Some years ago, during one of his Lake Wobegon monologues, Garrison Keihler described March as God’s way of letting dry folks know what a hang-over is like. This year I think we had a bender, stopped cold-turkey, and went into the DT’s (delirium-tremons) withdraw for three months. In case you are wonder where I have been, and why I have not been posting… let’s just say, I’ve been in the hospital… working that is, not admitted… no Covid19 positive test.
While the rest of the country sheltered-in-place, put institutional settings into lock-down, and experienced panic runs on toilet paper, cleaning supplies, and baking supplies, we ramped up our work hours and went into a dizzying schedule as health care is a 24/7/365 business.
As a reminder, we work in an out-patient rehab clinic. We treat mostly vulnerable clients who are the highest risk for faring poorly with any infections (flu/pneumonia season should keep these folks home for a few months if their issue is not acute). As the news of Covid19 spread out of regions of China to regions of Europe, in February, we began to talk with our clients about transitioning to home programs for a few months. By mid-March when the USA leaders acknowledged that Covid19 had dissembarked to our shores, we were discharge them.
We went from our usual four-day per week out-patient schedule, to three, to two, to one. We got a lot of our annual continuing education reading done and checked off. We were anticipating extended time in the garden, austerity budgeting, etc. What we got was reassignment.
Our health care system (18 hospital alliance, numerous skilled nursing facilities and out-patient clinics) has a policy of full-employment/reassignment if your usual job is not available. With the Payroll Protection Plans funds, they set up alternative jobs for staff. We were given the option to train as PPE (personal protection equipment) Wingmen (sorry for the military and gender biased language…).
In anticipation of the strict safety and hygiene procedures, the PPE Wingman position was created to train a group of staff, mostly rehab therapist and radiology/imaging service technicians, to assist the nursing, respiratory, and medical staff to go into and come out of the closed rooms in a hyper-sanitized state.
When our new hospital was built about ten years ago, the administration wanted to create a welcoming image to patients and guests. A policy of no-equipment in the halls was established. Staff work was moved into behind-the-scenes stations of computers and supplies. Niches were built into the hallways to store equipment that staff needed regularly (IV poles, scales, lifts, scanning equipment, etc.). The visual would be more like walking into a moderate level hotel, with a floor to ceiling window at the end of the hall to give you a visual of the Shenandoah Valley and mountains at the end of the hall.
Covid19 required isolating the patients onto units that would take on very different, pragmatic, and maybe over-zealous units. Three Covid19 dedicated units were set up. CCU (Critical Care Unit) with 6 beds and potential for doubling beds in room as needed for patients with ventilator assisted breathing. PCU (Progresssive Care Unit) for those with high-flow oxygen and other breathing assistance other than ventilators. And, a regular unit for those who did not need oxygen or lower levels with nasal cannula assistance but would be isolated from the rest of the hospital. Most of the rooms were negative pressure rooms (e.g. flow of air in room is outward to prevent airesolilng particles from flowing into the the hallways and rest of the hospital), which require that doors remain closed except for quick entrances and exits of staff.
Our PPE Wingman world was the hallway. We never entered rooms. Those hotel style hallways were now filled with everything that medical staff needed within arms reach: carts staged with PPE (gowns, gloves, masks, eye-shields, hair nets), IV lines, syringes, lab tubes, O2 lines, glucose test supplies, etc.); trash and recycle bins (for N95 and procedure mask cleaning and re-use) lined the walls; IV poles were stationed outside the room to allow nurses to set up and adjust medications without having to go into the rooms. And, us.
Then there was the silence… maybe the muffled sound of a patient’s TV… the blurt of unit walky-talky communication as staff requested supplies to be brought to the rooms to reduce their need to come out once set and up and working with clients… and the click of the doors opening and closing. Like Pavlov’s dogs, I shall be forever conditioned to stop, turn, and look for which door was cracked open as staff requested some supplies. We called it Covid19 Wack-A-Mole game when three to four rooms had staff in them and we never knew which would click and open.
Thus, on eight-hour shifts, we would station ourselves in the hallway between whichever rooms staff were preparing to go into or were providing treatments, and listen for the doors clicking of the walky-talky squawking. Then the Easter-Egg Hunt for supplies would start. Warm blankets, bath wipes, linens, trash can liners, easy-peasy. Red tubes, Green and Yellow ring tubes, red top IV needles, 10mm versus 20mm syringes, ECG pads, dressings, Coban wrap, periwick’s… first try to figure out what unfamiliar words are, then try to find them in the supply rooms. Fortunately, we are not authorized to set up medications, so we just found a nurse to figure out what someone just called for.
Depending on the shift, different events plotted the schedule of the day.
First shift, 7a-3p, started with change of shift for unit staff. This was a slow time for us. We used this time to check and restock the PPE carts. By 8 a.m. breakfast trays arrived. Staff would then need to get gowned up, go in rooms, take glucose tests, then ask us to bring 2113’s tray. We would be standing outside the door with the breakfast tray. Then 2109’s, 2118’s, 2115’s, 2107… etc. Once trays were passed, we sani-wiped down the meal cart & sent it outside the unity for dietary staff to retrieve. As meals and self-care time ended around 9:30, and staff were out of the rooms, we did an inventory of PPE supplies for the next 24 hours, and made a trip to “The Store” where we requested supplies to restock “The Cabinet”. Lunch arrived a little before noon, and we started the process over. If all was quite after lunch, we would have some quiet time before wrapping up the shift. Before we left, we checked all the PAPR’s (positive airway pressure respirators, I think…we’ll just call them moon-suit hood breathing devices used by some staff and for code-intabation situations) and sent a report that their batteries were charged and hoods in good order.
Second shift, 3-11p, started with checking the PPE cart supplies. Dinners arrived around 5 p.m. About the time that settled down, 7 p.m. change of shift occurred (most of the unit staff work 12 hours shifts, 7-7). The new staff would then check on patients until about 9 p.m. A lull in activity, end of shift-checking, emptying trash bins, and checking the PAPRs.
Third shift 11p-7a… The Night shift. You might be surprised how much goes on over night in a hospital, and how many of the patient are awake at odd hours. The mid-night run lasts until about 1 a.m. Then silence and muffled coughing and TV’s. I caught up on all my OT journals back to 2016, and most of my magazines from the last year to the present. At 4 a.m. everyone awakes and starts lab-draws. We stand outside rooms with clean lab bags (zip-lock style bags) to collect tubes of fluid, run them down the hallway, put them into The Tube (pneumatic delivery system) and send them away. Meanwhile, the yellow alert light come on and The Tube, alerting us to check to in-coming medications, which often the nurse in the room is waiting for and wants delivered pronto so that she can administer it while gowned up. At 6:30 a.m. as suddenly as it began, all the activity stops. Change of shift is coming up. Carts and PAPR’s can be checked. E-mail reports sent.
Time to check Mr J’s Bagel menu to decide what will be on our minds for breakfast if we are driving home.
Now, you may have noticed the less-than-subtle implication that our reassigned job might be scheduled at times other than M-F 8-6. I think that the most 11-7 shifts we did in a row was three, leading up to Memorial Day weekend. And, we found the most efficient sequence was Friday 11-7, Saturday 3-11, with Sunday 7-3. Eight hours on. Eight hours off. Fortunately, we have a friend who lives 10 minutes from the hospital who offered us the guest room. We tried to get about 4 to 5 hours of sleep between shifts. Did I mentioned that we are on either side of 60? Old dogs, new tricks. We keep our PPE Wingman clothes washed (with vinegar added to the load) and packed in our PPE Wingman suitcases for the next round of work.
Well, now you know where I have been for the 92 Days of March, 2020.