‘Death after death’: Washington Hospital offers look at life on frontline of COVID-19
The critical care unit in Washington Hospital is often a flurry of activity as health-care staff rushes to admit and care for patients. When a patient is in his or her final moments, staff lights this candle to remind other health-care workers to remain quiet so the patient may pass away in peace.
A nurse in Washington Hospital's CCU administers medication to a COVID-19 patient. Like other COVID patients in critical care, this patient breathes with the assistance of a ventilator.
A COVID patient in Washington Hospital's CCU is hooked up to a tangle of tubes that pump several medications from big, rectangular monitors into the bloodstream. The large blue tube is a ventilator, which helps the patient breathe.
Katherine Mansfield/Observer-Reporter
A room in Washington Hospital’s CCU is a flurry of activity as health-care workers rush to admit a patient. The staff works together to check vitals, administer medication and perform a COVID test.
Before entering a COVID-positive patient's room, health-care workers don personal protective gear, including gloves and face shields. Changing into and out of PPE countless times each day often leads to rashes or acne, which has become just another part of the job for nursing staff nationwide.
Katherine Mansfield/Observer-Reporter
A health-care worker quickly dons personal protective equipment before entering a COVID-19 patient’s room on Washington Hospital’s critical care unit.
An IV pump stands in a COVID-19 patient's negative-pressure room in the CCU unit of Washington Hospital. Along with IVs, patients are also attached to big, blue ventilator tubes, which pump air into their lungs.
A nurse in Washington Hospital's CCU wheels an IV pump into a COVID-19 patient's room. Along with upwards of six IVs, COVID patients in critical care are also hooked to ventilators, which help them breathe.
Nurses in Washington Hospital's CCU assess a COVID-19 patient before hanging IV drips and administering medications while clad in PPE. Patients are boarded in negative-pressure rooms like this one to facilitate easier breathing.
Katherine Mansfield/Observer-Reporter
Housekeeper Janell Mallory readies a room for the next COVID-19 patient. Mallory, whose background is in social work, started at Washington Hospital in 2021 and takes great pride in making rooms as welcoming as possible for the patients who often spend their final days in the CCU.
A COVID-19 patient is hooked to several IVs and a ventilator. The IVs pump medication into the patient's system, while the ventilator facilitates easy breathing – something COVID patients have difficulty doing on their own.
A Washington Hospital nurse ties on her isolation gown before stepping into a COVID-19 patient's room. The gown is one of several pieces of PPE health-care workers don before entering patients' rooms.
Health-care workers toss their PPE into a wastebasket inside a COVID-19 patient's room before stepping back into the hallway of Washington Hospital's CCU.
A nurse slips on an isolation robe in Washington Hospital's critical care unit. PPE stations are set up along the critical care unit hallway so health-care workers can access gowns, face shields and gloves easily before entering patients' rooms.
Katherine Mansfield/Observer-Reporter
IV pumps covered in protective gear stand at the end of the critical care unit at Washington Hospital.
Kayla Grant always wanted to be an ICU nurse.
“I went into the ICU because I liked knowing what I do actually makes a difference,” said Grant, a nurse at Washington Health System Washington Hospital’s Critical Care Unit.
Sixteen years into her nursing career, Grant’s feelings about wanting to help patients haven’t changed. But the COVID-19 pandemic nearly broke her.
“I want to make a difference, and I don’t feel like that’s the case at all with COVID patients. I have witnessed more death in the past two years than I have in all of the 16 years of my career, and it really gets to you when all you see every day is death after death after death,” said Grant. “But here I am; I’m still here.”
The latest COVID-19 surge – the third of the pandemic – has tested the endurance of health-care workers nationwide.
For 23 months, Grant and the hospital’s staff have dug in on the pandemic’s front line. They’ve comforted frightened patients gasping for air. They’ve turned patients from their backs onto their stomachs to help oxygen get to their lungs. They’ve held patients’ hands so they didn’t die alone and made sure dying patients got to say goodbye to their families on FaceTime.
“We’re all tired. We’re exhausted,” said CCU nurse Stacey Coon. “A lot of the time, I’m numb. You come in, and you know you’ve got to do what you’ve got to do just to get through the day. You’re scrambling around trying to meet the needs of everybody, you’re skipping lunch, you’re staying late. I still love being a nurse. But COVID is like nothing we’ve ever dealt with here before.”
Since late August, COVID-19 infections, fueled by the fast-spreading omicron variant, have stretched staffs and filled beds in Pennsylvania hospitals to their limits.
But COVID cases have decreased significantly over recent days, and Washington Hospital officials believe they have reached the peak of this surge, after months of skyrocketing cases.
“By all estimates, we have peaked at this point and are slowly declining in overall COVID admissions,” said Dr. John Six, Washington Health System’s Chief Medical Officer.
Doctors say that unvaccinated people continue to account for the vast majority of COVID-19 cases and deaths.
In Washington County, about 61% of its 206,865 residents are vaccinated.
On a recent Friday in late January, the CCU was less hectic than it has been throughout the omicron wave.
Sixteen of the 26 CCU beds were filled, and four of those patients had COVID-19.
In all, 28 patients were hospitalized with COVID that day.
“Thankfully, this week in the CCU has been better. Historically, since September, we’ve sat at around 20 patients, and a lot of times we had 25 filled. That’s about double what we were used to before COVID,” said Michelle Thompson-Pape, the CCU’s nurse manager. “It still could become unmanageable, though, because there could be three coming from 6E, the COVID unit, in the next hour or so.”
The hospital has converted other units into coronavirus wards throughout the pandemic, but the CCU houses the sickest COVID patients.
The patients there are sedated, intubated, and tethered by a tangle of cords to the beeping and humming machines that monitor their vital organs and pump oxygen to their lungs.
A Washington man sat in a chair beside his wife’s bed in one of the rooms.
In her early 60s, the woman had come in nine days earlier with COVID-19, and two days later, she was moved up to the CCU.
“She’s a fighter,” he said determinedly. “I tell everyone, she’s gonna kick it right in the butt. She’s not going to let this win.”
For half an hour, the man talked about his wife – how the first time he saw her, he was struck by her beautiful brown eyes. How she wrote her phone number on a piece of paper after they’d met, and that he still has it, all these years later. What they ordered on their first date at TGIFridays. He said he cried more over the past week than he has in his entire life.
He said he’d gotten the COVID-19 vaccine when it became available, but his wife chose not to.
“When she started to get sick, I said, ‘Promise me that when you get over this, you’ll get your shot,” he said. “She said, ‘I promise I will because I don’t ever want to go through anything like this again.'”
Six days later, though, his wife passed away.
’My hardest day'
Downstairs, the Emergency Department is seeing the usual emergency room issues – strokes, appendicitis, broken arms, car accidents – but it’s been swamped with people arriving with omicron, which has led to backups in the ED.
It’s late morning, and the 38-bed ED is jam-packed. Beds are filling up, and at least a dozen patients are sitting in the waiting room.
“It’s been overwhelming, it’s stressful, it’s fast-paced,” said ED nurse Erica Noordhuizen. “With COVID and nursing shortages everywhere, there are times when no beds are available, so that holds up a room, and people who need to be admitted get held here. We get patients who need to go to the ICU, whether it’s for COVID or not, and we can’t get them up there.”
Increasingly, nurses and staff in hospitals nationwide have been verbally abused by patients angry over the long waits.
During this surge, the hospital has cared for younger patients, in their 30s, 40s, 50s, and 60s, some with underlying health conditions, others without.
One of the lowest moments for the CCU was the death of a 38-year-old man in October, more than a month into the current COVID surge.
The patient was admitted with COVID-19 to the critical care wing, and his condition deteriorated fast.
Grant, worried about the patient’s failing health, encouraged him to call his wife.
“I said, ‘I just want you to call her,'” said Grant, “and he and I talked about how long of a recovery it was going to be for him. Then he looks at me and says, ‘I’m not going to die, am I?'”
Grant responded, “I’m going to do everything I can so that you don’t.”
But later that day, the patient was ventilated, went into cardiac arrest, and died.
His family arrived while the hospital staff was doing chest compressions, and Grant recalls sinking to the floor with the man’s sister, and they cried.
“When the family finally left, I came out into the hallway to get a drink because I had been in the room for hours, and Shellie, our boss, hugged me, and I completely lost it,” said Grant. “I was sobbing in the hall. I said, ‘I can’t do this anymore.’ That was my hardest day. And that was just a few months ago.”
Once cheered as heroes
Morale at hospitals across the country is low – before COVID, there was a massive nursing shortage, and about 20% of health-care workers have left the field since the pandemic started. Despite WHS Washington Hospital’s continued efforts to boost spirits, employees feel worn down.
There have been days when nurses have lost two or three patients or stretches of days in a row where patients died.
“This has been more challenging than I ever thought it would be. Mentally, physically, emotionally, it’s challenged every one of us. It’s taken a toll,” said CCU nurse Tracy Muncie, who had ducked into The Serenity Room – a respite for nurses and staff on the CCU floor – for a quick break. Another nurse heated up a bowl of stuffed pepper soup and ate it standing up before heading back out.
CCU Nurse Alex Amorose said he didn’t expect to still care for so many critically sick patients after vaccines arrived.
“I was talking recently with a friend, a nurse, and neither one of us could ever have believed that once the vaccine was available that there would be people who didn’t want it or wouldn’t take it,” said Amorose. “It never crossed our minds that there would be a point in time where there would be this battle over it. There are patients who are about to be put on a ventilator and they still don’t believe they have COVID. It’s pretty shocking.”
Nicole Carson is a third-generation nurse who graduated from Washington Hospital School of Nursing in August 2020 and immediately went into the CCU.
“Never in a million years did I expect to start my career in a pandemic. To be here and see all of these deaths is kind of shocking,” said Carson, who writes in a journal about being a nurse during COVID. “I definitely cry a lot. But I feel like I’m going to be a better nurse after all of this because I was thrown into it. I wasn’t coddled.”
Like hospitals nationwide, Washington Hospital is short-staffed – the result of nurses and staff getting sick from COVID or quarantining, and nurses quitting or retiring due to burnout, or jumping at travel nurse positions, which pay upwards of $5,000 a week.
Emergency Department nurse Chase Powell and her co-workers pick up extra shifts, working four, sometimes five 12-hour shifts a week, sometimes putting in 16-hour days, staying to help when the hospital is shorthanded.
Amorose recalled the early days of the pandemic when health care workers were cheered as heroes.
“When this first started, we were all heroes, and there were banners and signs, and people sending us things, and now we’re having situations where, especially recently, there’s open hostility toward health-care workers,” said Amorose. “People seem to have moved on, like they’re done with the pandemic. When you see on television where they speak about the pandemic in the past tense like it’s a thing of the past, well it’s not. It’s still here. People are still getting sick, and people are still dying.”
Dr. Six, the hospital’s chief medical officer, marvels at the strength and resiliency of the staff who keep showing up every day, despite the obstacles.
“Our dedicated and talented nurses and physicians and staff members have worked longer and harder over the past 23 months to meet and exceed the demands of COVID,” he said.
Looking for the finish line
Meanwhile, Muncie dons protective gear as she prepares to enter a patient’s room: scrubs, a gown, goggles and a face shield, N95 mask, hair net, shoe coverings.
Nurses repeat the routine several times a day.
They’ve become accustomed to headaches, pressure sores on their noses, dry and cracked lips, and rashes on their faces.
In The Serenity Room, photos and thank-you notes from COVID patients who survived are thumb-tacked onto a bulletin board: a young oil and gas worker from Hawaii, a 51-year-old engineer from Chartiers Township, a mother in her 30s.
“That’s our reward, seeing a patient get better,” said Muncie, who has been a nurse for 32 years. “That mother is home with her kids, and her mom and grandmother would come every day for weeks to see her, and there were so many days we didn’t think she’d make it,” said Muncie.
Housekeeper Janell Mallory started working at the hospital in April 2021. She’s sanitizing a room – spraying disinfectant, scrubbing the bed, neatly folding down fresh sheets – in preparation for a new patient who will be wheeled in when she’s done.
Mallory, who has a background in social work, recalled striking up a conversation with a COVID patient the week before and was shocked at how fast his health worsened.
“On Saturday, we were talking about Notre Dame. On Sunday, he was face-down. On Tuesday, he died,” she said. “His name’s burned in my head. That part’s so sad. You really see so many people who are just gone.”
Over the past two weeks, the hospital has averaged about 30 COVID patients, with a peak of 37 and a low of 18.
Weary health-care workers don’t know where COVID’s finish line is; they’re warily hopeful that falling COVID cases signify a shift in COVID to something more manageable. They’re exhausted, but they’re braced for anything.
It’s important, health-care workers say, to focus on prevention – get vaccinated. Wear masks. Wash your hands. Follow the guidance of health-care professionals. Be patient with health-care workers.
“I just want this to be over,” said Muncie. “Everybody – us frontline workers, our families, the community – has been going through hell, and I just want everyone to understand we’re going through it together. We’re going to keep fighting.”