The double doors to the Medical Intensive Care Unit swing open to reveal a scene of order and concentration. Nurses and respiratory therapists tend to patients, physicians round and environmental services technicians thread between; sterilizing, cleaning.
The antiseptic air is still.
Aside from patient care consultations and the occasional bleating of pagers, it is quiet.
As of today, there are no visitors allowed, except at the end of life or for patients with disabilities.
Every patient in every room is unconscious, their faces and bodies unfamiliar, distorted by tubes snaking from nearly every orifice.
OHSU has four intensive care units. The Medical Intensive Care Unit – 7A – is devoted to patients with COVID-19. Today, the team is caring for 14 people. Twelve are unvaccinated. Most are in their 40s and 50s. The oldest is 72. Two are in their 20s.
The curve of COVID-19 cases that Oregonians banded together to flatten in March of 2020 when the virus first struck is now arching higher than ever before in the state. As the experience at OHSU bears out, state reporting shows that the great majority of new cases are people who are unvaccinated.
Current modeling shows that unless more Oregonians get vaccinated and mask up, limit activities and physically distance, the state will have 500 fewer hospital beds than are needed by Labor Day Weekend, already a busy time for emergency rooms.
As of Aug. 16, patients with COVID-19 accounted for more than a third of the state’s total capacity for intensive care – 206 out of 606 occupied ICU beds.
At stake is the ability to also accept patients who need cancerous tumors removed, hips replaced, major injuries mended, heart valves repaired. Hospitals in hard-hit rural counties are full. The state is setting up temporary units outside the hospital walls to free up beds.
“The fifth wave of the pandemic in Oregon remains much more severe than previous surges,” said Peter Graven, Ph.D., lead data scientist in OHSU’s Business Intelligence unit. “Every action to flatten the curve will help us avoid overwhelming our hospitals and ensure all Oregonians have access to medical care when they need it.”
It’s 10:20 a.m. and time to flip another patient.
In its advanced stage, the COVID-19 virus loosens the body’s grip on its functions – swallowing, breathing, eliminating waste. Explosive diarrhea is common.
“We try to preserve their dignity,” said charge nurse Erin Boni, R.N., B.S.N..
Flipping patients face down onto their stomachs and then back again at regular intervals can help control fluids. For comatose patients unable to assist, the procedure takes four caregivers and a state-of-the-art sling.
The team members gather at the bed of a husky, middle-aged man, and follow a well-rehearsed sequence of using the bed linens to roll him onto the sling, lift, lower and carefully reposition him and his delicate assortment of tubes.
Boni said hospitals in hard hit counties are calling, asking OHSU to take their patients. They don’t have the staff to flip them. There is no cure for COVID-19; flipping patients can give them a few more days to live.
“We try to buy your body time to heal,” Boni said.
Down the hall is a high-tech tool used for the sickest of the sick patients for this same purpose. It’s called ECMO, or extracorporeal membrane oxygenation.
ECMO supports a patient’s heart and lungs – or just their lungs if their heart remains strong enough to pump blood – by taking blood out of a large vein, re-oxygenating it and returning it through a large artery. ECMO gives the heart and lungs a chance to rest and recover while the body keeps fighting the virus.
Some COVID patients require ECMO for many weeks. Ideally, the nurses would like to be able have six patients on ECMO pumps at a time. But they don’t always have enough team members to make that happen.
The care team on 7A is pulling together for strength.
Respiratory therapist Jenn Ellingson, B.S.N. says she left her job to go to nursing school at Creighton in Nebraska. She graduated Aug. 12, drove back to Portland by Aug. 16 and reported to work Aug. 19 to help her short-staffed team confront the surge.
“Portland and OHSU are my whole world, especially this unit. All my best friends are here,” Ellingson said, perching her glasses atop her head so she could wipe away tears. “This unit is where I want to be.”
Yet the foundation is cracking.
“In the last week, I had to call over to Doernbecher for a Beanie Baby for a pre-teen to hold while we removed life support from their dad,” said Emily Williams, R.N., B.S.N., outside a patient’s room. “I’ve held the hand of a pregnant woman while her husband is fighting for his life. It’s overwhelming, and it just keeps happening, and there is no end in sight.”
Boni, who has spent the summer nursing amid the plunge and then the spike of COVID-19 cases, thinks about cutting back her hours so she can be more present at both work and home.
She sees co-workers transfer to other units; she fears they will only be redeployed back here as OHSU calls for all-hands-on deck. She said she especially struggles seeing family members unable to be with their loved ones; harder still is hearing their regret that they did not get their loved one vaccinated.
She hears of people feeling scared about the contents of the FDA-approved vaccine, yet she knows how many medicines, some still experimental, she pumps into COVID-19 patients daily, trying to save their lives. She thinks about the many people whose COVID-19 impacts linger for months and how little we know about the long-term effects.
She knows that people, when they are fully functioning and living their lives, never think it will happen to them. Every day she goes to work, she is reminded that this just isn’t true.
“The risk is so much higher getting COVID than getting vaccinated,” Boni said. “I believe people are trying to make the best decisions for themselves. I just want them to understand: This is a preventable illness. This doesn’t have to happen to anyone anymore.”