BATTLE TESTED
Facing a third surge, COVID ICU team at St. Luke’s is battle-ready but looking for light at end of tunnel
A COVID intensive care unit team at St. Luke’s is weary — but ready for the next wave.
Twice a day, for almost every patient in the COVID-19 ICU where Alis Cummings works, a team of five, dressed in full PPE, assembles for “proning” — basically, turning the patient over.
The concept is simple: COVID-19 patients breathe far better if they lie on their stomachs, not their backs. But nurses know that what’s simple in concept is often, in the real world, surprisingly hard.
Tubes usually connect the patients to machines that perform the work of their lungs and kidneys. And because each patient is so fragile, just turning them from stomach to back, or from back to stomach, might cause the patient to code. That’s why a doctor is always part of the team. “If the tubes come out,” Cummings says, “it’s an emergency.”
Proning was awkward in April, when the teams started doing it. Cummings, 54, was herself still new to leading the ICU’s nurses. She’d started work at Baylor St. Luke’s Medical Center in late February. Less than a month later, the surgical ICU was abruptly converted to an all-COVID ICU.
Suddenly, she and her nurses faced wildly different, far more intense jobs than the ones they’d been hired to do. Grueling hours. Sicker patients. Far more of the hard-to-run life-support machines — ECMO, CRRT. Gone was the Zen Den, the lounge where nurses could eat together or put their feet up for a minute. PPE meant that now, they could see only each other’s eyes.
It hurt Cummings, seeing patients cut off from their families, able to connect only by FaceTime. In a surgical ICU, patients usually don’t stay long. But on the COVID-19 unit, the nurses had time to bond: Most COVID-19 patients stay in the ICU for more than a month.
The ones who leave early — it’s often because they die. Both the people who die and the people in the ICU tend to be in their twenties and thirties. They’re the same ages, Cummings says, as most of her staff.
Sometimes the nurses go to patients’ funerals.
In the worst week, when Houston’s spring surge was peaking, five patients in their unit died.
After the surge subsided, one by one, the hospital began returning its COVID-19 ICUs to their old jobs. In July, it briefly considered converting the last COVID-19 unit, Cummings’, back to a nonCOVID ICU. Cummings was proud that her staff, stressed as it was, voted not to change. They knew what they were capable of. They knew the pandemic would be back.
The very next week, COVID-19 cases in Harris County began climbing again.
And now the new surge is beginning. Cummings keeps a weary eye on the number of new infections. More infections lead directly to more hospitalizations, and the sickest of those patients will end up in ICUs like hers.
Her husband says that working in her unit is like being in a war. The nurses joke that right now, they don’t have time for PTSD. They’ll process all this when it’s over.
Cummings tries to keep their spirits up. She keeps track of the patients who live. She lets the team know about the ICU’s success stories, shares photos of former patients, now happily back home.
This week, at a staff meeting, she reminded her staff that they’re making history. Someday, she told them, nursing students will study what they’re doing now, in this hardest of times. The things they’ve learned. The things they endure.
These days, she says, proning is easy. The teams of five are coordinated, smooth: “We’re real quick at it now.”
Her team is ready for the surge, she says. But she wishes they could stop.