Margaret McBreairty is a woman with a plan.
Three times a month, she gathers her face mask, hand sanitizer, protective gloves and sanitizing spray and climbs into her car outside her home in Allagash. Then she drives just under 350 miles to South Portland, where she receives chemotherapy for her Stage 4 breast cancer at MaineHealth Cancer Care.
Three hours later, she drives halfway home to Bangor, where she pulls into the parking lot of a 24-hour gas station and convenience store and sleeps in her car for the night – she dares not tackle Route 11 after dark – before resuming her journey at sunup.
In any time, such grit would be laudable. But in a new era that revolves around the COVID-19 pandemic, McBreairty, 59, is nothing short of a role model.
“People are just not even using critical thinking skills anymore,” she said in a telephone interview from her home on Friday. “They have them. They’re just not utilizing them.”
She’s talking about people, like her, with serious, often-chronic health problems. But unlike her, they’re avoiding their diagnostic visits, regular checkups, ongoing treatments and other important trips to their health providers because they think they’ll catch COVID-19 simply by going where all the sick people go.
“It’s all about mitigation. You’ve got to have a mitigation plan and you’ve got to implement that plan,” McBreairty said. “And you’ve got to be adaptable.”
The numbers tell the story. In interviews last week with officials at MaineHealth and Maine Medical Center, the network’s flagship hospital in Portland, a good news, bad news trend emerged.
The good news is that the inpatient occupancy rates throughout the MaineHealth system, which fell to as low as 40 percent in the early days of the response to the pandemic, have gradually rebounded to the 60 percent range, according to Dr. Joan Boomsma, MaineHealth’s chief medical officer.
Some of that reflects the rescheduling of elective surgeries that were put off back when hospitals far and wide were postponing such procedures and ramping up capacity to deal with the pandemic.
But even as those beds slowly fill up again, another trend is emerging: For the month ending May 20, Maine Medical Center’s average length of stay was up 15 percent. Its “case mix index” – which reflects the complexity, diversity and resource demands of a hospital’s patient population – was up 6 percent. Yet its total patient days for the month were down 14 percent.
“Together, these paint a picture of how we have fewer patients, but they are sicker and staying longer,” said Maine Med President Jeff Sanders. While some COVID-19 patients require longer hospitalizations, he added, “most of the (length-of-stay and case-mix-index increases) are driven by delayed care.”
Meaning that when a cardiac patient finally shows up at the hospital after waiting too long to seek help, he or she is likely to be sicker. Ditto for those with diabetes and other chronic diseases that, left untreated, spell worse trouble.
The irony, according to Dr. August Valenti, Maine Medical Center’s epidemiologist, is that the hospital is far safer when it comes to COVID-19 exposure than other places pandemic-wary people might frequent.
“I tell people and I tell my family that I feel safer at the hospital right now than I do going to the grocery store,” Valenti said.
From constant cleaning to mandatory personal protective equipment protocols to total segregation of patients who have or might have COVID-19, Valenti said, Maine Medical Center is far from the high-risk petri dish many might assume it to be. The hospital has even implemented a new phone app through which all employees must answer a series of health questions before each shift – only when they clear that screening do they get an electronic pass to enter the facility.
The safeguards appear to be working.
“We’re very proud to say that we have no documented cases of any patient contracting COVID-19 in any of our facilities,” said Maine Health’s Boomsma.
Still, in times like these, reality doesn’t always parallel perception – particularly when it comes not just to hospitals, but to the doctors’ offices where many small problems are typically nipped in the bud before they become big problems.
“Interestingly, some of the reluctance we’ve seen has really been in the primary care office,” Boomsma said.
The point, for those trying to ignore that nagging chest pain or fearful of going ahead with their next cancer treatment, is that these things can be done safely. Just asked Margaret McBreairty, with her compromised immune system.
On her sojourns south – it being a seven- or eight-hour trip and all – McBrearity has to stop now and then for gas or to use a restroom.
Her standard operating procedure?
Before even getting out of the car, she first dons her face mask. Then, inside a restroom, she precedes her hand-washing by soaping down the faucet handles on the sink.
“And then, of course, once I leave the facility, the first thing I do is spray my hands and sanitize afterwards – even after I’ve done all those things – because I’ve touched the door handle. Then I spray the outside of my car, I spray the inside of my car, I take my mask off, I spray my mask inside and out.”
How about a gas fill-up?
“I’m blessed to have gloves,” she said. “And I spray the hell out of that pump. My credit card gets sprayed. I sanitize everything. Everything!”
McBreairty, like any of us, has no idea how long she’ll be around. She was first diagnosed while she was in the Air Force 14 years ago and her cancer returned in 2017.
But she has complete faith in her doctor in South Portland – hence the long drive – and can’t imagine holing up inside her home on the St. John River out of fear of contracting COVID-19 as she traverses almost the entire state three times a month.
Nor, if you’re having health troubles and live a lot closer to your doctor or hospital than she does, should you let fear of the pandemic rob you of a chance to get better or, at the very least, improve your quality of life.
“Being a cancer patient is not unique. I mean it’s really not,” McBreairty said. “Other people have illnesses that they too need to address. To neglect it, you might as well go out and get the virus.”