My Mask Matters: What has your experience been like in the ICU ward?
Carrie Ruff: Usually in the intensive care, we have roughly six patients with COVID at all times. We have a 20 bed unit in our ICU with the capability of expanding to 40 beds with adequate staffing. When they get up to ICU, they're very sick. I feel like we don't save many of them and there is mixed data on the survivability when a COVID patient is placed on a ventilator… They end up needing to be flipped on their stomach, just to help oxygenate them, because the ventilator gets maxed out… And we just try all the tricks that we can, but we end up so losing quite a bit of hope in the patients that end up in ICU…
It’s busy to work with COVID patients because we have to go in in full gear. We have machines called PAPRS that blow air into a special hood we wear to prevent aerosolized particles, so that we don't get infected… We really limit the amount of times we go in to the patients’ rooms and we cluster our care just to try to save PPE. So, they're very isolated as well and often can't have visitors… We've had people die without their families being present physically. We’ve been using zoom meetings or Facetime, as well as phone calls.
MMM: And have you noticed any increases in younger patients coming into the hospital?
Carrie Ruff: Yes, there has been. Quite often we have to put our younger patients on ECMO (Extracorporeal Membrane Oxygenation), and we have to send them to Portland. It's basically a bypass machine that helps oxygenate and circulate their blood… We have sent some of our young people to go do that when we are unable to save them with the just ventilator… It's quite sad to see young people like that get so sick.
MMM: Absolutely. And nationwide, this was a big issue, but have you guys encountered any PPE shortages?
Carrie Ruff: We've never had a problem, I’m grateful for that because we need that to protect ourselves, which is one of the other reasons why we limit visitors… We just don't have that amount of PPE needed for the community to come in and visit their loved ones. It's a struggle just daily to get what we need, just to provide care.
MMM: You mentioned that now six out of 20 beds are now occupied by patients. Has your work changed in other ways because of the pandemic, or could you describe some of the things that have stayed different or so?
Carrie Ruff: Initially when they had the shutdown, the governor mandated no elective surgeries, and the hospital kind of shut down just to divert resources to the intensive care unit to treat patients. So, we were expecting this huge surge of patients like New York was having, and we never did get it, but we were ready. We came up with different staffing ratios and how we could expand our ICU capacity. That was very busy and I was in contact with a lot of ICU nurses that had moved on in the community but were willing to come back in and work in case there was a surge…
MMM: Could you elaborate a little bit more on what the experience of actually working in the ICU with those patients is like? What sort of condition are they in?
Carrie Ruff: So once they get to the ICU, their lungs are failing. Then they often start going into multi-organ failure from the shock of the virus, working with this type of patients… You have to do everything for them because they're so weak, they can't lift a finger. We give them sedatives and other medications to keep them compliant with the ventilator (the breathing machine) to where they're not fighting it. And they often have to be paralyzed on top of it… Every time you go in a room, you have to get completely gowned up and wipe equipment down when you get out... You know that you're going to go in for an hour to do all the care they need for the next three hours… Sometimes, a patient needs to be put on their tummy, which we call proning. It requires a team of six to ten people just to flip somebody onto their tummy. You have to have the doctor in there... Anybody over 200 pounds, you're probably going to need 8 people. It requires most of the staff to prone a patient in a unit.
MMM: How does it take an hour to flip someone? What do you have to watch?
Carrie Ruff: They have the breathing tube in their mouth. You have to be very careful. You can't dislodge that. When you're flipping some of their stomach, you have to work as a team. You basically roll them over, but you have to do it safely enough to where you scoop them up in the bed where their head hangs off the head of the bed so that their tube has room to move… everything hinges on maintaining that tube in their mouth… We’re very careful and we organize ourselves and we communicate and work as a team to basically we roll them up like a burrito… And then you have to move all their monitoring equipment around because they're going to be on their bellies and you don't want to like the EKG leads digging into their bellies…
MMM: You mentioned a lot of the ways that Kadlec has been really proactive in response to this pandemic. Do you think these changes will stay in health care in the future?
Carrie Ruff: I think so, because this pandemic is not going away. It's sort of the new way of life. I think that we're going to start keeping more PPE on hand. I'm really scared of what the fall is going to be because we're going to also be hit with influenza on top of it. And if we think it's bad now, it's going to get really bad this fall…
MMM: Do you have any thoughts on what community members can do to help?
Carrie Ruff: Keep up your social distancing. Limit your gatherings. And you need to wear masks when out in public or around other people…
MMM: Well, thank you very much, Carrie. It was wonderful talking to you.
Edited for clarity and brevity.
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