When Ruth Godde hooks up her patients to a ventilator at Antelope Valley Hospital, sometimes they grab her arm and ask if they are going to make it.
“You can’t with assurance say ‘yes’ to them, but you don’t want them to be more stressed than they already are, so we say, ‘We’re doing this to save you,’ ” she said. “But you realize as you’re incubating them the chances are they might not make it. In several instances, they don’t.”
As the COVID case count surges across Southern California, medical workers report burnout, fatigue and exhaustion as they scramble to save their patients’ lives.
“It’s exhausting mentally,” Godde said, adding that during her 12-hour shifts she has only one opportunity to eat or drink. She often cries in her car on the way home.
Every minute 10 people test positive for coronavirus in Los Angeles County. Every six minutes someone dies from the virus, officials say. Some ambulances circle for hours until a bed is free at hospitals. And some mortuaries are so full, they refuse to take on more bodies.
Los Angeles County, in the meantime, has approached the grim milestone of 1 million coronavirus cases, with more than 13,930 fatalities.
Death takes heavy toll
That has taken a merciless toll on medical workers.
On some days, nurse Michele Younkin from St. Jude Medical Center’s COVID-19 unit in Fullerton sees multiple deaths, she said, and rarely makes it through a shift without crying or comforting other nurses.
“I hold every patient that I lost … I hold them in my heart,” she said, as her voice cracked. “I can picture every single one, and I will probably never forget them.
“It’s emotionally taxing on our floor,” she added, “because we have so many deaths.”
For Dr. Thomas Yadegar, a pulmonologist and medical director of the intensive care unit at Providence Cedars-Sinai Tarzana Medical Center, it’s been a long 10 months since the pandemic began raging. When he walks into the hospital, he knows the first few minutes there will be “one emergency after another” until the end of his 20-hour shift.
“No matter how many hours I put in, no matter how hard I work, it just seems like at the end of the day, there are another 10, 15, 20 patients that need my attention,” he said, “and it’s heartbreaking because I know that I’m not able to give them everything that they deserve.”
Every single day, depending on the caseload, Yadegar typically cares for about 35 patients, but there are days when he is responsible for up to 80. He can’t remember the last time he slept more than three hours at a time. These days, Yadegar said, he sees more deaths in a day than he did in a month before the post-Thanksgiving surge.
Within mere weeks in early December, he said, the hospital was functioning smoothly with a small number of coronavirus patients, and then the COVID patient volume kept doubling, overwhelming the staff.
“I had to expand our ICU and, even with increased capacity, 90% of patients in our ICUs were COVID-19 patients,” Yadegar said. “Every single floor is now filled with COVID-19 patients and over 80% of our acute care are devoted to COVID-19 patients.” The hospital had to cancel any kind of elective and semi-elective surgeries so it could focus on treating patients infected with the virus.
Keeping families connected
At the nursing station at UC Irvine in Orange County, meanwhile, the phone is ringing nonstop as family members seek updates on the conditions of their loved ones, said Angela Mayfield, a registered nurse in a medical-surgical unit during a recent virtual protest hosted by California Nurses Association/National Nurses United.
“Nurses have worked short-staffed for many months while the work at the bedside remains physically and emotionally exhausting. The patients’ conditions are declining and the pressure on the bedside nurse can be overwhelming,” she said.
Registered nurse Robin Gooding at Providence Holy Cross Medical Center in Mission Hills said nurses are “working really hard” providing emotional support to patients who often are not allowed to see family members.
“It’s kind of puts a burden on the stuff because you have to become a family member to patients,” she said, adding that the staff often feels “responsible for making sure those patients are passing comfortably.”
Patients in the hallways
Another nurse from UCLA Santa Monica Medical Center said during the same protest her emergency department is so crowded that patients are moved to the hallway, putting both patients and staff at risk for exposure.
Nurses describe similar experiences at other hospitals, citing exhaustion and burnout amid dealing with the overload of patients, the shortage of gowns and broken equipment.
Valerie Ewald, a registered nurse at UCLA Santa Monica Medical Center, said she was offered “decontaminated masks,” that not only smelled bad but also had broken straps, making her wonder whether they offer sufficient protection.
In a statement, UCLA Health spokesman said that the hospital has “sufficient supplies of personal protective equipment and follows CDC guidelines regarding quality.”
“The safety and well-being of UCLA Health nurses, our other health care workers and our patients is our overriding priority at all times,” Enrique Rivero said. “We understand the anxiety created by the high volume of COVID-19 patients and associated workload, and we value our staff’s dedication to safe, high-quality, compassionate patient care.”
Higher nurse-patient ratios
It doesn’t help that the state recently allowed hospitals to adjust their nurse-to-patient ratios. New rules adopted during the pandemic allow hospitals to ask ICU nurses to care for three patients instead of two while emergency room and telemetry nurses might be required to take care of six instead of four patients.
Hospitals say they are so overloaded with high numbers of coronavirus patients, they simply don’t have enough medical personnel to respond to the crisis.
But asking nurses to take care of more patients will overwhelm already exhausted medical staff and weaken their ability to provide quality care, workers say.
“We are working to exhaustion, sweating and dehydrated from the long hours of wearing the personal protective equipment that we need to keep safe,” Mayfield said. “Our patients are struggling to breathe and stay alive.”
On a recent afternoon, Godde stopped another nurse at Antelope Valley Hospital, a mother of a newborn, who’s still breastfeeding, to remind her to go pump.
“She’s been leaking for a couple of hours and … you can tell she isn’t even aware of it because we’re all running around,” she said. “It breaks your heart.”
Quality care suffering
One Godde colleague at Antelope Valley, intensive care unit nurse Cindy Gillison, said she deals with “the sickest of the sick” on a daily basis. Medical staffing, meanwhile, is stretched so thin, she added, they can’t provide the quality care their patients need.
“These patients are dying alone,” she said, adding that there’s nowhere for the staff to put the bodies. Two refrigerated semi-trucks parked in the hospital’s parking lot are holding bodies. “There’s a tremendous amount of crying. It’s devastating.”
Once the pandemic is over, “a lot of us are going to have PTSD,” said the single mother of three. “It’s like a war zone. … We’re in the wrong place at the wrong time all the time.”
Lancaster Mayor Rex Parris said FEMA and Samaritan’s Purse, the faith-based disaster relief organization, have provided about 60 medical personnel to Antelope Valley Hospital to relieve the workload.
Still, like many other medical workers, Gillison braces herself for another surge following New Year’s Eve. “It’s scary to think what’s going to happen after four weeks, when the New Year’s surge comes,” she said.
The most frustrating part of the latest surge? It was preventable, medical workers say.
In the beginning of the pandemic, said Yadegar from Providence Cedars-Sinai Tarzana Medical Center, health care workers sensed support from the general public, but in recent weeks that support has “dissipated.” That, he said, has been “truly demoralizing and has taken everything away from us.”
As he drives home after his 20-hour shift, he watches how people are “living their lives as if nothing is happening.”
“If the general public … could see the misery, the pain and the anguish that we deal with on a daily basis,” he said, “they would not want to go to the grocery store, let alone get together or go to parties or travel.”
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