As British Columbians escape some of the strict health measures of the past four months, front-line workers have been chronicling their experiences as the province slowly reopens many of the places and services people took for granted before it all began.
The journal entries that follow – the second part of a two-volume series – cover some of their experiences from April to July.
- Dr. Jeevyn Chahal, family physician in Kamloops
- Jayne Hamilton, advanced care paramedic, Metro Vancouver
- Megan Lawrence, primary care paramedic, Metro Vancouver
- Dr. Cyrus McEachern, consultant anesthesiologist, Vancouver Acute Department of Anesthesiology, Vancouver General Hospital and UBC Hospital
- Rachel Mrdeza, emergency-trained registered nurse, St. Paul’s Hospital, Vancouver
- Dr. Steve Reynolds, specialist in infectious diseases, internal medicine and critical care, ICU physician and site medical director at the Royal Columbian Hospital in New Westminster
Dr. Cyrus McEachern, April 23
I’m optimistic for the first time in weeks; the hospital’s moral momentum has shifted from reeling back on our heels to leaning forward on our toes.
Still, I struggle to balance the intense workplace stress with my personal life. In a career that thrusts you at the front line of a crisis, it’s hard to shake off the pressure when you change out of your scrubs.
Jayne Hamilton, April 23
Is the virus here? That question crosses my mind every single call, every single thing I touch, every single shift. Every call is COVID – it must be. We wear full PPE regardless of the patient’s complaint, since COVID is the Great Imitator, and we cannot risk our safety or let our guard down even for a second. My mantra 1,000 times a day is, I will not get sick, I will not take this home, I will not give this to my loved ones. I will not say goodbye to a loved one over the phone as they die. I’ve been forced into that horrible position myself once, when my father passed away five years ago in another city. It was my only option to say goodbye, and it destroyed me. I am acutely aware of exactly what my patients’ families may have to endure as I take their loved ones away from them. To take people away from everyone who loves them, possibly for the last time, and to see the faces of those left behind creased with worry, hope and despair, is the hardest thing I’ve ever done in my 12 years as a paramedic.
Dr. McEachern, April 25
My morning coffee is terminated by a “Code Blue” in the cardiac surgery ICU. It’s a patient I met two days ago, right before his heart surgery. His heart is devastatingly sick, and he cannot be revived.
It haunts me to have been one of the last people he ever spoke with. I find comfort in that I was able to take off my mask to speak with him then, to smile, face to face.
I do not have this luxury with my next patient. She’s younger than me and has suddenly become deathly ill, possibly due to COVID-19. I’m asked to intubate her in the ICU with full protective equipment. She’s panicking. I try to calm her down with my words – an anesthesiologist’s first-line drug – but the respirator muffles my voice.
Her blood pressure crashes when I intubate her. The respirator amplifies my heavy breathing; I am terrified. I cannot lose another patient this morning.
I overcome my fear and resuscitate her. She survives.
Megan Lawrence, May 1
I now have to wear a silicone respirator with filters and a face shield for every patient I see.
Today I responded to someone who has a fear of hospitals. Me showing up, without being able to see my face, only caused more panic and anxiety.
On my right wrist I have a tattoo that says “Breathe,” surrounded by 12 birds representing members of my family. So I pulled up my glove, and the patient looked and saw, and they remembered to take some breaths. They were able to understand that I am here to help. I understand their fears and their anxieties, even if they can’t see my face anymore.
Dr. Steve Reynolds, May 1
Today I spent hours with COVID-positive patients with a camera in their lungs, cleaning out secretions and taking samples. Not a glamorous part of my job, but necessary to help the lungs open up and optimize their function in the sickest of patients.
Much of what we do is to minimize stirring up the virus, to keep it in the lungs as best as possible. Prevention is far better than protection. Today I knew I couldn’t do that. I was kicking the hornet’s nest today. No way around it.
I asked everyone to leave the room – no need to expose others for the luxury of having more hands around.
As I started the bronchoscopy, with all of the necessary tools laid out in an array, I had a quiet moment of realization. There was no doubt that the virus was on the other side of my mask. It was there, waiting for me to mess up. Thick in a cloud.
I decided to push through the procedures I’d lined up. I skipped breaks in an effort to conserve PPE and avoid doffing. By hour five, I was sick of it. The inside of the mask smelled foul. I was sweating through my three layers and had resorted to muttering to myself.
I finished. Resettling my focus to doff cautiously. I felt tired, frustrated and somewhat battered.
Jayne Hamilton, May 2
COVID has an untold death toll that can never be counted, a number that we as paramedics can only guess at, a number that will continue to grow long past the end of lockdown: An elderly patient who was afraid to go to the ER for a bladder infection lest they catch COVID and who we find unresponsive and septic beyond hope of recovery. A patient who ran out of their asthma inhaler and was too afraid to go out and refill it, and is now suffering an attack so bad that we can’t turn it around. An overdose patient that doesn’t get Narcan because bystanders are afraid of getting too close.
How do you tally that?
As I finished working on a patient who didn’t survive today, I realized these untold numbers are the real price of flattening the curve. Not our economy or our freedom or our social lives – these people’s lives.
Megan Lawrence, May 10
Today was a hard day. Another day being away from my family on a special day to celebrate mothers. I am at work today, responding to calls. While driving around, all I see are people at the beaches and people at the parks. People laughing and happy with loved ones. Part of me is happy for them to see joy again after such a long time of fear. Part of me is jealous that I can’t do that, being at such high risk. I can’t be around the people I want to see. And part of me is angry. We’re not in the second phase yet! Is no one listening? Does no one understand the risks this is putting us all in?
Jayne Hamilton, May 11
Gratitude – it’s a hard thing to hang onto in this strange and upsetting time. I’ve set an alarm on my phone to go off every single day at the same time, to remind me to think of something I’m grateful for. For just one moment of the day in the midst of all this anger, fatigue, fear and frustration, I demand of myself that I pick one thing I’m glad I have, and that alarm silently buzzes in the pocket of my uniform shirt no matter what I’m doing. COVID can’t have that moment.
Dr. Reynolds, May 11
I laid in bed this morning. Was my sore throat from snoring? Was I more congested than normal? Nah, I was fine. These were normal – nothing to be concerned about. A cup of coffee and a shower, and I would be fine.
It was about eight days since I was working in the ICU. The correct incubation period – perhaps a touch long. There was an almost overwhelming sense that if I ignored it, it would just go away. I could avoid the complications of contact tracing any folks I had been near, the embarrassment of telling them that even though we had been careful to do everything we could to maintain social distancing, they should watch for symptoms. What if they got truly sick? What if my professional choices, my failure to do effective PPE, caused them harm?
I reluctantly told my wife I was going down to the testing station when it opened. She agreed that would be wise and kept my anxiety at bay with the regular morning routine.
No wait lines, and a kind nurse greeted me. A foul 10 seconds while the swab sat at the back of my nose, and then I was left with my worries.
Now I wait.
Rachel Mrdeza, May 11
Demanding freedom and “the truth,” the anti-lockdown protesters showed up at St. Paul’s ER today. I was treating an elderly woman, acutely short of breath. Peering into our ambulance bay, I saw a small crowd with aggressive signs and loud voices. I held back from stepping into their line of sight in hopes of discouraging any confrontation and to allow myself a barrier from their negativity. If there is one invaluable thing I have learned in my nursing career, it is: “Do not engage.”
I’m saddened with the realization that these people believe their cause is worthy of taking attention away from ailing patients. As many countries crumble from within, I can’t help but wonder, what more do these people want?
Dr. Jeevyn Chahal, May 14
The virtual visits are easy for me but onerous for many patients. Many don’t have access to the internet, and others don’t want me to see them in their PJs. Today some of them sound relaxed in their own home, proud to tell me about their normal blood pressure, their exercise routine, their newfound abilities in baking bread. Others are experiencing Zoom fatigue, home schooling frustrations, work stress, insomnia, loneliness and fear. I spoke with a few of my sweet seniors who are in lockdown at their care homes. These are my favourite visits of the day. It is rewarding to talk to people who are so isolated. They are very thankful.
Seeing a patient in the office has become quite the process. Each patient is asked to wait in their vehicle until we call them in. My masked assistant unlocks the door, lets the patient in, provides them with a mask and leads them directly to the exam room. I’ve already donned my eye protection, N95 mask, gown and gloves. The patient encounter has become less social.
I find that some patients are unnerved as they witness all the precautions we’re taking.
Rachel Mrdeza, May 20
Leaning forward onto his hands and knees, my young patient tries to catch his breath. Sweaty, visibly uncomfortable and feeling anxious about his health, the only way to get immediate relief is to give his lungs some space to open up. As he looks up from his bed, he sees a team of doctors and nurses peering in from behind the glass doors.
The patient in the petri dish is our new normal in the emergency room at St. Paul’s. We face the most difficult decisions in these moments, as physicians decide to intubate, or not, depending on how quickly the patient is decompensating. Whether it’s two metres on the streets or two inches of glass in the hospital, we are constantly separating ourselves from the virus. Yet the virus does not stand alone. It stands firmly with the ailing patient behind the looking glass.
Dr. McEachern, May 22
The curve has flattened in B.C., and we’re enacting Phase 2: the gradual reopening of society and inevitable second wave of COVID-19 infections. As I mentally prepare for the uphill battle at work over the coming months to years, I reflect on the unbelievably challenging past 10 weeks.
We have done a fantastic job in B.C. Credit is due to Dr. Bonnie Henry’s excellent leadership, the public health experts, the general public who took social distancing seriously and all the essential workers who persevered through tremendous stress. We kept each other safe, we kept our patients safe, and I’m confident we’ll be able to continue that throughout the second, third and fourth waves as well. Good job, everyone. Great job.
Dr. Chahal, May 24
I’ve had calls from teachers asking for notes allowing them to work from home rather than returning to the classroom. These are teachers who are immunocompromised or look after family members who are immunocompromised. Our teachers are increasingly becoming the new wave of front-line workers.
I’m hearing from parents feeling the pressures of trying to educate their children at home. Many are having difficulty deciding whether to send their children back to school. I encouraged them to do what makes most sense for the well-being of their family.
I peek into the staff room at my clinic, and my five-year-old daughter is doing her “math seeds” and “raz kids reading.” She has been coming to work with me occasionally, as her dad is working and also needs a break. During pre-COVID times, I usually didn’t see her until 5 or 6 p.m.
She looks up and sees me, and sends me a thumbs up.
Jayne Hamilton, June 1
One thing that never stopped when the COVID pandemic took hold was that other issue B.C. has been battling: the opioid crisis. Something changed when COVID hit. Maybe it was the volume of these calls that went up a bit. Maybe it was the severity of the overdoses from an unpredictable drug supply. Or maybe it was the palpable spike in desperation from an issue that’s being swept away by a pandemic that’s of more pressing concern. I don’t quite know. But the urgency of it is fresh again.
My last overdose ended in a cardiac arrest on the sidewalk, in the middle of the night, with nobody around. We don’t know who called it in, and like so many deaths, we as medics will never know who this person was to someone.
Dr. Reynolds, June 2
To be honest, it’s tougher now. We’ve entered into a transition phase. At a time when we should be healing from this enormous burden, we have to change our focus to address a long backlog of surgery and folks who have their health care put on hold. Not only do we have to ramp up to make up for the surgery and imaging that had to be put on hold, but we still have deep-rooted challenges that are resurfacing. The only way is forward.
Rachel Mrdeza, June 15
While sitting at the triage desk, my patient’s eye darted furiously around the emergency department. She mumbled something about palpitations and wanting to see a doctor. Through the thick glass, I asked her to repeat herself, and she apologized for her soft demeanour, explaining, “I haven’t been around people for three months.” She looked incredibly fearful of everyone nearby. She needed to know she would survive this experience and it was okay to be here. As someone who personally believes in the power of human connection, I’m nervous for what’s next. Do we reassure people they’re safe to be around the things that once harmed them, or do we encourage them to stay away from it all, in the safety of their bubble?
Jayne Hamilton, June 20
The beginning of summer and sunshine in the province also brought with it a new chapter in the COVID-19 saga for paramedics: heat. I mean the kind of heat that has made me seriously contemplate what would happen if I just left in the middle of a call. Of course I never would. Another cardiac arrest call comes in, and I am chugging water on the way to the scene, internally cringing thinking about the next 45 minutes of being unable to remove the mask, gown, gloves and face shield. This isn’t what I’m supposed to be worried about on my way to manage someone’s end, but I can’t afford to not prepare.
Rachel Mrdeza, July 2
With foggy glasses and a large Michelin Man suit, I go through the motions of assisting in an intubation with all my COVID-19 gear on. As I expect to be next to this patient for as long as needed, I understand that I can’t drink water, I can’t go to the bathroom, I’m in a non-breathable suit and I am sweating profusely.
A patient walks up to the Emergency Department asking to see a doctor, so I direct him towards the triage desk, requesting he wears a mask. He throws the mask on and slides it under his chin, And I explain why he needs to wear it properly. He screams that he can’t breathe with a mask on, along with a list of profanities, and refuses to wear it over his mouth or nose.
The pandemic has been a Pandora’s box of issues for our society and overall well-being. I’ve been front row to the emotional roller coaster it has inflicted on our communities and among certain relationships. I beg every one of us, myself included, to continue to exercise empathy on a daily basis.
Jayne Hamilton, July 4
My phone rang between jobs while my partner was driving us toward coffee, and I smiled to see the name of one of my closest friends and colleagues flash up on the screen – nothing has kept my sanity more throughout this pandemic than the intense laughs and epic rants with my “people,” as I call them. When I answered, I didn’t even have the chance to say hello before I heard him say “Hey...” on the other end. I recognized the tone immediately – he was going to tell me someone died. A colleague who I did my first-ever ambulance call with, a friend and mentor I had once worked with for years, was suddenly gone. (It wasn’t COVID.) I took a deep breath and pondered, not for the first time in my life, how everything in the world just keeps moving when tragedy strikes.
Dr. Chahal, July 6
I have been reminiscing about how my practice has changed more in the past four months than it has in the previous 21 years.
In mid-March, most doctors were being introduced to virtual health care platforms for the first time. Literally the next day, we began to start virtual visits and telephone visits.
Many patients still ask, “Are you seeing patients in the office now?” I have continued to do that since COVID-19 arrived. I used to see approximately 35 or 45 patients in the office each day in pre-COVID times. Now I’m seeing five to 15 patients in the office, and the rest are virtual or telephone visits. In the past four months, there were only nine working days that I didn’t have patients in the office. I haven’t taken a day off from my usual schedule since December, 2019.
I can see myself continuing with virtual and telephone visits interspersed with office visits indefinitely.
This doctor will always be in.
Megan Lawrence, July 7
I never thought I would be on the front lines of a pandemic – putting myself and my health second to my patients, the fears of being exposed to the unknown. I was a proud paramedic before, but now I’m honoured and thankful to do what I do. I can be that voice of understanding, even if my respirator makes it hard to understand me sometimes. I can be that hand that reaches out and holds yours during the hardest moment in your life, and I know what you’re going through in that moment and remind you that it will be okay.
People often wonder why paramedics never run into a scene. The reason is that if we’re running, it instills that panic in the bystanders around us. If we walk, we can take deep breaths, calm our surroundings and prepare mentally for what we’re about to deal with. I feel like Dr. Bonnie Henry did the same with her daily briefings, being calm and collected. She showed us all that through calm and kindness, we can tackle this as one community.