An Interview with Maria Weir, RN
by Carol Milano

For years, I remember hearing that something like SARS was bound to happen, as the world grows smaller through travel. To me, it was just inevitable," admits Maria Weir, RN. Nevertheless, "It's strange to see it unfolding before your eyes. I happen to be front and center right now."

She certainly is, as unit administrator of the severe acute respiratory syndrome (SARS) ward at North York General Hospital in Toronto, which opened on March 27. The staff knew about China's strange new health problem, but it was very far from their minds in Canada, until someone who'd recently visited the Far East came to the emergency room with symptoms that would soon become all too familiar.

Maria Weir, RN, is unit administrator of the SARS ward at North York General Hospital in Toronto, works 12-16 hours a day in the SARS unit.

"An alert was opened, we'd been briefed, and were in the midst of preparing for just-in-case. The Health Ministry was giving us directives," Weir recalls. Soon some people who had been in contact with the first patient began coming to North York, and the staff tried to ascertain whether they might have SARS.

Treating the cases as similar to tuberculosis, it was natural for Weir's respiration unit to be asked to look after the first patients. "We were already in protective mode, but needed to assess the patients and locate them to a floor in a controlled environment so we wouldn't have a spread of the problem. When healthcare workers don't know what we're dealing with, we go into very protective mode especially in respiratory isolation. We have normal protocols, and we followed them over and above," she explains.

Creating An Instant SARS Ward

Estimating how many cases might arrive, Weir's staff found a sparsely occupied floor, relocated its patients and cleared the entire area for up to 15 SARS sufferers "in one day Utilization coordinators, social workers, administrators, porters, and housekeepers all pulled together to get this done in the shortest possible time," Weir recounts. To prevent contamination, they removed all non-essential items, creating a minimalist unit, with "just the equipment we would need. That night, we admitted six patients. We put in 36 hours straight."

As soon as they'd filled the floor, the Ministry of Health ordered them to double their capacity. A larger unit, for 21 patients, opened a week later, which was fortunate because every bed was taken during the unexpected second outbreak

"My husband's very understanding. He knows I've had extremely long hours and wants to make sure I'm at least sleeping and eating good meals. I tell him, 'if you're still with me after this, it's really love,"' confides Weir.

that occurred in late May. Each patient has an isolation room, with no curtain or object that isn't deemed vital. Only hard surfaces, which can be easily wiped, are allowed. Inside and outside every room is a disposal system for gowns, garbage, etc. The unit entryway is a safe space for the staff between double sets of doors at the nursing station. "After the second set of doors, we start preparing: putting on double gown, double gloves. We're already wearing facemasks. Before entering the wing, we put on a yellow gown," says Weir. Patient's doors are firmly closed at all times. A knock on the door signals the patient to put on a mask so the nurse can enter.

Treating the Patients

When SARS patients first arrived at North York General Hospital, staff worked 36 hours straight in order to set up a SARS unit.

The nursing care is sensitive. "These patients are very tense, tired, frustrated, and upset, alone in their rooms with a disease no one knows anything about. You want to calm them, talk to them, answer questions," Weir observes. With 21 years of nursing experience, she anticipated oxygen saturation problems and temperatures as high as 104. Treatment includes antibiotics, hydrocortisone, Tylenol, and other temperature-reducing medications. Patients get either a phone or television set to provide connection to the outside world, and paperback books, newspapers, or magazines-anything disposable.

Rounds are hourly, or half-hourly for sicker patients. Weir tries to keep a ratio of one nurse to three patients, partly because of all the time required to undress, re-gown, wash hands, and change masks every single time a room is entered. She believes a rigid system is essential to prevent the spread of SARS. One of her nurses did become infected "because she relaxed her precautions and removed her mask." (She has recovered, as have many of the patients on the ward.)

Because they would have alarmed the public by going out in masks, the hospital let staff take taxis to and from work, "but we even had to wear our masks in the cab!" Weir exclaims.

When the second outbreak occurred, Weir's staff was in quarantine for two weeks. Her unit's population was up to 44 patients at the end of May

Professional and Personal Impact

Weir and her husband of 25 years, Roderick MacKinnon, an interior designer/space planner, have changed their lifestyle to vigilantly avoid contamination. "We're living separate lives, having as little contact as possible, and being careful. My husband's VERY understanding. He knows I've had extremely long hours, and wants to make sure I'm at least sleeping and eating good meals. I tell him, 'if you're still with me after this, it's really love,"' confides Weir, who works 12 to 16 hours a day--"whatever it takes. No one knows when the end is in sight."

As unit administrator of the designated area, she says, "I'd made up my mind that we had to do this. The problem was how to find the same commitment among the staff, and get them to come here when they had families. I always feel you lead by example," Weir reflects. "Nurses are in this profession for a reason; that came to the forefront. Someone had to look after these patients, so youanswer the call. I was surprised myself that the staff was so resilient. They came through, and they're still coming through, for these SARS patients." NWM

"These patients are very tense, tired, frustrated, and upset, alone in their rooms with a disease no one knows anything about. You want to calm them, talk to them, answer questions."