Long and Lonely Fight
Behind the figures, the numbers and the statistics, past the daily body count, there are the faces and voices, the sounds and the stories of those fighting the face-to-face battle with Covid 19. These warriors in our community are the physicians, nurses, social workers, therapists, psychologists, technicians, food and dietary staff, hospital housekeeping staff, paramedics, and EMTs. As in any war, these men and women are risking their lives to take control of an enemy, in this case, an invisible enemy.
The world of the frontline health care professionals seems to be divided into before and after mid-March 2020. In the beginning, when the world came to understand the extent of this pandemic, the need to stay current with continually shifting recommendations from the Center for Disease Control was critical. No one was sure of the proper protocols. Still, with the first surge, Dr. Kenneth Horlander, ICU Director at West Georgia Medical Center and pulmonary critical care physician, said the uncertainty and frequently changing guidelines had the staff “pulling out all the tricks.” What they were sure of was that the new normal meant a vastly increased workload. Amy Sheppard, a paramedic of 21 years who also serves as deputy coroner for Troup County, said that as the pandemic began, they really “didn’t know where it was going or what they were doing. There just wasn’t a lot of information.” She said they simply put on goggles, gowns, masks, any and all protective gear and waded into the struggle.
Dr. Horlander explains that Covid is an unusual illness and that it affects each patient so differently. The worst Covid patients develop respiratory distress syndrome leading to severe shortness of breath. Patients are unable to breathe on their own and need the assistance of a ventilator. In this condition, fluid collects in the lungs’ air sacs depriving organs of oxygen. “Patients need oxygen, so what we do is to supply them with oxygen.”
Kindall Dodgen, a nurse on the fourth floor of the hospital, said that when they realized the extent of the pandemic, everything changed- “the work schedules, the way we work, the times we work, what we wear, how we clean, how we give medicines; all the rules changed." It was decided to put the Covid patients in a small contained unit at the onset, but they went from a 12-bed unit to a 34-bed unit very quickly, and then during the 2nd surge, with the overloaded hospital census, patients were moved to all floors. Kim Gay, also a nurse on the fourth floor, related how nurses were pulled from all areas and departments to help with the overwhelming numbers of Covid patients. The hospital also used travel nurses who worked six weeks contracts. Besides caring for the sick, these additional nurses had to be trained in short order, taking time away from treatment and care. Nurse Gay said, “We had so many questions at the beginning. We wanted to know how this was spread, how can we protect ourselves? Everyone, EVERYONE, was terrified, and when we were chosen to be one of the Covid nurses, we took in a deep breath and looked at each other and silently wondered, will I get this? Will you get this?”
Ashley Owen, a mother of four and a nurse for six years, spent most of her time, pre-Covid, on the medical surgery /cardiac floor. As the pandemic unfolded, life changed for her at the hospital. When the Covid unit was established, and nurses were required to float there, she dreaded working the floor to fear what she might bring home. She has many older family members, some with underlying health conditions who could be compromised. And she worried for her own children, realizing she could be putting them at risk. The anxiety was so great, so unbearable; she said she often cried at work and at home. Her voice was full of emotion, thick with worry as she related these stories.
Nurse Owen tried distancing herself from her family, being extra careful to the point that when she arrived home, she would take off her clothes in the garage, shower, and scrub before seeing her family. If, by chance, she happened to see her two and a half-year-old before she got that shower, she would back off and not offer a hug. When that happened, her son would look at her and ask, “Mommy dirty?” At two and a half, he understood. She said, “We just couldn’t make a mistake with our families.”
After the virus’s first surge, the hospital opened up more space with more rooms and plowed ahead. As they learned more, they relaxed a little bit but not for long because the surge in the summer of 2020 crashed down. The supplies they used went from primary choices to having to scrounge for secondary choices. They found themselves critically treating people all summer as they predicted the third wave. Dr. Horlander said, “We knew it was coming. People were still socializing at Thanksgiving, Christmas, and New Year’s. We knew what that meant, and it has come to pass. We are in it, and there is no end in sight; this surge is worse than ever before.”
The toll it takes on the staff is crushing. Charge nurse Jazmin Allende tells a young woman’s story, a patient with no medical history of any underlying issues, who nevertheless contracted Covid. During her shift, Jazmin heard the IV machine beeping, rushed to suit up, and went into the patient’s room. Just inside the door, she realized that her patient was video chatting with her young son. She stopped in her tracks as she heard the child saying, “I miss you, Mommy. When are you coming home?” The mother tried to reassure her boy that she would be home soon and not to worry, but it broke Jazmin’s heart to hear the exchange. Jazmin didn’t want the patient to see her; she didn’t want to intrude on her precious time with her child, so she stepped outside into the hall and cried alone.
Even though the staff became a little bit more adept at managing the crisis, there was the ever-present stress. Because a patient’s family cannot be with them, the nurse frequently takes on the role of family member and becomes very attached to the patient. Nurses recognize that patients are terrified and frightened, lonely and alone, creating despair in both the patient and caregiver. There is a phone that is used to facetime, connecting the family to the patient. Communication with the family is essential, and the healthcare professionals walk a thin line in being realistic about the condition without frightening the family. The reality is that when a patient starts a decline, they go very fast, sometimes so fast that goodbyes can’t be said.
Health care professionals have different ways of coping with the stress of Covid and a variety of ways of dealing with death. Some cry, some lean on others, some gain strength from their faith. Many have developed a protective approach over many years dealing with critical illness and death. Their experiences give them perspective and insight and a way to handle grief. Dr. Horlander says that what “keeps us going is simply racing from one patient to the next. We don’t have time to stop and reflect. There’s no time to be broken up by the severity of the illness or the death of a first patient because we have to move right onto the next patient.” When asked if he had hope, Dr. Horlander said, “there is always hope for every patient, and I try to show the patients that there is hope and give them the things they can do to help make it happen. Then I let them know we (the staff) are all hoping and praying for their recovery. As far as the virus and the workload improving, there’s not much hope yet. At least not until most people are vaccinated”.
When Israel Contreras, an EMT in Troup County, was deployed to New York to assist with Covid, he recalls being sent to a cardiac arrest case. The man in distress subsequently died, and at that time, it was not unusual to have to leave the body at the place of death. He remembers being called back later to the same area and literally having to step over that body because there had been no place to take the man. Israel says it’s like wartime medicine, and the decisions they have to make when being called to a Covid patient are gut-wrenching. “Can this person be put on hold? Can his immediate treatment be delayed until we get to the hospital?” Israel says that in the past, like EMTs, their training was to speed to the event, dive right in, start treatment and never hold back. Now, if a patient is known to be a Covid patient, they must use precious time suiting up and taking extraordinary precautions. Even if the patient is deteriorating, they still have to take the time to don their protective gear first. Their goal is to get the patient to the hospital so that the hospital can take over. Israel says, “All of us are scared; in fact, we are terrified.”
Nurse Dodgen says that not all patients are elderly. She recalls a 40-year-old patient who had been on the Covid floor for 31 days and was so weary, sick of being there. “Part of our job is to encourage people. Sometimes patients ask us just to let them go home and die. When we see this, we have to give extra attention and extra love. They are so lonely, and without their family, they get very down and depressed. When this young man looked at me and said that he just wanted to be allowed to go home and die, I told him that’s not in our plans today. Today, you are getting better. But I knew, and he knew that it’s a minute-by-minute battle, and there is no guarantee.”
The stories are intense, coming from the frontline medical staff, and it would be easy for anyone to get discouraged. Dr. Shaundre Brown, an internal medicine physician and hospitalist, says there are so many sad stories of patients who get Covid and need critical care. She says, “What I like to focus on are those who do overcome. It’s those stories I take with me, knowing that it can get so bad so quickly, but it can also get better. I take that hope with me to each case, and I hold onto that hope.”
Dr. Horlander says the happy stories are limited, but they are essential in confronting fear and depression. He tells the story of a 50 years old man who was severely sick and on a ventilator. The hospital staff continued oxygen treatments until the time that his body could heal itself. We have to keep people alive so their bodies and God can turn them around.” In this case, the man did turn around, and he ultimately did go home.
Covid has upended so many lives and chief among them are the front-line medical professionals. Deputy Coroner Sheppard admits her faith in humanity has been tested. She says that it is her nature to always look for the good in people, but she has sometimes witnessed selfishness during this pandemic. She has seen people who are not doing their best to protect themselves and others. She recalls the story of a woman, who along with all her family, had contracted Covid. When she died at home, Sheppard and her team went to retrieve the body, finding no one at the residence wearing a mask or taking precautions to help protect each other. She said, “It’s just sad. If only they could only see what we see.”
Dr. Brown echoes that, “If the general public could glimpse into the hospital, in the ICU, on the floors- if the public could just see inside the units, it might change their perception. Some do not take this virus as seriously as they should; they think that this is no more than the flu. If only they could see what we see.” She is stunned by what she witnesses every day and says she has never seen the number of ventilators used in seven years. Now there are isolation signs on every floor. Isolation - that means patients die alone or with medical staff beside them.
Dr. Brown believes that the family members are the real unsung heroes as they are the ones at home, keeping the family in as usual a place as possible while those battling Covid work long hours and bring uncertainty home. She says, “They have to make the home a place of refuge and safety because what we’re dealing with every day is not.”
So many of these front-line warriors lean on their faith and prayer to sustain them. Each day they lift prayers for protection, for themselves and their families, and prayers for the wider community. They often stop in the midst of overwhelming crises to remember why they went into this profession, and they rest in the knowledge that they are exactly where they’re supposed to be.
Contributors to this article:
Jazmin Allende, Nurse
Shaundre Brown, Physician
Israel Contreras, EMT
Kendall Dodgen, Nurse
Kim Gay, Nurse
Bubba Henderson, EMT
Kenneth Horlander,Physician
Ashley Owen, Nurse
Amy Sheppard, Paramedic and Deputy Corner, Troup County