'This is a battlefield': Inside the COVID ICU

A look inside a COVID-19 Intensive Care Unit at Novant Health Rowan Medical Center in Salisbury, North Carolina, as doctors and nurses manage another hectic workday.

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(sound of ambulance)

Shelley Quan: This is a battlefield. This is mass unit stuff. This is not what we signed up for. It takes a toll. Never in 40 years... I mean, we would deal with HIV. We got, you know, you figure in my lifetime we've gone through economy crashes, too many nurses, not enough nurses, always short nurses. But this is unbelievable.

Gina DiPietro: Welcome inside Novant Health Rowan Medical Center in Salisbury, North Carolina, where Healthy Headlines spent several hours on three COVID-19 units following the doctors and nurses working tirelessly to treat COVID patients, and in many cases just fighting to keep them alive.

You’re listening to Novant Health Healthy Headlines. I’m Gina DiPietro, your host.

We opened with nurse Shelley Quan taking a step back to explain just how brutal life in the ICU has been for health care workers since COVID-19 descended. Next, her reaction to those who think COVID is somehow overblown.

(sound of heart beat)

Shelley Quan: Interesting the number of people that still think this is not real. Come spend an hour here. It's real. Come be a family member of these people. It is so real.

Gina DiPietro: Follow along as Healthy Headlines’ Roland Wilkerson provides an inside look at caring for COVID patients … many who will never return home. At times, the audio is a bit muffled. That’s because everyone is masked, and conversations were carried out on the fly as team members manage another hectic workday.

Here again is nurse Shelley Quan, who describes her time with patients - confronted with their own mortality during the pandemic, which has killed more than 700,000 Americans.

Shelley Quan: I cared for patient a couple of weeks ago and she didn't want to be put on the ventilator. She had been fighting it for three weeks. And she wanted to FaceTime her kids before we put it on her. Between the two of us, we couldn't figure it out. She's a year older than me. But I stayed with her for two hours, because she said, ‘Don't leave me.’ And I didn't leave her. And that was two weeks ago. She's still on the ventilator. She probably won't make it off. (cries) But her kids have been wonderful. I mean, I don't know how they do it.

Gina DiPietro: High patient numbers and a nursing shortage, made even worse by the COVID pandemic, has forced health care systems to send nurses who left bedside duty for administrative positions with better hours and working conditions back to the front lines. Many of these nurses thought this part of their career was over.

Think of it this way: They’re a bit like police officers who sought more stable and safer desk jobs … now suddenly back in patrol cars …. It’s not been easy. Nursing is a punishing job, where you’re on your feet for 12 hours shifts. Wearing extra layers of protective gear only makes it tougher. But these nurses are strapping in and ready to go where needed. One note, most of these nurses are there to assist the fulltime nurses actually assigned to patients. Here’s Tina Hartsell, who had not been at the bedside for 10 years.

Tricia Hartsell: So, I'm basically just an extra hand. I can help do lots of different things, but I don't take an assignment. So, it's helpful for them. They're very appreciative to have extra hands and to help. So, we'll make it through this. Isn't that what we always say? We'll make it through this together. But yeah, there's a big disconnect between what's happening here and what's happening in the world...

Roland Wilkerson: So, talk about that a little bit. Tell me what you hear out in the world and then what you walk into every day.

Tricia Hartsell: Well, hearing the politics out in the world... it's all political. And it's not political. You come in here and it's real. Like there are people that are fighting for their life for weeks. They're losing their life and it's just horrible. People need to see that it's not to be taken lightly. It's that never seen anything like this. As nurses you save lives, and I'm not very successful at that today.

Gina DiPietro: Let’s hear now from Erin Wolfe - another returning nurse who recently found herself back on the front lines.

Erin Wolfe: It's hard because everybody in our department got out of bedside nursing for one reason or another. I've been a nurse for 17 years. So, it was just hard coming back into this type of situation in this setting.

Roland Wilkerson: Talk about that. What's it like?

Erin Wolfe: I've seen more death now than I ever did in all of my career of nursing, which is hard. You know, patients look at you and they're scared. And it's a lot about comforting more now than it ever used to be, because they don't have their loved ones here with them. So, it's hard.

Roland Wilkerson: So, you kind of came back into a world of nursing that has never existed before.

Erin Wolfe: Right. Exactly. And I was never an ICU nurse, so to be put in this type of setting.... And I'm happy to help because I know they've been, you know, drowning with all of these patients. So, any way we can help, we're willing to do that.

(sound of heart beat)

Gina DiPietro: Now we’ll hear from Novant Health’s Dr. Abayomi Agbebi who’s treating COVID patients, nearly all of them unvaccinated. We’ll start in infectious disease doctor’s office before heading back to the hospital as team members work side-by-side caring for patients.

Dr. Abayomi Agbebi: The choices we're making around vaccines and COVID right now.. And, you know, masking, not masking and all these social distancing. Those are choices about how we live. Okay, you're making a choice about how you live. But I'm also explaining to people that in the hospital, if you are in the hospital, and you get sick, that's not a choice about how you live, that's not part of living. And then if you're unlucky enough to get sick with COVID there's a whole ‘nother set of choices you made. We have people who got sick enough to need a ventilator. They're alive. But now they have a tube in that throats, in their neck ... a tracheostomy to help them breathe. They're on dialysis, they're alive. But we would not say that's the best life we want. So that's a choice about how you want to live. And then we also have patients who unfortunately have passed away. So, you're also making choices not just about how you want to live. We're also making choices about how you want to die.

Gina DiPietro: You’ll hear a lot of medical terminology that might be tough to understand, but we’ve included it just to give listeners a feel for conversations in the ICU. Remember, these discussions continue around the clock as physicians and their teams care for profoundly ill patients, most who decided not to get the COVID vaccine. At the hospital, you’ll hear Dr. Agbebi talking with a nurse about a patient. From there, he discusses the tough odds many ICU patients are currently facing.

(medical chatter between team members)

Roland Wilkerson: How many of these patients do you think have a legitimate shot at leaving the hospital alive?

Dr. Abayomi Agbebi: Sadly. If they’re in the ICU and get this sick? Probably 10%. You know, it's not good. It's not good. It's not good, yeah.

Roland Wilkerson: In effect, you're kind of managing their death here, it sounds like.

Dr. Abayomi Agbebi: In some ways you are, because that's literally why it's life support. Because literally trying to support them to have some life. If the life support wasn't there, tliterally wouldn't. You know, you keep that blood pressure so their brains get blood supply…. You're basically keeping their life functions going. But you're keeping their life functions going so that they can recover and go home. But for some of them, the support can't stop. And once it goes too long, then you're really coming into a situation where, I mean, life is really over for them. And that's sad.

(ambient sound of hospital)

Gina DiPietro: We all know the far-more contagious Delta variant has put a lot of younger, healthier people in the hospital. Let’s rejoin Dr. Agbebi ... this time on an intermediate floor ... standing outside the room of a patient whose not yet hit his 21st birthday.

Dr. Abayomi Agbebi: He actually looks like he's improving a little bit. I'm hoping we get more improvements, so....

Roland Wilkerson: Why is he in the hospital? Is he having trouble breathing?

Dr. Abayomi Agbebi: He literally was on 15 liters of oxygen. A lot of oxygen, yea.

Roland Wilkerson: 15 liters is a lot?

Dr. Abayomi Agbebi: Yeah, 15 liters is a lot. Oh, that's a lot. Yeah. We're hoping to gradually keep winnowing him down. Plus, he's young. So we're hoping that helps that he has a (unintelligible) reserve. So we got 18-year-olds. We have 20-year-olds. Um, so, it's just not a disease of the elderly.

Roland Wilkerson: Are they surprised to be in a hospital?

Dr. Abayomi Agbebi: Yes. Oh, yes. And that's the other thing. You know, for a lot of patients at some point, because of the issue of beliefs that I spoke about ... you can see the confusion and fear all racing through their minds. Because you believe one thing and what you're seeing is not … It's completely different from what they believed. It’s a traumatic thing for them to experience.

Gina DiPietro: Before COVID, young, certified nursing assistant Kaceyann Robbins spent her time caring for mostly older patients at Rowan Medical Center. We caught up with her in a hallway where she explained how the delta variant changed that.

Kaceyann Robbins: Honestly, for me, because I'm 20. So, when I'm taking care of a 20-year-old... it … I almost feel like I don't really know how to describe it. It hurts your heart because you're like, ‘Well, I'm the same age as you and you're in this situation.’ So, it's kind of having to get used to that. But you treat everybody the same – unbiased, you know. You try to do what's best for them. And that's all that matters is you're doing best for the patient. So, yeah (sighs). It's ... it's a lot. It's strange but we're getting used to it. We're getting through it. We have a good team up here.

Gina DiPietro: You might remember when rare cases of serious blood clots caused by the Johnson & Johnson vaccine led to a brief pause on distribution and sparked even more hesitancy around the COVID vaccines. That pause was lifted after scientists determined benefits of the vaccine far outweigh any potential risk. Dr. Agbebi explains how COVID itself can cause serious blood clots .... sometimes with dire consequences.

Dr. Abayomi Agbebi: COVID - it causes people's blood to clot. One patient, she's lost the blood supply in her leg. And even though they tried to restore it, she's gonna end up in the amputation room because of COVID. So, yeah, unfortunately, it’s not going well for her. COVID can do just a range of things beyond just your lungs. So, which is why I said, you know, people are not just choosing how they want to live. They're literally choosing how they want to live and how they want to die.

Gina DiPietro: As we mentioned, COVID has ravaged the country and the nursing ranks. At 60, Shelley Quan muses about retirement and flashes a visitor a cell phone photo of an exotic beach she jokes about running off to. But when we ask her if she’d be ready to let someone else fill her shoes in the ICU, the tone changes.

Roland Wilkerson: Have you thought about putting in for a transfer to get out of the stress and chaos?

Shelley Quan: I have. My daughter who's a nurse tells me I need to get out of it. And I tell my kids and myself. ‘It's not about me.’ I heard a sermon about that about 12 years ago. It’s not about me.

Roland Wilkerson: What is it about?

Shelley Quan: It's about these people – the patients and the families. It's not about me. If it's about me, I would be sitting on an island drinking cold drinks, looking at crystal blue water. It's not about me. It's about these human beings in the bed and their families that are home – scared to death for them. It’s not about me.

Gina DiPietro: What we’ve heard here is just a few minutes of hospital life during a pandemic that’s killed more than half a million Americans. Although the delta variant is in retreat at this moment, thousands more will continue to die from a disease for which we now have a vaccine. And truth be told, what you heard in this episode just scratches the surface on what COVID is doing to patients. There were other compelling stories we heard that morning about people who rolled the dice, skipped vaccination, then took another chance to venture out just to have some fun. They were healthy. They had families, jobs and a full life. Then they got sick, and some died. What’s next for those families, we don't know. But when it comes to health care workers, they’re hoping more of us will get vaccinated so they can stop putting their lives at risk for what is now a preventable disease. Learn more about COVID-19 vaccines on HealthyHeadlines.org. I’m Gina DiPietro and thanks again for joining us on this episode of Novant Health Healthy Headlines.