Released: 4/26/2020 12:50:28 PM
By Tim O'Shei, News Staff Reporter
Published 5:00 a.m. April 26, 2020
“Nothing prepares you for the first time you walk into the ICU and you see so many sick patients and everybody is dressed like this."
A whiteboard hangs in the lobby outside Buffalo General Medical Center’s intensive care units. It’s several feet long and resembles something you’d see on a television show about doctors, with space to list schedules and tasks for up to five separate teams of attending physicians, residents and fellows.
A board like that would fit anytime, any year, in any hospital. But the words written atop it in black dry-erase marker would not: “Covid-19 ICU-Anesthesia Communication Board."
Someday, someone will be able to wipe those words away.
But not today. Right now, this is the hot zone. The virus is here.
When you pass through the doors leading to the medical intensive care unit, or MICU, there are words written on the wall: “The best group of nurses work here.” Inside this unit, those nurses – and doctors, pharmacists and therapists – are wearing masks and shields. Their patients, visible through glass walls, are battling for breath. They are fighting for life.
You have to be careful where you walk here, and what you touch. These patients are critically ill with Covid-19, the disease caused by a highly contagious, respiratory-attacking coronavirus. This place is probably pretty clean, because most of the patients are heavily sedated and breathing via a ventilator, which limits how much of the virus is in the air. But caution rules, right down to the placement of the ventilator machine and the rack of medications that would typically be located near the patient’s bed. Now, they are situated outside the room, connected to the patient by long tubes. If something beeps and needs a button-press adjustment, it can be done without entering the room.
This is not how it used to be.
“Everybody just wants to get through this, solve the problem, and get to the other side,” said Dr. Kimberly Zammit, a MICU clinical pharmacist at Buffalo General.
What hospitals are doing to treat the most acute cases of Covid-19 is new, because the disease is caused by a coronavirus that – as we are disquietingly aware – is novel.
Even several weeks into this pandemic, the effects of the coronavirus sound like a novel, like a horror movie we can’t escape. The reality is tougher. Outside of a hot zone such as this one, we deal with the pandemic through avoidance: staying at home, keeping six feet apart. But inside a hospital that is treating patients with Covid-19, health care workers are doing the opposite: They are diving in, trying to figure out how this disease works, and how to heal the sickest of patients.
“They say nursing is a calling,” said John LaForge, nurse manager at Catholic Health System’s COVID-19 Treatment Facility, located at its St. Joseph Campus in Cheektowaga. “Maybe this is it. Maybe this is our time to shine.”
Walking through the intensive care units in each facility was poignant: So many people are so very sick. They typically lay still, breathing through large tubes. Their eyes are usually closed, but sometimes they are open, seeming to gaze into the distance.
Critical-care medical professionals are accustomed to helping patients in this state. But the volume of them is startling, and so is the amount of time they stay on ventilators. Before Covid-19, a typical patient’s stay on a ventilator could be measured in days. Now, it’s weeks.
“It is a devastating disease,” said Dr. Ravi Desai, the director of pulmonary medicine at ECMC and associate director of the MICU.
To be clear, the vast majority of people who contract Covid-19 are not hospitalized. Not all who do end up in the hospital are put into intensive care. But when that happens, usually because the patient is losing oxygen, the drop is unusually fast.
“It happens quickly,” said Jordan Sutkowski, a day shift charge nurse at ECMC. She has had multiple patients whose oxygen levels were normal at 7 a.m., but dropped so much that by later in the day, they were intubated with breathing tubes. “It’s happened in hours,” she said, adding that in normal times – meaning pre-Covid-19 – “we don’t see that happen that fast. That might be something that would happen over a week.”
Once a patient is in the ICU and intubated, Desai said, the first step is “to liberate them from ventilators if possible,” he said. “That’s really where we’re at, at this point.”
Visser, from Catholic Health, calls the experience “grittier.” It does seem gritty.
But there's also an element of sweetness. Patients’ doors at multiple hospitals were affixed with signs that listed their name and interests. At ECMC, one man was listed as liking Billy Joel and rap. A woman nearby enjoyed being independent and helping others. Another man, a concrete laborer, was proud of his family and had a note written atop his sheet: “Please tell my dad that we love him, miss him, and hope to see him soon!”
The coronavirus is so contagious that most visitors aren’t allowed, which means nurses are often the connector between patients and their families who are embracing hope or coping with heartbreak. There are circumstances, if a patient is at the end of life, in which a goodbye visitation can be arranged. But the virulent nature of the disease sometimes makes it unworkable.
Registered nurse Shannon Fay suctions the breathing tube of a patient who is on a ventilator at Buffalo General Medical Center. (Sharon Cantillon/Buffalo News)
Cathy Papia, a registered nurse who is the MICU critical care family liaison at Buffalo General, was working recently with an elderly couple and their children. The man was in his final days, and it was clear that it would be risky for his wife to say a face-to-face farewell, even with protective equipment. At her children’s urging, the woman said goodbye to her husband through an iPad, which Papia held.
“It’s one of the most private moments that a person has in their life,” said Papia, who looked to the side as she held the tablet as a way “of letting them have that time.”
There are happy endings, too. On a bulletin board at Buffalo General, someone tacked a large red heart inscribed with the words “COVID transfers out of ICU.” Each time a patient is moved out of intensive care, a worker staples a smaller pink heart to the board. One the day we visited, there were 21 hearts.
Soon, hopefully, there will be more.