Qatari doctor and QF partner-university WCM-Q alumna Dr. AlReem Al-Nabet, a fourth year Dermatology Resident Physician at McGill University, Montreal, recounts 24 hours on a day in her life at the frontline of caring for Covid-19 patients
It’s become a pandemic-induced habit – waking up before my alarm goes off. Mechanically, I make my morning coffee and head to work. I drive myself – that is safer.
During my morning commute I realize how quiet it is. Eerily so. It is deceptive. The outside tranquility is at odds with where I am heading: the Jewish General Hospital, a McGill University affiliated teaching hospital, now a designated Covid-19 treatment center – and Montreal’s frontline in the battle against the virus.
I reach the hospital. I see a few people outside the main entrance. As I park and walk in, they shout out words of gratitude and encouragement at us; they know what we’re stepping into.
My first stop is at the scrub machine to collect my scrubs. Oddly enough, before Covid-19 I rarely wore scrubs dispensed from the hospital.
Masked and capped, there is no longer a way to recognize who is who. Everyone is wearing hospital scrubs, from the attending physicians to housekeeping staff. A virus that is barely 120 nanometers in diameter has removed all sense of hierarchy. It has driven home the truth that no matter how small you think your contribution is, it matters. In a way it symbolizes one-ness – that we are all in this together.
I head to the conference room – normally, a 3 minute-walk. But due to restrictions on which corridors are restricted, this turns into an eight-minute detour.
I pass someone in a hallway. It’s a patient. How can I tell? From the raw look of fright and bewilderment in their eyes. They do not want to be here, especially not now – the terror in their glances says it all.
Being healthy makes me feel almost privileged. And helpless. Sometimes I apologize to patients – involuntarily. ‘I’m sorry you are in this situation’. ‘I’m sorry there is a pandemic’….what I’m sometimes trying to say is, ‘I’m sorry I’m helpless’.
At the conference room, the overnight resident starts briefing our unit on the new Covid-19 patients who were admitted through her shift. We call the resident a night-watcher. I ask how her shift went; if she managed to get some sleep.
The look in her eyes says it all: these are the worst nights she has ever experienced as a resident, with an unrelenting inflow of sick patients – who seem to be getting sicker.
She gives updates of our current patients: Mrs. X was not doing well, Mr. Y needs to be eye-balled. ‘Eye-balled’? ‘Who comes up with our medical lingo?’ I think.
We head downstairs to the Covid-19 unit, the ‘hot-zone’ as we refer to it. Here, all the patients are confirmed to have the virus.
Before we enter the unit, we don our personal protective equipment (PPE kits). I am grateful that we have everything we need; I feel safe and protected. In the interest of hygiene and safety, we are forced to leave our phones, pens and notepads behind. In the hot-zone I will be disconnected from the world.
While inside, we take our first rounds on the patients. We assess how they are doing. We tackle any issues that crop up during the next few hours. As physicians, this is outside our comfort zones; we are all equally uncomfortable dealing with a disease we are still learning about. We are learning on-the-go.
We stand as one team. Our goal is to help these patients as much as we can, connect them with their families, and give them the dignity and grace they deserve as they fight this disease – irrespective of the final outcome.
While we go about our rounds, we are accompanied by a Computer-On-Wheels, or COWs, as we call them. We also have a new electronic member - the iPad. We use it to allow patients to communicate with their families and loved ones. With zero-visitation policies implemented in most Covid-19 designated facilities, patients are alone. We are their sole connection to their lives outside; the links to their families – and a channel to make end-of-life discussions.
As I switch an iPad on, my mind flicks back to my medical training. We were taught to be compassionate, and build connections with terminally ill patients and their families. But via pixelated digital channels? No. Is it the same? No. But, nothing is the same. And if nothing is the same, then using a digital platform to have an end-of-life discussion with a patient’s son or daughter is the ‘new normal’.
We start with the sickest patients. As we move from room to room, I notice it’s warm. My face-shield fogs up.
I need to call a patient’s husband who has not seen his wife since she was admitted to our unit. Nor has he been able to speak to her over the phone. I use the iPad to make the video call.
As he answers, I can see the emotions on his face – a mix of anticipation, trepidation, and love. He speaks. She hears his voice crackle through the screen. For the first time in days, she responds to stimulation. I can see and feel the struggle inside her; her heart wills her heavy eye-lids open. She sees him. Her face lights up.
I’m grateful for my foggy face-shield; no one can see the tears course down my face and moisten my mask. A figure engulfed in a PPE kit, I feel like an intruder. I stand stock-still. As I watch them interact, I tell myself: ‘This is why I am here’. As a dermatology resident, I may not be the most experienced to manage this patient’s multiple co-morbidities. But as a human being I have been able to provide a different kind of healing: love in the time of Covid-19.
We reach the final patient. My face itches in the heat and dampness. But I dare not touch it. My glasses have slid down the bridge of my nose. I cannot adjust them for fear of contamination. I use a sterile tongue depressor to satisfy the itch and push my glasses into place. Tomorrow I will tape my glasses to my face. Tape: it’s been the savior during this time. Duct tape holds things in place. Emotional tape – mental reminders that we will get through this – holds us together.
I focus on entering my notes in a computer, struggling to type with the thick long-sleeved gloves. My mouth is parched. I’m thirsty. I’ll have to wait till we are done. What I see and do has begun to feel surreal; otherworldly. I miss being able to walk freely in these halls, coffee in hand.
We finish our rounds. Time to ‘doff’ – a fancy way of saying ‘remove your PPE’. Peeling off our PPE is in stark contrast to suiting up. Our movements – in slow motion – remind me of the images beamed from man’s first landing on the moon. We are extremely cautious. We know that while removing gowns, face shields, hair nets and masks, you can inadvertently aerosolize viral particles. This is where healthcare workers have the highest risk of contamination.
After ‘doffing’ we meet with the auxiliary team. We discuss measures for patients who are getting better, and will be able to go back to their homes or other facilities.
Most days generous donors and patients’ families donate lunch for the whole unit. As the junior-most member of the team, I am assigned to fetch it. Today, I am prepared; I have a trolley with me. The first time I went on the errand, I showed up downstairs and faced 3 cardboard boxes full of food – I had to use a wheelchair to transport the cartons upstairs.
If there is anything good that is coming out of this pandemic, it is the acts of kindness. Most of the nurses and doctors have no time to prepare meals. So, to have a warm lunch waiting for you after an emotionally-charged morning in the unit, is akin to sitting down to a home-cooked meal surrounded by your loved ones.
We troop back to the conference room; it’s time for our radiology rounds. We use tele-conferencing; we discuss the imaging of our patients with a specialists and receive input from other services as well. This allows for more collaboration between different specialties such as infectious disease, pulmonology and palliative care, to name a few.
A few of us begin making phone calls to families of patients, updating them about the conditions of their loved ones, and discussing treatment plans, or end-of-life care plans, for each patient. My list is long – more than I have ever had in my entire residency so far.
It is an exhausting and mentally draining session. As I read through the rows of names and contact numbers, a dull ache starts in the pit of my chest. It gnaws deeper as I speak to each family. Conversation is a fine act of balance – I want to tell them the facts, and convey a realistic picture of what is going on, while at the same time provide hope, because at the end of the day, hope is all we have to look forward to, during these times.
We receive an update – two patients in our unit are not doing well. I have to re-enter the hot-zone to evaluate them. I suit up in PPE again, but this time, I use the stairs; I feel soiled and contaminated, and do not want to expose anyone in the elevators.
The minute I step back into the hot zone, it hits me – I realize the real heroes of this pandemic are not the doctors. The heroes are the battalion of nurse, occupational therapists, physiotherapists, social workers, housekeeping staff, nursing assistants and unit coordinators who man the units, non-stop, during their shifts. There are in the hot-zone for 8-12 hours a day, each day and night.
We have new admissions and I go to see them. The problem with Covid-19 is we are still learning; guidelines are changing constantly. What we were routinely prescribing 3 weeks ago is no longer the standard of care. And as we learn more, the array of emerging symptoms is extraordinary.
When this pandemic hit Italy and Spain all specialists were redeployed, including dermatologists. One observational study found that 1 in 5 patients admitted with Covid-19 had a skin manifestation that ranged from rashes, to hives to vascular skin lesions resembling Perniosis, or ‘Covid-toes’ as we now call them.
So, as a dermatologist, my first inclination is to examine the skin of a new patient – that is what I have been trained to do for the past few years. But now I also assess their breathing and do a full physical exam as well. I am thankful for my grueling intern years – akin to riding a bike, the hours spent on perfecting techniques and skills, kicks in.
It is time for our team to sign-out. We re-group in our conference room upstairs and discuss the latest patients’ status with the team member who will be staying late – today it’s me. I like this time as it tends to be quieter than the daytime rush.
I update our patient lists and start working on discharge paperwork for patients who are leaving tomorrow. Discharge – the word make me happy, because it means that we helped a patient get better.
I leave the hospital. As I drive home, I coax my mind to wander to thoughts other than the scenes I left behind. I consciously make an effort to observe nature. I notice the pink-and-purplish hue of the late Canadian sunset; the green of the trees that line the road home. I do this so that the struggle I left behind in hospital is not replaced by another – inside me.
I serve myself dinner, and a dilemma – one which all healthcare workers are facing at the moment: we are all exposed to the horrors of the pandemic; the reality that Covid-19 has made death commonplace. But we’re not immune to it; we don’t want to be.
At work, we don’t have the time to pause and reflect on each day’s occurrences, or to talk about it. After work, if we slow down to process our experiences we risk being engulfed by our emotions. Then there will be more suffering – ours. So we consciously ignore the urge to dwell on or analyze each day.
It’s a sacrifice you make on the front-line of a battle that is as much within us, as it is out there.