On the front line in Unit 4A
Medical team treats the sick and dying, risking their own health
It can be a lonely place to die. Cut off from family and friends, the people admitted to Unit 4A of St. Catharines hospital struggle for their lives against the virus that has paralyzed the entire planet.
Mostly older people from local long-term-care homes, they are easy prey for the novel coronavirus which feasts upon the lungs of the infected. Their odds of survival are grim. Of the 88 people with COVID-19 admitted to the unit, 35 have died. They won’t be the last.
But the patients are not alone.
On any given shift in 4A about 20 people — doctors and nurses, clerks and custodians — work to help those suffering the most from COVID-19.
While the rest of Niagara feels the grip of the pandemic slowly loosen, the team in 4A and their patients remain in the trenches.
The team members save the people they can. They comfort those they cannot. The only people patients have close contact with, the 4A team, act as counsellors, surrogate friends and bridges to their patients’ families outside the walls of the hospital.
“At first maybe the first hour or so it’s just like, ‘Hey, how’s it going? Are you in any pain?’ Just forming that initial connection,” says Devin Rankin, a nurse in Unit 4A.
“But as they start to feel a little bit more comfortable with us, then we ask them more personal questions like, ‘What did you use to do?’
“But then, sometimes when they’re struggling, they’ll tell us some pretty heartbreaking little things. I don’t know another proper word for that, but it is heartbreaking just to see them struggle. After you had that little bit of a personal connection, it just touches your heart a little bit more,” says Rankin.
“It’s more of a shock on the system for all of us. Because the progression in the virus is a lot faster than what we would normally see. Seeing people die on almost a daily basis, it takes a big toll on someone. It is — I’m not going to lie — it’s a big toll.”
It’s an impact that isn’t easy to leave at the hospital when shifts are over, says Dr. Lorraine Jensen, a physician in 4A and the hospital’s internal medicine lead.
“I think I would worry about myself as a physician if things like that didn’t affect me, because I think at that point I would have lost some part of me. I think I will always carry this time with me,” she says.
“I think it’s going to be something that all of the physicians and clinicians who have worked through this pandemic will
never forget. It has been a traumatic experience for everyone involved.”
When it became clear COVID-19 was a global threat Niagara had no chance of avoiding, Niagara Health designated unit 4A as its primary COVID-19 treatment area.
Due to the highly infectious nature of COVID-19, healthcare workers are put directly in the virus’s line of fire when treating patients. While that is worrying enough, in the early days of the pandemic there were global shortages of protective equipment needed to keep health-care workers safe, including N95 respirator masks, face shields and gowns.
So it was with more than passing apprehension that Rankin, who has worked in the unit for a year and half, learned 4A was to be Niagara’s front line against COVID-19.
“Personally, I felt very anxious, scared. All the emotions ran through me, even anger a little bit. But it’s just mainly because of the unknown. We had no idea what we were expecting. There wasn’t much research out there,” she says.
As a nurse, Rankin is taking a risk she was unwilling to pass on to her family. So she left the home she shares with her parents and moved into a hotel.
“Other nurses are living at hotels. They have used the RV services, others have tried to find additional accommodations for their children even though they go home, they found accommodations for their children,” Rankin says. “So we’re trying to protect our families because our floor is the front line of workers battling this awful virus.”
Others, such as Dr. Jensen — mother of a six-year-old boy and three-year-old girl — have opted not to separate from their families. Instead, she relies upon on a fastidious attention to detail when it comes to being safe.
The risk is real. To date, 11 Niagara Health staff, three of them 4A team members, have been infected. Five Niagara paramedics have also contracted COVID-19 along with more than 60 long-term-care home workers.
4A team members like Jensen work 12- to 14-hour days for as many as 12 days in a row. She knows a slip in attention from exhaustion or complacency is all the virus needs to spread.
“I have a routine in my head that I go through with every single patient that I see, in terms of donning and doffing my PPE, so that I feel safe. If I’m tired or near the end of the day, I’ve actually asked people to watch me, to make sure that there’s no mistakes,” says Jensen. Some gear has to be removed in patient rooms, where the hospital’s environmental services staff — also at risk of exposure — collect it for disposal or disinfection.
All that effort is made to keep hospital staff safe to treat patients who, in far too many cases, will not leave unit 4A.
“I would love if there was a magic treatment that could provide a cure to everyone, so the challenging thing is feeling relatively helpless at times, when someone’s disease is progressing and you don’t have a cure,” says Jensen, whose past experience in internal medicine includes elderly and palliative care. She says patients are provided with supplementary oxygen to help them breathe and antibiotics to fight secondary bacterial infections. But they cannot kill the virus.
“We do know that patients — especially the elderly patient who even if they do go on a ventilator — their mortality rate is quite high, so that’s why I do think that early involvement of our palliative care service has been helpful,” Jensen says.
The doctors and nurses in 4A work alongside physiotherapists, occupational therapists, personal support workers, dietitians, chaplains and, in the best cases, patient discharge planners.
Jensen and Rankin say the team is a conduit from hospital rooms to the outside world, helping patients connect with family — sometimes for the last time — through FaceTime and other digital services.
Those visits can be hard. Tears fall from patients, family and the 4A team members often.
In the face of all of it, the teammates lean on each other, knowing they cannot abandon the unit.
“If I stepped away ... that would not help anyone out. So I just kind of, like I said, I use my 4A team as shoulders to cry on, shoulders to lift me up. We know the exact struggles,” Rankin says. Team members find support from the other units in the hospital as well, who have put signs of support in the windows to let 4A workers know they are not alone.
“Overwhelmingly the attitude on 4A is one of positivity and optimism,” Jensen says.
“The team has really come together in this time of need, to provide care for the community of Niagara. And so if people do end up on our floor, if they need our care, we are here, ready to provide that patient care. We do consider it a privilege, and we really do work as a team.”