I leave work on a Thursday evening, March 19, 2020, around 8 p.m. I don’t work again until Tuesday, so I am looking forward to a four-day weekend. There has been much talk today about the possible coming changes next week, but I deliberately push these thoughts into the background. None of us knows the extent of the changes about to overtake us. What we do know is the world-famous Mayo clinic is planning on stopping all elective surgeries and procedures in response to Covid-19, a novel corona virus, that has become a worldwide pandemic over the last couple of months. The expectation is that all ICU beds and ventilators will be needed to care for the hundreds of people who will develop complications from this respiratory virus. I am not sure what to think. I am 62 ½ years old. Thoughts of retirement are starting to swirl in my head. As the anxiety of the unknown grows, I begin to wonder how quickly I can exit from a lifetime of working here?
Since I don’t have the ability to check my work e-mail from home and I don’t have a smart phone which is necessary to check the e-mail and my work schedule from home, I am effectively cut off from what is happening in my department. Sunday evening, I receive an e-mail followed five minutes later by a call from my supervisor.
“You will be on-call this week. We have divided everyone into one of three groups. One group will work, one group will stay home, and one group will be on call this week. You are in the on-call group and you need to check each morning to see if you are needed. Because you are over sixty, we are going to try to keep you at home. Do you have any questions?”
I am caught off guard by the phone call and am completely unprepared to ask any questions.
“No,” I reply.
But after I hang up, I am overwhelmed with questions and the anxiety builds. I’m “on-call!” What does that mean? Am I supposed to be available every day? Do I have any days that I can go anywhere and do some errands? Do I have a schedule at all? Am I working 8 hours or 10 hours during my work week? Because of my age, I no longer work “call” (evenings, nights, weekends). Is all that now thrown out the window? How do I find out what my assignment is? I don’t own a smart phone.
I start out this first week of what feels like the apocalypse overcome by anxiety and stressed to the max. I find that I can’t relax enough to even enjoy my time off. All one hears on the news is the number of people who have contacted the corona virus and how many have died from it. People are dying “like flies” in New York City. The governor of Minnesota has declared a state of emergency. Schools are closed, non-essential businesses are closed, churches are closed, and all people are ordered to stay at home. If one does go out; it is decreed that you stay six feet from any of your fellow humans and wear a face mask. We have all become terribly paranoid of each other. We scurry around trying to kill every bacteria and virus as if this will save us from the inevitable. The world feels out of kilter and seems to be wobbling on its foundation.
The week of March 23 turns out to be a beautiful spring-like week. The temperatures are in the 40s and 50s and the warmth of the sunshine brightens the landscape. I decide to put away the worries the best that I can and enjoy this time to do spring chores in the outdoors. Afterall, if we are quarantined on forty acres in the country, there is so much freedom and so much to do – doesn’t sound like such a bad idea actually.
However, the problem for me with work still remains that I have no access to e-mail and no remote access to the company website. We are being encouraged to apply for and set up remote access so that we can work from home on projects or do continuing education. All this for me hinges on having a smart phone to set up these functions. I have never had a smart phone. I have never wanted a smart phone. I do not want to be another one of the idiots walking down the street staring at a smart phone. But the inevitable stares me in the face. I need to buy a smart phone. And so I spend three hours on the computer ordering an iphone7, upgrading our cell phone plan, and buying some accessories. By Friday, I am the proud owner of the amazing 21st century gadget. I make a trip to the medical campus the following Monday to download all of the pertinent apps to keep me connected to the rapid changes occurring in the operating room suite. My supervisor also informs me on this day, “We can’t keep those who are over sixty at home.”
I shrug. What is there to say?
So after being away from work for eleven days, I return on Tuesday, April 28 to an upside-down working environment. As I stroll down the hall from the parking ramp, I notice a table that has been set up by the main entrance door from the two ramps. It is staffed by several employees who are busily asking for badge identification from employees and screening non-employees for signs of illness. “Have you been anywhere recently where the corona virus is endemic? Have you been in contact with anyone who has tested positive? Do you have a cough, a fever, or are you short of breath?” I stroll on towards the locker room and climb the steps to the second floor. My chest hurts. My stomach is tied in a knot. I am short of breath and lightheaded. I wonder if I am ill and dying too but decide instead that I am just panicked.
In the past, we always picked up our scrubs in the locker room, but I guess they have been disappearing from the linen carts like the toilet paper and hand sanitizer have been disappearing from the stores. I notice the hand sanitizer in the anesthesia office has been secured down with rolls of tape. Hording of everything has begun. I follow the signs in the hall to the surgical management offices where one must show their badge to pick up a set of scrubs. Here we are also asked, “Did you take your temperature this morning?”
“Yes, I did.”
Dressed but not at all ready to tackle this new atmosphere, I head downstairs for my 9 a.m. start shift. There are only about ten operating rooms running as the clinic is only doing emergency cases. I am assigned to the Multi division to do lunches and then relieve someone who has been working since 7 a.m. We have been instructed to treat every patient as potentially infected with this new deadly virus. Since being a Certified Registered Nurse Anesthetist (CRNA) involves performing aerosol generating procedures (intubating patients for surgery and extubating them at the end), our job is considered high risk for exposure to the virus. As a result, many new protocols have been developed and they seem to change from day to day.
On this particular day after lunches and breaks are done, most of the cases in the main operating rooms are completed or being wrapped up. I call the staffing supervisor.
“I have four choices for you,” she says, “you can do coronaries in the cath lab, vascular lab, GI (gastrointestinal lab) or MRI.”
I scramble through the choices being offered in my head. How about none of the above? I have worked in none of the areas mentioned in the last four to five years. Once one reaches a certain age, they have always been offered the option of no longer taking call and that usually involves no longer going to any of the outfields. I feel like there is no longer any stability in my world. I feel like I have been dumped to the wolves. All the spoken and unspoken rules that have provided constancy and allowed me to function in this profession while struggling with some underlying health issues have been thrown to the wind. I want to walk out the door and never come back. Instead, I say, “MRI.”
The first question is How do I get there? I decide to go the unconventional way since I, at least, know I will not get lost that way. I travel through the second-floor hallway and down the back stairway which brings me to my destination on the main floor. Because of our new protocols, the young lady who is to have the MRI was intubated and anesthetized in the only OR behind the MRI suite. This involves only two people being allowed in the room while induction is performed. They must don their personal protective equipment (PPE) before the patient arrives. First comes the N95 mask, some kind of eye protection or face shield, the gown, and double pairs of gloves. Once the patient is asleep, the clock starts for a twenty-minute time wait while the ventilation system of the OR changes seven times before others enter the room or in this case, the patient can be moved to the MRI scanner.
I arrive just as they are preparing the patient to enter the MRI scan room. I feel like I am smothering behind my N95 mask. Now that she is asleep, I could wear a regular surgical mask but changing back and forth between mask types several times a day has become a huge hassle. It seems to be easier to just put the one on that is most important and wear it all day. But behind the tight mask, it is hot and leaves me needing to talk myself out of the feeling of needing to faint on a regular basis.
I hurriedly check all my pockets and empty them onto the supply cart. Entering the MRI scan room with anything metal can result in being sucked onto the huge magnet. I would look funny being permanently attached there and the hospital kind of frowns upon it. The magnet also destroys hearing aides and the magnetic strips on identification cards, so everything comes off. Now I am deaf as well as nameless.
We maneuver the patient into the MRI scanner along with the ventilator after making sure everything she is being monitored by is MRI compatible. The big heavy door slams shut, and I drop into the chair by the charting computer as the scan begins. I can watch the patient through the window and see her on the remote monitor if any problems arise. This scan is to take about an hour to two hours. I do a survey of the room. Where are the supplies if I need any? Where is the Pyxis machine that dispenses our drugs? I do not see it anywhere. I get up and scout out both areas looking for the allusive machine.
“Where is the Pyxis machine?” I question a couple of individuals who are lounging around.
One points to the door. “It’s out there and to the left.”
Really? That seems rather inconvenient. My patient’s blood pressure has been extremely low, and I know I should treat it, but I hesitate. How do I get what I need without leaving my patient? I guess I am supposed to have all these things before we start but being unprepared seems to be the norm while working in an unfamiliar area. I finally cannot assuage my conscience any longer and decide that I can make a quick dash out to the machine, grab the drug I need, and be back in less than a minute. The first thing I discover is that this machine does not dispense in the same manner as the ones I am used to using so it takes me a hair longer than I planned. I turn to re-enter the monitoring room and discover the door is locked. Uggh! I forgot about that. I have no card on me to scan in and I am locked out. This is just great! Frantically, I pound on the door. A few seconds later I am back in.
“Can you find a time to stop for a few minutes so I can run in and treat the BP?” I implore. The MRI tech soon gives me that opportunity and then the scan continues. At least, I know how to care for the patient during this part.
A few minutes later, the vascular lab CRNA lead comes by and offers to help me with taking the patient out when they are done and be my second set of hands while waking her up.
“We will be out of here in five minutes,” he pronounces, “We need to remember to take the circuit along to use in the OR. We won’t start any other sedation. We will just turn off the gas and run for the OR.”
I laugh. I think he is being just a bit overly enthusiastic, but I think I can keep up with that. I try to plan my steps, so I don’t forget anything.
A half an hour later, we pull the patient from the MRI scanner and load her on the transfer cart. I try to get my hearing aid back in and stuff everything back in my pockets while the other CRNA gets ready to leave the room.
“Are you ready? I’m going to head on out,” he says.
I grab the last few items and run out the door after him. As we enter the operating room, I look around confused. I was told by the anesthesia tech that she was putting the face shields and gowns in the room for us, but I can’t find them anywhere. This is frustrating. I can’t find the gloves either. This OR has a different layout that most of the others. Where is the computer?
“I think we forgot the circuit,” announces my helper.
“And I think I forgot to finish the chart and sign her out of it.” I add.
By now I am totally flustered. Trying to give good care and take care of oneself in this situation is clearly impossible. Oh well, we will do without the circuit. The patient is breathing fine on the anesthesia bag, so she is OK. Once I find the phone, I call the anesthesia tech for help in finding our personal protective equipment and then all I have to do is figure out how to transfer the chart from the scan room to here without leaving here. While the other CRNA watches the patient, I get the chart in order. By the time she is ready to extubate, we have obtained our garb and donned it. We now have our twenty minutes to wait before we can deliver her to the recovery room. I guess all is well that ends well. But I know one thing, it is time for me to retire before I lose my mind.
Leaving the hospital is a reverse of coming in. Our scrubs are to be deposited in special bins in the hall. In exchange, we receive a small orange coupon to trade for our next set of scrubs when we return. I am so looking forward to that week I have completely off as everyone decides what to do with all the employees when there are no clinic appointments, no elective procedures, and very few Covid-19 cases either. Maybe by the time I come back, we will all be deathly sick. Only time will tell.