ICU nurses cried, talked with counselors, but none walked away.
Kris B. Mamula
kmamula@post-gazette.com
March 28, 2021
Worry continues in Uniontown about whether the staff would be strong enough to beat back a next wave — one that many experts are predicting — of a disease that kills four of every five people who become seriously ill.
The devastation of 2020 is still vivid to many at the hospital.
“Cardiac arrest after cardiac arrest after cardiac arrest,” recalled intensive care unit charge nurse Michelle Weaver, 48. “People dying every day, the unit full every day — I took that home every night. I don’t think the staff could tolerate that again.”
As mask mandates are lifted in Texas and other states and as U.S. COVID-19 case counts flatten, Uniontown Hospital critical care physician Anas Wardeh worries.
The disease is still here, he said. The deaths continue.
“The battle is ongoing,” said Dr. Wardeh, 55, who oversees the ICU. “Nothing can stop it. We’re fighting against the odds.”
Last year was the deadliest year in U.S. history, with COVID-19 killing 400,000 people. The fatalities were approaching 550,000 last week as more contagious, more lethal variants pop up.
At Uniontown Hospital, the prospect of a surge fueled by new strains brings with it the threat of new psychic wounds for caregivers.
Triage, the only guide
The Uniontown Hospital ICU had no crisis guidelines for medical care, no policies to follow as every bed filled with COVID-19 patients in December — just the principles of triage, which date to the Napoleonic era and steer medical care to the sickest, those with the most urgent needs.
Every day, families would call the ICU for updates on their loved ones, unaware doctors and nurses were racing room to room to shock a patient’s heart back to beating or insert a tube into the lungs to increase the oxygen in their bloodstream. An average of five people died every day in December, mostly in the ICU.
Uniontown Hospital President David Hess, whose mother was a nurse, worries about the emotional toll on caregivers forced to deal with so much death.
Distraught families, who weren’t allowed in the hospital due to COVID-19 restrictions, sometimes asked nurses to pray with their loved ones.
Left:Top: Karla Yurko, a nurse in the intensive care unit, arranges fluids for a patient in the ICU. | Right:Bottom: Dr. Anas Wardeh, a critical care physician, consults with intensive care unit nurses Sarah Empoules, Melinda Provance, and Linda Stoots before performing a procedure on a patient who has COVID-19.
Even now, during an uneasy pause in the outbreak, the crisis created by COVID-19 is still too fresh for executives at WVU Medicine, which manages the hospital, to have fully thought through how the virus will change the practice of medicine.
That’s because hospitals plan for the pileup out on the interstate involving a bus full of tourists, the paralyzing snowstorm, power outages. Hospitals haven’t worried much about things forecast to happen in the next 500 years.
COVID-19 may change that.
“We were prepared for the 100-year flood but not the 500-year flood,” said WVU Medicine President and CEO Albert Wright, who oversees a 15-hospital system including the 135-bed Uniontown Hospital. “We underestimated how widespread the community spread was going to be. In some ways, these were things we never imagined. What this feels like to me is a 500-year flood.”
Hospitals were not ready for the sustained assault COVID-19 mounted — the handful of new infections every day in Fayette County that grew to a flood of contagious patients clogging the hospital by December.
A total of 141 people would not survive the month — 82% of the total number of COVID-19 deaths in Fayette County in 2020.
“All hell broke loose in the fall,” said Stephen Hoffmann, a critical care doctor who has been guiding WVU Medicine’s response to COVID-19. “We had never seen a death rate like that.”
Virus defeated? Or just stalled?
WVU Medicine executives believe the vaccination campaign underway in Fayette County will head off a new wave of infections. Many experts agree, including Dr. Griffin of Columbia University.
Others see flashing red lights.
The Centers for Disease Control and Prevention in January warned of the potential impact of a COVID-19 variant called B.1.1.7 that spreads more easily than existing strains.
“A higher rate of transmission will lead to more cases, increasing the number of persons overall who need clinical care, exacerbating the burden on an already strained health care system and resulting in more deaths,” the study found.
A U.K. study published March 10 in the British Medical Journal found the B.1.1.7 variant was between 30% and 100% more deadly than existing strains.
Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, and other researchers sounded a similar alarm in a February report, saying the B.1.1.7 infections could push COVID-19 hospitalizations as much as 45% higher than the U.S. record of 132,474, set Jan. 7.
“We’re definitely going to benefit from vaccination, but at this point, the vaccination rates are still low,” Mr. Osterholm said.
As of last week, only about 14% of the U.S. population had been fully vaccinated, according to the CDC, far short of the 70% or so needed for the country to achieve public safety from the disease.
“This is coming,” Mr. Osterholm said. “How bad it will be is still unclear, but you can see what happened in Europe,” where cases of the B.1.1.7 variant, first identified in September, were doubling every 10 days, increasing hospital admissions and prompting government lockdowns on businesses in January.
“Please hear me clearly,” CDC director Rochelle Walensky said at a briefing in early March. “At this level of cases, with variants spreading, we stand to completely lose the hard-earned ground we have gained. These variants are a very real threat to our people and our progress.”
Talking to families
At Uniontown Hospital during the peak of the surge, conversations with families were constant and difficult. The ICU staff didn’t always know each patient as a person, but they got to know the sons, daughters, spouses.
Victoria George, 58, kept a log of every conversation she had with Dr. Wardeh and the ICU nurses when her mother was in the unit in December. The ICU, like most of the hospital, was closed to visitors, but she called every day — getting to know each by name.
“Your mom’s very sick,” the nurses would tell her.
Ms. George’s mother, Frances Pierce, had not been feeling well in the weeks before she began baking her Christmas chocolate chip cookies, nut rolls and lady locks in early December. Ms. Pierce, married at age 15 before having the first of six children a year later with her husband of 59 years, John, finally called her daughter to say she couldn’t breathe and needed an ambulance.
“They told me I tested positive for COVID-19,” she told her daughter, who lives three miles away.
The holiday season passed for Ms. Pierce — who raised her family in a frame house built by a coal company for miners — with her still hospitalized.
When she became too weak to talk, an ICU nurse used Ms. Pierce’s phone to text her daughter, telling her that her mother wanted her to know she loved her. Three churches remembered Ms. Pierce in prayer chains.
ICU nurse Sarah Ampoules comforts Frances Pierce, struggling for breath, before giving her a sedative to prepare her for intubation. Ms. Pierce died of COVID-19 on Dec. 27.
Dr. Anas Wardeh prepares to insert an arterial catheter in the arm of Ms. Pierce, who was taken to the hospital by ambulance in early December because of trouble breathing.
Later, Dr. Wardeh, who tells families he’s always available to talk, called with bad news.
“He said she’s a very sick lady,” Ms. George said. “ ‘I don’t want to make this phone call, but I don’t think your mother is going to be here much longer. We’re going to try to make her better.’ ”
“I knew we were losing our mother,” she said.
Ms. Pierce, 77, grandmother to 16 and great-grandmother to eight, died Dec. 27 in the ICU with festive green shamrocks decorating her fingernails instead of the Christmas tree decals she’d thought she’d picked for the approaching holiday. Her family never told her otherwise.
At a church reception following the funeral, the Christmas cookies Ms. Pierce had baked were served.
Not over yet
Uniontown Hospital’s ICU was a very different place the first week of March than it was the month of December. Back then, COVID-19-infected patients filled the halls, administrators weighed options for an overflow morgue and 40 to 50 hospital staff members were off work after being exposed to or infected by the disease.
Nationwide, too, pressure was easing as spring approached, with 91,206 fewer new cases on March 9 than the 226,148 new cases Dec. 31, a 40% decline. But the signals were different in Pennsylvania, where the week to week change in the number of new cases reached 1,380 more cases by March 18, including an increase of 31 in Fayette County. Testing positivity rates were ticking upward again, too, after a lull and so were COVID-19 hospitalizations.
For Uniontown ICU charge nurse Michelle Weaver, the anxiety never went away.
The winter surge in COVID-19 cases was the worst experience of her 25-year nursing career; 12-hour shifts spilled over into 13-, 14-, 15-hour shifts as the deaths mounted and counselors were called to comfort nurses, she said.
“Once we got hit, it was nonstop. That’s the oath you take as a nurse. It’s not always pretty,” said Ms. Weaver, who remembers a COVID-19-infected man in his 80s calling his children from his ICU bed, telling each of them he was going to die that day, which he did. Ms. Weaver stayed with him for two hours.
“I don’t want anyone to die by themselves,” she added. “That’s my biggest fear.”
A nurse takes a moment to herself shortly after a COVID-19 patient died in the ICU at Uniontown Hospital in December.
The surge in cases didn’t break the staff, though; ICU nurses cried with patients and families. None walked away from the profession after the harrowing month, Ms. Weaver said.
The thing that hasn’t changed since December is the the tough conversations with families.
On an early March afternoon, when winter cold gave way to cool sunshine, Dr. Wardeh was on the phone with the family of a 66-year-old woman who had COVID-19 — one of just three people with the disease in a 15-bed unit that had been filled with patients in December.
The woman’s odds of surviving were fading — a hole had developed in one of her lungs, leaking air, which often happens to people being treated for COVID-19 with high-flow oxygen delivered through a mask.
“We are really very close to putting her on a ventilator,” he told the family member. “If we do, her survival rate would be 20%; that’s it. There’s no way she could survive at home.”
He paused to listen, then added, “Let me see what I can do, and I’ll do my best.”
Joined by nurses, Dr. Wardeh quickly slipped on a gas mask-like device and other protective gear and swept into the patient’s room. Twenty minutes later, she was breathing easier, but the aid was temporary. The threat to her life remained.
‘COVID is here to stay’
So many questions remain about COVID-19 that the likelihood of another storm is not fully understood, Dr. Wardeh said. Will the vaccines provide protection for six months? Three months? Will mask wearing in public and social distancing measures continue?
He shrugs.
In any case, “vaccines won’t help my patients,” he said. “We need more therapeutics,” medicines to treat people who are already sick with the disease.
For those who are not sick, there is vaccination, he said.
“Guarantee yourself that, at any price, you won’t end up in the ICU,” he said. “A lot of people still don’t get it: COVID is here to stay. It’s not leaving.”