Working on the Frontline
Like many medical students, March was an uncertain and confusing time for me. With the cessation of clerkship activities due to the COVID pandemic, I looked for ways to help the Hamilton community. Frankly, the deluge of philanthropic efforts was overwhelming, and I felt dissonance when searching for ways to donate my time and energy. Initially I signed up to provide childcare and grocery support for a healthcare provider. It turned out that the family had two parents working from home, a nanny, and lived in a wealthy neighbourhood in Toronto. "Are we really helping those in need" I remarked to my co-volunteer as we took the children for their mid-day bike ride, "or are we just showing how most COVID support is actually furthering disparity in society?". Due to program restrictions, we could not support any other family, worsening our discomfort. As fate would have it, we were fined one morning by city by-law officers for violating social distancing, by taking the children to a local park. That promptly ended the volunteering, but opened up new possibilities.
Later that day, I applied to volunteer in a Long Term Care home struck by a massive COVID pandemic. Responsibilities would include soiled brief changes, hygiene care and bathing, and spoon-feeding - often for symptomatic, severely ill COVID(+) patients. I was nervous, not only for the radical shift in roles and expectations, but also because of one thought that kept circling through my mind. "What if I get COVID and become seriously ill? What if I die?"
Compassion. To me, compassion is an active word. To be compassionate is to actively think about the feelings and well-being of others. It means to care about and for others, at personal sacrifice. My goal for working in LTC was to be as compassionate a worker as possible. I wanted to take special care with each resident and staff member, understand their suffering, and alleviate it by any means.
My first day put these ideations to the test. It was harder than any single day of medical school. For context - nearly half the PSW staff at the LTC home had contracted COVID, and were home sick. PPE shortages were immense - to the point where we had a single gown, mask, and pair of gloves for an entire 12-hour shift. The work was backbreaking - an endless stream of soiled diapers, oozing ulcers, and dysphagic residents requiring patient spoon-feeding of puréed meals. One bed-bound resident managed to fall (GOMER falling from Ortho-height, anyone?) and suffer a head laceration - we cared for him amidst blaring call bells popping up like wildfires throughout the unit. I worked three more 12-hour shifts that week, and went back the following week.
Every shift was caustic to the senses. Each room possessed a unique odor - one of feces, one of the rank ammonia of urine, one of what can simply be labelled 'death'. Cognitively and sensorily impaired residents screamed, struck us, bathed their hands in feces and painted the walls and the staff with this odorous medium. Every movement was shrouded in anxiety - for the risk of contracting COVID was insidiuously omnipresent. Staff maintained social barriers with other staff; new volunteers (such as myself) were sent into close contact with coughing COVID (+) patients alone. So much uncertainty surrounded every action - did I just touch my mask? is my N95 sealed adequately? when did we last sanitize these door handles? this resident just started coughing - could they have the virus? Even "break rooms" were anxious places - what if the other staff weren't doing their part to keep surfaces clean? If that wasn't bad, then consider that the break room was a common place to hear rats crawling through the air vents, scraping at the ceiling panels.
Seeing COVID-19 up close has given me tremendous respect for this tiny strand of RNA. Anyone who says that COVID is "just the flu" is either willfully ignorant, or protecting their ego via denial. This virus has levelled previously healthy people. It has spread like no other infectious disease, and continues to worsen despite all measures being taken. Residents, already isolated from their families, spend all day in their room. They eat meals in their room, and do nothing other than lie in bed and watch TV. They are slowly declining into depression, feeling the effects of physical boredom, brains screaming for social stimulation. I've gotten to know all the residents well, and my encouragement has brought some of them out of their shells. I toss jokes back and forth with those cognitively able to engage, and take immense pleasure in learning their life stories, pleasures, and interests. I do my best to cheer them up - and I do a damn good job - but I cannot overcome the unspoken fear that permeates through the hallways. The fear borne from watching their close friends become bedridden, delirious, and pass away. The fear stoked by watching the news all day, hearing about how they are particularly at risk for severe cases of COVID. The fear that our deaf dementia patient fears when a pair of masked, shielded, gowned and gloved strangers come to change her briefs - from her perspective, assaulting her against her will.
Gradually, things have begun to improve. Nurses, physiotherapists, and even the occasional doctor have volunteered for deployment. PPE has been donated by the boxload, meaning we have enough to change our gowns and gloves between each COVID (+) patient. Some staff have returned from illness, looking gaunt and terrified to confront their invisible assailant. I was featured on CBC's The National, advocating for better PPE and support staff. Feeling the incredible support from our country has been uplifting. I love hearing everyone bang pots and pans at 7:30 PM, and the small acts of gratitude have grown my understanding of the compassion of Canadiana. I've become an adopted son of the PSW's on the unit - I brought them hand-picked flowers for Mother's Day. Soon, the outbreak will come to an end, and life will resume for everyone in the home. Well, everyone less the residents who passed away. And the friends or family who will continue to stay away from the home to protect their personal safety.
I want to finish by talking about one resident - Greg. Or as he is called by everyone "The Doctor". Greg was one of the only doctors in Toronto to treat HIV+ patients in the 1980s, and later, worked in Addictions at TWH in the 1990s. He is 89 years old, and has COVID+. Photos and resident accounts of Greg describe him as a vital man, always on the move, and enjoying his Thursday afternoon trips to the local pub for bridge games with his best friend. He was one of the first residents to contract the virus, and has been fighting it for the past four weeks. He is constantly coughing explosively, and his room is one that most PSWs and cleaners reflexively avoid. I understand this. These PSWs have also seen their friends become seriously ill from COVID. They all have families, and most of them are approaching the age cohorts that curve upwards when discussing mortality rates from COVID.
My job, since the first day, has been to spoon-feed Greg his meals. I'm pretty privileged to have this responsibility, because it's given me the chance to face my own mortality, every single day. He was a doctor, I am going to be a doctor. He lived the illustrious life, achieved the professional success, that I want, nay expect, for myself. And here he is, unable to move out of his bed, barely able to lift his head to take a bite. We moved him into his wheelchair using a mechanical ceiling lift, but had to move him back because he kept slumping forward. I am reminded of the film "The Curious Case of Benjamin Button", which may have been an allegory for regular life. We are taught about milestones in Pediatrics - these milestones reverse in Geriatrics. The elderly slowly lose their continence, advanced vocabulary, ambulatory ability, and ability to chew solid foods. Before long, they are completely reliant on others for care, surviving off straw-inbibed liquids and puréed food.
Every day, I sit with Greg for breakfast, lunch, and dinner. I play our favourite G.F. Handel classical music CD and we talk about his life. I ask him the big questions - What are your regrets? What are your favourite memories? What do you think happens after death? We see eye to eye on most of these topics. I give him the small courtesies I'd give to my own grandparent - rubbing his shoulder or back, treating him to extra ice-cream, and making sure he always has a mug of hot coffee. Most of the time, he is not lucid. He tends to doze off mid-sentence or mid-bite - awaking with a terrifying coughing fit. Often he greets me with the news "I am going to die today", to which I laugh and remind him of similar proclamations over the past few weeks. Some days, he threatens to punch me, or kiss me - equally terrifying prospects. I spend more than an hour, patiently spooning food or drink into his mouth, deciphering his gurgling speech and riding out the waves of confusion or nonsense.
I leave that room feeling drained, every single time. My body decreases respiration there, partly due to his tussive tendencies causing by COVID, partly due to the combined odor of death and urine. I am expending so much energy caring for him. And I keep going back. I believe that I am helping him. Not only am I easing his suffering, but I am injecting vitality into him. I am prolonging his life with care, love, and compassion, at my own expense. I still worry that I might contract COVID and die. Statistics are comforting, but anecdotes are not. Everyone seems to have heard of the healthy 23-year old Loblaws cashier who died in the ICU last week. 0.6% mortality among symptomatic COVID cases from 20-29 year olds is low enough for me to keep going. Still, I hold my breath when logging into the patient portal to check my most recent COVID swab results. I just want to hug my girlfriend, go home to my family, visit my newborn baby niece. But I won't - not until this is over. And neither will the hundreds of people across Ontario working on the frontline, many of whom do not have the privilege that I do - the privilege of an M.D. and escape from this home in the near future. We are so lucky to be medical students, to be born to families who pushed and supported us, endowed with the genetics and environment that gave us the work ethic to pursue and succeed to this point. We are privileged that we may complain about the rigors of clerkship or residency, write myriad reports about physician burnout and suicide, and limit the scope thusly, ignoring our hard working PSW colleagues. I have learnt more this past month than any other curricular programme of my life. This experience, these lessons, have shaped my perspective on society, the inequality, the disparity. I am grateful for having the privilege of working frontline during this COVID pandemic.
Like many medical students, March was an uncertain and confusing time for me. With the cessation of clerkship activities due to the COVID pandemic, I looked for ways to help the Hamilton community. Frankly, the deluge of philanthropic efforts was overwhelming, and I felt dissonance when searching for ways to donate my time and energy. Initially I signed up to provide childcare and grocery support for a healthcare provider. It turned out that the family had two parents working from home, a nanny, and lived in a wealthy neighbourhood in Toronto. "Are we really helping those in need" I remarked to my co-volunteer as we took the children for their mid-day bike ride, "or are we just showing how most COVID support is actually furthering disparity in society?". Due to program restrictions, we could not support any other family, worsening our discomfort. As fate would have it, we were fined one morning by city by-law officers for violating social distancing, by taking the children to a local park. That promptly ended the volunteering, but opened up new possibilities.
Later that day, I applied to volunteer in a Long Term Care home struck by a massive COVID pandemic. Responsibilities would include soiled brief changes, hygiene care and bathing, and spoon-feeding - often for symptomatic, severely ill COVID(+) patients. I was nervous, not only for the radical shift in roles and expectations, but also because of one thought that kept circling through my mind. "What if I get COVID and become seriously ill? What if I die?"
Compassion. To me, compassion is an active word. To be compassionate is to actively think about the feelings and well-being of others. It means to care about and for others, at personal sacrifice. My goal for working in LTC was to be as compassionate a worker as possible. I wanted to take special care with each resident and staff member, understand their suffering, and alleviate it by any means.
My first day put these ideations to the test. It was harder than any single day of medical school. For context - nearly half the PSW staff at the LTC home had contracted COVID, and were home sick. PPE shortages were immense - to the point where we had a single gown, mask, and pair of gloves for an entire 12-hour shift. The work was backbreaking - an endless stream of soiled diapers, oozing ulcers, and dysphagic residents requiring patient spoon-feeding of puréed meals. One bed-bound resident managed to fall (GOMER falling from Ortho-height, anyone?) and suffer a head laceration - we cared for him amidst blaring call bells popping up like wildfires throughout the unit. I worked three more 12-hour shifts that week, and went back the following week.
Every shift was caustic to the senses. Each room possessed a unique odor - one of feces, one of the rank ammonia of urine, one of what can simply be labelled 'death'. Cognitively and sensorily impaired residents screamed, struck us, bathed their hands in feces and painted the walls and the staff with this odorous medium. Every movement was shrouded in anxiety - for the risk of contracting COVID was insidiuously omnipresent. Staff maintained social barriers with other staff; new volunteers (such as myself) were sent into close contact with coughing COVID (+) patients alone. So much uncertainty surrounded every action - did I just touch my mask? is my N95 sealed adequately? when did we last sanitize these door handles? this resident just started coughing - could they have the virus? Even "break rooms" were anxious places - what if the other staff weren't doing their part to keep surfaces clean? If that wasn't bad, then consider that the break room was a common place to hear rats crawling through the air vents, scraping at the ceiling panels.
Seeing COVID-19 up close has given me tremendous respect for this tiny strand of RNA. Anyone who says that COVID is "just the flu" is either willfully ignorant, or protecting their ego via denial. This virus has levelled previously healthy people. It has spread like no other infectious disease, and continues to worsen despite all measures being taken. Residents, already isolated from their families, spend all day in their room. They eat meals in their room, and do nothing other than lie in bed and watch TV. They are slowly declining into depression, feeling the effects of physical boredom, brains screaming for social stimulation. I've gotten to know all the residents well, and my encouragement has brought some of them out of their shells. I toss jokes back and forth with those cognitively able to engage, and take immense pleasure in learning their life stories, pleasures, and interests. I do my best to cheer them up - and I do a damn good job - but I cannot overcome the unspoken fear that permeates through the hallways. The fear borne from watching their close friends become bedridden, delirious, and pass away. The fear stoked by watching the news all day, hearing about how they are particularly at risk for severe cases of COVID. The fear that our deaf dementia patient fears when a pair of masked, shielded, gowned and gloved strangers come to change her briefs - from her perspective, assaulting her against her will.
Gradually, things have begun to improve. Nurses, physiotherapists, and even the occasional doctor have volunteered for deployment. PPE has been donated by the boxload, meaning we have enough to change our gowns and gloves between each COVID (+) patient. Some staff have returned from illness, looking gaunt and terrified to confront their invisible assailant. I was featured on CBC's The National, advocating for better PPE and support staff. Feeling the incredible support from our country has been uplifting. I love hearing everyone bang pots and pans at 7:30 PM, and the small acts of gratitude have grown my understanding of the compassion of Canadiana. I've become an adopted son of the PSW's on the unit - I brought them hand-picked flowers for Mother's Day. Soon, the outbreak will come to an end, and life will resume for everyone in the home. Well, everyone less the residents who passed away. And the friends or family who will continue to stay away from the home to protect their personal safety.
I want to finish by talking about one resident - Greg. Or as he is called by everyone "The Doctor". Greg was one of the only doctors in Toronto to treat HIV+ patients in the 1980s, and later, worked in Addictions at TWH in the 1990s. He is 89 years old, and has COVID+. Photos and resident accounts of Greg describe him as a vital man, always on the move, and enjoying his Thursday afternoon trips to the local pub for bridge games with his best friend. He was one of the first residents to contract the virus, and has been fighting it for the past four weeks. He is constantly coughing explosively, and his room is one that most PSWs and cleaners reflexively avoid. I understand this. These PSWs have also seen their friends become seriously ill from COVID. They all have families, and most of them are approaching the age cohorts that curve upwards when discussing mortality rates from COVID.
My job, since the first day, has been to spoon-feed Greg his meals. I'm pretty privileged to have this responsibility, because it's given me the chance to face my own mortality, every single day. He was a doctor, I am going to be a doctor. He lived the illustrious life, achieved the professional success, that I want, nay expect, for myself. And here he is, unable to move out of his bed, barely able to lift his head to take a bite. We moved him into his wheelchair using a mechanical ceiling lift, but had to move him back because he kept slumping forward. I am reminded of the film "The Curious Case of Benjamin Button", which may have been an allegory for regular life. We are taught about milestones in Pediatrics - these milestones reverse in Geriatrics. The elderly slowly lose their continence, advanced vocabulary, ambulatory ability, and ability to chew solid foods. Before long, they are completely reliant on others for care, surviving off straw-inbibed liquids and puréed food.
Every day, I sit with Greg for breakfast, lunch, and dinner. I play our favourite G.F. Handel classical music CD and we talk about his life. I ask him the big questions - What are your regrets? What are your favourite memories? What do you think happens after death? We see eye to eye on most of these topics. I give him the small courtesies I'd give to my own grandparent - rubbing his shoulder or back, treating him to extra ice-cream, and making sure he always has a mug of hot coffee. Most of the time, he is not lucid. He tends to doze off mid-sentence or mid-bite - awaking with a terrifying coughing fit. Often he greets me with the news "I am going to die today", to which I laugh and remind him of similar proclamations over the past few weeks. Some days, he threatens to punch me, or kiss me - equally terrifying prospects. I spend more than an hour, patiently spooning food or drink into his mouth, deciphering his gurgling speech and riding out the waves of confusion or nonsense.
I leave that room feeling drained, every single time. My body decreases respiration there, partly due to his tussive tendencies causing by COVID, partly due to the combined odor of death and urine. I am expending so much energy caring for him. And I keep going back. I believe that I am helping him. Not only am I easing his suffering, but I am injecting vitality into him. I am prolonging his life with care, love, and compassion, at my own expense. I still worry that I might contract COVID and die. Statistics are comforting, but anecdotes are not. Everyone seems to have heard of the healthy 23-year old Loblaws cashier who died in the ICU last week. 0.6% mortality among symptomatic COVID cases from 20-29 year olds is low enough for me to keep going. Still, I hold my breath when logging into the patient portal to check my most recent COVID swab results. I just want to hug my girlfriend, go home to my family, visit my newborn baby niece. But I won't - not until this is over. And neither will the hundreds of people across Ontario working on the frontline, many of whom do not have the privilege that I do - the privilege of an M.D. and escape from this home in the near future. We are so lucky to be medical students, to be born to families who pushed and supported us, endowed with the genetics and environment that gave us the work ethic to pursue and succeed to this point. We are privileged that we may complain about the rigors of clerkship or residency, write myriad reports about physician burnout and suicide, and limit the scope thusly, ignoring our hard working PSW colleagues. I have learnt more this past month than any other curricular programme of my life. This experience, these lessons, have shaped my perspective on society, the inequality, the disparity. I am grateful for having the privilege of working frontline during this COVID pandemic.
