Crystal Schuler has been by patients’ bedsides for her share of deaths as a registered nurse.
But during this coronavirus pandemic, the patient deaths have been heart-wrenching, said Schuler, 36, who has been an intensive care unit nurse at Cleveland Clinic Akron General for five of her 13 years at the hospital.
Schuler and other nurses have been the ones at the bedside of the dying patient instead of family, due to visitor limitations to curb the spread of the virus.
Many families are on the phone or a video chat from their homes with the nurses holding the phone or tablet up to the patient.
Some families have been able to come to the hospital under an exemption for end-of-life that allows two family members.
But they still have to stay outside the ICU room and look in through the glass.
“That has been horrific because they can’t come in the room. They can’t touch them,” said Schuler, who takes the phone or iPad into the room.
“That’s an intimate moment between patient and family member that they can’t have,” she said. “That’s not my moment to have; it’s theirs.”
Schuler has had several patients die while their family members have been on the phone or FaceTime and said it’s hard, awkward and not the way it’s supposed to be.
“I’ve chatted with dying patients before that don’t have a family. That’s an honor and a privilege to make sure they’re not alone in the last moment,” she said. “When you’re on FaceTime or the family is outside the door and [the patient] takes their last breath, it’s hard to know what to do or how to comfort them.”
“I’m a hugger, and I can’t hug the family members or support them,” said Schuler.
The medical ICU at Akron General is now strictly a COVID-19 unit. While the hospital and other area hospitals haven’t seen the large surge in patients predicted, they have still seen a lot of COVID-19 patients who have had to be placed on ventilators for longer periods of time than other pulmonary issues, Schuler said.
She said it’s important that the community knows that the social distancing everyone has been doing by staying home is not only protecting themselves, but keeping people out of the hospital.
Being a patient inside the hospital is not the same right now.
“It’s people dying alone, not being able to see your family when you get sick. Or people who are stable or on a ventilator and still not being able to see family,” which can take a toll on a person’s mental well-being, Schuler said. “You don’t want to end up in this situation.”
Schuler couldn’t talk specifically about any of the deaths, but said in the beginning they were mostly elderly patients.
“Sometimes they can’t overcome this. It’s so aggressive and so nasty,” she said. “Now we’re starting to see more people getting extubated (removed from a ventilator) and leave the hospital.”
Schuler said the staff will celebrate those milestones when a patient is doing well enough to be removed from a ventilator — sometimes after two weeks.
“We form a ring and literally applaud and clap for them” and for the ones who have left the hospital, the staff helps “celebrate their life that they survived.”
“The tide is starting to turn a little bit. We’re starting to see people get better. I think we’re starting to see younger people come in,” who often can fight off the virus better, she said.
But Schuler hopes the community will continue to follow social distancing and protection guidelines.
“I’m thankful for the strong stance Ohio has taken and early on. We’re seeing different nurses and doctors in New York and they’re completely overrun. We are managing at this point the patients that we do have.
“I know people are getting frustrated. I completely understand, especially if you’re not working.
“I don’t want to see the health care system overrun if people are going out [after some restrictions have been lifted]. I already see people out and about, and it’s shocking to me,” she said.
Schuler has been volunteering to work more during the pandemic since she lives alone in Tallmadge with her dog.
Still, Schuler, who is from the Salem-Boardman area, said she has not seen her mom and sister other than from six feet apart.
“That’s been really hard. I’m really close with my family.”
The emergency department at Summa Health’s Akron City Hospital is still busy, but not overwhelming as the community has been good at listening and not coming to the ER if their COVID-19 symptoms are mild or unless they are in need of other emergency care, said Kelly Beard, who has been a registered nurse in the ER for eight of her 12 years with Summa.
But what’s different is that family members can’t accompany their loved one during the time of the emergency.
Beard, 32, recalls one female patient last week who arrived alone by ambulance.
“She told me many times while holding my hand that she was scared,” said Beard.
“I have a trauma phone that’s my work phone,” said Beard, who immediately called the woman’s daughter.
“I asked the daughter if we could FaceTime to give her peace of mind to see her mother,” said Beard. “If that was my mother in the hospital, I’d at least want to lay eyes on her.”
Beard said she could tell that interaction — different and new during the COVID-19 pandemic — made a huge difference for both the family and patient.
“I think seeing her family and being able to see them and talk to them eased her mind,” Beard said.
Beard cannot say for sure if she has treated any COVID-19 positive patients since the patients are usually tested in the ER, but often are either admitted to the hospital or sent home before test results are back.
She uses personal protective equipment (PPE) like gloves, masks and gowns while at work and when she arrives home in Uniontown, she undresses in the garage and puts everything in the washing machine. Her fiance is a firefighter/paramedic, so “we have been luckily going through this together.” She has stayed away from her parents to protect them.
Precautions for protection
Peter Dolson, a registered nurse in the emergency department at Summa Health’s Barberton Hospital, also has taken precautions to protect his wife and 20-month-old son at home.
He has a pair of shoes only for use at the hospital. He changes out of his scrubs at the hospital into a new pair of clothes and then once he gets home, he takes those off and immediately takes a shower before he interacts with his wife or son. Sometimes he gets to their home in Cuyahoga Falls at 4 a.m. Other times, he gets home when they’re waking up — and his wife takes their son into another room until Dolson has showered.
Similar to Beard, Dolson said his ER has still been busy because “the emergency department is always an unknown.”
“All the things that we usually saw in the emergency department, we’re still seeing, but now the added complexity of that is wondering if this patient may have [COVID-19],” he said.
“We don’t know who does or does not have the virus, especially when you’re in the Emergency Department,” so staff is always in full protective gear. It took some time to get used to wearing goggles and not having them fog up with other protective gear, said Dolson, who has been with Summa since last August and a nurse for nine years.
Dolson also said he can’t say for sure whether he’s treated COVID-19 positive patients, though many have been presumed positive while awaiting the test results.
“The hardest ones are the ones that come in and seem really healthy and [their health starts to] decline,” he said.
“Patients have leaned a lot on nurses. I know I’ve definitely spent more time I think than I ever have before trying to address things. Before, you could rely on [patients’] family to help support them. Now we’re having to spend more time giving emotional support to patients.”
Dolson said he’s been appreciative of the outpouring of community support of masks and food and positive messages.
“Walking in to work now the past few days, there have been different messages. I don’t know who is doing it, but in sidewalk chalk, they’re writing messages to the health care workers. The most recent was: “Heroes enter here” pointing to the main entrance.
Dolson and the other workers said they don’t feel like heroes. They appreciate the sentiment, but they are just doing a job they love.
Back at Akron General, Dr. Mona Turakhia, a critical care and pulmonary medicine physician, says she’s seen an unprecedented level of teamwork and bonding among all health-care workers from nurses to respiratory therapists and doctors.
“We’ve created this new environment that reflects such strong camaraderie and pure selflessness that has always been there, but has been completely amplified,” said Turakhia, a Solon native who came back to the area and to the hospital nearly three years ago.
Turahkia has treated patients of all ages with COVID-19 and said those who have had had to be on a ventilator were on it much longer than those with other ailments.
Before COVID-19, “we typically might see maybe 10 percent of patients a year with these types of respiratory failure to this degree. Now this has become the norm,” she said.
Her team has endured deaths, but “we’ve been fortunate enough to see recoveries, too.”
Like nurses, Turahkia said she and other physicians are spending a lot more time on the phone with loved ones since they can’t be at the hospital.
“Maybe it was one big update … Now it’s a lot more frequent and any sort of different changes a family would have otherwise witnessed if visiting,” she said. “We don’t just update about any kind of setbacks. We’re updating about any progress they’re making. It’s a big deal.”
Turahkia also credits social distancing with helping hospitals avoid the surge, but said the numbers of cases isn’t going down, either — so social distancing remains important.
Turkahia and her husband have been isolating themselves from their large, local extended family, which has “been really hard, but very necessary.”
“Everyone often talks about people on the front lines are heroes. I honestly believe everyone is really playing a part. There’s heroes at home; all the people at home,” she said. “I understand it’s a sacrifice, but that sacrifice is literally saving lives every day and allowed our numbers to remain manageable.”