In the Surge

TREVOR GAGNIER

In the Surge Three nurses describe life and death during the worst week yet of the pandemic.

TAKING DELIVERIES: Legacy Health was the first hospital system in the state to receive doses of the Pfizer vaccine on Dec. 14 as the state grapples with a surge in cases.

BY R AC H E L M O N A H A N

r monahan@wweek.com

On Dec. 2, Heather Rose, a Legacy Health nurse, sent WW’s newsroom a letter. Her holiday message was agonizing.

“I have found myself shaken by a different sort of suffering,” she wrote of the fact that Oregon’s COVID deaths had reached their highest rate since the pandemic began.

“The patient who is awake, staring at me with a mix of terror and tears in their eyes.”

“Health care is a different sort of job these days,” wrote Rose, who works in an intensive care unit. Speaking of herself and all the health care workers on the front lines in the U.S., she continued: “We are asking a lot of 18 million 12

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citizens who did not sign up to run into burning buildings…as mainstream Americans deny the building is on fire, while others add fuel.”

If the firefighters who ran into the Twin Towers on 9/11 were the heroes of that era, this decade’s heroes are the medical workers who care for those who’ve caught a disease they didn’t know existed this time last year.

The latest surge in the pandemic started early last month and continues unabated, even as vaccines arrive in freezer trucks. As many Americans perished from COVID on one single day this month as died on 9/11.Since the middle of November, the number of Oregonians hospitalized with COVID-19 has risen 70%.

After receiving Rose’s letter, we asked her and two other Portland nurses to share their experiences amid the most devastating week of the pandemic. Our hope: that readers will get a firsthand glimpse of what’s at stake if they take more risks.

What follows is not an argument for or advice on how to stay safe but rather three nurses’ stories of their workplaces during this pandemic—rooms few of us hope to visit and most would lack the fortitude to withstand.

News editor Aaron Mesh contributed reporting to this story.

WESLEY LAPOINTE

KJERSTEN OLSGAARD Olsgaard, 35, a Multnomah County nurse at the Mid-County Health Center in Gresham, serves the ethnically diverse populations of East County.

That community has been hit disproportionately hard by the pandemic.

Olsgaard, who has more than six years of experience in hospitals and clinics, described the conditions.

We do COVID testing every day in the afternoon. We have an outdoor tent that we, as the medical

staff, set up. I think this is our fifth tent, because they’ve blown away in the wind and broken. Supposedly, we’re getting a more permanent structure, but that has been in progress for a very long time.

We’re pretty much doing Third World medicine right now, to be very honest. We are some of the last people to get money. We are working out of a tent and trying to figure out how to not burn through our PPE. In a way, the burnout and the chaos is a little bit normalized. The fear is a little bit normalized, too. For me, in the beginning, it was like, “Oh my gosh, what if I get it?” And now it’s almost like, when do I get it. You know, that just helps me not be so anxious.

We have one of the most diverse patient populations in all of Multnomah County. And

I would argue probably even the state of Oregon. The majority of our patients do not speak English. We have a massive refugee and immigrant population. The majority of our patients are in poverty of some shape or form.

I do so much work that has nothing to do with medicine—patients that I talk to on the phone. When I say, “OK, based on your symptoms, you need to go to the emergency room,” their questions are not about their symptoms or their medical condition. It’s: How much is that going to cost? How do I get there? I can’t go and I don’t have a ride. I don’t speak the language. I don’t

know how to access public transportation or call a cab.

I have five children that I’m caring for and I don’t have child care. How do I take them? What do I say when I get to the emergency room to get the care that I need?

So half the time I’m acting more as a social worker, to be honest. My patients don’t know

how to navigate a system. And COVID time is showing more and more that the system was not built.

It’s 100% harder for them. They are living in multigenerational families. They have a family of 10 living in an apartment, for example, and I’m asking the entire family to quarantine for 10 days, which means that four of their financial contributors can’t go to work.

They are asking me, “How do I pay my rent?”

They have no financial safety net. They are the Amazon delivery people, the grocery clerks. They are the people who are still out working as essential workers who, because of their language barrier, don’t have the means to protect themselves like a lot of white people do.

The state does have financial resources to assist people who need to quarantine. You can get $120 a day for the 10 days of quarantine, which if you qualify would be a total of $1,200 to help with the financial assistance. I give the patients the phone number and the website. Who knows if they have a computer or internet? There are some resources, but it’s not enough.

The majority of my patients don’t know how to stay safe from COVID-19. And again, that has

to do with the fact that, for many, there are 10 of them in a home. Or they don’t have a car and are exposed because they have to use public transportation. The fact that they don’t have the financial safety to take time off work when they aren’t feeling well.

On top of that, the fact that a lot of them can’t read—whether it’s language or literacy—all of the news that’s telling them what to do, whether it’s billboards, posters, TV, internet. They don’t have access to that.

We are housed in the ZIP code that has the highest number of cases in all of Multnomah County. From earlier this month, I do have this

statistic: One week, we had a 45% positive rate, which I guarantee blows out of the water any other testing site.

And 45% is astronomically high. To me, it relates to the fact that these are some of the most vulnerable patients because of their language barrier or cultural barrier, the poverty that they see. They’re mostly women.

We’ve always tested higher than everybody. And again, that’s because of who we’re testing: vulnerable people. To me, it is systemic racism, 100%.

I think there are more concrete things that we could do, like give the vaccine to these patients first.

I see how our culture and our society does not care about these people as a whole.

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WESLEY LAPOINTE

ERIN BONI Boni, 37, works at Oregon Health & Science University as an intensive care nurse overseeing extracorporeal membrane oxygenation, or ECMO. An ECMO machine functions as an external lung, giving the blood oxygen when a patient’s lungs are too damaged to do it themselves. The treatment is a last resort for the most severe cases of reparatory diseases like the flu or COVID-19. Oregon has limited number of ECMO machines.

Boni, from Central Washington, is one of few Portland nurses with expertise in the procedure.

The numbers of patients in our hospital in ICU are exponentially growing. It changes

the day-to-day in some ways, because our hospital’s already full of patients.

So that means, when you’re at work, you’re just having to work really, really hard all day. And then they’re often asking if you can come in for extra shifts. So you can work up to a 16-hour shift and then come back the next day, oftentimes at your normal shift time. So people are tired. A friend who I work with clocked in 198 hours in a two-week period.

More errors are prone to happen, little mistakes.

It feels riskier. So much of what keeps us safe is our personal protective gear and making sure that’s clean and taking it on and off appropriately. And I worry.

The patients are really sick. Not just their lungs are being impacted, but they’re going into kidney failure. They’re having issues with blood clots. And then, at the same time, they’re having issues with bleeding. So we’ll be treating the blood clots with a blood thinner and then they’ll start bleeding from somewhere else.

They’re having what we call “agitated delirium.”

A lot of these patients, pretty early on in their hospitalization, will wake up thinking that we’re trying to harm them, or very, very confused and unable to be reoriented.

We also can’t have their families at their bedside, which can sometimes help ease their level of distrust

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or discomfort. Also, when I go in the room, I have a P100 respirator on my face, which looks like a gas mask, essentially. And then I’ve got a shield over my face. So I imagine, to someone waking up confused and thinking that someone might be harming them, they look at me and I’m supposed to take care of them, but I don’t look like a reassuring face.

A lot of our patients require translators, but the translators aren’t able to come into the room. We have this really cool video monitor where we call up a translator. But I’m trying to assess if someone is just confused or whether they’re delirious, whether they can follow my directions in a different language, using a translator video while they’re in a bed with a breathing tube and oftentimes ECMO cannulas.

Sometimes in the middle of the assessment, you have to just be like, “OK, we’re gonna stop this,” and re-sedate or give medication to help them calm down.

Because it becomes pretty quickly an unsafe situation.

I’ve been working with the same patient for the past three weeks and, for three days in a row,

he was making great progress.

We hadn’t been able to get him to be awake and communicating without having really wild swings in blood pressure and oxygenation.

We’d gotten him to this point where he was following commands in all extremities. And he was trying to communicate. Oh, it just was so exciting! Because

we’ve had a lot of people do really poorly recently. It’s hard not to get that hope.

And then the next week I come in and we’re back to square one. Except that there’s now new complications related to his illness, including kidney failure and a major bleed.

When you work with someone and you start to have that hope that maybe this outcome will be different, and then you just get knocked back to reality.

A lot of them are young. We do have a lot of older patients, but when I say older, I’m talking 50s, 60s, who are requiring ECMO. But I’ve taken care of pregnant women on ECMO. I’ve taken care of people in their 20s, 30s and 40s, all requiring the highest amount of life support you can get in order to survive— or often not survive—their illness with COVID-19.

We’ve had a lot of people who we think have gotten over the hump. And then, the next time you come to work, you’re like, “What happened to this person?”

“Oh, they died.”

And at that point, you just are like, “Well, was their family able to make it? Was it at least peaceful?”

It’s pretty distressing. It is emotionally exhausting.

If you saw this suffering of these real people, like I see every day and my colleagues see every day, you would see that they aren’t just numbers. And I would think that that would maybe change your behavior.

WESLEY LAPOINTE

HEATHER ROSE Rose, 42, has been a nurse for eight years in Portland, all of that time in an intensive care unit. She started a nonprofit for teens with cancer. That nonprofit, See You at the Summit, takes terminally ill kids on what may be their last hikes in the Cascades. Last spring, the nonprofit had to stop its outdoor trips. Starting in April, Rose began working on call at a Legacy hospital in Portland.

We didn’t have a surge like New York did back in the spring. And so I think

we’re starting to see what New York saw and was telling us. But to see it is so different. It’s just so different than anything I’ve done in nursing. The uncertainty that leads to that fear, that’s sort of crippling for patients, and it’s devastating to their emotional well-being.

My day job is working with adolescents who are in treatment for cancer, and I am not foreign to death or the fear of death coming.

But there is something so unique to have a person off the street who yesterday seemed fine. And today, they can’t breathe and can’t get in bed, and they’re asking you, “Am I going to die?”

I’m not used to looking into my patient’s eyes and them wanting to know if they’re going to die or not, and not being able to give them even information to help them.

They’re terrified. And I think that’s what’s I hate seeing.

We’re seeing it in greater quantities than we had in the spring.

As a nurse, you can have two awake COVID patients who are maybe not as critical, or you could have one COVID patient who’s requiring proning—being placed on their stomachs—and flipping. And in that case, we’re often paired up and chemically paralyzing those patients so they can tolerate lying on their stomach while they’re intubated.

Now, as the surge comes, the way that could look is up to as many as three patients per nurse.

What can you find to appreciate even as you struggle to breathe? The

patients that suffer less are those that have a sense of appreciation, even for the things in that moment. They get to take their mask off and have a drink of water. And they allow that to be enough, to be grateful for that moment.

There’s less suffering among those patients.

What can they find in that moment to appreciate, they can take a deep breath into that

gratitude and that feeling. That’s maybe one of the easiest things one can do, rather than start your meditation career. That would be the easiest first step.

I don’t know if that’s going to scare anybody into changing what they do

and wearing a mask or not.

I mean, I can’t get my own family to not travel. I try to share my experience—what I am experiencing, how tired I am. I try to share what our suffering is, to hope that is something that would break through.

I don’t really know what else to do at this point when your own family is going to fly for Christmas, you know? I don’t know what else to say to them, other than “You put my life at risk when you do that.”

When we are hit in the next couple of weeks with the surge where I can’t provide the quality of care, then I can feel that sort of fracture inside. That is a different level of anxiety—my own sense of terror and fear. We’re not there today, but I anticipate that that is coming.

I feel like it’s all hands on deck right now, and only half the hands are showing up. Not in terms of medical professionals, but in terms of our country and our citizens. I just feel like I have a skill set. My partner, he’s an ER doc, and I watch him go in and do the same thing.

And I feel like I’m supporting him as well by just easing the burden of the system.

I want to live in the America where we actually take care of our neighbor. If I want to live in that America, then I have to be that person, that citizen.

I’m not as tired as I am sad. I love to live

a full life. I have a puppy. I have a partner and we’re Pacific outdoor lovers and I’m just—I’m sad. I’m sad for a favorite patient of mine that we are going to withdraw care on tonight.

That sadness is the fatigue that is so deeply draining.

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TREVOR GAGNIER

Letter From a COVID Ward The Dec. 2 message that started this story.

BY HEATHER ROSE

As an ICU nurse I have seen a lot of tragedy and trauma in my career. Human suffering is everywhere in a critical care unit. Nurses are accustomed to suffering, our patients’ and our own, as we carry out our job. We are well versed in being uncomfortable.

As COVID patients slowly take over our unit, I have found myself shaken by a different sort of suffering. The patient who is awake, staring at me with a mix of terror and tears in their eyes. It is unlike any other critical care patient. There is an impending doom that lingers in the air. “Will I get worse? Yesterday I could walk to the bathroom, today I cannot even get out of bed? How much longer will I be able to breathe on my own?” On Monday, my patient is on high-flow oxygen, and by Friday they are on a ventilator. On Sunday, they are on a lung bypass machine. Thank God I encouraged them to talk to family as much as possible while they still could. Did I do everything I could? Did I expose myself to the virus? Have I exposed my family?

This is a different sort of human suffering.

The trepidation of the unknown. The old rules are upended, and we no longer know who will get better, who will go home but irreparably changed, and who will never go home.

I am a stoic nurse. Good, bad or otherwise, it is who I have always been. But these days I find myself crying with my patients, unable to wipe away the tears under my head-to-toe safety gear. Gear that hopefully keeps me from ending up in the bed next to theirs. That is part of what punches through my veil of safety: When I care for a patient from a motor vehicle accident, I am not at risk of being hit by that car. However, as I help my young COVID patient sit up in bed, that very act of care could be the head-on collision I never saw coming.

Health care is a different sort of job these days. We are asking a lot of 18 million citizens who did not sign up to run into burning buildings. Then compounding this request as mainstream Americans deny the building is on fire, while others add fuel. No citizen is an island in America; our freedom is interdependent on the collective. So how do we heal a nation with such blatant disregard for the well-being of that collective?

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This country was founded on freedom, liberty and equality. Rights that have always been interdependent on individual responsibility to the whole. An agreement preserved in our Constitution. It has always required collaboration to ensure our rights are protected.

That is the gift entrusted to us, each citizen, a thread woven together as the fabric of democracy. “One Nation, indivisible”—childhood words I mindlessly pledged allegiance to. No true context until now, as I watch us fall, divided. I fear as we lose the balance between individual rights and responsibilities, so will we lose our democracy.

As I prepare to go back into work this morning, on what was supposed to be a day off, I am worrying for the average American at home on Black Friday. To the millions of you who chose to travel for Thanksgiving and eat with others outside your household…I choose to let my anger towards you go. Some of you are my own family and friends. Coronavirus cases will climb as a direct result of your travel. Your actions have directly endangered my life as a bedside nurse. They have directly endangered the person I love most in this world, an ER doctor. I am choosing to wish you well and hoping that goodwill is a step towards healing our nation. Yet your disregard for the collective shows how fragile this great American experiment is.

I hope you will consider, as December rolls in, that you are not an island in this country.

Your actions impact me and my well-being.

Your actions impact whether there will be enough staff, hospital beds and ventilators available, maybe even for you. Please don’t put my life at risk any more than it already is.

Please choose all of us instead of just yourself, even if that makes you uncomfortable. I do not want to be looking into your eyes filled with terror and tears in the months ahead, nor the eyes of the person you love the most.

I do not want to be asking your family to call you now, because tomorrow may be too late. I wish I wasn’t using fear to scare you into being a responsible citizen. But I am. I am standing inside a burning building on the edge of a burning country, and I don’t know what else to do.