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VULNERABLE468 frequently. His condition was declining. Thursday morning, he looked exhausted and uncomfortable. Stuart had big brown eyes. That morn- ing there was fear in them. We needed narcotics to settle his breathing. I called a local pharmacy. They were extremely helpful and had inject- able hydromorphone. They didn’t have subcutaneous sets, but they had needles and syringes that would work. I wrote a script and our nurse practitioner dashed over to pick up the supplies. Now we could provide symptomatic relief to Helen and Stuart, the sickest residents. But I saw how unstable things were. Nurse Jen needed to run back and forth between these two—changing PPE each time because they were in different pods. The other nurse was giving medications and checking the other residents on site, many of whom were also exhibiting symptoms from their COVID-19 infection. Despite all efforts to keep these two patients in their home, sur- rounded by a few people who knew them, I could see that the situation was unsustainable. In those early days, we barely had assurance from one shift to the next that there would be a nurse on site. PSWs were still coming mostly from agencies. So, they were often new people every shift who needed to be oriented in their role and instructed in proper PPE use. The small core team of regular PHM staff was getting smaller by the day, as more workers became sick and had to stay home. When the crisis started, PHM made the bold decision to offer double wages for the duration of the outbreak to PSWs who would stay and new ones who would come on board. Looking back, that was one of the keys to stabilization. About two weeks after the PHM outbreak was declared, the Ontario government announced a policy to increase pay for many front line health workers during this period.5 Still, it was distressingly difficult to meet the staffing needs. Shelley and her team were using multiple job portals, agencies, and regional health resources. The Ministry of Children, Community and Social Services was trying to recruit help. Markham Stouffville Hospital made their human resources team available to assist. I made calls and sent emails to professional nursing organizations. Here’s what I learned: In the context of a pandemic, particularly in the setting of an outbreak, it’s a massive undertaking to hire and train a brand- new team of nurses and PSWs in a matter of days. 5. Office of the Premier, News Release, “Ontario Supporting Frontline Heroes of COVID-19 with Pandemic Pay” (25 April 2020), online: News Ontario <https:// news.ontario.ca/opo/en/2020/04/ontario-supporting-frontline-heroes-of-covid- 19-with-pandemic-pay.html>.