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Perspectives from the front-lines

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Respiratory therapist Krena Silver said for the first time in her 20 years of experience, her work scares her. She’s frightened for the safety of her patients and family.

TUPELO • Krena Silver, a respiratory therapist for over 20 years, has been on the North Mississippi Medical Center’s COVID-19 floor since late March to early April. In all of her years of experience, she has never been as scared as she is right now.

“I’ve been doing this a long time, so I’m not usually frightened. It’s not an usual thing that you do at work, and we appreciate anything everybody does to take down that fear and to keep us safe, but it’s always there,” Silver said. “The biggest thing is you’re scared for right now. You’re scared for your patients.”

For front-line workers, the fear isn’t for themselves, Silver said.

“I’ve never heard somebody say, ‘I’m scared to get sick.’ We’re very scared for our children. We’re scared for our parents, our grandparents,” Silver said. “We leave here and come in with a spirit of fear that we just have to pray about.”

COVID-19 represents a constant unknown for the case managers, physicians, nurses, respiratory therapists and others who have worked on North Mississippi Medical Center’s COVID-19 floors of 5 West and 5 Central since the beginning.

Both 5 West and 5 Central were medical/surgical floors before COVID-19 arrived mid-March. The sickest patients, including patients who may need to be on ventilators, are housed in 5 West.

Beverly Russell, 5 West nurse manager, described the unit as a battlefield and the staff on her floor as soldiers. Hospital staff have bonded through adversity as they shoulder through the fast-paced and constantly changing 12-hour shifts on the COVID-19 floors.

“Just because these nurses and these staff up here don’t talk about what they do day to day doesn’t mean it’s not real. It just means that they’re trying to cope with it,” she said. “They’re literally pouring their hearts out to take care of the community.”

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Nurses Leta Leonard, left, and Jessica Jackson work on one of two floors at North Mississippi Medical Center in Tupelo dedicated to the care of COVID-19 patients. For front-line hospital workers, the pandemic has dramatically increased the daily pressures of their jobs.

A crash course

Nurses new and old described feeling as if they are learning on the job. For 5 West charge nurse Jessica Jackson and longtime nurse Leta Leonard, their current duties fall outside what they were prior to the pandemic. Leonard described her current daily duties as being “more intense than normal,” and said the physical toll is much more demanding because of the level of personal protective equipment she has to wear and the constant stress staffers are under.

“Here, we’re constantly moving. You’re so mentally stressed, and you’re physically stressed, so you’re constantly almost in an adrenaline rush, and at the end of the day you kind of just wipe out,” Leonard said.

Nurses’ days begin with temperature checks and changing into sterile scrubs. They suit up, donning N95 masks, shoe and hat covers, and prepare for the day. The daily pressures of the job can vary, Jackson said. There are good days and bad days; sometimes, there are more bad days than good.

“We have a couple of patients that are able to come off of ventilators, or able to talk with us, talk with their families, and that’s a good day,” Jackson said. “Then there’s days that these patients are so sick that they go from bad to worst really quick, and we’ve done everything we can to save them, and we just can’t save them. After a while, that can really take an emotional toll on nurses and any of our staffers that are up here. They are just not used to seeing that everyday.”

Despite having over a decade of hospital experience between them, preparing to care for COVID-19 patients was like a crash course. ICU nurses helped train them quickly on the basics, Jackson said. Leonard said she was “really green” and anxious when she first began performing tasks like changing drips and working with respirators, but has since grown as a nurse.

For physicians, the greatest challenge with COVID-19 is often finding out how to best treat patients suffering the effects of the virus. Hospitalist Dr. Raymond Seay described caring for COVID-19 patients as learning on the fly. Because the virus is new, medical experts are constantly learning more about it and changing treatment methods and strategies.

Seay said they become better at treating COVID-19 the more they “recognize what is in front of us.” He has also seen some positive trends, including fewer COVID-19 patients who are seriously ill and a decreased rate of death.

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Dr. Raymond Seay described caring for COVID-19 patients as "learning on the fly." Because the virus is new, medical professionals learn new information daily and adjust patient care accordingly.

“For me as a physician it’s definitely been a challenge taking care of these people because we’re learning all this new,” Seay said. “We’re ... on the cusp of history here.”

Treating COVID-19 is also more isolated than healthcare workers are accustomed to. Prior to COVID-19, 5 Central charge nurse Amanda Tutor would enter rooms without masks and build bedtime rapport with her patients. With COVID-19, doctors and nurses are now limiting those interactions. Medical equipment like IVs and ventilator monitors are kept in the hospital hallways as opposed to inside the room. Any time a nurse or physician enters a room, they must wear personal protective equipment.

Nighttime nurse Nathan Sartin said the loss of interaction is a challenge, especially as they navigate patients not being able to see family members face-to-face. While they try to Facetime and call families, COVID-19 patients are not allowed visitors outside of end-of-life situations.

“That has probably been one of the biggest challenges, is nurses trying to be a support system,” said Cera Bates, nurse manager of 5 Central. “They are the sole person there in the room taking care of these people, holding their hands, giving them comfort whenever they need. That’s a shift because typically you would have other families here as well, so it’s been an emotionally trying time for the nurses.”

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5 Central charge nurse Amanda Tutor said the level of personal protective equipment health care workers must wear to remain safe makes it difficult to build rapport with patients.

Despite front-line workers’ dedication to treating patients, some patients still don’t survive their battles with the virus, which has its own emotional cost. Even after months of being on the COVID-19 unit, Tutor said she finds it hard to prepare mentally for each shift.

“Sometimes, just on the drive here, you’ll just think about what could happen and how your day could go, and sometimes it can be hard,” Tutor said. “Sometimes you can just dread it because it can go either way ... It is hard to prepare yourself for that.”

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The walls in the nurses break room just steps away from the COVID-19 wings are covered with letters and cards thanking medical staff for their hard work and offering words of encouragement.

More heart than medicine

Since nurses are unable to talk to families in the same way as before, case managers have filled the gap. Senior director of case management Angela Coggins said they spend 80% of the day talking to families, trying to keep them as connected as possible. In her 20 years with the medical center, she hasn’t seen “more opportunities to be more human than we are right now.”

“Regardless of the numbers of the community, they come in every day committed to those patients and the patients that we have here in our house, because they are our family today,” Coggins said. “We are using our compassion and our kindness to levels that we probably never knew that we had.”

Jade Hutchins, a registered nurse and case manager with the hospital for 16 years, said case managers are frequently the ones talking to families to share what is happening with their loved one’s care, whether good news or bad. She counts it as an honor to play this role for families, even though it can be an emotional roller coaster.

Hutchins admitted she has shed tears, but she considers her work very rewarding and said with the help of staff, she had been able to learn and adapt to challenges.

As a social worker, Taylor Moore was used to focusing on discharge care during her three years at the hospital. Now, her biggest challenge with COVID-19 is growing attached to families.

“We’ve cried tears of joy with some families and we’ve cried tears of sadness with some families,” Moore said. “It’s hard to be the bearer of bad news when we have to be, and it takes an emotional toll on you and it really tires you out. But I think the balance between the good and the bad • {/strong}and when you are able to get that good news – makes it worth it.”

Because nurses and physicians can’t bond with patients in the traditional ways with COVID-19, NMMC has found creative ways to build the patient/health care worker relationship. Director of patient care David Garrett said one way the hospital does this is through “Meet My Loved One.” Upon admission, hospital workers use a patient’s contact list to conduct short interviews with their loved ones and post information about the patient’s preferred name, hobbies, activities and interests outside his or her room.

“We’re trying to help them out by helping them know more about the patient than just a room number, than just a diagnosis, but more as a real person,” Garrett said. “It shows that these people are grandmothers, grandfathers, spouses, children, sisters, brothers, cousins.”

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NMMC nighttime nurse Nathan Sartin said the loss of regular face-to-face interaction with his patients has been difficult.

‘I had to find my way’

Many healthcare workers cited turning to their faith and families to help pull them through the days ... the weeks ... the months they’ve spent caring for the steadily growing number of COVID-19 patients.

“I find a lot of times prayer helps me a lot with things and just reading my Bible definitely keeps me on track for making sure I have a positive and joyful heart,” Hutchins said. “When I get home, I just want to hug on my kids and love on my family, and that just makes the day easier.”

Moore similarly leans on her relationship with God, asking for His strength. She uses her 45-minute drive from work to decompress. When she comes home to her daughter, she tries to take her mind off everything else.

Respiratory therapist Krena Silver said she listens to preaching on the way to work. These days, she avoids the news and tries to leave her work at the hospital. On the way home, she talks to either her mother or sister to wind down. She decontaminates in the garage, putting everything in a box before going straight to shower.

It’s her way of separating work from home. At least, as much as that’s possible.

“When I strip all that stuff off and get out of the shower, I have to strip the day,” she said. “The first few weeks especially, I would just cry and have bad dreams because it was so new and different. I had to find my way, and that’s my way.”

danny.mcarthur@journalinc.com

Twitter: @Danny_McArthur_

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