I’ve been asked by all my loved ones, my family and friends, what it has been like. Now that I spent one day on ‘Team E’, the COVID team (both confirmed cases and those being ruled out but sick enough to require hospitalization), it still remains pretty hard to describe but I can try to write down some thoughts. Of note I’ve done so much less than other people.
Hospital life has truly turned upside down. Every aspect of what I’ve been trained to do -and do well- every convention and protocol and all the structure, is literally gone. Both physically and mentally, the space has changed in the most palpable way.
Almost every patient room door is now closed and has 4 signs on it- denoting that it is an isolation room with a COVID patient (again, either confirmed or being ruled out. A lot of the cases we’re ruling out, almost certainly have it though- we can already just tell based on signs and symptoms). For now, each COVID patient is being roomed separately. Though eventually (soon) we will probably have to cohort multiple positive covid patients together, just given the numbers. So on a door there’s a stop sign to catch your attention, a sign in sign (which we’re not really using- a pen would be another thing requiring disinfecting), and then a sheet or 2 describing how to wear our PPE (personal protection equipment) properly.
I haven’t been down to the ER or this area we denote the EW which used to act as a low acuity ICU but is now entirely a respiratory unit. As is the ER. They’re both only for patients with respiratory symptoms. I’ve heard they’re both very intense places now.
Basically yesterday, on Team E, my friend/colleague Jon, 2 PAs and I went down a list of 20 patients and saw all of them. The PAs stayed outside and wrote notes, fielded and made calls, handed us supplies, put in orders… and Jon and I (sometimes both of us, sometimes one of us) gowned up and went into each room.
Throughout the day, there were probably 5 SPRT (special pathogen response team) alerts. They’re like the rapid responses/codes I’ve told a lot of people about, but they’re on the COVID patients, and instead of a dozen or more people rushing in the room, since we are being careful with preserving our PPE, only 2 or 3 of us go in (2 doctors, a nurse, a respiratory therapist) and everyone else stays outside and peers in through the door window. The anesthesiologists (who intubate) are part of that group who stay outside- waiting for the go ahead as to whether or not we think the patient needs a breathing tube (a sacred vent) immediately. Thank gd no one needed that escalation of care at the SPRTs yesterday.
All the patients have similar symptoms (though they don’t all have all of them)- bad headache, myalgias (muscle aches), high grade fevers, dry cough, and difficulty breathing. A lot of them have diarrhea too. And we’re noticing that there are a couple patterns in terms of how patients do, like how their illness evolves.
But the scariest symptom is the hypoxia -low oxygen- as patients just become more and more hypoxic over time, some leveling out and some crashing typically around day 7-10 (my sense at least). Again, that’s day 7-10 of symptoms, so if they come in on day 3 or 4 you have to account for that.
Now of note these people who are hospitalized have a coronavirus *pneumonia*, which is different from the pattern that people have in the community, the pattern -thank gd- my colleagues and I would almost certainly get.
It’s jarring how many patients there are… that we have a zero visitor policy in the entire hospital (so hard to be sick alone). During a SPRT yesterday with a 32 year old patient who was doing really poorly (she has end stage renal disease so has an underlying illness), in the room it was Jon, me, a nurse, a respiratory therapist, the patient (solely Spanish speaking), and on her sparkly pink iPHONE, her brother- translating and asking questions. Doctor, is she ok. Doctor, how are you treating her. Doctor, can I come in and be there with her. In this moment, I think she will be ok. In this moment, we don’t know how to treat her. In this moment, I am so so sorry but no, you cannot be here with her. So incredibly stressful for patients and their families.
It’s a process to don (put on equipment) but also doff (very carefully take it off). It’s the doffing piece of it that matters, because at that point the equipment has come into contact with the patient. It’s hard to balance when we’re beside with the patients these priorities. Because I’m so wired by that convention, structure, skill, bedside manner that I mentioned earlier. You go in and you want to get close and hold the patients hand or stroke their shoulder. But you’re also making sure the patient has their own mask on, that yours is on tight, that you are safe.
Hospital life has truly turned upside down. Every aspect of what I’ve been trained to do -and do well- every convention and protocol and all the structure, is literally gone. Both physically and mentally, the space has changed in the most palpable way.
Almost every patient room door is now closed and has 4 signs on it- denoting that it is an isolation room with a COVID patient (again, either confirmed or being ruled out. A lot of the cases we’re ruling out, almost certainly have it though- we can already just tell based on signs and symptoms). For now, each COVID patient is being roomed separately. Though eventually (soon) we will probably have to cohort multiple positive covid patients together, just given the numbers. So on a door there’s a stop sign to catch your attention, a sign in sign (which we’re not really using- a pen would be another thing requiring disinfecting), and then a sheet or 2 describing how to wear our PPE (personal protection equipment) properly.
I haven’t been down to the ER or this area we denote the EW which used to act as a low acuity ICU but is now entirely a respiratory unit. As is the ER. They’re both only for patients with respiratory symptoms. I’ve heard they’re both very intense places now.
Basically yesterday, on Team E, my friend/colleague Jon, 2 PAs and I went down a list of 20 patients and saw all of them. The PAs stayed outside and wrote notes, fielded and made calls, handed us supplies, put in orders… and Jon and I (sometimes both of us, sometimes one of us) gowned up and went into each room.
Throughout the day, there were probably 5 SPRT (special pathogen response team) alerts. They’re like the rapid responses/codes I’ve told a lot of people about, but they’re on the COVID patients, and instead of a dozen or more people rushing in the room, since we are being careful with preserving our PPE, only 2 or 3 of us go in (2 doctors, a nurse, a respiratory therapist) and everyone else stays outside and peers in through the door window. The anesthesiologists (who intubate) are part of that group who stay outside- waiting for the go ahead as to whether or not we think the patient needs a breathing tube (a sacred vent) immediately. Thank gd no one needed that escalation of care at the SPRTs yesterday.
All the patients have similar symptoms (though they don’t all have all of them)- bad headache, myalgias (muscle aches), high grade fevers, dry cough, and difficulty breathing. A lot of them have diarrhea too. And we’re noticing that there are a couple patterns in terms of how patients do, like how their illness evolves.
But the scariest symptom is the hypoxia -low oxygen- as patients just become more and more hypoxic over time, some leveling out and some crashing typically around day 7-10 (my sense at least). Again, that’s day 7-10 of symptoms, so if they come in on day 3 or 4 you have to account for that.
Now of note these people who are hospitalized have a coronavirus *pneumonia*, which is different from the pattern that people have in the community, the pattern -thank gd- my colleagues and I would almost certainly get.
It’s jarring how many patients there are… that we have a zero visitor policy in the entire hospital (so hard to be sick alone). During a SPRT yesterday with a 32 year old patient who was doing really poorly (she has end stage renal disease so has an underlying illness), in the room it was Jon, me, a nurse, a respiratory therapist, the patient (solely Spanish speaking), and on her sparkly pink iPHONE, her brother- translating and asking questions. Doctor, is she ok. Doctor, how are you treating her. Doctor, can I come in and be there with her. In this moment, I think she will be ok. In this moment, we don’t know how to treat her. In this moment, I am so so sorry but no, you cannot be here with her. So incredibly stressful for patients and their families.
It’s a process to don (put on equipment) but also doff (very carefully take it off). It’s the doffing piece of it that matters, because at that point the equipment has come into contact with the patient. It’s hard to balance when we’re beside with the patients these priorities. Because I’m so wired by that convention, structure, skill, bedside manner that I mentioned earlier. You go in and you want to get close and hold the patients hand or stroke their shoulder. But you’re also making sure the patient has their own mask on, that yours is on tight, that you are safe.
Shared this. Thank you! It is an honor to work with you at Bellevue
ReplyDeleteI haven't been able to write back to this comment.. some bug. But a delayed thank you so much. It is an honor working with you too, but what amazing Bellevue nurse is this? <3
ReplyDelete