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. The most we've ever had was twelve COVID patients at one time… And that was just probably two or three weeks ago… 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 often end up on ventilators, which are machines that help them breathe. They end up needing to be flipped on their stomach, just to help oxygenate them, because the ventilator gets maxed out and we help them maintain oxygenation in other ways. They are very hypoxic, which means they have low oxygen. 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. If they don't make it up to us and get placed on a breathing machine, they usually do well and get discharged. 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 are also gowned and covered head-to-toe. 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. It's been very sad. 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. We've had some 20 year olds… I don't know that exact number… We've had some 40 and 30 year olds as well with really no history. 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: Have you ever encountered people who are noncompliant, who won't wear masks?
Carrie Ruff: In the hospital, we require them… I don't work the front desk, so by the time they come up to us, they have a mask on. Sometimes the visitor has a language barrier and does not often understand the front desks questions regarding illness and fever. We have occasionally had people come in with fevers. When we check them, we have to escort them out the door using motions because of the language barriers.
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, and they had to be retrained and be oriented… So we did all that… And now we've opened up our elective surgeries and are really trying to take care of the needs of the community. Because people need things done, like they need their knees and their hips done… So we're able to manage the workload of the community with those elective surgeries. So now it's really not changed much because we've established our protocols and we're revamping of our business. It's back to normal, basically, just a little bit busier than what it would be in the summertime.
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. They require a lot of medication to keep them alive. 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, which is a lot of work in itself. Every time you go in a room, you have to get completely gowned up and wipe equipment down when you get out. It takes a lot of work. So, if you go into the room, you try to cluster care… You know that you're going to go in for an hour to do all the care they need for the next three hours, then you kind of get tied up in the room… You make sure that your other patient next door is doing well. We do have our monitors are set up so that we can watch multiple patients at a time in each room so we know what another person is not doing next door or down the hall… 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. It depends on the size of the person. 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: And how long does that take?
Carrie Ruff: It typically takes an hour to flip a patient onto their tummy and at times we'll have six flipped at once. We're just basically going room to room to flip them.
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. You can't dislodge that… So basically, everything hinges on maintaining that tube in their mouth… Once we lose that, we're done. 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… We put a sheet over the top of them… We roll that and then we roll their other sheets, and then we flip them. But it just takes a while to get all that organized. 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… We don't want to cause further harm causing skin breakdown and stuff like that. We just take a lot of time to get them ready to be on their belly.
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 and the hospital setting 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. We're very tired… Everybody's had a break but not healthcare. The hospital understands that we have to support the community and take care of this, and it's going to do what it needs to do if we get a rise in cases that need more hospitalization. They're going to back off elective cases and they're going to do what they need to do to take care of the sick ones.
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… It's not in your immediate family, of course… Wash your hands… I think wearing the masks and social distancing is the best. And then just try and encourage it and others.
MMM: Well, thank you very much, Carrie. This was wonderful.
Edited for clarity.
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