Staff prepare to perform a surgical procedure on the ICU floor. Every bed on this intensive care unit at Oregon Health and Science University was filled with a patient critically ill with COVID-19 in Portland, Ore., Aug. 19, 2021.
Kristyna Wentz-Graff / OPB
All but one of the patients at Oregon Health & Science University hospital’s COVID-19 intensive care unit are unvaccinated. OPB’s Amelia Templeton toured the ICU yesterday and tells us what she saw and heard.
This transcript was created by a computer and edited by a volunteer.
Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. There are 232 patients with COVID-19 in intensive care beds in Oregon right now. It is far and away the highest number since the pandemic began. About one out of every three patients in intensive care right now is there because of COVID. It’s putting incredible strain on the entire medical system. Often the sickest COVID patients from around the state and around the region are sent to OHSU. This week, the Portland hospital invited OPB’s health reporter Amelia Templeton to go inside its medical ICU and to talk to the nurses who work there. Amelia joins me now to talk about what she saw and what she heard. Amelia, welcome back.
Amelia Templeton: Thanks so much, Dave.
Miller: We’re going to hear a lot of the voices of ICU nurses that you talked to this week. Can you tell us what you did yesterday and the day before?
Templeton: On Wednesday I interviewed three nurses just outside the doors of the ICU. They had either just finished their shifts or were on break, and we were masked but sitting there face-to-face in person. And on Thursday we went into the ICU to watch them at work, trying to keep these patients alive, and you’ll hear some tape from inside as well. And this was really nothing at all like talking to people on Zoom. You can feel the urgency of what’s going on. You can see the emotions in everyone’s faces: exhaustion, frustration, sadness, and you can really hear it in their voices too.
Miller: We heard before the break from two doctors in southern Oregon, which has the highest per capita COVID rate in the state. What is OHSU experiencing?
Templeton: So OHSU has four ICUs. One of them, the one that I visited, is exclusively in use for COVID-19 patients. But all four of the ICUs are completely full. So they’ve had to start moving [COVID] patients into other areas of the hospital that wouldn’t normally treat people who need intensive care. Julie Kleese, R.N., B.S.N., one of the nurses, told me that they’re short on both the staff and the physical places to put the sickest patients:
Kleese: “So we are stretched to the max. We have the most COVID we’ve ever had and our COVID patients are ... we’re giving them every kind of treatment that they can receive that we can offer to save their lives. And the sickness of the patients is as high as it’s ever been. So our staffing is really limited: each of these patients require so much intensive care and monitoring and thought to go into how can we best serve this patient? What kind of things can we offer? Where are they at in their sickness process? Meanwhile, physicians are just being called at every opportunity. Can you take this patient? Can you help us consult on this patient? This patient is 26 and dying. This patient is 21 and dying. This patient is a father of four and dying. Can you help us? Our rural partners are struggling. They’re at the limit of their capabilities and that’s when they turn to us and it’s full.”
Miller: We’ve heard so much over the last year and a half about ICU beds. What does it mean physically for a patient to be in the ICU?
Templeton: With COVID it’s really grim. Thanks to vaccines, severe COVID-19 is preventable, but if you get the severe respiratory distress symptom, there is no cure for it. So what’s happening in the ICU is they’re trying to keep these patients alive long enough for the infections to subside and their bodies to start to heal themselves. And that means that people are hooked up to machines placed on life support for weeks or even months at a time. I asked Julie Kleese to describe what it’s like and here she is:
Kleese: I don’t think people have an inkling of the amount of suffering that you will experience being sick with COVID. It is extremely painful. Being critically ill is a very traumatizing experience. It is confusing. It’s scary. You’re alone with strangers. You don’t recognize their voices. You lose your free will being in the hospital. All of your bodily functions are not your own, they’re taken over by other people and machines. You lose the ability to speak, to swallow, to breathe on your own. The ability to touch your face and your body of free will because you have too many lines and tubes that are vital to your survival. And if you survive, your recovery is long, an undetermined amount of time to what state of independence you will ever return to, your mental capacity or physical capacity. It is an extremely lonely experience, a depressing experience. And for your loved ones as well, they’ll suffer. They will absolutely suffer watching you struggle.”
Templeton: Another one of the nurses that I talked to, her name is Sarah Mohkami, R.N., B.S.N. She goes by Mo, and she was really blunt. She said, ‘you know, you don’t want to remember any of this experience. You’re lucky if you don’t remember it.’ I think we have some tape from her as well:
Mohkami: People are sedated because they’re intubated. So they have a breathing tube down their throat. And so then to make them comfortable, we have to put them on medication to make them comfortable. That has a slew of side effects. They’re most likely septic, which means they have a systemic infection from COVID. So now their blood pressure is low, then it can affect their kidneys. So they can have kidney damage. So now we’re putting them on multiple medications to keep their blood pressure up. You know, their kidneys take a hit. They might need temporary dialysis. Maybe they’ll need continual dialysis, meaning like they’re getting dialysis 24 hours a day, seven days a week until their body repairs. They’re having fevers up to 100, 102, 103 [degrees], so then we’re trying to control that with other medications or keeping their body physically cold. We do as much as we can to keep somebody comfortable. But there’s a fine line between overly keeping somebody comfortable, and not keeping them enough comfortable. And in some ways, depending on how things are going or how long families are willing to let their family members be hooked up to all the machines, it can feel like their bodies are being tortured.
Miller: Amelia, as you mentioned yesterday, you actually were able to go inside the ICU itself. What was it like?
Templeton: It was essentially two halls with 16 patients. I was told that all but one of those people were unvaccinated and what I saw was room after room of people who were sedated and on life support. And you could look through the glass windows and you could see what that was like. And I was expecting all of that. But what I wasn’t really personally prepared for was how many of the people were young. Even though as a reporter I know that is true. I stood outside the room of a woman in her twenties whose lungs were too far gone for ventilation, so she was getting a form of life support that’s called ECMO where they pumped the blood out of your body through a large tube, essentially add oxygen to it and then return it. It’s sort of like dialysis for your lungs. And she had two little stuffed animals on the windows sill. This is heartbreaking. And Erin Bonai who is the charge nurse taking us through the ICU, told me right now they have one patient who’s in their seventies, and everyone else is younger:
Bonai: We have people in their twenties and their thirties in their forties and the fifties, that’s the majority of our patients. And we have had people in their twenties die in this unit. We have had mothers lose their babies in this unit. People always think it can’t be them because they are fully functioning in their lives. And that’s just not true. And the real truth is that we don’t know who is going to be impacted. We just don’t. We don’t have that data. We can’t look at five people on the street and say, ‘oh that’s the one who would get critically ill’. That’s just not how it works.”
Miller: In the previous segment, we heard from doctors in Medford and Roseburg about how they don’t have enough staff right now to provide the level of care that their patients need. At OHSU, how much time can nurses or doctors spend with their COVID patients right now?
Templeton: In the unit that I was in, they are still spending an incredible amount of time trying to save each life. It’s really demanding to take care of somebody who requires that level of support. You have basically one nurse for each patient. And I do think one thing people should think about in terms of what each of our responsibility is to try to prevent the spread of this disease, is you could require one nurse to take care of you for months. I think we all have a responsibility to consider that in our own actions. But one of the things that I watched was this very simple but powerful intervention that can help a person’s lungs recover and you just roll the patient onto their stomach from time to time. And that helps the back of the lungs open up more and get more healing and oxygen. Pretty early on in the pandemic, there’s evidence that COVID patients who have this treatment just called proning are less likely to die if they get put on their stomachs. And it sounds really simple. But we watched it happen and it takes four people working with the sling and a mechanical lift to do it because it’s so risky to move a patient who is on a breathing tube and a ventilator. That kind of care is still happening at OHSU. But the nurses told me it’s not happening at many smaller hospitals in Oregon. They’re getting calls saying we don’t have enough staff to prone people. Can we send them to you? And of course, it was ‘we can’t take any more patients right now.’ They’re scrambling to figure out how to ... COVID patients in Oregon today may be more likely to die because no one is available to move them onto their stomachs. And to me that is an indication that we’re heading towards, what’s known as crisis standards of care, where people just aren’t going to be getting the same quality of care they would if we weren’t overwhelming the system.
Miller: Is it the case once again that family members simply cannot be there with their loved ones, when their loved ones are very sick and potentially dying.
Templeton: It’s not quite that cut and dry. The rule right now for adult COVID-19 patients at OHSU is two visitors are allowed, but only when somebody is at their very end, really approaching death. But you know, the reality of the ICU is that a lot of these patients don’t make it. And every one of these nurses has been with people as they were dying. Many of them dying alone. It’s a big part of what they do, is facing these deaths sometimes when no one else can be there. It was something that Mo talked about with me:
Mohkami: It’s a lot. But I come back to the fact that if this was my mother, my father and any of my family members, that because of hospital policies and protocols that I couldn’t be there for them, how would I want them to be treated? And so it’s just a flood of compassion comes out: tears, sadness, a lot of empathy for them and their family members. I mean, that’s all we can do is be there for them when no one else can.
Templeton: You know, something that just really struck me about this was these people who are dying are largely unvaccinated. And I think there’s so much of a sense of a divide in this country between people who are vaccinated and people who aren’t. But that divide does not exist in this ICU. You have vaccinated nurses who are there till the very end with their unvaccinated patients and who are just showing them such love and such care.
Miller: All but one of the patients in the ICU last week was unvaccinated as you’re noting. What did you hear from nurses about that?
Templeton: I think it’s one of the hardest parts of this whole experience for them and one of the most confusing to care for people who are suffering immensely and dying from a disease that’s preventable with a vaccine. They shared so many different feelings. They feel grief. I think they feel even more intense grief, knowing that people are dying preventable deaths, that people are leaving behind their children, and their deaths could have been prevented. They also feel frustration. I heard that it almost feels like being gaslit as a nurse. Usually, people come to you and they ask you for your advice about all of their medical problems, and all of a sudden they really want people to hear this message, ‘get this vaccine,’ and it’s been so hard to get that message across through all the noise of the internet and the misinformation. So the message I got from them was really, we will do everything that we can to save you, but it’s far more powerful for you to get vaccinated. That’s the only way out of this. And that’s really a much better option for everyone, than winding up in this ICU.
Miller: Did the nurses you talked to, talk about conversations they might have with patients’ families about getting vaccinated?
Templeton: They did. I think a lot of people have this fantasy that if somebody gets sick with COVID-19 that everyone around them will suddenly understand the importance of vaccination, and that that certainly does happen sometimes. It can be a wake-up call for people, but I think it’s just a lot more complicated. That’s what I heard. Some people will hold on to their beliefs and their fears about vaccines, even in the face of losing a family member to COVID. And I was really moved listening to Mo talk about one of the conversations that she’s had with one of those family members: [Mo speaking] “I dealt with a family member, and he’s a very young man and his dad is dying, and will die and his family is coming to the grips of that reality. And I asked him if he was vaccinated, he said, ‘no, he has a very, very young child and family.’ And he gave me a lot of reasons as to why he didn’t want to do it. And you know, we just talked, and it was nice to have an open discussion with him because some people do not like to talk about things. And I think that’s all we can do, is try to have as much open discussion as we can. But it’s hard not to feel like this is the epitome of privilege, right? And in this country, we have the privilege to get this vaccine, and globally people would do anything for this vaccine, and they don’t even get this chance.”
Miller: In some ways, this is embedded into so many of the bits from the interviews that we’ve already heard. But I’m curious when you talked specifically about the emotional toll all of this is taking on nurses. And this is something that we heard, even in our previous conversation with the two chief medical officers, what did the nurses you talked to say?
Templeton: It’s so hard. A big part of their job is continuing to see people’s humanity, and continuing to be vulnerable to all of the real human pain that’s unfolding in the place where they work. But they’ve just been doing that for so long now, and they feel like they haven’t had time to recover emotionally from the surge in the winter, and now it’s happening all over again, and they’re all pretty clear-eyed that we are not at the peak of this yet. One of the nurses I interviewed, Kristin, wrote she had come in and picked up an extra shift to help out her colleagues this week, and this was how she put what it feels like right now to be a nurse.
Roach: I think part of what’s really hard right now is that we’ve been doing this for a year and a half. And we’re tired, we’re just we’re really tired of continuing to go in and give the best care we can. We’re doing the stuff that nurses do, like hold people’s hands, and to do that in all my ICU gear, and to have limited family allowed, all of that. It just really, it takes an emotional toll on you. And I think what we’ve asked nurses to do during this time, it’s not fair. To care that much for that long under such duress has been really hard on us.
Miller: You ask the nurses you talk to about what’s keeping them going, what kinds of answers did you get?
Templeton: They all said that camaraderie, and a sense that they are all in this together, and serving the public is what’s keeping them going. And they’re also proud of what they’re doing. They’re really humble people, but some of that pride in their role, and how they’re stepping up, really comes across and I want to let everyone hear how that nurse Kristen Roach R.N., B.S.N., answered this question, of what it is that keeps her going:
Roach: I think something that’s kept me going on some of the hardest days is that I think, five years, ten years down the road, I think I’ll be really proud of the nurse I was these couple of years. But I think that that could be extrapolated to a larger community five years down the road, maybe you could feel really good about wearing a mask, and you could know that you prevented the community spread, and you got vaccinated, and those are things that you can feel really good about. Because there’s not going to be a quick resolution to any of this. But I think we need to think about our future, our future selves, and how we would look back on this moment. And to feel like you did everything you could to limit the transmission of Delta, would be something that you could feel really proud of. I love being a nurse, I love being a nurse. But this has been really hard, and I’m really proud that I’ve continued to show up.”
Miller: Amelia, thanks for bringing these voices to us today. Thanks very much.
Templeton: You’re welcome, Dave, it was my honor.
Miller: That’s Amelia Templeton, OPB’s health reporter.
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