As 2021 began, Salinas Valley Memorial Hospital, like many other healthcare systems across the nation and the world, was dealing with a terrible post-holiday surge of COVID-19. But hope was also on the horizon. In January 2021, COVID-19 vaccines were also becoming more widely available.
“Our hospital was at its fullest with COVID patients. We were at the worst point of the surge, and that was with the ‘original’ COVID, so the death rate was very high,” says Carla Spencer, Director of Critical Care & Emergency Services at Salinas Valley Memorial Healthcare System. “At the same time, the availability of vaccines and the push for people to get vaccinated brought some relief to our staff.”
Spencer said the winter surge was unpredictable and affected people of all ages. At times, whole families would be hospitalized, with several members never leaving the hospital.
Staff navigated this difficult period day by day, but the effects this surge had on them were not fully evident until things started to calm down in late winter/early spring 2021.
“One cannot fully appreciate or overemphasize the physical and psychological impact to our frontline clinicians during the surge periods,” says Lisa Paulo, MSN/MPA, RN, Chief Nursing Officer at SVMHS.
“The physical exhaustion of spending 12 hours or more having to not only constantly take on and off the protective gear, but to be forced to pull in your breath deeper with each sentence spoken to compassionately connect with a patient through the equipment noise while sweating under the gloves, gowns, eye protection and hood. The psychological overwhelm of an emotionally distraught family on Webex, unable to be present with their dying loved one, and being the surrogate family member as they transition from this life. Holding the hand of one dying patient only to then hold their family member’s hand for the same reason the next shift. Experiencing so much death in such a short period of time, and that split second of eye contact, sharing the visceral ache in that defining moment of clarity when hope is no longer.”
Paulo says encouraging and caring for so many patients as they gasped for the air most people take for granted – and watching them struggle with little to offer in comfort – has left a mark on these clinicians that will never be erased.
Despite the weight of this each shift, Paulo says, every nurse, physician, therapist and other care provider remained fully present, often working extra hours to ensure patient safety.
They remained steadfast in their commitment to extraordinary, compassionate, patient- and family-centered care, but the huge emotional burden was evident especially in units like Telemetry, where nurses typically monitor the heart rhythms and vital signs of patients with cardiovascular care needs.
These were often the staﬀ who had responsibility to care for COVID patients ﬁrst. They saw them when they were still awake and alert and developed a rapport with them. After forging that connection, losing many of these patients was devastating.
“That’s why, in the spring, we kicked oﬀ our programs promoting resilience and wellness – things to help with caregivers’ emotional health, like the 1440 Multiversity ‘Healing Our Healthcare Heroes,’ Care for the Caregiver, and Code Lavender programs,” Spencer says.
Hope in the Summer of 2021
In the summer of 2021, everyone started to get a little more hopeful. Cases dropped, the Centers for Disease Control and Prevention loosened masking recommendations, and a return to normal seemed possible. But it only took weeks for the delta variant to take over.
This very contagious variant and the resistance to vaccinations, still demonstrated by a large segment of the U.S. population, led to a surge. Delta seemed to be targeting a younger population and once again drove up hospitalizations, especially among the unvaccinated.
Luckily for SVMH, the delta surge wasn’t as devastating as the winter one. The hospital required only one COVID unit, and while staff treated some very sick people, deaths were rare.
Handling the Surge in the Fall/Winter of 2021
Things remained relatively calm for a while. But as the holidays approached again, a troubling rise in cases – fueled by the omicron variant – sparked significant stress among staff.
“Here we go again. That’s what we were all thinking,” Spencer says. “Suddenly, we were up to four units again. We were seeing nearly the same numbers as we had in January. But there was good news – omicron was milder.”
Spencer says far fewer patients required ventilators or died. Staff saw more people leave the hospital – which was a huge boost to morale.
“In time, we were down to one unit again. People were more hopeful,” Spencer says. “With boosters, and so many people getting omicron, we’re hoping we can begin to move on.”
Looking Toward the Future
While everyone wants to be done with the devastating medical, social and economic consequences of this pandemic, there is little reason to believe that the virus that causes COVID-19 is going away, according to Allen Radner, MD, Chief Medical Officer at SVMHS.
“Our initial focus on preventive interventions such as masking and distancing were intended as mitigation measures until we had had readily available safe and effective vaccines and therapeutics,” Dr. Radner says. “We now have the tools needed to prevent and treat the recognized circulating COVID-19 variants. Overwhelmingly, in our community and our county, COVID-19 hospitalizations are occurring in either the unvaccinated or the severely immunosuppressed, who were unable to mount a strong immune response to infections or vaccine. The more people who are fully vaccinated, the better it will be for everyone.”
Because of their experience through all these highs and lows, SVMH staff are better prepared to deal with whatever comes next.
“We’re like a well-oiled machine at this point. And one of the things we’ve done well from the start was to ensure there was always protection available for our staff,” Spencer says. “Now, we focus on resilience – the fact that we’ve made it to the other side and that our incredible teamwork, leaning on each other as we’ve dealt with sadness and tragedy, has made us stronger than ever.”
On the Front Lines
Steve Lisowski, RN, an ICU nurse at Salinas Valley Memorial Hospital, wrote the following article about the tragic experiences of many COVID-19 patients and their families.
Working in the COVID unit, Lisowski’s concern grew as he saw firsthand how severe the illness could be and the impact it was having on patients and their families. Meanwhile, his frustration grew at the outside messaging that COVID was “not dangerous” and that “most people would be fine,” as well as the level of misinformation and resistance surrounding the lifesaving vaccine. His heartfelt message has received local and national media interest and attention.
Imagine you wake up one day with a runny nose and fever. A day or two later, you feel worse. You get tested. You are positive for COVID-19. You’re given an inhaler and some steroids, sent home and told to isolate. If you isolate the way you are supposed to, you are no longer seeing your wife or kids.
In the middle of the night, you can’t catch your breath. Your wife asks if you need an ambulance. You finally say “yes,” even though you don’t want to be taken to the hospital.
The ambulance crew arrives wearing N95 masks. They put a pulse oximeter on your finger. Your oxygen saturation is 82%; 90% or above is considered normal.
At the hospital, you are isolated. You call or FaceTime your wife and speak in short sentences because you are having a difficult time breathing. You tell her you love her and not to worry.
You try to sleep but you are having trouble. A nurse tells you to lay on your belly. It is uncomfortable.
You get up to use the bathroom and can barely make it there. Your oxygen saturation has dropped to 78%. The respiratory therapist (RT) comes in and tapes a nasal cannula to your face, which blows high levels of concentrated oxygen into your lungs. You call your wife and you both joke about how you look. She is worried. You tell her not to be; after all, 96% of people survive COVID-19. You will be fine.
You keep feeling more and more winded. You’re missing your wife and kids. You can’t even stand without feeling weak and horribly out of breath. The monitor constantly rings.
One morning you have a coughing jag. You panic because you can’t get enough air. The RT comes in and puts a full mask for oxygen on you. It’s like being a fighter pilot and it’s scary. You breathe better, but now you cannot eat. Your wife calls but she can’t understand you. The doctor tells you they will need to transfer you to the intensive care unit. You text your wife not to worry and provide her the new room number.
One morning, a critical care physician walks in and says because of how you are breathing, your muscles will tire out. They need to put a tube down your throat to help you breathe. He asks you if your heart should stop, would you want everything done to save your life. He explains that if your heart stops because of COVID-19, there’s little chance things can improve. You realize you would not want to be kept alive by machines only. They change your code status to Do Not Resuscitate.
You call your wife and tell her the news. She’s crying and looks like she hasn’t slept in days. Your oldest child is very worried and constantly interrupts. Your youngest child plays in the background. This is the last time you will see them.
Several people come into your hospital room. A bright light is turned on and the intensivist towers above you, telling you not to worry. They give you a medication to put you to sleep. You look around and then everything fades to black.
I don’t know if you dream. You can’t tell me if something is hurting you. I don’t know what happens when you start to wake up when we try to turn down your sedation and you look at me, wild-eyed and panicked. I try to comfort you. You are counting on me, and I will do my best.
I do know how worried your wife has been every time she calls. She hangs on every word. She is hopeful I will say something positive. I assure her we are doing everything we can, but your chest X-rays keep looking worse. We are treating your fever. We have to keep increasing your oxygen on the ventilator.
You are not getting better. Your wife and maybe your oldest child get to see you on a video call, with all these tubes in you. Do you know they are there? They try their best to sound positive. I can see how tired and cried out your wife is.
One day, a palliative care doctor calls your wife. I hear him talking to her in hushed tones. He is compassionate and honest. The next day the hospital allows your wife to come see you. This is a farewell.
She can only be in the room for a few minutes. She is crying, stroking your hair and touching your arm. I look away. I have to hold it together. You are both counting on me.
Everyone is being very supportive. Your wife can’t decide if she should look back. We understand how hard this is. We know she is barely hanging on.
Did you feel her touching you? Did you hear her say goodbye? Part of me wants to think yes, but a bigger part of me hopes you are not aware of any of this.
We give you some medication and withdraw the tube. You don’t stay with us long. The monitor is screaming at us to do something, but there is nothing else we can do for you.
We stand there a minute or two. This is never easy. Some of us say a silent prayer. Maybe someone strokes your hair, one final touch as you’re going wherever our spirits go.
Another patient is coming. It’s time to move on. We have more work to do. Maybe we can save this next one.
GET THE VACCINE!