In his 30 years working in the healthcare industry, Scott Smith has never encountered a phenomenon in the medical field that caused him to cry himself to sleep at night.
But nothing could have prepared him for the devastation evoked by the COVID-19 pandemic.
Smith works three 12-hour night shifts a week in the ICU at the Northwest Medical Center in Tucson.
In late February 2020, the hospital designated half of its 20-bed ICU for coronavirus patients. Soon, the inundation of patients caused the hospital to open the entire ICU for COVID-19 care. When cases dropped off in the summer, Northwest went back to 10 critical care beds for COVID patients.
But when cases spiked again in the winter, the hospital had to expand its capacity using its 15-bed cardiac ICU to care for COVID patients. At its busiest, the facility held 30 coronavirus patients.
As hospitals scrambled to figure out how to treat the new virus nearly a year ago, the treatments they’re giving COVID-19 patients have evolved.
“At first, since COVID was such an unknown, we didn’t really know how to treat it, so we treated it sort of like any other sort of respiratory ailment. We were trying all the different medications that they thought might work and turned out didn’t,” Smith said.
The hospital began administering Hydroxychloroquine to COIVD patients, but after finding out the drug caused cardiac arrhythmias, or erratic heartbeat changes, Northwest stopped using it for treatment.
Now, the hospital commonly uses the drug Remdesivir to treat coronavirus, as well as giving patients convalescent plasma. This procedure involves taking blood from a recovered COVID-19 patient and administering it to a current patient in hopes the antibodies that fight COVID will transfer over.
“We have good luck with that in the early stages, but by the time you get to the ICU, its results aren’t quite as good,” Smith said. “It’s constantly moving forward, constantly learning new things and trying new techniques.”
Unable to breathe adequately on their own, the first critical care COVID-19 patients receive is intubation. Smith said proning patients—flipping them on their stomach so they’re facedown in the bed—has become a frequent practice.
But while the workers on the frontlines of the pandemic exhaust a variety of treatment options to keep COVID-19 patients alive, their families wait for results behind closed doors due to many hospitals’ no-visitor policies.
“Since we’re not letting family members in, I think that it seems like the family is much more reluctant to acknowledge when it’s hopeless,” Smith said. “So there have been several cases lately where I’m trying to talk to family members and try to explain to them there’s really nothing more we can do. But they still want you to do everything.”
Northwest purchased iPads for patients to FaceTime their family members, but the virtual contact falls short at the most critical moments of a loved one’s life.
“Without family members around, just the actual patient care is easier, but trying to express just how grave a situation is without them there seeing a patient has been much more difficult,” Smith said. “It’s not the same as being there, seeing all the machines we have hooked up to them and all the medications we’re giving just to keep their heart beating and the body oxygenating.”
Smith said while healthcare workers deploy a variety of treatments to care for patients in the critical stages of coronavirus, the abundant deaths employees have witnessed and exhaustion of around-the-clock care have surpassed a point of desperation.
“Did you ever see the old movie WarGames with Matthew Broderick? There’s a scene in that where they’re facing World War III, and the general says, ‘Heck, I’d piss on a spark plug if I thought it would help.’ And that’s been my attitude,” he said.
The nurse is used to the enervation working tediously long shifts in the ICU causes, but caring for COVID-19 patients day after day has caused a different kind of fatigue.
“Physical exhaustion is easy to deal with, you go home and you sleep for a while and you’re fine,” he said. “But there’s an emotional and spiritual exhaustion with this that I’ve never experienced before.”
As they live with the unique, multifactorial burden of caring for coronavirus patients, Smith said his colleagues and he provide each other a support system of mutual understanding.
“We know that, as humans, we are a social species. So the advantage is during work we are able to socialize with each other, and it’s not really a support group, but we do kind of function as that,” he said. “We don’t get together as a formal support group but just throughout the shift, we do talk to each other about how we’re feeling and what’s going on. It’s good to be surrounded by people that understand what you’re feeling, who see all the same things you are.”
But after facing a year of caring for patients fighting an oftentimes lethal virus on top of non-COVID-related critical patient care, Smith and his colleagues are experiencing a seemingly inescapable crisis both in and outside of work.
“In talking with coworkers, a lot of us are showing signs of PTSD just from doing this day in and day out for so many hours, and there’s no escape from it,” Smith said. “Usually, when you get off work, you can go home and get away from it. But with this, you get off work, you go home, and it’s all over social media, it’s all over the news. It’s just constant ever-present, like COVID 24/7. And I think that’s really, really draining.”