Front-line workers entering pandemic 'purgatory'

We check in with our doctor, paramedic and nurse, who tell us they feel neither at the beginning nor the end of this health crisis, but somewhere in the disorienting middle.

Our doctor, paramedic and nurse find themselves stuck somewhere in the disorienting middle of the crisis

Dr. Kwadwo Kyeremanteng, seen here wearing his personal protective equipment, says health-care workers have entered the 'purgatory' stage of the pandemic, where they're neither overwhelmed with patients nor able to let their guard down. (Submitted by Kwadwo Kyeremanteng)

We are neither at the beginning of this pandemic, spurred on by the intense adrenaline rush that can power us through a fight, nor at the end, marking if not victory, then at least the relief of having come out the other side.

We are somewhere in the disorienting middle.

Again this week, CBC Ottawa checked in with three health-care workers on the front line of the COVID-19 crisis to gauge how far we've come, and what lies ahead.

The doctor

Kwadwo Kyeremanteng, an emergency and palliative care physician at the Ottawa and Montfort hospitals, had a week off from the ICU. He was on the backup list, ready to jump into action in the event of a surge in acute cases. It didn't happen.

People are still dying of COVID-19 in Ottawa, it's just that most of them aren't dying in intensive care. The majority of deaths have been in long-term care homes.

"Part of what makes it all difficult is being in this purgatory," Kyeremanteng said. "We are not clear what the next steps are going to look like."

He believes this is the pandemic's painful middle, where social isolation can come with other costs. For example, Kyeremanteng said a cardiology colleague told him patients are "presenting late" — in other words, they're putting off seeking medical attention until it's dangerously late.

Kyeremanteng takes a welcome break with sons Marlow, 5, left, and Teddy, 7, centre. (Submitted by Kwadwo Kyeremanteng)

"It's stemming from a place of fear. 'I don't want to come to the hospital because of coronavirus, but I'm having symptoms of congestive heart failure or angina.' If you need medical attention, please come to the hospital."

This "purgatory" is also weighing heavily on the medical professionals. Kyeremanteng and his colleagues have been talking about the doctor in New York City who took her own life.

"This is really heavy stuff," he said. "It's tragic, and I'm nervous that we'll see more similar scenarios. Not just within health care providers, but also just the general public.

"There's stress all around. People are extremely anxious during this time. Have you gone shopping recently? If you're within six feet and one inch from them, they start to get anxious and tell you, 'You're too close!' People are just on edge. All this adds up to issues regarding mental health, and I'm really nervous that if we're not proactive … you're going to see real issues."

What makes it challenging is that we don't know what the goals are to move on.- Dr. Kwadwo Kyeremanteng

He also worries about the often hidden impact on children.

"The one thing that is eating at my soul is all my conversations with our social workers about the kids that are being abused at home," Kyeremanteng said. "That's a lifelong damage we're doing to these kids.... We've got to do what we do to be safe, but let's recognize what some of the risks are and let's address them."

Kyeremanteng puts his faith in public health leaders, but he also has questions about the milestones: "What is the measure to say we are safe to progress? Is it enough to flatten the curve, or are we looking for death rates? ICU capacity? What makes it challenging is that we don't know what the goals are to move on."

The paramedic

Paramedics in Renfrew County will now be focusing their screening and swabbing efforts on the people living in long-term care, according to Chris Day. It's at the request of public health officials who want to target tracing efforts to those most at risk. 

"Some places will be just sampling, and other places we may go in and swab entire LTC facilities," Day said.

The situation in Renfrew County has been holding steady for much of the past month with 15 confirmed cases and just one death. Ten people have recovered.

It's been more than a month since Renfrew County paramedic Chris Day was able to get this close to his youngest daughter, Amyann. He's been keeping his distance to protect her from possible COVID-19 exposure. (Submitted by Chris Day)

Like Kyeremanteng, Day feels like the battle against COVID-19 has entered a middle stage. 

"That heightened level that we've been at? That novelty kind of wears off a little bit," Day observed. "You have to be very conscious to make sure that you're still donning and doffing your [personal protective equipment] properly. Not taking shortcuts, not getting complacent with cleaning ...  your vehicle or hand hygiene."

But he's aware things could swiftly heat up.

"This could all change with going into the LTCs. We just saw it in Ottawa … where all of a sudden they went and swabbed and now they have [131] cases just in one," he said, referring to a serious outbreak at Carlingview Manor, where 55 staff members have also tested positive for COVID-19.

"There's the worry of letting off [the pressure] too early, and COVID coming back even worse. I know we're gonna be in this for the long haul."

The nurse

Queensway Carleton Hospital nurse Peggy Freemark moved home this week after spending a month away to protect her family from possible COVID-19 exposure.

"It just felt kind of weird. OK, now I'm on to the next phase. Maybe this is almost over. It was just a weird feeling. It was like, good, I can go back home now., but is it going to get worse? It's just the fear of the unknown. What's going to happen next? Am I moving out too soon? Are we going to get worse at the hospital?"

Nurse Peggy Freemark relaxes at home with her dog, Bella, after spending a month away to protect her family from COVID-19 exposure. (Mike Freemark)

One thing is clear: Even though there's been no surge in patients, no one can relax their standards.

"Everybody wears a mask. Handwashing is big. Everybody still follows the rules," Freemark said.

She hopes the masks won't become the new normal.

"It's really hard wearing a mask all day. You get dehydrated. I get headaches a lot because I'm not drinking enough," she said. "The nose dries out. It's not fun."

She doesn't wear a mask on her infrequent trips to the grocery store. "I need a break from it. I get why people do, but I think … it gives them a false sense of security. If they're constantly touching the mask and lifting it up to drink coffee or pulling it down to take a smoke, it really defeats the purpose."

Freemark has also noticed the masks have an alienating effect.

"Sometimes you don't even recognize who you're talking to. That happened to me last week. Somebody said hi to me. I worked full-time with her all the time and I didn't even recognize her. Maybe it was because I was tired."

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