LIMA — Amanda Dunlap was one of the first critical care units to volunteer to work in the COVID-19 unit at Lima Memorial Health System. The disease was new and deadly, but Dunlap knew many of her colleagues shouldn’t be exposed to a novel virus that has since infected more than 17 million Americans and led to the deaths of at least 314,000.
Since March, Dunlap spends several minutes most mornings donning her medical gown, hairnet, N95 mask, gloves, face shield and goggles before entering patient rooms, an elaborate process. Prior to the pandemic, a typical day’s routine was a hand washing procedure.
The gear protects her from the virus, which often lingers in the air and could sicken Dunlap if she were to inhale it. But it also makes her indistinguishable from her colleagues, so each day, she attaches a photo of herself to her name badge.
Dunlap’s patients may not be able to see her smile when she says good morning, she reasons, but she always shows them her picture in the hopes that a human face will make the scene a little bit less traumatizing for her patients in the intensive care unit.
She calls her patients’ families a couple of times per shift, coordinating FaceTime calls when a patient is still able to speak or updating family members on treatment regimens, because visitors are not allowed inside the COVID unit.
The hardest calls are the goodbyes: Dunlap or her colleagues holding an iPad in front of a dying patient, some of whom are unable to talk after intubation, while their children, siblings and spouses send their love one last time.
In her nine years as a critical care nurse, Dunlap has grown used to death, but the speed with which COVID-19 has overtaken her community is unlike anything Dunlap has ever seen.
“I don’t know how else to describe it, besides heartbreaking,” Dunlap said. “Just sitting here makes me tear up, because I’ve watched patients pass away (with) their family watching them through an iPad. I’ve watched a husband and wife pass away in the same room, one before the other. It’s just terrible.”
The worst of the pandemic seemed to miss Lima initially. Most patients who were admitted to the hospital with COVID-19 in the early months were elderly residents who were exposed to the disease during nursing home and assisted living facility outbreaks.
But after Labor Day, as the Lima region slowly emerged as the epicenter of Ohio’s epidemic, Dunlap and her colleagues were overwhelmed by the influx of new COVID-19 patients they were seeing.
Lima hospitals were admitting so many new COVID-19 patients by October that hospital leaders starting speaking publicly about their challenges.
ICUs were so busy that patients were often boarded in the emergency department for hours.
Elective surgeries were rescheduled so those physicians, nurses and technicians could be redeployed to work the COVID units.
Some patients who presented at the emergency department were sent home with oxygen and pulse oximeters to monitor their blood oxygen levels from home. Others who no longer required acute care but were too weak to go home alone were discharged to local nursing homes to recover so hospital beds would be available for those who most badly needed them.
And the patients have gotten sicker since Jill Vorst started working the COVID-19 unit at Mercy Health-St. Rita’s Medical Center in March.
The COVID patients who come to the ICU typically require ventilation support. Even the ventilator settings are much higher for a COVID patient than the average ICU patient, Vorst said, which may lead to other complications.
Some patients develop kidney issues, requiring dialysis. Many require extensive medications and drips — much more than the typical patient Vorst had seen in her seven years in the intensive care unit.
Usually, an ICU nurse can care for two patients per shift, but because a COVID-positive patient requires so much additional care, Vorst said staffing in the COVID ICU is typically one patient per nurse.
As Vorst picked up additional shifts this fall, she grew accustomed to seeing younger patients in the COVID units now that the disease had spread to every part of her community.
That’s the hardest part for Vorst: Seeing how sick her patients are; knowing they may never recover; and in some cases, seeing someone she knows fall ill with a disease that may kill them.
“Sometimes there’s no good solution on how we can get them better,” she said. “It’s really hard to see that.”