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Uncertainty Amidst a Pandemic: A 19-Year Old Healthcare Worker’s Perspective

 

 

     My name is Mimi Maixner. I am a nineteen-year old student and healthcare worker. During the week I am on campus doing zoom classes and homework. On Saturdays, I return home and work an evening shift as a caregiver at a home for residents with traumatic brain injuries. These homes look nearly the same as any other house, with the only indicator it is an assisted living home being wheelchair ramp and wheelchair accessible vehicles that are parked out front. I work at house 1. The residents living there usually need someone to cook, clean, talk to, and offer cognitive assistance as opposed to many other houses needing physical help. The residents somewhat frequently shuffle around from house to house within the company, but at the time there were several women living there. I’ve worked at house 2 a few times, and there is a really kind older resident who lives there, Resident A.

     I was hired over the summer, and fortunately the company had only had one outbreak that was resolved by the time that I began working. This gave me a false sense of security, so I was surprised when my coworker told me in mid-November that there was an outbreak happening House 2. Furthermore, I was alarmed that employees working at House 2 had not been given adequate PPE. Below is the email I helped her write to the head of infection control within the company trying to find out where the N95 masks staff needed were.

 

 

Hello Company Infection Control,

 

     I hope this message finds you well. I am a worker at the company and have been a caregiver at house 2 for the last 5 1/2 years and am currently working one day a week. The person from human resources gave me your email today and told me that you are in charge of infection control at the company. Yesterday, I relieved House 2 staff at 4 PM in the emergency department to sit bedside with a COVID-19 positive resident. During this time, I noticed that the staff member I relieved only had a surgical blue mask and a face shield on while performing direct resident-care. I am contacting you to inquire why caregiver staff only received a surgical mask and a face shield in a house where there has been a known COVID-19- positive resident in the house since early this week. It is to my understanding and to OSHA guidelines that N95 masks are the preferred mask for frontline workers with possible positive and positive COVID-19 residents. Is there a particular reason that there were no N95 masks provided?  I understand that there may be shortages, but in the case of a positive resident and for the safety of company employees I assumed that there would be a supply of PPE.  I personally did not have an issue sitting with this resident in the ER and I have never been fit tested for a mask through the company and neither I, nor my coworkers were supplied with N95 masks Friday night. Almost the entirety of my shift I was in close contact with the resident, specifically near their face. They were lying in the hospital bed, but continually attempted to get out of bed and rip out their IV while coughing. Every time they coughed, their disposable mask would slip down the face which caused COVID-19 droplets to enter the air. Luckily, I had my own personal N95 mask with me and wore it under my company-provided surgical mask (I had been fit tested at my other job).

 

    My primary concern in this situation was for my fellow coworkers, as they only had a surgical mask and face shield in the ER. For my peace of mind, I wanted to know if the reason for this situation was because the company was unable to provide N95 protection to its employees. Additionally, I have noticed that KN95 masks have been used occasionally within the company and was wondering what the criteria would be to have a surgical mask and face shield, a KN95, or a N95 at the company. I recognize this is a challenging time and that PPE shortages may have made it harder to access certain protective equipment, but I wanted to ask for clarification as I genuinely care about both my company residents and coworkers and wanted to make sure we are doing everything possible to ensure everyone's safety now and in the future. I also would be willing to volunteer to assist with fit testing, if there is need at the company, as I was temporarily redeployed at my other job as a fit tester.

 

 

Thank you for your response and consideration in advance-- I appreciate it.

 

Sincerely,

Mimi’s Coworker

 

 

 Saturday:

 

 

10am:

     My phone pings with an automated text message from work, “Come work at house 2. The guys need you. There is a shift premium of $2.00 extra an hour.” This sounds like a great idea to me. In early December I am planning on visiting Chicago with my two close friends for a weekend away from school and stress in Ann Arbor. I could use the extra money and house 2 has residents that are relatively independent. All I need to do is help feed one of the residents, make dinner, and see if anyone wants to play a game or watch TV. I’ve met them all before and overall it should be an easy job.

     I guess I’ll wait until I get to House1 tonight to snag one of the shifts. I usually have some free time and can get my coworkers to help me figure out how to navigate the convoluted website. They really need staff if they’re giving us $2.00 extra a shift.

 

 

4:00 PM:

     I walk in the door house one and greet a resident who is sitting in the living room watching TV as usual. They are in a good mood and have a friendly response despite not remembering my name even though I have seen them every week for the past six months. I move quickly into doing the narc count and petty cash so the day shift can get out on time. As soon as they head out, I go into the kitchen and begin preparing dinner donned in PPE while talking with my coworker. At shift change, I was instructed to wear a gown, face shield, and gloves while passing meds, going into residents’ rooms, and cooking. This change isn’t anything out of the ordinary or alarming, as everyone has been on various droplet precautions for the past month or so and there haven’t been any residents sick with COVID-19. I feel pretty safe and think that we do a good job with infection control. In fact, I would probably be the most likely to bring COVID-19 into House 1 because I am the only employee here that bounces to campus, family home, and work weekly.

     As I begin to catch up with my coworker, I realized they hadn’t been to House 1 recently, instead, working at House 2.  I figure they could tell me why there was a premium and so many open shifts there, so I asked what is going on. They said, “Oh you didn’t know. There are residents that tested positive there.”

     I am shocked. Out of the whole company, House 2 would be low on my list for expected outbreak sites. House 1 and House 2 share a manager who is well respected for running her houses safely and having solid staff. How could COVID-19 have gotten into House 2? Both houses have been completely safe with the exception of a false positive over the summer at Carter. The only prior outbreak within the company was contained in May at a facility in a different county before I had even been hired. Sadly, this was a large medical facility with many residents and two or three residents died. The whole company had been coasting for several months without a problem. An outbreak shouldn’t occur in a house of only six men with decent staff and management.

    I am so grateful that I didn’t pick up there, but at the same time am slightly curious about what working in a COVID-19 environment would look like. For them the pandemic is real. Why, in the slew of about 20 messages encouraging me to pick up shifts, had there been no mention of COVID-19 positive residents? Don’t workers have the right to make an informed decision about whether they want to walk into a dangerous environment? How and why did the outbreak happen? Is everyone ok?

     I am somewhat ashamed that the question of the health and safety of residents and staff is secondary to my curiosity of the logistics of infection transmission and concern with company communication techniques. I suppose it is sort of okay if I ended up there eventually, right? That’s what I’ll tell myself.

     One of the residents is in the hospital. My coworker says that resident A, who I’ve worked with before and checks the box for every preexisting condition under the sun, was admitted last night. He used to have a little white fluffy dog and has a wife that loves him and calls him daily.

 

 

5:30 PM:

     Two residents at House 1, stand six feet apart leaning on the couch watching us cook. They technically should be in their rooms, but I don’t have the heart to tell them this or the will to start an argument about it. They have been in quarantine off and on for about a month and haven’t been allowed to leave the property since March, so they are going stir crazy and becoming more behavioral. One of them likens it to being in jail and frequently mutters her complaints. With these considerations in mind, I was instructed to be a little more relaxed with the residents who weren’t on droplet precautions. I know my personal mental health has deteriorated 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 that my own. I feel terrible for them, and it seems almost inhumane, especially given the fact that we haven’t had any issues with staff or residents testing positive. I don’t see why we need to be this strict if it is diminishing their quality of life.

 

 

8:30 PM:

     I complete the final scrub of the dining room table and chairs before sitting down. 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 can be transferred from the table and chairs from resident to resident.

     With the quarantine, we have a lot less that we can do in terms of resident interaction so there is lots of excess time to sit and look at your phone or attempt to be productive and do homework. Right now, after the cooking, cleaning, and meds are done, my coworkers tend to keep to themselves. That’s why I’m surprised when my coworker enters the room with the house laptop and asks if I can look over an email. We aren’t close and I have maybe worked with her 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 last night where they had relieved a coworker, not at the house, but at the ER.

     My coworker has worked here for several years so they informed me that company policy is that staff needs to accompany residents until they are admitted to the hospital. They said that Resident A from House 2 had started coughing and got really sick. They didn’t realize 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 don’t care if I have 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 his own safety for a full eight-hour shift as he coughed on her. Because he was so weak and confused, every time he tried to get up, his mask would slip down and droplets would get on her. Fortunately, my coworker had her personal N95 on her from her other job at Michigan Medicine and wore that in addition to the company provided PPE, so they were alright. As great as that is, it doesn’t help the rest of the staff and residents at House 2, many of who are getting sick, or are working until their test comes back positive a full week later 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 are several other staff members that frequently work at both locations and without adequate PPE the likelihood of transmission is probably pretty high.

     As I start looking at my coworker’s email, it is obvious that like most of my other coworkers, they don’t have the best writing skills and they’ve likely had less extensive and definitely lower quality education than me. My manager has 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 take the computer and try to reorganize her email. There is good content here, but her basic spelling, word choice, and sentence structure is 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? No. But does it matter? Absolutely.

     As I edit the email over the course of an hour or two, I become infuriated on my coworkers, residents, and my own behalf. Whoever is making the policies and isn’t providing the PPE is not the one at risk. I consider including the line, “Is the company UNWILLING or UNABLE to provide frontline healthcare workers with proper PPE?” but ultimately decide that the wording might be too strong. I wanted to rock the boat enough to have meaningful change, but not to the extent where Kacey could get in trouble. Additionally, I have a family friend 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, 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 think it has a greater chance of being seen, respected, and prompting change in the company than the original version. As I leave to go home for the night, I am glad I don’t have to deal with this again until next week.