Editor’s note: This is the second in a series of two reports about COVID-19’s impact on Brookings Health System over the past year.
BROOKINGS – COVID-19 was like nothing the health care industry has seen before, and Brookings Health System employees were not spared. They battled through a surge in COVID cases last fall, giving the same high level of care as always, through shortages of equipment and staff, and emotional ups and down.
Jaclyn Rauen, RN; Celene Hirrschoff, RN; and Derick Johnson, respiratory therapist supervisor, are just three of BHS’ staff who had to learn new ways of doing their jobs, fought to save patients and educate the public through the pandemic.
Critically ill patients
COVID instilled fear in patients and wore down staff.
“I remember my very first COVID-positive that was gonna get admitted and he said, ‘I don’t want a vent, you don’t waste a vent on me.’ At that time, we had plenty of vents, but it was scary to him to the point that he was already planning on passing from this. That was heart-breaking,” said Hirrschoff, who’s an emergency room nurse.
“The bad thing about the ER, you don’t know what they have when they come in. You’re just rolling the dice,” Johnson said.
People often don’t know or won’t tell staff exactly what’s happening.
“And it would present weird, too,” Hirrschoff said. “A lot of people would come in with GI (gastrointestinal) issues and you would never guess they had COVID and sure enough.”
“People’s perspective was different with this. When they’d come to the hospital, they’re like ‘I’m gonna die,’” Johnson said. “The majority of the people survive COVID.”
Not all of them stayed in the hospital; some were sent home with oxygen.
“Before, if they needed oxygen … they always stayed in the hospital,” Johnson said. “They couldn’t be on death’s (door) obviously, but they would have to be where they didn’t need a ton (and were) able to handle that at home.”
There were programs to help assess the patients while they were on oxygen at home, he added.
“I think part of the reason those programs were started was we needed that bed availability. We couldn’t keep all of those patients in the hospital,” Rauen said. “So we had to triage some of those patients.”
“They still may end up coming back,” Hirrschoff said.
COVID did not always have an expected recovery path.
“We saw several of those patients that came to us, we thought they were doing better; they went home, and we saw them on week 2 and they unfortunately didn’t survive,” Rauen said.
“In two weeks, they would be at the point where they were on so much oxygen, so much support, that they were just struggling just to stay alive,” Johnson said.
“It became all too common to have your patients deteriorate on your shift and these people don’t want to pass away. They didn’t come here to pass away. They came here to get better and we’re trying everything we could,” Rauen said.
“One of the things that we learned, we learned to deal with death because death was happening more frequently,” Johnson said.
They also learned to celebrate the victories.
“There’s certain patients we celebrated when they went home, and those were awesome days,” Rauen said, adding staff would line the hallways to see them off.
“Those were why you do this job,” Hirrschoff said.
“This gives me goosebumps … when that guy that walked out, I said, ‘We need you,’” Johnson said.
“We needed him to get through the pandemic. We needed to see that hope, ‘cause there was lots of days where there was not a lot of hope,” Hirrschoff said.
Not like anything else
Normally, patients follow a recovery pattern that medical professionals are familiar with, but COVID threw everything for a loop.
“It wasn’t the normal progression that we saw with respiratory illnesses,” Johnson said.
“Derrick and his RT, they worked in overdrive during our surge,” Rauen said.
“They are vital to our COVID recovery, vital to us feeling like we could do it,” Hirrschoff said.
The thing all three remember most about the COVID patients was the level of fatigue. Johnson added fatigue was one of his symptoms when he got COVID.
“They couldn’t lift their head up,” Hirrschoff said.
The oxygen needs of a COVID patient don’t even compare to influenza, Johnson said.
In a normal day, Johnson and his staff see patients with COPD, congestive heart failure, influenza, asthma and other chronic issues. Those patients might use two or three liters of oxygen, he said.
For COVID, “we were running patients on 60 liters of oxygen,” Johnson said. “I guarantee that we have never ever consumed so much oxygen in this hospital’s history.”
It was as if their bodies couldn’t absorb the oxygen, he said.
“It felt like they were suffocating,” Johnson said. “If they were to do anything or move, their oxygen demands would go up and then they would just feel, again, they were being suffocated.”
Movement could drop a patient’s oxygen intake to dangerously low levels, which is an emergency, Rauen said.
“We had patients accidently remove their oxygen and then it was a race against time to get back in there and get their oxygen back on before they didn’t have any reserve left,” she said.
Before, it would be multiple people running into the room; post-COVID, it would be one person who would have to take the time to put their gear on and follow all the protocols, Hirrschoff said.
“That was a hard mentality to wrap your head around, too,” she said.
“But we had to do it to protect our staff,” Rauen said.
“Otherwise, we become part of the problem and not part of the solution,” Johnson said.
More than medicine
Medical staff give patients more than medicine, they give emotional support. That was never more important than during COVID, when visitors were prohibited from the hospital.
“When we restricted visitors in the hospital, that was a huge change for staff. We were used to relying on family to give us some guidance” on what patients were normally like “or involving them in the care,” Rauen said.
“When we took away visitors, we really noticed that as a staff, it made our job much harder,” Rauen said. Staff was using telephones and various social media platforms to communicate with the family about how the patient was doing because the family couldn’t physically see loved ones.
Staff know the grieving process starts well before the patient’s actual death.
“It’s a huge component of making sure they have a dignified, comfortable death. And that wasn’t the case when we restricted visitors and when COVID was at its peak,” Rauen said.
“We had family on FaceTime while patients passed away,” Rauen said, adding sometimes only one staff member was able to be in the room. “Our team was emotionally their family while they were here.”
The staff walked a fine line with patients.
“We’re trying to keep their hopes up but be realistic with them,” Rauen said. “So it was just a weird mix of emotions, trying to be that cheerleader but also trying to prepare them that this could go a different route.”
“For staff to take on that emotional responsibility is very draining,” Johnson said.
Not the end yet
With the vaccine rollout and more people getting the jab, the COVID numbers have gone down, but the three said they are still seeing COVID patients.
“This is still going on … patients that are coming in that need the same level of care that we had before,” Johnson said.
They want people to remember COVID is still out there with new strains. The rules for warding off infection still apply.
“We know what works, why not just keep doing what works?” Johnson said. Humans need interaction, he acknowledged, “but we just need to be smart about it because we are not done.”
“The vaccine isn’t your golden ticket, either,” Hirrschoff said. “It’s a tool in our toolkit.”
There are many things that aren’t known, Johnson said, like how long does immunity from the vaccine last, and how long it will prevent the various COVID strains.
Masks are a tool that help prevent spread, he said, adding he still wears one when he goes out.
“I just think moving forward, everyone just has to be diligent about still preventing the spread of COVID. We’re not through all of it yet, we still have COVID patients coming in and everyone just needs to be smart, try to do their best to prevent the spread of it,” Rauen said.
“There’s a lot of things we know about COVID now: social distancing, washing your hands, wearing a mask, getting a vaccination,” Rauen said. “We need all of those factors to limit the spread of COVID. So the vaccine might not be the be-all, end-all, but it’s a tool that we have to hopefully … we don’t go back into the days of our COVID surge.”
And they are still feeling the effects in other ways: They are now seeing people, some with chronic conditions, who put off treatment.
“People feared the hospital,” Johnson said, thinking they might catch COVID.
“Now, a year later, they’re paying the price for it and we’re seeing people sicker than they have been,” Hirrschoff said. “It just feels like as an ER nurse, that we’re doing bigger things than we did before, on a more regular basis.”
If anything good came out of the pandemic, it was the support BHS received from the community, they said.
“I’d like to thank the community for their support,” Hirrschoff said. “The community as a whole, I felt like definitely showed appreciation and even people that were coming to the ER for non-COVID reasons …”
“They were patient, they knew we were doing the best job that we could,” Rauen said.
“The community was fantastic at supporting the hospital,” Rauen said, adding businesses would bring them lunch and drinks, and kept “our breakrooms well-stocked with encouraging messages and treats.”
“I would say you felt very loved and appreciated,” Hirrschoff said.
Contact Jodelle Greiner at [email protected]