Inside a Windsor ICU, exhausted staff fight 2nd COVID wave knowing worse still ahead
'We're very busy, we're very tight and we're very worried about what's to come'
Each new patient has a different name, a different face. But to Kaytie Slawik, a respiratory therapist in the ICU at Windsor Regional Hospital, they all feel familiar.
"They're hard to handle. They're hard to treat, they're hard to cure. There are no answers," she said.
Slawik is working at the heart of the far-deadlier second wave in this Ontario COVID-19 hotspot, operating ventilators for the sickest patients in Windsor-Essex.
She is there when patients with worsening conditions are intubated. Before they're hooked up to the ventilator, and unable to speak, they tell her the same thing: "I don't want to die."
She reassures them she'll do everything she can to prevent that.
Standing inside a near-capacity ICU wearing an N95 respirator and goggles, Slawik described it as something of a sterile spaceship. The unit has been transformed to adjust for the pandemic. White canvas tarps block off an entire wall of rooms to create additional negative pressure rooms.
Silver tubing stretches out into the halls of the unit, snaking along the ceiling while staff dressed in aqua-coloured scrubs rotate through rooms, checking in on a dozen patients struggling to breathe.
Despite these efforts, 40 per cent of COVID-19 patients who need a ventilator in Windsor-Essex die, according to the medical director of the ICU.
CBC Windsor was invited inside Windsor Regional Hospital on Monday, to see up close as hospital staff power through another day in what is a brutal start to a new year battling the pandemic.
Nurses and doctors walk the halls with a quiet urgency, patients cling to life with the support of machines operated by overwhelmed staff. Some health-care workers talk about their anxious mornings getting ready for work, worried they might be infected by the deadly virus and bring it home to family. Doctors talk about the unique challenges of providing urgent updates to family through video calls.
The hospitalizations are higher in this second wave and a recent provincial report said that health-care worker burnout is also on the rise.
A place like Windsor Regional Hospital is where the true impact of COVID-19 can be witnessed — and fully understood.
WATCH | Respiratory therapist describes some of the changes between 1st and 2nd waves of COVID-19 in Windsor-Essex:
Preparing for worse
Karen Riddell, vice-president of critical care at the hospital, compares this stage of the pandemic to a continuing series of car crashes.
"You have a large car accident, you deal with that car accident and you are able to get people into the system. You don't have another car accident, you know, an hour later, and an hour later and an hour later. With COVID, that's what we're seeing."
Nearly a year into the pandemic, more people are getting sick and more people are dying.
More than 11,000 people have tested positive for the virus and 271 people have died in Windsor-Essex since the health unit reported the first positive case on March 20, 2020.
By Ontario's standards, Windsor-Essex has a high COVID-19 case rate when adjusted for population, second only to Peel region. It has the highest rate of people dying of COVID-19 outside of Toronto, according to provincial figures.
It's worse than ever, and projections show that Riddell and her team need to prepare for more people with COVID-19 requiring critical care.
"We have to try and build that capacity for what has been predicted with the modelling. And although right now we're sitting about provincially over 400 cases in the ICU, they're predicting a thousand," she said.
Michelena Sockett, a registered nurse in the ICU unit, remembers the first people with COVID-19 arriving in the critical care unit at the hospital last year.
"Those were the sickest people I had ever seen," said Sockett, who was three months into a new role as a registered nurse on the intensive care unit at the Met campus.
"I thought, wow, I couldn't imagine myself taking care of somebody that sick, because I had only just started. But now, these COVID patients, a lot of them are that sick."
Sockett has direct contact with COVID-19 patients in the ICU. Wearing scrubs, a shower cap, booties, a gown, goggles, glasses, a face shield and an N95 mask, Sockett reaches down to the floor and zips open a flap and enters a room, careful to close the flap behind her.
The changes to the ICU make her job harder.
"Everything is really closed off, and it's hard to sometimes see in the rooms, depending on where the windows are, and it's hard to hear alarms and pumps and patients, especially down at the end, because of the [HVAC system]," said Sockett, standing in one of three empty rooms at the ICU after having just checked in on a patient.
WATCH | Nurse Michelena Sockett explains some of the lasting effects for COVID-19 patients in the ICU:
On this day, 12 of the 15 people in the ICU at the Met campus are COVID-19 patients on a ventilator. The open beds are managed for an urgent care emergency.
No visitors have been allowed in the hospital since December, one of the many changes brought in before Windsor-Essex entered a lockdown, which preceded a provincial shutdown on Dec. 26 and now a province-wide state of emergency and stay-at-home order.
As the city's status has changed, so has the ICU. Without family visits, there are no flowers. No balloons, no stuffed animals. Parts of the hospital feel hollow without the personal touches added to patients' rooms to make them feel comfortable.
Those absences also wear on the staff.
"I miss a lot of it, but I feel like it's so necessary for people to help us out because [the situation is] hard," Sockett said.
Since the pandemic started, 120 people have died at Windsor Regional Hospital — 29 in the last two weeks.
'It doesn't really feel like it ends'
"I have to really scrub down," she said after leaving a patient's room. (That patient died the next day.)
Going home doesn't feel like the end for Sockett.
"We're doing more shifts here. We're taking care of more people. It doesn't really feel like it ends," she said. "You get a little bit of a break when you get home and then you come right back in and do the same thing over again."
On the fourth floor of the Met campus, an internal medicine area is now a COVID-19 unit. It was changed over during the first wave of the pandemic.
Sleep rooms normally used to diagnose chronic health problems are now surge beds used when the hospital hits capacity, which it has operated above at various times during the pandemic. Staff recently moved more than 100 patients to hospitals in Chatham-Kent, Sarnia and London to create space for critical patients.
Jenn Hurst has seven years' experience as a nurse and finds the current pandemic pressure unreal. "It's very stressful," she said through an N95 mask and protective goggles.
On top of that, her unit is currently in an outbreak. Eleven staff members have tested positive for COVID-19 as they treat sick patients.
Filling in for absent family
The hardest part of her day is treating patients while filling the void left by visitor restrictions.
"Me having to play that family member role to a patient that I've just met is really stressful," she said.
Hurst knows it's a vital part of her expanding role during this pandemic, and one that families appreciate. She finds comfort in that.
Still, "it's like I'm a stranger walking into their life, being a family member to them, which is scary for them, intimidating for us," Hurst said.
The floor seems calm compared to the ICU, but only because of the demeanour of the staff, taking a brief moment to talk during a relatively quiet period on the floor.
"Right now, patients are stable on our floor. We're working very, very hard to maintain that level of calmness on our unit," said Hurst, emphasizing calmness with air quotes.
Staff check in on each other throughout the day to help manage the stress. But Hurst admits they all carry it home with them.
"Life outside of work is complicated as well. We're real people, we have families and we take the stress home with us to a certain degree," she said.
"When we have hard days, I can't just forget about it at home. But I do find comfort knowing I've done everything I can in my day."
'I've been put in this role for a purpose'
Tasia Seguin has been a registered nurse at Windsor Regional Hospital for 14 years and calls this the worst year of her career. She feels anxious heading into work each day.
"It's just the unknown. What's going to happen today? Am I going to have to call family members and tell them bad news?" said Seguin.
Her name is written in pink on her face shield for patients to read.
Seguin finds focusing on the positive parts of the work keeps her motivated even as the daily case numbers rise and hospitalizations increase.
"I'm grateful we're here for this community. How lucky are we to be those people to support them? I feel like I've been put in this role for a purpose."
WATCH: 'We're trying to avoid getting to chaos,' says hospital's vice-president of critical care:
Even so, Seguin and Hurst know it's hard for those who don't see what they do to fully understand how the virus can rip at families.
"When I am holding an iPad to a patient who is, you know, in comfort care ... and we are doing everything we can to let all their family members see them, say their goodbye.... That is not fake, that is real, and that is traumatic for everybody involved."
Always ready
Back in the ICU, a team rushes to put on additional layers of PPE. They're preparing to go into a COVID room where a patient is "crashing."
Five people are working on it, peering inside the room through a clear sheet of plastic in the canvas, writing down notes as they try to diagnose the problem.
"We try to get the minimum number of people in the room to minimize potential exposure," said Riddell, the v-p of critical care, as the team works at a dizzying pace.
"Proning" patients — that is, flipping them onto their stomachs or back while hooked up to a ventilator — could take six people at once, depending on the patient.
"Early on in wave one, there was a push to put patients on ventilators early, which we stopped doing after the first little while in wave one. We really now wait," said Dr. Natalie Malus, medical director of the ICU.
Malus said COVID-19 patients can quickly become seriously ill in a matter of hours. She's seen people go from needing limited oxygen to being on a ventilator within 24 hours.
Malus said they learned lessons from the first wave, but the problem with the second is how admissions have increased and continue to rise.
"We have surpassed our total number of critical care admissions from wave one and the curve is up-sloping and we're still on the very steep part of that up-slope," said Malus.
"We haven't reached the plateau yet. The deaths are going to follow with that."
Respiratory therapist Slawik enters the ICU each day with a full list of patients she will spend every moment of her shift trying to help breathe with a ventilator.
"We're overworked. We have like an average of seven or eight patients a person. Usually we only have about three or four. So we're at double capacity with no extra help," she said.
"We're bouncing from patient to patient and we manage to get things done. But patients aren't getting the best care that they possibly could."
Surrounded by the signs of a pandemic, such as spoiled PPE in waste buckets, Slawik points out the evidence that this is how things will be for a while — namely, there are no non-COVID patients.
"We all want COVID to be over. But it can't go back to normal until we have the ability to treat normal patients in the hospital. Right now, we are only able to treat COVIDs. Regular people that are sick aren't able to get beds."
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