How Houston health care workers are battling COVID-19
As an ICU nurse treating patients with COVID-19, I have seen how my hospital in Houston has prepared for weeks for the inevitable spikes in cases. It is a constant shuffling of beds to preserve those precious negative pressure rooms. Our first response was to open one dedicated COVID-19 stepdown unit — between a general and intensive care — then two, then three, with plans to open more. Because our two intensive care units were at capacity with positive cases and those waiting for test results, we opened another ICU this past week. Our hospital has done a good job of anticipating the medical needs regarding numbers of beds, but there are limits.
This is why much of the public has had to adjust their lives during this pandemic and are being told to simply stay home, while health care workers across Houston have had to make huge sacrifices in personal safety that are completely outside of their control. Every day brings new guidelines stemming from a fickle CDC, which appears to be making decisions not based on clinical evidence but on shortages of PPE.
Here is how a typical 12-hour shift in a COVID-19 ICU unfolds.
We arrive early to stand in lines to take our temperature and grab our one surgical mask that we wear all day except for a short lunch break. We enter our unit, get a quick update on our assignment and then are off to change our scrubs. We arrive back on our unit to obtain the rest of our personal protective equipment, or PPE, for the day. Those caring for positive and patients where the infection is unconfirmed receive one disposable N95 and face shield for the day, along with a paper bag to store their mask and shield. We were receiving a hair cap and shoe covers but the CDC recently stated this was not needed in light of shortages. Similar was their reversal on reuse of disposable N95s, which just two months ago would have been an absolute breach of protocol that would have warranted reprimand as it is an infection control risk. Most staff decline the paper bags, which may harbor the virus.. As we are seeing a rise of health care workers contracting COVID-19, we are getting creative with our own supplies.
Many of us have reusable plastic sandwich containers to store our masks in between uses of what used to be a one-time use mask.
Many of the COVID-19 patients, ranging from their 20s to 60s, require ventilators and other life-resuscitating measures. We are putting many of these patients on their stomachs in an attempt to help oxygenate and ventilate those suffering from acute respiratory distress syndrome. They are on numerous intravenous drips from blood pressure meds to sedation as we see their lungs, heart, kidneys and other organs fail. We are having difficult conversations about decisions such as “do not resuscitate” — over the phone. Because visitations have been extremely limited, we are seeing patients die alone with no loved ones, no human touch except for the nurses treating them.
Due to the increase in patient volume, we have also taken on responsibilities of housekeeper, patient care assistant, speech therapist to limit risk to those staff and reduce the need for PPE. It is a relentless day, but it is not over at the end of the shift. Many of us then go home and strip down our clothes in the garage, go straight to wash them, and then quarantine ourselves from our families. We are in isolation to protect our loved ones until the next day and the next shift begins.
In addition to the stress of increased risk and being isolated from family, the new stresses impacting others hit us too. My family owns a wedding venue that is now shuttered. Despite all of this, there are glimmers of hope and humanity. We have seen Astros players, along with many in the community, step up and support the restaurant industry with food orders to feed those on the front lines. We have seen the public practice social distancing in efforts to save lives and prevent overwhelming our medical facilities. We are thankful.
Being a COVID-19 ICU nurse, I am asking for specific help from the public. Limit the times you go to the store, don’t have that crawfish boil for a group of friends or go to a neighbor’s house to hang out. I know it is hard; I watched my child’s Easter egg hunt in our backyard from a distance. Without the public’s help, we will see additional strain on our hospitals and increased deaths. We are all in this together and will prevail. One day, one shift at a time.