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Grace under fire: Nurse copes with SARS outbreak
This will affect my practice forever’
On March 24, Carol Tough, RN, had to make a decision between going to work and possibly risk getting a mysterious new disease, or quitting the career she’d had for 17 years. She went to work.
The next weeks at Scarborough Grace Hospital in Toronto were surreal, as colleagues became patients. The emergency department (ED) where she worked was closed. For 10 days, she was in semi-isolation, only going to work and home. She wore an N-95-equivalent respirator at work and when she was near her husband and two children.
The ordeal began on March 24, when she was preparing for the night shift and saw a report on TV about cases of "atypical pneumonia" shutting down the hospital. She called in and was told to report to duty; she would be wearing a mask and other protective gear. Her 12-year-old daughter began to cry, "Mommy I don’t want you to go; don’t go to work. I don’t want you to die."
"Inside, I was very frightened, but I said, Mommy has to go to work. I’m a nurse. This is what I do. I’m going to protect myself,’" she recalls.
At home, Tough’s husband slept on the couch so she wouldn’t have to wear a respirator at night. She ate in the living room while the rest of the family ate at the dining room table. She even was advised against taking a shower because the steam could aerosolize any existing virus droplets; she took baths. At work, everyone was masked, including administrators who had no patient contact. She ate in the cafeteria, each member of the staff sitting alone at tables.
Wearing a respirator for most hours of the day was a challenge in itself. "The fit is very tight to your face," she says. "You’re breathing your own air. You’re constantly breathing in your own CO2. You would have headaches, dizziness. They recommended we break at least once an hour, but sometimes it wasn’t possible to do."
Everyday before her shift, Tough stepped into a parked bus where she would undergo screening — having her temperature taken, answering 12 to 14 questions. Anyone with a fever or who had unprotected exposure and another index symptom was sent to employee health.
It was impossible not to answer yes to some of the questions. "Wear a mask for 12 hours, and you’ll have a sore throat, too," she quips.
Tough, 40, had trouble sleeping and started having nightmares. "The fear that I was dealing with inside would materialize in my sleep."
She saw some of her friends come down with symptoms. After an initial assessment, they were transferred to an isolation center. "All seven or six [patients] would go out to the bus in full isolation gear. The ambulance crews were in full isolation gear, so were all the staff. You could go and hug them and had no idea whether you would ever see them again. There are just no words to describe that. None. And the fear they must have felt."
Ultimately, eight members of the ED staff were hospitalized with suspected severe acute respiratory syndrome (SARS). Two actually did not have the disease. The others are recuperating.
Meanwhile, the usually bustling ED became barren. Tough and other nurses spent their time restocking shelves, updating phone lists, doing paperwork. Even when the staff were allowed to stop wearing protective gear, some nurses kept it on as a precaution. "I’m happy to be rid of mine," remarks Tough.
The experience has caused Tough to think about her chosen career and why she does it. "There’s a risk every time I go to work. I’ve had my ribs fractured; I’ve been burned; I’ve been choked. I’ve had my share of back injuries after 17 years of nursing."
She had used protection against tuberculosis, HIV, Norwalk virus, and methicillin-resistant Staphylococcus aureus. But SARS was different. Much still is not known about the virus and how it is transmitted. Some health care workers in Toronto developed the disease despite wearing protective equipment.
"I make $33.75 an hour. Was it worth risking my life for that? I don’t think so," says Tough. "But I don’t do it for the money. In all honesty, that’s not what makes me get up in the morning and go to work. It’s my patients, the thrill I get in my job, and what keeps me going day to day is the hands-on. It’s the laughing, the comradery with the people I work with that keeps me going.
The staff at Scarborough Grace became bonded as they faced the crisis together. "It amazes me on a daily basis to realize how these people worked, and they came together as a team. It was an amazing experience. However negative and scary it was, it sure told me what I was made of and what I can cope with," she says.
Meanwhile, Tough says she always will take infection control precautions more seriously.
"I think this will affect my practice forever. I think I’ll look at a cough differently for the rest of my career, a shortness of breath," she adds. "I think I’ll more readily put on isolation gear for anything that might be perceived as a risk."