“None of us would have ever expected to work through a pandemic, let alone be the primary caregivers in a pandemic.”
Looking back on the state’s response to COVID-19 as the first cases were reported in South Dakota on March 10, Amanda Dosch said she can’t believe it’s been four months.
Dosch is a registered nurse at Monument Health who has been working with hospitalized coronavirus patients every day since March.
“We see a wide variety,” she said. “We see some that are here for a week or less. We have people that have stayed a month plus with us. It just depends on how critical of a case they have.”
Dosch has cared for patients in all walks of life — from young patients who didn’t have pre-existing conditions but had extreme complications from the virus to people dying of COVID-19 who couldn’t have family there in their final moments due to the risk of spread.
“We work very closely with these patients. We see and have a good understanding of how challenging and difficult it is for the COVID-19 patients,” she said. “Nobody gets visitors. These people are going through something really scary, and they don’t have their support here with them on top of being really sick.”
The room where it happens
Monument Health converted its heart and vascular unit (HVU) into a space for COVID-19 patients months ago. If the 32-bed HVU is at capacity, nurses have also put patients on the floor below, which they call the “foothills,” a 20-bed space that Dosch said is “very minimal.” The rooms in the foothills are private, but sparse: “sheetrock, a bed and a chair.”
Monument Health saw the most patients hospitalized on June 15, when 43 patients were there together. Dosch estimated anywhere between 20 to 40 patients have stayed in the hospital at once since the surge in cases first began West River.
If the hospital sees more than 52 COVID-19 patients at once, nurses would utilize the floor above the HVU which they call the “prairie,” a 152-bed unit with an open floor plan and little privacy for patients.
“The prairie is a little bit more dramatic, drastic change of practice,” Dosch said, whereas in the foothills, “each person at least has a private room.”
Each nurse is tasked with taking care of three to four COVID-19 patients a day, but Dosch said that can fluctuate based on what level of ICU care the patients require. For ICU patients, one nurse could be taking care of one or two patients. On a typical day, Dosch estimated 12 nurses and five or six patient care champions could be working in the HVU together.
Haley Cowan is a patient care champion, which she describes as an “aid for the nurses.” Cowan takes care of patients by checking vital signs, assisting with routine activities like showers and movement.
“In the aspect of trying to conserve PPE, it’s really important for us to do as many tasks in one trip into that patient’s room as possible,” she said. “If we’re going to go in and obtain a set of vital signs, we want to do that plus change bed sheets, see if they need to get up and use the restroom, shower, anything like that. It’s not unrealistic that you might be in a patient’s room for 45 minutes to an hour in full PPE.”
Personal protective equipment, or PPE, for both Dosch and Cowan includes an N95 mask and eye protection through the duration of their 12-hour shifts. When they enter a patient’s room, they also put on a gown and a pair of surgical gloves.
For eye protection, Dosch said they have two options: a face shield with their N95 mask, or a combination of goggles and the N95 with a surgical mask over it. Gowns, gloves and surgical masks must be switched out between patients. Dosch said those that can’t wear an N95 mask all day can wear what they call a PAPR — powered air purifying respirator — instead.
When the caregivers come in for work, they’re offered a set of surgical scrubs if they would prefer to not wear their own scrubs all day as they work with COVID-19 patients.
Dosch said in a 12-hour shift, caregivers can take a lunch break and are allotted two 15 minute breaks during their workday. Dosch said she and her co-workers try “really hard” to take breaks as often as two hours, because they can’t drink water or eat snacks where they work. They have to keep their masks on in areas with COVID-19 patients.
“Even if it’s just a quick step away to take the mask off and take a drink of water, we try to shoot for every two hours,” she said. “We try to step away a lot more frequently than that, just to give our face a break from wearing (a mask). The N95 masks are very tight.”
‘We are their family’
COVID-19 patients, who sometimes stay for a week or month at a time, aren’t allowed to see any visitors due to the risk of transmission.
“We are their family and their support for the most part while they’re here with us,” Dosch said. The connection caregivers share with their patients is stronger “in this space than we’ve experienced it before” the pandemic, she said.
Dosch said many of her patients aren’t capable of speaking with them because they’re experiencing the cough and shortness of breath associated with the illness, or they’re on a ventilator.
Three of the largest struggles for COVID-19 patients are their mobility, strength and diet, Dosch said. COVID-19 can “make food taste bad, or you lose your sense of taste,” she said. Patients also struggle with their inability to go outside, go for walks or get their regular activity.
It “wears people down really quick,” she said. For Dosch, “it’s hard to go home with a full cup at the end of the day.”
Twenty-one people have died from COVID-19 in Pennington County, according to statewide data. Some of these patients likely spent their last moments supported by Monument Health caregivers like Cowan and Dosch.
“When somebody can’t have family here, it’s hard for us because we know they’d like to have that comforting person” with them in their last moments, Cowan said. “It’s hard for the family. They want to be here.”
Cowan said she and other caregivers at Monument do everything they can to “be present with that person, to be somebody there for them, whether they know you or not.”
Not having the family present for the death of a loved one is a “very unique circumstance” of the pandemic, Dosch said. It’s “something that we’ve never encountered prior to this.”
Caregivers started a new project where they give a stuffed lamb to each of their patients to comfort them, as they spend a lot of time alone. The lamb comes with a prayer card and a bookmark. Each of the COVID-19 rooms is also equipped with an iPad, which allows patients to FaceTime their relatives and friends.
“We try as hard as we can to have the family present in whatever way, shape or form we can,” Dosch said. Caregivers also send out cards to the families after their loved one dies so that they “know their loved one wasn’t alone at the end,” she said.
“It’s a really sad thing that has come from COVID-19,” Dosch said. “Nobody should have to go through that. Nobody should have their loved one alone, and nobody should have to be without their loved ones at the end.”
When Dosch comes home after work, her two children, ages 3 and one-and-a-half, are waiting for her. But Dosch said she’s quick to sneak in the house and take a shower before hugging her kids, careful to wash herself and any scrubs and other items that may have been exposed to COVID-19.
“I honestly feel that we’re safer (at work) in our proper gear than we would be out in public for the most part,” she said. “You don’t know what you’re coming into contact with out in public.”
Dosch said she doesn’t stay separate from her family when she’s at home: “That’s not really an option for us.”
“We don’t know how long COVID-19 is going to affect our community. We don’t know how long we will be taking care of” these patients, she said. “To seclude ourselves from our families has never really been an option.”
Cowan takes similar precautions to Dosch when she goes home to her children, ages 10 and 6. She said she lives with the reality that she or her kids could be at risk for contracting coronavirus.
“That thought is kind of always in your head,” she said. “We know that the longer you spend time with a COVID-19 positive patient in a room or in that space, the more likely you are to at some point be infected. We know that’s a possibility” but we take steps to avoid that, she said.
Some of the steps Cowan, Dosch and their families take to avoid any COVID-19 transmission include wearing masks in public, practicing social distancing and good hand hygiene.
To those that aren’t social distancing, Dosch said she wants to tell them to “be considerate of your neighbor, your loved ones and strangers.”
“I think there’s a lot of stuff in the news and the research out there regarding the implications and what happens if you get COVID-19,” she said. “Simply just being considerate of those around you and wearing a mask (is) kind. It’s such a stressful, unknown, crazy time in this world. Take a little bit of effort to be kind to those around you.”
Cowan said she’s heard people complain about the pandemic and heard people in her field say “I didn’t sign up to work COVID-19.”
“None of us did, but it’s what’s present in our path and so that’s what we’re doing,” she said. “We do it because we want to work in a health care field. Somebody who has COVID-19 didn’t ask to get COVID-19. We didn’t necessarily ask to work COVID-19. But regardless of that, these patients need our help and there’s a reason that we’re here.”