‘It was coming for us’

Brookings Health System photo: Inpatient Care Nurse Kim Gray, RN, discusses a patient’s status with Respiratory Therapist Janie Isham outside an ICU room at Brookings Hospital this past fall, when Brookings County saw its biggest surge of COVID-19 patients.

Local hospital workers risked own health to stay at COVID patients’ sides

Editor’s note: This is the first in a series of two reports about COVID-19’s impact on Brookings Health System over the past year.

BROOKINGS – They haven’t seen the end yet, but staff members from Brookings Health System hope they are through the worst of the COVID-19 pandemic. 

“I don’t want October and November ever again. Nobody here does,” said Derick Johnson, respiratory therapist supervisor.

“There were certain days where we felt really defeated. We had multiple deaths in a row for days in a row,” Jaclyn Rauen, RN, said, adding staff stepped up. “They were amazing. We held lots of hands as (patients) took their last breath. … Our team sang them into heaven.”

“We became their family,” Celene Hirrschoff, RN, said. “How do you not love them like family? That’s our job. We just did it more than probably ever before.”

Hirrschoff is an emergency room nurse. Last year, Rauen was a floor nurse in BHS’ Inpatient Care Unit and took care of COVID-19 patients; she was promoted to director of Inpatient Care Nursing in January. Since COVID-19 affects the breathing of patients, Johnson and his team were vitally necessary.

The three spoke to The Brookings Register about how COVID completely changed how the hospital was structured, how staff cared for patients and how the pandemic pushed them to the brink physically and mentally.

COVID-19 struck globally and big city hospitals got national attention, but Brookings Health System faced its own onslaught.

“Our team has done all that has been asked of them during this pandemic for our community, plus more,” Jason Merkley, Brookings Health System president and CEO, wrote in an email to the Register.

“They’ve gone beyond their profession, not only giving high-quality care, but giving of themselves in ways they never imagined would be asked of them when they went into healthcare. I’m proud of and grateful to them for how they have answered this historic call,” Merkley wrote.

Like nothing else before

Doctors, nurses and other medical professionals are trained to deal with sickness and injury, like accidents. They have annual training for situations like active shooters and mass casualties. Handwashing is standard practice, latex gloves are everyday wear, but masks were situational before COVID-19.

Rauen said it was in early March 2020 when the country started hearing about COVID-19 cases that BHS started making changes to policies and implementing more training for nurses. 

“We kind of anticipated the worst,” Rauen said.

Masks became automatic all-day wear, “with the specialized masks for COVID patients,” Rauen said. 

Nurses were trained on how to handle COVID patients and their special needs. All of the inpatient care team was trained to manage ventilators and medication. 

Johnson and his respiratory team were tasked with fitting everyone with masks, including the cleaning staff and dietary staff, people who hadn’t worn masks.

BHS formed “a kind of a task force” to look into current research, find out what staff would need, and “what we were gonna do with additional patients if we couldn’t fit them all in our hospital,” Rauen said.

Every medical facility was looking at ways to prepare, Johnson said, even considering what would be done “when Sioux Falls was really bad” and brainstorming infection control procedures just in case.

“The providers and the staff were learning, reading, educating, trying to figure out if they’re doing it this way, what’s working, what’s not working,” Johnson said.

The local hospital learned from colleagues across the nation and in other countries, what worked and what didn’t, Rauen said. They saw the shortages of personal protective equipment (PPE) and ventilators, medications and other supplies. 

“We knew it was coming for us,” Rauen said.

They had to think ahead to how they could adapt the different areas of the hospital to meet any needs that could arise, Johnson said. Hospitals have always had cleaning standards, but now everything in every room had to be sanitized, adding to the time crunch.

“There was a lot of planning going on,” he said. “I don’t think the changes ever stopped.”

New protocols

Areas of the hospital were set apart to keep COVID patients separate from other patients because COVID was more contagious than other illnesses. Strict protocols were enacted for staff. 

Pre-COVID, nurses and other staff went from room to room as needed, with standard precautions. After COVID hit, BHS limited the staff who could be in the rooms. If nurses were assigned to care for COVID patients one day, the only patients they saw were COVID patients. 

“Nurses didn’t cross between COVID rooms to surgical rooms,” Rauen said, adding you didn’t go into the obstetrics ward unless you were an OB team member.

This meant more of a workload, they said.

“That’s our biggest change in the ER,” Hirrschoff said about routines before COVID. “In the ER, you work as a team. … You might have three to four nurses in there, the ER doctor, the respiratory care, the lab person, the radiology. All of them are in that room, and you do everything you can in a quick hurry. 

“COVID happened and all of a sudden, we were like a one-man show,” Hirrschoff said. “We’re doing the lab work, and you were setting the person up for an X-ray through the window and you were doing the EKGs when respiratory would normally do it, so it was a big change of process because we were trying to protect the rest of our teammates.

“So a process that we would normally do in 15 minutes of (patient) arrival would take us an hour and 10 minutes (after COVID),” Hirrschoff said.

Cutting down on personnel also cut down on the amount of personal protective equipment (PPE) used, which was crucial because they were running short, Rauen said.

Staff, families in danger

During this whole time, staff lived in fear for their own health.

“What was scariest in that October, November, December time was there wasn’t a vaccine available,” Rauen said, “so we were essentially risking our lives going into these COVID rooms, knowing that we were gonna give full care to these patients that had COVID and treat them no different, but there’s still that fear of taking it home to your family, taking it home to your parents.

“I mean, we were seeing people our age, we were seeing elderly people, people as old as my parents, getting really sick from COVID. So while we were stretched really thin, working really hard to care for these people, there was in the back of your head this fear that you were gonna take it home and get one of your family members just as sick as the people you were caring for,” Rauen said.

“I was scared to sleep next to my husband, even when I felt fine,” Hirrschoff said. “I felt confident that the hospital was protecting me all along, but I also felt like it’s just a matter of time before I get it. How do you avoid it when you’re around it all the time?”

It was just a matter of time: both Hirrschoff and Johnson contracted COVID. 

“I literally didn’t do anything for five days,” Johnson said. “Then it took a while to recover after that even: limited mobility, no energy, complete fatigue.”

When staff members got sick, that put more strain on the ones remaining to take care of patients. In Johnson’s case, his five-member team was left to carry the load, raising the ratio of patients to staff member even more.

A really tough thing for them to deal with through the past year has been the misinformation.

“I heard people say, ‘This isn’t real,’” Johnson said, incredulous.

“In October, I shut off my social media I was so frustrated … because I just couldn’t handle all the outside opinions when we were in the midst of it,” Hirrschoff said.

“It took a toll on lots of different patients and staff,” Johnson said.

Autumn surge

It really hit in fall 2020.

“It just kind of … exploded,” Johnson said. 

“October, November, December was our surge,” Rauen said. “We were asking nurses to work up to five 12-hour shifts a week, instead of their three 12-hour shifts a week, which is full-time.”

“We were put to the test,” Johnson said. “I don’t think anybody realized the influx that we really did have.”

One weekend, the respiratory department “used every piece of equipment we had,” Johnson said, adding he was forced to look for equipment he could borrow.

“Our equipment was maxed out,” Hirrschoff said. “Everything we could put our hands on was being used.”

“I know the community maybe thought we only had one to two (COVID patients), but we had beds full of really sick COVID patients,” Hirrschoff said.

“It was just like handling multiple ICU (Intensive Care Unit) patients,” Johnson said.

“There were times that we had 11 or 12 COVID patients,” Rauen said. “Very hard days.”

“At our peak, we had somewhere in the teens (for number of COVID patients),” Hirrschoff said.

The trio said the reports on the COVID beds and “80% capacity” were misleading. 

“It’s like 80% is max staff. It was taxing,” Hirrschoff said. 

“We were at maximum capacity for what the hospital (was) intended for,” Johnson said. 

“Some of the naysayers would say ‘there’s still beds available.’ No, there’s not,” Hirrschoff said, frustration ringing in her voice. “We would have a stroke patient in the ER for hours because there was nowhere to send them. And hours are important.”

The hospital didn’t stop caring for non-COVID patients.

“We had patients that were being cared for in other departments that would typically be in our department, but we had to kind of divert them to a different floor, a different unit to care for them,” Rauen said.

Contributing to the bed shortage and overworked staff was the fact some patients that BHS would normally have sent to Sioux Falls couldn’t be taken there.

“Cardiac patients and stroke patients that weren’t appropriate to stay in Brookings because we don’t have a cath lab, but they didn’t have room in Sioux Falls to even accept these people,” Hirrschoff said. “Sioux Falls just didn’t have the staff to take these people.”

“And we were, at the same time, taking (Brookings area) patients back from Sioux Falls … because Sioux Falls was so full that they were transferring people back to Brookings, which is typically not the case,” Rauen said, adding it was being done so Sioux Falls hospitals could take Brookings’ very sickest patients.

No matter how hard it was or how many setbacks they faced, the staff at BHS continued to do their jobs and support their patients in every way.

Contact Jodelle Greiner at [email protected]

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