On the front line
They start their days in scrubs and surgical masks, moving sure-footed down the halls of Butler Memorial Hospital.
The masks are required to move around anywhere in the hospital — no matter when a shifts start: early morning, late-afternoon or long after the sun has crept below the horizon.
Even before coffee, the nurses at Butler Memorial conduct a changing of the guard, relieving their weary outgoing co-workers.
In these moments, the nurses exchange information about patients, but for COVID-19 patients even the slightest detail needs extra attention.
Nurse Stacey Vensel has been assigned to the COVID-19 unit in the Tower, a specialized wing of the hospital nestled in the city.
“With these patients, they can come in and seem fine,” Vensel said. “One moment, they're on room air, and a couple hours later, they're needing a couple liters of oxygen.”
The worst of these COVID-19 patients fight harder for shorter breaths. They come in all sizes, ages and existing health conditions, and there is often a fear in their eyes, one Vensel says she tries to abate with calm words and sure work.
Vensel said she is seeing more COVID-19 patients “code” every day. Codes red, blue and others indicate various levels of emergency need of care.She said it's not just the lack of oxygen that can be difficult to combat. She said there are severe fevers, blood clotting probabilities, and also altered mental states and confusion stemming from the virus.“They're not following commands. They're climbing out of bed, and by the time we get our gear on, the risk of a fall is there,” Vensel said.Nurses are a vital link between patients and the world outside their hospital beds. Nurses converse with patients, no matter what their affliction, and help them connect with their families, usually through iPads or other technology.Nurse Hannah Osborne spends her workdays in Butler Memorial's intensive care unit. She entered the hospital at 3 p.m. Wednesday to start her shift, tending to a non-COVID-19 patient.Regardless of whether patients have COVID-19, Osborne said she has to be prepared to call their families or arrange for communication, so that tough decisions can be made.“Now we have to be their eyes, their ears, their voices, their everything,” Osborne said. “We now have all become caregivers to the families as well.”After helping her non-COVID-19 patient, Osborne focuses on her coronavirus patients. Two are her primary responsibility, and she supports other nurses with their patients.Every time a medical professional steps into a COVID-19 patient's room at Butler Memorial, they wear gloves, hair covers, gowns that completely cover their bodies and booties on their feet. Probably the most vital piece of personal protective equipment is the PAPR.PAPR — the powered air purifying respirator — is no ordinary mask. It fits over a person's face and head and provides oxygen from a pack that runs through a tube into the mask itself.Osborne said in the spring, she wasn't sure if PPE was enough. She said today, with more information showing the spread is primarily through the air, she feels confident every time she dons the gear, but it doesn't make it any more comfortable.“It's very loud in the COVID rooms,” she said. “The PAPRs make noise, and then the air scrubbers make noise.”
Osborne spent the early part of her shift Wednesday helping with “proning” COVID-19 patients. Studies have shown that moving a COVID-19 patient to lie on their stomach can improve their condition and may prevent them from needing ventilators. “It often takes four, sometimes five skilled nurses to flip a patient from their back to the belly,” Osborne said.When proning doesn't work, when ice packs and cooling blankets don't help, when nothing works to make the patient better and the breathing becomes excruciatingly difficult, the ventilator becomes a last lifeline with few guarantees. Sometimes, the patient knows the situation is dire. Vensel can see the fear in their eyes.Vensel said COVID patients on ventilators will be heavily sedated, a tube will be placed down their throats, and there is a likelihood that they never will wake up again, which is all explained to the patients' families. Multiple studies have shown that more than 50% of COVID-19 patients placed on ventilators die while on them.They've always had to deal with the death of a patient, but for those who treat COVID-19 patients, the separation of the patients from their families places more of an emotional toll on the nurses.Some families say goodbye to the image of their loved ones laying motionless displayed upon a digital screen. A nurse holds the device for this conversation in one hand and the patients' hand in their other.“Nobody dies alone in this hospital,” Vensel said. “When there is nothing else we can do, we make them comfortable and pray for them, and that's something I never thought I'd be doing as a hospital nurse.”
While some patients succumb, others survive. There are some in intensive care who never see a ventilator and remain conscious during their stay.Osborne said for these patients it is important to show compassion. She said nurses and other staff will spend time with COVID-19 patients, just talking about anything.She said the staff becomes so involved in the lives of these patients and their families that they feel every loss and every victory deeply.“As much as you want to separate for your own sanity, it's hard to because you get to know these families,” Osborne said. “I remember every COVID patient. I remember every COVID patient's family. I remember the conversations and the phone calls because this is unlike anything we've ever seen.”At the end of the day, a tired Vensel drives home from the hospital, parks in front of her house, wipes down the inside of her vehicle with Clorox wipes, enters her home, goes directly to the wash with her dirty clothes and gets a shower. A process that can take between 30 minutes to an hour.“Then you tell your kids they can say, 'Hi,'” said the mother of two. “You just don't want to take anything home.”Osborne left the hospital shortly after her shift ended at 7 p.m. Thursday. On the way home, she called her mother. She was raised by parents who were critical care nurses, so it helps to discuss her day with someone who has had similar experiences.Not every day is as easy to leave behind in the hospital parking lot. “There have been multiple days I've driven home quietly and tearfully,” she said. “There's a lot of emotion that we have to lock up in these situations.”
The nurses have not shied away from the challenge of hardship, according to Karen Allen, Butler Health System chief nursing officer and chief experience officer.“Our nursing and respiratory therapist, nursing assistants and ancillary staff have risen to the occasion,” Allen said.She said staff members help one another through emotionally difficult times. There are also Employee Assistance Programs available for any staff member who needs extra support. The ultimate indicator is that no one wants to abandon their post. “The staff continue to want to stay there. They don't want to rotate out,” Allen said. “When you're in a crisis, you see the best of people.”As chief experience officer, Allen helps to gauge the hospital's responses from former patients and families. She said she has received many letters of thanks, filled with gratitude for the compassion shown by the nurses and other staff at Butler Memorial.“I'm proud of our staff for continuing to step up to the plate,” Allen said. “I believe we have the best clinical staff out there.”Allen said the health system administrators have also done their part to ensure the success of the staff by keeping them up-to-date on the latest information and education. Currently, the hospital has adequate levels of PPE, and it's made decisions to prioritize the growing need for COVID-19 and emergency capacities.On Wednesday, BHS shifted to Phase 1 of its surge plan, stopping non-emergency procedures and repurposing its post-anesthesia care unit to a critical care unit, which will add 15 ICU beds.“I'm proud of the administration for being so proactive, for focusing on patient care over finance always,” Allen said.
There are about 120 nurses working in the ICU with 40 more support nurses re- allocated and trained for current and future COVID-19 surges. There are about 700 nurses systemwide. There are also many more staffers, doctors, specialists, assistants and sanitation workers, among others, who provide essential services at both Butler Memorial and Clarion Hospital and continue to put their own health at risk in a pandemic.While community leaders battle some people's belief that COVID-19 is a hoax or not as bad as the case counts show, the health system administration works to keep its doors open.Vensel said she tries to remind people they have to acknowledge the impact it is having on the hospital's capacity. She said one more bed used for a COVID-19 patient is one less available to those in need of other emergency services — heart attacks, strokes, cancer patients.“I know if they could come take a walk down these halls of ICU, it would change their whole outlook of COVID. Their eyes would be opened widely,” Vensel said. “I wish they could see what we see every day.”
