As a nurse in the intensive-care unit (ICU), Sarah Johnson is accustomed to high-pressure medical scenarios and the ever-present prospect of tragedy.
Working in Kalispell Regional Healthcare’s dedicated COVID-19 unit, however, brings a particular brand of stress and exhaustion. Whereas patients with a severe case of, say, influenza have a peak sickness of only a handful of days, novel coronavirus patients are severely ill for an extended, grueling period of time.
“The thing that’s different about COVID is that the people who get really sick are so incredibly sick with this huge inflammatory response — it’s really hard to oxygenate them — and once they are sick they’re sick for a really long time, maybe weeks,” Johnson said. “It can be a long haul.”
A number of those patients require a cocktail of treatments simply “to keep them alive,” perhaps including steroids, Remdesivir, anticoagulation, feeding tubes in the stomach, nitrous oxide and oxygen support. Patients are often prone on their stomachs for more than 12 hours per day, perhaps up to 18 hours, to improve oxygen flow. Intubation and ventilation are necessary in some instances.
“We try to support people as much as we can without intubating them if we don’t absolutely have to,” Johnson said. “Anytime you have a patient that’s intubated or ventilated, they can’t communicate. They can’t make their needs known. We watch their vitals and try to anticipate their needs.”
“These patients are going through this exhausting, strenuous process of staying alive, and they’re doing it without family support at the bedside,” she added, noting that visitors, including relatives, aren’t allowed in the unit. “Nurses have been great about loving those patients, communicating with family and helping them feel safe and supported. But it’s hard when the patient can’t communicate their needs.”
Nurses’ job of emotionally supporting patients and contacting their families extends to all COVID patients, no matter the severity. Johnson said that role involves regular phone calls with concerned loved ones. The hospital also provides social workers and case managers, and she said the palliative care doctors “have been incredibly supportive.”
“They really deserve a big shoutout,” she said.
Johnson said a dedicated hospitalist is always on shift in the unit, and she points to that as one of various examples of the admirable job KRH has done in supporting COVID patients and staff throughout the pandemic. She had high praise for the critical-care director, Carla Genovese.
“She has done a phenomenal job and she is super supportive of her staff,” Johnson said. “She comes in on her days off in her scrubs anytime they need extra help.”
While Johnson hasn’t worked in the COVID unit recently, she was previously working 12-hour shifts there regularly. Even the process of preparing to work in the unit, and then sanitizing and decompressing at the end of shifts, is consuming.
Johnson leaves her scrubs at the hospital, changes into her clothes and different shoes, wipes down all her belongings before packing up, Lysol wipes her keys down when returning home, and then leaves her belongings in a pile in the garage before heading straight to the shower.
“No hugs when I walk in at home,” Johnson said.
In the last several weeks, the number of COVID-19 hospitalizations has spiked at KRH, now regularly hovering between 25 and 30 patients. Twenty-three people have died from the virus in Flathead County.
The recent patient totals far surpass the original unit’s capacity of 12, meaning the hospital has had to transform other areas — a process that includes HVAC updates to ensure air doesn’t escape the unit and travel into other parts of the facility — into treatment zones for patient overflow.
“We’ve busted our seams in the COVID unit,” she said. “The staff is giving their all every day. They’re putting forth their best effort for those patients. But it’s exhausting, it’s draining, it’s stressful because there aren’t enough beds, and we have a nursing shortage at the hospital.”
Johnson understands there’s a “fine line between living life in fear and being smart,” but she pleads with people to make good choices: eat healthy and take multivitamins, wash your hands, wear a mask and social distance as much as possible with the understanding that “you can’t isolate yourself to the point of loneliness.”
“I think it’s important to nurture and love each other during this time,” Johnson said. “I don’t think we’re at the end of COVID. It will be around for a while. I hope as a community we can step up and take care of each other and be supportive and hopefully make it through this without a lot more hospitalizations and deaths.”
Johnson gets a front-row seat to countless moments of nurturing and loving in the COVID-19 unit, including an instance she recalls of a nurse tending to a very ill patient who was going to be transferred to comfort care. The nurse remained bedside for 45 minutes until the patient passed away.
“To watch that nurse, her compassion, talking to family afterward, it definitely left a lasting impression,” Johnson said. “Knowing the nurses are there and loving on these people — I think that’s the heart of nursing. That’s why we went into this. We care about people. We love them and we want to be with them at their most difficult times.”