THE FRONT LINE
After eight years as a nurse at suburban Carroll Hospital, Megan Andrews was used to stepping in wherever she was needed, whether that meant treating sprained ankles in the emergency room or tending critically ill heart attack patients.
None of that prepared her for this.
Andrews has been caring for dozens of county neighbors desperately sick with COVID-19, often elderly victims of the outbreak at the Pleasant View Nursing Home. She’s become adept at caring for those with ventilator tubes down their throats, allowing panicked people to breathe easier.
“I tell them I won’t give up if they won’t give up,” she says. Some die anyhow.
Weeks into the biggest medical crisis of modern times, health care workers in Maryland hospitals are leaning on their training and experience — but
Clockwise, from top:
a nurse at St. Agnes Hospital in Baltimore; head of the Johns Hopkins Biocontainment Unit; and
a nurse at Carroll Hospital in Westminster. also their gut — as they adjust to treating a flood of coronavirus patients that has yet to abate.
Some patterns are new and sometimes hard: An ICU nurse holds a patient’s hand as her husband of more than 60 years says goodbye over an iPad. A veteran Baltimore intensive-care doctor worries about how much time he can safely spend with infectious patients. An administrator balances telemedicine at work and online learning at home. A hospice nurse eases the pain for those who won’t survive.
Hospital hallways can be eerily quiet because no visitors are allowed. Normally close colleagues are masked and distant, relying on cellphones to talk even when near.
Thousands of patients of all ages and backgrounds have been admitted to Maryland hospitals since the pandemic began, and more than 1,700
remain in hospital care.
And the state passed a grim milestone Thursday. More than 1,000 people have died, making some days unbearably sad for hospital workers.
Scientific models show that after more than 20,000 cases of COVID-19 in Maryland, the pandemic in the state, as in the country, may be approaching a plateau. But even with continued restrictions, thousands of new cases and hundreds more deaths are expected before the end of the summer.
Despite the losses, medical workers report a jumble of emotions that include pride, joy and appreciation for their mission. The feelings are punctuated not only by unlikely recoveries, but by smaller moments when local restaurants deliver lunch or volunteers drop off homemade gear and cards.
Here are some of the ways the unprecedented events are melding into a daily rhythm for those on the medical front lines of COVID-19 care.
ST. AGNES HOSPITAL
After more than two decades as a nurse, LaKya Taylor feels like a beginner again. The coronavirus has upended so much of what she and her colleagues at Baltimore’s St. Agnes Hospital have seen before.
“We don’t know what to expect,” said Taylor, who works in the intensive-care unit. “We hear new things coming out weekly, like people having strokes. We’re still learning and still kind of in the teaching realm.”
With no medical journals as guides, they repeatedly run blood tests to gauge how treatments are working — or not working — on the 28 ICU patients they now regularly care for. Their unit normally would have no more than 16. An additional 25 to 30 patients with COVID-19 are in another unit for the less sick.
They disinfect masks and shields meant for a single use with Clorox and hydrogen peroxide wipes and wear them again, an “unnerving” process to learn.
Her message to the rest of us? “Wear your masks. Wash your hands with soap and water. Stay home,” Taylor says, raising her voice. “If you could see what I see, you would.”
Some changes for nurses don’t directly involve medical care, like taking out trash and cleaning rooms because housekeepers aren’t allowed.
Taylor has watched many people die over the years and been on the sidelines for a family’s last goodbye. Days ago, for the first time, it was only her at the bedside. She held an iPad near the dying woman as her husband of more than than 60 years reminded her of their lifetime together.
He asked his wife to squeeze Taylor’s hand. She didn’t respond. He told her he and their children loved her. She died later that night without her family or even Taylor. He remains in grave condition with the virus in another room.
Taylor lives for the times patients recover enough to leave the ICU and are transferred to other units. Staff members line the halls and clap.
JOHNS HOPKINS HOSPITAL
When patients drive up to the tent on Broadway, many are so frightened for their future that they’re in tears. Kimla Baugh gets it. And she knows the swab test that will eventually tell them how sick they are won’t be a comfortable process.
For the nasopharyngeal test, a long swab is inserted into the nose, so deep into the nasal cavity it’s practically at their ears. Some people lurch halfway through and need to get swabbed twice. Afterward, they might gag or sob. One woman vomited.
As ambulatory operations manager for Johns Hopkins Hospital, Baugh coordinates the torturous but vital process for the hundreds of patients a week. She also helps in the hospital’s new ambulatory command center, a central hub where staffers track COVID test results and follow-up care for patients.
“The days have definitely gotten longer,” Baugh said. She stocks her purse and her car with hand sanitizer, and matches her cloth mask to her outfit.
Baugh also has spearheaded the hospital’s switch to telemedicine for her departments as doctors look to reduce the number of people coming in and out of the hospital. It’s been a rocky transition — Baugh worries about seniors and others who may struggle to use the new technology. A weekly clinic that used to see 200 patients a day now gets 50, including the virtual visits.
Baugh knows just how hard the shift to doing things online can be. She was standing in the command center when her son called recently, unable to log into his seventh grade language arts class.
“Virtual learning,” Baugh joked, “is going to drive me to drink.”
After work each day, she heads home to Parkville. At the dining room table, she sits with her kids, 13 and 8, doing homework. She sometimes Googles math lessons she hasn’t thought about in years.
“There have been times when I’m so overwhelmed I feel like, ‘I don’t want to do this.’ ” But quitting isn’t an option.
CARROLL HOSPITAL
After weeks of caring for patients sent from a local nursing home, Megan Andrews was shocked to see a woman in her 20s.
“You see people in the 40s, 50s and older,” the Carroll Hospital nurse said of COVID-19 patients. “She was so young. She was just doing her thing, and bam, she was here.”
Andrews spent her shifts turning her on her stomach and coaching her to breathe, a technique to help patients get more oxygen and avoid a ventilator. With no family near because of a ban on visitors, Andrews also made sure to reassure her, hold her hand and advocate for her care.
Irregular schedules mean nurses aren’t always there when a patient dies or goes home. But they always ask about them. The young woman went home, to Andrews’ great relief.
These days, the nurses also ask about each other. They do “COVID checks” by text message. Sometimes they bump elbows in the hall just to feel the touch.
When dealing with coronavirus patients, Andrews wears a “spacesuit,” complete with a tight-fitting N95 mask. It’s hot and uncomfortable on her face, but better than not having it.
The community has sent supplies and food, like any good neighbor during a crisis. They also send cards with pictures drawn by children and notes of thanks.
Someone made a pile of “prayer squares,” small hand-knit trinkets with prayers written on them. The writing on Andrews’ square faded after repeated washings, but she still keeps it in her pocket.
When her shift ends, she goes home, dumps everything into the washer, and showers. She has dinner with her husband and talks little of work. In the morning, she goes for a long walk “until I don’t feel heaviness in my chest anymore.”
JOHNS HOPKINS HOSPITAL
Dr. Brian Garibaldi is director of the federally designated biocontainment unit at Johns Hopkins Hospital, where he and others have been training for a pandemic for years. It’s where the sickest and most contagious patients are treated.
There are now four similar intensivecare units on four floors of the hospital, where coronavirus patients from Baltimore, as well as the hard-hit Washington suburbs, have been sent. Recently, doctors such as Garibaldi were caring for close to 40 patients, who stay for days or weeks at a time.
Garibaldi puts on and takes off special protective gear needed to go near COVID-19 patients under strict protocols to avoid infection.
But with limited protective equipment at Hopkins and elsewhere, care for patients is bundled into fewer visits to the bedside.
“I don’t believe we spend enough time next to the patient in general,” he said. “Now I’m working to maintain that sense of connection to everyone while I’m wearing two sets of gloves and a respirator and trying not to spend too much time in the room.”
Garibaldi uses video conferences to keep family members informed.
On the calls, he tells frightened people that doctors are still learning how respiratory disease can ravage someone’s lungs and move onto other organs. But the disease hasn’t always been predictable, and there are no specific treatments. They try different drugs like the hydroxychloroquine touted by President Donald Trump, but move on when they don’t help or new problems arise.
Everyone has witnessed deaths. Yet distancing measures mean hospital caregivers, too, are prohibited from huddling together to grieve.
“We are all mindful that there is a real possibility of burnout just because of what we’re seeing,” Garibaldi said. “We’re trying to figure out how to bridge the isolation gap not just for patients and families, but for us.”
The health care workers spend time with their own families and call each other. They set up Zoom conferences where the doctors and others can virtually be together and see each other’s faces, he said.
“Sometimes we don’t talk about coronavirus.”
GILCHRIST CENTER
In some ways, a death by the coronavirus can be similar to deaths by other diseases like lung cancer or COPD, with the same respiratory distress. Anti-anxiety medications can ease breathing. So can changing a patient’s position or cooling the room.
What’s unique, says Kristin Metzger, a hospice nurse at Towson’s Gilchrist Center, is the isolation.
In normal times, Gilchrist staff usually encourage families to spend as much time as they wish at the bedside of their dying loved ones. They can come 24/7, and even bring pets. Volunteers read, and offer music therapy and massages.
But in these times, most visits to the hospice are prohibited; families can come just once at the end of life. A garden is cordoned off with plastic tape. Those who do come to visit have their temperature taken at the door.
Gilchrist recently created a 10-bed unit on the ground floor of its Towson center to separate COVID-positive patients into one location among its three branches.
Here, staff members like Metzger carry the emotional burden in place of families, holding hands of patients when their loved ones can’t be there. Even those interactions need to be limited to ensure the safety of nurses.
For the first time in Metzger’s career, many goodbyes are happening via teleconference.
Metzger recently started setting up laptops for families to videoconference with patients. They can sit for hours on end, singing songs, reading Scripture.
For a moment, Metzger’s own face fills the screen — only her eyes visible beneath her layers of protective equipment. Still, through the layers of distance, she feels a connection.