“It’s feels like you’re under water — like scuba-diving.”
It’s a comparison Dr. Donald Griesdale never thought he’d make 13 years into his career as one of the intensive care physicians leading the fight against COVID-19 at Vancouver General Hospital.
“It’s surreal,” he says, describing the complex ordeal of donning personal protective equipment. “You’re wearing your visor, your face mask, your respirator, your gowns and your gloves; you literally have that barrier between you and the outside world.”
That armour is to protect them from the patients they know are coming.
VGH, the biggest hospital in B.C., is one of 17 around the province that has morphed into a primary site specializing in treating coronavirus patients.
As one of the front-line physicians handling those incoming patients, he and his team are notified of suspected COVID-19 cases even before they arrive, most with typical flu-like symptoms: cough, fever, shortness of breath.
When the nurses come out of the hot zone, they’re drenched in sweat and you can see their mask that’s outlined on their face.– Dr. Donald Griesdale, VGH intensive care physician
The first line of defence is the team in the emergency room, which does an initial assessment. If the patient needs critical care, they’re transferred to a section of the intensive care unit that has been hived off as a dedicated ward.
Hot zone vs. warm zone
The COVID-19 critical care unit is divided in two: the warm zone and the hot zone.
The hot zone is where the infected patients themselves are examined and treated. The warm zone is a buffer area that acts as a staging zone for health-care workers.
Each team spends up to three hours making the rounds inside the hot zone before peeling off their personal protective equipment, washing their hands like lives depend on it, then rotating and swapping out.
“When the nurses come out of the hot zone, they’re usually drenched in sweat, and you can see their mask that’s outlined on their face,” said Griesdale.
“Then in the warm zone, if issues come up … we have a really good two-way system, so we’re easily able to communicate with the staff inside the hot zone.”
The warm zone is also where all of the experts involved — from physicians, nurses and respiratory therapists to dietitians and pharmacists — convene and communicate. As a team, they discuss all of the issues for each patient and come up with individual care plans for the day.
Watch doctors and nurses treat patients in the dedicated COVID-19 unit at VGH:
‘They’re scared when they come in’
Nurses are the main point of contact for patients. And there’s an underlying uncertainty on both sides that’s hard to describe. Mostly, it’s fear of the unknown.
“It’s scary,” said Jess Donald, a registered nurse who’s worked in the emergency room at VGH since 2007.
“They’re scared when they come in, they’re scared of getting a breathing tube put in, they’re scared of what’s going to happen. And we’re scared for them, to be honest.”
Her biggest daily struggle is making human connections in a unit that’s defined by isolation. FaceTime has become a lifeline, a way to communicate with family forced to remain on the outside. Despite technology’s best attempts, the feeling of isolation never really goes away.
“The best we can do is reassure them, make sure they know they’ve got a really great team behind them and that we’re here to care for them and help them get them home…. That’s our priority.”
Griesdale echoed that, adding they often take for granted the intrinsic role the family plays in caring for a patient.
Usually, they’re at the bedside, engaged in care, communicating with medical workers. But in the new COVID-19 world, the in-person interaction with loved ones has been replaced by a unique bond between near-strangers.
He gave an example of a young woman he was treating who became quite ill with coronavirus.
“It was really hard, because every day I would phone her husband who was at home sick himself with the kids and have to say, ‘Well, your wife isn’t doing well,’ or ‘She’s getting worse,'” Griesdale recalled.
“I put myself in that position thinking what would it be like if that were my wife in there…. I found it emotionally quite difficult.”
Most pleasant surprise of all
But ask the doctors and nurses about the pressure, the responsibility, the weight of serving as the front-line fighting chance against this virus? They say it’s not about them.
It’s about everyone: a caring community that’s become an unexpected inspiration, and the support of a province is the most pleasant surprise of all.
“[People] have been so great, sending us food, making masks — it’s the kindness that really permeates through when we’re feeling isolated. There’s this whole ‘we’re in this together’ movement, and I really feel that,” said Jess Donald.
“We see it on the front lines, absolutely, but I certainly understand the sacrifices the public is making as well,” said Griesdale. “It’s been really heartening, and certainly the most fulfilling time in my career, bar none.”
The public’s gratitude is audible. Like clockwork, at precisely 7 p.m., a giant chorus of cheers rises from the city, in a moment that still brings tears to their eyes and smiles to their faces. Every single night.