From behind an N95 facemask and a plastic face shield, Lindsay McAuley’s voice is a bit muffled. In fact, it’s hard to see much of her at all. Covered up beneath a thick nylon and cotton safety suit — suspendered pants and a hooded jacket — only her eyes are visible.
It’s a far cry from the physician’s assistant’s pre-pandemic uniform.
“It’s very, very different. A lot of my patients don’t recognize me at first, that’s why I have my name written on my jacket,” she said, standing in the parking lot of the clinic’s Ethete location. She pointed to the area over her heart, where her last name is scrawled in black marker.
For McAuley, a family care provider at Wind River Family and Community Healthcare clinic on the Wind River Indian Reservation, it’s just one facet of the new normal of working on the frontlines of a global pandemic in what is considered one of the most vulnerable places in the state.
Inadequate housing, high rates of underlying health conditions, poverty and other factors mean that reservation residents are particularly susceptible to tragic outcomes from COVID-19. This spurred the clinic, operated by the Northern Arapaho Tribe and commonly known as Wind River Cares, to take early and aggressive action. The tribe and clinic were quick to issue closure orders, triage care, establish quarantine housing and offer widespread testing to all tribal members who want it. The clinic is now contact tracing as well.
Even with those precautions, case counts continue to rise and four tribal members died of COVID-19 complications on Monday.
So for McAuley and her coworkers, the story of the pandemic has been one of rapid and ever-evolving response, quick-thinking triage and pivoting at a moment’s notice.
It’s been a head-spinning journey, McAuley said, but she’s proud of the work they’ve done.
“At the time when we started for some people it looked a little bit premature or extreme,” she said, but, “I feel like our clinic actually did a really good job of getting out ahead of it.
“We knew that the impact would be really high in this area,” she said, “I think our leadership did a really great job of taking this very seriously.”
Then and now
If the outbreak has brought seismic change to daily life, perhaps nowhere is that as evident as in health care. Health workers have taken on a host of new duties, reimagined how they do their work and wrestled with new patient care demands all while trying to minimize their own heightened risk of contracting the virus.
Before the outbreak, there was nothing terribly remarkable about McAuley’s work life. She is fairly new to the field, having graduated from PA school at the University of Utah in 2018, and was just getting her feet under her at her first job out of school. Seeing eight to 10 patients a day, she would perform wellness checks, write prescriptions and outline care protocols. She spent a lot of time listening, she said, and enjoyed the luxury of time to really understand her patients’ healthcare pictures in order to problem solve.
Once COVID-19 arrived in Wyoming, with the first case confirmation on March 11, work at Wind River Cares accelerated as the clinic shifted into response and planning mode. The operation erected tents, started triaging patients outside and shifted to telehealth as a mode of keeping people home.
McAuley’s work load pivoted from in-person visits to assessing and triaging, her workspace shifted to the parking lot outside the clinic and she began the daily doffing and donning of personal protection equipment that has now become the norm. She and her coworkers sanitize their face shields regularly, change their gloves and take extra care when handling their N95 masks to preserve them as long as possible.
When the clinic began widespread testing of tribal members, McAuley was deployed with swabs to gather samples. Wind River Cares had conducted more than 1,800 tests as of Friday. (As of Wednesday, there were 24 confirmed cases on the reservation, according to the Fremont County Incident Management Team.) She’s also been tested herself — negative. And she’s gone into quarantine, early in the outbreak, after coming into contact with a patient who tested positive.
Most recently, the clinic has begun contact tracing, which adds the task of calling positive cases, checking on who they’ve been in contact with and carefully tracking any symptoms among those people.
With the novel nature of the virus and the constant flux in guidelines and understanding of its behavior, learn-as-you-go adaptations have become the norm, McAuley said.
“So much of this is out of our control,” McAuley said of health care workers. “We are building the plane as we’re flying it … Every day we’re updating and modifying things to improve them. ”
The big picture
With so many changes unfolding in a relatively short time, the last six weeks have been a blur. Work has been both an all-consuming diversion and an affirmation, McAuley said.
“I would say most of my life and thoughts right now revolve around work,” she said.
She lives alone, so hasn’t had to worry about infecting family or any housemates. While she’s been doing her best to keep up connections digitally and to spend time outdoors, she deeply misses hanging out with her friends. Her dog Wavey has been her savior.
At work, she said, the hardest part has been not having concrete answers for her patients.
“I struggle with that piece,” McAuley said. “The thing that I’m used to being able to give to my patients, at least to some extent, is answers, knowledge, indication, treatment and reassurance, and I feel like I can only minimally give any of that stuff. People want to know when this is going to be over … People are very anxious, they are scared and I wish I had some answer for them or some solution,” she said.
“I try to remind my patients — and myself actually — that this is not going to last forever, things will go back to some version of normal,” she said.
McAuley, who comes from a long line of physicians, thinks of her grandfather, who was the only doctor in the tiny town of Choteau, Montana.
“I feel like I’ve been channeling him a little bit,” she said, considering “what it would be like to have very limited resources and a lot of responsibility.”
And while she could never have imagined starting her career in a historic global health crisis, she says she can’t imagine herself anywhere else.
“I wouldn’t choose to do anything else,” she said. “I think it’s no accident I ended up here and at this time.”