Dr. Kimberly Heckert is a physiatrist at an all COVID-19 rehab facility. She took every precaution to ensure she would not bring the virus home. She was blindsided when it found a way in.
It’s Tuesday morning in August 2020 at 5:30 a.m., and I’m not getting ready for work today. I’m a physiatrist, a physician specializing in physical medicine and rehabilitation, and my rehab facility became an all COVID-19 rehab facility in the aftermath of the surge in Philadelphia. I have had hundreds of encounters with patients recovering from the coronavirus. To keep me and my family safe, I have a system. I review the electronic medical records remotely from my office before walking over to the facility. I read what happened overnight. I generate the list of patients I will be seeing. I make notes in the margin of just one piece of paper that goes with me. I bring a change of scrubs. I tuck my hair in a cap and don an N-95 mask and goggles before entering the building. I then suit up in a double layer microfiber gown, gloves and face shield. I see all of the patients on my list. I speak to the therapists, nurses, nurse practitioners, and aids at the facility. I speak with the other physician there, who is an internist, about the medical issues. Together we make plans and set goals to get our patients home. We derive ways to train caregivers remotely. We measure for braces and adaptive equipment. I do not eat, drink or use the bathroom. It’s hot under the layers. My clothes are wet when I change to go home. I take off my PPE in the reverse order that I put it on. I wash my hands and face and arms and double bag my contaminated clothing. I leave the facility and walk back to my office. I shower before I enter my home. But I won’t be doing this today, or at least not all of it.
Typically, once I get home a wave of relief washes over me. There is no coronavirus here. My children greet me and sit on my lap. I can breathe freely with no mask. We can hug and be in close contact.
But today is different. I am in my home but wearing my N-95 mask. The coronavirus has entered my home, but it didn’t hitch a ride with me. I’ve already had two negative swabs this week. Today I will put on my face shield and gloves to care for my eight-year-old daughter, who is quarantined in her room, ill with COVID-19. I will try not to contract it myself or to spread it to my six-year-old daughter. My husband, thankfully away at the time of her diagnosis, will stay away on reserve, supporting us from a distance.
Our nightmare began four days ago with a text at 6:30 a.m. from the babysitter who had watched my children two days prior while I worked at the COVID rehab facility. She wasn’t feeling particularly sick that morning but had chills by the afternoon. She was sent home to rest but by that time had already been throughout our home and in close contact with our daughters. I woke the children and told them we were under quarantine, and they would need to be tested for COVID-19 immediately. The following day we got the news of my negative result and my daughter’s positive result. My other daughter’s negative result remained elusive until a couple of days later.
After months of taking careful precaution to prevent infection from COVID-19, despite caring for hundreds of patients infected with it, I am completely blindsided by the unwanted visitor–the virus–that slipped in through the back door. Our sitter, who is thankfully having a mild course of illness, had been cautious during the pandemic but had been with a friend who had been exposed and failed to disclose it to her. She had close interactions with people who had been to casinos and bars and unmasked social gatherings. She is learning a hard lesson and is likely feeling terribly guilty.
My older daughter is under strict quarantine. I bring her some Jell-O and check her temperature and oxygen saturation. Her vital signs are good. She ran two miles with me last week, but she is mildly short of breath walking to the bathroom. How fortunate we are to have enough bedrooms and bathrooms to truly quarantine. She is able to call my phone from her iPad. How fortunate we are to have this technology. I send text messages to my partners and administrative assistant to troubleshoot coverage of patient care and manage my leave of absence. How fortunate I am to have empathetic co-workers. My associate drops off an extra N-95 and Kinesio tape to cover the pressure sore on my nose. I am saddened by the thought of how different this disease is for someone with fewer resources.
I know that my older daughter is going to recover, and I feel extraordinarily lucky. My younger one and I aren’t out of the woods yet. I recognize we could develop symptoms any day. She has asthma, and might not fare as well if she contracts COVID-19. In the liminal space, I feel as if I am waiting to be shot. We might get sicker than we’ve ever been before, and we are simply waiting around to see if it happens. I was encouraged to keep my N-95 mask on around my younger daughter too since there is a high likelihood her first swab is a false negative. I take every precaution. I clean the entire house and wash everything. Even if my efforts are futile, should there be a small chance I can avoid this disease, I am clinging to it.
Days go by. My younger daughter with asthma has been prescribed a prophylactic inhaled steroid to prevent a severe reaction to the coronavirus, in case she should become infected. But she is too little for an inhaler. That means the medicine must be delivered by a nebulizer, which causes aerosolization of her breath and, potentially, the virus, if she has already contracted it. This procedure represents one of the highest risks of caring for a patient with COVID-19. I ask the pediatrician twice if he is sure this is the right thing. In the end, I trust him. We do the treatments outside so as not to potentially aerosolize the coronavirus throughout the house repeatedly.
It’s Sunday night. I’m not preparing for work tomorrow. I remain under quarantine, but here is the good news: my younger daughter and I have remained negative after seven days, despite my caring for my older one and despite all of us having had close contact before we were aware of her status. Remaining free of this virus has been thanks to many prayers, gloves, several N-95 masks, and a lot of bleach.
I’ve had some time to reflect on these circumstances. Here is what I want others to learn from my experience:
1. One can be as careful as possible to stay healthy, following precautions to the letter of the law. But in order to stop spreading this disease, we depend on the collective responsibility of all people to follow basic precautions. This is the only way we can truly overcome a pandemic.
2. There is a large cohort of people who believe they are invincible and cannot fathom the ways that their decisions may affect others. We must find ways to help people understand the ramifications of their decision making.
3. Social isolation is terribly hard. Mistakes will happen even under the best of circumstances. When possible, choose forgiveness.
4. If someone in your home contracts COVID-19, though it is terribly contagious, it is not a foregone conclusion that everyone in the home will contract it. You can prevent spread even within your own home with the right personal protective equipment (PPE) and strict quarantine. Without enough rooms and bathrooms to truly quarantine and without PPE, it is likely the virus will spread within the home. That means that people and families with fewer resources will be hit harder.
5. We must be careful not to stigmatize children who contract COVID-19. My daughter did nothing wrong. More children are going to contract COVID-19 this year at school. Teachers may get it too. We need to support them, not shame them. My daughter looks forward to starting school, albeit late, and showing other children that she is fine. I hope to be a support to anyone in my community who finds themselves in my shoes.
6. Until we can put the safety of others before our own desires to live life the way we did pre-pandemic, we will never get ahead of this disease. We must care for each other in prevention and in infection. In this endeavor, as a community and as a nation, may we be bound together, six feet apart.
Editor’s Note: Dr. Kimberly Heckert continues to navigate childcare and keeping her family safe while working on the front lines of COVID-19 care. To date, she has remained negative for COVID-19, and no one else in her household has contracted the virus.