Heather Miller has a checklist constantly running through her mind. It includes things she seldom thought about before, but absolutely must consider now.
The process is both frustrating and exhausting.
Did she put on her personal protective equipment the right way? Did she touch her face at any point? Did she wash her hands frequently and thoroughly enough?
In Miller’s world as an intensive care nurse at Frederick Health Hospital during the coronavirus pandemic, the answers to these ever-present questions could mean the difference between good health and critical — potentially even fatal — illness.
“Now I have a 6-year-old and a 10-year-old at home. They want to hug mommy after she takes a shower. Am I going to give them the virus?” she wonders.
Being an ICU nurse has given Miller a thick skin. She helps care for the most critically ill patients on a daily basis and comes into contact with death frequently.
But a pandemic that has picked up considerable steam in recent months has presented challengers to Miller and her colleagues they could have never imagined.
Recently, a father and a son came to the hospital and had to watch through a window as a member of their family — a wife and a mother — passed away from COVID-19 as a nurse held her hand, Miller said.
In order to keep the virus from spreading, visitation restrictions imposed by the state have prevented family and friends from being at the bedside of loved ones during their most critical and, perhaps, final moments.
Last goodbyes are taking place on Zoom, and it often falls upon ICU nurses like Miller to provide that final moment of comfort and support.
“It’s a lot to carry all of it on your shoulders and have no one there to pick it up because they have stuff on their shoulders,” Miller said.
For more than two weeks, daily coronavirus cases have surpassed 2,000 in Maryland and 100 in Frederick County.
As a result, hospitals across the state, including FHH, are being stretched to their limit.
On Dec. 11, there were more coronavirus patients at FHH (62) than at any other point during the pandemic, and more than half of the patients in the hospitals 19-bed ICU unit were being treated for COVID-19.
In her conversations with fellow ICU nurses, Miller is hearing more of them say, “I am not OK.”
Then she took it a step further.
“We are not OK,” she said. “There is not enough support.”
Cheryl Cioffi, the senior vice president, chief operating officer and chief nursing officer for FHH, said in a recent interview the hospital was closely monitoring staff levels and making sure that everyone that worked there felt supported. Some nurses were being placed on teams to help manage workloads, while others were being trained to help in other areas.
Still, the nature of the work can feel unrelenting, both physically and emotionally. Some in the ICU are working 16-hour shifts to make up for the shortfalls. The burnout factor is real, Miller says.
“It’s nobody’s fault,” she said. “You can’t pull nurses out of thin air. A doctor is only one physician.”
As FHH began vaccinating some of its front-line health care workers Thursday afternoon, Tom Kleinhanzl, the president and CEO at FHH, praised the work of his ICU team.
“I can’t thank them enough,” he said. “They have done a tremendous job caring for this community. They are being resilient. They are hanging in there. It’s been a long process. Let’s hope this [vaccine] is beginning to getting to other side of this.”
Being ‘The Bad Guy’
Leslie Stine has worked at FHH for 13 years, including the last seven in the ICU.
“I have always wanted to be a nurse,” said Stine, a Brunswick High School graduate. “I like helping people, and I like the science behind medicine. It was really the only career path I sought.”
Over the summer, Stine took on a supervisory role with the hospital. So, in addition to providing care for her critically ill patients, she was bestowed with the task of informing families and friends they could not visit their loved ones due to COVID-19 restrictions.
“I have witnessed some of my own extended family in the beginning of this not be able to come and see their loved ones who didn’t even have COVID,” she said.
Stine said people have yelled at her and pled with her through tears. But she is bound by the restrictions imposed by the state and must protect the health of her staff and patients.
“Always the bad guy,” she said. “Really, it is heartbreaking because you know for these families that this is the last step.”
Learning to Cope
Stine and Miller are among the working mothers on the ICU staff at FHH.
So, when they leave the hospital and arrive at home, their jobs are not over.
“We are everything to our kids,” Stine said. “We have to facilitate virtual learning. We have to figure out how to keep them entertained 24/7. They can’t just go over to their friend’s house because we don’t know who their friends have been around.
“I know it has been a lot on everybody. But I feel like there is a certain level up for the staff that has to work with this [virus] day in and day out.”
The fear of bringing the virus home to their families is a major concern for ICU workers.
“It’s a constant ‘What do I do?’ Miller said. “You don’t want to be around everybody because I am the plague, even though [health-care workers] are probably the safest people. Even my kids, they wear masks when they go outside to play. They have hand sanitizers in their pockets.”
To help manage the daily, job-produced anxiety, which can be “through the roof,” Stine and Miller bought exercise bikes from Peloton and often ride them together.
“We ride our bikes that go nowhere,” Stine said. “Just that exercising, it kind of gets different hormones going and allows you to get rid of the stress a bit.”
During the spring, Miller started a Facebook page titled, “You Don’t Have to Save the World Alone.” It was meant to provide health care workers an outlet to share their experiences and support one another.
Some doctors picked up on Miller’s effort and began offering mental health services to front-line health care providers for free.
“You just have to work through it,” Miller said. “I can’t stop working. I signed up to take care of people who are sick. That’s what I am going to do, no matter what. If something happens and I do get [the virus], I’ll just go from there.”
Meanwhile, Stine said the best thing people can do to help front-line health care workers during the pandemic is to take basic steps such as wearing masks, washing hands and maintaining physical distance.
“Help us make our jobs easier,” she said.