Inside the ICU

In Community Health, Feature by admin

A Wichita ICU nurse monitors an unstable COVID patient.

For some physicians, appearances can be deceiving.

The number of positive COVID-19 cases in Sedgwick County has declined in recent weeks while deaths in the Wichita area remain below 100. But if you ask the exhausted physicians and nurses working in Wichita’s busy ICUs, COVID is still as real as it gets – a horrifying, unpredictable virus that requires constant vigilance and response to keep its victims alive.

“Everything has changed about the COVID ICU,” said Shauna Kern, DO, a hospitalist intensivist at Ascension Via Christi St. Francis. “The words to describe it are rather depressing and somewhat terrifying. We haven’t really had a situation before in which we don’t know what we don’t know, so it’s really hard to watch people pass away despite our best efforts. We’re not used to it.”

Chloe Steinshouer, MD, dons her PPE

Just days ago, a Wichita nurse in an ICU remained covered in full PPE to stay inside the closed room of a critical patient who was both on dialysis and a ventilator and required the administration of a half dozen medications. The patient was COVID-positive with unstable heart rhythms and needed constant monitoring.

On the other side of the transparent sliding doors, physicians and nurses read notes written on the glass with dry erase markers and advised or rushed off to gather needed supplies, which were carefully passed through the doors to the attending nurse. There is no rushing into these rooms. Physicians and their care teams must stop and suit up in multiple layers each time an ICU patient crashes or needs attention, which can be as many as 30 times a day. Seconds tick by, but there is no other way.

A look into the room of an isolated COVID patient with constant monitoring.

Not long before that, an older man in his late 80s had one wish: to eat lemon cake with his wife for his birthday as he had done every year for many years. As he was COVID-19 positive with multiple comorbidities and was being treated in a Wichita ICU, his bereft care team chose to get him a lemon cake, which they arranged for him to eat with his wife on FaceTime. The man passed away not long after from complications of COVID, his comfort care team at the bedside in place of his family.

The COVID risk is real

This is daily life for physicians and their teams in Sedgwick County hospitals today. For them, COVID remains as devastating a monster today as it was in early 2020 as the virus expanded into the United States and became a full-fledged global pandemic.

“We are seeing people fight for their lives all day and we’re trying to stay safe while taking care of them, and then you hear 120 people argue at a city council meeting about why they don’t want to wear a mask,” said critical care intensivist and pulmonologist Chloe Steinshouer, MD, ICU medical director at Wesley Medical Center. “It’s very disheartening.”

Hospitalists Shauna Kern, DO, left, and Daniel Dejong, MD, in full PPE

She’s referring to a Wichita City Council meeting on Sept. 8 where council members heard testimony from anti-maskers who complained the ordinance was negatively impacting their lives and businesses. Many conspiracy theories were shared, as were opinions that masking and social distancing do not save lives. The council ended up voting to extend the mask mandate until Oct. 21, or until the COVID threat drops to the green level or the rate of positive cases in Sedgwick County drops below 5%.

In the past few weeks, Sedgwick County’s new positive COVID test rates have been declining from a high of 14.1% in late July. The county has bore witness to more than 8,000 cases since the pandemic started.

Such numbers don’t seem very high when compared to states such as Florida, California and Texas, though on a per-capita basis Kansas has been considered a “hot spot” at times. Wichita also has fared better than peer cities in the region.

Not just a matter of luck

Have we just been lucky? Not really, said Garold Minns, MD, Sedgwick County’s public health officer. We’ve been smart because Sedgwick County instituted masking and social distancing ordinances early on and has kept them in effect in addition to other restrictions. And the majority of people in the county have cooperated, which has made these tools effective right now, he said.

“There’s no reason to think the numbers won’t go up if we stop masking,” Minns said. “The virus is still circulating and over 90 percent of us are still vulnerable. We don’t have our own immunity. If we stop doing the things we’re doing now – wearing masks, social distancing, and frequent testing and isolation of people with symptoms – then the virus is going to take advantage of that and the numbers will go right back up.”

For ICU workers, COVID constantly shapes their perspectives as positive patients continue to fill ICU beds and physicians and their care teams are forced to stay on top of every detail that will keep them and the families they go home to safe.

“We’re scared that we’re going to contract the virus and take it home to our family,” Kern said. “We’re all just human, and this virus scares us too.”

Because of the risks, families of ICU patients are not allowed to visit their loved ones, and many patients who die from COVID do so surrounded only by the health care team that tried to save them.

That’s been a real game-changer for most ICU specialists, not having the family be by the bedside, supporting the patient in ways only a loved one can. This frustrates physicians, who can’t even share an encouraging smile with a patient through an N95 mask, goggles, head cap and face shield.

“We know we’re doing really important work, but it takes its toll,” said Michael Lowe, RN, ICU manager at Wesley Medical Center. “We like to be stoic and proud and not admit to the toll that patients getting worse and worse takes on us, with family members sobbing over the phone, not being able to visit.”

The stress rarely abates

While perhaps not as shell-shocked as many felt in early March, frontline physicians are anxious and exhausted, both emotionally and physically as they strive to keep patients alive amidst a virus that still does not have a cure or vaccine.

Many doctors are juggling obstacles to providing an elevated standard of care in the COVID era and must think outside the box to get the things people need to get better, Steinshouer said. The stress of caring for so many sick patients with limited tools is very real. “Even with the best care we provide, we can’t save all these patients,” she said. “You can’t watch someone die every day and stay the same.”

That’s why self-care is such an important component of a medical professional’s mental, emotional and physical health, said Shawna Allen, LMSW, LMAC, with the Mental Health Association of South Central Kansas. That includes talking about the day with a friend, colleague or professional and taking regular, even short, breaks from work to relax and revive.

“We all in the helping field think that we are supposed to hold and have it together at all times,” Allen said. “But in reality, we are experiencing secondary trauma, and we have to address that and treat ourselves to be healthy to treat our community.”