Vaccines offer hope, workers battle fatigue

Diana J. Smith

Michelle Fernald, a coronavirus ICU nurse manager at UMass Memorial Medical Center in Worcester, said lightheartedness is a coping mechanism in the seemingly endless battle against COVID-19 that can leave workers with lingering trauma.

“You are here and you laugh then you go in your car and cry and come back and laugh,” she said last week as the hospital invited the Herald behind the scenes for a glimpse at the front lines.

COVID Intensive Care Unit Nurse Kelley Padgett said, “In the spring it was hard but we were all energized and we wanted to conquer it … now it’s more like a little bit of doom and gloom because it’s like, when is this going to be over?”

Padgett, her voice thick with emotion added, “Now it’s almost like people don’t even want to know that this is still going on.”

In the coronavirus ICU on Thursday, a group of at least six nurses, respiratory therapists and other health care workers clustered around a patient in distress to administer care, an event that can happen several times a day.

The commotion was set against an eerily quiet ICU, pierced only the constant sound of automatic hand sanitizer dispensers, beeping monitors and the crinkling of personal protective equipment being donned and doffed.

ICU patients with coronavirus are sequestered off into their own negative pressure rooms with the door closed and large block lettering in red stating, “DOOR MUST REMAIN CLOSED AT ALL TIMES.” The typically empty hallways are dotted with supplies to limit the amount of times workers have to enter a patient’s room.

The nurses on the unit said most of the time, patients aren’t even awake to realize how isolated they are.

The hospital has been reconfigured to use every inch of space for surge areas, which were empty last week, as well as socially distanced rooms for staff to eat safely, and a non-COVID-19 intensive care unit in a repurposed recovery unit.

Inside another COVID-19 unit with less severe patients, a cleaning crew in full PPE moved through the halls and nurses often communicate with patients via iPads to reduce the need to enter a room.

Nurse Manager Nickelda Chiari said staff try to find time each day to express gratitude or celebrate successes.

“It can be extraordinarily draining but we are holding up,” said Chiari.

The heavy weight on health care workers is one of the biggest concerns for hospital administration as the state starts to slowly come down off an intense holiday peak in cases, hospitalizations and deaths and looks onward toward vaccination efforts.

“You can’t over-emphasize the toll that this has taken on the staff,” said Justin Precourt, chief nursing officer, adding that the hospital has implemented a number of programs to help employees manage the mental stress of their work.

“Everyone’s moving on to the vaccine but hey, we’re still here with these sick patients,” said Precourt.

Dr. Michael Gustafson, president of the medical center, said a good supply of PPE and vaccines have left him feeling much better about his front-line employees. He said, “What’s left on the staff side is a year of fatigue.”

He added, “After you’ve been through so much trauma, so much morbidity, so much death, you kind of run out, you don’t have as much of the tank left to give.”

A daily command call joined by 225 people from different departments and led by Gustafson revealed more goals in addition to caring for worn-down staff, including getting out of surge spaces, resuming elective procedures and finishing up employee vaccination while ramping up patient vaccination.

One person on the call chimed in to say, “Memorial is very busy today,” while another said, “Watch ICU capacity very closely.”

Those same concerns were echoed later in the day during a weekly town hall with hospital leadership and employees.

Staff sent in questions fielded by CEO Dr. Eric Dickson and others, asking everything from if vaccines will protect against new virus variants to what to tell patients asking to be vaccinated.

One employee even asked if they could volunteer to drive elderly patients to their vaccine appointment.

Dickson, providing an update to the town hall’s virtual attendees, said the second surge around the holidays led to 386 hospitalized patients across central Massachusetts, which has now come down to about 270 inpatients.

He said the continued decline in cases across the state will translate to less hospitalizations, unless a new variant threatens vaccine efficacy.

“I think for the most part, the worst is over in terms of COVID,” said Dickson.

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