Sep 27, 2021 | Grit
Part of my job as a neuropsychologist at HDGH is providing neuropsychological assessments to diagnos brain impairment in the outpatient Acquired Brain Injury program and on the Inpatient Rehabilitation units. The other part of my job is rehabilitation psychology, which entails working with individuals with disabilities and chronic health conditions to support them as they cope with and adapt to the mental, emotional, and physical challenges related to unexpected changes in their lives. It is the part of my job that is the most rewarding and the reason I moved to Windsor over 26 years ago. My practice has evolved over the years as I integrated evidence-based practice from cognitive-behaviour therapy, acceptance and commitment therapy, motivational interviewing and mindfulness-CBT along with lessons learned from my patients. This practice involves helping patients acknowledge their negative emotions and then step back and look at their situation differently as well as identifying barriers, setting short-term goals, and focusing on the present moment. When the pandemic was declared in March 2020, it seemed that the whole world suddenly shut down. It was a scary time as there was so much unknown about the COVID-19 virus and the pictures and news stories coming out of Italy and then New York City were apocalyptic. In the initial stages of the pandemic, to protect the health and wellbeing of our patients, staff and community at large, all in-person services in the outpatient programs at HDGH were stopped and inpatients were isolated in their rooms with in-room therapy and no family visitors. My outpatient colleagues were redeployed to provide support to inpatients and to provide a valuable linkage to their families via phone and Facetime calls. I continued to provide psychological services on the inpatient units to address our patients’ mental health issues. No longer providing comprehensive neuropsychological assessments on my outpatient days, I pivoted to completing brief assessments over the phone and to providing education and psychotherapy by videoconference over OTN. Suddenly, I was reading articles and watching webinars on telepsychology to adapt to this new way of providing psychological services. The push to provide virtual healthcare services may not have occurred without the pandemic and it has been a God-send for those living at a distance. Student placements were cancelled so I scrambled to finish up reports that a University of Windsor Ph.D. student had started as part of her clinical placement with me. We had to change our work habits, pivoting to follow new procedures and rules that seemed to change on a weekly basis. Fortunately, we received frequent and consistent communication from our administration about these ever-changing rules.Patients missed in-person visits from their families but made do with the virtual connections facilitated by the Family Support Team. Confined to their rooms in the early days of the pandemic, they focused on their rehab goals, working towards a level of independence that meant they could be discharged out of the isolation. Over my years of working on the Rehab units, I have been astounded by the resilience of many individuals to cope with sudden changes in their functioning that accompany conditions such as stroke, spinal cord injuries and orthopaedic injuries. Their resilience is facilitated by communication of information about their condition, clear expectations about their prognosis, respect for their goals, and encouragement from the staff. While people at home were baking bread and working virtually, our patients chatted with their roommates and the staff, watched T.V., did word searches, read and listened to music in between their therapy sessions. Listening to music at lunch was one of the ways that I dealt with the stresses of the pandemic. I had the luxury of closing my office door and turning up the volume of the music on my playlist. The orchestration of Nightswimming by R.E.M. would transport me away from the uncertainty of those early pandemic days. Adapting to new infection control procedures, I wore masks to see all my patients and my wardrobe shifted from blouses and dress pants to scrub pants and t-shirts that could be washed at the end of the day. At first, I was frustrated by my clothing options but with curbside pick-up, I curated a new work wardrobe. The simplicity of my wardrobe meant more brain energy for other decision-making and I may never give it up. Staff began wearing surgical caps sewn by family members and volunteers. I unearthed my sewing machine but with no cotton fabric stash (my late mother, an avid quilter, would have been dismayed) and stores closed, I improvised and made caps out of pillowcases for myself and my co-workers. My sister shared a quilting store’s website for a pattern and later I ordered cap kits from it. With no travel, shopping, socializing, or visits to out-of-town family (stay away, they said, Windsor is a hot-spot), life at home slowed down. There was time to dust off old hobbies like handcrafts and baking, go on bike rides and have weekly game nights with our adult children (yes, they still live at home, sponging off the family payroll while attending university online). Walking in my neighbourhood, I was reminded of Marc Cohen as he sang about a spiritual awakening in Walking in Memphis.As spring turned to summer and then fall, there were more changes and more pivoting. Students returned to the hospital, outpatient programs resumed and inpatients had Designated Care Providers in to visit them. For months, I had been wearing a mask, slipping it down to take a drink, removing it to eat my lunch, or escaping it when alone in an office. Keeping two metres apart was a luxury at the nursing station & nonexistent when providing care to patients. Wearing a visor when providing patient care, I sanitized my hands until they were red and chapped. Following the public health rules to reduce the spread of the virus, it seemed like a well-oiled routine. For inspiration, Walk Off the Earth sang, Home, We’ll Go on my playlist.Then in late November, the day started out with laughter at the nursing station, but it ended with worry over a patient who tested positive for COVID-19. Over the next few days, more patients and then staff tested positive and an outbreak was declared on an inpatient Rehabilitation unit. The rules changed; we pivoted and adapted. Visitors & students were once again paused and, admissions were halted, creating a backlog in other hospitals. Patients were restricted to their rooms with only a phone or a tablet to stay in contact with their family. Patients and their families felt alone and worried; if they catch the virus, would they survive? Staff were restricted to working only one unit and I stopped working on the inpatient Rehab units (except for therapy over the phone) and only provide in-person services to the complex care units and outpatients. One day, I provided therapy over the phone to a Rehab patient, and the next day, they were transferred to acute care because they were sicker with the virus. Over the days and weeks, more and more staff tested positive and became sick; twice as many as the patients who tested positive. Hearing about my colleagues through the hospital grapevine, I was reminded of my sister, a nurse in another city who had become sick with COVID-19 in March 2020 for several weeks with a cough, shortness of breath and fatigue. Playing Burden (by Foy Vance) on my Spotify reminded me of the nightly phone calls I made to her while she was quarantined in her bedroom and I would “sit” with her for a while. Wanting to support my Rehab colleagues while respecting their privacy, I pulled together materials from my coping groups and sent out an email with some coping strategies and reassurance that they would get through this difficult time. My outpatient office is directly across from the Rehab units so I posted signs of support on my window. Some staff were off for two weeks of quarantine and others were off for six weeks or more; sick and worrying every night if they too would need to be admitted to hospital. How did the virus slip in? The rules changed again so we pivoted and adapted: wear your mask and shield everywhere in the hospital. Staff numbers in break rooms were limited, so alone, they removed shields, lowered masks, and quickly sipped a drink or inhaled a meal. Mask, shield, gown and gloves, wiping down surfaces, and sanitizing hands. Following the rules to keep our patients, ourselves, and our families safe. When it all seemed overwhelming, I would listen to It’s Alright by Mother Mother.Then, the outbreak was over and the rules changed again; admissions resumed, staff could work across units & caregivers returned to visit. Breathing a sigh of relief, again, I pivoted and adapted; back to juggling both an inpatient and outpatient caseload. Staying the course by continuing to support my patients and my colleagues as we adapted to these challenging and unprecedented times. With the roll-out of vaccines gathering steam in early 2021, my heart sang to the uplifting lyrics of Roseanne Cash in Land of Dreams during my lunch time music breaks.Today, as I finish this recap of my story through this year in our collective and shared organizational history, I am reminded that all of us have experienced this pandemic in different ways as in that now famous saying - same storm, different boats. My experience is just one story of dealing with the uncertainty and I am very aware of my position of privilege and good luck. It was not always easy to deal with the repeated need to pivot and adapt, but it helped to have clear communication from administration, inspiring music on my playlist, and support from my work colleagues (especially my braid & running shoe buddies) and my family at home.Dr. McLachlan’s Pandemic Play-list Nightswimming by R.E.M.Walking in Memphis by Marc CohenHome, We’ll Go by Walk Off the EarthBurden by Foy VanceIt’s Alright by Mother Mother Land of Dreams by Roseanne Cash