Stress on the front lines
Health care workers steadfast in face of devastating virus
The COVID-19 nurses at West Penn Hospital have learned one another’s breaking point — those wrenching moments when they just need to step away.
When one found her threshold, breaking into tears last spring, Jessi Showalter stepped in, taking on extra patients for 15 or 20 minutes so her co-worker could walk outside the Bloomfield hospital for fresh air.
“We try to alleviate some of that [stress] so that we’re all OK,” said Ms. Showalter, 26, a registered nurse from Vandergrift who volunteered to care for West Penn’s coronavirus patients starting early in the pandemic.
Ten months on, the hospital staff was treating two dozen COVID-19 inpatients Friday as Pennsylvania set another daily record for new cases of the disease: 11,763. More than 5,000 were hospitalized. Since March, more than 11,100 statewide have died.
For front-line hospital workers across southwestern Pennsylvania, the nation’s worst health crisis
in a century has brought emotional trauma, extraordinary work hours, a constant learning curve and perpetual efforts to keep the virus from following them home.
But it’s also meant profound bonds with ailing patients, a hopeful sense of mission and close reliance on one another, clinicians said in a series of conversations last week. None gave any inkling the pandemic had shaken their resolve to care for the sick.
“Everybody sometimes has to find a person to cry with, you know? I think that’s what we all know,” said Monica Krinock, 60, a charge nurse and clinical coordinator at Excela Health Latrobe Hospital. “It’s not like oneof us is going through it. We’re all going through it. Everyone knows whatthe experience is.”
While the hospital admitted a lot of elderly COVID-19 patients in the spring, now she’s seeing those in their 50s, said Ms. Krinock, of Blairsville, who started as a nurse’s aide in 1979. She estimated she’s cared for hundreds of people with the virus.
Masked at a conference table Friday morning, Ms. Krinock recalled happier days, like when the Latrobe staff gathered outside to send off their first recovered COVID19 patient after monthslong hospitalization. She’s also “had many husbands and wives,” not all of whom survived.
For one woman, the staff used FaceTime to host a virtual visit with family before she died. Her husband, also hospitalized, couldn’t attend the funeral because of his own COVID diagnosis. He succumbed, as well.
“It was heartbreaking,” Ms. Krinock said. “But it was rewarding to give the family a little bit of time with her.”
On the inside
Even as case counts surge, doctors and nurses are gaining more tools to help the sick. Overall patient outcomes should improve, said Dr. David Rice, the clinical director of COVID at UPMC Passavant in McCandless.
“That has definitely happened since the initial wave of patients several months ago. We’ve become more comfortable with managing them. There are more therapeutic options now,” said Dr. Rice, who doubles as director of critical care. “We were all just trying to learn as we went.”
Early on, he said, the biggest challenge was twofold: the disease’s unfamiliarity paired with fears about exposing staff and relatives. Many front-line workers isolated themselves at first, staying at hotels and avoiding seeing their relatives at all.
But “the upfront assumption that we all were going to get sick within a couple weeks just isn’t happening,” said Dr. Rice, 46, of Richland. Since they’ve realized that “the protective gear works,” he said, workers have allowed themselves to return home with routine precautions.
Still, much of COVID’s mystery persists. If the hospital admits two infected patients of the same age — and with similar disease exposure — one might be released in three days while the other ends up on a ventilator, Dr. Rice said.
That’s not the only uncertainty weighing on hospital COVID units. Some worry, too, about having enough staff as inpatient demand grows. Clinicians said work days already have stretched as long as 16 hours, and health authorities warned of likely staff shortages in the next week.
For many workers, a key concern is their own coworkers’ “getting sick and not being able to come to work,” said Claire Zangerle, chief nurse executive for the Allegheny Health Network. “That leads to staffing issues.”
Community hospitals in outlying areas could be especially hard hit because they have fewer options to add space and plug staffing gaps, said Dr. Amesh Adalja, a Pittsburgh-based infectiousdisease physician and senior scholar at the Johns Hopkins Centerfor Health Security.
“I think we have to think about Western Pennsylvania hospitals as a kind of coalition,” Dr. Adalja said. “It may be that we have to be much more creative about pooling resources so we don’t have any of these hospitals go down” without backup.
Beyond the sheer volume of need – COVID patients occupied about 35% of Excela Health’s beds last week, a spokeswoman said — workers face a nuanced process to care for each infected person. They suit up in thorough protective gear for inroom visits, coordinating to streamline foot traffic inside the negative-pressure quarters designated for coronavirus cases.
“It takes a lot [to serve] meals now,” said Ms. Krinock, who relished making a patient smile over the “man cave” in his hospital room. “I try to spend some time in there. You don’t want just to go in there and put the tray down.”
“The rooms aren’t the biggest,” she added. “If you’re hooked up to oxygen, you’re hooked up to an IV, your ability to go anywhere is limited.”
And with family access often restricted for safety reasons, nurses and doctors “definitely become part of the family,” Ms. Showalter said. When families exchange their final goodbyes through video calls or speakerphone, she said, the hospital staff is there.
“I’ve had patients I will never forget,” Ms. Showalter said, recalling a health-conscious man who tried to exercise in his hospital bed. “They still have hope.”
Finding relief
The traditional relationship between a patient and clinician can turn murky in these conditions, said Adam Sedlock, a licensed psychologist at UPMC Altoona. Although health care workers are trained to deal with death, many aren’t formally prepared to be a surrogate family member.
Mr. Sedlock expects a lot of them will need mental health care to cope with posttraumatic stress in the years ahead.
“Many [people] are dying in nurses’ arms and instead of family members’,” he said. “We have to gear up for this — in the aftermath — on a national basis.”
For the time being, workers said they’re finding their own relief mechanisms. Shutdowns at the start of the pandemic “really helped both my wife and I re-evaluate what was truly important to use in life and reconnect as a family,” said Dr. Kevin Bartolomucci, a graduate of and faculty member in the Excela Health Latrobe Hospital Family Medicine Residency program.
“I think that’s been the biggest takeaway: Now more than ever, I think I value that downtime at home to spend with my wife and my son and people that consider family, as well,” said Dr. Bartolomucci, of Greensburg.
Ms. Showalter said she still wants to spend her career as a nurse but might want to be in a hospice or palliative-care facility instead of an intensive-care unit. Seeing her patients’ resilience and deep desire to rebound and care for their families sticks with her, she said.
“People are always so different, but it always comes down to the same things: love and being cared for,” she said. “They are so fundamental to human life.”