Nothing could have prepared nurses and therapists for what 2020 would bring: a potentially deadly and definitely contagious respiratory virus.
Emergency departments and intensive care units are always the scenes of life-or-death situations, but COVID-19 has changed how providers in those settings do their jobs.
Bill Putren has been a nurse for 28 years, and he currently works in the emergency department at MultiCare Valley Hospital.
“Call us what you want,” Putren said. “We call it the front door.”
And while those who work in an emergency room have seemingly seen it all, Putren said COVID-19 “had a different feel from minute one.”
What made it so scary initially was just how quickly information about the virus changed.
“What makes it frustrating is much of emergency medicine is based on algorithms and we follow this process, and there is none for this,” Putren said. “There is now, but there wasn’t so much at the beginning. We were forced to be so very flexible in what PPE we’re using, what was really effective and what information was reliable.”
To help bolster order and predictably, all patients entering Valley Hospital now come through the emergency department, and every person is treated as though they have the virus, Putren said.
The emergency department comes together in a “huddle” every day and every shift, Putren said. Providers pass back and forth new information about how long the virus lives on surfaces, how long it can stay in the air – all of the factors that could have important implications in the emergency room.
Spokane County hospitals began seeing COVID-19 patients in mid-March, according to health district data, but due to lagging test results at the time, health care workers would not know if they had worked with a COVID patient for days.
Putren said he would be at home on his day off and get emails saying he had had contact with several COVID-19 confirmed cases. The Valley emergency department, like others around the state, saw a decrease in overall patient volume when the pandemic hit, but Putren described the patients who were coming into the emergency department as very, very sick.
Once the emergency department stabilizes a patient, they are sent elsewhere in the hospital for treatment or to the intensive care unit. COVID-19 patients take a longer time to recover than normal patients do, nurses and respiratory therapists said.
Katherine Taylor, an ICU nurse at Providence Holy Family Hospital, said COVID-19 has changed the way she is treating patients. While she still usually works with only two patients on a 12-hour shift, she can’t just run into a room anymore to fix a machine or answer a patient call button.
Health care workers must don a lengthy list of personal protective gear every time they enter a room with a novel coronavirus case to protect themselves, but this process takes time.
Every time Taylor leaves a patient’s room, she has to take off some of her protective gear. That means she has to think about more than just the patient’s immediate needs when she enters a room. She also also has to consider what she might need five or 10 minutes later.
It’s a high pressure role, and she said she spends about 80% of her time in her patients’ rooms. Nurses are getting creative in order to not waste time or re-use PPE. Taylor said nurses use small white boards and hold them up to the room windows to ask others in the hallway for supplies they need.
“We’re the eyes and ears for our patients, and it’s up to us to notice when small changes are happening, whether they are good or bad, to keep our physicians in the loop,” Taylor said.
That means monitoring vital signs, oxygen levels and other patient needs and alerting other team members when help is needed. Respiratory therapists play a crucial role in caring for COVID-19 patients too and spend time in rooms adjusting ventilators and monitoring a patient’s airway and ability to breathe.
Denell Allen has worked as a respiratory therapist at Holy Family for 20 years. COVID-19 has presented unique challenges for Allen and others because respiratory therapy techniques almost always require aeresolizing, or dispersing particles into the air, which could spread a patient’s respiratory droplets throughout the environment.
“Trying to find ways to not expose the nurses I work with has been challenging, while also trying to do the best for the patient,” Allen said.
Holy Family converted several rooms into negative air pressure rooms early on, which helped take some of the pressure off of the therapists, Allen said.
On a typical day in the hospital, Allen could be working on any floor, and running into an emergency situation is a normal part of her work life. But with COVID-19, Allen too must put on all the proper gear before going to check on a patient.
“On a good day prior to the pandemic, it’s often uncontrolled and very rapid, running in to a code situation,” Allen said. “And now with this, it makes it even more nerve-wracking. You want everything to be as controlled as it can be for a good outcome and not spreading it as well.”
The first time Allen intubated a COVID-19 patient, connecting them to a ventilator, she remembers having to calm her own nerves and not think about all the things that could go wrong. Ventilators are complicated machines, and if her hand trembled and a certain circuit popped off or something became unhooked, things could go wrong, she recalled.
“I think the unknown is what’s scary about this,” she said.
Allen has noticed her patients with COVID-19 who come in sick can get sicker quickly, increasing the need for her continued attention and various respiratory therapies, including ventilation. Not having quick test results made care challenging for Allen at first because she did not know who to prioritize or who might decline quickly.
Connecting with patients and saving lives are a welcome part of the job for nurses like Putren and Taylor as well as for therapists like Allen.
COVID-19 has made this challenging, too.
Donning full PPE, patients can only see their caregivers’ eyes. Sometimes, Taylor said she will use only her face shield to protect her face so that her older patients, who might have trouble hearing her, can at least read her lips so they know what she is saying.
No one can have visitors in the hospitals right now, leaving COVID-19 patients alone except for their caregivers.
Holy Family provided iPads to patients in order to FaceTime with their families, and Taylor said one of the brightest moments of the entire pandemic was when she held an iPad so that a patient could spend 15 minutes talking to his family.
“Being a part of that and having to hold an iPad was something I never thought I would be doing in an ICU,” she said. “And in today’s world, that’s what we’re doing.”
Some patients on ventilators cannot speak at all, so Taylor said she does her best to keep her patients company, telling them how different the world is now, recounting her stories from the grocery store and sharing with them what the weather is like.
Anything “so they don’t feel like they’re laying there in isolation with no human interaction,” Taylor said. “That’s been really, really hard on patients.”
While front-line workers continue to treat COVID-19 patients, they do worry about bringing the virus home to their families. Some health care workers change clothes before they leave their hospitals or in their garages at home. Others shower and change before they even hug their spouses or family at the end of a long work day.
“One of my biggest fears is to spread it to the people at the bedside or in my home or community,” Allen said.
And yet, they persist.
While Putren acknowledged that Spokane has not had it nearly as bad as other places, he said he and the system at large are prepared, whatever happens.
“We didn’t see what some of these other cities are seeing,” he said. “I don’t want to say we’ve got inundated because we’re not. (But) we’re ready, and I know we can handle it.”
While increased testing, increased availability of PPE and the creation of established processes to deal with patients are comforting to health care workers, Allen acknowledged there is still more to come.
“I feel like we are prepared – not to say that it’s not unnerving,” Allen said.
Editor’s note: A previous version of this story used the incorrect pronouns to refer to Bill Putren in a sentence towards the end of the article. We apologize for the error.
Arielle Dreher's reporting for The Spokesman-Review is funded in part by Report for America and by members of the Spokane community. This story can be republished by other organizations for free under a Creative Commons license. For more information on this, please contact our newspaper’s managing editor.
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