Fatima Kakkar is a pediatric infectious diseases specialist at CHU Sainte-Justine, and associate professor of Pediatrics at the University of Montreal.
In non-COVID-19 times I have the dual role of clinician-researcher. In my role as a clinician – a pediatric infectious diseases specialist – I’m in charge of a unit of 15 children with general pediatric and infectious diseases pathologies, usually for a week at a time. During these regular times, I do my best to look the part of the doctor in charge, dressing in professional work clothes, wearing a white coat, displaying my ID badge front and center as I round with the students and resident. During these times, every member of our team has a role and with it, a uniform. Housekeeping staff wear pale blue, nursing assistants are in green, nurses in deep blue, and I’m in my white coat. We also have our own dedicated work spaces, with the medical team set apart. Every morning I smile and say hello to everyone, but there is work to do, decisions to be made and little time to chat. This is our usual day-to-day on the ward.
In our new pediatric COVID-19 unit, however, all of us – doctors, nurses, orderlies, administrative assistants, housekeepers – are dressed exactly the same in identical hospital scrubs, gowns, masks, visors, sneakers. Pretty much all we see of one another is our eyes. No name tags are visible. There’s nothing on the outside of our garments that could become contaminated and spread SARS-CoV-2. While I’ve known many of my team for years on the ward, I’ve really gotten to know them while working on the COVID-19 unit. Every action we take now is a team decision, from how to bathe a patient, to when a test can and should be done, to when a room should be cleaned or a patient moved, because it is up to us all to limit exposure to the virus. We have to ask all newcomers who they are – be it the head of the unit, the hospital CEO, the cleaner, the consultant. Without our suits and uniforms the roles we play aren’t clear if we don’t establish who we are, what we’re doing, what we need from one another. No matter what our role in the hierarchy of the system outside of this unit we all look alike now. It’s fascinating to see the reactions. With our labels off only our actions define our roles. I’m still the leader, the MD in charge, the one who ultimately decides what gets done for each patient, but the hierarchy means so much less now as we all depend on each other to get to that final decision. We’re all just people working to get our patients back to health and back to home, while trying to keeping everyone else safe. It’s an extraordinary team of people who choose to work in the “warm/red” zone, who do so calmly and efficiently with never the slightest hint of worry or panic.
During COVID-19 we all try to limit our movements at work so as to not waste personal protective equipment and to limit potential exposure to others. Ordinarily I might have come and gone from the unit, returning to check on labs or results and check in on my patients again. Now I spend a lot of time waiting on the ward – waiting for X rays and admissions and results – waiting together with others. My team tells me their news from home, they tell me how their kids are coping with the lockdown, and we share strategies on how deal with pandemic hair without our trusted hairdressers. We keep up with the pandemic news and they ask me questions about where I think things are headed in Montreal. My title doesn’t matter here, only my presence, my ability to listen, empathize, contribute and think.
Two weeks later I am back in the “Green” zone as the consultant physician. Several members of the COVID-19 unit team that I worked with are also here on the regular ward and all of us are back in our pre COVID-19 role-defining uniforms. But I know and appreciate this team better than I ever have before. While there are many things that I have learned and continue to learn through the course of this pandemic, one of the things I won’t forget is this brief time when our COVID-19 uniforms made us all equals in battle against this pandemic, not one braver or more dedicated than another.