When Cana Jenkins finishes a 12-hour shift treating COVID-19 patients inside the emergency department tents at UCSF Medical Center, a different kind of work begins.
She takes off the kit that makes up her personal protective equipment: face shield, hair bonnet, gown, N95 mask and UCSF-issued scrubs. The hair bonnet gets thrown away, the gown and scrubs head to hospital laundry, and the face shield and N95 mask — the crucial covering that keeps Jenkins from inhaling coronavirus-laden droplets — go into a numbered bag to be reused.
Under normal circumstances, the nurse practitioner would chuck that mask too, but these are not normal circumstances.
Next, Jenkins changes into a clean set of scrubs, walks to her car and places her shoes in a plastic bag in the trunk. She sanitizes her hands and drives home to Penngrove, a small town just north of Petaluma. There, she pulls straight into the garage, stuffs her scrubs into the washer and heads for the shower.
“And I shower vigorously.”
Only then is she ready to see her husband and two kids, Isaac, 3, and Samara, 5.
Jenkins’ choreography of cleanliness is the new normal for medical workers treating coronavirus patients in the Bay Area. And for those coming home to children and partners, a new question lingers over every shift: How can they provide care for the people who need them — and also keep their families safe?
Doctors and nurses in the Bay Area have watched the pandemic play out abroad like an ominous preview of what’s to come.
China wrangled its crisis under control through aggressive quarantining and a massive national health care effort, but not before the virus infected around 81,000 people including more than 3,300 medical workers. In Europe, where Italy and Spain have been particularly hard hit, at least 30 health care professionals have died from COVID-19, and medical staff make up almost 15% of Spain’s confirmed cases.
Jenkins says following the news feels like “pre-traumatic stress disorder … watching your colleagues from around the world just get annihilated.”
Lately, the devastation has moved closer to home. In New York, the surge in coronavirus cases has sickened health care workers and killed a 48-year-old nurse. In California, 73 medical professionals have tested positive, including seven staff members at Laguna Honda Hospital and an emergency department worker at San Francisco General Hospital.
Jenkins has worked through pandemics before — in 2009, she treated H1N1 and fell brutally sick with the virus for three weeks — but this feels different.
“H1N1 was a lot less deadly than this is,” she says. And this time, she has a family.
Medical professionals manage the risk to themselves through an array of procedures. There are strict protocols around what to wear, how to don and doff, and screening questions meant to reroute symptomatic patients from primary care to home isolation or emergency rooms.
But the shortage of personal protective equipment haunts many workers, and how each person mitigates the risk to their families is essentially up to them. The City of San Francisco is securing hotel rooms to house workers between shifts or in quarantine, but medical staff who spoke with The Chronicle said they’ve received no guidance from employers or health departments on additional precautions to avoid bringing the virus home.
Some believe infection is inevitable, that the best they can hope for is a mild case.
Jenkins says she trusts UCSF to keep her safe, but she still purchased hazmat suits on eBay. She wonders aloud about what would happen if the hospital ran out of personal protective equipment: “Does that mean I walk off my job? What level of sacrifice should we as health care workers be willing to make?”
Tania Yarema is an intensive care unit nurse practitioner at California Pacific Medical Center and lives with her partner and 6-year-old son. Since the coronavirus arrived in the Bay Area, she has dedicated one car to work and wipes it down after every shift. Then she cleans the doorknobs and handles of her home in the Oakland hills, anything she might touch.
“You know nurses, we’re a little obsessive,” she says.
She showers before she lets 6-year-old Julian hug her and has bribed him with movies to sleep in his own bed. Keeping her family safe is on her mind 24 hours a day, a layer of stress on top of patient care and her own health.
“We’re morally compelled to help these people, because we’ve done this our whole lives,” she says. “And then you’re so scared of getting sick and passing it to your family. It’s a tough position to be in.”
Valerie Sobel-Twain feels the same. A nurse practitioner, widow and single parent to 6-year-old Miles, she works evenings at San Francisco General. When schools closed, she worried about finding child care, about sending Miles to emergency centers, about exposing him every time she picked him up.
Miles was staying with his grandparents for the weekend when the shelter-in-place order went into effect, and Sobel-Twain decided he should stay.
“Any decision I made was going to be painful and difficult and also imperfect,” she says. “I explained that there’s a virus out there that’s making people sick, and they’ve asked all the doctors and nurses and nurse practitioners to come out and help the sick people. … I’m almost glad that when I dropped him off I didn’t know about the shelter in place. It would have been really difficult to say goodbye.”
For medical workers coming home to kids, parenting during the coronavirus outbreak is its own challenge.
Yarema is working 12-hour shifts in the ICU, then, in the time it takes her to cross the Bay Bridge, tries to flip the switch to mom of a kindergartener.
It’s a hard transition made easier by a great kindergarten teacher leading virtual classes, co-parenting with Julian’s father and long walks around the neighborhood.
After years in the ICU, Yarema believed she was well-practiced at work/home separation, but the coronavirus is testing those skills. Exercise, she says, is the one thing that gets her mind off what’s waiting back at the hospital.
“You wake up in the morning like, ‘Is this really happening?’” she says. “I go back to work tomorrow. I’ve been home, and I’m trying to psych myself up to do it.”
Kaiser Permanente doctor Stephanie Scott comes home to Noe Valley and three teenage daughters who are sometimes more up to date on the news than she is. “We talk a lot about washing hands. We talk about why it’s important that we’re social distancing,” says Scott, who does primary care and has been working in the drive-through testing clinic.
With the kids out of school and her wife, a school social worker, home all day, Scott sometimes feels “outside the bubble.” She’s working six days a week, exhausted, and the rest of the family is together constantly, “going on walks and really connecting with each other.
“I feel like an outsider. I feel like I’m watching my family from afar,” she says. “I also know that that will end.”
Jenkins describes the feeling of coming home as “whiplash,” the cognitive dissonance of trading hospital scrubs and COVID patients for an acre of Sonoma County with her husband and two young kids. It can be tough to jump into mom mode, and Isaac and Samara are too young to understand why she’s picking up extra shifts or wiping down door knobs after work. But the other day when Jenkins stopped to listen to the two of them, they were playing coronavirus.
Even if her family emerges from the pandemic unscathed, she worries about how this will impact her children. “Trying to lead a child or children through something horrific without causing them trauma or harm is an absolute art form,” she says. “And I think that’s kind of the situation that we’re faced with.”
She’s stressed about protecting them — from the virus, from the news, from the anxiety that’s given her chest pains and headaches. But her kids are also a form of stress relief.
Some days when Jenkins comes home all her daughter cares about is if she’s drawn the enchanted forest from “Frozen 2” correctly. The kids just want to make up stories and dance and play. There’s a joy that comes from watching them, from forgetting the pandemic for a second and being fully present in their universe.
Beyond the front door, the coronavirus has made us scared to touch each other, Jenkins says, but in their universe there are still hugs. “It’s kind of wonderful to have these little people that want nothing more than to be close to you.”
Sarah Feldberg is assistant features editor for the San Francisco Chronicle. Email: email@example.com