It is often forgotten that the spring lockdown was put into effect not only to slow the spread of the SARS-CoV-2 coronavirus, but also to reduce the number of people who would go on to develop acute COVID-19 and thereby also reduce the likelihood that emergency rooms, intensive care units, and hospital staff would become overwhelmed by the sheer volume of patients needing care.
With the fall surge of coronavirus cases, and the number of people requiring hospitalization, hitting record highs, we decided to check in with some of the healthcare staff working in the COVID-19 Isolation Unit at Door County Medical Center to find out how they are fairing.
We spoke with: Jill Austad, Registered Nurse who is a House Supervisor who spends extra shifts in the COVID-19 Isolation Unit; Rachel Mallien, a Registered ICU Nurse who works exclusively in the COVID-19 Isolation Unit; and Dr. Marc Binard, Hospitalist, lead physician, and primary admitter of COVID-19 patients to the COVID-19 Isolation Unit. Note: This interview has been edited for length and clarity.
Tell me about your experience with COVID-19 patients.
Dr. Binard: My experience dates back to March when we had our first patients. I’ve been a physician for over 30 years and I’ve never, ever treated anything close to this. Early on, we didn’t have a lot of data on how to treat or how to prevent COVID-19. We do have some now, but it’s unique to our experience to have a disease process where we still don’t have great treatments. And, to watch so many people die from a virus is something completely new to all of us currently working in the healthcare field.
Can you describe the different level of care required for COVID-19 patients versus other patients?
Dr. Binard: The care is intense. Patients with COVID-19 are complicated—they demand an incredible amount of attention from nursing and medical staff. It’s very intense intellectually; it takes every bit of medical knowledge and decision-making that we have. It’s intense physically; most of us have been working incredible hours—well into overtime. It’s stressful psychologically; we’re used to dealing with people that are sick, we’re used to dealing with people that are dying, but never in these large amounts.
Jill Austad: And, how patients respond can change rapidly. That’s the scary part about—how a patient can be doing really well one minute, and the next minute they are not responding in a way that we had hoped.
Rachel Mallien: When we walk into a room, it’s not just, “you walk in and walk out.” You have to get ready; you have to put on all the gear—booties, gown, double-glove, double-masks, face shields and head cover, and then double check you have everything on. Right now, because the nurses are effectively the only people in the COVID-19 Isolation Unit, we don’t only fulfill our normal roles, we also draw everybody’s labs, we’re PT, we’re OT, we’re case management, we’re dietary, we’re IT, and we’re maintenance—we literally do all of it.
What are you seeing from the patients? What are the emotions that the patients are experiencing?
Dr. Binard: We see a whole range of emotions. The majority of our patients are extremely thankful for what we’re doing. But generally, when patients come in they’re terrified and they’re frightened—they can’t breathe! We don’t think about breathing because we don’t have to. But, the minute you can’t, that becomes the priority in your life—it’s all you can think about—so the number one concern becomes, “Am I going to die?”
Jill Austad: These patients are really scared. And, they are put into an isolation room where they’re separated from their families and the outside world, and then they have these strange people coming in with all the PPE—masks, gowns, gloves, respirators and shields—they can hardly hear what you’re saying, and can’t really look into your eyes. Their emotions are overwhelming.
Rachel Mallien: We have heard a lot of people say they were afraid when they found out that they had COVID-19, and then, when things started getting progressively worse at home, some of them were afraid to come to the hospital, and some patients had to be forced to come in by family members. Right now, patient’s families can’t visit the hospital, and that’s very isolating.
What are patients’ families experiencing?
Jill Austad: Generally, family members are in disbelief—they can’t believe that they have a family member who has COVID-19. And either they don’t know how they got it, or more often, it’s a family member that gave it to the patient because of a potentially careless act—not masking, having a large gathering, not maintaining any type of social distancing—and some of these patients are losing their lives. Unfortunately, it’s not until they go through something like this that people realize the severity of the disease.
Rachel Mallien: A lot of anxiety and sometimes anger—a lot of fear, frustration, and helplessness at not being able to do anything. But also, there is the relief they feel in knowing that they’re in the hospital and getting the care they need. There is joy when the family member leaves the hospital, and appreciation—families understand that we’re not just taking care of their family member medically—we’re taking care of their whole being.
How are the pandemic and the number of people in the hospital affecting staff—how are they feeling?
Dr. Binard: Well, I’m a physician, and though I care for my patients, and I care for a lot of patients, it’s the nursing staff that is in with the patients for huge amounts of time because these patients need a lot of one-on-one.
We all get attached to our patients, and these patients are our neighbors, these are our friends, these are our families—so, there is a very personal connection. And, COVID-19 typically does not kill you quickly—it’s a slow, drawn-out process. I see the sorrow and trauma. I see the impact this is having not only on the faces of the families, but also on our nursing staff. The emotional toll is huge, especially on the nurses and the respiratory therapists—the people that are spending 8–10 hours at a time taking care of a patient.
Jill Austad: Everyone is definitely feeling the strain and stress related to this pandemic. We all watch out for each other and you kind of know when somebody’s teetering—we know it’s time for them to take some time off and be with their family and just get out of the hospital. We all try to make that happen for them, even if that means taking time out of our lives with our families—to give that other nurse or staff member a break.
Rachel Mallien: I think that we’re getting burned out. The COVID-19 disease process is frustrating because we think we have a handle on what to do, and then something else pops up. What works for one patient doesn’t necessarily work for another. The COVID Unit is primarily staffed by ICU nurses and House Supervision, and there are 5 day nurses for ICU and 3 House Supervisors. It’s one of us everyday of the week. When we have a lot of patients in the COVID unit, you need 2 and 3 nurses, and when you don’t have a big pool to pick from, it’s exhausting. I’ve worked a 12-day stretch, each day a 12-hour shift. We’re exhausted.
If you have one thing to tell the community about stopping the spread of COVID-19, what would it be?
Dr. Binard: We are presently at capacity, not only for COVID-19, but also for other problems. And usually, we refer patients suffering from heart attacks and strokes to Green Bay, but you should know—Green Bay is full. And I don’t mean full for COVID-19 patients. I mean, if you have a stroke or a heart attack, there is a very good chance, if you’re lucky, in 5 to 10 hours we can arrange transport to (maybe) a hospital somewhere in Neenah or Milwaukee.
So, if you choose to have family gatherings—Christmas, weddings, or funerals—just realize you’re overburdening an over-burdened system. And, in all likelihood, people will die because of your reckless behavior.
Jill Austad: I want people in the community to know that now is the time to put everybody else before yourselves—swallow your pride, wear a mask, socially distance, stay away from unnecessary gatherings. I want this to be over just as much as everybody else. If we can just buckle down, this could be done sooner rather than later.
Rachel Mallien: We have a great small-town ICU, but it’s not a complex ICU. We don’t have all of the specialties like cardiology, nephrology, and neurology that larger hospitals have. When somebody comes in and needs that kind of specialty care and Green Bay hospitals are full of COVID-19 patients, we have no place to send them.
That’s why, in March, everything shut down—so that we could get prepared, so that we could take care of patients the way that we need to, and, we have done a great job at that. Now, it’s just a matter of the community helping us to help you by putting the mask on, and keeping a safe distance, and staying home if you know that you’re positive.
We’ve done everything on our end to keep you safe, and now we need your help.