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     It all started as a summer job. I wasn’t supposed to continue it through the school year, but I didn’t want to be bored on the weekend, so I continued it.  

 

     The pandemic hit in March 2020 during the second semester of my freshman year at Michigan. I was sent home, and because I refused to let go of my hope to work in healthcare, I found a job in a group home for people with traumatic brain injuries (TBIs). I worked there for three months, and when the fall semester was about to begin, I decided to continue working there because any and all fun parties or tailgates that would happen on campus would be cancelled with the pandemic.

     Essentially, I was afraid to be bored on the weekends, so I decided to work at arguably one of the least desired workplaces during the pandemic, in healthcare, in a congregate living setting. I thought that I would be out socializing and meeting new people. Instead I spend every Saturday night playing Yahtzee with a woman who doesn’t recognize me or know my name.  

     Now, was this a wise decision at age 19? I don’t really think so. In order to go to work every weekend, I would be picked up from my apartment where I live with three other girls on campus and go to my house where my siblings who play high school sports, and my parents who work in healthcare live. Then, I would go to this group home and work with two other staff members and multiple residents of the house. I had one other house on campus I would go to where my friends lived, which increased the exposure to six more people. I felt that being a student on campus made me one of the riskiest employees because I have so many sites of possible exposures, and as the school year started in fall 2020, Michigan had extremely high infection rates. One of my friends was formerly employed by a nursing home and they fired her at the beginning of the school year because they knew she had a high risk of bringing COVID-19 to their residents. In direct opposition to that mindset, when Michigan students were given a stay at home order by the county, my boss asked me to work more shifts.

     Over the summer, I was lulled into a false sense of security. When I was hired, I was informed that there had been one facility, the one with the most dependent residents, that had a few COVID-19 cases, and that sadly, a couple of the residents died from the outbreak. This facility was 45 minutes and a county or two away from where I was working, and there had been no positive cases in any of the company’s facilities in the month before I was hired. My first months on the job, all I had to wear was a surgical mask, which in all actuality is not very intrusive or obnoxious to wear. The residents there didn’t wear masks inside the house, and all ate dinner together in the dining room. I acclimated to working a 4pm-12am shift and got to know the residents that were living there. I talked to them as they smoked outside, prepared dinner for everyone, watched TV with them, painted our nails, and tried to deescalate any behavioral issues or conflicts that arose. It became my normal and I had nothing but baseline stress about the virus, which wasn’t worsened by working in healthcare.

     My house, House 1, provides support for more independent people living with brain injuries. They typically only need minor cognitive help. These homes appear the same as any other house but are designed to be more wheelchair accessible. I typically only work at House 1, but occasionally am asked to work at another house, with similar residents, House 2.

     One day, probably mid-July, I entered House 1 for my typical shift and the manager was there. She never came in on that day of the week and on the table, there was a wide variety of PPE, more than was standard to wear, strewn about.  As soon went into the office the manager closed the door and told me that one of the residents had just tested positive for COVID-19. I didn’t even know what to say about it. At that point in the summer, we were still learning about the virus, and I didn’t know anyone who had it yet, or anyone who had worked with COVID-19 positive patients. I accepted a KN95 and goggles, then started cleaning the table and kitchen. I didn’t have time to panic about it with such short notice.

     Fortunately, a day later they retested that sample and it came back negative. After that false positive, we went back to working as usual like nothing had happened.

     In the fall I adjusted to online school, working on Saturdays, and coming home one night every week. The communication within the company was less than mediocre. When I arrived every weekend something always changed, whether that be clients themselves moving in and out of different houses within the company, medication changes, the office being rearranged, or, one week during mid-fall a new shelving unit with 12 heavy-duty face shields appeared. They were heavy duty and looked fit for transformers.

     The PPE changes were the most significant. The mask and shield became the new standard. As COVID-19 cases started to spike once again in Washtenaw County, residents would have various exposures at their work, or at doctor’s appointments. As a precaution, after these exposures these residents were put on a two-week quarantine, where they were confined to their room and only allowed to leave to smoke outside. Additionally, this meant that when we passed medication to these residents, we had to have full droplet precaution PPE, which included gloves and a disposable gown. Sometimes I had to put on a full gown to make dinner for everyone. This was always conveyed from the outgoing staff, and rarely explained by managers before arriving.  

     I want to stress that this is a living situation that I would not wish upon everyone. Usually, the residents can leave and go shopping and do fun activities, but now the homes were locked down. During the pandemic I had my apartment, friend’s house, home, and work. These residents hadn’t left the house in eight months—literally. They hadn’t seen their families and weren’t even allowed to do their own grocery shopping. A few of the residents had young children that they hadn’t seen in almost a year. They are anxious to return home and make up for time that was lost. One of the residents said that they would hug their kids and not let them go. They said their children would hate them for it, but they weren’t planning on letting them go for a long time.

     During phone calls with their families, they ask how their families are doing. One of the residents said their children are pains in the ass, but they miss them a lot and wish they were there to tell them to get their shit together. The tough love of a parent is taken away when the residents cannot be there for their families.  

 

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THE NIGHT OF THE EMAIL

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     One Saturday morning towards the end of the semester my phone pinged with an automated text message from work, “Come work at House 2. The residents need you. There is an extra $2.00 per hour.” This sounded like a great idea to me. In early December I was planning on visiting Chicago with my two close friends for a weekend away from the school and stress in Ann Arbor. I could’ve used the extra money and House 2 has residents that are relatively independent. All I would need to do is help feed one of the clients, make dinner, and see if anyone wants to play a game or watch TV. I’d met them all before and overall could’ve been an easy job.

     I elected to wait until later that evening during my shift of House 1 to snag one of the shifts. I usually had some free time and my coworkers could’ve helped me navigate the convoluted shift website. I thought they really needed staff if they were offering us $2.00 extra a shift.

     Later that evening as I walked into the house, I greeted a resident who was watching gameshows as usual. She is in a good mood and has a friendly demeanor even though she doesn’t remember me after I worked there every week for six months. I moved quickly into counting the medications and the cash at the house so the day staff can leave on time. Once they headed out, I went to the kitchen to prepare dinner, donning my gown and gloves to cook and begin talking to my coworker. At shift change, I was instructed to wear full PPE during cooking and any interactions because the house was on full droplet precaution. This change wasn’t out of the ordinary or worrisome because there have been various exposures at the facility, but no one became sick. I felt pretty safe at House 1 and think that we do an excellent job compared to other locations and companies with infection control. At this point, I believed that I was the highest risk employee to bring COVID-19 into the home because I was on a college campus that was brimming with the virus.

     When I caught up with my coworker, I realized that they had primarily been working at House 2. I inquired about the extra $2 per shift, and they explained that in the previous five days, several of the residents living there tested positive for COVID-19.

     I was shocked because House 2 is run extremely similarly to House 1, and I thought they were both safe. These two homes were well respected for having a solid COVID-conscious staff. How could the virus have entered House 2? These houses had no COVID scares, beyond House 1’s false positive months earlier. An outbreak shouldn’t have occurred at one of the smaller homes within the company, and especially not in houses with a reputation for being safe and organized.

     I was grateful that I didn’t pick up an extra shift there, but also curious as to why there wasn’t a notification on the text message that the extra money was hazard pay. Do workers not have the right to be informed of walking into a hazardous situation? I wondered what it would be like to work in a COVID positive environment. The pandemic would’ve felt real. Was I truly an essential healthcare worker if I didn’t work with COVID residents or patients? It felt like I wasn’t. Was everyone ok?

     I am still ashamed that the question of health and safety of residents and staff was secondary to my curiosity about the logistics of infection transmission and concern over company communication. It’s ok as long as I ended up there eventually, right? That’s what I still tell myself.  

     One of the residents from house two, Resident A, who was a really kind person was admitted to the hospital. I’d worked with them before and they checked the box for nearly every preexisting condition under the sun, was admitted previous night. They used to have a little white fluffy dog and has family that loves them and calls them daily.

 

     Later that evening, two residents at House 1 stood six feet apart leaning on the couch watching us cook. They technically should’ve been in their rooms, but I didn’t have the heart to tell them or the will to start an argument about it. They had been in quarantine off and on for about a month and hadn’t been allowed to leave the property since March, so they were going stir crazy and becoming more behavioral. One of them likened it to being in jail and frequently muttered complaints. With these considerations in mind, I was instructed to be a little more relaxed with the residents who weren’t on droplet precautions and quarantine. I know my personal mental health has deteriorated significantly during the pandemic and the abnormal situation we are all in, but I try to check that at the door because the kind of confinement these women experience is on a completely different level than my own. I feel terrible for them, and it seems almost inhumane, especially given the fact that we hadn’t had any true issues with staff or clients testing positive. I didn’t see why we needed to be this strict if it diminished their quality of life.

 

     I completed the final scrub of the dining room table and chairs before sitting down. In the past several hours I had to take the cleaning supplies from the office where they are kept for safety, clean the table, and return them before and after each of the six residents sat down to receive their meds. With everyone on different levels of quarantine, I need to make sure that nothing could be transferred from the table and chairs or from resident to resident.

     With the quarantine, there was a lot less that we could do in terms of resident interaction so there was lots of excess time to sit and look at your phone or attempt to be productive and do homework. Usually after the cooking, cleaning, and meds are done, my coworkers tended to keep to themselves. That’s why I was surprised when my coworker entered the room with the house laptop and asked if I could look over an email. We weren’t close and I had maybe worked with them twice before. I thought they weren’t very talkative and didn’t help that the PPE; a face shield and mask, made it difficult to read anyone. When I asked what sort of email it is, they explained how they had worked at House 2 the night before where she had relieved a coworker, not at the house, but at the ER.

     They had worked here for several years so they informed me that company policy was for staff to accompany residents until they were admitted to the hospital. She said that Resident A from House 2 had started coughing and got really sick. They hadn’t confirmed he was positive until they did a rapid test at the hospital, despite having been exposed at House 2 the past five days. The staff member they relieved was only provided a surgical mask and a face shield which was the only protection offered at House 2 for those five days. My coworker’s email was addressed to the infection control person within the company to inquire about why N95s hadn’t been supplied in a COVID-19 positive environment.

     Had they not had months with no outbreak to prepare for this?? My parents are both healthcare workers and my dad, who has worked in the hospital throughout the pandemic, was always provided with an N95. At the beginning, he had one N95 per week and would wear a surgical mask on top of it and store it in a paper bag to prolong the life of it. Now they have a greater supply. I didn’t care if I had one N95 per week and need to re-wear it like he did at the beginning. I would rather have that than a single flimsy surgical mask.

     My coworker had to restrain a disoriented Resident A for the resident’s safety for a full eight-hour shift as Resident A coughed on my coworker. Because Resident A was so weak and confused, every time they tried to get up, their mask would slip down and droplets would get on my coworker. Fortunately, my coworker had their personal N95 on them from their other job at a hospital and wore that in addition to the company provided PPE, so they were alright. As great as that is, it didn’t help the rest of the staff and clients at House 2, many of who were getting sick or working until their test came back positive. This usually took a full week to receive results due to the contract the company had for testing. Additionally, just like my coworker working at House 1 after being exposed at House 2, there were several other staff members that frequently work at both locations and without adequate PPE the likelihood of transmission is probably pretty high. I started to shift to create an extra foot or so of distance between myself and my coworker.

     As I began looking at my coworker’s email, it was obvious that like most of my other coworkers, they didn’t have the best writing skills and they likely had less extensive and definitely lower quality education than me. My manager had complemented me on my ability to write an incident report because it was both thorough and clear compared to most of my coworkers who seem to struggle to write a coherent paragraph. I accepted the computer and tried to reorganize their email. There was good content here, but spelling, word choice, and sentence structure was off. From my parents and all of my classes I’ve learned the value of writing that sounds credible and how it encourages people to take you seriously. Right now, if I read this email, I would likely question if it was relevant or trustworthy. Should credibility be based solely on the ability to communicate, especially in this setting? No. But does it matter? Absolutely.

     As I edited the email over the course of an hour or two, I became infuriated on my coworkers, residents, and my own behalf. Whoever was making the policies and isn’t providing the PPE is not the one at risk. I considered including the line, “Is the company UNWILLING or UNABLE to provide frontline healthcare workers with proper PPE?” before ultimately deciding that the wording might be too strong. I wanted to rock the boat enough to have meaningful change, but not to the extent where my coworker could get in trouble. Additionally, I have an acquaintance who works higher up in the company, so on the off-chance the email could be tracked back to me, I need to remain in good standing and balance the extreme disappointment and issues I have with the company with the positive relationship and mutual respect we have for each other. I would feel significantly safer working with an N95, especially working with staff who have been exposed at another site. If an N95 is mandatory for healthcare workers at the hospital, I felt it should be mandatory here, especially because we do direct patient care. Putting basic prevention strategies in place could stop an outbreak from occurring. Even though I know I am not the most spectacular writer, I am confident that my editing helped this email. Despite the final product not being the most polished, I still thought it had a greater chance of being seen, respected, and prompting change in the company than the original version. As I left to go home for the night, I was glad I didn’t have to deal with this again until next week.

 

 

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BACK TO SCHOOL

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     After the email was sent, I returned to a normal week of school. Because this was the week before my Thanksgiving break, and to disincentivize people from returning to campus and the dorms after the break, Michigan had given us the full week off instead of the typical three days. I was excited to take a break, but everyone had big midterms or essays due at the end of the week, including myself. I had a Public Health essay (I know, fitting right?) due at 5:00 PM on Friday. Being my typical self, I had procrastinated until the last day, and had been working in the basement of our student Union building the entire day. I was nearing the end of the paper at about 4:30, when I got a phone call. When I picked up my phone, I saw it was my manager who never calls me. I felt my stomach drop and the panic start to set in. There were very few things good things that this could be about, and if she needed something less urgent, they usually would’ve texted me earlier in the week before the weekend. Needless to say, I knew exactly what the call was about. In my haste and panic to grab the phone, I forgot that the Union, which already has terrible cell service, had even worse reception in the basement. I hurriedly collected my computer, charger, and notes that were scattered across the table and shoved them in my backpack and quickly walked out past the computers, through the door, up the staircase until I was standing in the stairwell near enough to the door where I had service.

     I picked up the phone and asked my manager what was going on.

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     “Hi Mimi,” they said mid sigh, their tone confirming what I already knew was coming, “So here’s the situation; two of the residents at House 1 tested positive.”

 

     As it turned out, the tests were taken the previous Friday, the day before I worked, and now it was a full week later. This meant I had worked with positive clients. She told me that I needed to go get tested, and my mind went into overdrive, racing in a moment that many of us have experienced this year, not just worried for ourselves, but worried for everyone that we came in contact within the time since exposure. I try to rationalize it and think that even though I had family dinner on Sunday right after my shift, even if I am positive, I probably wouldn’t be able to transmit the virus until 2-5 days out, and because I am asymptomatic right now, that further lessens the likelihood of transmission. Despite whatever rationalization I can put forth, it doesn’t change the fact that I may have unintentionally inadvertently exposed my family and friends on campus.

     The only other part of the conversation I remember was me telling her that “I cannot work on Saturday. I cannot expose my parents or my family. It is not fair to them.” I am not the priority in my family, if I have COVID it doesn’t matter, but if my parents got it, besides the risk to their own health, it would inhibit the work that they do. Is it ok for me to be out sick for a while, work one day a week, and stay at my apartment? Sure. Is it ok to give two full-time healthcare workers COVID who have a much greater impact on many more people than I do? No. They work a lot more, have a much more positive impact than me, and could possibly expose so many more people. That would just be stupid.

     Before hanging up, I asked about how the different residents were doing. The two positive residents at House 1 were doing alright with mild symptoms. Sadly, it sounded like Resident A’s health was failing and that they would be moved to hospice.

     After I hung up with my manager, I called my dad who I trust not only for general guidance with my life, but to give me medically sound advice during the pandemic. I walked to the front of the building and up a different flight of stairs to a different stairwell and I talked to him. It was decided that I wouldn’t return home until I had a negative test, and that I would go back to my apartment and quarantine there for the time being. Fortunately, this would work out because my roommates had already returned home for break and weren’t planning on coming back. We agreed to talk later once I finished my paper.

     Once it was determined I was staying on campus for a couple of days I had to call my friends. I called my friend’s house, to tell everyone there about my exposure. I had been at their house nearly every day that whole week, which would be a lot of potential exposure to their entire house from me. Even though I tried to triage my calls (parents, friends, then my roommates who weren’t on campus) to who was most affected first, the damage was potentially already done. As I talked to my friend, I explained to them about the exposure. It was unexpected, but not improbable because they knew I was working here. Fortunately, they were extremely understanding, as possible exposures and temporary quarantine weren’t an uncommon thing on campus at the time. As I talked to them, there were two boys walking through the doors of the Union, and I’m sure they overheard me talking about the potential outbreak because they gave an even wider area around me as they exited the door than usual. Honestly, I would do the same.

     Suddenly, my small net which I had prided myself on, seemed huge. As I walked back to my apartment, I kept on thinking crap, crap, crap, crap.  It is not cool to give your friends covid.

 

            When I got back to my apartment, I quickly sent an email to my instructor that I was submitting my paper a half an hour late because of having to isolate due to the exposure. I sent it in at about 5:30 and was a little forgiving of myself. Should I have saved my paper for the last minute? No. Would it have been done on time had there not been a crazy COVID plot twist? Yes.  Is the paper more of a priority than making sure that people know of exposures and keeping everyone safe? No.

     I was about to hop in the shower when I saw the temporary pink hair dye sitting on my desk that I had collected from the mail the day before.  It had been a rough semester and I had every intention of using it earlier that week, but I eventually decided against it. I thought my stress was in check and a crisis was averted. The bottle was sitting temptingly on my desk when I somewhat impulsively grabbed it, this situation provided the last fissure needed to engage in a personal crisis that had been brewing since the beginning of the pandemic. The exposure was the catalyst that temporarily broke me that night.

     I threw on a black T shirt that wouldn’t be ruined by the dye, which coincidentally was the one article of clothing I owned from my work. I squeezed the dye out onto my hair and rubbed it in with gloves, then tied it up and went to order food. Because I didn’t want to give anyone COVID, I used GrubHub or one of those websites that charge an astronomical delivery fee for a meal.

     I dragged myself to the shower after waiting the thirty minutes for my hair to be colored and watched the pink dye rinse out of my hair and slide down the side of the once white shower stall. It seemed final.

     I blow dried my hair straight and it was hideous. A full head of pink hair on someone like me does not work and while Snapchatting my friends they told me it was ugly. I wasn’t mad because it was true. I gathered my lukewarm takeout food and attempted to find a covid test near me. I couldn’t get one through the university without filling out a form and them deciding if qualified for a test which would take a few days. I didn’t want to wait until Monday to get tested through work because I knew I wouldn’t have the result back before Thanksgiving because of the company’s testing lag. After several failed attempts at trying to find a one- or two-day rapid test and receiving recommendations from both family and friends, my best option was an Urgent Care that I just show up to in Ypsilanti. For Ann Arbor being advertised as a wonderful place with one of the best Medical Campuses in the nation, the city did not have adequate testing available. I was disappointed and frustrated. I had no idea if I showed up to these places if they would even give me a test.

     Needless to say, COVID-19 exposed the healthcare system as being inadequate. I feel as if I had lots of resources available to get tested and get treatment, likely more than the average person, but I still struggled. How would this be for someone that was not me?

I had planned to unwind by hanging out at my friends’ house, but that was obviously out of the picture now. I laid down on my couch while blasting Linkin Park, because it fit the pouty, grunge, and frustrated vibe of the night.

 

 

 

THE NEXT DAY: FIRST DAY OF ISOLATION

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     The next morning, I had to unpack most of my bags that I had prepared to go home. Of course, this was the one time I prepared for this instead of haphazardly shoving things into bags once my family said they were on their way. My parents dropped a car off on campus for the weekend for me. We were distant, and they also laughed at my hair. I had to check with them if it was ok if I went to the grocery store because I didn’t want to put others at risk. I would prefer to have an abundance of caution than none at all. Apparently as long as I wasn’t symptomatic and was following PPE guidelines it was fine. I thought I was smarter than the average person and knew a reasonable amount about the virus during the pandemic, and that I was definitely safer than most, but this highlighted the fact that there were still big huge in my knowledge.

     I went into a sketchy Urgent Care facility in a rundown strip mall that I had to use my Maps app to locate, because even though it was only 15-20 minutes away from where I grew up, it was off the beaten path. I was definitely skeptical that it was a credible medical place, it seemed kind of poorly run, and once I filled out a questionnaire, they let me in. I was shocked that they had minimal PPE just like us. I was definitely in a really tight room with two other people, both only wearing surgical masks. Neither had face shields. They looked naked for being in a medical setting, even by my work’s standards. Lack of PPE is a problem everywhere.

 

     That afternoon, my Manager called me and told me that because I wasn’t working today and refused to work in a COVID positive house it would have to count as one of my 3 ‘call-offs’ which add up and if I get too many I am fired. I offered to work at a different house without known positive cases for the weekend, but they told me that I would be fired from the company if I didn’t work at House 1. Personally, I felt that this was kind of ridiculous because the company had been short staffed throughout the pandemic and firing someone would only worsen the situation.

     Later that evening, my family friend who works at the company texted me to see how I was doing, and what was going on with House 1. We ended up calling and talking for an hour about what could be done to get me from working. They directly told me that they didn’t want me working in a positive house. No one wants to be working in a positive house. We ended up trying to figure out what we could do to prevent me from working there during an outbreak. We had three options: call off until the end of the outbreak, work at a different house until the outbreak is over, drop down to be an infrequent worker which means you work either once a month or three times in a three-month period. These are in order of what would be ideal. The first was off the table because although I would be willing to call off twice, I signed up to work a shift during break and was on the schedule for Saturday. This meant that after calling off for those three days I would be out, it seemed naive to think that the outbreak would be done after a week so that was a no go. I already tried the plan to work at a different house until the outbreak is over and it was eliminated. That left the option to drop down to infrequent, which seemed like a good idea.

     I texted my manager asking if we could talk about this within the next couple days.

 

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THE SECOND DAY OF ISOLATION

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     On Sunday, I returned to an outbuilding at company house to be fit-tested for an N95 and encountered on of my coworkers that I look up to. She works hard on behalf of the residents to make their experience positive. She had been working over a full week straight and was complaining about the residents. They had become more behavioral and mean with the mandatory quarantine to their room. It is an awful situation, and especially because one of the residents had a hard time understanding or believing COVID, she frustrated with the additional challenging mood swings. Residents were refusing to go to their rooms and cussing out the employees. No one wants to be in this situation, and I am sympathetic, but sometimes with their brain injuries, they are impulsive and don’t remember to think beyond themselves and see the hard work and sacrifice that my coworker had put in on their behalf.

 

     Fortunately, later that afternoon I received my COVID test result back and it was negative. I returned home to spend time with my family. My manager had responded to me and said that I needed to give a full two week notice to become an infrequent employee and that I would either have to quit, be fired, or work with COVIDs

 

     As I sat down with my dad to discuss what I should do, he asked me what the heck I was doing. This was supposed to be a stupid summer job. I get a little clinical experience, some spending money, but you don’t need that right now. It might be time to call it quits. He said I wasn’t supposed to get COVID from a job that was supposed to have an end date. I was torn. On one hand, this is a job, but on the other hand, I see these residents every day and it seems shitty to dip right when they get sick.

     I felt like was in the eye of a hurricane. Especially during the first lockdown and over the summer I watched the news every single night where they showed and described the horrific conditions in the hospitals and nursing homes. I felt like even with the right PPE I would surely get it. What if I touched the table and accidentally touched my eye? Did I need a different pair of shoes, one for COVID positive houses, one for normal? I felt like walking into some sort of battle. This was the biggest fight that I have seen recently, and now shit was getting real. I wasn’t just an ‘essential healthcare worker’ without any proximity to the pandemic anymore. I was what I deemed truly essential. Anyone can work in healthcare but working as essential healthcare worker with COVID positive people felt different. My dad told me I was being melodramatic, but it felt insane that this was what my summer job was coming to and not at all how I envisioned my sophomore year of college to be like.

     I definitely agreed that this would be a dumb way to get sick, but I did like the job. It is usually lowkey, but I tried to think about it in a different realm. Was I really about to abandon all of these people in their time of need? Is that not the entire purpose of medicine and healthcare? Is that really ethical that I leave when I am probably the most resourced person in the position? I know I am only there once a week, but will that perpetuate those of lower SES having worse outcomes if I have the privilege to leave? Does my fear of a virus keep me from doing the right thing?

     I talked this over with my dad, and because I wanted to continue working there for at least the rest of the school year we decided to review PPE precautions and distancing so I would likely be pretty safe when returning. When we googled PPE efficacy, I couldn’t get the percentages of if I would be ok or leave sick. It seemed like there were several of my coworkers that had gotten sick, but I didn’t know if that was before, or after N95s and air purifiers had been added to the house.

     I realized I hadn’t been instructed on how to properly don and doff PPE since high school. I was concerned about having to work closely to residents that were positive and wanted to know the right way to put on, and especially remove everything without contaminating myself. I found some videos with my dad and listened to how he changed PPE between patients at the hospital, yet another resource my coworkers did not have.  I had the luxury of taking a day off, whereas they were stuck working with symptomatic residents. I was making a game plan to return to work in the safest way possible. I even was able to get extra signage for PPE put up in the house before I worked.

 

 

 

 

WORKING IN A POSITIVE HOUSE

 

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     Mid-week of my break I returned to work at House 1 that had residents with COVID. Before entering, I took a deep breath through the N95 I already had on, took my temperature at the door, then exchanged my mask for a fresh one and put my face shield on. I began the shift change procedures of counting the medications and cash, and then asked how everyone was doing. It sounded like all of the residents were still upset to be quarantined. They were only allowed to leave their rooms to smoke, the COVID positive residents smoked at the front of the house which was usually locked and alarmed as a precaution, and negative residents smoked on the back porch where everyone usually smoked. One of the positive residents overheard us doing our typical shift-change, and as she began her slow ascent up the stairs, we could hear her muttering nasty things about us. The outgoing staff told us that there was one staff member that left early the previous shift with a fever and was presumed positive. Most of the staff had been tested by the company on the previous Friday when clients had confirmed positive statuses. The testing, as aforementioned, took about a week to hear back which was longer than any other testing I had heard about. Employees were required to work until they showed symptoms or tested positive, the former usually happening first. They also said that it would be nice if we made door decorations for one of the residents who had a birthday the following day.

     I made dinner with a full gown, gloves, and shield on, then delivered it to everyone’s room. Then I passed medications to everyone, putting on and taking off my PPE in the way that I had just relearned between each client. Every time someone touched any surface, I wiped it down. I had never cleaned more than I did that night. I thought that the typical preventative cleaning before was bad, but this was much worse. Instead of wiping down the table once or twice, I cleaned it four or five times thoroughly. I cleaned the legs of the table and chairs. I cleaned the counter and cabinets. I cleaned every single handle and light switch in the house. I cleaned the handrail on the stairs. I cleaned the couches. I cleaned the TV remotes. I cleaned the keys.

     There was no significant interaction that I had with the residents that night, besides delivering whatever food or coffee they wanted to their rooms. I thought about doing some homework, so I wiped down my computer and the area in front of me before setting it down. I ate dinner standing up, in a corner away from everyone, and if someone entered the room I hastily put my mask and shield on mid bite. My focus was off, so I shifted to decorating the door for the resident. I wanted to do something cheerful and realized that in an activity pack that had been delivered to the house there was a package with 20 different kinds of glitter. There was a lot of craft paper as well as some school glue. I decided to cut up different pink, yellow, and orange flowers, and layer some on top of each other, then sprinkle them with glitter. After that was done, I blew up some balloons, cut some streamers, and taped it all to their door with a sign that said happy birthday.

     With the exception of some of the negative residents wanting to smoke out front things were uneventful. I couldn’t make them go out back, so I tried to distance the seating in the front and wipe down the door handle every time someone touched it. All things considered it was a calm shift and by the time I left I felt relieved and much better. A few people here may have been sick, but they were still the same as before. I had hyped the virus up way too much in my head. Everything was alright and I was, as my dad had said, being melodramatic.

 

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COMPLETING THE REST OF MY SHIFTS OVER BREAK

 

  

 

     The next few shifts I did were at several different houses. I believe I worked at 4-5 within a week I had never worked at. Most of the time, the residents were really patient with me, but I wore my new N95 everywhere, sometimes with a surgical mask over it to try to ensure I wasn’t bringing COVID-19 to new houses. This brought up some looks of distain from other staff members who thought I was being ridiculous or opened the floor for questions about why I would do that in a house that didn’t have COVID. It seemed rare to think of prevention, and many people seemed to be a little bothered by what they saw as unnecessary PPE.

     Another worrisome situation that I noticed while going around to these different locations was the different requirements about PPE. Even though I had heard one thing about full company strategy and mandatory PPE or quarantine for residents, every place had slight differences that were confusing. One had virtually no change from a few months prior and minimal additional PPE requirements. Another had signs up everywhere about wearing gowns in residents’ rooms, but there were no gowns out for use. When I asked about it, the remaining staff seemed put-off by my inquiry. Additionally, they had some weird sort of system where residents could leave their room one at a time for an hour each to spend time in common areas without risking transferring disease to other residents. At the time this seemed extremely insane because I thought everyone was supposed to stay in their rooms (not that I agreed with the harm this had on everyone’s mental health). Although I was uncomfortable with this strategy then, it did eventually become a company-wide way to give the residents some more freedom throughout the tail end of the pandemic.

     People seemed a lot less tense than I did. Maybe this was a product of them accepting the risk because they were in these houses much more frequently than me, but I could not be as calm as them. I had never considered myself to be a germophobe, but maybe the pandemic, working in healthcare, and talking about it daily with family and peers had brought out the latent trait in me.

     Later that week, I unexpectedly worked in a house with residents that had more medical than behavioral needs. Despite being fairly confused with what I was supposed to be doing, not just in the sense that I had never been there before, but needing to bathe, change, and use a Hoyer lift for a severely impaired resident during this crazy pandemic, I had to laugh. We had trouble communicating, but as long as they got their coffee, and could ask me the same questions over and over while calling me “Ms.” as I responded good naturedly, we had a good time together even with the barrier. Even though it was such a weird situation for us, this was one of the more positive memories from this stressful time because although we were fumbling through this situation together, we both took a step back sometimes and laughed, because that was all we could do. All of the stress and chaos of the past week bottled up that evening had a positive outlet in laughter.

 

 

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PRESUME POSITIVE UNTIL PROVEN OTHERWISE (AND A FEW FIRE ALARMS)

 

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     Later that week, I worked at House 1 again. We were operating as if everyone was positive. It seemed impossible that it had stayed contained to just the two confirmed positive cases, especially because almost half of the staff ended up getting sick. There were rumors that there may have been several negative tests for the residents, but it was unclear because no one knew how or when they would be notified with the results.

     The shift went on the same as usual, cleaning, making sure everything needed was done. Unfortunately, while making dinner, an oversensitive fire alarm went off. I was passing medication at the same time, so I had full PPE on. I quickly logged off of the medication application on the computer and lock the med cabinet as the alarms blared. In this house it isn’t just a single fire alarm, it is a whole system that shrieks while the fire department is immediately called. We have to pick up the phone call from the security company and tell them to stop the fire department from coming and that it was a false alarm before EMS shows up. When I picked up the phone for this alarm after telling all the residents that it was a false alarm, I asked the company to stop the fire department from coming. They said that they would try but they might already be on their way.

     The worst part about this is that you have to open the window or stand outside and see if you can hear the fire truck pull up. Anyways, about 5 minutes later I could hear the sirens and see the lights through the darkness as the fire truck pulled into the driveway. I had to run outside, in full PPE. Out of habit, I started jogging out through the back porch out into the soggy light snow filled grass, as my shoes got damp, to the muddy gravel driveway. I looked like I was working in some hazardous waste place. Then I had to tell the firemen that it was a false alarm, as usual, and that we were all ok. As they headed out, I walked back inside where one of the clients, whose brain injury makes them somewhat inappropriate at times, immediately asked how the firemen were, and if they were cute. These firemen were significantly younger than the resident. I tried not to engage or exacerbate this by acknowledging that I found the firemen attractive. I changed the topic to Wheel of Fortune which was on in their room so they would refocus and continue quarantining.

     Then, my coworker realized that the alarm had been reset to its original settings. This meant that if one of the COVID positive residents walked out the front door, then the whole alarm sequence would go off again, and again. We had to try and dig through paperwork and text various managers to reset the alarm so the front door zone wouldn’t go off. The alarm went off several times as we tried to fix it, and the alarm company couldn’t help over the phone. We did try to tell them to stop any more EMS from coming, and they said that they would cancel it. Eventually, by putting our minds together we got the alarm reset, when guess what happened? I heard some new sirens. So, yet again, I trekked outside while holding the phone in case someone called, a clipboard that we use to track client’s activities, with the keys to the medicine cabinet jangling around my neck over my gown, gloves, and really cute COVID outfit. The police got out of their navy SUV with the red and blue lights flashing through the night. As they exited the car, what were they putting on? N95s. Apparently the cops had them at their disposal and medical workers trying to mitigate and prevent an outbreak did not have any. Preemptively, I told them that everything was alright and that we had just succeeded in fixing the alarm system. After seeing how I was dressed, they asked if this house had COVID, and I said yes. They didn’t come any closer. They seemed a little bored but wished us a good night and I apologized for the inconvenience and thanked them for coming.

     I mean, this definitely was an interesting night. Every time you think the shift will be calm it becomes chaotic. The chaos was more welcome this time to serve as a distraction from the virus. It was hectic and irritating, and while I do not want to put undue stress on the emergency system, it did give everyone there something else to focus on for a couple of hours to break up the tension that the virus had caused.

 

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DECEMBER

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     Later the week after the firemen and police came, we heard that everyone in my house was negative. I don’t know how it didn’t spread to more residents beyond the initial two, but I was incredibly grateful, and it lifted a huge weight off of everyone’s shoulders.

     Although my house made it through relatively unscathed, there was a damper put on our happiness. We heard that Resident A had died from COVID-19. It was a bitter reminder that although most of us ended up ok, their life was cut short. This was the first person that I personally knew that died from COVID. Even though I had worked in the presence of the virus, knowing someone who died reframed the whole pandemic for me. Although they had several preexisting conditions and I had only spent a short amount of time with them, they still were a person with thoughts, feelings, likes and dislikes, who was just like you or me. Every single person who died from COVID, including the several hundred thousand in the U.S., was like them. This reality, especially with many states and the University of Michigan going into a renewed lockdown in early December, further emphasized the severity of the situation.

     The agreement I made with my dad was to wear an N95 at work until I was vaccinated. We both felt safer like that. I was the only one who continued to wear one of these after the residents all came back negative. Every week, I would come in, grab the keys, unlock the door to the basement, and grab a fresh N95 as my coworkers looked questioningly on. I understood those staff who already got it and had antibodies not wanting to wear one, but I would much rather be safe than sorry. Every weekend as I drove home, I would have red lines left on my face from my mask, even after I got out of the shower.

     As I worked toward the end of my semester everyone at the house got antsy. They had been in some form of quarantine for over a month which was extended around the holidays. The reasoning for that was because they didn’t know what staff was going to be exposed to over the holidays. I don’t think the residents should’ve been ‘punished’ with more isolation because of the staff’s inability to stay safe around the holidays. The residents' behaviors deteriorated, there was the occasional fight, one of them needed additional psychiatric help, and the police were called when residents got into a fight. Some residents were shuffled around to different houses and any doctor’s appointment became the excursion of the month because it was the most outside interaction they could get. The best thing that happened for some of the clients was being driven around in one of the company cars to see the Christmas lights in a local neighborhood.

     This was the first time that I, like many others, stayed home for Christmas in my entire life. I didn’t see any extended family which led to an abundance of idle time which coincided with the approval of the first vaccines. My parents, through their occupations as healthcare providers within a large medical system were able to receive their first doses around Christmas. They were the first people that I knew who got it. During the pandemic they worked incredibly hard to keep their patients well. They deserve it and have the occupational hazard of COVID in their field.

     The issue I began having was when I saw my peers who were working as volunteer or researchers without direct patient care being able to finesse the system and jump the line potentially displacing those at risk. From my knowledge several of them should not have been in the first wave of vaccinations (1A) that includes healthcare workers, residents in nursing homes and congregate living situations, and those that work there.  My parents obviously counted for this, and my work, with a COVID outbreak just the month prior, should have qualified as well. Vaccination through Michigan Medicine would’ve been the fastest way for me to get this. In Michigan Medicine’s plan for vaccine distribution, because I was employed by this company and not by them, I did not qualify. Had I been employed in the same capacity at Michigan I could’ve gotten it in December. According to Michigan Medicine, where I attend school, I would receive it with the student population, which just opened in mid April.

 

     I needed to be reasoned with and refocused from the vaccine conversation. Even though the vaccines seemed to be within reach, I felt an urgency to get one. I needed it now, especially after the outbreak at my work made the pandemic seem so close. I did everything right. I was extra careful to wear PPE. I isolated away from my small group of friends while House 1 was positive so they wouldn’t bring COVID to their families over winter break. I did everything the best I could, but at the end of the day I was returning to Michigan’s campus to attend school. There was a very real possibility that if one step was messed up, or if I touched my eye at work, I could’ve tested positive, and unknowingly started an outbreak on campus which would worsen the already bad situation Ann Arbor was facing.

     I don’t want to take this so personally, but when someone like me poses a risk to your campus and Michigan Medicine can vaccinate researchers that don’t interact with people, would it not be in their best interest to vaccinate me as well? Especially because the congregate living situation proved to be a breeding ground for COVID. Even if my work would gain a supply of vaccine down the road, I felt as if I should have qualified certainly earlier than a standard ‘student’ which was last on the vaccine plan. It was insulting and I felt betrayed by the lack of support from an institution that I had formerly respected a lot more.

     Sometimes over that winter break I would get so worked up about it and my mind would race that I couldn’t fall asleep for hours. Even now, while I write this my hands are trembling. It is still uncomfortable. My chest tightens, my shoulders tense, and my breath gets shallower.  I felt passed up by people who had not done the same sort of work and had not put themselves in harms way. I know that this is incredibly biased, and I don’t want to play god of vaccine distribution, but I never realized how much of a number I was here until this situation.

     This whole situation was further exacerbated when I saw my own family becoming inoculated, had an abundance of time to think, and when there was radio silence from the company I worked for about vaccines. I didn’t even know if there was a plan to get residents and staff vaccinated because in some ways, their response to the pandemic felt haphazard. Every time I entered House 1 in December I asked if anyone had heard about vaccination and no one knew anything.

 

 

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JANUARY

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     In early January we received a vaccination schedule out of the blue for the different houses within the company. On January 13th I received my first dose, about a week after the announcement. None of my coworkers had heard anything about the company pursuing vaccination, which brought about even greater uncertainty as we heard of other companies getting vaccinated. Had I had some warning, I could’ve had a tentative timeline for what my vaccine schedule was like and wouldn’t have spent my whole break becoming increasingly agitated. My parents, yet again, had to tell me to chill and stop being melodramatic, and that it would be ok eventually. This did not help me when I didn’t know what was going on, and yet again, I wished for stronger communication within the company. After getting my second dose in February I stopped wearing the N95 which was a lot more comfortable. All of the residents were vaccinated so I felt a lot more at ease.

 

 

 

WHERE ARE WE NOW?

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     When I began writing this, I was much more distraught than I am now. That being said, I do not want to discount the feelings that I had during this pandemic. In hindsight, everything is a lot better, but it takes away the uncertainty and confusion that was there in the moment. I have mostly accepted what happened, but some parts hurt more than others. Distance from the situation definitely has helped me, but if I think too hard about some of this I do still get upset and jittery. When I started this project, it was to discuss my frustration with lack of PPE and masks, but I wanted to show how the pandemic is so much more than that. It is a system of individuals all being affected differently and no one is truly safe. Distance from the situation helps.

     The homes are slowly returning to normal. The residents are now able to do their own shopping and have various outings, like going to a movie theater. It is still not ideal, but I think it will slowly improve with more of the state and country being vaccinated.

     At the present, there are only about 40% of employees at this company that are vaccinated out of everyone who was given the opportunity. I still feel as if this is abysmal. In such a setting where many of the people who work there are heavily impacted by the virus due to occupational hazard one would hope that this would be a sign for more people to become vaccinated, especially after outbreaks got not only residents and employees sick, but also their families.  It is disheartening.

     We are all upset, frustrated, and tired. Whether that be because of losing freedom and fun during the pandemic, or from trying to evade a miniscule virus that can have catastrophic effects. We are forced to confront the uncertainty that is there all the time but is especially pronounced this year. For most of us, our own, and our friends’ true priorities have been exposed. The pandemic has unveiled the underlying issues and weaknesses within our communities.

     I will say that this whole situation made me feel uneasy as not only a healthcare worker, but as a citizen who interacts with others and impacts disease spread. I feel like some values of ours may have been thrown out the window in favor of doing something to benefit oneself without regard for others. Even though this past year has been filled with terrible stress, loss, and exhaustion, I believe there is hope, and that we are resilient. Vaccinations and the immunity they bring are making the future brighter. I certainly don’t have all the answers, just opinions and anecdotes, but I think that sharing what happened this time can help us make better policies, so people suffer less in the next crisis we face.