As this unprecedented crisis casts an indelible mark on the U.S. healthcare system, a new sense of camaraderie and purpose has emerged. Empathy has overcome fear. Partnerships have solved everything from supply chain shortages to access issues. Former foes are sharing best practices. Clinicians have found more personal ways to reach patients. Healthcare workers we spoke with say they are exhausted and devastated but also hopeful the positive changes they’re seeing will stick.
Beds lined the hallways. Beeps and chirps from bedside equipment sounded in an endless loop. Rapid-response team and code blue calls happened 20 times a day, up from about 90 a month. The ICU at Southside Hospital in Bay Shore, N.Y., housed patients from their early 20s up to their late 70s.
Hundreds of new COVID-19 patients came into Southside’s parent system, Northwell Health, daily. At one point, Northwell had a thousand more patients than its worst-case scenarios projected.
Dr. Dixie Harris, a pulmonologist specializing in critical care at Salt Lake City-based Intermountain Healthcare, traveled with a team of 50 colleagues to help two Northwell hospitals. As she was waiting for her ID badge, she overheard a conversation between staff and visitors about how at least they hadn’t resorted to “stacking bodies” like Detroit reportedly did.
While she discussed extubating patients and futile interventions with ICU teams, she heard doctors spend an extraordinary amount of time updating family members.
“The most uplifting thing is the focus on maintaining the humanity in this process,” Harris told Modern Healthcare from her hotel room, preparing to work the late-night shift when the system had the fewest critical-care doctors. “They were talking them through it in a calm, honest but not overly optimistic way. Even though they don’t have the time, the family is put on the highest priority. This is a whole different level of caring.”
“The profound sense of goodness that you bring to the situation has me just in awe of you, and I thank you truly for your spirit of partnership,” Dr. Erica Olsen, an emergency medicine physician at New York-Presbyterian, wrote in a letter to Dr. Harland Hayes, an Intermountain emergency medicine physician, after Intermountain deployed a second team of caregivers.
Clinicians and staffers may not have been trained to work in an ICU, but they learned fast and did the best they could, Harris said. Some of them learned “proning,” a tactic to relieve pressure on the lungs. Harris taught clinicians to use ventilators that she hadn’t seen in 25 years.
“We develop protocols, and they change every day. We have to adapt,” said Harris, adding that a group of her friends from medical school are holding a virtual book club of sorts to discuss the latest COVID-19 literature. “We can’t wait for randomized trials.”
There is progress, Harris said. In March, the mortality rate for COVID-19 patients with acute-respiratory failure was around 40%. In April, that dropped to 10% to 15%, she said.
A 36-week pregnant woman with acute respiratory failure had an emergency C-section and was on a ventilator for 11 days. When she recovered and was on her way home to her child, “Here Comes the Sun” by the Beatles played on the hospital PA system.
“This is what we’re called to do,” Harris said. “This is what we signed up for.”