Inside hardhit county’s ICUs, it’s ‘ like working in quicksand’
For weeks, intensive care nurse Suzie Minnich has labored on the front lines of the Bay Area’s latest COVID19 surge in the heart of the region’s crisis: Santa Clara County.
An astonishing 154 people a day have been admitted to ICUs in Santa Clara County on average in January, and Minnich, the nurse manager of two ICUs at Santa Clara Valley Medical Center in San Jose, said dealing with the flood of patients “is like working in quicksand.”
“I make one bed, and two patients are already waiting for it,” she said.
The number of people in the county’s ICUs is nearly seven times higher than in October before the holidays, and hospital officials estimate that at least half of those patients have COVID19.
The deluge of people needing critical care is prompting administrators to bring in doctors from outside the ICU to help.
“Normally, we would not even consider doing that because these doctors are not trained as well to care for these kinds of patients,” said Dr. Cliff Wang, chair of Santa Clara Valley Medical Center’s Department of Medicine.
But these are extraordinary times, he said, and those doctors are able to take on tasks that free up the ICU doctors, such as calling families about a patient’s condition.
Santa Clara County hospitals are by far the hardest hit in the Bay Area, with 37% more new patients arriving daily into its ICU beds than in the next most saturated county, Alameda, which is seeing an average of 113 new ICU patients a day this month, up from 19 a day in October.
Although Santa Clara County is struggling with the highest number of new ICU patients each day — it’s the largest county in the Bay Area, with 2 million residents — every county in the region has seen a tremendous jump since before the holidays, with increases that are nine, 10 and even 17 times higher in some counties.
The rising numbers suggest that many people simply ignored public health experts who implored them to stay home over the holidays, if not to spare themselves from disease, then to keep ICU beds available for emergencies, from car accidents to heart attacks. Not everyone listened.
“Over Christmas was the worst week of nursing I’ve had in 10 years,” said John Pasha, a coronary ICU nurse who works the night shift at Good Samaritan Hospital in San Jose. A decade ago is when Pasha traveled to Haiti to help out after a 7.0 magnitude earthquake destroyed much of the country.
In some ways, he said, this
surge is even worse than that.
“I’ve never seen someone go into respiratory arrest faster than someone with COVID19,” Pasha said. “This person was saying they were having trouble breathing. I looked away and turned back, and the person was dead.
“That is COVID,” he said. “That’s what’s scary.”
Intensive care units, with their specially trained doctors and nurses, accept only the sickest of the sick. All ICU patients have their own room. Each person is surrounded by lifesaving machinery, sometimes
up to 15 IV pumps. Wires connect the patient to a monitor that beeps and flashes a constant stream of vital data about oxygen levels, heart rhythm, breathing rates and body temperature.
And now, as families are barred from visiting patients, the mix of equipment includes tablets on stands so that those visits can happen virtually.
By California law, each ICU patient can share a nurse with only one other patient. But because of the surge, and over the objection of nurses who call it unsafe, state officials are now
allowing hospitals to apply for a waiver to these ratios.
Despite the limits, a patient’s cramped ICU room is often a crowded place as nurses and technicians collaborate to safely turn the patient over sometimes twice a day, or when a team of doctors and other experts surround a patient, fighting for that person’s life.
Minnich said that at least half of the ICU patients at Santa Clara Valley Medical Center have COVID, many of them in their 40s and 50s — a younger group than she saw last spring.
Pasha, Minnich and Wang all described their ICU colleagues as tired beyond belief.
“People are drained. Exhausted. Everybody is running on reserve,” Wang said. “The additional shifts means you aren’t home on a regular basis — and you don’t sleep as well because you know you could get called in at any time.”
The difference from the usual experience of dogtiredness in the ICU is that now “there are so many patients, you don’t really have time to recover,” he said.
The other day, Minnich was walking down the hall and saw a nurse beside the IV pump outside his patient’s room gazing off somewhere, his shoulders hunched.
“He looked exhausted,” Minnich said. “I said, ‘ Are you all right? Do you need help?’ He goes, ‘ No, I’m OK.’ I said, ‘ You want this all to be over, don’t you.’ He said, ‘ YES!’ ”
Five ICU beds have been added to the 40 that Minnich usually oversees, she said, and there’s no guarantee the unit won’t be expanded again. She manages about 140 nurses.
Across town at Good Samaritan, Pasha works 12hour shifts “with no meal breaks,” he said. “We can’t leave our patients because we don’t have people to replace us. There is no break nurse. We usually have one rapidresponse nurse who can come if a patient is getting worse. We don’t have that anymore. There are no extra hands.”
Patients can remain in the ICU for weeks at a time, sometimes more than a month, Minnich said, which is long enough for the doctors and nurses to get to know them and care about them.
“Think about that,” she said. “You’re with somebody every day for two to six weeks. You’re taking care of them. This is someone who has a life. They have people who care about them and love them. They have hobbies. They had a life before they came to the ICU, and now they’re very sick.
“People hear about numbers. But they’re not numbers. They’re people. The losses have been way too many. And those who survive, many will face lifelong disabilities. It’s not going to be over for them.”
Dr. Ahmed Kamal, Santa Clara County’s COVID19 director of health care preparedness, warned this week that relief from the postholiday surge is not yet in sight, despite the arrival of vaccines.
“As awful as it is, things could get worse,” he said, adding that the county “has not been in a situation where two people are gasping for breath and only one gets a ventilator.
“But we could get there.”