“Please put your car in park,” I say. Parque.” You don’t want to risk a foot slipping off the brake, when you are sticking a q-tip into someone’s nose.

That was Dr. M’s first lesson. Dr. M, who usually focused on feet, was tasked with setting up the testing tent in Spring, 2020, for the health center where I work. Providence needed a testing location in the neighborhood, so patients had the walk-through option. With his military background and experience with program implementation and measurement, the medical director identified him as the ideal person for the job.

By the time I joined him this December, he’d collected over a thousand tests. He’d managed the chill of Spring, 2020, and the scorching Summer. Now as winter approached, he was retiring from this task.

Many of you have already experienced the Covid test. Some might accuse testers of trying to tickle their brain, or shoving a roto-rooter up their nostril. The process is definitely fodder for the late night comedians.

The weekend before the testing tent opened, Dr. M built a wooden testing platform, a little bigger that a cutting board, to hold the specimen kit while the test is collected. This allowed the tester to work without an assistant. A small box keeps the plastic bag from blowing away. The requisition is tucked in the bag’s front pocket. Next to the box is a place for the cap, then a hole in the wood steadies the open test tube.

Putting on the PPE (Personal Protective Equipment) is the first challenge. PPE includes a gown, hairnet, face shield, and shoe covers as well as a special mask. The N95 mask is fitted to your face to keep out airborne particles. It requires a special fitting session. The fitter sprays sweetened air into a plastic head cover that sits on the fitee’s head like an astronaut’s helmet. You breathe, talk, read a poem, and bend over to make sure you can’t taste sweetness during any of the maneuvers. A second mask is layered over the N95 to keep it clean. Four pairs of gloves are needed: 2 that are never removed and 2 that are removed with each test. Dressed up for Halloween, maybe, but Covid has made PPE-garbed health care workers a common image on television.

I will spare you the testing procedure step, by step. Dr. M’s cellphone tuned to Spodify set an upbeat mood. A heater blowing at our feet kept our toes warm on the December day.

Collecting the test takes some skill, and eye-hand coordination. As gently as possible, I reach a flexible q-tip into the nose and push it to where the nose meets the throat—the orophyarynx. Eyes water, some people gag, others sneeze. Ideally, the patient holds still and doesn’t jerk their head, grab your hands, or squirm their body away. However, all reactions are to be expected. Four to six year olds are the hardest because they are too young to be trusted to hold still, and too big for parents to restrain. Sleeping infants are easy, but what a horrible way to wake up!

My most delightful patient was a 4-year-old who sat on her mother’s lap. I entice all children telling them this will tickle. “Giggle, giggle.” This little girl heard my suggestion and her chirp lightened the procedure for me and her mother.

On Dr. M’s final day, a six-year-old boy shot out his leg as the q-tip went into his nose. Dr. M jumped back with a yelp. You can guess where the boy’s foot made contact. Good-natured Dr. M considered it his farewell send off, and had a good laugh. I am guessing he has retold that story a few times.  

Collecting and giving test results reminds me that our efforts to manage this virus are far from perfect. It depends on the collector, the patient, the quality of the test, the availability of tests, as well as the accessibility of testing-sites.

Initially, we rationed tests in the US because we were unprepared for the pandemic, and national planning was nonexistent. In most US locations, we are doing better, but some rural areas, including the Native American reservations, still struggle. Many countries still have inadequate PPE to protect staff and insufficient test kits.

Other instructions are equally important. Mask-wearing, social distancing and avoiding groups are not options, and not political statements. They should be mandatory. Unfortunately, many have underestimated the gravity of this pandemic. In a recent editorial, physician-journalist Elizabeth Rosental suggested public service announcements should adopt the fear approach that smoking cessation efforts eventually embraced.

The virus knows no walls and while asymptomatic for some, is debilitating and deadly for others. I hope and pray the vaccine will be successful and side effects will be minimal. Wishing you health and the courage to cope during these dark winter months.