Kevin Pehr, DDE ’02
I’m a doctor (Dermatologist) in both private practice and in academia (McGill University), living in Montreal, Quebec, Canada. Although the city and province are largely locked down, I’m keeping my office open. Right now, I’m only seeing urgent patients in person: lymphoma, solid cancers, rapidly-progressing infections, and auto-immune diseases, and working others by phone or secure video-conferencing soon. Tele-dermatology is really 2nd rate compared to in-person, but 2nd rate is better than “no rate.” I have started working in a COVID-19-positive community clinic, set up by my hospital to work general medicine, not Dermatology. My Army background has trained me to be adaptable! I’m also starting some research projects about the effects of COVID-19 on the skin, on the psyche, and other aspects not generally considered. My hospital is a major university teaching hospital, but the clinic is not at the hospital, it is set up in the community. Here are my thoughts from my first day in the COVID ‘hot’ clinic:
People keep comparing the pandemic to a war, which it isn’t, but there are similarities. Wednesday was my first shift on “the front lines,” the COVID “hot” or COVID “red” clinic (they seem to alternate which is the official term). Like much war experience, it was far from as dramatic as it sounds, but also like much – well some like — war experience, it was needful. It really did make me feel like I was back in my Army days, because it was set up in a parking lot… in tents. Yes, really, tents. Not the big camo monsters I’m used to, just small, white tents, maybe 10’ (3 m) on a side, but undeniably tents. We had protective gear, which is to say: masks, face shields, gowns, gloves, and lots of sanitizer. It’s cumbersome to work like that, but wasn’t anywhere near as bad as working in MOPP (i.e. NBC or Nuclear-Biological-Chemical protective mask & suit), but the idea was the same: don’t contaminate yourself! Medical people aren’t especially good or bad at MOPP, but at least already have the training and understand the concept behind MOPP gear/not contaminating oneself. There are supposed to be one or more hot clinics in each area. We’re seeing patients by appointments on rapid referral. They’ve already been screened by telephone, either by their Family Doctor or a Public Health Nurse. If it is determined that they just need covid testing, it is literally drive-through, which is the other half of what our set-up is doing. If it is determined that they actually need to see a doctor, then they see one of us. Prescriptions are faxed directly to their pharmacy, a system that works great if their pharmacy is in our system, and cumbersome for the few that aren’t. Two doctors, 2-3 nurses, and a clerk staff each 6-hour shift. The ones I worked with seemed good. The major downside was that the “waiting room” was simply chairs in the parking lot (set the requisite 6’ / 2 m apart). It was fine when the weather was decent (although we did still have, and toward evening need, heat lamps in our tents), but not when it was raining, then snowing. I wanted everything I was wearing to be washable, not to mention warm, so I didn’t wear my usual “uniform” of dress pants, dress shirt, tie, and lab coat. I also didn’t wear my old Army camouflage uniform (any of the half-dozen or so different patterns I’ve saved over the years); I did, however, wear my Army-issue multi-layer extreme cold weather long underwear, with jeans and a casual shirt, covered by the surgical gown. When I got home, I took off everything in the extension (which doubles as the laundry room) and put it straight into the washer on hot. Then I went to the shower we’d installed in the basement when we’d renovated, which we had never actually ended up using for anything before this. The hot clinic is still ramping up, and will grow exponentially in the next several weeks. All this is being set up on the fly, the entire pandemic response is being ad libbed, but I’m overall impressed with how well the province is handling it (health care is primarily a provincial responsibility). I think everyone here is impressed. It isn’t perfect, or seamless, or even smooth, but they jumped on it pretty quickly, are working on it constantly, improving as they go along. I’m pleased and proud to be doing my small part of it.
COL (Ret) Kevin Pehr, MD
Distance Class of 2002
Jewish General Hospital
Senior Investigator, Lady Davis Institute for Medical Research
Associate Professor Dermatology McGill University
Chief Multidisciplinary Cutaneous Lymphoma Clinic
Montréal (Québec), Canada
