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Anyone going to the emergency department at the Halifax Infirmary will notice some changes. First, you’ll go through a pre-triage process in the vestibule at the front doors. There, two nurses will screen for COVID-19 symptoms. Patients showing symptoms are sent directly to a room if one is open or back to their cars until a room is ready. If a patient arrives by ambulance, doctors meet them in the ambulance bay first. For those at risk, a path is cleared to a room, safely away from other patients. Those patients who aren’t showing such symptoms, or have no risk factors or contacts, head to the normal triage procedure.
One of the doctors you might see at the emergency department is Dr. Constance LeBlanc, who’s worked at the QEII emergency department for 31 years. COVID-19 might be new, but working in an emergency department means being ready for any emergency.
“You never know what you’re going to get when you go to work,” LeBlanc says. “Going to work in the emergency department is never boring. You have fun days, sad days, frustrating days, horrific days.”
LeBlanc says the hospital has been very flexible, nimble, and adaptive in its approach to the COVID-19 crisis. She says officials here had time to collect data from other countries to learn more. The COVID-19 processes at the emergency department were set to meet national and international standards, and then adapted to local settings.
LeBlanc works about 10 shifts in the emergency department a month. A full-time schedule is anywhere from 14 to 16 shifts. LeBlanc says the number of visitors to the emergency department has dropped, although when the Examiner spoke with her last week, LeBlanc says the numbers were picking up again, but not back to normal. She says she’s concerned some Nova Scotians with severe symptoms like chest pains, shortness of breath, extreme headaches, or abdominal pain will stay home, too afraid of contracting COVID-19 to head to the emergency department to get checked out. “Medicine is not perfect, but we have a process in place to keep them safe,” LeBlanc says. “They can safely come in and know we’re doing everything we can to keep them safe.”
Everyone on staff at the emergency departments wears masks; LeBlanc says it’s one mask per worker, per day. “We have enough, but we don’t have a tonne,” LeBlanc says. They wear full PPE when working with patients at risk of having COVID-19 and wear N95 masks, removing them when they leave the room and putting back on their regular masks.
LeBlanc says while the team at the department misses socializing, COVID-19 has brought them all closer together. They’ve had business meetings at 8am and process of care sessions led by Janet MacIntyre, clinical chief of emergency medicine at the Halifax Infirmary, every morning for the last several weeks. For COVID-19 related protocols, they’ve undergone intubating training, watching videos on how to safely offload ambulances, how to put on and take off work clothing safely, and more. LeBlanc says MacIntryre has done a “fantastic job” of prepping and leading the team.
On her down time, LeBlanc says she’s been hosting a lot of Zoom parties from home, which she says are less exhausting than in-person parties because she doesn’t have to clean the bathroom, but she does it anyway. At one party, everyone ordered their own pizza and she made cheesecake. Otherwise, LeBlanc says she keeps busy with music, exercise, running, karate, and spending time with her family. She misses going to the park. LeBlanc is also the associate dean, Office of Continuing Professional Development and Association Professor and Director of Education, Department of Emergency Medicine at Dalhousie University. So, that means she’s often part of Zoom meetings, including those for national committees she’s on. She says it can be hard to turn work off. “You’re always home,” LeBlanc says. “Everyone knows you’re home.”
LeBlanc has her workday planned out pretty good now. “I look terrible going to work,” she admits. She wears special shoes she only wears to work. She doesn’t take a purse with her and wears a watch she “can basically boil.” In the daytime, she walks to the emergency department from home, but not at night.
When she gets home, she changes in the porch, puts everything in the laundry, and takes a shower. “I can’t get undressed on the street,” she says, laughing. “There are limits.”
LeBlanc says the nature of emergency medicine hasn’t really changed because the staff always deal with severe problems. “We aren’t doing anything we haven’t done in the last 30 years,” she says. “I haven’t heard from peers that they are afraid to go to work.”
Still, she says “everyone has respect for this virus.” She says some colleagues have moved into apartments so they don’t put their families at risk.
LeBlanc says she thinks healthcare in Nova Scotia has risen to the challenge of COVID-19, but she doesn’t know yet what emergency medicine might look like in the future. “I don’t think we go back to normal,” she says. “I think we go back to a new normal. We have to wait and see.”
On the South Shore, Dr. Chris Randell came out of retirement to work in one of the COVID-19 secondary assessment centres.
Randell has practiced as a family physician for more than 40 years, 20 of those in Newfoundland and 20 in Nova Scotia. He just retired on December 31, 2019. He says once COVID-19 was found in Canada, teams in different zones in the province started to organize. Randell says he got a call from the Nova Scotia Health Authority back in late February about working again. “I was already thinking about it before I got the call,” Randell says. “It was an easy discussion.” He says he never worried about his own risk of contracting COVID-19.
This is the second time Randell came out of retirement to practice. He retired in December 2015, but went back to work again in 2018 to offer patients a connection to family medicine while they waited to get a new family doctor.
Randell worked in a secondary assessment centre in Yarmouth, starting on April 1. The centres were created for those patients suspected of having the virus or those with confirmed cases. Out of about 38 shifts during the time the centre was opened, Randell worked six, including the last one in mid-April. The Yarmouth centre is now closed because it wasn’t getting the volume of patients like centres in other zones. “People are going to the emergency department instead,” Randell says. Randell says he’s now on standby in case his work is needed again. For now, he’s spending time gardening, fishing for cod recreationally, and doing some DIY projects at home.
He already completed a survey that asked about his other skills that might be helpful for deployment in the fight against COVID-19. Randell once served as the mayor of a small town in Newfoundland, where he’s from originally. He’s served as a school board member and on health committees in Newfoundland.
Randell says they didn’t find any positive cases of COVID-19 at the assessment centre where he worked. He spent much of his time studying the virus. “I filled my brain with whatever I could about COVID-19,” he says. He looked at studies about coronavirus from China, Singapore, Italy, and France.
The protocols for how to deal with possible cases were being developed on a daily basis. Randell says there was a lot of discussion about which patients should be going to the centre and what should be done when they got there. He says they kept up-to-date on the best practices and knowledge and they helped other physicians manage what type of cases they might see.
Randell says many of the measures put in place to reduce the spread of COVID-19 — like isolating patients with positive cases of the virus — were those he learned in his first days of medical school. COVID-19, he says, is similar to another pandemic he dealt with in his career. “I liken it to HIV in the 80s, when physicians like myself were faced with something we knew nothing about,” Randell says. “And we still don’t know everything about it. There are loads of parallels, including the amount of attention it got.”
Randell says it’s not just doctors on the frontlines who are fighting COVID-19. He says when he speaks at high schools about his career in medicine, he tells students it’s the cleaners who prevent disease, doctors just treat the disease when a patient contracts it. “That’s a belief I’ve had since I started as a physician,” he says.
In the Western Zone where Randell works, there have only been 54 positive cases of COVID-19. Randell credits that low number to the residents of the area themselves. “They really took it to heart,” he says.
Randell says historic pandemics like the 1918 Spanish Flu taught lessons about best practices, and he hopes we remember what we’ve learned through COVID-19. “We’ve known so much for so long and we get complacent,” he says.
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