Small Changes Big Impact
Small Changes Big Impact
Faces fighting COVID with Dr. Gray Moonen
This week, we have Dr. Gray Moonen, a resident physician at Toronto Western Family Health Team in the Department of Family Community Medicine at the University of Toronto. He discusses how he started the social media campaign #FacesFightingCOVID and his experience as a resident during the pandemic.
Recorded April 20.
Small Changes, Big Impact: a DFCM podcast. I'm your host, Dr. Jeremy Rezmovitz. Welcome to Small Changes, Big Impact. In studio today, we have Dr. Gray Moonen, a resident physician at Toronto Western Family Health Team in the Department of Family and Community Medicine at the University of Toronto. Welcome.
Dr. Moonen:Thanks for having me.
Dr. Rezmovitz:No problem. So I think it's great. Let's just get off on the right foot here and tell everyone that as a resident physician- I think it's great, what you're doing with the- what is it? The faces- I can't remember the name of it now. I've been looking at it the whole day. I've just been reading the stories. I can't even remember.
Dr. Moonen:It's- the hashtag initially started as faces fighting COVID.
Dr. Rezmovitz:That's what it is. Faces fighting COVID. And what has it morphed into?
Dr. Moonen:It is- well, that's how- those are the tweets that I had initially sent out and that's how I kind of just themed them. And then the CBC had gotten in contact and then they ran a story on it and they're doing their own series now called Frontline Heroes. And yeah, so they they've done that. I'm still doing kind of my own tweets about showcasing folks in the hospital, both obviously directly and indirectly related to patient care, but the CBC has kind of done their own spinoff where they're doing Frontline Heroes, that's the branding and they showcase a new person every day, which has been really cool.
Dr. Rezmovitz:So tell me the origin story of this. How did you get started with something like this?
Dr. Moonen:That's a great question. I mean, I've always been just a very curious extroverted person and being in the hospital in this period of time where everyone's kind of wearing a mask and the people that I had initially talked to- be it the barista or the janitorial staff pre-pandemic- it just seems so isolating and different. So I just- I kept up chatting with people and probably as a way to connect with people myself deep down. And then, I was hearing these very like interesting responses from people and how they're internalizing things and how their job has changed and some of their stresses and their worries about what was going on. And I was like,"huh." It kind of dawned on me like the doctors and the nurses are getting, they're very, very, very due credit, right? Like the media has galvanized behind them, I think entirely rightfully so. Like we're utilizing our skills to the maximum of their ability and it takes a lot of courage and I don't want to downplay that at all, and that's as someone being kind of on the front lines myself, but I just wasn't hearing a lot of the recognition for these other folks that were in the hospitals, were working hard as well, and hadn't really signed up for this. Like we, as doctors, we signed up for this sort of thing. We- in some ways, we had signed up for providing care and putting ourselves at a certain level of risk. But a lot of these other folks, they weren't- the barista and the person working at the pharmacy didn't really sign up for that. And I just- I thought it was a bit of a blind spot that could use some recognition. So I just started talking to people and then it just emerged in my head to showcase them on my only way of showcasing them, which was Twitter.
Dr. Rezmovitz:Great.
Dr. Moonen:Yeah.
Dr. Rezmovitz:Illuminating the infrastructure that holds up the health care system, I think is very important. I think too often we forget about the couriers that pick up specimens after hours. We forget about the baristas. I had an idea that I wanted to propose to the Ministry of Health and Longterm Care. It was called the coffee care program- instead of PharmaCare, it's coffee care because our system is run on coffee and caffeine. And that all coffee or caffeine products, tea- I mean, the problem is as soon as I said coffee care, someone's like,"I only drink tea." Okay. So it's just- it's in its first stages. So maybe it's caffeine care because really that's how you run an 18 hour to 24 hour shift. You use caffeine, you use stimulants and it is tiring.
Dr. Moonen:Yeah. It's Q four hours for me every- you know, I need something that has caffeine in it.
Dr. Rezmovitz:Yeah. I've got a transdermal patch right now. That's[inaudible]-
Dr. Moonen:Send that over.
Dr. Rezmovitz:Yeah. Well, the IV was difficult to carry around in the car. The pole was just way too big. And so we've gone transdermal[ inaudible] you could actually just- there's a takeaway cup. Like you can have a mobile mug if you will. I'll look into that.
Dr. Moonen:Awesome.
Dr. Rezmovitz:Yeah. So what's happened out of all of this? So you made these little small clips of people. And so how often are you doing this?
Dr. Moonen:So I mean, I was just taking photos of people in the hospital and then taking notes, really- just getting the essence of what they were saying. I wasn't recording anything. And it was just like these little edges of time I would have in the hospital when I was waiting in line for a coffee or something, or- like, it wasn't like going and seeking people out in any way. But I mean, I had a bunch of these kind of on my phone as- just in a backlog of them, if you will. And then it dawned on me, like after I had done this to like, maybe I'll post some of these. So I was posting one every like couple of days or one every day or every few days, just with all these people that I had seen in the hospital. And it was a really interesting process actually, because as someone that works in the hospital, like both of us, we have a general sense of all these people that work in the hospital, but there were so many more than I had even an insight into. Like I took about probably like 10 photos. And then, what was really interesting about the processes I started thinking about,"well, who else is in the hospital? Who am I missing here? What are my blind spots?" And I was like, phlebotomy, like lab technology, porter, Uber Eats driver that like is delivering us food in the middle of the night. There are so, so, so many. So I just started posting a few of these and then other people have reached out and say, what about speech and language pathology? They're there. And respiratory therapy, like, what's up with that? Dieticians? And I'm like,"Oh my God." Like, there are quite literally dozens and dozens and dozens of jobs. Like the construction worker, the IT person- like I could go on. So I was posting a few of these intermittently and then obviously it picked up a little bit of steam and then that's when the CBC had gotten in contact and we did that. And then it really kind of exploded from there. And they've- like I said, they've run with their own stories, which has been amazing. They featured so many really like amazing family physicians and specialists and other frontline workers- both medical and nonmedical. So it's been really cool to see.
Dr. Rezmovitz:So you should be honored as a frontline worker, as a resident, because there are a ton of residents that are being redeployed and doing things that they're not used to doing.
Dr. Moonen:Yeah. I mean, I've been on obstetrics and gynecology, so I've been doing family medicine as well. And I put my hand up a little bit early to be redeployed to internal medicine or emerge but they were like- I'm on obstetrics and there are COVID positive moms and babies, unfortunately. Most of them are doing quite well, but that is deemed an essential service still. So my program was like,"you know what? You stick to obstetrics and gynecology because that's still- like women are still having lots of babies."
Dr. Rezmovitz:Are they?
Dr. Moonen:Oh yeah. Yeah. So, I mean, it's as busy as ever on the labor floor. And I've been doing a lot there, so it's been, it's been really great. And it's one of the only areas of medicine t hat still has a lot of joy to be honest. Like the a nxiety i s high, but when that baby gets delivered, it is still like very, very special and unique. So-
Dr. Rezmovitz:It's a magical moment.
Dr. Moonen:It really is. I got to say.
Dr. Rezmovitz:So we had some questions from viewers. And so we're going to do ask the doctor segment. One: if the mom has COVID-19, does it automatically mean that the baby has COVID-19?
Dr. Moonen:I am no expert in any of this. I'm going to have to defer to the specialists at Mount Sinai that I'm working with that have all been absolutely incredible. Although I do have a Zoom call with Dr. Whittle who's like the boss of all the Mount Sinai obstetricians, where we do a COVID update about how to care for everyone and what the current data is. And they've been really good. They've been sending updates like every day with,"okay, here's the update on the literature. Here's how we're changing our practice. Here's how we're doing PPE." So they've been on the ball, which has been really nice.
Dr. Rezmovitz:Well, have there been any- talk to me some stories from the front line, have there been any moms that have had COVID-19 where they've had to isolate the babies?
Dr. Moonen:Yeah. Yeah. So there's been evolving guidelines about like, should we do skin to skin? Should we not do skin to skin? Is the risk from mom to baby transplacental during the actual pregnancy? Or is it during the delivery process? Is it due to- I mean, if you do a C-section, are you going to be as likely to get it? We just don't have the answers to that right now, from what I can tell and as my latest non-expert read of the literature, but I can say that the general level of anxiety on the floor from these healthy folks that are in the hospital is quite high. And what is unfortunate about the situation is that- I think they're moving towards this now, but friends of mine that have just had had babies in Hamilton, the spouse, male or female, can't be at the delivery anymore. They can't even be in the room, mom and dad and grandma and grandpa and brothers and sisters are not able to come and celebrate that. So trying to counsel patients through that and that challenge adds a little bit more complexity, bu we're doing everything we can, and it's justifiably like not a great situation for people having babies right now.
Dr. Rezmovitz:Listen, isolation is hard for everybody. That's why they use it as a torture technique, right? I can tell you two certainties, I guess. One: skin to skin, as you mentioned before, is probably how most of the patients ended up on the floor anyways delivering babies.
Dr. Moonen:Exactly.
Dr. Rezmovitz:Right? So I mean, it's like from dust to dust and skin to skin, to skin to skin, so most people end on the delivery floor. The second certainty that I can give you is that in about nine months, I don't expect there would be a boom- a Corona boom, at all. And I'll tell you, this is just anecdotally, but as somebody with four kids, there is no way we're adding more kids to this. There is no way- only people without kids are going to have kids. But there's no way people with kids want more kids right now. It's enough. Anyway.
Dr. Moonen:There will be a surge in firstborn children.
Dr. Rezmovitz:I think there'll be a surge in first born children. Yeah.
Dr. Moonen:[inaudible].
Dr. Rezmovitz:Yeah. Let's flatten the kids, forget the curve. So, yeah. So you're still doing what you're doing as a resident. Do you know- has it impacted- are you a first year or a second year resident? I should ask.
Dr. Moonen:First year.
Dr. Rezmovitz:First year resident. So I guess assuming that everything's going back to normal next week- which probably isn't- does it impact- have you spoken to any of the second year residents about this impacting their graduation, their testing, their career?
Dr. Moonen:Yeah, they're- from my knowledge of it and speaking to a few residents, they're definitely in a bit of a- they're a bit more stressed out because I think the CCFP exam, I know they've canceled the SOO, so like the oral component, but they're still going forward with the written component, but they've delayed it from last time I checked. And there's a lot of just questions about, do we need a provisional license? What sort of provisional license is there? Do I need a supervisor? Who do I actually put as my supervisor? I'm doing a third year? And enhance skill year? Is it my supervisor from Toronto Western? Is it my supervisor in London, Ontario? Like no one really has a lot of clear answers for that. All the clear answers are, I think, emerging right now as everyone's kind of coming together and wrapping their heads around this. But the last time I checked, yeah, they're definitely like a bit more stressed out because some people have job offers on July 1st. That's like- and they're going to enhanced skill years and it's like, what happens? I'm not sure.
Dr. Rezmovitz:[inaudible].
Dr. Moonen:I know as a first year, a lot of people that are interested in the enhanced skill years, there's been some discussion about moving things back a little bit as well. And there's conversations about how to apply for those years for the people that are interested as well. So, I mean, I think like we're all in this milleu of who knows what's going on and that uncertainty, I think causes a lot of anxiety in residents and staff and everyone. Like, we don't have the level of responsibility staff physicians have, but we're also like required to still do lots of stuff before we graduate and develop the skills we need to graduate. So I think there's rightfully a lot of anxiety in the program. And that's across residents- I mean, that's people that I've spoken to in OBGYN and internal medicine and surgery and all that. But I think that there's like a lot of really, really good opportunities for us as well to really hone our skills. Maybe not as directly like here's the EPA and here's the actual competencies you have to check, but yeah.
Dr. Rezmovitz:EPAs- I assume entrusted-
Dr. Moonen:Entrustable professional activities. That's mostly for like the Royal College stuff, but in family medicine, we have our 99 topics. We have our things on Quercus that we need to like be seeing this many patients in this broad age range and with these chronic and acute conditions. Potentially we're not getting all of that, but I think the leadership and the communication aspect and the advocacy piece, and-
Dr. Rezmovitz:Can you check this off? Like being on a podcast on Quercus? Is there a checkmark for-
Dr. Moonen:I think somebody needs to evaluate it. So if you want to send me- I'll send you like an evaluation and if you send me it back, I think then that that'll be okay.
Dr. Rezmovitz:We'll let the public evaluated by the number of likes and downloads that it has. Okay?
Dr. Moonen:Okay. Sure.
Dr. Rezmovitz:We'll feed that back to you.
Dr. Moonen:Okay. Sounds good.
Dr. Rezmovitz:Anything less than 10,000 and I guess it's a fail.
Dr. Moonen:Yeah, yeah. It's just pass fail, but once we get to that threshold, then we're gonna pass. Okay.
Dr. Rezmovitz:2000? Pass. For anybody listening, please retweet this for Gray to pass residency. He needs 10,000 likes and or retweets.
Dr. Moonen:My future is depending on it.
Dr. Rezmovitz:And that's fine. Yeah. We'll use that as the opening bid. My future is depending on it. Yeah. So what story- just to go back to the stories that you're doing- what story sticks out in your mind the most right now? And did you do anything with these afterwards? Have you recognized that you've got these unsung heroes, these faces- frontline faces fighting COVID- have you done anything with that information other than posting it on Twitter? Have you gone back to, to support these people?
Dr. Moonen:That's a really good question. I mean, I could think of a lot of them right off the top of my head. I mean, some of them are like, for example, Denise, she was like just full of energy, full of positivity, full of joy. And that was early on. Like, that was one of the first ones that did, that was probably like mid March. When there was- there's a lot of uncertainty, but there was also room for positivity because- hey, who knows how bad this is going to be, right? So that was really nice at the time, and that gave me a lot of like inspiration and energy from that. But, you know, and then there's some that are a little bit more like, well- for example, one of the nursing leads Catarina was saying that like,"I can't see my family right now that kind of sucks." You know, like some people would highlight those things. And some were like more funny, like the administrative clerk was like, this was right when we started making masks for- making everyone wear a mask in the hospital. She's like,"I don't- I'm an admin. I don't wear a mask. Like I'm fiddling with it all day. I'm probably making myself higher risk," right? So there were these funny little like- there was a range from really astute like- here's my role in this and here's where I'm playing and here's how I'm thinking about it, which I had not thought about, which was kind of like the entire purpose of this. But then there were like really funny things and I'm like,"Oh my God, like, that's such a practical, hilarious thing that like, we're all suffering through" or something I didn't think about to be positive and uplifting, right? So what I've done to independently go and support these people, I think I've focused on the campaign I think has done a lot, right? And I've read more- I don't want to take credit for this. Like I personally, to be honest, I'm uncomfortable with anyone referring me to a hero in any of this sort of thing because I'm really not. Like genuinely do not feel that way at all. I am showcasing and getting the ball rolling for these unsung heroes, but I don't see myself as doing anything special. Like I'm doing my job, I'm doing any- I'm doing my job. I'm doing my work. That's all. It's not like this big thing. But I think that the campaign and the recognition that other people have been supportive of- so the CBC, and then all the hundreds and hundreds of people that are sending in submissions that has raised a little bit of awareness towards the stuff. And I'm reading articles in like The Globe and reading articles in The Times and Washington Post about like our grocery store clerks are like frontline workers and they don't get paid to do anything. And oh, by the way, like a lot of these people are from marginalized populations and huh, maybe they don't get paid enough. And when are we going to start valuing these people? Like should they get paid more? Should they have sick benefits? Should they have some form of job security? Some form of unionization? Like all of that stuff. I think I'm actually like more hopeful now that there will be positive change for these low wage, minimum wage workers that are seen as totally disposable, but in a period where there's a pandemic and everyone's at home, who's outside working, right? And I think that that needs to be valued a little bit more. So, I mean, I'm seeing a lot of stuff happening there and I'm going to try to find ways of supporting more directly, I think, as this evolves. I don't know what it's going to look like yet though. I mean, I think it's going to have a lot to do with like political influence and that sort of stuff, but I've just kind of[inaudible].
Dr. Rezmovitz:I think you're raising points that are consistently described as the social determinants of health. And you know what? I've been in academia for eight years now and I can tell you I've met residents that don't really come face to face with the social determinants of health and realize how important it is- what your economic status is- financial status, what your race is, the- I can't think of the term right now- the structured racism that exists- it's around us and what you're talking about is values. And I think it's this virus, as much as it has disrupted the way we live, it has exposed vulnerabilities. It has exposed inequities. It is exposed system frustrations that we need to change. And, you know, it would be really positive if a lot of change could come to what we refer to as marginalized populations based on social determinants of health. If we could really make change and make strives towards improving the lives of Canadians. So as much as you say that you're not a hero- why don't we just call you the canary in the mineshaft? The canary in the- I can't think of the word right now.
Dr. Moonen:Oh canary in the coal mine.
Dr. Rezmovitz:Coal mine, that's it? Yeah. The canary in the coal mine- as you raised awareness and raising awareness is an important job and you did that and it's brought a lot of light and attention, right? You've illuminated these figures that are otherwise left in the dark. And so for that, we want to congratulate you.
Dr. Moonen:Okay. Well, thanks. I do appreciate that. And I mean, I just- I didn't see it as this like heroic thing and when they were going to term them frontline heroes and I'm like, well, I don't- like I have conversations. I'm not really that comfortable with that. Like you can call it whatever you want, but I'm just literally like doing this small thing and recognizing these other people. So let's like divert as much attention to those people as possible. And I couldn't agree more about the social determinants of health. I mean it's really interesting. I wrote an opinion piece for Stat News, about this sort of these photos and this feature. And it was interesting that I had looked through all of the photos and I was like, huh, wow. These are literally almost all minorities- like visible minorities. And I started thinking a lot about that. And that was when the literature started emerging about like in the United States, like African Americans are like disproportionately affected by this. And you heard some stuff at the very beginning of this- like all of this is the great equalizer. Everyone's equally affected by this. And I'm like,"no, not at all." It's actually gonna like completely underline and bold and italicize all of our marginalized people, right? In Canada, we're talking like the Indigenous population, we're talking people in longterm care that have been- as we've seen- grossly neglected over the course of the last however long, people in institutions, people that are vulnerably housed, like these people are going to be absolutely disproportionately affected by this. So I think it's a bit of a falsehood to say that it is the great equalizer and the drivers of the people- like the drivers behind who is going to disproportionately suffer are exactly what you've said. The social determinants of health: it's race, it's culture, it's institutionalized racism. It's vulnerable housing, it's food deserts, it's-you name it? I mean, there's a list just like a lot longer. And you know, I've been reading about faculty that y ou featured on this podcast- t his awesome podcast- Naheed Dosani, Dr. Boozary, Tara Kiran and I'm reading it- Jane Philpott- like all these people are thinking really hard about this- and Dr. Gary Bloch- I've never met him, but all these people in the Faculty of Medicine at U of T, which is why it's so awesome to be here are like- they've been doing this for like a long time. Like t hey've b een advocating for this sort of stuff for decades. And I don't know, I think it's like, maybe it's their time to shine. And these are the sort of people that we could elevate to be these leaders and give them more playtime and s ort o f stuff on the news, as opposed to like the Dr. Oz people. I'm hopeful that we're g oing t o make some changes.
Dr. Rezmovitz:So just so I'm clear- the biggest change that you'd like to see is Dr. Oz lose some media time.
Dr. Moonen:I'll take that. Yeah. That's the one.[inaudible] that one to the bank right now. Dr. Oz, Dr. Phil, Dr. whoever that's on TV that doesn't know what they're talking about- if it's not Dr. Bogoch on[inaudible]
Dr. Rezmovitz:Isaac's a good friend? So yeah, he's been doing a great job. So listen. Any other advice for residents other than, of course, listening to this podcast? Do you have any advice for residents going forward and plans for future, projects that you want to collaborate on?
Dr. Moonen:Great question. I mean, I'm not some elected resident leader. I'll speak on behalf of myself and at least the conversation that I've had with some residents, but advice I'm kind of taking to myself is accept the situation as it's happening, don't worry about the things you can't control, and focus on a lot of the silver linings in this- like it's a stressful environment, we're all stressed, but there are a lot, a lot, I think, of opportunities to enhance our skills, both as medical experts, as leaders, as collaborators, as communicators- literally across the spectrum and we joked around about it, but I think that there are equal opportunities to provide value to our patients and to provide learning opportunities. So, I personally, I try to focus on that sort of stuff, and that helps me personally. So- and just like reaching out to people I think is huge. And I've been lucky at the Western and at the UHN- the leadership has been amazing. Like I get to benefit from having amazing preceptors and Dr. Lemieux as our Chief of Staff at the Western and Dr. Kevin Smith, who's like the CEO of the UHN- like there've been clear communication, amazing advocacy efforts, and we really feel like they have our backs at the Western. So I've been really lucky. So I can just speak to my own experience there. And just give yourself a break. I mean, it's not the time to be the best version of you at all times and settle these goals. It's not realistic, you know? So if we have a day off, it's okay. We don't need to feel guilty about that, you know?
Dr. Rezmovitz:Yeah. But I think we can all still be the best version of ourselves, but it's about the context. So best version of ourselves given this context, because as you alluded to before, although we're not all in the same boat, I think we safely say that we all are in the same storm.
Dr. Moonen:Yes.
Dr. Rezmovitz:Right? We all are in the same storm. And we all are trying to be in this together, but the boats are different and some are bigger and some are smaller. Some have holes in them. Some people don't even have boats. And we need to remember that there are varying sized boats in the storm and that we will weather and we will get through, but it does take leadership to get us through this. And so I want to thank you again for your leadership and raising a voice to the unsung heroes of this pandemic. Thank you.
Dr. Moonen:I appreciate it. And I love that analogy. And I might steal it.
Dr. Rezmovitz:No, you can steal it. Listen, here's the key: steal shamelessly and cite liberally.
Dr. Moonen:Okay.
Dr. Rezmovitz:Okay?
Dr. Moonen:I'll take that.
Dr. Rezmovitz:Now. They're using the same strategy, I believe for testing of COVID-19.
Dr. Moonen:Seriously.
Dr. Rezmovitz:Yeah. But they're just saying swab liberally.
Dr. Moonen:Perfect.
Dr. Rezmovitz:Not cite liberally.
Dr. Moonen:Get those numbers up.
Dr. Rezmovitz:Yeah. All right. So listen, be well. And I'm looking forward to seeing you in the news again, sometime soon.
Dr. Moonen:I doubt it, but thank you. I appreciate it.
Dr. Rezmovitz:No problem.
Dr. Moonen:Thanks a lot.
Dr. Rezmovitz:This podcast was made possible through the support of the Department of Family and Community Medicine at the University of Toronto. Special thanks to Allison Mullin, Brian Da Silva, and the whole podcast committee. Thanks for tuning in. See you next time.