They say they’re just doing their jobs.

But for these Mainers, that means protecting their communities – us – from a virus that has sickened millions of people and killed more than 158,000 around the world, as has shut down economies and upended daily life, with no end yet in sight.

Maine has been fortunate compared to some other parts of the country, even with 847 illnesses and 32 deaths. But the risks are here, too, especially where cases are concentrated in southern and central Maine.

And these six people – medical professionals, first responders and critical social service providers – are at work on the front lines.

 

Crystal Smith, 34, of Dayton cares for patients suffering from COVID-19 at Southern Maine Health Care in Biddeford. “I try to think of what it would be like to wake up in that situation, not really knowing … what’s happening,” she said. Derek Davis/Staff Photographer

Special care unit nurse: “My name is Crystal. I will be taking care of you”

When a COVID-19 patient wakes up in the special care unit at Southern Maine Health Care in Biddeford, disoriented and breathing with the help of a ventilator, he might hear the voice of  nurse Crystal Smith.

“My name is Crystal. I will be taking care of you,” Smith said she tells the patients. “Your wife called and she says she loves you. This machine is going to give your lungs a break for a while and help you breathe.”

Smith said she “puts herself in the patient’s shoes” and tries to be as reassuring as possible. Being on a ventilator is scary and seeing nurses and doctors dressed head-to-toe in protective gear, including N95 respirators, plastic visors, gloves and gowns, can be unsettling. And, because of their contagious disease, they can’t have visitors.

“I try to think of what it would be like to wake up in that situation, not really knowing where you are or what’s happening,” said Smith.

Nurses, doctors and other front-line health care workers have treated more than 130 patients in Maine who have needed to be hospitalized since the novel coronavirus pandemic began.

While Maine has not been overrun with patients – and there are some encouraging signs that social distancing efforts are working to “flatten the curve” and stop exponential growth of the disease – COVID-19 has nevertheless upended the health care system in Maine.

Hospitals have delayed elective surgeries, eliminated most visitation, reconfigured rooms to prevent cross-contamination and secured as many protective supplies as possible to prepare for the epidemic.

Smith, 34, of Dayton, works in the special care unit that is designed specifically for COVID-19 patients. Because the epidemic hit Maine later and is so far not as severe as some areas of the country that have been overwhelmed with patients – such as New York, Washington state and Michigan – Maine had time to prepare.

That prep work has helped to keep stress levels down. A sense of teamwork also has helped, she said.

“When you walk into our COVID unit, you don’t feel alone,” Smith said. “We saw this coming and had time to plan and prepare for this.”

So far, supplies of protective gear like masks and gloves at Southern Maine Health Care has held up, although there are always concerns about supply shortages, Smith said.

The days have now settled into a routine of caring for about six to eight COVID-19 patients at a time, about half of whom need to be on a ventilator to help them breathe and give their bodies time to fight off the virus.

She does everything from monitoring vital signs, administering medications, giving oxygen, encouraging deep breathing and coughing, and suctioning fluid from the lungs and proning patients who are ventilated. Proning means moving ventilated patients onto their stomach, which encourages improved lung functioning.

“It’s a lot about keeping them as comfortable as possible,” Smith said. “A lot of patients are anxious, so we also want to reassure them by having conversations with them, educate them properly on what their personal health status is.”

— Joe Lawlor

Standing outside the Portland Expo, which is serving as a temporary quarantine site, director Sara Fleurant says working at the Oxford Street Shelter in Portland is challenging in the best of times. Now, the level of uncertainty has grown exponentially. Brianna Soukup/Staff Photographer

Director of the Oxford Street Shelter: “You really have to look out for each other”

Sara Fleurant doesn’t like to talk about herself.

She doesn’t want to be singled out from the 68 staff members she leads at the Oxford Street Shelter in Portland or the hundreds of homeless people they serve.

She’d rather talk about the “team” of dedicated people who continue to show up for work every day knowing that five shelter guests have tested positive for COVID-19 and many others likely have been exposed to the coronavirus that causes the illness.

“We’re all in this together,” said Fleurant, director of the city shelter. “When you’re doing this kind of work, you really have to look out for each other. And the clients really appreciate what we’re doing. They have nowhere else to go.”

Fear of the virus as an invisible threat intensified last week, when the Maine Center for Disease Control and Prevention reported that many people who have tested positive for COVID-19 have been asymptomatic.

On Thursday night, 91 men and women stayed at Oxford Street and 21 men were quarantined at a temporary shelter set up at the city-owned Portland Expo because they could have been exposed to the virus. In addition, two people were isolated at the city’s family shelter because one had tested positive and the other was awaiting test results.

Some of Fleurant’s staff members have told her they are afraid. They’re working with a population that often doesn’t respond well to rules or restrictions. She knows what they’re up against, and not just because she has worked at the shelter for 11 years, starting as a per-diem shelter attendant fresh out of Smith College with a sociology degree.

Two weeks ago, while the Portland Expo was being converted into a quarantine for shelter guests who may have been exposed to the virus, a 49-year-old homeless woman approached Fleurant and forcibly coughed in her face.

The woman was arrested, charged with criminal trespass and banned from the shelter. Fleurant was wearing a mask at the time. Her health has been OK since.

“Unfortunately, that did happen,” she said. “That was a very chaotic time.”

Fleurant, 33, became director of Maine’s only municipal homeless shelter one year ago this month. It’s been a tough anniversary so far, though it seems to be the job she was destined to have.

“I’ve always wanted to help people,” she said. “I graduated from college, I started doing the work and I’ve never considered doing anything else.”

Fleurant acknowledged that working in a homeless shelter isn’t easy in the best of times. Shelter guests often come with a bundle of challenges, including chronic unemployment, alcoholism, drug addiction, physical and mental health issues and domestic and sexual abuse trauma.

During the pandemic, shelter staffers are using masks, gloves and hand sanitizer, working behind Plexiglas barriers, disinfecting shelter facilities more often than usual and trying their best to meet public health guidelines for social distancing.

Fleurant said she’s grateful for support from city officials, volunteers, family members and friends. It means a lot as she and her staff strive to keep the doors open at one of the few places in southern Maine where a homeless person can still find a bed to sleep in and a meal to eat.

Dealing with the unknown isn’t unusual at a 24-hour emergency shelter, Fleurant said, but the level of uncertainty has grown exponentially.

“You can’t really anticipate what’s coming,” she said. “Clients ask when things will get back to normal. I wish I knew.”

Now more than ever, Fleurant finds herself on duty around the clock, working long days, keeping her phone by her side at night. Through it all, she’s focused on the shelter’s mission.

“I took on the responsibility to lead 68 people and run a shelter,” Fleurant said. “If I don’t show up to work every day, why would anybody else?”

— Kelley Bouchard

Posted at the Allen Avenue Fire Station, firefighter/paramedic Jacob Cole, 25, has been working for the Portland Fire Department for two years. “My personal opinion is that I may be more apt to catch (the virus) at the grocery store than at work,” he says.

Paramedic adapts to new precautions, ‘turns off’ exposure concerns

Jacob Cole has never had to change clothes more frequently in his life.

As a paramedic for the Portland Fire Department who is also a firefighter, Cole, 25, is used to returning to the fire station reeking of acrid smoke after fighting a fire, or having to clean himself up from a messy medical call.

But the wardrobe changes have accelerated considerably in the last month, as Cole and the city’s other paramedics adapt to new routines as they care for patients during the coronavirus pandemic, he said.

“Before all of this, really I’d only had to change my uniforms a few times, mostly when we had structure fires of some sort, ” Cole said. “Now it varies so much between shifts, but I’m at least changing once a shift now, for sure.”

On particularly busy shifts, Cole will shower and swap into new clothes three or four times a day. It is one more precaution in a risky, unsettling environment.

“It is a process,” he said. “But I think it’s most important because we don’t want to have this virus on us and then go take care of some little old lady who fell and needs help back up and risk transmitting it.”

Cole, like most first responders, is also suiting up in an extra layer of personal protective gear when he goes out and meets the public. Eye protection, gloves and N95 masks are standard for his workday when meeting patients.

When on calls where he knows someone has tested positive for the coronavirus or is considered high risk of being infected, he wears a disposable plastic suit and a full-face breathing mask. Then, it’s back to the station to take a shower, do laundry and head back out on the road.

Cole said he finds comfort in knowing the fire department is updating its practices constantly, and that so far he has the equipment he needs to be safe.

“My personal opinion is that I may be more apt to catch it at the grocery store than at work, because I’m so well protected,” Cole said. “I do worry about it, especially now that the (infection) numbers are climbing, but I have to turn it off, so I don’t bring the worry home.”

Patients are changing, too. Cole said he’s seen fewer people going to local hospitals and they seem wary of health care, even in the emergency department.

“It’s not as full as it usually was,” Cole said. “People are afraid.”

— Matt Byrne

Dr. Patrick Keaney, 46, is a pulmonologist at Mid Coast Hospital in Brunswick, where about 20 COVID-19 patients have been treated. He says ventilated patients “need a lot of help when they get out.” Shawn Patrick Ouellette/Staff Photographer

Doctor, respiratory expert hopes ‘tsunami’ never comes

In some ways, COVID-19 is similar to other respiratory diseases, says Dr. Patrick Keaney of Mid Coast Hospital in Brunswick.

But because it is a new virus, he and other doctors spent the months before Maine had its first confirmed cases in March learning about the latest research and treatment recommendations and helping to prepare the hospital for a potential surge in patients.

“I had four days off in all of March,” Keaney said. “It’s highly unusual to know you are going to see cases of a disease that you had never previously seen, heard or read about.”

Keaney and the hospital’s staff have now started to settle into a busy, but more manageable, routine. And they hope the surge they have prepared for never arrives.

Keaney is a pulmonologist who treats respiratory issues like asthma, COPD and lung cancer. During the ramp-up as the disease spread around the world,  he would finish his work at Mid Coast and then go home and look up the latest research.

“I found that if I was going home and doing research and looking into every recommendation, it could get overwhelming,” said Keaney, 46. “The biggest uncertainty we had is what exactly was it going to look like. We knew it was a very severe respiratory illness. People get really sick, very quickly.”

Mid Coast has so far treated about 20 COVID-19 inpatients. Because there is no cure, care is supportive, such as medication to reduce fevers, oxygen to help patients breathe and ventilators for the most severe patients. The treatments buy patients time to let their body fight off the virus.

Maine had 847 cases, 136 hospitalizations and 32 deaths through Saturday, but has so far not seen a wave of hospitalizations that could overrun hospitals and jeopardize patient care. Maine in recent weeks has not seen an exponential increase in cases or hospitalizations, but rather steady increases, with some spikes due to outbreaks in congregate care settings like nursing homes.

Keaney said he’s thankful that the social distancing efforts appear to be working well enough to ensure that hospitals have patient loads that are manageable.

“I’m pretty hopeful that we’re not going to see the tsunami of cases,” Keaney said.

So far, supplies of personal protective equipment like masks, gloves and gowns have held up. As a doctor who treated contagious respiratory diseases, he’s used to wearing all of the protective equipment, but COVID-19 patients are especially contagious and health care workers must be extra careful, he said.

To preserve protective equipment, Keaney said he will make the patient rounds of the COVID-19 patients all at once, so he doesn’t have to keep changing in and out of protective gear. Stacking up those patient visits also means he doesn’t have to dispose of as much of the gear, which is in limited supply all over the country.

Keaney said one thing that worries him now is ventilated patients who leave the hospital and may have a difficult time getting the consistent rehabilitation care they need. That’s partly  because of restrictions on elective health care services put in place in an attempt to preserve health care system resources during the pandemic.

“Patients who are ventilated are complicated to care for, complicated to discharge and do rehabilitation and physical therapy,” Keaney said. “They need a lot of help when they get out.”

— Joe Lawlor

Sgt. Chad Arrowsmith of the Wells Police Department reflects on how life has changed: “I’d also never thought as a police officer, I’d be coming up to someone’s house and asking them when they came into town, and if they’re quarantining.” Shawn Patrick Ouellette/Staff Photographer

Police officer patrols eerily quiet streets of seaside community

The last time Wells police Sgt. Chad Arrowsmith can remember the streets this empty, America was on the brink of war and still reeling from the fall of the Twin Towers and the attacks of Sept. 11, 2001.

At the time, Arrowsmith was near the start of his law enforcement career as a police officer in Presque Isle, and he said he remembered the international airport there – the only rapid way to get to Portland, Boston or beyond – completely shut down, and life slowed to a standstill.

“It felt like a ghost town,” Arrowsmith said. “It was a weird time.”

He sees the same eerie quiet today in the seaside tourist community he’s patrolled for the last 7 1/2 years: Highways nearly silent without cars. Sidewalks without people, and businesses without customers. And the town’s iconic beaches, at least for now, are strictly for the birds.

Although Arrowsmith said he’s optimistic for a vaccine and a return to normal life, he is realistic about what the next several months hold for the nation and his corner of the world, where springtime and summer have always meant a local swell in population and activity as the tourist town comes alive with visitors and seasonal residents.

Now, the majority of time spent by him and his officers are enforcing the various local and statewide restrictions related to the virus, reminding folks from away of the requirements to self-quarantine, and gently shooing along the dozens upon dozens of people who attempt to park and stare out at the ocean from their vehicles, a once-mundane activity that for the moment is forbidden.

“I’d also never thought, as a police officer, I’d be coming up to someone’s house and asking them when they came into town, and if they’re quarantining,” he said, adding later: “It’s going to definitely be a different tourist season.”

Like after Sept. 11, Arrowsmith predicts that our way of life and aspects of our government may change forever, and this historic time will be the divider between before and after.

“(After Sept. 11) we never went back to what we thought was normal,” Arrowsmith said. “Even when we say let’s open everything back up, you’ll have people who will shy away from going back to what is normal life. I think us getting back to normal would be having a vaccine and keeping some sort of social distancing in effect for a while, through the fall.”

For now, he said, he has to focus on enforcing rules designed to help us all, while also protecting himself and his family.

“What worries me the most is having to put myself out there unnecessarily because people don’t follow the governor’s order, and then going home to my wife and kids,” he said. “My uniform never goes home.”

— Matt Byrne

“One of the ways we communicate with residents is with a smile,” says Nikki Mowatt, 33, a nurse at a long-term care facility in South Portland. “That’s very hard to do with a mask.” Shawn Patrick Ouellette/Staff Photographer

Nurse, long-term care facility: ‘We really have to be there emotionally’

Nikki Mowatt has rearranged her life to respond to the upheaval, uncertainty and fear that pervades the landscape around Maine nursing homes during the coronavirus pandemic.

Anxiety escalated last week when four nursing homes reported dozens of residents and employees had contracted COVID-19 and many of them were asymptomatic.

Mowatt, a nurse at the South Portland Nursing Home, has been battling an unseen enemy for weeks now, trying to keep the coronavirus out of the 68-bed skilled long-term care facility.

At the same time, while others stay at home to flatten the curve, she knows she’s risking her life each day that she goes to work, increasing the possibility that she could become ill and bring the virus home to her two young children and her boyfriend.

“I don’t want to know how I would manage that,” she said.

For now, Mowatt is submitting to daily health screenings at work, taking on additional duties required to stave off the pandemic and dealing with an ever-increasing number of public health precautions related to co-workers, residents and their loved ones.

“The hardest thing is juggling everything and dealing with what feels like chaos every day,” Mowatt said, noting that she also misses interactions with staff members who are restricted to other units.

Mowatt, 33, started working at the nursing home as a housekeeping attendant when she was 15 years old. “I’ve pretty much done every job here,” she said.

During the pandemic, she’s filling various administrative and patient care roles, and she’s restricting her movements between work and home, stopping only for groceries or gas to reduce her potential exposure to the coronavirus.

She’s also working 12-hour days, often starting at 3 a.m. to get paperwork done and reduce the need for child care for her 5-year-old son, Colby, and her 3-year-old daughter, Charlotte. And because Colby’s preschool class meets online while Mowatt is working, she has taken on home-schooling duties as well. Then it’s time for dinner, household chores and the kids’ baths before bedtime.

“It all caught up with me last week,” Mowatt said. “I’ve been drained.”

Social distancing is being enforced among residents and their contact with family members has been reduced to phone calls, virtual chats and window visits. As a result, Mowatt and other staff members have increased the time they spend socializing with residents, playing cards, chatting, reading and getting to know family members during FaceTime sessions.

“I feel we’ve all become really close because of this,” Mowatt said. “We usually become like family to many residents, and in this situation, we really have to be there emotionally for people because their loved ones can’t visit them in person.”

She finds it especially challenging to wear a mask all the time, though she knows it’s necessary.

“One of the ways we communicate with residents is with a smile,” Mowatt said. “That’s very hard to do with a mask.”

— Kelley Bouchard

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