Like the lungs of acute COVID-19 survivors, nurses, doctors and front-line healthcare workers remain scarred a year after the pandemic flooded South Florida hospitals with gasping patients sickened by an invisible, insidious virus.
While most people huddled at home, they stood at bedsides, knowing their own infected patients could kill them. The mental and emotional toll has been profound.
Through the first wave and succeeding, worsening surges, they worked grueling shifts, managing a complex, heavy and often hopeless caseload with the most critically ill patients hooked up to ventilators, dialysis machines, extra corporeal membrane oxygenation (ECMO) life support and a web of IVs.
“My unit was the original ground zero,” said Laura Rivas, a critical care nurse at Miami’s Jackson Memorial Hospital, who described the demands inside the COVID unit. “Our patients tend to be very unstable as far as heart rate and blood pressure, so you can be monitoring 13 pumps per patient and refilling meds with alarms and code blues going off around you. You have to put patients on their belly to improve oxygenation, so you’ve got an obese, 240-pound, sedated patient that several of us have to turn while making sure the breathing tube doesn’t come out.
“Then, after 13 hours, you drive home — I would cry or scream or play loud music and belt out a song as my release. Strip in the garage, wash your clothes, fall into bed and do it all over again the next day.”
Because of unprecedented prohibitions of visitors, nurses bore an additional and exhausting burden of connecting frightened patients with desperate loved ones, often comforting the dying with a compassionate touch in their final, lonely moments or positioning the phone as families wept final goodbyes.
“I’m holding their hand, watching it happen, and I say, ‘It’s OK, it’s OK. Your family loves you,’” said Grace Meatley, a nurse assigned to Jackson’s COVID unit. “I pray for the patient, and the family that can’t be there. Each person has their own story and I try to be enriched by each life.
“You see them passing away right before your eyes.”
Death comes with the calling of a medical career, but the random, rapid strike of COVID hit healthcare workers hard. Over and over, their patients described a feeling of drowning. They can’t shake the memories. The elderly patients isolated from their children. A couple on a Coral Princess cruise vacation (the husband died shortly after he was belatedly evacuated from the ship, his wife survived hospitalization at Jackson). A family of three hospitalized at the same time (only one made it out). The poor farmworkers or housekeepers worried about how relatives in Central America would eat without the money they sent home.
There were more victories than tragedies, and hospital staff celebrated with recovered patients, wheeling them down hallways lined with balloons as “Rocky” played on speakers and out the sliding doors into the arms of family members. At the three hospitals in the Jackson Health System, 5,662 patients diagnosed with COVID were discharged while 1,032 died. Since the July 27 peak of 485 COVID patients at Jackson, the number of cases had dropped to 107 as of Thursday.
But COVID-19 remains relentless. Even as vaccination rates have risen in recent weeks, the daily tally of positive cases remains on a roller coaster. Nearly 34,300 people have died from coronavirus in Florida, 565,000 nationwide and 3 million worldwide.
A Nurse Grid survey showed the percentage of nurses reporting burnout more than doubled to 61 percent from April 2020 to the end of the year. While confidence in caring for COVID patients increased, 78 percent said they are concerned about how nursing shortages affect quality of care, 40 percent are worried about their mental health and 22 percent said they plan to leave bedside care or the nursing field in 2021.
“We’ve been changed by the pandemic,” said Martine Aerts, a nurse at Jackson for 28 years. She caught a mild case of COVID in June. “We suffer a little PTSD in that this was not normal or acceptable and never will be.COVID is a psychological virus as well. It plays with everybody’s mind. Your mind goes a mile a minute filled with fear and uncertainty.”
The pandemic will have a long-lasting impact on healthcare professionals. Some have rededicated themselves. Some are ready to retire early or seek non-clinical roles. Others accepted lucrative traveling nurse assignments at hospitals with high need, earning three or four times their regular $30-40 per hour pay, which exacerbated the nursing shortage around the country and stretched standard critical care nurse-to-patient ratios from one-to-one to one-to-two, three, even four during COVID peaks.
The demand for nurses is only going to increase. More than 1 million registered nurses are expected to retire by 2030, just as the number of Americans age 65 and older grows to 82 million.
“We’ve been expecting a nursing shortage, and the pandemic will accelerate departures for nurses who might have stayed longer but are feeling tired or want to move into a less exhausting specialty,” said Wendy Stuart, chief nursing officer at Mount Sinai Medical Center and a registered nurse since 1989. “We’re feeling the lack of clinical experience in our workforce already and can’t replace it fast enough.
“We love what we do. But it’s been a long haul. And it’s not over yet. No way.”
In interviews with the Miami Herald, a half-dozen healthcare heroes reflected on the past year:
‘Worse than wartime’ in some ways
Dr. David Farcy, chair of emergency medicine at Mount Sinai Hospital in Miami Beach, served as a U.S. Air Force medic during the Gulf War. He was a resident in New York City at the time of the 9/11 terrorist attack. He was an emergency responder during Hurricane Andrew and the 2010 earthquake in Haiti. But the pandemic has been unlike any crisis he’s faced.
“In many ways it’s been worse than wartime because in war you know your enemy and you know your mission to defeat the enemy,” he said. “The magnitude of COVID is so different compared to 9/11 because post 9/11 people could meet each other, hug each other and reassure each other that it was over. COVID just seems never-ending, and our patients’ support system is missing. People are dying and grieving in isolation.”
Farcy started logistical planning in January “when we first heard about a potential epidemic that resembled SARS and MRSA.” He warned his colleagues to prepare for a marathon.
“On March 6 we decided to put up a tent outside and convert the old emergency room into a COVID unit,” he said. “By March 17 we had 100 COVID patients. During the second surge in August, it was worse. Then the staffing situation became stressful as nurses left for other jobs.”
Along the way, Farcy lost one of his mentors, a well-known Miami cardiologist who was still doing housecalls when he died in May.
“I had to break the news to one of his daughters because we couldn’t let her into the ICU,” Farcy said. “I felt ready to hang up my coat that day.”
One of his first patients to survive intubation recently came to say thank you to him. Determined to avoid the invasive measure, Farcy decided early on to make intubation a last resort and collaborated with pulmonologists, respiratory therapists and pharmacists to adopt other treatments.
“To know that we’re making a difference, that keeps me going,” Farcy said. “But COVID will leave us with a mental scar. Healthcare workers are already at risk for depression, PTSD and suicide. We’re at higher risk now. That’s the dark side of the pandemic for us.
“And we understand putting our lives on the line at work, but with COVID we could be endangering our families’ lives, too. When I hear people calling it a fake disease or a bad cold, I get very angry.”
‘It was a feeling of doom’
Registered nurse Martine Aerts was assigned to Jackson’s rapid response team, handling the most severe cases and rushing to code blues.
“In the beginning we all faced a great fear of the unknown,” she said. “We heard horror stories from China, Italy, Spain, then New York. We were really scared.”
Araceli Buendia Llagan, ICU associate manager with 33 years of experience at Jackson, died from COVID in late March. Three other Jackson healthcare workers — an obstetrician-gynecologist, a nurse and a radiology technician, also died after contracting the disease. Over the past year, 1,051 of 12,948 Jackson employees tested positive for COVID — about 8 percent of its workforce.
“When we lost Celi, we lost our leader, and we were thinking, ‘OK, who’s next?’ It was a feeling of doom,” Aerts said.
Swaddled in PPE, wearing what some called astronaut suits , nurses often skipped lunch breaks because they didn’t have time to remove layers of masks, shields, gowns and gloves to eat.
“You’re in a COVID unit for 12-13 hours, you’re sweating like there’s no tomorrow, it’s pouring down your back. We had to remind each other to drink water,” she said. “Early on, you guarded your N95 mask, kept it in a bag and had to re-use it. We instinctively run into rooms when there’s an emergency, but we had to think twice and check our PPE.
“We had patients who got confused when their oxygen got low and they’d climb out of bed and wander into hallways and we had to hustle them back into the negative pressure rooms. Just on high alert every minute to prevent contamination.”
Going home at the end of a shift provided marginal relief because healthcare workers feared bringing the virus with them. Some stayed in hotels or slept in their garage or backyard tents. Aerts’ husband has high blood pressure, so she confined herself to the spare bedroom and bathroom.
“I switched shoes in the parking lot and put my work shoes in the trunk,” she said. “At home I took everything off and went straight into the shower. I did my laundry with bleach. I disinfected my car every night. I stopped wearing jewelry.”
During the August surge, Jackson was packed with nearly 500 COVID patients. As soon as an ICU bed was vacated, it was occupied. Staff vacations were canceled and extra shifts added as patient loads doubled.
“We’d see a patient on one floor in the morning and by evening they had deteriorated very fast,” she said. “It was intense.”
Aerts said the isolation of COVID patients caused her to feel more sadness on the job than ever before.
“We called the young ones the ‘happy hypoxics’ because they were always on their phones despite their saturation levels,” she said. “But the older people would lie there staring at the wall. They were so fragile. Some were from nursing homes. Some didn’t understand what was happening. The loneliness of the elderly — that will stay with me forever.
“We, as a society, failed the working-class people who had to work, getting exposed all day, and had no choice but to go home to a crowded house or apartment. That was a helpless feeling, that they could not have been protected better.”
Aerts, 60, said her husband wants her to retire but she’s not ready.
“Jackson is my home away from home. It’s a unique place to work. It’s a little city that reflects Miami. I don’t want to leave yet.”
‘We were like a football team’
Consumed with keeping patients in contact with loved ones, healthcare workers were cut off from their own.
Jackson nurse Grace Meatley, whose medical ICU unit was converted into the main COVID unit, didn’t dare make her usual visits to her mother, but dropped off groceries on her front stoop. For relief, she meditated before work and listened to books on tape in the car. A self-described political junkie, she watched Rachel Maddow’s show every night and reveled in “a highlight of my life” when she was chosen to introduce Barack Obama at a Miami campaign rally for Joe Biden.
Mentally and physically drained, front-line workers relied on adrenaline and camaraderie.
“I lost five pounds the first week,” Meatley said. “We came up with creative engineering solutions to deal with the cramped conditions and keep the tangle of drip lines and beeping pumps sorted out. It takes six of us to turn obese patients and make sure the tubes don’t rip out. We got really good at it. We were like a football team.”
She made a special effort to give patients the human touch.
“Every shift I gave them a warm bath, a back rub, mouth care,” she said. “Your job is to relax them, reduce their stress level. They’d have delirium or be agitated and I’d say, ‘Hang in there, I’m here for you.’ Think of the nightmare for the patient who is on a ventilator, hallucinating, and can’t talk: ‘We’ll get the tube out soon. Do you need suction? Your daughter called to say she loves you.’”
Another task was managing the sheer volume of phone calls from family members.
“Even for the patients in an induced coma, it’s important to keep communicating because when they come out of it they tell you they heard everything,” she said. “It’s therapeutic for the family to talk to them. Facetime enabled them to catch a glimpse.”
In January during the third surge, Meatley considered a recruiter’s offer for a high-paying nursing job in Texas, but she decided to stay.
“I envied friends who could work from home offices, but I was determined to get back to Jackson every day and send patients home,” she said. “That brought us the joy to get through the heartbreak.
“We had a family of three in our unit. I took care of one of them and thought she had a chance. But one day she went into flash pulmonary edema and they couldn’t resuscitate her. I couldn’t stop thinking about the only one who lived.”
Meatley cared for a colleague, Rosa Felipe, 41, an electroencephalograph (EEG) technician who was infected in March, fell gravely ill due to underlying conditions of asthma and diabetes, was intubated, hooked to dialysis and ECMO machines, and wound up hospitalized for nine months. Lengthy treatments weaken circulation and can cause necrosis of the extremities. Several of Felipe’s fingers turned black and she anticipates they will have to be amputated.
“I remember her pleading, ‘Please don’t let me die. I have to get home to my children,’” Meatley said of Felipe, mother of two boys who also lives with her 82-year-old mother. “Not many survived from those beds. She got out before Christmas.
“I had a gentleman last week who really moved me. He was so weak. He was cloudy mentally. But when I put the phone in front of his face, he rallied and waved his hand, using every ounce of strength. He’s going to leave us and go to rehab. Multiple times he was placed on the ventilator, ECMO, had complications from a tracheostomy. He’s a miracle. He’s a victory.”
‘You never, ever get used to losing a patient’
Laura Rivas, 44, was a social worker in hospitals and in the foster care system before becoming a critical care nurse at Jackson.
“By August the influx was out of control and we had to expand the number of COVID beds but we had advanced our knowledge through a huge learning curve,” she said. “Still, not many made it out of our unit. We had the most acute cases. COVID is freaky. All of a sudden a patient is in respiratory failure, renal failure, multiple organ failure. The disease showed its powerful side to us.”
COVID was cruel, too, in how it essentially imprisoned patients in solitary confinement.
“The phones were blowing up with loved ones calling: ‘I’ve been on hold for an hour, please, please put me on with my father. Can you help me Facetime with him? How is he doing? What does the doctor say?’
“We had to be their eyes and ears. Many times it was hard to offer hope. Nothing replaces having a loved one at your side. We can’t come anywhere close to that relationship and we were expected to assume that role.
“I remember a lady who was flown in from the Keys. Despite everything we did she was not responding. I was thinking, ‘How can I honor her?’ Her daughter asked if I could put her on speaker phone. I still get choked up. There were four children, six grandchildren, brothers, sisters, nieces, even her mother on that call. COVID has ravaged patients’ bodies but nothing severs that connection with loved ones. They got to say goodbye. I was holding her hand. I was crying. Fifteen minutes later she passed away.
“You’d think my career dealing with difficult cases would have toughened me up. But you never, ever get used to losing a patient.”
‘Less invisible and more appreciated’
Wendy Stuart, who oversees nursing operations at Mount Sinai, began her career in 1989, during the AIDS pandemic.
“One thing that’s different with COVID is that when you’re covered in PPE, the patients can only see your eyes, not your whole expression. It’s added to the isolation factor,” she said.
She’s also had to be cautious around her husband, a cancer survivor. “I’d come home, go straight to the backyard, change into my bathing suit and go into the pool.”
If there is an upside, COVID put nurses in the spotlight that they deserve, which should be a plus for the profession and may drive more people to pursue careers in healthcare.
“We do feel less invisible and more appreciated,” she said. “But we’re also seeing a shift in nursing toward specialties like ICU, OR, anesthesia, cath lab, cardiac and surgical nursing. Clinical, bedside, hands-on jobs are more demanding, yet so fulfilling.
“Those are the caregivers who, despite everything, connected with their COVID patients.”
‘We never ran from it’
Lisa Byrd, associate nurse manager in Jackson’s main operating room, was among the nurses asked to manage a COVID unit when elective surgeries were halted.
“It was dead quiet at that meeting, and then I raised my hand very slowly,” she said. “I was scared but felt I needed to help my hospital and my community.”
She reorganized Southwing 8 into a COVID ward with 26 beds in heavily-equipped negative pressure rooms. She tried to cleanse her floor of “fearful energy” and lift morale.
“We did a Tic Tok dance to MC Hammer’s ‘Can’t Touch This’ while we put on our PPE,” she said. “I requested extra iPhones to keep patients and families talking as much as possible. It’s good for them. Breathing is more difficult when you’re feeling anxious. Once we got knee-deep in COVID I tried not to have the bad news from Italy and New York on the TVs.”
At home, Byrd was worried about her teenage daughter, stuck in virtual school and unable to see her friends.
“When I got home at night, I didn’t want her coming near me because of transmission risk,” Byrd said. “She’s depressed. I’m exhausted. It put a strain on our relationship.”
At Jackson, certain cases affected her deeply. “We treated a lady whose husband died on their cruise trip,” she said. “She beat it, but I can’t help thinking about how she lost her husband on vacation and she was sick and alone in Miami, far from her home.
“A man on my unit died and his brother was calling to find his belongings. I tracked them down and took them to him at the door. He never saw his brother. And all I could bring him was his brother’s clothes and keys.
“I talked to a mom with a 26-year-old son in our unit. I went into his room and held that young man in my arms. If my child had COVID I would want someone to treat him with love.”
Byrd remains concerned about COVID variants, anti-vaxxers and staff burnout and shortages. But she is extremely proud of how healthcare workers rose to fight the novel, brutal challenges of the pandemic.
“This thing came riding into Miami on the Super Bowl,” she said. “We never ran from it.”