Katrina Hawkins, MD ’05, RESD ’08, FEL ’11, is an assistant professor of anesthesiology and critical care at the George Washington University (GW) School of Medicine and Health Sciences and medical director of the Cardiothoracic Intensive Care Unit at GW Hospital. Hawkins and her husband, Monte, live in northern Virginia, where they are raising their two children, 12-year-old Hannah and 5-year-old Flynn. In this Q&A, Hawkins offers a glimpse of life as an essential worker on the frontlines of the COVID-19 pandemic.
How are you managing with child care and school while you come to work in the GW Hospital Intensive Care Unit (ICU)?
Katrina Hawkins: My daughter, who is in 6th grade, has autism and, though high-functioning and fully integrated into all of the mainstream classes, she receives help in school with a lot of things. We have had excellent leadership from her school, especially her special education teacher, to keep things achievable and organized. I help when I'm home, but I’m fortunate that my husband is working from home and is able to do the lion’s share of help with distance learning. My son is in pre-K and fortunately ahead of where he needs to be, so we have some educational apps and books, but mostly I’m just letting him play, draw, and use his imagination as much as possible. And, because I just made myself seem like I have it all under control, he has way more time on his iPad than I would like, but there’s only so much you can do.
Are you staying at home or have you moved into temporary housing to avoid the risk of bringing the virus home?
KH: I am staying at home. I considered staying at a hotel, but I would have to be there for months. So I take the risk. I don’t worry about my risk when I’m in a patient room as much as I do everywhere else on the unit. My hands touch desks, the mouse, keyboards, etc. It’s impossible to know what’s contaminated and what’s not, and that’s scary. All I can do is my best to wash my hands, keep them out of my face, and wear my mask. I keep my phone in a plastic bag at all times in the hospital. I have a strict routine at the beginning and end of each day.
At the start of the day:
- Put my phone in plastic bag when I leave the house.
- Drive to work, put on mask, get my work shoes out of; my trunk, and put home shoes in the car.
- Enter the hospital, get scrubs out of scrub machine and change; in my office. My home clothes go in a drawer that is never used for anything else.
- Wipe down my desk, computer, keyboard, etc. with disinfectant wipes, even though I did this the night before.
At the end of the day:
- Change into my home clothes.
- My phone comes out of plastic bag, I wash it with alcohol spray and then it goes directly into my pocket.
- I wipe down my desk and the surfaces in my office with Lysol-type wipes.
- Change into my “everyday mask.” I put my surgical work mask into paper bag on my desk.
- Walk to my car, put my work shoes back in their bag, and change into my home shoes.
- When I get home, I wipe down every surface of my car, including my keys, with Lysol wipes.
- I enter the house through the basement, strip down, and go upstairs directly to the shower where I get clean and then put on clean clothes; ready for a hug from my kids.
How are you managing your regular day-to-day home responsibilities, plus self-care, through all of this?
KH: I am extremely lucky. My husband is an amazing partner and he handles the day-to-day stuff when I’m on service. We have mostly been ordering dinner from local places, which is not great for the waistband, but it eases the burden at home and supports local businesses. I put my kids to bed; it’s the one thing I can really contribute when I’m home. I also make sure to leave my phone out of the room so that for the two hours or so I’m here [and the kids are awake] I’m really present.
As far as self-care, I have a Peloton and love it. But the weeks that I’m on service are long and exhausting and I need sleep. I can’t sacrifice sleep to get up early, and I won’t sacrifice time with my family at night, so I give it up most days on those weeks. I use the meditation sessions on the Peloton app to help keep my mind as well as possible. There’s also support offered through GW Hospital and university. There are meditation classes, zoom meetings with our Psychiatry colleagues, zoom happy hours through our department, and many others I’m forgetting at the moment. We are doing a good job of supporting each other and the GW medical enterprise has been extremely supportive as well.
What are your family and friends saying to you about being in the thick of the response?
KH: Most are proud; some are scared. Well, I think they are all proud and scared, just in varying degrees. My mom is terrified for me, I think, but equally proud. My best friend is a worrier, she is also scared. But the overwhelming pride and support have carried me through. My husband said the most amazing thing one day. It was near the end of my first 14-day stretch on a COVID-19 unit. I was feeling guilty for barely knowing what was going on in my own home. I told him how thankful I was that I didn’t have to worry about anything at home while I was at work. I have a true partner that can do it all. His response was, “You have the most important job right now. It is my honor to stay home.”
What types of illnesses are you seeing?
KH: We are mostly seeing COVID-19 cases. There are still heart attacks and strokes, but there is very little trauma right now. I’m an intensivist (ICU physician), so I’m seeing the sickest COVID-19 patients. They either come into the ED in extremis [near death] or, more commonly, they get admitted to division of medicine and some of them get worse, need more oxygen, a higher level of care and/or a ventilator, and they end up in the ICU as my patient. It’s difficult. Once they are intubated their chances of survival are 20% at best.
How have your protocols changed? Are your patient interactions different?
KH: Our protocols have changed drastically. No one is allowed in the hospital if they aren’t an essential employee. We get our temperature taken at the door when we enter and we have to wear masks at all times. Patient interactions are quite different. First of all, they are much fewer and further between. We don’t go in the room unless we have to. We speak to patients on the phone as much as possible. If we go in, we are shrouded in personal protective equipment (PPE), which immediately puts a wall up between you and the human in the bed. Having conversations about difficult things, like being put on a ventilator, CPR, or end of life, are part of our everyday job, and we are used to that. But having those difficult conversations through a mask, shield, hat, gown, and gloves is less than ideal for both parties. And this is the best-case scenario. Often, the patients are intubated and too sick to speak for themselves, in which case we turn to family. Typically, we would be in a family meeting room with tissues and sometimes a palliative care team joins to help support us and the family. Now, these conversations are held over the phone because people cannot visit their loved ones. They cannot hold their hands or know what they look like in the bed tied to so many machines. The human connection part of my job, that I love so dearly, has been stripped away. We try our best to succeed in these circumstances and get folks to trust us over the phone. I’ve been amazed by how many of these phone calls have ended with people’s kind words about what we are doing, all while they are also worried about their family member in our unit. I’m amazed at how kind the human spirit really can be.
