ICU nurses describe battle against COVID-19
You're given drugs to deeply sedate you and paralyze your muscles, a ventilator tube is snaked down your throat and your eyes are taped shut so you don't scratch your corneas while you lie for 16 hours a day on your belly in the intensive care unit.
One catheter collects the urine from your body, while a rectal catheter catches diarrhea.
Nurses try to regularly reposition your ventilator equipment so you don't get bed sores on your face. As your body fills with fluids, you bloat and become unrecognizable.
Your fingers and toes turn black as your tissues die.
With ventilator use hitting a pandemic high in the Rogue Valley on Thursday, a record number of patients are facing those risks. At least 20 COVID-19 patients are on ventilators in Jackson and Josephine county hospitals.
“With COVID-19, the lung injury is so severe. It’s like nothing I’ve ever seen,” said Holly McEwan, a registered nurse who works in the intensive care unit at Asante Rogue Regional Medical Center in Medford.
ICU nurses who work in the Rogue Valley are taking care of COVID-19 patients who are enduring gruesome battles against the virus. They described conditions in Medford, Ashland and Grants Pass hospitals that have been overwhelmed by skyrocketing COVID-19 cases and hospitalizations.
More than 90% of patients in local ICU beds aren’t vaccinated against COVID-19 or have received only one shot, McEwan said.
On Thursday, 182 people with COVID-19 were in Jackson and Josephine county hospitals, with 46 of those patients in ICU beds.
In general, doctors try to avoid ventilators because the machines, coupled with the strong drugs that have to be used, can damage the body.
Before COVID-19, spending a few days on a ventilator could give a patient’s lungs time to rest and heal. But COVID-19 patients are so sick they’re spending longer periods of time on ventilators.
“I’m seeing patients in their 30s, 40s and 50s. They are so sick. Once you’re on a ventilator, there’s not much we can do. Prior to COVID, most of our patients lived. Sometimes an older person with pneumonia would die. Two patients died today out of 15 rooms,” McEwan said earlier this week. “One died yesterday and two will probably die tomorrow.”
Earlier in the pandemic, ICU nurses were mainly caring for COVID-19 patients who were senior citizens with health problems. Now the COVID-19 patients are younger, said Josh Eckroth, an ICU nurse at Rogue Regional Medical Center.
Eckroth, 42, said he’s seen people younger than himself die.
“It’s awful. When you see a guy’s 10-year-old son wail on his dad’s body for two hours, it just ages you. I’ve got two kids. There’s just about nothing worse,” he said.
Eckroth said many COVID-19 patients aren’t surviving their ordeal on a ventilator.
"There's a very high likelihood you won't come off. Your family is going to have to be put in a position of continued treatments that are so hard on a body, or letting you pass away peacefully and painlessly. It's that suffering in between that most people don't understand,“ he said.
Nurses position COVID-19 patients on their bellies so their lungs can get the most air possible. They lie that way for 16-18 hours a day, spending the remaining hours on their backs, McEwan said.
“You get swollen hands and feet when you spend that much time on your belly,” Eckroth said. “Your face gets swollen. You end up with cuts on your lips from the tubes. The medications for blood pressure, if you get that sick and we have to use massive doses of those, it can turn your fingers and toes black."
If people were left conscious while on a ventilator, they would fight to breathe against the machine. They have to be deeply sedated and are often given drugs to paralyze their muscles. They can’t blink or close their eyes on their own, McEwan said.
“We tape their eyes closed so their eyeballs don’t get scratches on them,” she said.
Given the low odds of survival and the damage done to people’s bodies and brains, why do COVID-19 patients go on ventilators?
McEwan said patients who are on oxygen in the hospital are struggling to breathe.
“What really gets to me is that before they’re intubated, they’re so uncomfortable. People say, ‘I can’t breathe. I can’t breathe. I can’t breathe.’ They want us to turn the oxygen and the anti-anxiety drugs all the way up. We have to tell them they’re already at the limit. It’s really hard,” she said.
People can continue to stay on oxygen and feel like they’re suffocating while they hope for improvement.
If they decide the time has come to die, they receive morphine for pain and to stop the gasping reflex. The oxygen mask is removed and they pass away.
For patients who decide to go on a ventilator, nurses try to facilitate phone calls or online visits with loved ones ― knowing those might be the last conversations they have.
McEwan remembers one man who decided to go on a ventilator. His wife couldn’t visit him before he was intubated because she was sick with COVID-19 at home. He couldn’t talk on the phone because of an oxygen mask on his face, so McEwan relayed messages between the husband and wife.
“We promised her we would stand next to him and hold his hand as he passed,” McEwan said.
The patient died Tuesday with nurses holding his hand.
Caring for patients on ventilators is a labor-intensive, exhausting job. Multiple nurses have to use a mechanical lift to move patients. They suction patients’ mouths, change out IV and catheter bags, monitor their vital signs and shift them to try and prevent bed sores.
If a patient has to go on dialysis due to kidney failure, a nurse has to be there around the clock, ready to fix a clogged or kinked hose within 90 seconds, McEwan said.
Another nurse has to watch the patient in order for the first nurse to take off protective gear, go get food and water, use the restroom, put gear back on and return to the patient’s bedside, McEwan said.
With too many patients filling Rogue Valley hospitals, nurses are hungry, dehydrated and exhausted.
“We’re spending 12-16 hour days in full gear — a plastic gown, an N95 respirator mask or ventilated hood system, cap and gloves. I’m just sweating all day. I can’t go to the bathroom, eat or drink. We’re physically and emotionally at our limit,” said McEwan, who is down to eating two meals a day.
She knows nurses who have worked up to 18 days in a row without a day off.
The workload is stressing marriages and causing conflict in families — especially when nurses have children younger than 12 who aren’t yet eligible to be vaccinated. Nurses said they are terrified about bringing the virus home from work and infecting their kids, but don’t want to abandon their co-workers and patients.
There’s conflict in hospitals, too, with some patients refusing to believe they have COVID-19.
“When patients think we’re lying about their diagnosis, it’s hurtful. It feels like we’re very unappreciated despite our sacrifices,” McEwan said. “I have two small children who can’t be vaccinated. My husband and I are vaccinated.”
Some patients and family members insist the problem is pneumonia or some other condition, not COVID-19.
“We’ve had patients deny it to their death. They say, ‘It’s not COVID. It’s something else.’ We’re tired of arguing with them, so we say, ‘Fine, it’s pneumonia.’ But it’s pneumonia caused by COVID,” McEwan said.
She said she questions every day whether it’s worth it to go to work.
“But we’re a close-knit team in the ICU. I don’t feel like leaving when my community needs nurses,” said McEwan, who grew up in the Rogue Valley and sees people she knows hospitalized with COVID-19.
Nationwide, thousands of nurses and other medical workers have left the field during the pandemic. The same exodus is happening in the Rogue Valley, too.
Eckroth said many strong, experienced medical workers are reaching their limit. But many are staying.
"I guess if there has to be a good thing, it's that the ICU nurses that I work with and I are going to be so tight. It's just this bond,“ Eckroth said. ”I've never been to war. I've never been in the military. But it feels like the same kind of thing as they would describe. You're brothers-in-arms. We're the only ones that we can turn to to help each other out with this. If you need to cry or just run away for a bit, we understand. And it's happening more and more."
Like McEwan, Eckroth said he’s had patients in the ICU who refuse to believe they have COVID-19. Most change their minds and realize they should have gotten vaccinated. But some patients and family members believe COVID-19 isn’t real and call vaccines a farce, he said.
"There isn't a way to properly describe how the nurses are feeling. I could keep talking until I'm blue in the face and it won't do it justice,“ he said. ”It's hard when people have decided what you're doing is fake or the whole reason is fake — and it's not. It's not political. There's no other agenda other than health and safety.“
Eckroth said people are trusting false information they hear on social media rather than seeking out accurate medical information.
"They're accepting information on its face that isn't true — and it's dangerous and it's killing people," he said.
McEwan asked the community to join health care workers in the battle against COVID-19.
“In the whole hospital, we’re doing everything we can for your family members, and we need help right now. We need people to find it in their hearts to get vaccinated and wear a mask,” she said. “I don’t want the community to be as sad as the nurses are, but I want them to understand.”