Breathe in: One. Two. Three. Four.
Hold: One. Two. Three. Four.
Breathe out: One. Two. Three. Four.
Registered nurse Julie Solomon walks COVID-19 patients through exercises to help them breathe as long and deep as they can.
“The greater the deep breath is, the more they open up their lungs and get more oxygen so they don’t have to be intubated,” she says.
Cough medicine, deep breathing exercises and machines that aid with oxygenation of the blood are all important tools to keep patients breathing on their own, but Solomon also deploys humor for patients who would rather talk about anything but COVID. She loves to share stories about her 89-year-old grandmother in Boca Raton who poses as a 70 year old to pick up men on JDate.
The 24 year old lives in the Waterfront neighborhood in the District and works in the intensive care unit of an area hospital. Like her colleagues at other hospitals interviewed for this story, Solomon describes the terror of COVID patients who come into the hospital conscious, and the confusion and anxiety of those who only discover that they are in the hospital when they wake up from medically-induced comas.
ICU nurses care for some of the most critically ill patients in a hospital. In that sense, “in a lot of ways, everything’s the same,” says Solomon. “I am still my patients’ biggest cheerleader.”
Yet Solomon and countless Jewish health care professionals like her are fighting for their patients under circumstances unprecedented in their lifetimes.
“The risks [of my job] always seemed very manageable and mitigated, until now,” says Dr. Jonathan Wenk, 51. Medical director of the emergency department at Frederick Health Hospital in Frederick, Wenk, contrasts COVID with tuberculosis and HIV, diseases that are “blood-borne and now easily treatable.” It isn’t just coughing or sneezing but casual speaking that can spread this coronavirus, he says.
Every time Solomon enters a confirmed COVID patient’s room, she needs to layer up with protective gear: a pair of gloves, a gown, two face masks, another pair of gloves and a face shield. When she leaves the room, it all has to come off and she needs to wipe down any equipment that came out of the room with her. Then the process starts all over before she can visit her next patient.
Because of this time-consuming process, and because doors to patients’ rooms need to remain closed as much as possible to prevent the spread of the virus, nurses do their best to “cluster” their care and maximize each visit. “You have to think of the things that need to be done for the next three hours as opposed to the next 30 minutes,” she says.
Social work case manager Allison Cannon, 30, who works in a Northern Virginia hospital, finds the necessity of physical distance from not only families of patients but the patients themselves to be one of the biggest practical changes for her at work during the pandemic. Hospitals want to reserve gowns and gloves for the nurses, doctors, therapists and techs that have to be with the patients, she says, so she has to call patients on their room phones to conduct their assessments. She works with families over the phone and via email to ensure they can get their questions answered and needs met.
“I feel when patients and families see us face to face, we are able to build a better rapport in order to ensure they’re discharged safely,” says Cannon. “It’s a very different experience, but we’re in health care because we want to take care of those around us.”
“Within Jewish circles, when a loved one gets sick there’s an outpouring of wanting to see that person and be around them and support them,” says Wenk. “This disease kind of robs us of that.”
It also results in nurses like Solomon feeling compelled to fill the roles family members would otherwise assume. For instance, she had a male COVID patient who clearly was not going to live past the end of her shift. Family members requested that the staff play a prayer for him before he died. There was nothing Solomon could do a nurse as she watched his oxygen levels drop, but she went into the room and held his hand in the final minutes of his life. “No one deserves to be alone when they die,” she says.
“As a nurse, my whole job is to see these patients succeed and do well and leave the hospital. For a lot of these people, that doesn’t happen,” she says. “You have to have solace in the fact that you at least were there for them. They weren’t alone.”
‘We are the front lines’
Medical professionals are not immune to the risks of this virus nor the fear it holds for people. They have to work in spite of it.
Jonathan Bart, 56, works as an EMT. He is at additional risk to contract the virus, not just from being in close proximity to patients in the back of his ambulance, but because he also has diabetes and hypertension.
“Because I’m an EMT transporting patients, I’m one of those essential people who have to work,” he says.
When the coronavirus first hit the region, members of his crew were provided with an N-95 masks at the beginning of a shift and one size of protective gear for everyone. “Now they’re giving us our own personal bags of PPE [personal protective equipment] because not everybody wears the same size,” he says.
Providing properly fitting masks and gloves is one of the ways Wenk seeks to protect the more than 100 people working in his department. “I think of my providers as an extension of my family and I’m tasked with their safety and wellbeing,” he says. For example, when hospital administrators instructed workers to don protective equipment only when dealing with suspected COVID patients in an effort to conserve supplies, “we had to show them the CDC guidelines that anyone could have the virus and not know it.”
“We had one of our own get sick from the disease and nearly die in the intensive care unit” of another hospital, he says. “When that happened we all became hyperaware of our safety.”
Wenk estimates his department is seeing 10 to 20 COVID patients a day, many of whom are well enough to be discharged. The majority of those people, however, return when their symptoms worsen. The critical time window is days 8, 9 and 10 of the illness, according to Wenk. For some people symptoms are bad right in the beginning, while and others “smolder along for a week.”
He thinks that initial reports on the virus dangerously downplayed the risk to young, previously healthy people. “In this line of work, we have not seen many diseases where entirely young healthy people crash and burn in this way, and it kind of spooked us all,” he says. “It was very sobering.”
He also wishes there was more coverage earlier about how readily the virus is transmitted, even before people know they’re sick with it, but acknowledges that it is “far more contagious than initially realized.”
As soon as Cannon arrives home from the hospital to the apartment she shares with her husband, Joel, and their dog, Bruno, she takes off her shoes, washes her hands and throws her clothes straight into the washing machine. Solomon and Wenk describe similar routines.
Both Cannon and Solomon expressed appreciation for the hospital management where they work and said they feel safe doing their jobs despite the contagiousness of this coronavirus.
Solomon lives alone and decompresses after work by playing with her dog and watching “New Girl” on Netflix. She was disappointed not to spend Passover with friends in person, but participated in a Zoom seder and prepared a giant batch of matzah ball soup to share with Jewish co-workers at the hospital.
“It’s hard,” she concedes of her work during the pandemic. “But if I let the physical and emotional exhaustion get to me, what kind of nurse would I be?”
“Until this pandemic I don’t think emergency physicians were ever really thought of as heroes the way a police officer or fireman put themselves in danger’s way,” says Wenk, who lives in Gaithersburg with his wife, Jennifer, and their two teenage children and attends B’nai Israel Congregation in Rockville. Every day now he gets text messages from distant relatives and friends he hasn’t spoken to since college who say they’re praying for him and asking if there is anything they can do for him and his family.
“We are the front lines,” he says. “We’re at risk and we’re aware we’re putting ourselves at risk, and I haven’t had anyone run away and say they want to retire or quit.”