes of family time together before the chaos of the day ensues. But also coming home every night. Enjoying dinner, putting the kids to bed and sitting on the couch watching TV with my wife. I love to cook our dinner when I get home to decompress from my day, and work out to start each day. But, this simple day-to-day is all I need to hang tough. As stoic as I can be with routine, I will be looking forward to getting back together with family and friends. And a date night with my wife once all this ends!
What advice are you sharing with the people you love?
Be patient. There is a lot of frustration, angst and confusion with everything COVID. This is a new virus. New. Think about something like appendicitis. We have been removing the appendix for more than 100 years, but most people do not understand how revolutionary it was to figure out easier surgical techniques for removing the appendix – how long it took for something like appendectomies to become routine, how many failures there were getting to where we are now. Even take the common cold, something that has been around forever — still today we have no magical potion for it! We live in an age where we want a cure RIGHT NOW. But things take time. This virus is brand new, and any degree of mastery — from what we do in the ED, in the hospital, and in society — will take time.
Expertise carries the connotation that someone with it is an expert. To be an expert requires you to have successfully accomplished that act that makes you an expert, — usually many times over. This global pandemic is on a scale which we have never seen. Repeat: humanity has not experienced this. That means there are NO EXPERTS! Just people doing their very best to do the very best for everyone. I can tell you this: every single nurse, pharmacist, physician, emergency care assistant, custodial staff, cafeteria worker, IT staffer, maintenance person and everyone else I have directly worked with have in every way possible done everything they can to do their best for every single patient and each other during COVID. That can keep anyone hanging tough.
Can you convey more about what a clinical pharmacist does?
A clinical pharmacist is part pharmacist, part physician and part nurse. We are called ‘jacks of all trades’, ‘Swiss Army knives’ and ‘hybrids.’ In essence, we are a decentralized pharmacist that assures the safety and efficacy of every medication being administered to a patient. This may be as simple as preventing drug interactions or adverse drug reactions. But some of us round on clinical teams; we see the patients. Based on the wound we see on rounds, we may synthesize from the patient’s parameters the bacteria common in our hospital, the percentage at which certain antibiotics kill certain bacteria and the ideal antibiotic and dose. We monitor drips, respond to codes, are consulted by physicians to dose and manage certain medications and fulfill a thousand other responsibilities.
One singular event to sum up the role of an ED pharmacist is acute stroke. We want to assure the most rapid administration of a clot buster, but also assure that the benefits outweigh the risks and that there are no contraindications because a brain bleed is always a risk treating stroke. So, we have the tele-stroke neurologist on the video, the attending physician in the room, and I’ve already calculated the dose and am mixing the drug. During any downtime, we are discussing risks and benefits with the patient/proxy/family; myself or the nurse is priming the intravenous line with the clot-buster; I or the nurse is programming the pump. And if that drug is appropriate for that patient and the patient or proxy consents to therapy, the second the physicians give the green light, the nurse is starting that drug. No time lost. All parties — physicians, nursing, myself, the clinical pharmacist — working together to assure optimal therapy.