A veteran nurse heads our pandemic response: 'It gives me peace to know that we've put everything into place'
By Louise Kinross
Cara Sudoma is a registered nurse who came to Holland Bloorview over 35 years ago, when it was known as the Ontario Crippled Children’s Centre. She’s worked as a frontline nurse with our inpatients and day patients, and 20 years ago moved into infection control. Cara has been instrumental in preparing the hospital for the coronavirus pandemic, and putting practices into place to protect children, families and staff.
BLOOM: How did you get into this field?
Cara Sudoma: I wanted to be a pediatrician. As the oldest of my siblings and with 28 cousins, I was always around kids, taking care of them and babysitting. I love children, and if someone wasn’t feeling well, I wanted to make them feel better.
In high school, I didn’t know if I had what it takes to go to university, so I did an aptitude test. The test came back saying I wouldn’t be good in university, but should do more of a clerical or secretarial role. I hated that idea. So I thought maybe the next best thing to being a pediatrician would be nursing, and working in pediatrics.
BLOOM: What was your first role here?
Cara Sudoma: I did some nursing training here, and then I worked casual for four years, and my home unit was the adolescent unit. I worked mostly nights, and I really enjoyed the team I worked with. We had a great camaraderie. We had international nights, and when the kids were asleep, we had tricycle races down the hallways at the old Hugh MacMillan building.
BLOOM: You worked with teens. What did you enjoy most about that?
Cara Sudoma: The kids—they’re so resilient. Many had motor-vehicle injuries, and even though they’d been through trauma, they were able to overcome some of the obstacles. I’ve had a lot of adversity in my life, a lot of family illness, and the kids really helped me grow as a person.
They showed me that if they could overcome some of their obstacles, then so could I. As a bedside nurse, I wanted to make sure they were comfortable and cared for. Being on nights, I didn’t interact a lot with the families. But after we merged and I worked day shifts, I wanted to make sure families had everything they needed. I like to teach, so I wanted to help parents with any learning they needed to transition to going home.
BLOOM: How did you get into infection control?
Cara Sudoma: At the time, I was a team leader on a day-time shift. I was teaching my son to skate and I fell and broke my wrist. While I was off at home I was going stir crazy, and I asked if there was anything different I could do. Sandi Cox said I could do surveillance for infection control. I had no idea what that was, but I thought if it can get me out of the house, sure!
It involved looking through lab tests and trying to figure out whether these were infections, and tracking whether we had a number of kids in a particular area that were coming back with the same bug. I had no experience in infection control. These bacteria had big names that looked like the name of a dinosaur—out of this world. I didn’t initially have a good grasp of it. But I had a love of detective work. The novels I read were ‘whodunnits’ by John Grisham and Agatha Christie. When I was young, I loved Nancy Drew. I could see that infection control was like solving a mystery.
I went to take a two-week intensive course on the basics of infection control at Centennial College, and I came out of there going ‘We need to do this, this and this,’ and ‘We’re not doing this, this, and this.’ Sandi Cox said ‘Calm down, let’s focus on what we can do. Right now that’s hand-washing and education and putting policies in place.’
BLOOM: What are some other areas of infection control?
Cara Sudoma: I do construction audits. Many people don’t realize that you can get hospital-acquired infections through the mold and spores kicked up by construction. For children who have respiratory issues, that could be a real problem.
If we have construction or do renovations, we need to make sure that bacteria don’t go through our ventilation system. If the plumbing is shut down for a period of time, bacteria can be produced in the plumbing lines, so we have to make sure they’re flushed. To protect the workers in these areas, we would use HEPA filters and have them wear respirators.
BLOOM: What does a typical day look like for you during the pandemic?
Cara Sudoma: We go to the units and speak to the clinical resource leaders or team leaders to make sure kids aren’t experiencing respiratory symptoms. We also look at orders, to see if any have been written for tests for respiratory viruses. Mostly, we’re involved in meetings, whether it’s a pandemic huddle, or a meeting with senior management. At the beginning, there were three meetings a day.
Then it’s setting up all of the things we need to do, informing staff about updates, and reporting to the health ministry on various things. We need to collect and input data on whether we have any COVID-19 cases or swabs pending, what our census is, how many personal protective equipment (PPE) supplies we have and the types we’re using, how many staff are fit-tested for masks, and how many beds we have available.
BLOOM: Are you inputting all of that?
Cara Sudoma: Yes. We also need to act on all of the ministry directives and guidelines and implement them for the organization.
BLOOM: Has your role changed during the pandemic?
Cara Sudoma: Not really, I’m doing what I’ve been trained to do. It’s a busier time, and a scary time. I’m trying to manage my emotions and remain calm, so that people have a level of confidence in what we’re doing. And I’m trying to help everyone else to remain calm.
We know this stuff. We’ve put kids in isolation before, and we have the policies and procedures in place. It’s a new bug that we’re not familiar with, and that’s the scary part. We don’t know how it acts or reacts. There’s a level of fear, or concern, and it’s totally warranted.
If we remember what we’ve been taught and what I teach—hand-washing, how to don and doff PPE, and our isolation practices and how we manage those clients—thankfully we don’t have any cases—we will be okay. COVID-19 doesn’t seem to be as prevalent, or severe, in children.
The concern is for long-term care homes and other congregate settings. Their infection control practices are minimal, and they’re not designed like a hospital.
BLOOM: That would include a home like Markham’s Participation House, for adults with disabilities, where they had a terrible outbreak.
Cara Sudoma: Yes. My heart went out to them. I went to Julia and asked if there was something we could do. We were able to send them some PPE. And we also sent Safe Haven some PPE, just today. We were in a good situation where we could donate some, and still have enough.
Part of our pandemic plan is to stockpile things we might need that would be difficult to get during a pandemic. We stockpile gloves, gowns, 95 respirators, masks, sanitizers and some respiratory equipment.
When our supplies are close to expiring, we start to use them up. Sometimes things expire before we can use them, and we have to get rid of them. Or sometimes products change and we need to replace our stockpile with new items.
BLOOM: What’s the greatest challenge of your job?
Cara Sudoma: It’s time. Not having enough time to do the things that I would really like to do. I’d like to get out of my office more, and spend more time with the staff going over things. Thankfully, it’s not just me—I have a great team in Caroline Ivorra, Viktoria Dashevsky and Barb Bowman.
I want to make sure staff and families get their questions answered, and I want to talk with the kids, to try to alleviate their concerns. But because I’m in meetings, or having to read directives or answer e-mails, I’m stuck in my office. That’s my biggest challenge now. Dealing with those things that need to be dealt with, but I’d rather be out on the units ‘doing.’
BLOOM: What are the joys of the job?
Cara Sudoma: Putting someone in isolation is never a fun thing. It’s restrictive, and I always feel like I’m the bearer of bad news. Test results come back and I go ‘ugh,’ or the patient has symptoms and we want to make sure they don’t pass them on. That’s never a good thing. But what I like is to be able to say: ‘The results have come back negative, so we can take you out.’ That makes me happy.
It’s the same with an outbreak. They’re never fun, and they’re always challenging. But when I can say ‘We’ve met our eight days without any cases, we can come out of outbreak,’ and the signs come down, and everyone sighs with relief and is so happy, that gives me peace. Our record of days without an outbreak is over 700. It gives me peace to know that we’ve put everything into place and are doing what we should be doing to keep the children safe.
BLOOM: How did we change the way we offer services to keep people safe during COVID-19?
Cara Sudoma: We’ve done a lot of things: screening, masking, enhanced cleaning, social distancing, hand washing, telling people to stay home when sick. We’ve also limited the number of people coming into the building.
We’re offering virtual appointments for our outpatient clinics, although we still have some clinics for urgent needs. A lot of our clinicians have had to learn how to do things in new ways. I heard about one who made a splint for a child by looking at their hand virtually. I want to know how that works.
In anticipation of our inpatient staff becoming sick, we’ve had some outpatient staff assisting on the units, to be ready in case we need them. Our inpatient and outpatient areas function a little differently, especially in charting, so we’ve done some refreshers. Allied health and nursing staff are being buddied up on the unit, and will also have some independent shifts. If, and when, they’re needed, they’ll be ready to step in.
BLOOM: Which changes has been most challenging for staff?
Cara Sudoma: I’m hearing a lot questions about how to do group therapy and maintain social distance, and sometimes that’s challenging. There may be group projects like baking, or a physiotherapy or cognitive group. Usually they have about eight to 10 clients. Maybe a room isn’t big enough for them to maintain physical distance, so they need to split it into two smaller groups. People are being creative.
I get asked every day how to maintain social distance when working with patients, because we have to be very close to patients. And I explain ‘That’s why we’re wearing masks, because we can’t maintain social distancing, and the masks protect them.’
Our Information Services department has been phenomenal getting people hooked up to work from home.
BLOOM: What’s been most challenging for inpatient families?
Cara Sudoma: A number of things. I really feel for the families not being able to go home on the weekend. Also, children are only allowed to have one visitor, and siblings are not able to visit. Outside of their room, parents have to wear a mask, and I understand they don’t like it.
For the most part, families have been very understanding, and they know the measures we’re taking are to keep their kids safe.
BLOOM: It seems like the aesthetics of masks haven’t evolved very much over the years. Especially in a children’s hospital, it would be nice if they were clear, so that children could see a clinician’s smile.
Cara Sudoma: We’re still exploring the possibility of clear masks. A couple of our staff are hearing-impaired. The problem is that the current clear mask wouldn’t give us enough protection, and would have to be worn with a face shield. But at the moment, face shields are in short supply. Also, the clear masks are made in the United States, which can be challenging because some of our supplies have been blocked at the border.
BLOOM: Was Holland Bloorview well prepared for the pandemic?
Cara Sudoma: We were reviewing our pandemic plan and going through our mask fit testing every two years. When the pandemic was declared, we’d already done some preemptive things like moving our stockpile here and making sure we had enough supplies.
So many teams in the hospital have contributed. Building services helped us to set up the plexiglass desks for screeners in a couple of days. That helps us conserve PPE.
Environmental services are doing a phenomenal job cleaning. Certain high-touch areas of the building, like bathrooms and doorknobs, are being cleaned much more often. It’s a lot of work, and without them doing that that, it could have been a different story here.
Our nursery schools and our school had to close and staff have offered to work as screeners. I’d also like to acknowledge the work of the Quality, Safety and Performance team, and Laura Oxenham-Murphy’s co-leadership on our pandemic committee.
It’s phenomenal how we’ve all pulled together as a family to do what needs to be done. It’s been a team effort, and that’s been instrumental in enabling us to keep functioning.
BLOOM: It sounds like some innovation has come out of the pandemic. For example, are we offering inpatient therapy seven days a week now?
Cara Sudoma: It’s five days of therapy over seven days, because they’re not going home on the weekend now. But for some kids who can tolerate it, they may get seven days. Having an accelerated therapy may help them go home sooner. The families were really onboard with this change because the kids aren’t bored on the weekend. They also have recreation programming, which is done with social distancing.
BLOOM: What emotions come with your job?
Cara Sudoma: I feel sad when I have to put someone in isolation as a precaution. I really feel for the family. I know it’s not fun to be stuck in a room. Also, therapy is different. Some can be done in the room, but you can’t do gym things like the treadmill or therapy bars, so that may cause a delay in going home. I feel happy when they come out.
Frustration sometimes. When you send a communication and you think you have it right, it’s clear, and then you get inundated with e-mails that show people have interpreted it differently. Or a communication has gone out and someone will ask the question that’s answered in the
e-mail. ‘I didn’t read it, just tell me,’ they’ll say. Sometimes I lose my patience.
This coronavirus is very different from SARS, which was a very hospital-focused outbreak. As long as you could keep it out of your hospital—which we did—you were good. Being out in the community during SARS wasn’t scary.
This coronavirus is in the community, so you need to be careful when you’re grocery shopping or getting gas. Even I get nervous, because I don’t know if the person has washed their hands. Also, people can have the virus, but not be showing symptoms.
There are a lot of emotions: fear and anxiety and all of the unknowns.
Another challenge is that because some of our people have lived through SARS, they think we should be doing the same things we did then. But the directives from the ministry are different for this virus.
BLOOM: What did we learn from SARS?
Cara Sudoma: I think we really learned from SARS and H1N1. We learned we needed to have a supply of PPE and a pandemic plan. When we moved to this building, we had to rejig the plan because the units and fire doors were set up differently. As an organization we were prepared in many aspects.
Where we fell as a country was that our stockpile wasn’t handled well. The pandemic supply expired, and was never refilled. We wouldn’t be in the situation we’re in now if that had been better managed.
We’ve also heard about the problem in long-term care with staff that work in multiple facilities. I’m hoping that when we do the pandemic debrief internationally, and as a country, it really sheds a light on this problem. Personal support workers need to be paid better, so that they don’t have to work multiple jobs. And long-term care homes and group homes need the infection control guidelines and education that we get in hospitals.
BLOOM: How do you manage your emotions?
Cara Sudoma: I pray. I have a strong faith, and I have a good support group at my church. I get people to pray for me. I often listen to Christian music on the radio when I drive in and as I go home. It gets me in a good frame of mind.
A bunch of us who work here get together on Zoom every Saturday and play virtual Yahtzee. We each have our own dice and a scorecard, and we take turns. There are four or five of us. Some of us will have a glass of wine. It’s a total distraction from the pandemic and infection control.
When the weather is nice, we go away for a weekend to a cottage, or go on art studio tours.
BLOOM: You mentioned you are doing a master’s in public health.
Cara Sudoma: I like to learn, and I’ve certainly learned a lot about parts of public health that I didn’t know about. I’m taking it online through the University of Waterloo. I have a goal of one day being a manager of infection control within Holland Bloorview, or having another manager role here. Or if I get tired of the commute from Whitby, I might find a job closer to home in public health, or manage infection control in another hospital. We’ll see. The education can open up so many doors.
