THE THIN WHITE LINE: the history of a future avian influenza pandemic

Chapter 2: State of Emergency

Interview with Elizabeth Barris, RN, Mountain View General Hospital

CALGARY, ALBERTA

[Elizabeth Barris, RN greets me in Mountain View General Hospital’s busy emergency room wearing hospital greens. A nursing veteran, before the Pandemic she was active in the Canadian Nurses Foundation and the Alberta Association of Registered Nurses. The hospital is busier than ever, trying to work through its backlog of elective and non-essential cases that could not be resolved during the Pandemic. In the cafeteria, she explains life under quarantine.]

    The hospital administrators called the clinical staff together in the Amphitheater several hundred at a time and explained the rules of quarantine. Everybody wore masks, which concealed facial expressions and revealed only their eyes. It’s hard to understand what somebody is saying if you can’t see their lips move. People kept shouting at the brass to repeat themselves. This might have been because they couldn’t believe what they were hearing.
    So you want me to tell you about what life was like under quarantine, about the average day of a hospital nurse during the Pandemic.
    The next morning, we lined up outside the back of the hospital, waiting our turn to go into a tent where a nurse screened you for flu by putting a thermometer in your ear to check your body temperature. Nobody spoke. Everybody was feeling sour and depressed. I’d just had another fight with my husband, Tom, during the drive here, me wearing a mask the whole time, arguing about the quarantine and the fact that our upcoming vacation to British Columbia, like everybody’s vacations, got canceled. It was freezing, I remember, and you could cut the dread in the air with a knife. We watched our coworkers go into the tent as if to their execution.
    If you showed a fever, they sent you to the ER. If you didn’t, they gave you your ration of PPE [personal protective equipment, including an N95 mask and gown) and let you in.
    Out front of the hospital, a city transit bus, protected by armed guards, blocked the emergency room entrance.(16) To get into the hospital, you had to go through military-style triage in the bus. First, a rapid flu test to determine whether you had Avian or seasonal flu. Then examination and triage to separate patients into priority groups. If you got green, we usually sent you home for home care. If you got red, we considered you a high priority for the ICU if one became available. If you got yellow, you might do well in an ICU, you might not, so you were hospitalized but had to wait.
    And if you got black, well, we’d make you as comfortable as possible until you died.
    Some good news when we came in the door: pamphlets informing us that we would be getting hazard pay and free life insurance until the epidemic ended. However, counseling would not be available today, as the therapist hadn’t shown up for work yet. She never showed up, in fact. Last I heard, she’d skipped town, took off to a cabin she had over in Saskatchewan. [She laughs sourly.] You can’t make this stuff up.
    Inside, we suited up in masks and gowns, gloves and eyewear, which would soon make us feel hot and suffocated. Then we went to work for several hours until lunchtime. In the cafeteria where we’re sitting now, a security guard made sure that you sat at least two meters away from everybody else.

Nurses at a Calgary hospital put on personal protective equipment before beginning their hospital shift during the Pandemic. Hospital staff worked under extreme conditions, with highly stressful 12-hour shifts in hot and suffocating masks and gowns, wards filled with flu patients, and quarantine procedures that produced overwhelming feelings of isolation.(17)

    Other guards watched over the drug lockups and medical supply closets. We ate little; all we could think about was sleeping, even to catch a quick catnap in an empty office. We gulped water because of dehydration and the fact that wearing a mask for hours at a time makes your mouth dry out. We came to really hate those masks.(18) After lunch, more patients, more blood, more deaths, more crises as resources gave out: Somebody told me we were using up something like 4,000 gowns and 6,000 masks a day. The phones rang constantly, families trying to find out how their loved ones were doing. Communication between us and our patients was hard as hell as everybody wore masks and was often unable to read facial expressions and understand what people were saying. Between the stress and long hours, later on nurses would constantly come down with bronchitis and colds. After weeks of living in a mask unable to touch other people, the sense of loneliness and isolation and alienation became soul-crushing, while the stress of the endless workload and fear of infection shredded the nerves.(19),(20) Some of our patients were people we worked with, which was the hardest of all, and when we lost one we would feel devastated. Nurses would snap at each other and at the doctors, and start crying over the smallest things.(21) By the end of a 12-hour shift, we were dead on our feet, practically dizzy, our voices reduced to whispers, with little memory of the previous 12 hours except one big long blur.(22) On the way out, I sprayed the soles of my feet with bleach and received another pamphlet, this one reminding me to wash my hands.(23)
    My husband picked me up, eyeing my mask as if it were a giant zit on my face. It was good just to sit down in the car, my back aching, my feet throbbing and swollen. I was still drenched in sweat from the clothes and gown I had on all day, and I had a mild headache. While we drove home, Tom said he would support me if I decided to stay at the hospital. We both knew I was staying regardless. Besides my family, nursing was my life. Throughout the Pandemic, whenever I fantasized about quitting, I just couldn’t do it.
    When we got home, Jenny and Tom Jr., my kids, ran to the door like puppies, reaching up for hugs and kisses, our daily ritual. I reminded them about how mommy was working with really sick people right now, and couldn’t hug and kiss. . . . [She sobs, resists crying with visible effort.] I’m sorry. Excuse me for a—I’m sorry. Whew. You see, I felt so guilty, like I already had the disease and it was my fault. That’s how I felt the entire time. When I’d forget, the way people looked at me would remind me.
    Tom made us dinner, spaghetti, which was all he knew how to make, as I wasn’t allowed to cook for other people. Luckily for us, the kids loved it; they’d better have, because spaghetti, TV dinners and mac and cheese would pretty much become our diet for the duration. I ate only a little, using a disposable plastic fork; I was too tired. I could barely keep my eyes open. All I wanted was to go to bed. I fantasized about being in bed. I prayed for bed. My kids were quiet all through supper, watching me warily while I nodded off, suspicious of my mood. They wanted to make me happy, but they couldn’t. As for me, I had nothing left to give. I tried to smile, but nothing came out. Tom said he would put them to bed later. I stumbled like a zombie into the bathroom and did a temp check, which showed normal. Then I made up the bed in the spare bedroom, where I would be sleeping. Quarantine rule: You must sleep alone.
   That night, I dreamed that a flu patient had started bleeding out, his eyes wide open and completely red and a dark fountain of blood erupting from his nose and mouth, which I tried to stem with my hands. Another nurse looked at me in horror and pointed at my face: I wasn’t wearing a mask. I woke up drenched in sweat, shaking, my heart pounding with terror and pure adrenaline.(24) It was still dark outside. My alarm clock told me I had to be up in an hour to get ready for my shift. I got out of bed, felt my way through the dark, and took a long, hot shower, remembering to hide my towel afterwards so nobody else would use it.
    That was my first day of hospital quarantine, and it turned out to be a typical day until the end of the epidemic.