60 nurses have been diagnosed with
probable, suspect or "under-investigation" cases of SARS
and hundreds have been quarantined.


She can't sleep in the same room as her husband.
She must wear her face mask at home, and when she has to take it off to eat,
she must do so in a separate room from the family.
But that pales in comparison to the rigmarole at work.

HEALTH CRUSADERS, the play making its debut in Toronto, is now well into the second act. What started off as high drama has now morphed into a B-Grade horror. As you read the following news story you may have to pinch yourself to see if you're awake or nightmaring. ~ Jackie Jura

Fear and loathing on hospital floor
Endlessly masked, gowned, shielded
Nurse hasn't told mother, children
Theresa Boyle, Toronto Star, May 30, 2003

In the course of a single shift, Grace goes through at least 25 pairs of latex gloves, 10 gowns, 10 masks and five sets of green scrubs. For the registered nurse in the SARS unit of a GTA hospital, frequent wardrobe changes have become de rigueur in this "new-normal" era of infection control.

The bridge of her nose is peeling because of the chafing from two masks she must constantly wear. They have left red indentations on the sides of her mouth, making her look as though she's got cat whiskers.

Even though the infection control precautions seem excessive, she sometimes worries they're not enough. "We wonder all the time if we're going to get sick. We just hope that the isolation techniques that we're using are good enough," says Grace, not her real name. She has asked that her identity be kept confidential because of a hospital edict prohibiting staff from talking to the media. Plus, she has a personal stake in keeping her status as a SARS nurse quiet. Her mother and two young children don't even know. "I don't want to alarm them," she says, her voice cracking with emotion. "I don't want them to worry about me." All they know is that she works in a hospital affected by SARS — which explains why she has to wear a surgical mask even at home. They don't know she's caring directly for patients infected with the deadly virus.

Like the legions of other nurses and health-care workers on the front lines of the SARS outbreak, Grace takes pride in her work, but is finding it increasingly taxing. They face unprecedented infection-control measures, affecting both their personal and work lives. Yet despite this, some 60 nurses have been diagnosed with probable, suspect or "under-investigation" cases of SARS and hundreds have been quarantined. Staff have even passed the virus to family members. Meanwhile, the disease's death toll mounts. "It's harder the second time. It's draining and it's disappointing," Grace says, expressing frustration over the fact that the first outbreak wasn't contained as originally thought.

Her life has been turned upside down since the end of March. For much of that time, she's been under a "work quarantine" — meaning she can go to work and go home, but nowhere else. That means no grocery shopping, no socializing with friends, no outings with her children. "I'm really lonely," she says. Invariably, her family is feeling the ripple effects. Her husband must drive the children to all their activities. And the children can't have their friends over to the house. What's more, she can't sleep in the same room as her husband. She must wear her face mask at home, and when she has to take it off to eat, she must do so in a separate room from the family. "I can't hug my kids or kiss my husband. It's strictly hands off. I've been eating in the backyard," she laments.

But that pales in comparison to the rigmarole at work.

There, she must change into clean scrubs every time she takes a break or goes to the cafeteria. A special room has been set up where staff in the SARS unit doff their "dirty" clothes. And there's another room where they don clean scrubs and gowns. "When we leave the SARS unit, we have to completely disrobe. We are changing over our garb continuously," she explains.

The infection control procedures mean wearing layers of clothes. First there are the green scrubs over top of which she wears a gown. When she's at a SARS patient's bedside she must wear a second gown. She wears a required N95 facial mask. And because it's "scratchy," she wears a smaller, more comfortable surgical mask underneath.

There's a head cap that looks like a shower cap and there are shoe covers. And then there's a head shield and a face shield. And finally, there are the never-ending glove changes. Though infection control protocols require staff to wear two pairs of latex gloves, Grace opts to put on a third when she comes into direct contact with a SARS patient's bodily fluids. She puts them on in order of size — small, medium, then large. "If we get the gloves contaminated, we're discarding them," Grace says. "When we dress, we ask our co-workers to double-check that we've got everything on. We're always asking each other: `Have I got everything?'" The constant washing and use of alcohol jelly has left her hands dry.

If she goes to the cafeteria, she has to ensure she's not sitting directly across from anyone else if she takes her masks off to eat. Staff end up spacing themselves apart at long tables in a zigzag pattern. Grace prefers to eat outside so she can "breathe the fresh air" -- a nice break from carbon dioxide build-up from the masks that has caused some of her co-workers to hyperventilate. When it's cold or rainy, some staffers eat lunch in their cars.

She's somewhat irked to hear that hospitals are paying private agency nurses about three times more an hour to do the same work she's doing. "We feel resentful because we feel we're worth that much too," she complains.

Hardest of all, says Grace, is seeing the patients suffer. "I don't really think that I've dealt with this number of younger patients being ill." Most are sedated because they are mechanically ventilated. Doctors and respiratory technologists wear what look "like spacesuits" to intubate patients or perform tracheotomies. She talks to the patients even though she's not sure they hear her because of the sedation. "We hold their hands, we tell them what day it is, what our names are. We have read prayers to them," she says. Grace assists in giving patients steroids, blood transfusions and in helping to restore their electrolyte balances. Some don't respond: "These are the sickest patients we've ever had to deal with. I get very emotional talking about this," she says, her voice cracking again. "We want these patients to get better so badly. We're doing everything we can to try and help them."



Jackie Jura
~ an independent researcher monitoring local, national and international events ~

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