Some of you may recall that for the last couple of years, my day job has been driving what’s called a paratransit vehicle, or in the common parlance, a wheelchair-lift van. Mostly taking mobility-impaired folks to the doctor and home again, hospital discharges, things like that. Occasionally you get a novelty like taking special-needs kids to school or a prison transfer taking a sick inmate to the hospital (with an armed escort riding shotgun.) It’s never not interesting. Even if we won the lottery tomorrow I’d probably still do it, at least a couple of days a week, because there’s a need and for the most part I enjoy it.
We go all over but my beat is mostly south King County. There’s a reason for that. It’s because since March, I’ve been one of four drivers (of forty-three total, don’t get me started) at my outfit who’ve agreed to go on Covid-19 duty, taking patients who are either confirmed positive or at least possible positives. As recounted here, it’s not heroics. It’s because my wife is currently on unpaid medical leave and I was terrified of getting laid off. It was a kind of grim job security.
The reason I’m in south King County a lot is because that area, particularly towns like Auburn and Kent, is a virus hotspot. Not coincidentally, that’s also an area with a lot of low-income families trying to get by on Medicaid and Medicare, with people working sick and taking risks because losing the job is a bigger risk. It’s brutal and cruel and a work day rarely passes for me where I don’t see something that makes me feel helplessly angry and frustrated at how fucked up our system is.
Even more maddening is the bad information our patients are working from and their vague sense that we are trying to sabotage them by insisting on safety measures.
We are, all of us in health care, learning as we go. I figured out pretty early on how to get the most out of my PPE; I rarely bother with the full gown any more, and generally a regular mask gets me through a whole day. (Still going through rubber gloves and Lysol like a house afire, but my employer keeps us well stocked.) But, as I’ve said before, in my profession it’s not that big of a leap; we are dealing with immuno-compromised folks all the time anyway, and you get into the same groove as a hospital nurse, habitually sanitizing the hands and gloving up before you deal with a patient.
All that is the background. That established, I wanted to tell you about a thing that happened last week, two days before Thanksgiving. I’ve changed the names, but not the locations, because location plays a part here.
It happened like this. I got a call from my dispatcher. “This pickup at Auburn, it’s one of the special ones. Hopelink says she’s symptomatic. When you get there check in with the ER nurse because they’re going to want to do a different procedure to get her out.”
Translated, that boiled down to, they don’t want to use the regular lobby exit, too many people around. And for me personally, it also meant, game on. A lot of the cases I get aren’t actual Covid-positives, but only maybes. Mostly folks who are waiting on test results before a surgery, things like that. For the real cases they usually use an ambulance. But apparently this was a real case. Because fucking Auburn. Of course.
Most of the local hospitals and clinics are locked down HARD… meaning there’s only one way in or out of the building for both staff and patients, and every person entering has to be screened, get their temperature taken, and be issued a temp badge. I didn’t really know what else to do so I pulled up at the one entrance I knew was open, the main lobby. A nurse in scrubs with full Covid regalia– mask, gloves, gown and face shield– came running up to the van. “You’re here for Gertrude?” I nodded. “Oh good, I’m glad I caught you. We don’t want to bring her out through the lobby, there’s too many people, I was hoping you could pull around the back, opposite here.” She pointed.
I knew where she meant but couldn’t quite believe it. “By the dumpsters?”
“Yes.” Even behind the mask I could see she looked apologetic. “It’s our delivery entrance, but there’s a ramp and it’s isolated. We’ll meet you there.”
“Okay.” She trotted back inside and I took the van back out of the turnaround to go to the other side of the building.
It was pouring rain and there really wasn’t a good place to put the van; I finally just decided I’d be unpopular and block access to the alley for the ten minutes or so it would take to get Gertrude aboard. She was muttering into her phone and swearing; I did my best to diplomatically ignore all of this while I got her wheelchair safely secured and then belted her in. (It’s a little bit like nursing, I suppose; everyone sort of agrees to accept a higher level of personal indignity for the sake of the job at hand, though I do try to keep people from feeling like they’re just being strapped down like luggage.)
I asked her if she was comfortable? Warm enough? and she glared at me. “These tests are bullshit.”
Oh great, I thought. Another denialist. This is going to be a fun trip.
“I mean it,” she went on. “I asked for a real test here and all they have is the shitty one with the short swab.” (That is the antibody test, which in fairness is honestly unreliable.) “I’ve had thirteen other tests in the last six weeks because of my surgeries, they all came up negative, but they gave me this one and it’s positive and even though I got no symptoms everybody’s in a panic.”
“We don’t have a choice,” I said, mildly. “We have to act as if. Whether anything shows or not.”
“But it’s the crappy test! It comes up with false negatives alla time! Can’t there be a false positive too?”
“It’s possible,” I admitted. “But unlikely. It’s a test for the presence of antibodies. If it’s positive, it means you have them. I’m not sure how you get a false positive with that.”
“I want a real test,” she said. “With the swab that hurts. The long one. Isn’t there a free testing place around here?”
“What, you mean go now?” She nodded. “Well, you’d have to call Hopelink and get your destination changed, which is going to mean being on hold for a while, but if you want to call…” She had her phone out and was dialing before I finished talking.
I sighed and called my dispatcher. “Client wants to get a full-on Covid test and is calling Hopelink for a destination change, so we’re waiting here at the hospital till she gets that squared away.”
(I need to explain that a destination change is almost never granted, not by Hopelink OR my dispatchers, for lots of different reasons mostly having to do with liability. This was largely an exercise in humoring an old lady who was having a bad day, as far as I was concerned.)
My dispatcher acknowledged this and I waited for Gertrude to finish her call. Then my radio crackled again. “I’m going to try Hopelink from here, so she won’t be on hold for forty minutes. I need the street address though. Do you have it?”
“Uh.” I thought a second. “The closest one is on C Street, south of here, the old factory lot. Give me a minute.” I pulled out my own phone and Googled. “2701. That is, 2701 C Street Southwest.”
Gertrude, still on hold, looked up at me. “What?”
“We’re trying to speed this up for you,” I told her. “Hang on.”
My dispatcher came back on. “Hopelink’s cleared it. New ride’s on your phone now. And then you return her to her home, right?”
“Uh-huh. Same as the usual drive-through.” My radio went quiet and I put the van in gear. “It’s done, you can hang up,” I told Gertrude. “We’re going to try the testing site on C Street. You’ll need your ID and an insurance card if you have one. Do you have them?”
“Oh, God.” Gertrude looked panicked. “My husband has them, he’s at home…”
“Maybe he can text you a photo,” I offered. “We just need to show some kind of documentation for you.”
Gertrude started texting, telling me her story as we went. She’d been in lockdown at the assisted-living place she was staying at, recovering from her surgery for the last ten weeks, and had finally managed to get them to agree to let her go home for the holiday so she could see her husband.
Now, this facility, I happened to know, was not a particularly good one. Not bad, not anything worthy of reporting (and we are mandated reporters for this kind of thing) but… well, let’s put it this way. There are facilities staffed with people who are really good with patients and care about the work, and there are those that are just punching a clock and doing the minimum. Gertrude’s was a minimum-effort place. “They don’t do tests on site,” she said. “I asked, but they don’t have but the one doctor on call and he doesn’t do ’em. They sent me down here to the hospital and all they had was the shitty one. Now I’m screwed. If I can get a real test– I know I’m negative. I haven’t seen anybody, I haven’t been out, I feel fine…”
“Well, let’s see what we can do.” I didn’t want her to get too optimistic, so I added, “Even if we can’t get you in today, Hopelink signed off on the ride, so we can set you up with an appointment and maybe get you in tomorrow. Worst case,” I added.
Most of the testing sites in King County are outdoors, with tents set up in a sort of MASH-unit type of thing. The idea is to get as many people through as quickly as possible while limiting exposure for the people staffing the testing stations. I’d chosen this one because it was the closest, I knew it was free, and they were able to spread out enough to have more than one line.
“Will I have to get out?” Gertrude was a little anxious.
“No, it’s a drive-through,” I assured her. “They’ll come to us. I’m just worried about if they’ll accept a random drive-up like this. Usually you have to make an appointment. Did your husband come through on the pictures?”
“He’s looking,” she said. “Oh! Here they are!” She held up her phone triumphantly.
“Good. Here we go.” I pulled up to the main entrance and a security guard waved me to the second line. A fully gowned and masked worker came running out and I explained we needed a test but didn’t have an appointment, and also that my patient had mobility issues and whoever administered the test was going to have to get in the van.
“Not a problem!” the worker assured me, and tied a red ribbon on to my rear-view mirror, which I assumed was shorthand for whatever special needs Gertrude had. Then he motioned me to pull forward.
There was almost no wait at all. In less than five minutes another gowned-masked-and-shielded worker had climbed aboard.
He started to explain about how to get the results and I pointed at Gertrude. “I’m just the Hopelink driver. Tell her.”
It transpired that it would take twenty-four hours for the result to come in, and he gave her an information handout with a code she could scan into her phone to get it online. “Okay? Now we’re going to do the swab. Just lean back and pull your mask down…. just a little, just the nose. Here we go.”
Gertrude made a muffled sound of discomfort. I couldn’t blame her. The swabs are long and really invasive. A patient of mine once described it as feeling like ‘getting a frontal lobotomy with a Q-tip,’ which I suspect is understating it.
The upside is, it’s done in moments. The worker pulled the swab out and bagged it, confirmed Gertrude’s identity against the ID photo on her phone, and assured her the results would be online in twenty-four hours. I thanked him for getting us in and he laughed. “Thank you for coming in! The more people get tested, the quicker we beat this thing.” He hopped out of the van and waved us on, and we pulled out and headed for the exit.
“That quick and easy,” Gertrude marveled.
“Surprised me too,” I admitted. “I was expecting my dispatcher to say no. Then I was expecting Hopelink to say no. And then I was pretty sure they’d turn us away at the gate. That’s three different times things broke your way. You lucked out.”
“You left one out,” she said, quietly.
“You. You could have said no.” Her voice quavered and I realized she was near tears.
I was embarrassed. “I just drive the van, my dispatcher did the heavy lifting. She’s the one made it happen.”
“You do not just drive the van,” Gertrude snapped. “You knew who to call and where to go and you listened to me. First one since this started actually goddam listened.”
“Well, it’s part of the job.” I was really embarrassed now. “And, well… when my wife was in the hospital last month and I couldn’t see her and nobody would tell me anything… I know how maddening that is. It doesn’t cost me anything to make a couple of calls.”
“How long you been married?”
“Twenty-seven for me.” She added ruefully, “Missed celebratin’ that too. I told him he had a lot of making up to do.”
There was no question about what she meant. It tickled me that even after surgery and rehab and being stuck in a wheelchair, Gertrude had every intention of rocking her man’s world as soon as she had the chance. I told her, “Speaking as a guy, I think that’s going to be an easy sell.”
“Oh, I know,” she said, chuckling.
I have no idea what the test results were or if Gertrude got to go home for Thanksgiving, but I feel like we at least helped her get through the holiday with a clear conscience that she’d made every effort. Some days, that’s as close as you get to a win.
What I keep thinking about is all the people who are working so hard, and their patients, getting blown off by the folks actually in a position to genuinely make a difference. And rage at all the people who are spreading disinformation for the sake of ratings or deceptive fundraising or some other grift. Seeing how hard the workers are trying to keep it together at testing sites and then seeing assholes like Ted Cruz talking about how the virus is just a publicity stunt… you have no idea how maddening that is. Come do my job for a week, you smug son of a bitch. Look my patients in the eye and peddle your bullshit to their faces. See how you feel then.
In the meantime, speaking as someone who deals with this every day… it’s not that fucking hard. Mask up. Wash your hands. Stay home. Please, for the love of God.
Anyone telling you different does not have your best interest at heart. Period.
Back next week with something cool, and a little lighter. I promise.