Nurse practitioner reflects on outbreak in NOLA
Nurse practitioner praises ‘culture of teamwork’ during NOLA outbreak
For nurse practitioner John Stanley, a short stint in New Orleans caring for veterans afflicted with COVID-19 showed him much more than the ravages of illness.
Stanley treats veterans at Texarkana’s VA Clinic, but he spent a couple of weeks in the Big Easy at a time when life was anything but easy back in late March, early April.
The once tourist-swamped streets were empty then as the coronavirus raged in Louisiana, but hospitals were inundated with patients needing immediate care and respite in the intensive care unit.
Outside, what Stanley noticed at the New Orleans VA Medical Center, a facility he described as gorgeous (“state of the art in every way”) and newly opened in 2017, were the empty parking spaces.
One look at them told a disconcerting story: Family and friends of veterans could not visit at the hour of need.
Inside the hospital, though, what Stanley saw remained impressive as medical professionals from all backgrounds came together for the betterment of their patients’ lives.
Stanley, who has worked clinical and leadership jobs in healthcare for more than four decades, described it this way in a letter he later sent to the New Orleans VA staff:
“Never in all my prior experiences did I witness the exceptional striving for excellence through the cooperation of an interdisciplinary team. In a room where the average IQ was well over 130, the personal drama level was zero. No showing off an attitude of academic superiority nor dominating the meetings with lecturing. Each professional who contributed to the discussion received the attention and appreciation of others. Most importantly, the culture of teamwork permeated the room and radiated tangibly throughout the ICU,” Stanley wrote.
In an interview, this primary care nurse practitioner reflected on that time when New Orleans was a hot spot in the story of COVID19 in the U.S. Now, other cities and locations have become hot spots as hospital conditions in places like New Orleans and New York City have stabilized somewhat.
But New Orleans was hit hard.
“All of a sudden New Orleans was spiking,” Stanley said. “They were thinking maybe the Mardi Gras. Obviously, it’s a tourist city and Mardi Gras did go on this year. They were thinking, oh my gosh, a million people in a square mile, shoulder to shoulder.”
To him, it was surreal to see New Orleans without all the hustle and bustle.
“It just felt like the back lot of a movie studio,” Stanley recalled. He only saw sanitation workers on the NOLA streets. “But there was nothing to clean up. It was clean as a whistle.”
He stayed at the Hyatt Centric in the French Quarter, the only resident in a 300-room hotel. Room service wasn’t available, the kitchen closed. But he had an up-close view to gauge how seriously the city took the virus.
Stanley’s job at the New Orleans VA Medical Center demanded the skills he gained via years of critical care experience. He put it this way in a Facebook post: “My intention is to give grace to those who have given us so much.”
His work took him to the center’s ICU where he served alongside its director and offered clinical support administrative work. He coordinated between different services.
“Overnight it just swelled so fast. They were overwhelmed,” Stanley remembered, noting that in the multi-story parking garage for visitors, his vehicle was the only one. Family members couldn’t connect to their loved ones, the veterans in the hospital.
For those with COVID-19, the coronavirus wasn’t the only medical hurdle to move past.
“The veterans that were in there in ICU all had other diseases going on — COPD, endstage kidney disease — but they were independent. They were living their lives, and now all of a sudden within 24 hours staff is having to make palliative phone calls to their family,” Stanley said.
As he explains it, these phone calls would share with families the possibly dramatic changes occurring in a patient’s condition. Patients weren’t necessarily terminal, but their conditions were complex.
“These were long conversations that required a great deal of deep listening,” Stanley said, noting too that most patients were able to transfer to a step-down unit before being discharged. These phone conversations lessened the burden for nurses, the only people allowed into a patient’s room. Those nurses didn’t have time for long, detailed talks, he said.
That was much of his work and also the hardest part of it all: connecting to families on the phone. He’s been blessed with hospice work as part of his vocation, he says.
“It’s remarkable to see how fast the administration was able to dial up human resources. The facility is beautiful and has great capacity. It’s brand spanking new,” Stanley said. It’s like a huge cruise ship. But the human component was the other side of this.
You can’t crank out ICU nurses overnight, he said. He notes they never experienced any limits on ventilators or staff.
“Getting the staff was phenomenal, how they were able to bring in force so many competent people. That’s one of the things I was most impressed with,” Stanley said. Nurses, who came from all over, had special skills. Operating ventilators is complicated.
“The only people going into the room are the nurses,” Stanley said. Doctors and other staff look through the glass and look at the numbers, preventing as much contact as possible, he explained.
About the ventilators, he described the distress a patient feels. Everyone in ICU was on a ventilator.
“Once that flipped, when it happens and you get that shortness of breath, the cough, fever, the respiratory distress, acute respiratory distress syndrome is very rapid onset,” Stanley said. “These are patients with complex health histories.” Oxygen levels drop precipitously. Kidneys start shutting down.
“There was never a challenge with getting enough ventilators,” Stanley said. The resources were there. He thinks the VA has been a model for how hospitals respond to COVID-19, and he notes that most of the veterans he took care of got out.
“Most of them survived and got through this,” Stanley said. For families, though, they wanted to be at the bedside. But the VA took a hard stance of no, they can’t do this.
“Sometimes the most compassionate thing to do in the long run is the most painful thing to deal with in the short term,” Stanley said. The VA took the lead on this and other hospitals followed, he said.
He also worked with a spreadsheet which was able to extract data that could help the team each day. A tool called SOFA, short for sequential organ failure assessment, provides a number of key indicators, such as kidney function and oxygen levels, to help with a prognosis.
Such were the types of critical care questions he helped the team consider during his 15 days in New Orleans as the coronavirus spiked. They anticipated a further spike. “But praise God, it didn’t,” he said. Numbers were dropping by the time he left.
Through it all, he was there to help answer the essential questions of care for these veterans, and to relay the complexities to families who needed to know how their loved ones felt behind the glass.
“Are we getting better or are we getting worse?” Stanley said.