Home Health in the Time of COVID-19
The office is closed. The door is locked. If you need supplies, you make a request by email 24 hours in advance. Text when you get there and the supplies will be placed outside the door. Maybe by elves.
I’m in my car. The air conditioner is blowing. I’ve been waiting for 20 minutes for my bag of hand sanitizer, chucks, gloves, masks, gowns, booties, and various dressings and accouterments of wound care. My next case is across town and I’m not getting paid to sit around.
Across the parking lot is Regional Medical Center’s Emergency Room. They’ve closed the waiting room and put up tents in the parking lot with chairs placed well away from each other. I watch as people drive up to be tested for COVID-19 or to unload someone needing emergency care. A tech in full PPE walks out and waives a thermometer across the forehead…OK, next station. Such is medicine in the age of COVID-19.
My first “official” case of COVID-19 is a man in his early 60s. He shuffles to the door with a walker. His skin is hanging off of him in folds. He looks like one of those dogs with droopy flaps around his face. He got sick in February, a construction worker with a cold before we really got the news of a brewing pandemic. Three months he lived on a ventilator. He points proudly to his tracheostomy scar. “It couldn’t kill me,” he says.
I say “official” because you never really know who may be contagious since so many people show no symptoms. I’m standing outside the door of his house at 2 pm on a hot California day wearing a yellow gown, a mask, face shield, blue gloves, and blue knee high paper boots that are making my feet itch like crazy. Sweat is dripping down my forehead onto my glasses and I can barely see a thing. Sweat is also dripping down my back and arms. I think my gloves are full of sweat. I should have drank more water.
He lets me into the house. There is no air conditioning. The windows are all open. The living room and dining room have been stripped bare for remodeling. There are boards piled up, things in boxes, a new floor. It’s going to be nice. He’s staying with his daughter while he recovers and he’s anxious to get back home but still too debilitated to take more than a few steps.
The home health start of care evaluation is 29 pages long—29 sweaty, hot pages. We are sitting on those cheap folding camp chairs. The only other furniture is a small fish tank on the mantle that needs water. The pump is sucking air and making a sound like a jet engine. I rock the fish tank gently back and forth and get enough water to the pump that it starts working quietly again. He looks at me. The fish look at me. I sweat. I hope he’s not noticing the growing splatter marks on his new hardwood floors.
What should take 40 minutes takes 90 minutes. Each step of the way I’m double checking what the patient has touched. Did I give him this pen or that pen? I clean the BP cuff twice. Next time I’ll just leave it there. He’s not even shedding virus any more. He’s recovered. Not exactly spry, but he definitely has the air of a man who escaped the tiger’s den. He doesn’t even need oxygen. He’s a lucky dude. I tell him to buy a lottery ticket. One for me too. He laughs.
I ask him who is in the house and I document each person I come in contact with and what PPE I was wearing. It’s a new policy at our company. We document every person and what we were wearing. Let’s face it, sooner or later, one of us is going to come up positive and it will be the unpleasant job of someone in the office to call all of our recent contacts. I can hardly imagine how that conversation goes.
“You know the nurse that came to visit you? We are calling all of the people that she visited because she has COVID-19 and we want to ask you to get tested yourself and self isolate for 14 days. Also everyone in the household and everyone they’ve come in contact with. Have a nice day.” I pray to God I’m not that one.
So I check everything twice, three times. My next patient is even sicker…and older. I can’t be the dark angel of death. I sanitize my hands again. I stagger out the front door and take off all the gear. Sweat is literally pouring off of me and off the inside of the slick yellow gown. My shoes are soaked. I take a moment to red-bag my PPE and wipe down the outside of my ditty-bag. I have an hour of paperwork to do on this guy. I have to call his doctor and get a verbal order for start of care. I have to drink a lot of water…I mean right now because my vision is getting grey around the edges. The blessed blessed AC is blowing cold in the car. Thank God for small favors.
This is the new normal. Everyone has to make changes. I don’t understand the resistance to wearing a mask that some people have. For some reason, someone in the highest office has decided that wearing a mask makes you liberal. The virus makes no such distinction. I don’t understand how wearing a mask to protect the people around you has any political significance at all. But there you have it—the new normal. Stay safe out there.
