As Gina McCarthy recalled a hopeful time earlier this year when MultiCare’s Tacoma General Hospital briefly closed its COVID-19 unit, the faint melody to “Twinkle Twinkle Little Star” played over the loudspeakers in the background. It happens every time a baby is born.
The sound offers a momentary glimmer of joy for the longtime respiratory therapist, who treats the sickest COVID patients every day. It’s a reminder that good things are still happening in those hallways.
But there is one place you can’t hear that music: within the walls of the airtight COVID ICU.
“I personally have had some emotional times where we really lean on people that we work with to kind of get us through those moments because they become long,” McCarthy says, holding back tears. “Death is part of our job, but to see people that are dying that didn’t need to.”
Her emotion is palpable as she talks about some of the worst conditions her hospital has dealt with since the pandemic started. McCarthy has worked as a respiratory therapist for 28 years. She’s never seen anything like this. Right now, she is working 16-hour shifts four days at a time. Staffing is thin, making it hard to take regular days off. COVID patients are overrunning the ICU more than 18 months into the pandemic. Almost all of them are unvaccinated. And it’s hitting every age group.
McCarthy is often one of the people to hear a patient’s final words, before they are placed on a ventilator.
“And it’s really hard because I have not had a patient yet who I’m putting a tube in that hasn’t said, ‘I wish I would have gotten vaccinated,’ ” McCarthy said. “In the back of our minds, we wish that as well.”
But McCarthy says health-care workers can’t fixate on a patient’s vaccination status. Their energy is focused instead on offering the best care they can, regardless of the choices that landed them in those beds. McCarthy says that is harder to do when she leaves work.
“It’s hard to talk to people who aren’t here. When you hear someone say, ‘I’m not getting the shot,’ I just can’t get myself involved in those conversations,” she said. “I really depend on the people who see what I see every day. And so we become quite a bubble here, socially and otherwise.”
McCarthy’s voice cracks a lot while we talk. That emotion comes from caring for patients around the clock under seemingly impossible conditions.
McCarthy says she and her colleagues were hopeful earlier this year that we had turned a corner. As cases dropped and the vaccine became widely available, the COVID unit at TG closed. It looked like the virus might be under control. But the Delta variant changed everything. The number of critical patients on ventilators has doubled. McCarthy says health-care workers are now told to stick strictly to the facts when communicating with families to avoid giving them false hope in a hopeless situation.
“The patients we’re seeing are going onto ventilators much quicker,” she said. “Every patient we get that’s ill has to be placed on their stomach and they’re ventilated. So they have a tube in their mouth, they have to be manually put onto their stomach. That takes seven people.”
That’s a third of the unit’s staff. It’s part of the ongoing staffing crisis at Tacoma General and all hospitals throughout MultiCare Health System. And the surge in patients is trickling down to all corners of the hospital.
Support staff are dealing with frustrated and, at times, violent family members who can't be at the bedside as their loved ones die. Social workers are tasked with virtual check-ins with those families because nurses are too overwhelmed to speak with all of them. Doctors are combating misinformation, attempting to explain why unauthorized treatments like ivermectin aren't viable treatment options.
Margaret Korkes, clinical director for Tacoma General’s emergency department, walks through the hallways of a normally dark trauma unit.
“It is now kind of overrun and staffed due to COVID patients,” Korkes said.
Another area of the emergency room has been repurposed for people who are admitted to the hospital. Korkes says more than a third of all ER beds are now private in-patient rooms for all patients, COVID or otherwise, because other areas of the hospital are at capacity.
“We are so overwhelmed with all patients that it’s created a cascading effect down to the emergency department,” Korkes said. “And every emergency department sees this.”
That means anyone who goes to any hospital right now for any reason is likely to see longer wait times and possibly less privacy. At Tacoma General, patients are even being treated in the intake triage rooms near the ER front desk. The COVID surge is pushing patient care to the front doors of the hospital. Just outside, a tent offers more space for patients waiting to be seen.
“We’re starting to use the measures that when COVID first started, we all had meetings for the ‘what if,’ ” Korkes said. “And we are now in that ‘what if.’ ”
McCarthy, the respiratory therapist, says she does what she can to recharge when she is not at work. That includes Zoom yoga sessions with her friend who is an instructor, or quick phone calls during her breaks with people she loves. And she focuses on what she can control.
“I haven’t seen anybody die from the vaccine, but every day I’ve been here, I’ve seen someone die from COVID,” McCarthy said. “I feel like we’ve tapped out who’s going to listen, and then everybody else is on belief status. You can’t change other people’s beliefs.”
So McCarthy says she doesn’t try to have those conversations. She says they don’t go anywhere or benefit anyone. She stressed that she doesn’t have any energy left after working long hours each day.
Still, McCarthy wishes people on the fence would get the vaccine. So does Korkes. She says it’s one of the simple ways people can support health-care workers.
“Wear a mask. Take a vaccine. From a health-care worker standpoint, it makes a tremendous difference,” Korkes said. “A majority of our very, very sick patients are unvaccinated. And it’s very tragic to see younger and younger people die of things that we could have controlled.”
Right now, hospitals are closer than ever to rationing care. So health-care workers are bracing for things to get worse before they get better.
