Humboldt’s daily COVID reports are a heavy weeknight ritual.
First come statistics: How many community members died today? How old were they? We learn new hospital admittance numbers, and their ages, too, then confirmed case counts. We get news and survival tips: No more communitywide contact tracing; additional shots now available to the immunocompromised; please don’t take ivermectin. And finally, in every report, Public Health tries to persuade vaccine-hesitant locals toward a potentially lifesaving choice, with a promise that vaccination is the best way to protect yourself and your community from more days like these, and more reports like this.
One recent evening, after a particularly grim report, a nurse emailed the Outpost.
“I am an ICU nurse at Joe’s,” she wrote. “I would love to talk anonymously about my experience when it is applicable.”
It’s applicable now, we think.
“What I’ve seen over the last — I don’t even know how many months we’re into this — 18 months or so has changed me as a person,” the nurse, who we’ll call Iris, told the Outpost in a phone interview.
“I just wish people could understand what we see every day and what it is actually like to be a patient in the ICU, because it’s brutal, and if it’s one thing I hear time and time again from patients who are not intubated is that they have regret. And that’s, I guess, what led me to reaching out.”
Soon after, we reached a second nurse who works in the intensive care unit at St. Joseph Hospital, and she was also willing to anonymously share her experience. She’ll be called Teresa.
“It’s hard to even talk about this. It’s just so stressful. It’s easier to just shove it down and not talk about it,” Teresa said. “But at the same time, I do want to because I do think there are so many misconceptions about what’s actually happening and whether it’s even happening within our community.”
Staff at St. Joe’s aren’t allowed to speak to media about what it’s like inside. Iris and Teresa both emphasized that the conditions at St. Joe’s ICU are not unique. By sharing their experiences, they are not trying to expose any flaws with the hospital. They want Humboldt to understand the context behind those nightly numbers. They hope to help people avoid regret.
Here is Humboldt’s COVID, as told by St. Joe’s ICU nurses Iris and Teresa.
A virus evolved
Over COVID’s first year in Humboldt County, St. Joe’s ICU saw just a few COVID-positive patients at a time. At St. Joe’s and across the nation, healthcare workers stressed over PPE (personal protective equipment) shortages, ever-shifting Centers for Disease Control and Prevention guidelines, and the unknown threats of the novel virus.
Teresa: Obviously, in the beginning, everybody was scared. We didn’t know what was coming our way. We were kind of bracing for impact.
We had just kind of a slow and steady flow of patients that came in. And at that point in time, we were worried about PPE, but we had it. Our hospital actually has done a good job at providing that. We have really not been without it the entire time.
Everybody was concerned and careful, but there was a lot of fear.
Last year, the pandemic really hit our older folks. 80s, 90s. That was really hard because there were a lot of people that would write off these people that were in their 90s as if their lives didn’t matter anymore. And they did.
People said: “Oh, you know, it’s the end of life.”
I would argue that whether you’re 50 or you’re 99, those individuals still deserved to be given a chance. They still deserved their life and they still deserved to die with their family members.
Then things kind of settled down a little bit, and everybody was very hopeful with the vaccine that it might end altogether.
This year’s COVID is different than last year’s COVID.
Now the situation is we know that people with a vaccine are still getting sick, but they’re not ending up in the ICU, for the most part.
This time around, they’re younger people. They’re people with children, families. They’re not 80 and 90 — I mean, obviously, we have 80- and 90-year-olds that pass — but we have many that are middle-aged or younger.
Now we’re seeing death of people that shouldn’t be dying on almost a daily basis. And that starts to hurt your soul — especially when you know that they could get a vaccination and it wouldn’t have to be this way, that we could prevent some of these deaths.
Inside the ICU
Inside the ICU are twelve single-bed patient rooms with glass doors. A main nurses’ station and several smaller nurses’ stations are scattered throughout the unit, and there’s a workspace for a physician and another for a pharmacist.
There’s also the IMCU, a separate “mild” ICU unit the hospital added because of COVID. It has six beds and is staffed with two nurses, and is separated from the ICU.
The ICU is a closed unit, meaning its staff doesn’t venture into other parts of the hospital. Its rooms are filled with intensive-specific equipment, like ventilators. Because of COVID, each room has been converted into an isolation room. To do that, the hospital installed negative flow units — which prevent air from entering and circulating the hospital by directing it outside — in every room that didn’t already have one, sometimes removing windows to accommodate the equipment. Isolation carts stocked with PPE — like gowns, masks, gloves and face shields — are parked in the hallway outside each room.
Teresa: If you were to walk in the unit, you would see carts and people gowning up to go inside of rooms. You would see lots of engineering staff — they go around and test to make sure that the rooms are, in fact, negative flow and that there’s no flow coming out of the door into the main hallway.
Iris: All of the rooms are telemetry rooms. So they have a monitor that’s monitoring all sorts of data, but the basics are heart rate, respiratory rate, oxygen level, blood pressure — those are the main ones.
And that’s in the room, and that’s at all the other nurses’ stations, it’s hanging from the ceiling, so that we’re always — that’s why I try to reassure people — we’re always watching you. Even if it [feels] like you haven’t seen someone for a little while, we’re always keeping a close eye.
In ICU, you have a doctor (specifically, an intensivist, which is a physician who works solely in the ICU), you have a respiratory therapist, you have a pharmacist, and you have charge nurses (“in charge” nurses who manage the ICU), break nurses (nurses who tend to patients while staff nurses are on their breaks), staff nurses.
Teresa: [Intensivists] usually have a specialty of pulmonology or anesthesiology. They’re usually kind of the cream-of-the-crop physicians, and they have a ton on their plate. A ton on their plate.
Iris: While we each have our own patient assignments, we’re all working together to care for those patients.
Every bed is full.
Iris: We do 12-hour shifts. We do work from 6:00 to 6:30, plus or minus a little bit of time. Sometimes it’s extra.
We get our assignment. At this point, most of us are taking one, if not two, COVID patients.
We are rounding with our physician. We do that every day, where we talk about each patient on an individual level and kind of go over their body systems. And then [we discuss] what could we be doing next, what’s our plan of care? So that’s evaluated every single day, sometimes more often than just once.
Throughout their shift, nurses manage their patients.
Teresa: Typically that means that we are gowning up, going into these rooms — we have tons of PPE, so that’s not an issue — then gowning down and going into another one.
Several patients are sedated. Those on ventilators can’t easily speak.
Teresa: Many of them require flipping them over on their bellies, and that’s called proning.
Proning helps patients experiencing respiratory difficulties breathe and protects them from developing bedsores.
Teresa: There are a lot of things that come with proning, but it requires a huge amount of people to flip these patients back and forth between their belly to their back because they have breathing tubes and lines and all sorts of things. Many of them [are] on many, many, many drugs, from sedation to pressors to antibiotics.
Iris: We’re assessing. We’re passing meds. And we’re cleaning patients up…We’re doing all sorts of personal care to help keep someone at the best that we can, with whatever they’ve got going on.
Teresa: These patients are really, really intensive. That’s all I can say: They’re critically ill right now. Many of them are kind of holding on by their pinky.
Most people who become extremely sick with COVID develop hospitalization-worthy symptoms — probably not being able to breathe — between days 6 and 11, Iris said. Once they’re admitted, patients are first put on a BiPAP (short for Bilevel Positive Airway Pressure) machine, and then a ventilator if need be.
Iris: I think what strikes me the most about specifically non-intubated COVID patients — because those are the ones you can really interact with, they’re not receiving sedation or anything else — is how scary it feels to be that short of breath.
I can’t count the number of patients who, for whatever reason, they take off their BiPAP mask or their high flow falls out of their nose, and their saturation starts to drop. And what we see with most of these people — I mean, if you’re this sick to be admitted, specifically to the ICU — is their saturations on just room air, like you and I are breathing, are in the 80s or lower. In a normal healthy person, you should see them in the mid-90s to 100.
So that feeling of being hypoxic — without enough oxygen — and that feeling of not being able to catch your breath, like the hardest workout you’ve ever done and you just can’t catch your breath afterward, is frightening. And to just keep feeling that way — that’s a terrible way to feel. And the anxiety that people feel in conjunction with that? It doesn’t surprise me, because being short of breath or feeling like you can’t catch your breath is a very unnerving and unnatural feeling.
I can’t tell you the number of patients who then have regrets.
After four days in the ICU, one of Iris’s patients asked her a question: “Where do I go from here?”
Iris: I explained the settings that they’re on. They’re on a BiPAP, which is the face mask that’s delivering breaths for them. It’s loud, it’s noisy and it’s uncomfortable, it breaks down the skin around your nose, and it’s at its maximum setting. So the only place to go after this is intubation.
And they asked me: “What percentage of people are we seeing coming off the ventilators?”
Honestly, I didn’t know. I know it’s not great odds, but I had to go ask somebody else.
She learned that less than 20 percent of patients successfully come off ventilators.
Iris: Those are really scary odds.
And this particular patient told me that that is consistent with what they had researched, and they didn’t want that.
So that’s really hard. I mean, they made this choice that they felt like was in good faith, based on information that was false: to not get vaccinated. And now they themselves are kind of facing their own mortality.
As a nurse, I can be frustrated that they made that choice, but on a human level, I’m still caring for someone who’s really sick and is scared. And that’s hard. And it’s like that day after day after day.
Teresa: Many [patients], when they get to the point where they know that they’re going to go on a ventilator, have a breathing tube put in (same thing) — they’re scared. A lot of them regret not getting a vaccine. We have people that ask us for the vaccine at that point, which of course is too late.
But I see on social media people wonder about this.
She sees people speculate that unvaccinated people hospitalized with COVID-19 maintain pride in their choice.
Teresa: I would strongly disagree with this.
There’s nobody, that before you put the breathing tube in, says, ‘Well, I fought the good fight against the government.’ For whatever reason, many people on social media think that this is the case, and I can surely tell you that it is not the case. They’re sad. They’re scared. Many of them regret not being vaccinated in the first place.
And very few — not even very few — nobody sits there and says, ‘Fought the good fight against the government,’ like so many people seem to think.
Patients and their families
In this COVID age, visitors are not usually permitted inside the ICU. Recently, the hospital instituted an exception.
Teresa: When a person is passing, if [their family member] is fully vaccinated and has a COVID test, I think within 72 hours, they can sit at the door, outside of the glass, to view their loved one, which is terrible.
In that situation, or when family members are not able to come in person, they can talk to their loved one through a phone.
Teresa: Mostly these people have breathing tubes. Often the nurses will get the phone, and they’ll put the phone up to the patient’s ear, so that their loved ones can talk to them.
We do that all the time.
That’s heartbreaking. It’s really heartbreaking to listen to people say goodbye to their loved ones on a phone. It’s awful. It really wears you down.
The nurses watch their patients’ sickness progress, and hopefully regress, and communicate changes to families.
Teresa: We’re talking to families, day in and day out, all through the day, about their loved ones.
Iris: Everyone’s different, but on average, a family calls two or three times a shift maybe, probably more so on a day shift than a night shift. And then, of course, if something changes, we would reach out to them.
You’ve got families who can’t come in, and they’re scared at home — either sick or healthy — wanting updates. And so often it’s like, ‘No change, no change.’ It’s the long haul. We’re waiting ‘til something does change, hopefully for the better. But it’s scary.
Teresa: Families are often just bewildered how this could be.
They’re so bewildered that their loved one even has it, or that this is happening. You get a lot of: “I can’t believe this is happening”, “Why is this happening?”, “My loved one is healthy, I don’t understand.”
And we continue to try and educate them.
Iris: For the most part, people are really understanding, are grateful, really thankful. I’d say 95-plus percent of people are that way.
We have had a few instances of family members playing Dr. Google — where they’ve read something online, or they saw something on Facebook, or a cousin told them about something — and they get frustrated that we don’t practice Google medicine. We practice evidence-based medicine.
Teresa: Some [families] wonder if [their loved ones] even have COVID. A lot of them are very angry and upset. A lot of them have heard of all these viral ideas and medications that have kind of come down through Facebook and other avenues of social media; what their loved ones should take. So we often get requests for experimental drugs that have no studies done supporting their use. They often are very upset at us because they believe that we’re withholding these medications from their loved ones.
It makes for a very, very tricky situation.
It’s hard on us nurses to have these patients and families that are unwilling to take what they call an experimental vaccine, but they demand experimental medications, it seems.
I think that’s really hard on the staff because it doesn’t make sense to us.
As more patients seek help and the pandemic wears on indefinitely, St. Joe’s is facing challenges. They’re losing staff, and the beds are full.
Iris: We were busy before COVID was like this. I mean, a year ago, we had one or two or three COVID patients, but we still had 12 total patients [in the ICU].
It makes me wonder: Where are all those patients? What is happening to them? They’re not all elective surgeries. They’re people who are getting sick and needing intensive care for other reasons…various different disease processes or illnesses that require the same level of care. We’re full of mostly COVID, so we can’t offer those services. Just makes me wonder, where did all these other patients go? They’re out there somewhere.
Teresa: [If a new patient is] ICU status, and they need a bed, and we don’t have a bed? Well, if we have a patient that can be downgraded, we would downgrade another patient. Otherwise, we look for a place to transfer them to, which is very, very difficult right now, too, because every hospital is full.
Iris: I know there’s all this talk about ‘Oh, there’s so many available other beds!’ But you have to understand what that really means. In the actual ICU we have 12 rooms. There are other beds we can convert ICU beds, but that’s not ideal for so many reasons.
Remember that the ICU is a closed unit filled with specific equipment and staffed with physicians and nurses who specialize in intensive care.
Iris: Now, say they’re opening up beds in another part of the hospital. You don’t have those same resources, you don’t have people at your disposal to help care for the sickest of the sick. And that’s scary.
St. Joe’s is low on staff, too. Two of their three resident intensivists recently left the hospital, and nurses aren’t staying, either.
Teresa: Now we’re relying on what is called locums, and those are traveling physicians. We have kind of a revolving door of traveling intensivists that are coming on.
Our manager in the hospitals [is] actively recruiting, but it’s an incredibly hard time to recruit new nurses. We do have a lot of them coming on board, but that involves a lot of training, so the nurses that are already there are still having to pick up shifts to make up for the ones that left, until the new ones are ready to be on their own.
We’re all picking up shifts when we can. Because of the burnout, people are making different decisions. Possibly they don’t want to work as a bedside nurse anymore.
I’ve heard, throughout the hospital, a lot of people [are moving] back to where their family is. I think people have reprioritized what they care about through this whole thing. I think that’s not only happening here, within the hospital, but it’s happening across the board.
There is a lot of sadness because we have so many of these critically ill patients. We’re working harder, and so there’s more burnout. People are tired. At this point, it’s been kind of a long haul. And it doesn’t feel like there’s an end in sight, because there are so many people that choose not to be vaccinated for whatever the reason is.
It starts to feel a little hopeless when you see so many people dying, and still people [are] refuting that it’s even happening.
I think we (nurses) all talk with each other like, “If only people could see what’s actually happening, if only they could understand what’s happening here, they might change their mind.”
Outside the ICU
The messages that lead some to doubt COVID are everywhere, from Facebook to the sidewalk in front of St. Joe’s. It’s hard to avoid and it weighs on healthcare workers.
Iris: I’m frustrated with the amount of misinformation that gets disseminated amongst people, specifically on social media.
Teresa: We all felt repulsed by whoever decided to do that demonstration outside of the hospital. I think that that really hit a lot of the caregivers hard. And it hurt pretty badly, not only for the caregivers. I would imagine patients’ families might be hit by that as well.
That protest was advertised by an organization called America’s Healthcare Workers for Medical Freedom. Teresa heard from others that some protesters were wearing fake stethoscopes, though she didn’t see that herself. None of her coworkers she’s spoken with since recognized any demonstrators as local healthcare workers.
It just felt like a huge slap in the face, when there are people dying inside the hospital.
Iris: I think people forget that as nurses and practitioners and providers, we’re just people too. People you live with, in some cases, or your neighbors or friends of friends. We’re all one degree separated here in Humboldt.
I know there was an article in the Times-Standard, a month or so ago, about a gentleman who was in the ICU who has since changed his mind and convinced others to get vaxxed, and I applaud him. I wish more patients or their family members would speak up who’ve had that same experience.
I can say it all I want, and doctors can say it all they want, and things like that, but when we hear it from somebody and they describe their experience, I think it hits kind of a different tone with people.
We’ll keep doing what we’re doing. But it’s hard.
Teresa: I would like people to know that these are real people. These are your neighbors, the person that works at the restaurant, or businesses that you frequent. These are real Humboldt families, individuals, that are in the hospital and are dying unnecessarily. If it wasn’t for COVID, they would not be dying. And they are.
I think we lose touch and we think if it’s not happening to one of your loved ones — friends, family members — you think that it’s not happening.
Until it’s your family member, it’s unreal. But I assure everybody: these are real people — that we live with, that we live next to, that we know — that are in there, dying, or fighting for their lives.
The easiest way we could turn things around is by vaccinating.
I’m not pretending that you won’t get COVID [after] being vaccinated, but the likelihood of being in the ICU is drastically reduced. These people — or 99 percent of them — are unvaccinated. It’s the easiest thing people could do to protect their loved ones and their family.
If not doing it for yourself, do it for your family members. Humboldt needs to come together and support each other and fight for each other and unify in that we all love each other.
We can do this as a community.
I think that’s about it.