Can patients see my smile behind all of this PPE?

I walk into my fifth operating room of the morning.

“Good morning, Mr. Jacobs. My name is Dr. Michaelis. I will be the anesthesiologist helping to safely get your breathing tube in as we get your surgery started today.”  He nods and closes his eyes. That’s all he can see of me. My eyes. I am wearing my PAPR (powered air purifying respirator) and mask. For the second day this week, I am part of the new intubation/extubation team that we have instituted in response to the COVID-19 pandemic. Two of us come in with our PPE gear on and intubate with an intubation box positioned over the patient’s head. Once the tube is placed, we confirm with end-tidal CO2 presence and chest rise. Then comes the waiting and the wiping. Wait 15 minutes for the OR air to recirculate while wiping down the intubation box, door handles, and other surfaces.

While I am wiping and waiting for the prescribed timeframe, I think about what our patients must be thinking. Can they tell that I am going to do my very best job of taking care of them despite not meeting me before I walk into the OR immediately before getting them off to sleep? Can they tell I am smiling behind all of my layers of PPE? Do they know that they will be safe here, under my care?

These are the things worrying me lately. I want my work colleagues and patients to know that I’m doing well and smiling at them through my mask and other PPE. I want to try to reassure them. I try to make eye contact as I walk by or talk to them — but from 6 feet away when possible.

When will the current standards of care change back to normal? Will they ever be normal again? It has opened my eyes to the importance of the basics of hand washing, covering a cough or sneeze, and not touching my face. I hope those things don’t get forgotten easily when this pandemic simmers down.

There is so much speculation about treatments, vaccine timeframe, and easing of restrictions. My friends and family ask me for guidance and suggestions. There are many different experts saying many things. I cannot even keep up. I know that I am thankful to live in a Midwest state with lots of space and lower COVID numbers. I feel lucky that I work in a facility that has taken proactive steps that have allowed us to have ventilators, ICU beds, and PPE availability to spare.

In the meantime, I hope for the best and continue to smile at my patients and colleagues through my PPE.

Maria Michaelis is a pediatric anesthesiologist.

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