Claire, Oncology PA on the frontlines of COVID-19

Claire is a Canadian Certified Physician Assistant working in Oncology at University Health Network. She is a McMaster PA Graduate.

April 2020 - As coronavirus ramped up in Ontario, I just transitioned from acute inpatient oncology to an outpatient oncology clinic where most of my patients are receiving immunotherapy. Our practice is changing daily. We started wearing masks to clinic today.

“Due to the shortage, we are allocated two masks a day. We want to protect our patients in case we are asymptomatic carriers. The wellbeing of our fragile patients are always on our minds.”

The decisions I make about social distancing in my personal life and monitoring myself for symptoms are centred on the fact that I will see several immunocompromised people in a day. It’s as if I have 10 grandparents and I’m worried about exposing all of them to COVID-19.

“We have pared down the number of clinicians in our clinic in order to allow for social distancing. We take turns working from home. We call our patients from home and facilitate their investigations to be done close to their home rather than the hospital. We have converted many of our appointments to telemedicine or by telephone. We do everything in our power to keep them away from the hospital because we know that is their best chance of avoiding COVID-19. But it’s a fine dance.”

Immunotherapy is wonderful in that it may extend life even in advanced cancers. But at the same time, patients can develop adverse effects that if not addressed promptly can become serious and even fatal. So we are always trying to balance the risk of bringing them into clinic and risking exposure or seeing them through OTN but not being able to do a physical. These people also need to continue treatment.

We then try to evaluate risk of COVID-19 exposure if a treatment site is crowded versus making sure their malignancy does not have a chance to progress.

I think that at the heart of all of this, it is always a conversation with the patient about what is important to them and how we can best treat and protect them. That is how my practice looks like today.

However, I’ve been told that in future I may be deployed to acute care if the hospital gets overwhelmed. I have 6 and a half years of acute oncology experience and I would be honoured to share those skills during a time like this.

I think everyone has said the important stuff: stay at home, wash your hands, flatten the curve – and I wholeheartedly endorse all of it. What I would like to touch on is how incredibly tough this time is for everyone. And tough times can inspire some existential reflection. Like all other front liners, the fear I have of acquiring the virus is real and raw.

Many peoples’ lives will change forever. Many will be alone in the scariest time of their life in hospital and sadly, of these, there will be people who will die alone. These are such harrowing thoughts and despair can run deep.

What I encourage is that we all take some time in our isolation to think: how might this change the way we live once all this is over? What will you do differently? Will you love a little more, take better care of the environment, look out for the vulnerable? Will you intentionally slow down every once in a while to appreciate the life you have? Will you value your relationships and those intangible life moments as much as you do your achievements and aspirations?

That’s what I look forward to, how I’ll live my life better when this is done.