Swabs and Sweats

This morning, as we were sitting down to breakfast, Cora ran over to the sliding doors and pointed a chubby finger towards the east. “Sun! Sun!” she cried. The rest of the family went over to look, and saw a beautiful sunrise – a sky full of clouds tinted with orange and purple as the sun started to peek over the horizon. “Pitty! Pitty!” Cora cried. She noticed that Annie wasn’t paying close enough attention, so she said “Ennie! Ennie! Pitty! Pitty!” because she knows that Annie loves pretty things. Sometimes it’s hard to leave the kids in the morning to go to work. Even though the days at home with them can be long and exhausting, they are a lot of fun.

It’s the little things that are challenging at work, nowadays. It’s the way an N95-respirator doesn’t quite fit on my face, no matter how many little adjustments I make, and leaves a red mark on the bridge of my nose even when I try to use gauze to keep the metal from digging into my skin. Or the way my skin reacts to having a mask pressed up against it all day. Or the way I sweat and sweat in the white suit when it’s a hot day. Sometimes when I try to change my gloves, I can peel off the old ones but I cannot get the new gloves onto my hands, because my hands are so sticky with sweat. 

We keep all the cough/cold/flu patients out of our office. They are not allowed in the front door. We are able to manage this because we have a little plastic shed set up out in front of the medical centre, which has a desk, a chair, a rack with basic medical instruments, and a very long extension cord running out to it. There is a laptop computer on the desk, which has difficulty connecting to the router inside and often freezes as a result. Sick patients get evaluated in the shed. You are only allowed inside the clinic if you have no respiratory symptoms, and no fever.

Most patients we can talk to on the phone and keep at home. Patients expect this. A few weeks ago New Zealand instituted a draconian house arrest for the entire country, with the goal of eradicating COVID-19 from New Zealand, rather than just containing it. But sometimes it’s tough to tell if the little kid with the barky cough or the wheeze is really sick or not, without seeing him in person. So after speaking to his mum on the phone, a phone doctor invites them to come visit my shed for evaluation. We trade off roles – it was my turn in the shed last week, but I will be back on phones again this week.

When they arrive and I find them in their car (they have to wait in their car until I’m ready for them), the first question I have to ask myself – and sometimes the patient or his mum – is whether to leave the door to the shed open, or close it. If I close it for privacy reasons (although it faces an empty parking lot), we have about ten minutes on a sunny day before the room turns into a sauna. The bleach spray that I use after every patient lends the air a nasty, biting quality that makes people cough even if they don’t have a cough to begin with. This smell is worse if I close the door – although with my mask on, I don’t smell it as much as my patients do. Usually we all agree to leave it open. I keep an eye out for other people in the parking lot during our visit.

Evaluating patients is usually not the most challenging part of the visit. Lungs okay? Oxygen and heart rate okay? History of asthma? Any fevers? Ear infection? There are just a few questions to answer, and then I usually feel pretty comfortable with the plan. The problem, of course, comes when I need to prescribe a medication. Perhaps they need an antibiotic, or a steroid to open up their lungs a little. In the old days, I would turn from the patient to my computer, type a prescription into the computer, press a button, and a prescription would come out of the printer sitting next to my computer. I would hand it to the patient, and then it would become their problem rather than mine.

Now, I have no printer, and even if I did, I couldn’t hand a patient a prescription – pharmacies only accept faxed prescriptions nowadays. So I do the following:

I type in my prescription. Then I fumble, through my suit and my gloves, with my cell phone – which is in a plastic specimen bag to protect it.

I try to turn it on, and fail because it can’t recognize me in my mask. I try to press the buttons to type in my code, but between the gloves and the bag, it only recognizes my fingers sometimes. It tells me I typed the password incorrectly and then shuts off. I try to turn it on again. It tries to recognize my face again. It won’t allow me to bypass this screen. Several seconds go by before I can get to the button screen again. The patient sits quietly, watching me. Eventually I get into my phone. Then I call up the front desk of the clinic, and talk to the receptionist (who is trying to do about 18 things simultaneously at this moment, half of which she has been doing for years, and half of which are totally new and require concentration). She stops everything she is doing and prints my prescriptions for me. Then she has to wander around until she finds another doctor, who can stamp my prescription and sign his or her name to it. Then she has to fax it. Then she has to make a note in the patient’s chart to say that she faxed it. The patient has to wait around a little while for this process to take place, then call the pharmacy to make sure the pharmacy received the prescription. Then the patient has to send someone else to pick up the prescription because sick people aren’t allowed in the pharmacy.

After the patient goes, I have to carefully wipe down all the medical instruments I use, put them away, and then spray everything with bleach. This takes longer than I initially thought it would. Sometimes for my verbose patients I start subtly wiping down the instruments while they are still talking to me.

It was okay at first, because we weren’t seeing that many patients. Then I guess the New Zealand government decided that it was important to get more data on how many cases we have here – a week ago, they decided that everyone with cough, sore throat, fevers, etc should be swabbed for COVID-19.

Everyone really wants to be swabbed. This is a bit of a mystery, since a positive test doesn’t mean you get any special treatment – you just have the privilege of knowing that you have the illness that is killing people all over the world. You have to stay in your home either way. I feel confident that patients would not be so anxious to request swabbing if they knew what it entailed. Not knowing, they are happy to give it a try.

As I explain the test, I watch their rising uncertainty, then outright reluctance, but it’s too late to turn back. They are already in my chair, and I have already spent time printing out labels and lab slips for them (I have to do this in the morning before I go out to the shed, or at lunchtime). They are already doomed. I tell them that it’s like jumping into a swimming pool without holding your nose; the water goes up into your head and burns and makes your eyes water. I know it feels this way because patients have told me; they all confirm that this is a very apt description. And they cry. They always cry.

At the end of the day, after I peel off my suit and my gloves and my mask and my helmet, and I feel a great weight off my body, I walk home. Leaving my backpack and shoes and coat in the garage, I sneak into the house through the garage door – knowing Peter has (by arrangement) sequestered the children in the living room – and tiptoe into my bathroom, where I shower quietly and then put on some new clothes. Then I walk silently back to the garage, noisily close the garage door, and make a loud entrance into the living room. “I’m home!” I cry.

“Mommy!” the children cry, and run over to me.

“Your hair is wet,” Annie says, every single time, frowning suspiciously at my hair.

“Huh,” I say. “That’s weird!”