Working in a hospital COVID-19 unit right now feels a little like being in a disaster flick, said Jake Perkins.
A 24-year-old registered nurse in a medical intensive care unit at UAB, he’s caring for the hospital’s sickest COVID-19 patients.
“It reminds me of a movie about a tsunami,” he told Reckon. “You turn around and you see this wave coming at you.”
Recently, UAB Hospital hit a new record with 171 hospitalized COVID-19 patients. It’s a staggering number, eclipsing the previous surge in hospitalizations over the summer. Hospitals around the state are seeing similar increases.
In April, AL.com detailed a day in the lives of Perkins and Taylor Floyd Hightower, both nurses in UAB Hospital’s COVID-19 units. This week, we spoke with them again to see what’s changed, whether anything has improved, and how they’re managing the newest wave of patients.
As Alabama’s COVID-19 cases and hospitalizations soar, nurses and other frontline healthcare workers bear the brunt of the pandemic even as travel and Christmas holiday gatherings could push hospitalization numbers higher.
“I think fatigue is really setting in,” said Perkins. “We have not stopped since April. The hospital is doing everything it can but there’s only so much you can do. We worry we’re having this huge surge now and we won’t have enough nurses to do what we have to do for our patients. That’s the worst part.”
Back to COVID
Hightower, 25, works as a registered nurse on the night shift in one of UAB’s COVID-19 units, a step before the ICU. Back in April, her unit had 20 beds; now it has 30. There was a point, earlier in the fall, when hospitalizations were low enough that her unit transitioned back to a non-COVID unit. It was wonderful, she said. But it didn’t last.
“We’re fully COVID now,” she said.
Early in the pandemic, Hightower said, more patients were elderly or came from nursing homes. After a few months, the COVID patients began skewing younger. Now, she said, it’s mostly a mix of ages and medical histories.
Perkins said the most surprising part of treating COVID patients is how differently the disease affects people.
“We could have an 80-year-old woman and a 25-year-old man with what looks like the same hospital trajectory,” he said. “One could have (existing health problems) and the other none, and (the patients) look the same.”
Gowns & masks
One positive change since April is that health-care workers better understand the virus and how to treat it.
“We can anticipate certain things better than we could in the beginning,” Hightower said.
Protective equipment like gowns and masks, called PPE, is also no longer in short supply. Nursing staff no longer have to reuse masks as often, and UAB now has cloth gowns that can be worn once and then laundered for reuse.
“The PPE situation looks completely different than it did in March, April and May,” said Hightower.
At the start of the pandemic, as hospitals tried to limit exposure and preserve scarce PPE, nurses were some of the only staffers allowed in COVID patients’ rooms at UAB. As a result, nurses had to clean rooms, empty trash and conduct treatments like dialysis in addition to their regular duties. But now, thanks to more PPE, environmental staff are allowed inside rooms to clean while specialists, such as respiratory therapists and those who administer dialysis, are also allowed in patient rooms.
“At the beginning, you felt like you were on an island,” she said. “But now the teamwork keeps morale up when we’re all able to jump in and help, and our unit is good at that.”
Needing more nurses
Now well into the tenth month of the pandemic, Perkins said it’s easy to feel fatigued.
After a particularly grueling morning for Perkins and fellow staffers, a respiratory therapist turned to him and joked: “I’m tired of being a hero.”
Caring for COVID-19 patients requires more one-on-one and specialized care, which means more hospitals need more nurses. On COVID-19 units, each nurse typically has fewer patients.
This week, UAB Health announced it has enlisted more than 120 nursing students and faculty of the UAB School of Nursing as it faces a nursing staff shortage due to COVID-19‘s spread and the intensive care treating the disease requires.
Earlier this month, UAB called on retired nurses to join its efforts. The hospital has also hired more than 100 travel nurses to help bolster its staff.
“It’s very emotionally draining, and physically and mentally too,” said Hightower, who typically has four COVID-19 patients at a time, though the ideal number is three. “That’s nursing, but I feel like now it’s heightened because there are so many unknowns and this is an unprecedented time in general.”
Worried for the future
Hightower said she her fellow nurses try to keep morale up by supporting each other and trying to leave the job behind when they’re off.
“In the beginning, it was so all-consuming,” she said. “But now I’ve gotten to the point, when I’m at home, sometimes I vent to my husband about rough patches. But after that, I have to leave it and enjoy my time at home.”
Early on, local groups and individuals often sent food and other items for COVID nurses, who were hailed on social media as heroes. Hightower said there were weeks where she didn’t bother to bring a lunch because so much food was donated to her unit.
That public outpouring has slowed.
But more than care packages, they want people to follow safe social distancing guidelines and to wear masks in public. It can be frustrating, said Perkins, to see people ignore rules meant to keep people safe.
“People now are fatigued of quarantining and mask-wearing,” he said. “Yes, it’s frustrating (to the public) to have to wear a mask to Publix, but it’s not your full-time job.”
Hightower said that in April, she wanted people to know that good news was coming out of hospital COVID-19 units and that not everything was doom–and–gloom. But now, she said, she’s grown more worried as the surge in hospitalizations shows no signs of abating.
Said Hightower: “It does scare me.”