The staff at Capital Area Pediatrics is at the sharp end of the nation's vast swine flu vaccination push. They have been screamed at and cussed at, and some have gotten the virus themselves. One has already ditched the job.

"We are receiving an unprecedented amount of verbal abuse and threats to the staff at the front desk," Elizabeth H. Watts, the Northern Virginia practice's medical director, wrote in an urgent appeal to patients. "If we have staff quit, we will not be able to provide you with the service your family deserves . . . "

"Please do not yell at or threaten the staff in any way."

Parents clogging the phone lines seeking the vaccine are competing with hundreds of patients who already have swine flu, enraging both. Employees have ended up in tears. "They're just . . . they feel like they don't need it," Watts said of the stress.

For the past two weeks, thousands of people have been engaged in a fevered call-a-thon in the District, Maryland and Virginia, bombarding doctors' offices with queries even though doctors don't know when they will get more -- or any -- of the H1N1 vaccine. "It would be nice if it could be a more civil process, where we just walk into the office and leave," said Allison Evans, who called her pediatrician and obstetrician for weeks with no luck before lining up at a District clinic Thursday and waiting for three hours with her 3-year-old asthmatic son, James, and his stuffed panda.

But inside the doctors' offices, where the phones keep ringing, there are sick people to worry about. Watts said her practice's half-dozen offices from Falls Church to Ashburn have already seen hundreds of patients with swine flu. The Vienna office alone had 200 patients on a recent day, about half with the flu. Three doctors and some staff members have been laid up with H1N1. Although many have been immunized, some fell ill before the vaccine kicked in.

It's a confluence unlike any Watts has seen in 22 years. And it has turned the basic act of trying to be clear with patients into a minute-by-minute test.

The starting point is this: There's tremendous demand for limited vaccine, and the system for distributing it to private doctors' offices is opaque. It's not clear to the public or the doctors who is going to get what when.

Moreover, in a typical fall week, Watts and her staff would be racing through seasonal flu vaccinations about now. But because of the swine flu, she received only 20 percent of the seasonal flu vaccine she ordered and had to cancel clinics, irking patients. This flu season, there are more sick people now than at a normal year's winter peak. And the staff is simultaneously scrambling to immunize thousands against H1N1, shifting strategies on who is eligible after federal officials said production was slower than expected.

"It's all hitting together," Watts said. "And then parents are concerned and scared and want to do the best thing they can for their kids, so when they call, it takes a long time to answer their questions, which means that the sick people can't get through on the phone."

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