Doing Our Quarantime | Episode 2

If you missed Episode One, Teach Me, you can check it out here.

Episode Two: The Front Line

It’s been a month since Episode One, when I chatted with two elementary school teachers who used innovation and creative thinking to keep their students engaged and supported leading up to year-end. 

And in that month, things have been changing pretty rapidly as patios, salons and parks are starting to open up. But no one has seen more rapid change throughout this pandemic than healthcare workers.

Imagine being on the front lines, every single day, dealing directly with people presenting COVID symptoms. Now imagine that the equipment protecting you from that virus is quickly running out. And the disease control protocol you were given this morning, is different from the protocol you hear at the end of the day – and it will probably be different again tomorrow.

That’s how the past few months have looked like for this episode’s guest, Dr. Caitlin Carew, pediatrician at St. Joseph’s Health Centre:

I was actually working in Iqaluit and got back March 6th. Things just started evolving very quickly. In Iqaluit, nurses were starting to talk about, “do we have PPE supplies and do we have a policy in place?”

Remember that low hum of menace we all felt those first couple of days in lockdown? You’d better bet Dr. Carew and her colleagues were feeling it too:

We were starting to see posts coming out of the States and they told some really harrowing stories about patients who would come in, have a little bit of trouble breathing, and then within a few hours, they would have deteriorated so quickly that they'd be on a ventilator. They were running out of space in their ICUs and having to triage who received care. I can speak for myself and say that I felt scared. There definitely was an atmosphere of anxiety. Things were constantly changing and that's because everybody was trying to respond to new information coming in, in real time, and update policies to reflect that new information. We were taking in so much information, just like the rest of the general public was, and we're trying to make sense of it.

PPE is one of the new acronyms I’ve added to my verbal dictionary thanks to the pandemic. And that’s because Canada (and the world)’s supply of medical PPE was every news station’s top topic. So, what was Canada’s supply like? How were hospitals managing the situation? How are they now?

We had daily updates and a websites for employees to see what our PPE situation was on a daily basis. At CHEO, they had a live board up that said “this many masks”, and then how many days remaining based on current usage. You were considered in a pretty good place for PPE, and still are, if you had a 30-day supply. But when things really started ramping up, a lot of hospitals had a less than five days’ supply, and that was considered a critical scenario.

We were allotted two masks, and those are your two masks for your shift. It didn't really account for the fact that some people work 8-hour shifts, some people were called for 12-hour shifts, or 24-hour shifts. We were told to leave our masks on at all times, and if they became visibly soiled, then we could change them.

And what’s problematic about issuing only two masks? Why is that unusual?

When we're seeing patients who might have an infectious disease that could be spread by droplets, like the coronavirus, we wear a mask and a gown. And then as soon as we leave the room, we would take all that equipment off. And then if you went on to see another patient with that type of infection, you would put on a brand-new mask and a brand-new gown and brand-new gloves.

I think all of us are super fearful of the situation where, we contract coronavirus, don't have symptoms yet, and then accidentally cause an outbreak amongst patients or colleagues. And so the masks protect other people from us, but wearing the same mask that could have been exposed, and taking it off to have a sip of water or to eat a meal, then putting it back on, was high risk for us, contaminating ourselves with the virus. And that that's been the case up until two weeks ago at St. Joe's when we've now officially been told that we're allowed to change our masks in between patients.

For me, simply going to the grocery store is an enormous process of wiping down, sanitizing and being cautious, but what does it look like for doctors just going to work? How have their daily routines been adjusted?

Usually I go into work in casual clothes that are washing machine friendly. I basically just bring in the necessary items and leave everything else in my car. And then in the lobby of the hospital there's a screening checkpoint set up. They screen you for any symptoms or any new exposures. They scan your badge, they give you your masks. From there I usually go and pick up my scrubs from the scrub machine. I have a hair covering that goes on before my mask. I go get my face shield – we’re re-using face shields - so I go to pediatrics, disinfect it, put on my face shield. And then walking around the hospital, I try to have as little stuff on me as possible. So I have my stethoscope, my badge, I put my cell phone in a Ziploc bag, so that I can wipe it down.

And when I come home, I come in our back door, I take my shoes off and leave them outside. I actually strip down on our back porch and then run inside and go straight to our basement. I put my street clothes into the laundry machine. I go into our basement bathroom, which is my designated decontamination zone. It doesn't have a shower curtain. It has a makeshift curtain that's made out of recycling bags that my lovely husband taped together. I shower, wash my hair, throw on the laundry, get dressed into another set of clothes that are effectively decontaminated and carry on with my day.

And keep in mind folks, for doctors like Caitlin, that whole process may be happening at 7 or 8 in the morning after a 12-hour shift.

And because Dr. Carew is seeing patients exhibiting COVID-19 symptoms on a regular basis, coming into contact with the virus feels like just another day. Until she started experiencing symptoms herself:

I had a fever, I felt terrible. I had a bit of a cough and so I got the swab. And I had a little bit of bad luck in the timing of when I got my swab - things were adjusting from where the swabs were being run at public health versus at some of the hospitals. And so my swab got kind of stuck in limbo.

I was at home alone. There was a lot of uncertainty in the air, including how to actually get my swab results. I was spending hours on the phone every day, trying to find out where my swab was. I was worried about when I would be able to go back to work. And we knew that there were younger, healthier people who were getting really sick with it. So it starts to get in your head a little bit, even though you feel fine, you start to have this feeling of like, “am I going to wake up 12 hours from now gasping for air and need to be rushed to the hospital”?

Thankfully, her swab came back negative and she was back at work. But fear of catching the virus and spreading it, has made healthcare workers examine the stigma around calling in sick:

Doctors are notoriously bad for what's called presenteeism - showing up for work when you really shouldn't. I think with this, we've all been forced to be really cautious that if we have any symptoms, we're absolutely not going to work until we're feeling better. Which in some ways has made it easier because it means that inevitably you're going to have to ask someone to come in and cover for you, but inevitably you're also going to go in and cover for somebody else.

Not only have Dr. Carew and her colleagues fought tirelessly in the front lines against this virus, they’re also coming up with innovative ways to provide care:

I think there's been a lot of creativity of people figuring out how to continue to provide care to their patients, even though they're not necessarily able to see them in person. And I think it maybe has opened up an opportunity for a different model of care for some patients that we will hopefully keep going forward, which is kind of cool to see. It's put a huge time pressure to expand the possibilities of telemedicine in Ontario and across Canada. I think this has given us all a bit of a push to at least try it out and start to work out some of the kinks around it.

I recently had a mild health issue and realized, for the first time, that I wasn’t exactly sure where to go, or what to do – which is a scary feeling. Especially if you’re a new parent, with a sick child. Here’s what Dr. Carew recommends:

If you or your child is unwell right now, first find out if your pediatrician or family doctor's office is open. I know earlier on in the pandemic, a lot of people were just assuming that everything was closed, but there were actually lots of offices transitioning to virtual care models. If that's not an option, then depending on where you live, there are some urgent care and walk-in clinics available.  

But I think the most important message is that if you're really worried about your health or your child's health and normally you would go to the hospital, then you should still go. I would say pretty much every single patient and family that I've spoken to through this pandemic has said the exact same thing: “we thought so hard about if we should come here, we had multiple conversations, we called family members for advice.” People are terrified to step foot in a hospital but it’s important to know that hospitals have put in place every precaution that they can to keep people safe. Because now we’re seeing people are waiting longer than usual to be assessed. And sometimes because of that, they're sicker than they normally might be.

So, how can we help support our fellow healthcare workers beyond window signs and banging pots?

Don't take your foot off the gas in terms of your caution around spreading the infection. I know everyone has COVID fatigue, myself included, and it's starting to feel like it would be really nice to pretend that it's gone and go back to normal life. But that's not the reality.

The best way for the general public to help us out is by remaining really vigilant about wearing masks, especially if they're in indoor public areas, trying not to socialize in groups above what the government's recommending, and lots of hand washing. And if you have any symptoms, get tested and please stay away from other people.

With folks like Dr. Carew battling the virus on the front lines and coming up with innovative ways to provide us care, we can breathe a little easier during these tense times. But it’s important we continue to support them by wearing masks, washing our hands and sticking to physical distancing.

Has your career transformed extensively during COVID-19? I’d love to talk to you about the creative solutions you’ve come up with during this time. Give me a holler.