The New Normal For Now

I have been throwing around the idea of starting writing about my PTSD for awhile, but the state of the world  as of late has shifted the focus of what this blog will entail for the foreseeable future. As a healthcare worker in the age of COVID-19, life is dominated by this new pandemic and many of my plans are now revolving around this. But I really felt I need to share my daily experience with the world after reading this article toward the end of my shift on March 29, 2020.

I regularly have a beard. Because facial hair doesn't allow the N-95 mask to seal properly on my face, I have used a PAPR respirator. It has a battery operated filter that blows air into a hood that allows me to breathe in the presence of a patient with an airborne illness. The most common use up until a couple weeks ago would be a patient that may have tuberculosis. I believe my hospital has 8 PAPR respirators. 8 has always been more than enough. they are supposed to be decontaminated after each use, and the hood is disposable.  The first few days, they were easy enough to come by, but now you are highly unlikely to get your hands on a fresh one. If you do, the battery is likely to be close to dead. I learned this the hard way when my PAPR unit started beeping very loudly and my patient said I sounded like a truck backing up. My unit died as I was walking out of the room. It is almost impossible to breathe in this thing when the air stops flowing.

I have stopped going to Central Stores to get a PAPR unit when I have a COVID-19 patient because they never have them, and I have learned where to find them. The third floor of my hospital is where our patients with symptoms are mostly treated. Those really sick are in the Intensive Care Unit. ICU has the majority of the PAPR units. There is one on the third floor, and I assume the rest are in the Emergency Department. The ED is set up almost entirely to receive patients with COVID-19 symptoms.

Most of the patients I see with COVID-19 symptoms are going to be on the third floor.  I was lucky enough a few days ago to be given a brand new PAPR hood. they are disposable, and I do not know how may times they are supposed to be used, but I have been using mine for four days. There is a cart where the PAPR is supposed to be located on the third floor, but it is rarely there.

This is my ritual before going into a COVID-19 room. At least how it went today.

I have to draw blood on the third floor, that means I have to bring my PAPR hood with me on top of all the other gear I need to carry.  I get to the cart, the unit isn't there. I know it is likely somewhere on the floor, so I go room to room. I find it outside of a room. It is plugged in, so at least it's charged. I hope that the last guy who used it disinfected it, but seeing how it was on a random countertop outside of a COVID room, I imagine it's contaminated. I glove up and wipe it down with a disinfectant wipe before carrying it to my patient's room.  When there, I sanitize my hands, put on gloves, and prepare all my supplies to draw blood from the patient, then I assemble the PAPR unit. the hose must leak because it is taped together. There is a testing unit with a marble. if the marble blows above the line after it is turned on, the airflow is strong enough. Despite the tape, the unit is blowing enough air to pass. The filter unit is heavy, it is attached to a belt that goes around your waist, and it is hard to turn on once you are wearing it. I turn the unit on, fasten the belt and pull the hose up over my shoulder. I hold the hose on my shoulder with my face to keep it from falling on the ground and getting contaminated. The gown goes over the PAPR unit, but I cannot make it fit over the hood without tearing it, so the hood goes on last. I remove my hood from the bag, making sure to leave the bag in a way that I can place the hood back in it without contaminating anything. I attach the hood and pull it over my head, It is loud, it is hard to see through, but it is the freshest air I have ever breathed in my life. I am grateful for it. Now I am ready to go into the patient's room.

Anything that goes into a room with you is potentially contaminated, so I have to leave a specimen bag outside the room, turned partially inside out, so I can leave the patient's specimen in the bag without contaminating anything else.

After the procedure, I place the specimen in the bag, assuming nobody has thrown it away.  Still in the room, the gown is torn off before leaving, and thrown in the garbage. Immediately after leaving the room, gloves are removed while taking care not to touch your hands. Your gloves are contaminated. Hands are sanitized, then you put on another pair of gloves to take off the PAPR. The gown was over it, but it may be contaminated.  You detach the hose from the hood, being extra careful not to touch your face or the inside of the hood. The gloves you  just put on, they're now contaminated. DO NOT TOUCH THE INSIDE OF YOUR HOOD! After the hood is removed, set it on the bag you left outside the room and wipe it down with a disinfectant wipe. Detach the filter unit belt, and wipe it down with a disinfectant wipe, You will never feel like you are wiping it down good enough. Return the PAPR unit to the bin (and hope they guy who put it in the bin before you disinfected it before returning it.) Return the bin to the cart.

This happens every time I go into a room of a patient with COVID-19 symptoms. It's not that often, just a couple times a day. Not nearly as often as other healthcare workers who are working only with these patients for hours at a time.

Working second shift, I get home about 2300. All my clocks are set to 24 hour time, because that's what we use in healthcare. I take off my clothes and put them in the COVID laundry. I actually stopped separating by now, because COVID laundry makes up the vast majority of my dirty laundry. I have kids, I don't want to get them sick. My girlfriend has some health issues, I don't want to get her sick. We haven't seen each other in a couple weeks. The town she works in has very few cases, and I fear giving this virus to her and having her take it back to her town. We all know how long the virus can remain viable on stainless steel, and on cardboard. But how long will it remain on the soles of my shoes? I try to wind down but I fear sleep. I have had nightmares about running out of PPE, about how bad this is yet to get. I usually try to numb myself with a horror movie or some sci fi. I watched all the Terminator movies except the newest one. Tiger King was good for a few days.  Last night I watched the original Child's Play. Last night I had dreams of fishing and not seeing any other fishermen because everyone was social distancing. It was the nicest dream I've had in a long time. I stay up too late, then I sleep in too long to do anything. I wake up, take my temperature, try to make food before going to work, so I don't have to prepare much when I get home. My kitchen is a mess because dishes are piling up. I do some dishes every day.  I am down to my last roll of toilet paper and every store I have gone to in weeks is still out. The easiest solution... I poop at work when I can on my way out. I have to leave early for work because they take our temperature before letting us punch in. Once in, we are essentially locked in. All the drinking fountains are off limits to prevent the spread. I usually don't even notice until I'm home that I haven't had anything to drink in 8 hours.

And the scariest part about all of this is that it is just the beginning, and we have a president who is accusing us of selling protective gear.