From our dharma sister, Alisa Tu, about COVID-19 and her facility, Gordon Manor
Part II
Only one was left from our
medication staff of 4. She was about to break. She was carrying the burden of
68 people's medication. Meticulous, she was plagued by the idea that she might
make a mistake. The AMI staff recognized this as a huge danger and stepped in
to help. AMI's nurses helped sort out the new medications, order refills,
monitored the medications, etc. Dr. Plotkin in collaboration with Kaiser as
well as the hospice agency mobilized support for the medication function and
was able to support until we could hire more med techs. Keepin in mind that
hiring any staff in this industry was difficult before the COVID crisis.
Dr. Plotkin and team were able to
swab the entire population of residents and staff (including staff that had
electively stopped working). While awaiting results, the team was still dealing
with the issues of wandering, dementia behaviors and the challenges to
isolation. Several of the residents became combattive, one tried to escape by
exiting the front door to get into a FedEx truck. Another successfully climbed
over the temporary fencing. Yet another constantly meandering from room to
room. All of this going on while worrying about transmitting the virus, the
short staffing due to fear, and the fact that people were getting sick.
Dr. Plotkin was able to work with
families and physicians to safely sedate and/or contain residents to prevent
transmission. This was a very dangerous situation and was expertly handled by
Dr. Plotkin with resident doctors and families' cooperation and my and
VITAS's collaboration. This was probably one of the most crucial pieces of
the puzzle and had to be handled by a physician who can synthesize the
problems, know the infection control measures, and be able to act on best
decisions in time of crisis. Dr. Plotkin was able to balance risk to the
resident vs. risk to the others and community. He communicated with the primary
physician and the family to explain the risks and the importance of these
measures, and in the end, everyone was cared for in this difficult situation.
Once the positive test results for
the residents came back (after a couple of days), we implemented the plan for
cohorting. 20 of our 68 residents tested positive. Dr. Plotkin and team, by
this time understood more about the facility, the rooms, the layout, the types
of residents and the type of care they need. Cohorting involved relocating the
positives to a designated "hot" area. This involved erecting a
temporary wall to create a separate space where the positive residents would
live. We had to move negatives out of their rooms and move positives into those
rooms. We had to decontaminate rooms of positives before moving people into
those rooms. We had to move clothes, names on the doors. We had to account for
the fact that a roommate of a positive had been exposed and therefore needed to
be isolated. We are not a hospital, but a home, and so residents have
paintings, their own furniture and tv in the rooms. To move a resident wasn't a
trivial matter for them, physically, cognitively or socially. AMI orchestrated
this with the help of our intrinsic staff. It was epic but again totally
necessary to prevent cross-contamination between positives and negatives. Once
this was complete, there were three zones: the hot zone for COVID positives,
the cold zone for COVID negatives, and the warm zone for indeterminate test
results, people who might have been exposed, for people who became symptomatic
after the testing was completed.
The staff results also showed that 7
staff members were positive. This presented even more drastic staff shortage
where all 7 staff members obviously couldn't work (who were in quarantine), but
these staff members exposed other staff members (some of whom also needed to be
isolated because they live together) so now about a dozen staff members were
not able to work. By this time, AMI with the additional assistance that Public
Health provided (Gurnick nursing students, Stanford EMTs, and other volunteers)
had been able to stablize care in the building with the help of our staff who
were bravely staying the course.
Many of the Gordon Manor caregivers
that still remained working were unable to overcome their fear of serving the
residents in the "hot zone". Only three intrinsic Gordon Manor staff
were willing to go into the hot zone. To be fair, their job descriptions and
roles had changed overnight to something that they were not willing to do. AMI
staff supplemented care in this area. We were trying to reassure that PPE would
keep them safe, but they still refused, and many elected to not come into work
claiming that they want some time off. At this time Dr. Plotkin and I began
working with VITAS Healthcare (and Kaiser ) who was providing hospice services
to many of our residents. Gordon Manor doesn't contract with only one hospice
provider as families have a choice of which agency they want to use. However,
in this coronavirus infection battlefield medicine situation, we took advantage
of the availability and services of VITAS. VITAS just happened to be the
hospice agency that had the most clients at Gordon Manor. Furthermore, the
VITAS medical director, director of nursing and nurse practitioner had
dedicated their time to their residents at Gordon Manor were present at the site
ready to help where ever they could. They offered to staff the entire COVID
wing, if we would refer all positive residents to VITAS, and they would provide
care with nurses and HHAs. We contacted physicians and families to explain
the situation and how this would work. This was such a wonderful service.
Again, however, there were many details to work on like who would prepare the
medications for this wing, who is in charge of communicating with families, but
we were able to iron out the kinks in the end and it was a very fruitful
collaboration. (side note: there are/were no alternative care sites that
are/were capable or designed to serve a high-acuity dementia COVID positive
population like the Gordon Manor population yet, so we couldn't have
transferred them anywhere except to a hospital, but many of our positives were
asymptomatic which, according to the rules at the time, would not warrant
hospitalization.
If one has never been a combatant in
a war, or part of a rescue effort during a natural disaster, or serving in a
place/time of great danger, one is not able to know what it is like to be in
the middle of a crisis. In a crisis you don't have the luxury of state of the
art equipment, the time to apply all typical conventional options, or to confer
with a committee of regulators. You use the guidance you are given, and your
experience and judgment, to figure out what the most important things are to
do, and you do them. The health professionals who are military-trained,
emergency room health professionals, emergency medical services personnel and
who are seasoned disaster first responders, are experts in crisis. They
are wickedly good at it, where most of the rest of the population has no idea
that they exist. They are stealth superheroes (like "Men In Black")
that put themselves at serious personal risk to serve the rest of us clueless
people so that we can have a life. It takes special people to be this decisive,
skilled, caring and compassionate in a novel crisis. They saved us, our
residents, our facility, and our community. We are forever grateful.
With admiration and deep gratitude,
Alisa Mallari Tu, Director, Gordon
Manor
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Special bows for today:
Wonderful links shared by sangha members and friends:
Many thanks to those of you who are sending me articles to share, links to helpful information, and for making comments…it is a gift beyond measure. Please know that you can either leave a comment on the blog itself, or send something directly to me and I will be happy to paste it in.
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Our ZHS on-line schedule:
- Mondays: 7-8:30pm - zazen, short service, lecture/discussion
- Tuesdays-Fridays: 5:30-6:10pm - zazen, offering of merit/bows
- Saturdays: 8:00-10:15am - zazen, short service, tea, discussion/study
- For more information: www.zenheartsangha.org)
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Special bows for today:
- Please offer bows for Dottie Kelly, Misha's family member, who died of COVID-19 on May 20th
- Please offer bows for Annette Merrill, Misha's cousin, who died on May 13th from lung cancer
- Please offer bows for Donald Kennedy, former president of Stanford University, who died from COVID-19
- Please continue to offer bows for Nick Battaglia, Camille Spar's father, who died Aprill 13th
- Please continue to offer bows for the family of Alison Templeton, a PS parent, who died on April 1st
- Please continue to offer bows of well-being for:
- Claudio Pannunzio, dharma friend of Twining Vines Zendo, who is undergoing chemotherapy
- Rev. Les Kaye, Misha’s Zen teacher, who is recovering at home while undergoing chemotherapy
- Brendan, Kate Haimson’s son, who is recovering at home from surgery
- Michael Tieri Ricaud, Dainuri Rott’s brother, who is suffering from MS
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Wonderful links shared by sangha members and friends:
- Zen Heart Sangha website: resources about COVID-19: www.zenheartsangha.org
- From our dharma sister, Misha: article from the New Yorker, Reinventing grief:
- https://www.newyorker.com/maga
zine/2020/05/11/reinventing- grief-in-an-era-of-enforced- isolation - From our friend, Candace Pierce: Song of The Longest Time - Quarantine Edition
- From our dharma sister, Camille: a modern fairy tale about the pandemic:
- From our friend, Candace Pierce: Bolero from Juillard: https://www.juilliard.edu/
school/news/media-gallery?utm_ source=pardot&utm_medium= email&utm_campaign=content& utm_content=bolerojuilliard_ 04.30.20#/node/146356 - From our dharma sister, Lucille, for a little humor on 'What You Should and Should Not Do: https://youtu.be/wVs5AyjzwRM
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Many thanks to those of you who are sending me articles to share, links to helpful information, and for making comments…it is a gift beyond measure. Please know that you can either leave a comment on the blog itself, or send something directly to me and I will be happy to paste it in.
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