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Mary Elizabeth McDonough dreams about how she and her colleagues at NorthShore University HealthSystem will celebrate when the COVID-19 pandemic finally disappears. Ms. McDonough, a registered nurse and Evanston resident, works three 12-hour shifts a week at NorthShore’s Glenbrook Hospital COVID intensive care and step-down units, where she says she has witnessed or heard of more patient deaths than she can count.
One of the doctors there has proposed a big celebration dinner when the times comes with her nurse and doctor co-workers. And when will that be? When enough people have been vaccinated to generate herd immunity, Ms. McDonough said. She’s not predicting when the joyful day will arrive. “It’s something we all dream about.”
The Louisville native had just graduated with her RN diploma from Western Kentucky University before she and her husband relocated to Evanston for his new job in the fall of 2019, a few months before the pandemic began to spread. She decided to volunteer for the COVID-19 intensive care and step-down wards at Glenbrook Hospital because, without children or local family, there was less risk of her contaminating someone she loved.
She said there was “no way to prepare” for the physical and emotional toll she had to face. Part of the toll was due to the surprisingly wide age range of victims. “That’s one of the perplexities we wonder about,” she said. Older and sicker patients sometimes recover while younger ones die, as young as in their 40s and seemingly healthy. She has also cared for or witnessed multiple members of a single family die.
For emotional support, she says, health-care workers tend to rely on each other. “It’s been pretty taxing on everyone,” she says. “The best therapy is talking with co-workers.”
Because patient families are unable to visit their loved ones, it falls on ICU staff to facilitate communications. “We can never fill that family role,” she said, but she and her colleagues have become adept at stepping up their support role, including “setting up lots of Zoom calls.” She said the hospital has done a good job of streamlining the burden by requiring each family to select a single point of contact.
As of March 3 there were 15 COVID-19 patients at Glenbrook Hospital and one at Evanston Hospital. At the peak of the pandemic NorthShore had 180 patients. In total, more than 550 COVID patients have died in NorthShore hospitals in the last year.
As the pandemic worsened last fall and again last month, the hospital had to devote more space, more staff, and more resources to COVID care. The number of cases has “waxed and waned,” Ms. McDonough says, “and when it spikes, we’re slammed.” Everything changes “from week to week,” she added. “Walls go up, walls go down.”
Evanston resident Chris Winslow, who for 14 years until last fall was Director of Critical Care Services at NorthShore, says the hospital system has done well at adjusting to the changing number of COVID-19 cases and getting enough supplies. “We never had shortages of gloves, gowns, ventilators, or other supplies. We saw what happened early on in Italy and New York, so that gave us time to plan.”
He also praised the “excellent job” by hospital engineers to convert its heating and air conditioning systems. The intensive care ward and selected COVID-19 rooms had to be converted to “negative air flow” to change air frequently and vent it outside.
As senior attending physician for Pulmonary and Critical Care Medicine at NorthShore, Dr. Winslow continues to rotate from his office at Evanston Hospital one week a month to each of the other system hospitals. He pointed out that starting last March the COVID staff had to quickly learn the disease’s “pattern of progression” with seriously ill patients, in order to optimize patient outcomes. One example was “proning” patients – turning them on their stomachs – so they could get more oxygen to their tissues and breathe more easily. This technique was already known to physicians but came into focus with the pandemic. Such a procedure sounds straightforward but actually requires a highly trained team of up to five people working in tandem, in part to ensure lines don’t get snared.
Dr. Winslow said providing care to the COVID units continues to be “very difficult.” Intensive care staff are used to seeing the sickest people in ICU, “it’s part and parcel of the care we provide,” he said. “But we were struck by the number of patients dying, some in their 50s and 60s.”
He said one particularly challenging aspect of COVID care is the end-of-life phone calls to patient families who cannot be with their loved ones. “It’s hard enough to have those conversations when a family is there. It’s way harder to have to do it on the phone.”
He said his routine has changed to accommodate COVID safety protocols. Especially during the worst months, “I was very concerned about getting and spreading disease to my family.” After his 12-hour and overnight shifts at Glenbrook hospital, he would shower there before returning home. He said he would occupy a separate bedroom for a full week after every COVID rotation.
The disease has taken “a huge emotional toll on ICU nurses.” He called them “amazing caregivers.”
We can’t thank these front-line hospital workers enough. All we can do is bear witness to their heroism, courage, and skills.