Squawkers and complainers about COVID-19 restrictions curtailing their restaurant visits and bar hopping might benefit from a timeout to focus on Hawaii’s medical workers, quietly going about their business every day to ease the suffering of terrified patients stricken with the virus.
If you have a minute, tie a white ribbon around a tree or a plant in your backyard to say thank you to Hawaii’s critical care nurses, pulling 12-hour shifts under the cold blue fluorescent lights of intensive care units to minister to the severely ill and dying.
Although doctors have become more proficient at treating the virus and there are promising new medicines to reduce its severity, people are continuing to die of COVID-19 nationally by the thousands.
In the Year of the Nurse — so named by the World Health Organization in honor of the 200th anniversary of the birth of Florence Nightingale — it is fitting to hear from three Hawaii nurses whose personal lives have been upended by COVID-19.
‘It Breaks My Heart’
“It is the kind of work I am meant to do,” says Randi Mears, 34, a critical care nurse at Straub Medical Center.
Mears has been working in intensive care units since she graduated from the University of Hawaii at Manoa School of Nursing three years ago.
When the coronavirus pandemic arrived in Hawaii in March, she was slammed with caring for some of the sickest people medical workers had ever seen in their lives.
She was also pregnant with her first child, a baby boy she had at Kapiolani Medical Center Sunday.
Mears kept working up until four days before her baby was born. I spoke with her by phone Friday as she was preparing to go to Kapiolani for the delivery of her son.
She was initially worried when she began caring for COVID-19 patients in March. Thousands were dying in Italy and New York’s coronavirus cases were soaring but not much was known about its effects on pregnant women.
But she said after Straub issued enough protective equipment for the hospital staff, she felt secure.
Mears says what has surprised her most about COVID-19 is the severity of sickness in many patients.
“They come in sick and they get sicker. Especially older folks,” she said.
Mears says the virus can exacerbate heart and kidney issues and that the length of stay for virus patients is two or three times longer than other ICU patients. COVID-19 patients need so much more support, she says.
“It is just sad to watch patients deteriorate every week, to know they are not going to make it no matter how many therapies that have been tried,” she said. “It is a very strange virus.”
Treating patients can be lonely for ICU nurses. They remain cut off from the rest of the hospital, working long hours in COVID-19 patients’ rooms with other nurses prohibited from entering for fear of spreading the virus.
“We have learned to write backwards on the glass windows in a room to tell the workers outside what supplies to bring to us,” Mears said.
She says sweating under heavy protective gear has been one of the particular irritants of the work.
She awakens every morning she is on duty at 5 a.m. to make the drive to Straub from her home in Maili on the Waianae Coast. She gets there 30 minutes before her 7 a.m. shift to allow enough time to put on multiple face masks, a plastic face shield, scrubs, protective shoe coverings, a protective plastic gown and double gloves.
“The hospital rooms we work are called ‘negative pressure,’ which means the air remains in the room when the door opens, making it doubly hot,” she said. “We are soaking in sweat as we stay in the same room with the door closed for hours. When we remove our scrubs at the end of the shift we stand in pools of perspiration.”
The worst part about COVID-19 is many patients die alone without the comfort of family members at their bedside to hold their hands and soothe them when they die.
Medical personnel become their only in-person human contact.
Mears says up until very recently, visits with patients at Straub have been limited to Facetime and Zoom with an iPad held up to the face of a patient who is often sedated and on a ventilator.
“Some patients die completely alone,” Mears said.
Sometimes emotionally upset family members don’t want to watch people die electronically, declining the chance to say goodbye on a device.
“It is very sad. It breaks my heart to think of a patient dying alone,” she said.
When a patient is close to dying, she stays in the room and holds their hand.
“The patient may not know me and be sedated and on a ventilator but they say the hearing is last to go. I cannot let someone die on his or her own. I say my name. I tell them it is OK to go. Sometimes a family member will ask me: ‘Please tell him I love him.’ It is comforting to think I can be a human presence for a patient who is dying.”
Colene Geier says an additional sadness she and other nurses sometimes face is trying to calm the guilt-ridden relatives of the COVID-19 dead who fear they transmitted the disease — like a young adult who is COVID-19 positive with mild symptoms who is watching his grandfather dying of the virus in front of him.
No matter how many times she tries to reassure a relative that it is not his or her fault, that the virus is sweeping the world, she says their emotions at the time of death are so raw they are unable to accept it.
“This is particular to COVID. With cancer, adult children don’t feel guilty because they might have given their parent cancer,” she says.
Geier, 50, is a critical care nurse treating COVID-19 patients in an intensive care unit at Kaiser Permanente Moanalua Medical Center.
She has been a nurse for 24 years and before that she worked as a paramedic.
She said her worst day during the pandemic was when she and another nurse struggled to care for four critically ill COVID-19 patients when they normally work long, intense days caring for two patients.
“I felt so spread out. I felt I had to be everywhere at once. I didn’t feel I could do the job I wanted to. The patients were so sick. I just cried in the car all the way home,” she said.
She says it is disheartening that some people are still unwilling to see the lethality of COVID-19. She says despite all the news reports, people continue to ask her, “Is it so bad? Isn’t it like the flu?”
The state health department asked her to appear in its new TV public service campaign to stress the seriousness of the disease — not only to patients but also to exhausted health care workers.
Geier works three or four 12-hour shifts a week, rotating with other nurses, assigned one day to a COVID-19 ICU and another day in a virus-free adult ICU unit.
“So we don’t get beaten down,” she said.
Geier develops a closeness with patients. “When they come to the ICU we get to know some of them before they become sick enough to be intubated. We find out about their lives.”
“We are fighting for them as much as we are fighting for ourselves to stay healthy. We don’t want to lose them.” — Colene Geier, nurse at Kaiser Permanente Moanalua Medical Center.
It is nursing plus so much more.
“We are a patient’s only contact with the real world. It is emotionally draining to be an extension to a patient’s family,” she said. “I hold up an iPad so they can see their relatives. Sometimes the Internet connections don’t work. It is frustrating and scary for their families. You can feel the emotional rawness.”
When she drives over the Pali to her home in Kailua, she listens to audiobooks about faraway topics like the exploits of female resistance fighters in World War II.
“It gets my mind off work to get lost in a different story, to leave behind the hospital and be relaxed by the time I get home to my family,” she said.
In the early days when even less was known about the pandemic, she worried constantly about bringing home the disease to her husband and 16-year-old daughter and 12-year-old son.
Geier says COVID-19 affects people in such different ways.
“People are not getting well fast. We try one thing and then we have to try another thing. The something else pops up. The virus is outsmarting us. It is always changing. There is so much we don’t know,” she said.
“The key lesson here is this is something you do not want to get.”
Keeping Their Families Safe
Tiffany Martinez, a critical care nurse at Hilo Medical Center, has been caring for COVID-19 patients in the hospital’s ICU ever since the disease first showed up in Hilo.
Some of the very ill and dying patients have been transferred to Hilo Medical Center from the Yukio Okutsu State Veterans Home, the beleaguered facility where 71 residents have been infected with COVID-19 and 26 have died.
Martinez, 40, who was born and raised in Hilo, says it has been a sad and frightening time treating a disease that is so little understood.
“There is no gold standard for treating patients. We have to evolve and adapt as we treat patients. It is the first pandemic we have seen,” she said.
She is very worried about bringing home the disease to her family. With the coronavirus infections continuing to spread, she has sent her 15-year-old son to live with her ex-husband.
“It hurts my heart that I can’t hug my kid,” she said via phone from Hilo.
She also worries about her 21-year-old daughter who has asthma and an 85-year-old grandfather.
She showers at the hospital when she finishes her 12-hour shift; then showers again when she returns home.
Armed with a plastic bottle, she sprays surfaces in her house with 70% Isopropyl alcohol — anything that people touch like house keys, doorknobs and the TV remote control.
“Then I douse them with alcohol a second time,” she said. “Some people say that’s overkill. But until we are certain how it spreads. I am being hypervigilant.”
She said one of the most difficult parts of caring for COVID-19 patients is trying to explain what’s happening to the 80- and 90-year-olds who have dementia. Frail and alone, like small children, they can be filled with fear.
“We are covered from head to foot in protective gear. They don’t know who we are. I try to explain logically but they don’t understand. It is really sad,” she said.
She said caring for patients who lack understanding can be dangerous. If one of the elderly patients panics and tries get out of bed or to tear off monitors and tubes, a nurse’s inclination is to immediately rush in to save them but the nurse has to be protected.
“I have to gear up first. I can’t risk myself to help them. We have to protect ourselves first,” she said.
She says she is rarely able to unwind because of her increasing work demands, but in her time off she likes to go to the beach or on hikes with her children and boyfriend, who is also a nurse, to scenic spots like Pololu Valley Lookout.
“I want to be any place in the sun and not under the hospital’s fluorescent lights,” she said.
Martinez is aware that the pandemic is singular and will be embedded in her consciousness forever.
“We are writing history right now,” she said. “We are a part of it. We are scared but we have an opportunity to learn about an entirely new virus and be part of its history.”
Straub nurse Mears says when her son is old enough to ask about the virus, she will tell him she was uneasy.
“We thought we knew a lot about medicine when this devastating disease came along and we didn’t know what to do. We didn’t realize until it was upon us how fragile we were as human beings and a society,” she said. “It was very humbling.”