Based on an article by Matt Schur from the AMT Pulse, Summer 2020.
It was only a matter of time.
Cherry-Ann Da Costa-Carter knew she was going to get COVID-19. After all, she worked in East Manhattan, in the heart of the outbreak. Traveling to and from work, she took two trains and a bus. People coughing, sneezing. Poles and handles slick—with what, exactly?
Cherry-Ann is the city research scientist at the New York City Department of Health and Mental Hygiene Public Health Laboratory. She is also chief of the bacteriology and rabies lab, which pivoted its focus to support the city’s coronavirus testing needs. Part of her job requires overseeing several staff, many of whom also have similar journeys into the city, each voyage yet another threat of getting and spreading the disease.
“It’s very sobering when your mortality is in question, and there’s precious little you can do about it,” says Cherry-Ann, MSc, MPH, MT (AMT), RPT (AMT). Her experience isn’t singular among AMT members. Fanned out across the country, they’ve also put their lives at risk to combat the coronavirus.
It’s a tale of two worlds. The nonessential workers sheltering at home, and the essential workers who face this deadly virus every day. COVID-19 ravaging one county while leaving a neighboring one relatively unscathed. The rich with the mans and resources to withstand the worst of this, and the poor who have been disproportionately affected.
“I’ve seen the look of pure fear in a patient’s face when he was told it’s very likely he has COVID-19 and must quarantine away from his wife and children,” says Nicole Gonzalez, RMA (AMT), Medical Assistant, Chicago, Illinois. “I’ve seen the devastation from a patient’s family because said patient was on a ventilator. I have seen the fear this has caused people.”
The variety of experiences exists even within the healthcare field’s boundaries. Deaths have rattled some medical facilities while others have weathered the storm. Some healthcare workers have gotten sick and been asked to work through their illness. Scores of medical professionals have taken to the streets in protest, begging people to stay home. Some have been furloughed or laid off. Through a fortunate twist of geography, job requirement or plain, dumb luck, others have been spared the worst.
Cherry-Ann wasn’t among the lucky. A sore throat and dry cough came one Monday in April. Her fever spiked two days later, her body roaring-hot one second, shivering the next. On day three, she lost her sense of smell and taste. Severe pain set in all over. By the week’s end, she couldn’t so much as drink a glass of water.
“You have to mentally prepare,” Cherry-Ann says. She sent her three children reminders about the family’s life insurance policy and gave them the PIN numbers to her bank accounts. “I told them, if anything happens, be sure to take care of your dad. If there’s anything we know in life, it’s that it’s not infinite.”
It is the unknown that haunts, ramping up the intensity of once mundane tasks. Wiping down rooms, greeting patients, taking off the day’s medical gear—is the virus lurking somewhere undetected?
Nothing troubles Elizabeth Roper, RMA (AMT), more than this uncertainty. “Not knowing how this virus is going to affect our future as a human race—are we ever going to get back to our previous ‘normal’ lives?” she says. “Is it here in our office? Am I going to bring it home to my family? Am I, as an asthmatic and prediabetic, going to get it, and if I do, will I be strong enough to fight it?”
Elizabeth is a medical assistant in the pediatric office at the Florida Community Health Centers in Port St. Lucie, Florida. Before patients are admitted into her facility, the staff administers a temperature screening and COVID-19 questionnaire. Elizabeth often oversees the process.
'"To be honest, it’s a little terrifying,” she says. “Because of the personal protective equipment, they can’t see my face, and I’m kind of grateful that they can’t see that I’m fearful or nervous.”
It’s her job to put patients at ease in these moments, a crucial duty. Patients are scared, and the test’s swab goes deep into the nose; people naturally try to move their head and avoid that sensation. The stakes could hardly be higher: If not enough of the sample is gathered from the swab, it could compromise the subsequent COVID-19 test, potentially letting a carrier go unabated into the world.
“I try to mask my fear and keep as much of a calming, soothing voice as I can—being reassuring makes it a little easier for patients,” Elizabeth says. “We have to be the strong ones.”
New and changing processes are the norm, including for Rachel Prosser, RMA (AMT), a float medical assistant for Piedmont Health, a community health center with nine sites, in Bear Creek, North Carolina. Her job has always been a bit hectic. She sometimes starts at one facility and finishes her day at another. A new policy is creating additional stress: Only one adult per patient is admitted into the office to minimize spreading the illness.
“I have to explain to a mother and father that only one of them can come back for their 4-month-old child’s exam, or I have to tell a father that we can only allow the patient herself back for a prenatal visit,” she says. “It’s heartbreaking to tell somebody that, especially with the younger children that are developing so much. Both parents want to be involved”, she says.
With emotions running high, it’s hard to anticipate how a patient will respond. Sometimes it’s quite negative, leaving Rachel as a target for simply following best practices. “You feel like a horrible person for denying somebody something like that. But, you know, it’s for their safety.”
The coronavirus has changed the nature between co-workers, too. The vibe used to be lighthearted, people always joking, Rachel says. There was almost always a potluck or a pile of sweets in her breakroom. “Now, we can’t do any of that. We still try to joke and keep the mood up, but it’s hard when you can only be so close to each other. Plus, you can’t see smiles under a mask.”
A Muddied Homecoming
There is yet another hurdle after workers clock out for the day: decontamination.
Whether in the backwoods of North Carolina or in an apartment complex in New York City, healthcare workers have a similar routine. Shed the day’s clothes before entering the home. Take a hot shower. Wipe down any surfaces that were touched before the shower. Toss the clothes in the wash. Then, maybe, relax.
The process can be physically draining. “You’re already excited at the end of the day to go home and see your family, but then you’ve got to stop and think about their safety before you walk in the door,” Elizabeth says. “Have you been thorough enough, or did you miss something?”
Elizabeth lives with her sister who has two kids. She had to let the kids know that when she pulls into the driveway, they can’t run out and greet her anymore. It’s hard, Elizabeth says, because she wants to give them a big hug and tell them how much she loves them. It’s an adjustment not just for her, but her whole family. “My nephew has special needs, and he doesn’t quite understand waiting,” she says. “He’s on the spectrum. I have to let him know that he can’t just grab me and hug me until I get out of the shower. He’s starting to understand it, but I don’t think he’s got the full understanding.”
Eventually, relief does come. When Rachel finally gets to be with her 3-year-old daughter after a day of work, “The stress and anxiety is gone. It’s normal life again.”
A Sense of Duty
Cherry-Ann recovered and returned to work as soon as she could. She’s been through worse—she grew up in the Caribbean with severe asthmatic attacks and survived dengue fever while working for the World Health Organization after college.
But for all the pain of having COVID-19, for the 12-hour days to do her part to ramp up testing, for all the stress—it’s worth it knowing she’s made a difference. “Being a medical laboratory scientist takes dedication, focus and a desire to make a difference in the lives of people who you may never meet,” Cherry-Ann says. “There is no patient in a room on the next floor that you can see like in a hospital. There is only the knowledge that somewhere in the city, a family has the answer to the question most on their mind and that a physician can now act because they know what they’re dealing with.”
It’s a familiar refrain for healthcare workers: a call to duty, a higher purpose, a love of helping others.
For Elizabeth, it runs in the family. Her dad is a retired firefighter and EMT, something he had been doing since his teenage years. Her mom was a labor and delivery nurse for 42 years. Her parents lived in New Jersey during 9/11. Her dad shepherded injured patients from the wreckage to a ferry to get them medical treatment in New Jersey. Her mom helped receive pregnant patients from New York.
In a sense, among her family, it’s her turn to help the country in a time of crisis. “I am a person who is at my best by helping others,” Elizabeth says. “I take care of people no matter their health or economic circumstances. I do my job because I am my job.”
Duty is something Bree-Ann Hermosillo, RMA (AMT), knows well. “I’m retired Air Force. I was part of the invasion of Iraq. A lot of things don’t scare me. It’s kind of in my nature that I run toward things that I know are my duty.”
Before the outbreak, Bree-Ann worked as a medical assistant at MercyOne South Des Moines Family Practice and Urgent Care Clinic in Des Moines, Iowa. She was assigned to a primary care provider, occasionally rotating into urgent care or the lab. Before the coronavirus, her office received more than 100 people a day. After the virus struck, with patients scared to come in, headcounts tapered off.
“Many non-healthcare professionals think that since we are considered ‘essential’ that our jobs are guaranteed,” Rachel says. “But they aren’t, especially in an outpatient setting. The number of visits we see are declining to increase safety, which means income for the business declines. Nobody is safe from the economic effect of this virus.”
At first, Bree-Ann’s hospital system shortened family practice operating times by two hours a day. By late March, the urgent care clinic closed. The system began consolidating other family practices into Bree-Ann’s building, doubling the number of family practice providers while reducing clinical support staff. They began ramping up the use of telemedicine.
“Our providers are still able to see their patients via apps like Zoom, or on the telephone if they don’t have access to smartphones or laptops,” Bree-Ann says. “It’s really brought our family medicine into the 21st century. Patients have really, truly, appreciated it, but it changes the nature of my job.”
In April, Bree-Ann was furloughed to working just one day a week.
“I’m used to being in constant motion,” Bree-Ann says. “I will be on my feet for 10 hours straight, running around like a crazy person when there are two medical assistants to manage eight rooms, two providers, 25 people in urgent care and phone calls. You go from that level of intensity to nothing. I want to get back to work. I want to get back to my patients.”
Even in a crisis, life has unusual ways of disrupting plans. Long has Rachel tried to put off surgery for her back, she couldn’t postpone it any further.
Her April surgery was fretful for numerous reasons: the six-hour surgery itself, potential exposure to the coronavirus, and in a cruel coincidence—she was on the receiving end of the same process her facility implemented. She had to go through much of the surgery process alone; once admitted, she wasn’t able to see friends or family until being discharged.
It was scary, lonely, frustrating. It was also revealing. Her co-workers—who are stressed and exhausted and worried and not able to go inside their homes until they’ve completely decontaminated—are reaching out to her. “They’ve been checking up on me and have been worrying about me,” Rachel says. “I think that just speaks volumes.”
As worried and sad as Bree-Ann is about her job, including thoughts of pivoting her career, she can’t help but notice the good, too. “Everybody at my clinic has rolled with the punches,” she says. “They’ve done their best to take care of each other and each other’s responsibilities when we’re not able to be there because of layoffs or furloughs. If you can keep your chin up, be kind, and keep your coworkers and patients laughing while doing your job to the best of your abilities in a time like this, it says a lot about people within the healthcare system.”
So, yes, it is still a tale of two worlds. But in this one world of healthcare workers, the bonds may never be stronger.