February 23, 2004, was the one-year anniversary of the arrival of the deadly virus that causes Severe Acute Respiratory Syndrome (SARS) to North America. As the many significant anniversaries related to this crisis pass, I find myself reflecting on the traumatic events of this last year, when health care professionals had to confront this disease we knew very little about.
Most people listen to the evening news and then rest their minds from the day’s disasters, until they are reminded of them in casual conversation. For many people, SARS was just that — a distant disaster. For health care professionals around the world, the crisis’ impact was more significant because the rules about relationships to patients changed dramatically. For the health care professionals in the Greater Toronto area, however, SARS was a serious, deadly enemy that had to be fought with every resource at hand.
When SARS arrived in Toronto, I was an executive in an addictions and mental health center and was focused on ensuring that our particularly vulnerable population was safe from it. At the time little was known about the disease, other than the troubling fact that health care workers were at immediate risk. I also worried about contracting SARS and taking it home to my family. However, as we learned more about the illness, my anxiety level decreased.
At the end of March, I was offered a job as vice president of patient services and chief nursing officer at North York General Hospital (NYGH), a large community teaching hospital in North Toronto. It was a good career move, full of challenges and opportunities. I have experienced God’s hand guiding my life many times throughout my career, but never in my wildest dreams would I have imagined that this job would plunge me into the maelstrom, and that my new workplace would eventually be the epicenter of what would be called SARS II. Clearly, God had plans to use my personality, gifts, skills and talents. What I experienced would challenge me psychologically, physically and spiritually. It changed me forever, cutting deep with emotions so intense that I cry even now as I try to articulate them.
Here, succinctly, are some of my experiences as an executive leader in the world of SARS.
I started my new job on Monday, June 2, 2003, which was the last day of work or home quarantine for 3,000 staff and 4,000 patients and visitors. The hospital itself was closed to the public and was taking in only SARS cases. On that first day, as I walked in wearing my regulation N95 mask, the first thing I was told was that it was not safe and that I should change into a different one. My new CEO, Bonnie Adamson, was in the entrance lobby, and after introductions she walked me through the screening process. All these elaborate defenses were signs that the hospital was a place in crisis.
Much of this first day is a blur, but a few vivid flashes still continue to haunt me.
On the top of our list was dealing with the crisis in the staffing situation. We had approximately 45 patients with SARS, 14 of them in intensive care. To ensure the safety of the staff from contagion, we needed twice as many staff as was usually required to tend to this number of patients. As they were in a high-risk environment, Bonnie had been trying all weekend to get approval to double their pay. By that first afternoon we were going to the staff in several of the high-impact areas to tell them we were giving them double time whether we had approval or not.
Early that afternoon Bonnie, another colleague and I went to the emergency department, one of the hotspots in the hospital. The staff there, normally the first point of contact for any sick person coming in, was deeply resentful. There had been a heated interchange a week earlier about whether SARS was back or not, and the staff had faulted the administrators for not taking more preventive action. Before we went in, the director had us change out of our clothes, put on hospital greens and make sure we were garbed in personal protective gear. Then we faced the staff. All I could see were their eyes, as the rest of their bodies were wrapped in protective clothing. That was enough; those eyes and body language projected a mixture of fear and anger. We gave what answers we could, which to me sounded sorely inadequate, given the circumstances.
My second and even more vivid recollection is of the next place we visited, which was the Intensive Care Unit, a place facing the most intense battle against SARS. We sat down with the staff, with 14 critically ill patients behind us — most of them on life support. Several of the very ill were my new colleagues. Here, the protective gear was even more elaborate and again all I could see of the staff members were their eyes, which were covered by goggles and face shields. The ICU staff was also a very angry lot at the time. In their voices I heard a combination of anger, fear and fatigue. Much of the fury was directed against us, the senior management, for not preventing the recurrence of SARS. There were other issues as well. They were irritated and frightened by the constant changes in the rules to prevent contagion spread and upset about the conditions that they had to work under. It would take me months to comprehend the true nature of all these emotions. I remember myself going numb and unconsciously shifting into survival mode.
By the end of my first week at NYGH, a total of 54 co-workers in our building had become ill with SARS. (The hospital took care of 120 SARS patients in total, 30 in SARS I and 90 in SARS II.) Apart from the toll taken by this highly debilitating disease, the sick also suffered terribly from extreme isolation and stigmatization. Under these circumstances I felt that senior management should visit the sick staff members to encourage both them and the staff who were caring for the SARS patients. When I proposed this to my senior colleagues, some of them looked at me in shock.
Eventually, I decided to go it alone, and that first visit continues to be a vivid memory. I went to one of the SARS units with the list of ill staff members and asked one of the nurses to help me get dressed in the complex array of personal protective equipment. When I was all dressed and checked over to ensure there were no gaps in protocol, the staff nurse left me and I stood at the door of a patient’s room hesitating to go in. I finally did find the courage to push the door open and go inside and introduce myself to the ill nurse inside. This was the first of a number of visits that became easier over time.
On one of my visits to the ICU, one of the nurses and the chaplain took me around the unit and told me the story of each of the patients. There was both tragedy and hope. There was a mom and two sons sick at the same time. The mother and one of the sons died. There was a nurse who was recovering and had just spoken to her children on the phone for the first time. Next to her was another nurse, Nelia Laroza, who was critically ill and later died. I saw several elderly patients and assumed they would not survive, as this illness is ruthless on the elderly and those with other illnesses. Surprisingly, they did come through. Finally, two patients who had been infected early in the Toronto SARS epidemic three months previously and had been on life support for more than 80 days were unexpectedly recovering.
The most difficult time up to that point came on June 29, 2003, when Nelia Laroza died. The impact on the organization was dramatic. The mood of the hospital had yo-yoed along with the condition of Nelia and other colleagues. We had hoped and prayed that Nelia would recover like the others. But this was not to be.
For me, the toughest times were yet to come. Through July and early August, as patients recovered and left, we knew the crisis caused by the disease was finally abating. But it left in its wake a staff deeply traumatized by the battle. Over time, I began to understand the dramatic psychological, emotional and social impact to both those infected by the virus and those uninfected but affected by the experience. The emotional and psychological struggles of the staff had the greatest impact on me, to the extent that by the end of July, I realized that I, too, was crying a lot and often.
This experience affected every single person working at North York General Hospital. The extent of the psychological impact tends to be directly proportional to the proximity to the illness, with those who were infected suffering the most — both physically and psychologically.
As the first year of SARS ends, we are healing slowly, at varying paces and in different ways. SARS changed our lives. Individually, all those who fought the disease will never be the same again. It also has affected the individual institutions as well as the entire healthcare system within the region. They, too, have probably been changed forever.
Georgina Veldhorst-Witteveen is vice president of patient services and chief nursing officer at North York General Hospital in Toronto, Ont.
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