by Nancy Humphrey
Taking care of patients critically ill with COVID-19 takes an emotional and physical toll on health care providers who say many of these patients are among the sickest they’ve ever encountered.
But they also have hope that each patient will fully recover and return to a meaningful and productive life.
Five providers from Vanderbilt University Medical Center’s COVID Intensive Care Unit took part in last week’s Bedside Matters, a monthly forum intended to help front-line providers deal with some of the difficult and emotional issues that arise in caring for their patients.
Of about 1,000 COVID patients hospitalized at VUMC since the beginning of the pandemic, the COVID ICU has cared for 183 patients in the past six months, many of whom stay for weeks.
The forum focused on the health care journey of one patient, a man in his mid-50s who has spent more than two months at VUMC, including 52 days in the COVID ICU, located on the eighth floor of Medical Center East. He had no significant medical history prior to being infected, but his health quickly declined. He was intubated for 40 days.
The man had to be heavily sedated throughout his stay in the unit and was placed on two circuits of ECMO (extracorporeal membrane oxygenation), something many of his providers had never seen occur at VUMC. He has been moved from the COVID-19 unit but remains hospitalized with significant medical issues.
“It cannot be understated the emotional stress the bedside nurse experiences caring for COVID-19 patients at the ICU level. These are the sickest human beings we’ve ever seen who require the most aggressive and invasive care we can offer,” said Caroline Gardner, RN, a clinical staff leader in the COVID unit. She had been in her leadership role for about a year when the pandemic hit.
“The physical devastation that (COVID) does to the body would be traumatic to anyone caring for those patients, but COVID-19 has also presented us with additional and new challenges. We’ve had to remove the families from the bedside. The patients can’t be loved, can’t be touched or supported by their families, which created this uniquely isolating environment that is heartbreaking for us.”
Gardner said despite wearing substantial personal protective equipment (PPE) for each patient encounter, many caregivers have an underlying fear at times that they will get sick, or bring the virus home to their family. “It’s a perfect formula for complete physical, emotional and psychologic exhaustion,” she said.
The extreme medical care received by the patient discussed at the forum was “quite profound,” Gardner said.
“The view of this patient’s room was overwhelming. He was outnumbered by life support machines 5 to 1, easily… a configuration none of us had seen before,” she said. Many of the staff wondered “if we save this life, what quality will he be going home to. It was emotionally distressing, but these interventions worked.”
Gardner said that caregivers have faced a stigma of working in a unit taking care of highly infectious patients and “they’re on a continuous loop of staying in their PPE, staying at bedside providing interventions, covered in sweat, claustrophobic, delaying breaks to use the restroom to feed and water themselves.”
The team is dedicated to their work and patients despite the stress of the job, and the nurses have the freedom to vent their concerns and emotions, helping them to cope with the stress, Gardner said.
“Our proximity to human suffering causes a strain on your ability to hope and causes you to question the big picture and your own resilience in it. But there’s honor in serving humans during this time; and we all feel that, and when we aren’t feeling that or can’t see it, we have a great team to remind us that’s where we exist in this space. It’s what we do.”
Kate Sessler, RN, a bedside nurse on the unit since May, has been on the Medical Intensive Care Unit (MICU) staff for the past two years.
It can be easy to determine the course of an MICU patient, she said, but not with patients with COVID.
“This man was the sickest patient I’ve ever taken care of. If you left the room and had to get back in, (putting on PPE) takes so long to get back in the room it feels like an eternity. Twelve hours of that is overwhelming, and that’s just one patient. You may have two to three other patients who are equally as sick and that makes for a really exhausting shift.”
Sessler described herself as often “nervous, anxious and super uneasy” taking care of the patient. There were many times she wondered if what the team was doing to save his life was “ethically right for him.” But ultimately, she believes his is a success story.
“In the moment it can be hard to see the forest when you’re so thick in the trees,” she said. “I just hope he can come back in great health and tell us what we did was right. I think about his life post COVID and hope his quality of life is fulfilling and meaningful for him.”
Sherry Perry, MDiv, supported the patient’s girlfriend, family and friends as well as the staff who cared for him on the COVID unit. She likens her role in the COVID unit to a “disaster chaplaincy.”
“This (caring for patients with COVID) has stretched me vocationally, spiritually, emotionally and sometimes physically in ways I never would have imagined in a million years. It’s stretched our moral/ethical compass,” she said, but added, “it’s an honor to be on this mission.”
Perry said it’s difficult for family members who visit their loved ones who are critically ill with COVID. They have to remain outside the patient’s glassed-in room. “There are a whole lot of emotions and they don’t always get to see the patient’s progression. We ask them to fill in the blanks of the story that we don’t have; but this is one story we don’t get to be outside narrators of, because we’re in the middle of it ourselves. COVID scares all of us; it could be us or someone we love on the other side of the glass and we’re always mindful of that.”
The panel was moderated by Joe Fanning, PhD, associate professor of Medicine and director of the Clinical Ethics Consultation Service that was called in to consult about the patient. Other participants included Susan Hellerquist, NP, and Todd Rice, MD, MSc, associate professor of Medicine and director of the MICU.