Don't Stop Fighting: We're All in This Together
Sabrina Bates RN, a Master of Science in Nursing (MSN) student at the USC Suzanne Dworak-Peck School of Social Work and a nurse at Keck Hospital of USC, was working in the new transport center created by Keck for the purpose of receiving COVID-19 patients. While on duty, one of her closest friends was admitted, and Bates had to transport her to the ICU to be placed on a ventilator.
“It was shocking,” Bates said. “As a nurse you have to keep your professionalism and you have to keep your emotions at bay because this is your job, this is your work place and you have to disassociate in a good way so that you can get your work done.”
Bates worked methodically that day, processing her friend’s intake, making sure everything was done correctly, keeping herself and her colleagues safe, but also feeling confident that her friend was in the best possible place to receive care.
On the way home, she had to pull over because tears were blurring her vision and she could not see the road.
“There's a human side to nursing that you forget because you're so caught up in what you have to do for the moment, and how you need to perform and what you need to get done,” Bates said. “And you get it done. And then I forgot that… she's a good friend and she's a person, and she has a family and that family may never see her again and it breaks my heart.”
For the most part, Bates has been able to disassociate at work, but is having a difficult time doing this at home. She snaps at her kids, yells at her husband, and then with a little space and time, she catches herself and realizes that what she is really feeling is emotional distress and hurt related to the current demands of her job. And she apologizes, and so does her husband.
To feel better, she retreats outside. The recent gloomy, grey, rainy weather in Los Angeles was comforting. She felt it fit with her current attitude, but also beautiful with the clouds hovering over the mountains. Looking out at it brought her joy.
There have often been moments in Bates’ career when nothing she or her associates could do could save a patient.
“I think just talking about it and expressing it to my family is huge for me,” she said. “The words that are underlying all the feelings of that emotion or rage or anger—it’s not just the stuff that comes out, but it’s all the underlying feelings of inadequacies that we carry.”
Bates works twelve-hour days, three days a week, while also continuing with her studies for her MSN degree. She said Keck administration has been amazing in anticipating and responding to staff needs. They are guaranteeing hours, even if staff is not called in, so that no one has to worry about their salary. They are allowing paid administrative leave for mental illness, including anxiety. They also created Care for the Caregiver, providing housing to all employees who may have been exposed or who do not want to risk exposing their family members.
“Every problem that we’ve come up against as nurses, management is really trying to meet us, and I feel very fortunate to be [at Keck],” said Bates.
Anticipating a surge
In anticipation of the surge of COVID-positive patients, hospital management is trying to remove all the patients that are COVID-negative and are not required to be there—the ones who can rest at home or get outside medical care from home. They are also discharging patients who are COVID-positive for home isolation once they are progressing in their treatment.
According to Bates, they have started to lay the COVID patients in a prone position. This is often the procedure within the ICU when people are on ventilators. Placing them on their stomachs makes their lungs less strained to work and evens out the secretions within the lungs. They want the fluid to disburse throughout the lung so that the whole lung can do the work to excrete it, not just the small section at the bottom of the lung.
“So that’s what we’ve started doing with our patients who are not even on ventilators, but who need oxygen,” said Bates. “Two of them we sent home. They didn’t ever go on ventilators. We took care of their symptoms by scheduling time on their stomachs.”
Pulmonologists at Keck have encouraged Bates and her co-workers to share this information with other nurses in ICUs across the country.
“I sent an email with our proning guides just to get the word out,” Bates said. “These patients don’t need to be on ventilators to go prone, because that’s what we’ve always done. They’re just on oxygen and we prone them. The goal is to keep them on their stomachs for twelve hours a day, which is hard, but we’re seeing results. So I was really excited about that.”
One of the hardest aspects for Bates about caring for the COVID patients is that they are coming into the hospital alone, either vented or too sick to tell the staff about themselves. At Keck, usually there is an intake paper completed at admissions called ‘Known.’ But now, all the medical staff see is a medical record and a number for each patient.
Bates talked to one of the social workers at Keck, and asked for her help in finding out more about the patients, so the medical staff could make their care more personal. Everyone is trying to work together, to find solutions to problems that they never had before, said Bates, and she loves that about Keck, and about USC.
“We’ve all gone through something in our lives that has broken us, or that has brought us to the brink of hopelessness,” said Bates. “But we’ve gone through it, and it’s not the end of our story. There’s so much more and we’re going to get through this too. I love that everyone is coming together and pulling for each other and cheering each other on. When our patients leave our ward, we clap. We cheer for them! We’re excited because they beat it. They’re beating this virus, they’re winning this fight and I’m just so proud of that. Don’t stop fighting. We’re all in it together.”
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