An Inside Look: on the Front Lines
Byline: Dimitri Joseph Moise
Before the coronavirus outbreak, NYC nurse practitioner Michele Galo recounted the ability to number the amount of rapid responses, or codes, each week on a single hand. After being mandated to work at Mount Sinai Hospital in Brooklyn, NY due to the rapid spread of COVID-19, she painted a different picture: “For the two-and-a-half weeks I was there, there were many emergencies throughout the day, sometimes two or three going on at the same time. Many codes led to intubations,” Galo tells HIV Advocates. As part of a rapid response team, Galo assists in responding to patients experiencing respiratory or cardiac arrest. As of today, there have been over 40,000 hospitalizations and almost 20,000 probable deaths across New York State due to COVID-19. 1,154 of those deaths were in Brooklyn. “I didn't really believe what was going on in the world,” Galo said. “Stepping foot into a hospital and seeing it with my own eyes was a real eye opener. Seeing refrigerated trucks outside of the hospital, containing deceased patients because there was no room in the morgue, made me sick. I have been more vigilant of my actions (because of it).”
Like Galo, healthcare workers across the US are putting their lives on the line each day to help put an end to this crisis. But as some states begin to reopen while much of the country continues to stay at home, how are healthcare workers and health aids feeling today? We spoke to a few essential workers around the country who gave us an inside look on the front lines.
Laura McKnight works in ambulatory settings with melanoma and kidney cancer patients at Smilow Cancer Hospital in Wallingford, Connecticut. To date, over 32,000 people have been diagnosed with COVID-19 in Connecticut, a state that has since reached its peak in the crisis. “Normal life was taken for granted and patients were able to come in as needed at the drop of a hat,” said McKnight. “Now, we are having to question every symptom and determine if it is absolutely necessary to be seen in our clinic, or if it is severe enough to send someone to the emergency room –– which we are trying to avoid at all costs.” In an effort to mitigate the spread, McKnight pointed out that her clinic was moved to a satellite location: “We no longer work where we call home,” she says. We are now in an outpatient satellite Smilow building where there are no visitors allowed to accompany their loved ones for visits and treatment. While it is very different — it is much safer for our patients.”
Upon arrival at her mandated position at Mount Sinai Hospital in Brooklyn, NY, Michele Galo remembered the beginning of the outbreak as a “scene from a horror movie.” She told us, “The emergency room was on overload. Patients were getting swabbed on admission, but results were taking days to come back. Pretty much the whole hospital was tested positive for COVID-19.” Galo witnessed emergencies firsthand and explained feeling a sense of helplessness: “Just by looking at the patient’s chest x-ray, you could tell what their result was going to be. Patients were fighting to breathe using all their accessory muscles and going into a panic as they were sucking for air to survive prior to being intubated.”
Monica Lewis, Director of Nursing, told HIV Advocates about the changes that were implemented at her long term care facility in Houston, Texas –– a state where 207 of its 254 counties have reported cases of COVID-19: “Before COVID-19,” Lewis told us, “families were allowed in the facility to assist the staff with some responsibilities and provide emotional support to their loved ones, the residents in the building.” Some of Lewis’ daily responsibilities include staffing, conflict resolution, making rounds on the residents, reviewing labs, and providing communication updates to physicians and any responsible parties. Family members of residents would assist Lewis in making sure all of the residents’ needs were met: administering food, showers, hydration, wound care, repositioning every two hours, and head-to-toe assessments for changes of conditions. “The staff was more energized to interact with the residents. Robust activities were allowed, such as receiving visits from local churches, girl and boy scouts, pets, and volunteers. Sadly, since COVID-19, that has all ended,” Lewis tells HIV Advocates. At a time where PPE is in dire need all around the country, Lewis ensured that facilities like hers received the proper PPE needed to take on any COVID patients –– “We have a wing designated with all appropriate face shields, N95 masks, gloves, and gowns,” she said. The SouthEast Regional Texas Advisory Council provided her facility 72 face shields, 400 N95 masks, 750 surgical masks, and 1 bottle of hand sanitizer in hopes of helping her facility mitigate the spread.
At Mount Sinai Brooklyn, Galo was also equipped with the proper PPE though admitted she knew many colleagues across the city who were not receiving the same level of protection. “Every time I stepped foot inside the hospital, I felt somewhat contaminated, even though we were given proper PPE,” she said. In addition to living in self-quarantine to protect her family, she learned to adopt a new routine after leaving work each night: “Before coming home, I would change out of my scrubs into regular clothes and leave the ‘dirty scrubs’ at the hospital. The hospital would provide me with clean scrubs for the next day. When I got home, I would leave my shoes outside at the door and take off all my clothes inside at the door and go straight to the shower, not touching anything. The dirty clothes went straight into the washing machine.” When it came to PPE for McKnight and her team at Smilow Cancer Hospital in Connecticut, she told HIV Advocates that receiving the proper protection they needed was a barrier at first, but changed over time –– “we were not given proper PPE in the outpatient setting at first, however that was quickly changing, day by day, and even hour by hour.”
In Texas, Lewis admitted the new changes being implemented had been increasingly difficult for residents. From wearing masks all day to prohibiting eating in the main dining room, “AKA their social hour,” said Lewis, the staff has certainly been feeling the stress. “Yes COVID-19 has changed the way we work. Our day starts with temperatures being taken, and face masks are on for the entire day— that is hard for the residents, who are now confused due to the fact that our voices are muffled, and no facial expressions are shown.” Hugging between family, staff, and residents, is no longer. “Residents refuse to get up at normal times — overall it's sad — so, I dance in the halls or in the residents’ rooms and even take a few and push them in their wheelchairs to see outside. We even had a jeep parade and took residents outside to view the parade — of course everyone had on a mask,” joked Lewis cautiously.
“Masks have become part of our uniforms,” Galo told HIV Advocates. “It is scary because we do not know when this will all subside. I am terrified for the next ‘wave’ that is going to happen. I’m not sure when our lives will have some normalcy again.”
So … what might things look like in the coming weeks?
For now, in Connecticut, McKnight tells us: “Trying to manage the outpatient world via phone and not panic patients has been a major priority of ours. Still having patients that need their treatment come in and feel safe has also been a learning curve for both the patients and the nurses who are triaging phone calls –– it is really functioning on a patient-by-patient basis, reviewing patient history, and the risks of coming in to be treated versus not receiving treatment, are discussed daily with the oncologists.” As Connecticut begins plans to slowly reopen, things still remain a bit unclear on what’s coming next. “Currently, we are at the new location for an unknown period of time, McKnight tells HIV Advocates. “For the staff, it’s okay, since we’ve moved as a unit together. We are there to support one another, however patients are questioning when we will get back to our normal day-to-day routine in New Haven.”
In Brooklyn, Galo tells us Mount Sinai’s census, or daily hospital count, has gone back to normal: “In the beginning, I felt that this virus was unreal, or maybe I didn’t want to believe it was happening,” she says. “Once I arrived at Mount Sinai Brooklyn and saw the amount of deaths increasing by the second, then it became real. I have never witnessed a pandemic in my life until now. I hope the second wave will not be as bad as the first.” Today, Galo says everything about the virus still feels unclear. “ At first, it was only affecting older populations with medical histories. It wasn’t affecting people without comorbidities, or children. Now, children are being diagnosed. People of all ages are dying with no underlying medical issues. We still have a lot to learn about COVID-19, including what proper medications to use, acquiring enough respiratory treatments, and developing a vaccine.”
For Galo, she believes this pandemic has made her more compassionate. “We take life for granted and do not appreciate our health like we should,” she says. “People are dying alone. There are no families or visitors allowed at the bedside as someone is taking their last breath. Funerals are prohibited. This is evil. No one should have to die alone. Stop the spread, stay home, it saves lives!”
If there’s anything Monica Lewis wants people to know, it’s that the stigma of long term care facilities is real. Deaths linked to nursing homes are at an all-time high, but that doesn’t mean staff members are negligent in overall care. “I would like to say that great care is provided in long term care, despite what reports say. Personally, I have loved, loved making sure the end of life for my residents is really the best it can be, that’s why I can’t stop working in this environment.” Even though nursing homes may get a bad rap, Lewis assures, “overall, people who work in long term care are very special people –– now I’m all teared up.” For Laura McKnight, it’s the wish that everyone is a bit kinder to one another: “do one extra nice gesture, say one extra kind word –– it may make someone else’s day just a tad better. We are all in this together and you never know if, or when, the virus will hit home.”
Dimitri Joseph Moise is an actor, award-winning editor, and national HIV spokesperson. He is currently featured in a national HIV awareness broadcast campaign titled “Keep Being You,” also featured in GQ magazine. Dimitri has also been featured in HIV Plus magazine, Them magazine, Thought Catalog, PAPER magazine, Teen Vogue, and on Good Morning America. Instagram: @dimitrimoiseofficial