‘They’re dropping dead — two, three a day.’
Kris B. Mamula
kmamula@post-gazette.com
Alexandra Wimley
awimley@post-gazette.com
December 27, 2020
A man’s heart stops and a woman’s measured voice comes over the hospital intercom:
“Code 68; ICU; room 3008.” There’s a pause, then again: “Code 68; ICU; room 3008.”
In room 3008 of WVU Medicine’s Uniontown Hospital intensive care unit, a doctor joins nurses in rushing to jolt the man’s chest with electrical shocks, start chest compressions and flood his blood vessels with strong medicines. It’s the eighth time in 12 hours that someone’s heart has stopped in the intensive care unit — five times for the man in room 3008.
It’s 7 a.m. and the start of shift in the red zone — a term for the expanding number of units at the Fayette County hospital where COVID-19 patients are segregated for treatment to contain the spread of the infection. At this point in mid-December, 1 in 3 people being tested at the hospital are coming up positive for the disease, up from 1 in 10 at the start of the outbreak in the spring.
A line of cars filled with people seeking tests snakes through the hospital parking lot to the emergency department, where swabs are taken in a tent. Sometimes the line backs up onto a hospital connecting road called Easy Street.
Every person in the 15-bed ICU is infected with the novel coronavirus. So are about half of the patients in the 145-bed hospital.
Hospital visitation has been suspended. The public elevator doesn’t stop anymore on the second floor, where another red zone has been set up for another 27 people with COVID-19.
A few days earlier, more rooms in the hospital’s shuttered fourth floor were opened to accommodate still more patients with the disease. Hospital staff say a sharp uptick in cases began in the past few weeks.
Transporter Richard Halbrook takes the body of a COVID-19 patient who died in the intensive care unit to the hospital morgue.
In just a day or two, the hospital was scheduled to give the first doses of a new COVID-19 vaccine to 1,200 staff members, offering what physician David Hess called a “glimmer of hope” after a nine-month siege by the biggest public health crisis in a century.
“We needed a glimmer of hope,” said Dr. Hess, who takes over as the hospital’s CEO next month. “Science is finally going to win.”
He worries about Uniontown Hospital doctors and nurses suffering a kind of post-traumatic stress syndrome — emotional problems that are best known in soldiers returning from war.
Science will be too late for the ICU patients on this day. Only one, maybe two, of the 15 will survive, a veteran respiratory therapist says, glancing around.
“You can just tell,” she says.
‘This is nonstop’
Respiratory therapist Walter Smith helps push oxygen into the lungs of a COVID-19 patient, moments before a tube is threaded into his lungs and he is attached to a breathing machine.
Anas Wardeh, 55, a critical care doctor who has presided over 10 deaths in four days in the intensive care unit, is worried.
“We’re not winning,” says Dr. Wardeh, a stooped man who leans forward in a determined walk.
He’s starting a shift that will stretch 15 hours.
“This is nonstop. This is COVID. I don’t know what else I can do,” he says.
Hospitals nationwide are feeling the same pressure.
On Dec. 18, a record 114,751 people with COVID-19 were hospitalized, a number that has been climbing for months, according to the COVID-19 Tracking Project. Doctors worry about shortages of staff, hospital beds and medications, leading the Johns Hopkins Center for Health Security to join eight other national organizations in asking state governors to help “protect the health system from functional collapse.”
On Dec. 17, Johns Hopkins reported 3,435 U.S. deaths from COVID-19, a single-day record.
COVID-19 is hammering rural Pennsylvania, too, where case counts are up sharply. Nearly a quarter of the tests given in Fayette County for the week ending Dec. 11 came back positive, according to the state health department, while hospitalizations and ventilator use rose.
More sickness means more death. Uniontown Hospital’s morgue reached capacity three days earlier when three ICU patients died in a 3.5-hour period, said Chris Hair, 44, who has been a registered nurse at the hospital since graduating from nursing school.
The hospital is discussing temporary refrigerated storage for bodies if the counts continue to rise.
“This is the worst I’ve seen in my career,” says Ms. Hair, a hospital manager who is often called to console families when a patient dies.
Assault on the lungs
Nurses and x-ray technicians examine an image of a COVID-19 patient's lungs
Disease is framed as a battle of good and evil. COVID-19 is simply a battle for breath.
Most people with COVID-19 can be treated outside the hospital. Others will need a hospital stay that can last days to weeks before they recover after receiving oxygen and medicines.
For many COVID-19 patients in ICUs around the country, no amount of oxygen helps because it can’t get into the patient’s bloodstream. Above all else, COVID-19 is an assault on the lungs, a disease that just says no to oxygen.
“Once they get this bad, it’s quite a battle for them to get back,” said Kari Magill, 51, who is director of the hospital’s respiratory department. “It’s dire.”
The result is oxygen hunger, anxiety and sometimes panic. Air hunger can feel like suffocation.
Patients who are ill with COVID-19 get oxygen by face mask in increasing amounts as needed. If that doesn’t work, oxygen is delivered directly into their lungs through a plastic tube hooked to a machine that takes over their breathing while they are sedated.
“I’m not leaving you,” Dr. Wardeh tells a 75-year-old man in the ICU who is writhing in bed, hungry for air, before a tube is threaded into his lungs and attached to a ventilator.
“I’m with you. I’m going to help you out, my friend.”
It will be Dr. Wardeh’s third intubation of the morning. For many patients, even a breathing machine pushing air into the lungs is not enough; oxygen levels in the bloodstream are still too low to support life.
All that’s left then is frustration.
‘Save one person’
Critical care physician Anas Wardeh confers. with ICU staff about the status of each patient at a morning meeting
Dr. Wardeh and the nurses have restarted the heart of the man in room 3008, the monitor on the crash cart has been wiped down with disinfectant. An infusion pump quietly grinds nearby while heart monitors throughout the unit call out for notice with bursts of beep-beep-beep.
In the center of the unit, behind a counter, the doctor gathers with the nurses to go over the condition of each patient. All of the staff wear face coverings that look like gas masks worn in wars, with portals sticking out to the left and right.
It’s a routine morning review.
Anas Wardeh, a critical care doctor, prepares to insert an arterial catheter into a patient’s arm, shortly after they were brought to the ICU.
Some patients will be turned onto their bellies to improve their oxygen levels; the doctor will push plastic tubing into arteries to deliver medication to others; blood and samples of lung tissue will be drawn from still other patients.
The report on the ICU patients is grim: kidneys failing, little brain activity, pupils fixed, falling oxygen levels.
“We know where this one is going,” Dr. Wardeh says frustrated and pointing to a patient room. “We know where that one is going. They’re dropping dead — two, three a day. I have seven patients on 100% oxygen; there is no 110%. We have to go unconventional.”
Going unconventional in this case means trying nitric oxide, which, when inhaled, has been shown in early clinical trials to improve blood-oxygen levels in critically ill COVID-19 patients. Dr. Wardeh said the effects are variable, but he’s out of options and wants to try it.
He insists that Ms. Magill, the respiratory supervisor, ask hospital executives to obtain the colorless gas, which is undergoing clinical trials as a treatment for COVID-19.
“Make something happen,” he implores her. “It’s all we have.”
Ms. Magill listens quietly, tells him she is doubtful, but finally agrees to talk to a supervisor.
“If I could save one person,” Dr. Wardeh said, his voice rising. “If I could save one life.”
Family loss
Dr. Anas Wardeh, guards the patient's breathing tube, which is attached to a ventilator, as ICU staff flip a COVID-19 patient to try to ease his breathing.
Veteran ICU nurse Michelle Weaver wipes away tears in telling a patient’s family about the deteriorating condition of their loved one
While COVID-19 tears through the fabric of the country, the infection is ripping through families. Mothers and daughters, mothers and sons, sisters, brothers have all died from COVID-19 in the ICU.
A woman in her early 60s prepares to go home from Uniontown Hospital after being treated for COVID-19 while her son, also infected, is unconscious in the intensive care unit.
The heart of a man in his 80s slows toward death, while his wife at home tells a nurse on the phone she is starting to feeling sick.
Since March, three pairs of siblings have died from COVID-19 in Uniontown Hospital’s ICU, including a couple from out of town who came in for a funeral.
Michelle Weaver, 48, is the no-nonsense ICU nurse who calls the family of a woman, intubated and unconscious, who is slipping away. Ms. Weaver offers to arrange a virtual meeting, likely their last chance to see mom alive. But the children live in different states; would it be possible for all of them to see their mother by iPad or iPhone simultaneously, they ask.
Ms. Weaver, a powerfully built woman whom the other nurses call Cupcake, pulls down her mask to talk to the family on the phone in a low voice, wincing and wiping away tears running down her cheek. They say they need some time. They will call back.
‘IT WILL GO HIGHER’
Gary Workman, pastoral care coordinator, leads a prayer with retired and current healthcare workers who volunteered to administer the first doses of the Pfizer-BioNTech COVID-19 vaccine to hospital staff Dec.18. 'Today is a good day,' Mr. Workman said before the prayer. 'If we could just take a moment to ask God for his blessing as we start what is hopefully the beginning of a healing for our community, our patients, our families, our friends, and for us today.'
The heart of the man in room 3008 stops again. This time, Dr. Wardeh had received permission from the patient’s guardian to withhold treatment if it happened. The man dies quietly.
He was 55.
The mom clings to the barest threads of life. Ms. Magill returns to the ICU to tell Dr. Wardeh that trying nitric oxide gas in the unit isn’t going to be possible right now.
There are other priorities, equipment shortages, mounting infections in the county, she calmly tells Dr. Wardeh.
“It will go higher,” he snaps, not angry.
A pine tree outside the window of room 3008 is getting frosted in a snowstorm that has blown up in the southwestern Pennsylvania valley holding Uniontown Hospital as the man’s body is zipped into a blue bag, tagged and heaved onto a stainless steel morgue cart. Sleet spits against the window pane.
Kris B. Mamula: kmamula@post-gazette.com or 412-263-1699