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‘The front line is failing us’: Regions ICU handles severe COVID cases – TwinCities.com-Pioneer Press

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Nov 29, 2020

  • Nurses get ready to enter patient rooms in an intensive care unit of Regions Hospital in St. Paul, Tuesday, Nov. 24, 2020. (Scott Takushi / Pioneer Press)

  • COVID-19 patient Norman Brunn, 93, of Circle Pines lies in bed in the Regions Medical Unit of Regions Hospital in St. Paul, Tuesday, Nov. 24, 2020. At Regions, there are 90 patients hospitalized with COVID, many unable to breathe without being intubated with a breathing tube or being laid flat on their stomachs. (Scott Takushi / Pioneer Press)

  • Registered nurse Gail Gachalian puts on personal protective equipment before entering a patient’s room at Regions Hospital. (Scott Takushi / Pioneer Press)

  • A patient’s preferences are listed on the window of a room in an intensive care unit at Regions Hospital. (Scott Takushi / Pioneer Press)

  • Registered nurse Hayleigh McLellan holds the hand of a COVID-19 patient in an intensive care unit of Regions Hospital in St. Paul, Tuesday, Nov. 24, 2020. (Scott Takushi / Pioneer Press)

  • A patient is transported down the hall of in an intensive care unit of Regions Hospital in St. Paul, Tuesday, Nov. 24, 2020. (Scott Takushi / Pioneer Press)

In an ideal world, the nurses in Sara Yernberg’s overflow “surge” intensive care unit would be assigned one to a room, each caring for a single patient.

“Here, we’re so stretched, we have nurses with two patients, and some have three,” said Yernberg, a 33-year-old nursing manager at Regions Hospital in downtown St. Paul, standing in front of patient rooms containing some of the sickest COVID-19 sufferers in the state.

Yernberg and her colleagues have been bracing for a grim milestone, one that’s fast approaching. At Regions, the number of COVID inpatients hospitalized at any one time peaked last May around 65 patients, then sometimes fell as low as the teens over the summer.

On a blustery November day, two days before Thanksgiving, even as millions across the country prepared to fly out to visit family for the holidays, there were 90 Regions patients hospitalized with COVID, many unable to breathe without being intubated with a breathing tube or being laid flat on their stomachs.

Yernberg, whose unit is largely made up of nurses pulled off other units or called in for overtime and double shifts, knows it’s only a matter of days before that COVID patient load grows to a record 100, and then climbs higher still.

“This is not normally an ICU, but now it is,” she said.

THE END OF THE LINE

If there is one thing that the doctors and nurses at Regions agree upon, it’s this: They are not the front line against the novel coronavirus that has claimed the lives of more than 3,300 people in Minnesota alone since March. They are the end of the line, the last stop before a slow and difficult recovery, or for many, the morgue.

For these workers, the public is the front line. Elected leaders are the front line. Everyday people who choose to congregate at length, maskless, indoors, are the front line. And far too often, says Dr. Charles Bruen, a cardiovascular intensive care specialist, “the front line is failing us.”

It’s a statement that makes Dr. Sara Spilseth, chief of staff for Regions Hospital, nod in agreement. As beds fill with COVID-19 patients, there’s little room for routine health maintenance, or even chemotherapy and other priority medical services.

COVID is forcing ambulances to divert to far-off hospitals with available beds, and striking such fear in the hearts of pneumonia sufferers, they’re choosing to delay care until they show up at the hospital “almost to the point where they need a breathing tube,” Spilseth said.

HealthPartners, which runs Regions, has issued public statements urging residents to continue handwashing, social distancing and wearing masks that go above the nose and below the chin. At Regions, some wonder if the message is falling on deaf ears.

“We’re not the front line,” Spilseth said, during a hallway conversation with Bruen. “We’re the last line. When we say the front line is failing us, it’s our population, it’s our community. When we can’t be here, that’s going to be a bad day for Minnesota.”

HEALERS NOT ACCUSTOMED TO BEING UNABLE TO HEAL

As a young nurse new to the profession in 1988, Chris Boese arrived ready to help patients heal. Instead, she met young man after young man fighting a losing battle against a mysterious disease called AIDS — a virus-driven killer that even many of her colleagues refused to treat.

Her unit was different. “We said, ‘Bring them to us,’ ” Boese recalled.

These days, armed with the same readiness to help, Boese is one of two incident commanders at Regions Hospital, overseeing teams of nurses in charge of what’s essentially a respiratory ailment.

In other words, COVID “is a nursing disease,” Boese explained, while tying the hospital gown of a young male nurse behind him before he entered the room of 93-year-old Norman Brunn, who might even go home in a day or two.

It’s the nurses who will monitor oxygen levels and turn patients onto their stomachs when they need more air, and it’s the nurses who will literally hold their hands through the worst of times.

‘A LOT OF MORAL DISTRESS’

That’s the good news. And the bad? The impacts of COVID-19 have spilled over to almost every aspect of the hospital. On this non-critical care “step down” floor for patients who have left the ICU, 17 of 18 beds are occupied by COVID patients.

Some could be discharged in a day or two, or their conditions could worsen, and back to the ICU they’ll go. A nurse assigned four patients here will enter patient rooms at least twice an hour, donning and doffing personal protective equipment such as goggles and hospital gowns some 50 times or more in a single shift.

“They’re tired,” Boese said. “They want to drive home the point, ‘Stay home.’ ”

Nurses are healers, Boese said, and COVID is inundating them with higher volumes of patients who require constant supervision and may never heal. Exhaustion and emotional burnout are real.

“There’s a lot of moral distress, this endless stream of really sick patients, nurses saying, ‘I did everything I could to keep them alive,’ ” Boese said. “It’s just really hard.”

But there are no illusions here. Things will get harder still. “Everyone is really worried about Thanksgiving, that people are still going to gather,” Boese said. “You’re going to be in our ICU by Christmas. And in the ground by New Year’s.”

DAY-TO-DAY REALITY

Registered nurse Gail Gachalian puts on personal protective equipment before entering a patient’s room at Regions Hospital. (Scott Takushi / Pioneer Press)

Across the country, medical workers say they’re already exhausted, and they’re being pulled in to help with patients and procedures outside their expertise. The impact will be felt by non-COVID patients whose serious elective surgeries will have to be delayed by weeks or even months.

On social media, an outpatient pediatrician from Akron, Ohio, says he’s been placed on the call list for serious geriatric procedures. A doctor in Chicago says her husband, also a doctor, is deferring serious procedures, including installing pacemakers.

In St. Paul, a physical therapist says she’s almost never seen a patient come to her after officially recovering from the flu. She’s drowning in post-COVID sufferers who can barely lift their arms.

Here, at Regions Hospital, none of that chatter is just social media caterwauling. It’s day-to-day reality.

Non-COVID patients are choosing to delay care until it’s almost too late, and arriving with increasingly complicated health needs.

In a particular medical unit, “where we used to be able to handle 16 patients, now we can handle 12, because that’s how sick they are,” Spilseth said.

“It’s the triage ‘MASH’ kind of set up,” Bruen said. “I just got a call from the Emergency Department. I have three patients waiting, and I have to figure out where to put them. It’s whack-a-mole trying to figure out where they can best get care.”

STILL HOLDING ON

Behind him, a nurse has just returned from holding an 83-year-old woman’s hand. Usually, the very sick die with a breathing tube in their throat. Now beyond help, this woman was extubated — had her tube removed to die in peace — but is still holding on.

For whatever reason, family have declined to join her, but the nurses won’t let her die alone. “She’s a fighter,” the nurse said.

Eileen Schouveller and Nicole Bodin are two nurses accustomed to post-ICU care. They’ve been called into ICU procedures more and more as “surge” ICU overflow rooms have opened up around them.

“For a while, we didn’t have COVID on our floor,” said Schouveller, taking a breather in front of a breakroom table full of “Thank You” cards, some from families who have lost loved ones but recognize the nurses did all they could. One card features a picture of a man who could be in his late 30s.

“Then you come back and all of a sudden, there’s 10 (COVID patients) and they’re in intensive care,” she said. “They’re wildly ill.”

Sick patients at a hospital is nothing new, she acknowledged, but the patient volumes and duration of their treatment are. “The patients are a lot sicker and they’re here a lot longer,” she said.

PATIENTS AS YOUNG AS 24

The widespread assumption that COVID-19 is almost exclusively an old person’s disease is just a myth. The Regions medical units have seen patients as young as 24. While young people may not constitute a sizable share of patient deaths, they too may face grueling recoveries and lasting health issues of unknown duration.

“It’s not just young people,” Bodin said. “It’s not just older people. There’s a spread.”

And it’s not just patients at risk.

Across its hospitals and clinics, Bloomington-based HealthPartners had 242 employees out with confirmed or likely cases of COVID-19 as of Tuesday, and another 340 workers quarantined after viral exposure.

Those numbers may seem small compared to a total workforce of some 26,000 HealthPartners employees, but concentrated worker shortages at a time of growing demand for health services helps no one. Other health networks have reported similar labor impacts.

Restaurants and other well-wishers used to drop by with free lunches, cookies and other pick-me-ups for the nurses and health care providers. As time has gone by, those pick-me-ups — which are well appreciated — have become fewer and further between, Boese said.

BAD DAYS

A patient’s preferences are listed on the window of a room in an intensive care unit at Regions Hospital. (Scott Takushi / Pioneer Press)

So the workers lean on each other. There’s camaraderie and socialization at work, and a great sense of reward when things go well.

But the bad days are coming faster.

“There’s the bad day of the patients you’ve been pouring your heart and time and energy and sweat into who pass away after caring for them for three or four weeks,” said Bruen, the ICU doctor. “That’s very hard for us to see.”

“Then there are the chaotic bad days, when we just try to (focus on) the next task, when we have 10 tasks ahead of us, and we lose some peacefulness in that sense.”

“It’s a bad day when we have a colleague who gets sick and can’t work anymore,” he said. “And it’s a bad day when we’re getting five calls from the Emergency Department looking for admits, and I have to tell them no, or no for right now.”

 

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