TMC PULSE

21 t m c p u l s e | j u ly 2 02 0 STELLA E. CALLEGARI, BSN, RN, a nurse at the Michael E. DeBakey VA Medical Center, was reassigned as an outside COVID-19 screener during the pandemic. She spoke to TMC Pulse on May 16, 2020. Before this, I was working in physical medicine and rehabilitation on the second floor, where people would come in for their spine clinic or musculoskeletal appointments, acupuncture or the chiropractor. But now, I have shifted outside along with the other nurse from the department because the clinics aren't running like they were before. I had been wearing a face shield, but honestly, the plastic on it had gotten cloudy. I can't see through it like I had been because I've wiped it down with alcohol so much. Now, I wear some kind of goggles. Sometimes I will just wear glasses. I always try to have something. Now that people are wearing masks, I'm not so concerned that something is going to fly out of their mouths. When the patients come in, I'm pretty much the first person they see with these other nurses who are out there on computers. We get it all. They're either complaining of diarrhea or having some kind of cough or this or that. We have to shift them over to the COVID provider who is out there—either a doctor or PA [physician assistant]—near the building. We will walk the patient over to an area where there is a vital sign machine and hand off a report and find out what their vitals are, especially if they're having hypoxia [deficient oxygen supply to the body] or a high fever. The provider out there will decide what to do. Sometimes, they go off to the ER where they do a rapid COVID screening. Sometimes, patients don't realize their appointment has been converted to a telephone appointment or by Zoom. We have to explain to them what's going on and what we're doing with the social distancing to help prevent people from spreading COVID. We make sure that the phone numbers in the computer are up to date so that when the provider calls them, they are able to reach them. Pharmacy and mental health are outside with us. Some of these patients have to go in for their methadone or for injections for schizophrenia, so they have to go upstairs to do that. If they have pharmacy refills they need, they can go directly to talk to them. I'm at the very front where the Metro bus comes in under this overhang. There are a couple of tents. I'm not under one of those, so when it rains, that roof thing kind of leaks. We have to keep shifting our computers. Sometimes, the shade goes away and the sun is right at me, so I have to keep using the com- puter in a place not right under the sun. It's interesting because I usually work in a department where there are no windows. So, when I come in, it could be one way and when I go out, it could be cold or hot. I just never know. And now I'm out there all the time. It's been cold, hot and humid, rainy, windy—just everything. It's been an interesting experience also because I am working alongside nurses from the primary care clinic that I'd never met before. I feel like we've come together. Sometimes, we have patients who come for chemotherapy and radiation. They have to come on a schedule every day for those treatments, so you start to learn who they are and what they're there for. They get used to seeing you. When they finish their treat- ments, we applaud them. They give us their certificates and we sign our names and write 'God bless you.' Even though there's a terrible thing going on, I have enjoyed having this interaction with patients outside. I am honored to serve our veterans. —Stella E. Callegari, BSN, RN, as told to TMC Pulse assistant editor Cindy George non-COVID patients, you have to be aware that they are alone. I had a patient who was elderly and awaiting major surgery and she's there, alone, without her family. She's a non-COVID patient, but it's the same. So your job expands. I've always felt like this was part of the job, but I feel like it's all the more important right now to focus on mak- ing the patient feel like they have an ally within the hospital walls because they can't have the physical contact with people they love and rely on for decisions. Another surprising thing is just how differently different doctors and nurses interpret new infor- mation. It feels like everything is confirmation bias right now. Let's say a new COVID study comes out and it doesn't clearly point in one direction or another. Somebody thinks about it and says, 'Well that reinforces what I previously thought about COVID.' Everything is so scattershot that people are just using whatever is written out there to confirm their own preconceived ideas about illness and philosophies of medicine. Science takes time and we're forcing science to produce answers too quickly. That's why I really believe we should be focus- ing on the person in front of us as much as possible, because if you start to think about all of what's written right now, you'll just go crazy. It's an interesting time to be a doctor at a safety net hospital because there's a clear message with COVID, which is: Save as many patients as possible. Save them all. America does not usu- ally send that message clearly. In a health care environment with so many uninsured people, there are conflicting messages and questions, such as: Should people be receiving health care if they're not insured? There's something relieving about treating COVID patients because you know your job is just to do the best that you can. —Ricardo Nuila, M.D., as told to TMC Pulse editor Maggie Galehouse " Even though there's a terrible thing going on, I have enjoyed having this interaction with patients outside. "

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