Tricia Beth Nelson has seen a lot of patients and illnesses come and go during her 16 years working at Rockcastle Regional, the last 12 as an RN. Exhaustion written all over her face, she takes a few moments to stand aside and talk about what she has seen in the last few weeks while working on the COVID unit at the hospital.
“I had a patient in their 60s who I sat by her bedside, holding her hand while she cried, asking me to not let her die, that she had so much to live for. She was expecting her first great-grandbaby in a few weeks,” Nelson said. “All I could do was cry with her and pray for her.” She died a few days later.
The patient had incorrectly thought the vaccine contained the live virus, and therefore, declined to take it.
“We had a husband and wife in here a few weeks ago, both were infected with COVID,” Nelson said. “The wife got better and was able to go home, but her husband’s condition continued to decline, and he had to stay hospitalized. I listened to them say what they thought might be their final goodbyes to each other.” This couple was in their 40s and, both were unvaccinated.
“I’ve witnessed more final goodbyes between husbands and wives over the last few weeks than I ever thought I would in this short amount of time,” continued Nelson. “Each time this happens, every time I lose a patient, I cry my entire drive home that night.”
When asked how often that happens, Nelson sighs, and after a few moments, quietly replies, “I cried after every shift last week. I lost at least one patient every day.”
Nelson tells me that she and the rest of her coworkers are running on fumes and even less hope as each day passes, and more patients are admitted to the COVID unit. The patients coming in are younger and sicker as each week goes by.
Acute care/COVID unit coordinator Claudia Adams, RN, echoes the same sentiment as Nelson. “We are sending 30- and 40-year-olds home on oxygen. That is heartbreaking.”
Adams tells about a patient in his 40s who is a father.
“The day he was discharged home, he couldn’t even walk a few feet on his own because he couldn’t breathe well enough,” she said. “He will be on oxygen for a long time. He didn’t know how he was going to take care of his kids, his family, if he can barely breathe.” He wasn’t vaccinated, either.
ROBBING PETER TO PAY PAUL
News of hospitals throughout the nation being overrun by COVID patients is ever-present since the Delta variant began spreading. Hospitals in nearly every state are reporting that they no longer have open ICU beds.
“We currently have ten referrals for our ventilator facility from a hospital in Tampa, FL looking for a bed,” said Rockcastle Regional president and CEO Stephen A. Estes. “Every day, we are getting calls from Paducah, Bowling Green, LaFollete in TN, from hospitals 200 miles away, looking for a bed. This isn’t an isolated issue to just us, it’s everywhere. There are simply too many patients and too few beds.”
Since the pandemic began in March of 2020, Rockcastle County had not seen nearly the surge in cases or deaths that some of the larger, more populated areas were experiencing.
That is no longer the case.
Dr. Angela DeBord Isaacs has been treating COVID-19 patients both in the hospital and through the clinic at Rockcastle Family Wellness, and she explains that the Delta variant is a different beast.
“The Delta variant is impacting younger people, those in their 30s, 40s, and 50s. And this age group of people are typically those who have decided to not take the vaccine.” said Dr. Isaacs. “It’s no longer only affecting the 80- and 90- year olds and those with comorbidities. It’s affecting young, healthy people.”
In total, as of Aug. 31, Rockcastle Regional Hospital has treated 163 COVID-19 patients in its acute care unit. Of those, 161 were unvaccinated. Forty-three of those patients had to be treated in the hospital’s 4-bed intensive care unit (ICU).
“We officially hit ‘crisis mode’ on Monday, last week,” said chief nursing officer Tammy Brock, MSN, RN. Crisis mode occurs when the number of patients requiring ICU care exceeds the number of available beds.
Throughout the pandemic, the number of COVID- isolated beds the hospital designated has fluctuated, depending on the need. Now, the COVID unit consists of more beds in the acute care unit than non-COVID beds, all ICU beds are full, and physicians and nurses are playing a sort of “musical chairs,” switching patients back and forth between the COVID unit and the ICU, having to make the difficult decision of who needs that ICU bed the most on a given day.
Dr. Isaacs tells of a patient she had to intubate on the acute care unit, a procedure typically performed in the ICU. “I know it’s against protocols, but we had no other choice. This patient needed to be in the ICU, but all our beds were full. I called twelve other hospitals trying to find them a bed, but they were all full, too.”
“Patients’ lungs are destroyed by COVID, so they take longer to recover and have longer hospitals stays than non-COVID patients,” Dr. Isaacs said in explaining why bed availability is such an issue in all hospitals. “We have the standard medicines to manage COVID: steroids, anti-virals, supplemental oxygen; and then you just have to wait and see and hope they get better. But it is a very long road to recovery.”
Hospital staffing is just as critical of an issue as bed availability.
“We shut down our outpatient surgery center for two weeks, mainly for the purpose of redirecting that surgical staff to assist on the COVID unit,” Brock said. “Last week, we temporarily shut down one of our ventilator units, moving those patients to other units in the Respiratory Care Center, so that we could send more relief staff to take care of the increasing number of COVID patients. We will re-evaluate this week if we can open it back up.”
Rockcastle Regional’s 143-bed Respiratory Care Center, the largest facility of its kind in the nation, treats patients who need mechanical ventilators to breathe. Those patients typically are admitted due to injury or chronic disease. Very few are there because of COVID.
Rockcastle Regional COVID-19 Admissions
*As of 8/31/2021. **”Cumulative” means since March 2020.
COVID-19 Hospitalized Inpatients
Unvaccinated COVID-19 Hospitalized Inpatients
COVID-19 ICU Patients
COVID-19 ICU Patients on Ventilator
COVID-19 Inpatients by Age
Over 50: 129
Under 50: 34
Over 50: 9
Under 50: 2
“I could hire 40 nursing positions, alone. That number doesn’t include the need in other patient care areas,” reports Brock. “And I’m not seeing any hope in sight of that number improving.”
Rockcastle Regional’s outpatient clinics are also reporting record numbers of patients. The QuickCare clinic’s increasing number of patients is resulting in higher numbers of tests performed, blood draws, respiratory treatments performed, lab tests run, therapy and rehab treatments conducted. This is creating an even greater strain on other departments already experiencing staffing shortages.
Director of respiratory therapy Jeff Smithern reports nineteen open positions for respiratory therapists.
“If I had 100 qualified applicants for positons throughout the organization,” said human resources director Carmen Poynter, “I could put them to work today,” The majority of those open positions are clinical roles involved in direct patient care.
3 of 17
Taking a very rare break from her unit, ICU coordinator Patti Halcomb, RN, talks about what she’s seen just over the last month.
“It’s heart-wrenching to stand in a room and watch a 50-year-old patient die,” said Halcomb. “I don’t mean for this to be a scare tactic, but these are horrendous deaths.”
“We are seeing devastation every day. We see children saying goodbye to their parents through a window, holding their hands to the other through the glass. It’s pure devastation. It’s not like the heart attacks and the strokes we normally see. These are healthy people dying.”
Dr. Kevin Rowe sees patients in both the acute care and COVID units, as well as in the clinic at Rockcastle Family Wellness. Sitting in his office, he’s working on his computer before he goes to see his next patient. Dr. Rowe has been one of the strongest advocates for the vaccine with his patients and fellow employees, because he’s seen the devastating effects of this disease first-hand.
“I’m 3 of 17,” he says, shaking his head and looking out the window. “I’m 3 of 17 on ventilators.”
Then he clarifies, “I’ve only had 3 COVID patients live after being placed on a ventilator. Fourteen have died.”
When asked how many of those 17 were vaccinated, he replies “Zero.” His frustration is visible
When talking about the vaccine, it is obvious Dr. Rowe is very well informed about the medical and pharmacological side of the vaccine, as well as incredibly passionate about encouraging people to get vaccinated.
“This vaccine works. It’s been tested. There is no reason to wait. Three-hundred, seventy-one million vaccine doses have been administered. More than 205 million Americans have received at least one dose. There’s no better testing that can be done on it than that.”
According to the Centers for Disease Control (CDC), of the more than 39.5 million COVID cases reported in the U.S., there have been 644,848 deaths (as of Sept. 7).
“There have been 6,500 COVID deaths of people who were vaccinated,” Dr. Rowe said. “You have to look at that through the lens of 200 million Americans. That translates to .00325 percent of Americans. Of all the COVID deaths, only 1 percent of those were people who had been vaccinated.
The CDC reports that only 30 percent of Rockcastle County residents of the eligible age (12 years and older) are vaccinated. Rockcastle County has a population of nearly 17,000.
Through his many conversations with patients and staff, Dr. Rowe has heard practically every reason given for not taking the vaccine. The two most common reasons: “It’s too new; I’m going to wait and see what happens,” and “Aborted fetal cells were used in its development, and I am pro-life.”
Dr. Rowe acknowledges these concerns and discusses them and the truth behind them.
“The Moderna and Pfizer vaccine are based on mRNA technology. This has been around for 10 years, it’s not a new science. It has been used effectively in various other vaccines. It is safe. Period.”
Talking about the concern over aborted fetal cells, Dr. Rowe says he understands patient hesitancy, but he says it’s based on incorrect information. “The vaccine developers used what is called ‘immortal life cells.’ Let me be clear, these are not aborted fetal cells.”
In 1951, a scientist at Johns Hopkins Hospital created the first immortal human cell line with a tissue sample taken from a young woman with cervical cancer. Those cells, call HeLa cells, quickly became invaluable to medical research. These cell lines are “immortal” – meaning they can grow indefinitely, be frozen for decades, divided into different batches, and shared among scientists. Medical researchers use the laboratory-grown human cells to learn the intricacies of how cells work and test theories about the causes and treatment of diseases.
“These are the cells used to develop the COVID vaccine,” Dr, Rowe said. They are the same cells used to develop literally every vaccine, medicine, and medical treatment being used in the U.S. today. Every medicine and vaccine is tested against these cells.”
(To learn more about the Henrietta Lacks story and the HeLa cells, go to www.hopkinsmedicine.org/henriettalacks/.)
RUNNING LOW ON HOPE
“This disease is unlike any other,” said Dr. Mary Saylor Joenborg. “The sheer terror a patient experiences from being able to breathe to suddenly not being able to breathe cannot be overstated.”
“The Delta variant, as we all know, is affecting the younger people. It’s affecting healthy people, people with healthy cardiovascular systems, healthy lungs – young, active people.”
Dr. Joenborg tells about the emotional strain this disease is having on her patients.
“I had a patient in his 40s who had always been active and, for the most part, healthy. By the third day of his hospitalization, we had to switch him over to a bipap, which is a full-face mask that forces oxygen into the lungs. With the increased anxiety over suddenly not being able to breathe, combined with the constricting mask, the patient frantically grabbed at the mask and was pulling it off. We had to use extremely strong sedatives to get this patient comfortable enough to treat him.”
Working in the clinic, as well, Dr. Joenborg sees the recovery side of COVID, and its outlook is also bleak. “There are so many long-term side effect to manage post-COVID. Your lungs are severely damaged and we are sending young people home on oxygen, not knowing how long they will have to stay on it,” she said.
“A patient I treated in the hospital comes to see me in the clinic for her follow-up. Before COVID, she was an absolute ‘go-getter’ at her job. She loved it and was always on the move, sometimes working 14 hours a day. She is now nine months out from the hospital, recently returned to work, but can’t even get up from her desk. Her co-workers now have to come to her,” says Dr. Joenborg. “The emotional strain of trying to return to ‘normal’ life after COVID is a struggle for every one of my patients.”
Tricia Beth Nelson echoes Dr. Joenborg’s point.
“These are long-term side effects that patients are going to have to deal with for who knows how long. We aren’t talking about a patient who is hospitalized for a short time, gets better, goes home, and returns to their normal life. We are looking at patients whose lives are possibly forever changed because of the damage to their lungs.”
Throughout the pandemic, quality director and infection control coordinator Traci Bullens, RN, has led the charge to contain the spread of COVID throughout the organization and the community.
“The emotional trauma that our staff are experiencing right now is tremendous,” Bullens said. “They are worried they will bring the virus into the hospital and give it to a patient, or they are afraid they will take it home to their family. The fear is often overwhelming.”
“We get into healthcare because we want to help people, but this disease is a different case. Many times we have no ability to help. We have exhausted all medical options. Normally, the good outweighs the bad, but there are an increasing number of days where this is no longer the case.”
That feeling of helplessness is widespread among much of the staff.
“Sometimes, there’s nothing you can do for them other than sit with them, hold their hand, pray for them, cry with them, and just hope they can get better,” Nelson said. “But many times, you know there’s no hope, even still, you try to give them some glimmer.”
“I watch the staff stand and cry,” Patti Halcomb said when asked about the effect COVID is having on her staff. “We pray at the door of these patients. It’s the helpless feeling because you know you can’t do any more for them. But every morning, I make the decision to still come in to work, to make it through another day, to care for another patient. Who else will take care of them?”
Tricia Beth gets ready to go back to her patients, but leaves with a final thought, “And to think, this all could have been prevented with a vaccine. It almost makes it worse. People shouldn’t have to lose their people."
Dr. Kevin Rowe treats COVID-19 patients in Rockcastle Regional’s COVID-19 unit and ICU. As a strong advocate for getting vaccinated, he says, “This vaccine works. It’s been tested. There is no reason to wait. Three-hundred, seventy-one million vaccine doses have been administered. More than 205 million Americans have received at least one dose. There’s no better testing that can be done on it than that.”