At the end of another shift, in a week in which she’ll work more than 80 hours, Katrina Doyle walked into the patient’s room to clean.
She’s been at this, in varying degrees of intensity, for nine months, a stretch that includes her own bout with COVID. Earlier that day, Katrina had a frank conversation with the patient (to protect the patient’s privacy, the name and gender are being withheld). The patient has COVID-19, and wasn’t doing well. Katrina feared another intubation, the tube placed in the throat, down to the windpipe, the ventilator taking over the breathing for another set of lungs battered by the virus.
“I’m going to try my darndest to not let that happen,” she said, “but some things, I can’t control.”
The patient grasped what she was saying. Katrina went back to her shift — she’s a charge nurse working at UCHealth Highlands Ranch. She spent her 20s working in hospitality, for Disney and Hyatt, a career that took her to the Hawaiian island of Maui. She worked on “every emergency committee” for the hotel chain and realized health care was her calling.
She’s the mother of triplets, and when she’s upset, she “cleans like crazy.” At the end of her shift, she had five, maybe 10 minutes to spare, so she went to the patient’s room and “cleaned like nobody’s business.” She thought about how isolating it must be, to be a COVID patient in a hospital. You’re away from your family. Your regular visitors — nurses, doctors, respiratory therapists — they come in with head-to-toe protective gear. Patients can’t see their faces, and they can’t see comforting smiles.
As Katrina began to clean, the patient took her hand, and said, “I don’t have the breath to talk to you. But thank you.”
She cried as she remembered. But in the moment, she held back her tears, not wanting to further alarm the patient, but to reassure: she was there.
Katrina tells this story a few days after it happened. She hasn’t been back to the hospital since, and she hasn’t checked in on the patient. But her concern is unabated.
“I have not stopped thinking about that patient, and I don’t even know how they’re doing right now,” she said. “I’m afraid to call and ask. I know I’ll find out when I go back to work tomorrow. I call what I have mini prayers all day. A happy thought. That one particular patient — maybe they turned a corner and they’re doing better, and that patient will get to walk out our doors and maybe I’ll actually get to touch their hand without a glove.”
In March, Katrina and the rest of Colorado’s health care system were slammed with a virus that had been isolated to their TV screens. It was shrouded in the unknown — how deadly it would be, how it could spread, what it would do to the human body, and most importantly, how it could be treated. Providers say they found their way through those months together — they were effusive in their praise for each other, for the camaraderie that had been forged between them.
Now, nine months and an eternity later, the unknown is largely gone from the virus, and an exhausted familiarity has settled in. But the crush of patients has returned, surpassing the peaks of the spring. UCHealth has more than 430 COVID patients, nearly 170 more than its spring high. Roughly a third of Colorado’s hospitals say they’re projecting a staffing shortage in the next week, and roughly 1,800 people are hospitalized with the virus through the first week of December.
Reinforcement providers are being brought in because so many health care workers are getting sick in the community. Katrina contracted COVID, outside of her hospital. The fatigue was terrible, like she’d just run three marathons. But she was lucky, she said. She didn’t have to go to the hospital.
The patients keep coming, and the providers who treat them keep waking up and heading back to their hospitals. There’s exhaustion, hope, frustration, commitment. Above all, there’s a focus on the task in front of them.
The task is hard. “Hard” isn’t a good word, either — Katrina said “some expletives” would better describe having to tell families that their loved one is going to die. She doesn’t know how many times she’s done that.
“I don’t count,” she said. “I can tell you it’s almost every shift I work I have that conversation with a patient’s (family) or sometimes more than one patient’s family.”
Erin Trujillo misses the intimacy that Katrina embraced when she cleaned the patient’s room. The “really good qualities in nurses” — the small flashes of humanity, the personal touch that sets nurses apart — are gone. There are too many patients, and COVID curtails the time they can spend with any of them.
Erin’s grown accustomed to working with the sedated, ventilated patients at North Suburban Medical Center, where she’s a clinical nurse coordinator in the ICU. Now, she has to explain to families over the phone what they can’t see in person: their father, husband, mom, daughter, grandmother, cousin, they’re sick and they’re dying. The distance makes it hard for families to accept. They may have dropped off their loved one at the ER, when they were still walking and breathing on their own.
“Being in a hospital is very sensory,” she said. “There’s smell, there’s touches, there’s things you can see. You can see that your loved one is declining. We have to paint that picture for families while being supportive, and that’s hard because families don’t want to give up.”
She feels more prepared now than she did in the spring. There’s a lot more protective gear now, for one. That unknown is largely gone, and providers know more about when to put a patient on a ventilator, how to better roll patients onto their stomachs, what drugs work.
But eight months, bookended by unprecedented hospitalizations, is a long time. She often has “difficult conversations” with her coworkers. They all lean on each other to push through the anxieties and weariness, and she gives pep talks.
That sense of unity, of a collective cause, was ubiquitous across the providers who were interviewed for this story. It’s why Katrina would go back to work after putting her kids to sleep. It’s why Rhonda Turner, a nurse at North Colorado Medical Center, holds her office as a place to vent and breathe.
Trujillo loves working on the ICU. She became a certified nursing assistant at 18 so she could take provide for her baby. She worked a variety of health care jobs before she “pushed herself through” and became an ICU nurse. It’s where she’s supposed to be. But she’s tired.
“I don’t think there’s an ICU nurse that’s not tired,” she said. “I think we’ve been able to sustain this for this long, and we’ve been doing things to help each other through it. Sometimes there’s days when you need to cry, and you cry and you talk to your coworker there and you get up the next day and you do it again.”
The stress has pushed some nurses out of the field, she said. She admired those people for knowing their limits. But the providers who’ve stayed have bonded into a unit.
“There’s been good things,” Erin said, like when a patient rallied and made it out. “There’s been times I look around a room and I’m surrounded by my coworkers, and we’re sweating from head to toe, and we just did CPR and tried to save someone’s life, and had to put another body in the body bag.”
“Then it’s time to purge feelings, walk out of the room and hug each other,” she said. “It made us a unit. It made us stronger in different ways.”
Tobias George, a nurse practitioner in Denver Health’s ICU, wondered at the beginning of this latest surge if he was ready to go through this again.
“Am I ready to have these conversations again?” he said. He said he’d had more conversations with families about their loved one dying “than I can recall.” “We have an overwhelming number of patients come in, and we take care of them. I think we’re better prepared this time for sure, but emotionally, it’s the drain of, ‘Here we go again.'”
It didn’t really matter if he or anyone else was ready. The patients keep coming.
“You just snap yourself out of whatever you had to and you make yourself ready,” he said. “If we’re not here to do it, who’s going to do it?”
They knew another wave was coming in the fall. It had been predicted back in the spring and foreshadowed more than 100 years before that, when the Spanish flu roared through the world in fall 1918.
“We expected it, but once it’s here, it feels overwhelming because I don’t think we had a good chance to breathe in between,” Rhonda said. “I feel like it’s more overwhelming now. And again, we know what’s coming if people don’t wear their mask, people continue to work sick, just the progression of the surge. We’re hearing that the numbers go up every day in Colorado.”
Tobias, like Erin and others, spoke of the bond that’s grown between providers. But there’s fraying there, too. Anuj Mehta, a National Jewish pulmonologist and critical care physician, said that people are visibly exhausted.
“They’re just looking at each other,” he said. “In the spring, there was this camaraderie — ‘we can do this.’ All of that is still happening, but it went from high shoulders to shoulders down, heads up to looking at the floor. When are we going to be done with this?”
Tobias George moved here when he was 19. He’d already been working in health care for five years — he started as a nursing assistant at 14, working in a nursing home in his hometown of Asheville, N.C.
He says providers are going through the same thing now as they did in the spring: trying to take care of a wave of patients that “you’re just not quite sure are going to make it.”
“The question they always ask you — ‘Do you think I’m going to live, do you think I’m going to make it, and how long do you think I’m going to have to be here?'” Tobias said. “And the response every time is, our team is going to do the best we can to get you through this.”
He, like health care providers speaking to reporters across the country, vented frustration about what was happening outside of his hospital’s walls. They’re frustrated that the actions needed to slow the pandemic — wearing masks, not traveling for holidays, staying home — have all become politicized.
Paige Cunningham, a nurse and clinical coordinator at St. Anthony Hospital, said health care workers are “in this for the patients” and the “hardest part” is having that commitment warped onto a political compass.
“I don’t know how to put this — we’re all going to take the best care of our patients if we can,” she said. “We just want people to listen, and to listen to the front-line workers. We’re not making this up, we’re putting our families and us in danger every day when we’re walking into that hospital taking care of these patients.”
“Those people don’t care because they don’t see it firsthand,” Tobias said. “All of a sudden when it’s them or their loved one in the hospital, they get an inkling, ‘Oh, this does matter.’ A majority of the public don’t know. They don’t have to be here every day and see what happens when a patient doesn’t make it. Or even when they make it, the extended issues.”
Tobias stopped using social media in the first wave. The lack of humanity “borderlines on making you extremely angry.”
Katrina, the UCHealth nurse, said that if anti-maskers, doubters, COVID skeptics — if they could see what happens in an ICU one time, “they’d rethink some of those comments.”
“It hurts,” she said, “because they have no idea how hard it is to tell a family member who can’t come in to the hospital to see their family member on a ventilator and tell them you know that they’re not doing good, I don’t think they’re ever going to get better, and we need to have a bigger discussion about what your family member would want.”
She said she doesn’t know a single provider who isn’t frustrated, with the public or a friend on Facebook. Several providers talked about social media’s role in spreading false information, which flew in the face of their daily lives.
The doubts and negativity spread alongside open support and love for health care workers. It’s whiplash, to go from videos of people clapping to Facebook posts about masks not working, or tweets about doctors making money off of COVID deaths.
“It’s just a hurtful place to be, when one day we’re being called heroes and the next day people are saying, ‘This is a made-up disease anyway,'” Trujillo said. “What have I been doing these past few months? What have I been fighting?”
Cunningham has been a nurse for 10 years. When she was in high school, she fell in love with the profession after watching the nurses who cared for her uncle after cancer forced him into hospice care. She remembers the hospice nurse patting her grandmother’s hand, genuine and comforting.
She remembers every patient she’s lost. Paige says it confidently, as if she were saying she knows the sky is blue.
When the pandemic hit St. Anthony Hospital, she was pregnant with her second kid. She remembers patients coming in, and “they’d act OK, then they wouldn’t be, and it was a matter of minutes.”
The community support in the spring was “beautiful,” she said. She watched a video of people clapping for health care workers and cried. Restaurants were catering food, people howled at night.
She’s hesitant to say she’s frustrated or angry. She’s disheartened, she said, about people letting their guard down this summer, about social media posts of people going to weddings or baby showers.
“It was hard to see it again, to see those numbers rising, and I remember when we had that first 2,000 number,” she said, referring to when Colorado confirmed 2,000 cases in one day. The state has posted more than 3,000 cases, often even higher, every day in November since Election Day. “I was just hoping that was it, maybe was the fluke, maybe we got all the people tested, we’ll social distance, get back down.
“We haven’t seen that yet. I’ve been watching the numbers daily. A lot of us have been.”
If the providers’ focus is on treating patients and doing what they can to control the pandemic, then their wish is that everybody else shared that goal.
They’re tired but still committed, to the patients, to the job, and to each other. They’re frustrated, they’re disheartened, they’re hopeful, they’re focused. Their emotions and experiences are not monolith.
What is consistent is their ask. It’s been consistent for months now, throughout the year and pandemic that would not end. It is simple: Wear a mask. Wash your hands. Don’t socialize beyond your household. Have compassion.