Women of the Pandemic

by Lauren McKeon

  For weeks, she didn’t see her family at all. Her husband read the girls their bedtime stories and tucked them in, while Vela read medical journals and attended hospital Zoom meetings. Eventually, it became unbearable. Though she knew there wasn’t much science to back up her decision—there still wasn’t very much science on the virus at all—she started making trips home on the third day of her three-day weekly break, so long as she felt well for the first two. There, she’d be sure to socially distance from her parents, playing a sort of musical chairs through the house, from the kitchen to the family room to the living room. Back at her makeshift home, she followed an elaborate sanitization routine—one she stuck with when, two months later, she finally moved back in with her family.

  Like many frontline staff treating COVID-19 patients, she avoided eating or even drinking water through most of her shift because the risk of removing her mask at the hospital was too high. At the end of her shift, she’d change at the hospital, then strip out of the clothes she wore home from work in the garage, and either tie them up or put them in the laundry right away. Then she’d run naked up to the shower. Nobody else could use her bathroom, just in case the steam from the hot water was infected and helped the virus aerosolize. Afterward, she’d use a Lysol wipe to clean anything she might have touched: her keys, her phone, doorknob handles. It took at least forty-five minutes, added on to the lengthy decontamination procedure she already did at the hospital. Sometimes, she wouldn’t make it home until 3 or 4 a.m., barely able to drag her body to the shower. “You can easily forget things when you’re tired and stressed,” she said. “And then you spend the next day worrying, like, ‘Did I miss a step? Will that mean someone at home gets sick?’ ”

  To help cope with the uncertainty, Vela focused on what she could control. Every healthcare worker in Canada had the perverse advantage of watching the pandemic unfold elsewhere first—the virus might have been sketched in question marks, but Canadian workers had more information than those in other countries did when they started. And they knew, if they were to have any chance, they needed PPE. Instead of waiting to run out of N95 masks, Vela and a few colleagues started a PPE drive. She got her husband to make a website. Another doctor reached out to CP24, the local news station, to talk about the drive. They urged chiropractors, dentists, family doctors, and any other medical office that was closed to donate their masks. “Yours will come,” they urged them, “but we need them right now.” Medical students volunteered to do inventory, and another doctor offered up their empty clinic to store the bounty. Word of mouth spread and people crafted face shields; Vela and her colleagues scoured the city for extra stock, for protection normally used in other, industrial fields. Fear threaded through those moments. Vela refused to let it paralyze her; action became an antidote.

  It all helped, but it didn’t cure the frustration and the trauma of not quite knowing how to treat her patients. “We’re trying to treat a disease that we barely know about,” Vela said—a disease, she added, that had no treatment. “That can be very hopeless.” Too much of her job was reduced to guesswork and supportive care. The constant surprise of helplessness gnawed at her. So too did watching patient after patient die alone, with nobody to hug them, to hold their hand, or to place a gentle, final kiss on their brow. That was true of all end-of-life patients during those months, whether they had COVID-19 or not. Sometimes a loved one could say goodbye through a tiny window slit. Later on, they could FaceTime through a donated iPad. Vela knew it wasn’t enough. And she ached to know she couldn’t give them, or their families, the dignified, full deaths they deserved. Sometimes she’d think about the already-emerging group of pandemic deniers and think about whether they’d still believe it was all a hoax if they could shadow her through the hospital, see the same sickness and grief that she did. If they could feel what it was like to try everything to save someone and still have it feel like throwing dice in Vegas.

  By April, the only thing that seemed certain about SARS-CoV-2 was that it did not act like any other coronavirus. “It can attack almost anything in the body with devastating consequences,” said one U.S.-based doctor that month. “Its ferocity is breathtaking and humbling.” A subsequent research paper published in the Lancet termed the stages of infection as “the four horsemen of a viral apocalypse.” It deemed the first horseman a “sneaky virus.” That virus, doctors and scientists knew, entered through the lining of the nose, where it found a lush expanse of cells that have a cell-surface receptor called angiotensin-converting enzyme 2, or ACE2, which is usually responsible for regulating blood pressure in the body. It also marks tissue potentially vulnerable to infection, and SARS-CoV-2 needs it to enter a cell. (In fact, any virus that infects animals needs the right cell receptor to infect—think of them as carrying, or perhaps stealing, the right key for the corresponding receptor lock.) After that, the virus begins its endless chain of reproduction and invasion. This can cause the more well-known symptoms of COVID-19: dry cough, sore throat, achy body, loss of smell and taste, fever. In the Bible, the first horseman is the Antichrist, riding in on a white horse, sowing disruption and readying the world for the other three—war, famine, death. If the body’s immune system doesn’t beat back the first horseman, things get similarly grim.

  The virus will continue down the weakened body, travelling the windpipe to attack the lungs. The lung’s so-called respiratory tree ends in tiny air sacs called alveoli. A single layer of cells rich in ACE2 receptors lines each one—an irresistible home for the virus to ransack. This is when SARS-CoV-2 can turn deadly. As the immune system tries to defeat the virus, the resulting battle inhibits the healthy, normal flow of oxygen. Then come the classic pneumonia-like symptoms: pitching fever, coughing, a struggle to breathe. Sometimes, with medical intervention, such as a ventilator or even oxygen through simple nasal prongs, a patient can get better. Other times, most times, the battle between immune system and virus pushes a body toward rapid, baffling deterioration. An estimated 80 per cent of those infected with the virus remain asymptomatic, or only develop minor or moderate illness. They stay home, they isolate, and they get better. The other 20 per cent get sick enough to require hospital admission. And 5 per cent of those end up on ventilators, silently, unconsciously fighting for their lives in the ICU.

  In the first months of the pandemic, there seemed to be no way to tell which path a body would follow, or how to intercept the last horseman in any analogy: death. Compounding the unpredictability—the maddening senselessness of it all—was the virus’s tendency to sometimes travel, and invade, any part of the body with ACE2 receptors. Usually, the chief mandate of a coronavirus is to reach the lungs. But SARS-CoV-2 can also target the kidneys, which have ample ACE2 receptors, and which, if infected, significantly heighten the risk of death. Sometimes it kept travelling down, to the intestines, causing diarrhea. Other times it targeted the liver, messing with enzyme levels. Some of the sickest patients developed pink eye. More rarely, the virus will make its way to the brain, which houses ACE2 receptors at its neural cortex and stem. It can invade them, but it can also suffocate nearby cells, sucking up needed oxygen and causing them to die. Neurological invasion can cause strokes, seizures, confusion, headaches, and delirium. At its deadliest, the virus seems insatiable, overtaking every part of the body it can. Some studies have suggested that pre-existing conditions, like asthma and diabetes, the size of the initial viral load, and age may provide clues as to how sick a person will get. Even with those scientific hints, however, concrete answers remained evasive.

  “We see these weird cases, and we can’t just say, ‘Oh, it’s just elderly who are at high risk’ or ‘it’s just patients who have other medical conditions,’ ” said Vela. “It would be easier if this disease followed rules.” Every doctor or nurse who treated COVID-19 patients seemed to have at least one case they couldn’t make sense of. For Vela, it was a man with a young family, who had returned from travel in March, and, as far as they could tell, ha
d no major medical problems. He had come to the COVID-19 clinic after his cough and fever worsened. Staff at the clinic thought he didn’t “look so good” and sent him to Vela’s emergency department. She swabbed the man for the virus, did some blood work, and took some X-rays. It seemed likely he had the virus, but his vitals were stable and his X-rays looked okay. She sent him home to isolate, but also took his name and number so she could call him immediately with his results. There was no scientific reason for her worry—she just had a bad feeling. When his test came back positive the next day, she called him. He was still coughing, but he wasn’t short of breath, the tell-tale sign of a worsening case. They decided he could stay at home and keep resting. But Vela couldn’t shake her apprehension. She called him the next day, and the day after that. On the fourth call, she noticed a difference in his speech pattern, a shortness of breath. She told him to come back, paused, and said, “Actually, call 9-1-1.” He needed an ambulance. She warned him that she’d call back to make sure he had; she didn’t want to hear about any stereotypical male stubbornness.

  As soon as he arrived at the hospital, he was put on oxygen. His X-rays were covered with white splotches; black areas represent air. Shortly after, doctors intubated him and put him in the ICU, where he only got worse. Within a few days, they transferred him to Toronto General Hospital, which has an extra-corporeal membrane oxygenation (ECMO) machine. Considered to be the next level of therapy for COVID-19 when everything, even a ventilator, has failed, an ECMO machine is the most aggressive form of life support available. It pumps and oxygenates blood outside the body, then returns it—in this case, doing the work of the lungs when a patient’s own have stopped working. It can perform miracles, but it just as often doesn’t work. Vela followed the man’s case from afar; he had small children at home and, painted in the broadest strokes, he reminded her of her husband, or even herself. He was relatively young, generally healthy, and they’d gone over and above with his care, calling him at home, pushing him to come in. Surely, if anybody could make it…The thought hurt too much to finish. But he didn’t make it. When Vela found out he had died, she did the only thing she could now do: she cried.

  * * *

  —

  And sometimes, just as puzzlingly, a patient survived. During the first wave, Janet Pilgrim’s COVID-19 ward at Toronto Western Hospital became a busy place, ebbing between hope and devastation. Most of her twelve-hour days were emotionally draining. She still ran every meeting with her ward’s three shifts. She continued to comfort nurses, even as they moved into a slow, steady routine—carefully, deliberately donning PPE before entering any patient’s room. Together, they figured out how to care for patients who all had the same disease but not always the same symptoms. Together, they watched people die.

  And together in October 2020, they also weathered an outbreak in the hospital that would temporarily close Pilgrim’s ward. It was the hospital’s sixth and, at that point, worst outbreak; by the end of October, the cumulative outbreaks had infected thirty-eight patients and sixty-eight staff. Pilgrim later said of the intense time, “I went on autopilot—there was no time to feel upset or distraught.” She had work to do: moving patients out of the ward, ensuring a “terminal clean,” directing her staff, trying to keep everyone safe.

  The stress, the fear, the long days were all worth it, though, when someone reversed the expected story and walked out of the hospital. The first patient to deteriorate quickly in Pilgrim’s ward was a seventy-six-year-old man who, she recalls, was quite sassy. He was transferred to the ICU, where he stayed on a ventilator for a month. After he was transferred, so were five other patients, in short, bleak succession. She didn’t think he would return, but he did—delighting the staff with freewheeling stories of his life as they helped to rehabilitate him. When it was time for him to be discharged, she gathered all the nurses on her ward, the physicians, the clinical director, everyone. As he walked out, they formed a wall of support, clapping so hard and for so long their hands probably turned red. He clapped, too. Pilgrim remembers looking around and seeing people crying. But this time they were elated. They clapped out the next patient and the next and the next. They did it for the patient and they did it for themselves, a reminder that they weren’t so helpless after all.

  As a nation, we have widely celebrated healthcare workers as heroes, particularly during the initial months of the lockdown. Corporations offered stacks of online discounts, stores offered front-of-the-line privilege, restaurants donated scores of food. Those of us who have lawns staked signs of gratitude. Most healthcare workers I spoke to, from cleaners to doctors, were uncomfortable with the word hero. Others were angry. They appreciated the kindness and support; some days, hearing the clanging pots and pans, or not having to worry about packing a lunch or finding an open take-out restaurant near the hospital was all that got them through the day. Vela joked that she was happy people finally realized there was more to the profession than fancy cars; doctors made sacrifices, too. She added that it was also humbling to see her community recognize the sacrifices she, and other frontline workers, made to work through the pandemic. It was their job, what they’d trained to do: they didn’t need, or want, to be exalted. But it was also more complicated than that. Around the world, healthcare workers worried the hero worship made it too easy for governments to evade responsibility. In a healthcare system that worked and was well funded, they argued, heroic efforts would be unnecessary. There would be enough PPE, enough ventilators, enough safety.

  “COVID-19 is not a terrorist or intergalactic villain,” wrote one healthcare worker. “Heroes are not necessary to kill a virus. Heroes are a symptom that our system has failed.” And that failure extended beyond the most visible front line, to another area where women largely made up the neglected troupes in charge of another life-saving measure: staying home.

  “MOTHERING RIGHT NOW IS AN ESSENTIAL SERVICE.”

  Andrea O’Reilly, York University professor

  Five

  CRISIS AT HOME

  Natalie Bruvels knew it would be bad the moment professors ushered her class into a conference room. She doesn’t remember the exact date her school announced the pandemic shutdown—everything that came after has blurred the early details, like tears splotched on a page, bleach on a stain. At thirty-nine, Bruvels was the only student in her master of fine arts program at the University of Ottawa with a young child. Speaking to the first- and second-year students nearing the end of their term, her professors tried to frame the campus closure as a boon. The positive spin presumed more time for creativity and research, a blessed pause from the daily grind. Those in the room collectively conjured images of blissful hours spent hunched over easels, masterpieces spun from fingertips, time to do the best work of their lives. Despite the fear and the uncertainty of the rapidly advancing virus, most people seemed determined to try the bright side. Given all that, Bruvels still can’t believe what popped out of her mouth, as loud and clear and shocking as a gunshot: “I’m fucked.”

  March break was starting soon, and she’d been prepared to spend two weeks with her son, who is nine. But after that? She didn’t believe his school would resume either. As a single mother, she didn’t have another parent at home to help balance the weight of her new normal. Bruvels loved her art and her work but unlike the other students, on that last day on campus she didn’t bother grabbing many supplies from the studio. She understood immediately that her painting practice was over, if only—hopefully—temporarily. She wanted to focus on keeping her son healthy, happy, stable; to do that along with all the work required for her master’s felt impossible. At first, she did at least try to attend her online classes. But her overwhelmed son had an outburst every time, either during or after the class. Bruvels asked her professors if they could, perhaps, record their lectures so she could catch up in the evenings, after her son fell asleep. She was told everyone else had made the effort to attend class, so she should too. They
were all in the same boat. Except, of course, they weren’t.

  “Something snapped in me at that point,” she confessed. “I felt completely removed from my cohort.” If her son could have her undivided attention, he seemed better able to cope with his inside-out world. Whenever she tried to multitask, though, he’d tailspin, angry. She kept asking herself, How can this situation continue? As it turned out, it didn’t. After a few disastrous do-it-all attempts, she chose her son. The moment she mentally let go of school, Bruvels felt relief. As far as decisions went, this one was relatively easy—she hadn’t had many other options. But she had chosen, and she could now feel that particular weight evaporate. Other decisions quickly rolled in to take its place. Unfortunately, parenting through a pandemic doesn’t come with a manual. Nobody can tell you what to do when your usually sweet-natured kid becomes filled with sudden rage. For Bruvels, there were both good days and bad ones. Sometimes those days stitched together the good and bad moments, creating a tapestry of emotion and exhaustion. Bruvels and her son fell into a routine: every day they’d head to the empty greenbelt near their house and walk and talk, bushwhacking through the trees. Some days the hike would last an hour, other days they’d traipse for three. Bruvels remembers the beautiful scenery, the beautiful conversation, the beautiful reprieve. But one day in the forest was also the Worst Day.

  Her son was mad at her for something. She thinks it was because they had gone for a walk in the forest, even though it was, at that point, their favourite thing to do. It gave them structure, routine, a way to decompress and talk about school, themselves, the virus—her son had taken to watching explainer videos about COVID-19 on YouTube. She hadn’t expected this time to be any different, any less peaceful, magical. But her son, for whatever reason, did not want to be there that day. He began screaming at her, then charged her as though he was going to hit her. He didn’t. But then he charged her again, this time barrelling his small body right into her. Bruvels was so startled she began to cry. Never, ever would she have expected her son to attack her. She had no idea how to deal with that type of violence and aggression from her kid. Nothing had prepared her for it, nothing had hinted that this would be a thing she’d need to know. I know this is not my child, she thought. This is the madness of the world being funneled through him. Even the good days often felt stressful. Homework was arduous, for both of them. Outside of the visits to the forest, she struggles to remember how she filled the rest of their days. They ate and they slept and they kept on trying to get through.