As a podiatrist, Dr. M usually focuses on feet. But years of military service and expertise in program implementation and measurement qualified him for another clinical job, setting up a COVID test site. Testing stations were available in the suburbs, but the heart of the epidemic, the urban center, needed a walk-up and drive-up option. The medical director tasked him with the job. “We can’t spare a nurse to assist you,” the medical director said.
“I’ll figure it out. Give me the weekend. Start scheduling appointments for Monday.”
Dr. M watched the National Guard’s testing video and read the pertinent CDC guidelines, then disappeared into his workshop to create a contraption to support a solo COVID tester.
A little bigger than a cutting board, the wooden testing platform secured the parts of the specimen kit so they wouldn’t roll or blow away. A small box held the plastic bag with the requisition tucked in the bag’s front pocket. Next to the box were two parallel fragments of wood, no longer than a six-inch ruler that provided a place to set the tube’s cap. Finally, a hole drilled in an elevated piece of wood steadied the open test tube. The platform sat on a table inside the tent along with boxes of gloves, bottles of hand sanitizer, and a Styrofoam container with a bag of ice. Cars and people queued in the alley, checked in with the receptionist at a kiosk who tucked the kit and requisition under the windshield wiper or hand-carried it to the tent. Inside the tent, patients’ noses were swabbed through rolled-down car windows, or they took a seat in a plastic chair.
“Please put your car in park,” I say. Parque.” You don’t want to risk a foot slipping off the brake when you are sticking a long Q-tip into someone’s nose. That was Dr. M’s first lesson for me. By the time I joined Dr. M in December, he’d collected over a thousand tests. He’d managed the chill of Spring, 2020, and the scorching Summer. Now as winter approached, he was retiring from this task and training a squad of testing newbies. I was one of them.
The first challenge was putting on PPE (personal protective equipment). When you are swabbing patient after patient with COVID symptoms, you can’t afford to infect yourself or someone else.
If you have never donned PPE, you can watch YouTube videos to learn. If you have, you likely have your own funny anecdotes. The first task is to secure the materials (gown, gloves, and mask) and choose the correct size. If your shoes can’t be cleaned with alcohol wipes, then you need shoe covers too. After pulling the one-size-fits-all paper version over your shoes, be sure to wash your hands with sanitizer.
Next, the paper gown is pulled over your clothes, often hospital-style scrubs. In cold weather, wear long underwear. In summer, remember you’ll sweat, so dress accordingly. You can tie the gown in the back if you’re ambidextrous, or better yet, ask for help. The hair cover does what the name suggests, and the face shield protects the eyes because the virus enters mucous membranes around the eyes and lids.
Pulling on gloves follows, and the first pair goes over your gown’s cuffs. Depending on what you are doing, you may wear additional layers of gloves. Without an assistant, you will be wearing four gloves: two are never removed, and two are peeled off with each test and replaced. Four gloves get tight, and it’s a struggle to pull on the final pairs after dousing the second layer in sanitizer. As a whole, gloving is the most time consuming and frustrating part of the process, and nerve-wracking as patients wait patiently or not so patiently.
Next is the specially fitted N95 mask to keep out airborne particles. The fitter sprays sweetened air into a plastic head cover that sits on the fitee’s shoulders like an astronaut’s helmet during the special fitting session. You breathe, talk, read a poem, and bend over to make sure you can’t taste sweetness during any of the maneuvers. If the mask is too tight, you’ll find yourself talking like a ventriloquist.
Many of you have already experienced the COVID test. Some might accuse testers of trying to tickle your brain, or shoving a roto-rooter up your nostril. The process is definitely fodder for the late-night comedians.
Dr. M calls it the great equalizer. It doesn’t hurt, but it’s discomforting to everyone. Eyes will water at the very least. Girls aged 8 to 10 are the bravest. They sit quietly and often wipe away a tear when you are done.
Tough, city gang kids try to be cool but grunt out the hurt, “Wow, man, where did you go with that?”
One twenty-something had a roll of money in his lap, smelled of pot, but was the model of politeness. “Thank you, doctor.”
After Dr. M collected a specimen from a fellow with tattoos and chains, the tough fellow warned, “I’m jumping out of my car to punch your face for that.” Instead, the fellow gunned his Prius and pulled away.
A couple rolled up in an old Honda. The husband went first and yelled, “Take it out, take it out!” as he white-knuckled the steering wheel. The wife smiled after watching her husband and said, “I really enjoyed that,” then submitted to her own swabbing.
My most delightful patient was a 4-year-old who sat on her mother’s lap. I entice all children telling them this will tickle. “Giggle, giggle.” This little girl heard my suggestion, and her chirp lightened the procedure for her mother and me.
On Dr. M’s final day, a six-year-old boy, who sat in the chair, shot out his leg as the swab went into his nose. Dr. M jumped back with a yelp. You can guess where the boy’s foot made contact, yup, his groin! Good-natured Dr. M considered it his farewell sendoff, and we had a good laugh. He’s retold that story a few times.
Therese Zink is a family physician. Michael Neary is a podiatrist.
Image credit: Shutterstock.com
