Dr. Allison Cable, ’01 MSN, DNP, ACNP, APRN
Cable has 15 years of experience as an ICU nurse practitioner, caring for patients who have complex, multi-system medical issues such as critical illnesses involving the lungs, liver, and kidneys. During the start of the pandemic, Cable was at Yale New Haven Hospital, a tertiary medical center with more than 1,500 beds. Cable was stationed in the Medical Intensive Care unit at the Smilow Cancer Building.
Dr. Laura Kierol Andrews, PhD, APRN, ACNP-BC
Andrews is a senior acute care nurse practitioner at the New Britain campus of the Hospital of Central Connecticut, a 450-bed facility. She treats an adult geriatric population on a mixed medical surgical unit. Their 24 ICU beds were broken into three pods at the start of the pandemic, and COVID-19 patients eventually filled them all.
Dr. Philip Martinez, ’06 MSN, Ed.D, APRN-BC, CCRN-CMC
Martinez works at Middlesex Hospital, a 207-bed facility in Middletown, Connecticut, as an acute care nurse practitioner. The Critical Care Unit (CCU) is a 12-bed intensive care unit and a 12-bed intermediate care unit together on one floor. The primary service is pulmonary critical care, and the team consists of four physicians and four acute care APRNs.
As with nursing worldwide, many members of the YSN community ha ve served on the front lines of the COVID-19 pandemic. Donning and doffin g layers of personal protective equipment (PPE) many times a day, isolating from their own families, and living with a daily uncertainty of how long, how long, how long will this last. Three faculty members share in their own w ords what it was like during the initial surge and beyond, an experience that continues to shape the way they care for patients and teach the next generation of nurses.
A DEVASTATING SICKNESS
Andrews has cared for critically ill patients throughout her career, but those cases stopped short of the ravages of COVID-19.
“To see how quickly a patient deteriorated, I’ve never seen anything like it,” Andrews said. “You could be talking to them one minute, and they’re a little short of breath, then minutes later they’re gasping, the saturations are plummeting, you have to intubate them. They got sick really quickly.”
Faced with the unique needs of COVID-19 patients and a dearth of resources, Martinez and his team deployed innovative care modalities to rise to the challenge.
“Early on, as admissions and transfers to the unit increased, we realized that patients were requiring increasing amounts of oxygen to breathe appropriately, and a lot of the sicker patients were requiring being intubated and placed on mechanical ventilation. Once intubated however, it was quite difficult to ventilate patients,” Martinez said.
“Novel therapies were employed in an attempt to increase the oxygen levels in the blood and stabilize patients. Patients were being proned, that is, placed on their belly for prolonged periods of time, which helped increase oxygen levels. Other ventilator settings were also employed, ones which traditionally hadn’t been needed except in the case of severe lung disease,” he said.
THE ABSENCE OF FAMILY
Cable recalled how jarring it was not to see a patient’s loved ones visiting them during their illness.
“The biggest change during COVID-19 was not having family come into the hospital,” she said. “We were having to communicate through the phone, and family members would literally wait by the phone all day for this one call. And these were the most stressful conversations that we were having. Families were panicking because patients were not getting better quickly, and we didn’t have much new to say to them each day.”
As an added complication, many of Cable’s patients were not native English speakers, so they first heard medical information in another language before understanding what was happening.
“A lot of patients I took care of speak Spanish, so I was working with an interpreter who had to deliver bad news, repeatedly,” Cable said.
Martinez pointed to a lack of familial presence as a tough burden for the patients, families, and providers.
“The absolute hardest part of being a provider during the first wave of COVID-19 was the inability of patients to see their family during their critical illness,” he said. “Intensive care nursing and medicine both recognize the importance of family during the acute phase illness and healing process, and we strive to have families at the bedside as often as possible. We implemented things like Zoom calls, and when possible offered compassionate visits, but nothing replaces having family with you when you aren’t feeling well.”
CARING FOR THE CAREGIVERS
Nurses are used to 12-hour shifts but maintaining such a high level of care to critically ill patients during a global pandemic for so long takes an emotional and physical toll. Throughout COVID-19, a constellation of supporters did their best to buttress the providers with means available to them.
“My family and friends were unbelievably supportive,” Cable said. “They dropped off food. They sent cookies. And I always really appreciated getting a quick text just asking how it was going. Food was pouring in at the hospital for the frontliners from so many restaurants in New Haven. It was unbelievable how the local businesses supported us,” Cable said.
“With my colleagues, we were so focused on running in headfirst that we weren’t able to take the time to check in with one another. As we go through this again, I want to make sure I’m reaching out to coworkers and making sure they are okay. No one did that for me, and a little conversation of just two seconds can make such a difference,” Cable said.
Andrews’ hospital set up a serenity room with spa water, comfy chairs, and a lavender oil diffuser. You could even do yoga in there, but you would need the time first. Since bathroom breaks were a luxury, taking time on the mat remained a distant possibility.
Andrews said that while the team didn’t always have time for formal debriefings after particularly rough days or cases, nurses would grab an opportunity for comfort when one presented itself.
“One of our ICU nurses had been taking care of a patient for many weeks, and the patient was doing poorly. There were family meetings to discuss goals of care. And I could see this nurse had a look on her face that she needed a hug,” she said. “And you can’t hug anybody, but I gave her a hug! We’d both been in the same ICU, where it’s impossible to socially distance. We’re both in full PPE and I said, ‘You needed it, and frankly so did I.’”
“The community support we received was unbelievable,” Andrews continued. “Restaurants were taking collections from customers to send meals to the hospital, patients’ family members sent pizza, radio stations took collections, and the hospital chipped in, too. There was food for every shift, every day, for months.”
Martinez was amazed by the outpouring of support from the local community.
“Middlesex County and the public at large did an absolutely amazing job during the surge carrying us along,” Martinez said. “I will never forget the dozens of red hearts I saw every day on my way to work, and frankly I am tearing up now even thinking about it. My neighbors would sometimes stand at their houses when I would leave for work, and the kids would clap and cheer.”
“Someone even delivered a bottle of Lysol spray to my house to make sure I had something to clean my shoes with when I got home from work. And I would be remiss if I didn’t mention the hundreds of social media well wishes I got every day and still get. There is no way I could have worked as much as I did without all of the amazing people who carried me along,” he said.
“And the food deliveries, oh my goodness all the food deliveries!” Martinez exclaimed. “A local pizza restaurant delivered dozens of pizzas a day to us, every day, every shift, to make sure we were fed. The desserts. The snacks. It was an amazing show of love and support.”
MOMENTS OF BRIGHTNESS
Keen observers by profession, these providers were quick to notice moments of brightness in the dark weeks and months of the pandemic.
“One day there was a socially distant gathering outside with the local fire department, EMS, and police, who all came over to say hello. One of them held a sign that said, ‘Our heroes wear scrubs!’ I walk by a photo of that every day,” Andrews said.
Andrews remarked that during the once-in-a-lifetime crisis, team members squared their shoulders and forged ahead with their best efforts.
“I tell my students I can’t do my job without a good nurse at the bedside, and I saw the best of the best during COVID-19. Our respiratory therapists were in and out constantly, putting everything on and taking everything off in a systematic way to avoid contamination. They might visit a room six or seven times in an hour. And every time, everyone stepped up to the plate,” she said.
Martinez shared that sometimes respite and rescue came from unexpected avenues.
“A local tattoo artist who had heard we were taking donations was making face shields at his house with a 3D printer. He donated 100 of them to us by delivering them in person in the middle of the surge, just when we needed them most.”
“Local musicians who could no longer play in person were playing online concerts while sending love and shoutouts to those of us in healthcare. It was seeing the best of everyone for sure,” Martinez said.
THE LASTING EFFECTS
With just a little bit of distance after the first wave of COVID-19, YSN faculty reflect on how the novel coronavirus has altered health care.
Cable summed up her impressions succinctly.
“Not much has changed, and yet so much has changed. Patients were critically ill before COVID-19, so taking care of patients on ventilators was very routine for us. I’m not scared of COVID-19 patients anymore. It doesn’t scare me to put on all that PPE and go do what I need to do for that patient. I’m desensitized to it now, but in the beginning, it was terrifying,” Cable said.
“I’m fortunate that I worked in a facility that was very proactive, and from a systems perspective, was well prepared. I felt very safe and felt like we were going to get through this,” she said.
Andrews urged preparation for the next wave.
“Take this seriously. Wear a mask,” Andrews said. “I wear one for 13 hours a day. The best part of the day is when you take it off in the parking garage.”
“I don’t think a lot of people understand how sick people get, and how easily it spreads,” Andrews said. “Until there is a vaccine, you really have to be cautious. Practice good hand hygiene. Don’t have big gatherings, and stay in your work pod and your home pod. It will eventually get better, but it will probably get worse again. We know how bad it was, and we know we got through it.”
Martinez exhibited the humility of each provider, praising the teamwork that all three credited with making it possible to put one foot in front of the other.
“I’m not so sure I personally made any difference at all, but I can say that our team did an amazing job in the moment handling what ended up being a surge of at least four to five times the average amount of ventilators we would handle on an ‘average’ day in the CCU.”