Interview
SARS and Spirituality:
An interview with two Christian nurses who lived on the front lines of the 2003 SARS outbreak in Toronto.
Christianity promises to help people through the worst time of their lives, and in early 2003, it appeared that an entire city was facing a crisis of lethal proportions. Toronto, Canada suddenly faced a mysterious new disease, which seemed to be spreading from hospital to hospital. Severe Acute Respiratory Syndrome had arrived with tourists from China, where the outbreak began. Death rates were alarmingly high, and no one was sure whether this was the start of a global outbreak. Nurses were acutely affected by the crisis, being on the front line of care for the afflicted patients. Among those nurses were Amanda McFarlan and Joanna Mills. In this interview, they explain how being Christians helped them and many others through the crisis, even when they faced quarantine and possible infection.
THE TURNING: Amanda, could you tell us what were you doing for a living when the SARS outbreak hit Toronto?
MCFARLAN: I am a registered nurse and at the time of the SARS outbreak I was working in a trauma/neurosurgery intensive care unit in the downtown core.
THE TURNING: So for those of us who aren’t health experts, what is a neurotrauma unit?
MCFARLAN: Half our unit is devoted to neurosurgery beds so people who’ve had aneurisms or brain tumours or spinal cord injuries and the other half are trauma beds. And to qualify as a trauma, you have to have sustain injuries to two major systems. So you can have a broken leg and a smushed-in chest ,or a head injury and broken bones, or a chest injury or abdominal injury. So generally our traumas are motor vehicle accidents, sporting accidents, industrial accidents, suicides, gunshot wounds, knifings.
THE TURNING: Now, before we get to how SARS impacted your unit, does spirituality play any role in your unit, generally? Even when there isn’t a crisis going on?
MCFARLAN: I suppose there’s a number of levels. There’s always a chapel because many of our patients are critically ill and there’s some question as to whether they’ll survive. We always offer a chapel to families coming to the hospital. From an institutional point of view, we’re keeping aware that the patient’s and their family’s spiritual needs need to be addressed. In addition, many of the nurses I work with have deep spiritual beliefs and that’s in part what has drawn them to a healing profession. There are a few nurses who are very overt about their spirituality and very vocal about the Church or the synagogue or whatever they belong to. And there are some who are much more quiet about it. But a great many nurses when you talk to them will admit to praying for their patients, will admit that part of what draws them to this job is that it’s a chance for them to explore spirituality in a deeper and more meaningful way. They are more connected with life and death because of the kind of work they do and because they bring spirituality to it.
THE TURNING: Do you think that the proportion of nurses who are spiritual is higher in this unit than it would be in other units in the hospital?
MCFARLAN: No. I’m not sure if that’s the case. I think there’s a certain breed of nurse who wants to go into critical care and the nurse who likes excitement because it is kind of exciting. So I would say that that’s more true. I suspect that there’s about the same percentage in most units and palliative care comes to mind as an area where there’s a tremendous sense of spirituality that goes along with the job. So I’d say there’s no more or less spirituality then many other areas of the hospital with the exception of palliative care but that spirituality among the nurses is higher than the general population.
THE TURNING: Okay, let’s get onto the SARS nurses. Joanna, you were working in a very different kind of unit when SARS hit. Can you talk about where you were working?
MILLS: Yeah, I work at Baycrest Centre for geriatric care, so it’s a really large teaching hospital that has only geriatric patients in it. It also happens to be a Jewish institution. We do have Christian patients there, particularly in the hospital part, but in the nursing home part, there is really very few people who are not Jewish and so it’s not just a culturally Jewish institution, it’s a spiritually Jewish institution. And so really, spirituality and everyday life, I think I see it more there than I have anywhere that I’ve worked. I worked there as a nurse.
One of the things that I really enjoyed about that was that a very large percentage of our staff at Baycrest are not Jewish and in fact they are Christian. I don’t mean Christian in just a cultural sense, I mean Christian as an actively practicing Christian. And in fact I think more so then anywhere else that I’ve ever worked and I’ve worked in lots of different hospitals all over the world. I think that that does have something to do with it, being a geriatric institution. There’s no glamour attached to working there. In fact, its’ sort of seen as the lowest spot in the totem pole in the nursing profession. It’s a very, very difficult job. You work doing very hard physical care for long hours with the same patients over and over. Many of them are very difficult because they’re Holocaust survivors or they have dementias and yet these nurses are among the most kindest and caring and nurturing people that I’ve ever met.
Most of them are very openly Christian and in fact I remember being at report one day and saying you know Mrs. So-and-so is really sick. We’re not sure how well she’s doing. Her family is really upset. Make sure you say a prayer for her tonight, actually, in our taped report in the unit. So it was very much a fact of life in the everyday of Baycrest life. Whether that’s-your faith was Jewish and because of that, the whole sort of daily routines in the hospital revolve around that faith, but also for the Christian staff. And I often wonder if the-because it’s such a faithful institution, I mean faith-full, full of faith, I think those nurses are a lot more comfortable with expressing their own faith and the patients are very comfortable with the nurses expressing their won faith.
Right now I’m actually working in the IT department and what I do is I teach the nursing staff how to use the computer systems and that kind of thing. So I am up on the floors a lot teaching the nurses and helping them to use the technology that they have available to them. During the SARS crisis itself, a lot of our projects that we were working on in the normal course of our workday, came to sort of a screeching halt. And half of us were thrown into trying to develop information databases that would help us to make sure that our patients were safe. And people were working twenty-four hours a day, just putting in insane amounts of hours to do that and those of us who weren’t needed for that basically became patient care givers.
THE TURNING: Well, I guess the big twist for the SARS crisis obviously was that it wasn’t just the patients who were at risk this time, it was also the health care workers. Amanda can you talk about how SARS first hit your unit?
MCFARLAN: I can remember, it’s sorta funny, we were at a function for a staff nurse who had been in the institution for thirty-five, forty years. She was like one of our longest, most senior nurses and she was retiring. It was just as the SARS crisis broke out, if her retirement party had been a day later, it wouldn’t have happened because they cancelled all external, nursing activities. They didn’t want any nurses gathering in large groups and I can remember being smushed in the back of a very small car joking about how we’re all going to be in quarantine soon.
And we went to work the next day and people were not taking the precautions as seriously as they could have been at first, partly because I think they were afraid. We were asked to wear gowns, gloves, goggles. No one that point, this was in March, was very clear about how it was being transmitted. They knew it was respiratory airborne, but beyond that we weren’t really sure what sort of parameters we were dealing with. And you know, people were nervous and making light of it because they were nervous of-like the staff were making light of it. And then within a week or so everybody had gotten used to the fact that this was very serious. That we were required to wear gowns, gloves, masks, goggles. And particularly because in an intensive care, we have a lot of patients that are receiving forced air ventilation, meaning that they have a breathing tube doing in that forces oxygen in. You get a lot of sort of secretions flying around in the air so it’s a particularly high-risk area for air borne diseases.
THE TURNING: Did wearing masks, goggles and gloves impinge on your ability to give the kind of care that you’re used to giving to patients?
MCFARLAN: Absolutely. What it did was set up a huge barrier between both the patients and their families and the nursing staff. I like to think of nursing as the human face of medicine and medical care and we’re a liaison. We advocate on behalf of our families and the patients. We are the information, the primary information source for the families. Visiting hours were extremely restricted and when they came in, the families were unable to recognize one nurse from another because we had goggles and masks on; large masks that covered most of our faces. Our nametags were underneath our gowns because we wouldn’t want to contaminate them. Most people put labels on their gowns, like sticky labels, but we were changing our gowns so frequently, that you’d forget to put another one on so it’s really hard for the families to know who’s taking care of their loved one.
I just felt like for the patients, for many of our patients because they can’t verbalize because they’re ventilated-, nonverbal communication is an extremely important part of their repertoire and of our repertoire as well. And for them to not be able to see us smiling at them, your winking and showing a compassionate face, and it’s really hard to do that when you’ve got glasses on and goggles on top of them, you know for the nurses that wear eyeglasses. They just couldn’t see our faces. We looked like monsters coming up to their bedside.
THE TURNING: How did SARS restrictions affect visits from family members and the chaplains and stuff?
MCFARLAN: Visiting in our unit was extremely restricted. We had at least one patient die with no family members at the bedside because the death happened very suddenly and wasn’t anticipated. But we had severe restrictions on family members coming into the unit. What it forced us, not forced us, but what it led this nursing staff to was to do a lot more explaining over the telephone to family members about situation. And family members were very good, very receptive. They understood. It was well publicized in the paper. So they understood that it wasn’t the staff nurses at the bedside who were restricting visitors, but it was very frustrating for families.
THE TURNING: At the beginning of the outbreak, it seemed that in the popular press, particularly outside of Ontario, that Toronto is a place where everyone is at risk from SARS and it could be caught on the street whereas the reality was that of course nobody was wearing masks on the streets. You guys were on the inside track for this. You knew that of all the populations at risk, you guys were the ones, right? How did that feel?
MILLS: To be honest with you, I really didn’t worry about it that much. I think when you work in nursing, pretty much in any of the medical professions, but particularly in nursing and perhaps physicians as well, where you’re really dealing with life and death everyday, you really get a sorta fatalistic attitude and I think for those people who don’t necessarily have a strong faith, it truly is fatalism. Like, if it’s my turn, it’s my turn and there’s nothing I can do about it. And I think for those of use who have a strong faith background, it’s not truly fatalism. It’s that I just have to trust in God that things are going to be okay. And when you have a patient who’s like a twenty-five year old guy who slips and falls on the sidewalk and smacks his head, and dies instantly and the same day at the same sidewalk you have some little ninety year old woman who falls and gets up and walks away with just a broken ankle, you realize that it’s really in the hands of God and there’s not much you can do.
I really didn’t think much about taking precautions for myself. I always thought of taking precautions for the people I was taking care of or my family. I don’t think the thought of myself getting ill ever entered my mind, to be honest with you. I knew it was possibility, but it wasn’t something I worried about. I worried about making sure that I wasn’t possibly spreading it around. I did not have any direct exposure but I was up on a unit-we had one SARS patient up at Baycrest and he was identified very quickly. He was actually in isolation when he came to our hospital. He came from another hospital. He was put on isolation as standard procedure for somebody who comes from an acute care institution and he therefore had very limited contact. But there was one group of nursing staff and care workers who had had direct contact with this patient. And it happens to be one of our busier units and it happens to be the unit that I end up spending a lot of time with the nurses because it’s busy and therefore they use the technology a lot. And so I actually was there that day. And I fortunately did not have to go on home quarantine because I hadn’t actually been in that patient’s room and he was on isolation. All I had to do was self-monitor and take my temperature and that kind of thing. I didn’t have to wear a mask at home or anything.
And to be honest with you, I never really thought about it. I worried a lot about my colleagues who were working on that floor. I have a lot of close friendships with those nurses, many of whom are devout Christians and I worried about them a lot because I didn’t want them to become ill and I also knew that, I think, it was such an isolating experience for them. I remember one nurse in particular whom I had some faith discussions with from time to time, walking out of the hospital wearing her mask and going home in the cab, to go straight home and not go anywhere else. People that knew her, nurses at the hospital, some of them were just sort of walking around her and nobody was saying ‘ Hi,’ to her or anything. And I could see how exhausted she was because she was working all these double shifts because they were only letting those people who had already been exposed back on that unit. She was so exhausted and I just walked up to her and gave her a huge hug and said ‘I’m really praying for you’. And she just burst into tears and she said, ‘you’re the first person who’s touched me in a week’. So that’s really the people I was really worried about. I never once worried about myself getting it. I knew, intellectually, it might happen. I was taking my temperature twice a day because of it, but it wasn’t a fear for me. I just felt that, I just had faith that what was supposed to happen would happen and if that was part of God’s plan to get that illness, well then there was a reason for it.
THE TURNING: So Amanda, did you have any close brushes with SARS?
MCFARLAN: I think I wanna just pick up on what Joanna’s saying because I would agree I felt the same way. Like, I took tremendous precautions for my family and for my patients to make sure I didn’t spread SARS to anyone else and that I didn’t bring it home with me. And intellectually, I was acutely aware that, you know, there’s a possibility because it had been happening and nurses and health care workers had already been hospitalized early , had been hospitalized early on in the outbreak. So I knew it was a good possibility given the area I work in, that I might be exposed. But I worried about my family, my kids, my coworkers and the other patients more than myself cause it was ‘well, it’s either going to happen or it isn’t and we’ll cross that bridge when we get to it’. And as Joanna says, part of the reason I think I chose ICU is because there’s something about brushing up against death and severe catastrophic injuries all the time that makes you fully appreciate your life that much more and makes you cherish every moment that you have and trust in God that it’s gonna to go the way it’s gonna go. And then, I went into quarantine!
In our ICU, we have a patient who is on something what’s called jet ventilation and he was prone for a couple of days. Most of our patients get to lie face up and because he was having severe ventilatory issues, it was very hard to get him to, to get oxygen to his lungs. He was placed on his abdomen with a ventilator and he was getting very high pressure and fast breaths. This kind of ventilation spreads a tremendous amount of secretions into the air, particularly when you take the person off the ventilator to move them and it turns out that he was a suspected SARS case and our entire unit went into work quarantine. And what that meant was that when we’re at home we’re expected to wear a mask, and not to prepare any food for anyone else, to not take showers, to sleep alone because obviously you weren’t going to wear masks at night and you didn’t want anybody coming in and be coughing on them. You were expected to eat alone. You couldn’t touch your loved ones and we were asked to come into work with one particular taxi company. We weren’t allowed to ride our bikes or drive our cars in. They would drop us at the door. We would wear our mask in the taxi. We’d go up to our unit and then we were quarantined in our unit. All our food was brought up, and we were fed in on the unit and we couldn’t leave until the end of our shift.
The work quarantine went on for quite some time. Our individual quarantines were for the duration of, from our exposure, ‘til ten days after. So, by the time I had been notified of my exposure, I had already been three days into the quarantine and so there were another seven days of quarantine after that that I had to endure these lovely circumstances.
THE TURNING: And so, did you feel a sense of fear? This is cutting pretty close to the bone.
MCFARLAN: I…because the patient was a suspected SARS case, not a confirmed SARS case, when we first went into quarantine, I assessed my risks realistically and thought ‘well, there’s a possibility I was exposed’. So there is a risk there. At the same time, I felt fairly sure that I had taken all the precautions I needed to. And I hadn’t actually taken care of this patient, although our unit is open and so the reason why we were all in quarantine was because of the architecture of our unit. So I was more frustrated and concerned for my family then I was upset for myself. It was extraordinarily frustrating, you know, wearing a mask at home and not being able to leave the house and not being able to manage my own affairs.
THE TURNING: Joanna had said she didn’t fear for her life in any way because she doesn’t really think about it that way. Have you found your faith affects how you encounter this possible brush with death?
MCFARLAN: Well, I would agree with Joanna that, you know, you just have to trust in God. I’ve been exposed to death so much in my work and it’s been such a blessing for me to be around people who are on the cusp of dying, because it makes me understand-it makes me live each day of my life in a way that’s meaningful and mindful. I always go back to a sermon that our minister gave once where she said, you know, ‘If you won a million dollars, or you found out you were going to die next week, or six months from now, would it change how you live your life?’ and honestly, no. I would continue to do exactly as I’ve done up until now. I would interact with people the way I’ve interacted up until now. I would live the way I do. And so I’m at peace with that and I’m not particularly afraid of dying because I’ve seen it a lot.
THE TURNING: Joanna, how did the patients deal with this? You said that some of your patients are Holocaust survivors and in your unit were people wearing sort of the same spaceman outfits that they were in Amanda’s?
MILLS: Yeah, the staff that were allowed to go in the unit with the exposure were wearing you know, full face shields with-it looks like a bee keepers mask basically that they wear over their heads. They were wearing everything. When they were actually on the unit, the rest of the hospital when we were providing care, we wore long gowns with long sleeves tied up tight around the neck. Huge facemasks that covered half our face. We wore goggles and if anyone had respiratory precautions, not necessarily for SARS but for any possible cough.
It was really difficult for the patients, particularly for our Holocaust survivors. It was a very difficult time for them. A lot of triggers -- strangers walking in. A lot of them were involved in medical experiments in the concentration camps, and so to see people coming in wearing marks and gowns and goggles is extremely, extremely frightening for them. [Editor’s note: Many of the patients’ regular caregivers were private health care workers, and hospitals decided to exclude them lest they accidentally carry SARS between hospitals. As a result, unfamiliar nurses had to take over the care of these patients.] And to have complete strangers taking care of them, doing the tasks that normally their really trusted companions would do for them was very difficult for them and the people who were providing those tasks were not trained to do them, you know, in a sort of global way. I mean, we did provide a certain amount of training, but they were hesitant, they didn’t feel comfortable. It took them a long time to do those things and that made the patients feel uncomfortable because so much of your care is making your patient feel confident in you. And it was very difficult for them.
But, you know, I can’t think of one individual that I work with in any of the departments that did not go above and beyond the call of duty and I think some of that is just because they’re health care workers and that’s what health care workers do. I mean, we chose this job knowing there would be times when we would be putting ourselves at risk and that it would be a really difficult job. I don’t think any of us thought that it would come in the way that it did, but you still know that in the background that something-you know you hear about when you’re studying the history of your profession and so you know, there was that aspect of it. But I think as well, like I said I think there is a lot of very faithful people in our institution and I felt very strongly that their faith was what was really supporting them through this and what was helping them to remain patient and to be supportive and kind and caring and nurturing through the worst of times.
THE TURNING: Now Amanda, your patients are a little bit different. They don’t get there because they’ve lived a good, long life. They’re often there suddenly. So how did they react to suddenly being isolated from their family at probably the most stressful time of their lives?
MCFARLAN: Yes. Now in intensive care there are times where we do restrict access to the patients. There’s only two visitors at a bedside, generally speaking, anyway. So, there are always some restrictions on visitors but the patients really miss their family members and in our unit there aren’t individual phones at the bedsides mostly because many of our patients are unable to speak so they’re not able to talk to the families on the phone. So it really meant that nurses had to pick up the slack and be a strong source of communication between the patient and the family. You know, I can remember being at the desk and calling out to a patient, ‘Oh your mom’s on the phone and this is what she says and she says she loves you and-‘ and you know, so you’re having these funny little conversations trying to relay information to family members who are you know, once they’re getting a bit more well, rolling their eyes and going, ‘Yeah, that’s what she always says.’ It’s sort of funny. But you know, they did, they felt utterly separated from their families at a time when they needed them the most and their family members felt utterly powerless in a situation where you know, so much had already been taken away from them and a loved one’s gotten ill very suddenly.
THE TURNING: Do you think the city got lucky with the way things worked out with SARS in the end, when it left?
MCFARLAN: I think it was really good management. I think that the public health system, the hospitals managed SARS in Toronto extremely efficiently. They did absolutely the best job that they could and they went totally overboard. Like that restrictions were, you know, they were really-they were so stringent and everybody abided-like once the initial shock of what we were expected to do and kind of the humour about it passed, everybody complied and understood that this was a huge public health issue and I think it’s what saved up from a huge outbreak.
MILLS: I agree. I agree. I think it was very well managed here. I know for instance, Baycrest, even though it’s not an acute care hospital, adopted all of the plans and rules that an acute care hospital needs to have because they want-even at a huge cost to themselves, because they wanted to make sure they were doing everything they possibly could to protect their clients and their families and their employees. I think it could have been a lot worse. It could have been like China.
THE TURNING: Any spiritual lessons for either of you that came out of this?
MILLS: I think it was for me just a reaffirmation that, you know, most people are basically good and that even when they don’t recognize it, that Christ is moving and working through them. And just to be able to sit back a little bit now and think back at all the good deeds that were done and the really hard work that people put through. It was just a reaffirmation of my faith that God is active in the world and that, you know, bad things don’t happen because there’s not a God. Bad things happen because that’s just the way life is and the good things that come out of it are the way that God is acting in your world; the way that Christ is alive in every single one of us everyday.
MCFARLAN: For me, I would say that it reaffirmed for me as work does everyday the fragility of life and how quickly things can change and how you just have to treasure every moment that you have and just be mindful of every moment that you have. It’s understood in Christianity that faith is what gets you through horrible experiences. That that’s how you move through them. God isn’t causing awful things to happen. What we do is we take our faith as we move through difficult and trying times and that’s how we get through them the best possible way.