It’s what they signed up for. That’s why, even though they’re tired and terrified, they keep going.
The COVID-19 pandemic is overwhelming health care workers with longer hours, exhausting work environments and constantly shifting procedures.
Despite the challenges, along with concerns for their own health and that of their loved ones, local health care professionals say they’re committed to caring for COVID-19 patients.
Pre-shift preparations
Before they begin a shift, health care workers take precautions and submit to screenings. At South Suburban Hospital, every person entering the building first has their temperature taken, said Linda Herron, a nurse at the hospital for 33 years.
“Patients, employees, administrators — anyone who walks in the front door has their temperature taken,” said Herron, a Homewood resident. “If it’s over 100.9, you’re sent home and you can’t come back until it goes down.”
Except for healthy staff members and patients experiencing a medical emergency, no one else may enter the hospital. Everyone who enters South Suburban Hospital must also wear a mask.
Gearing up for her day, Herron changes into scrubs and straps on an R95 respirator mask. The supply of masks is limited, so she only gets one mask per shift.
“We wear the same R95 masks through the whole shift, eight to 12 hours,” Herron said. “I only take mine off to eat lunch.”
Tiffany Victor-Castleberry wears business attire to her job at University of Illinois Hospital where she is director of utilization management and discharge. Her job involves managing nurses who coordinate patient’s plans for leaving the hospital to go home or another care facility.
While some parts of her mostly administrative job bring her into hospital units and patients’ rooms, much of her work could be done from her home in Flossmoor.
“I’ve thought about modifying my schedule to work from home, but I’d feel bad leaving my team. I would feel like a bad leader if I left them on-site and stayed home,” Victor-Castleberry said.
“At the same time, I’m sacrificing myself and my family by going into the hospital every day to make sure people can get out of the hospital.”
Working on a COVID-19 unit
Three years from retirement, nurse Herron had been working as a presurgical nurse for 14 years. In a fairly low-stress nursing job, she knew all her co-workers, the unit’s procedures and its computer system.
When all elective surgery was canceled, the hospital redeployed the entire unit to different departments. They moved Herron to the telemetry unit, a “critical condition” unit where she cares for COVID-19 patients.
“It’s the worst thing I’ve ever seen in nursing, and health care in general,” she said, referring to the COVID illness.
Though her new co-workers are helpful, Herron said the learning curve has been steep.
“Normally even an experienced nurse would have four weeks of training to work in that unit. I had four days of training,” she said.
Nearly every part of South Suburban Hospital now houses COVID-19 patients, Herron said. The hospital is at capacity but not actually crowded — rooms that normally housed two patients only hold one now, as COVID patients must be isolated.
Patient-to-nurse ratios have been reduced, Herron said. Normally, one telemetry nurse cares for six patients, while now each cares for only three COVID-19 patients.
“The main reason is the time and planning it takes to just go into a patient’s room,” Herron said. “It takes 10 minutes to put on a gown, gloves, the face shield and prepare everything we need. We also have to disinfect every single piece of equipment going in and out of rooms.”
Nurses plan their patient room visits to maximize their time in the room, thereby minimizing their exposure. However, many of the patients Herron treats have advanced illness, and room visits sometimes last longer than planned.
“We were in a room yesterday for 40 minutes with a guy who was not doing really well,” Herron said. “It’s extremely scary; it’s very intense. You’re walking into these rooms where people have this virus that can kill you.”
Gowns, gloves and goggles
Working in full personal protective equipment also presents challenges. On her most challenging day, Herron said she sweats like she never had before. Wearing a full plastic gown with sleeves creates a moisture bubble like a rain poncho.
“Then you’re in a room that’s hot. And the patient is hot because many of them are running fevers. And you’re exerting yourself on top of it, to help them turn over or get up to use the bathroom. Then you’re wearing a mask that is airtight and you can’t breathe through it,” Herron said. “By the time I get out of the room after 20 minutes, I’m dying. I’m loaded with sweat.”
The face shield Herron wears fogs up, but she has to wear it because the hospital ran out of goggles right away, she said. Also in constant short supply are plastic gowns and disinfectant wipes. They go through a “massive” amount of gloves.
Over at University of Chicago Hospital, nurse Cheri Thomas said staff have good access to personal protective equipment. She’s normally a nurse in the hospital’s solid organ transplant unit. Since the COVID-19 pandemic set in, Thomas was redeployed to the pediatric emergency department and will soon move to the adult emergency department.
“Our hospital has been amazing at providing PPE for us,” said Thomas, of Homewood. “They have provided us the option of using surgical scrubs, so we don’t have to wear our scrubs we have at home. At least for the most part, I can say at the beginning of it, we’ll be protected.”
Even so, many of her co-workers wear donated homemade cloth masks and bring in disinfectant wipes from home. Thomas gears up to protect against COVID exposure for every shift, and she’s feeling the impact of wearing PPE all day.
“I started getting a pressure sore on my nose, and my ears are about to fall off. It’s terrible,” she said.
A new way of operating
As a manager of discharge nurses, Victor-Castleberry has been developing new protocols so her employees can avoid entering patients’ rooms at all. Though their work often relies on face-to-face communication, it isn’t necessary to their work and threatens their health under the current circumstances.
“We’ve recently changed our guidelines for face-to-face contact with COVID patients and we’re no longer going into their rooms. Every day we’re asking, ‘How can we still provide a high level of care without physically going into the room?’” Victor-Castleberry said.
Now conversations with discharge nurses happen by phone, except in the emergency department, where she said nurses must be more hands on with patients.
Discharges that involve transferring a patient to another facility have become dramatically more difficult since COVID-19 hit, Victor-Castleberry said. Many facilities such as nursing homes and rehabilitation centers require patients to pass screenings before being admitted, causing patients — some of whom do not have COVID-19 — to stay longer in the hospital.
“Many facilities are asking for two negative COVID tests in a 24-hour period before they’ll take a patient. This is for patients who aren’t even exhibiting symptoms,” she said.
“We’re also seeing equipment issues with discharging patients, including a shortage of oxygen tanks. If there’s no availability of oxygen tanks, the patient has to stay in the hospital until we can get more delivered.”
What’s more, the rules and regulations change daily for other medical facilities accepting their patients, Victor-Castleberry said, forcing her and her staff to call each location during every shift for the latest updates.
“I work harder now than before this happened,” she said. “I find that I’m not eating until I get home, and barely drinking water during the day. That’s the health care worker mentality. We don’t want to miss a beat.”
Nurses, who already shoulder a great emotional burden in caring for the sickest among us, now also find themselves the sole companions for the sick and dying.
To prevent the spread of COVID-19, hospitals are not allowing visitors to enter during this time. For patients who are suffering from the virus, many of whom are quite ill, the loneliness this causes can be devastating.
Staff try to help patients connect with family through phone calls and video chats, but it’s not the same. Nurses and physicians often give comfort at patients’ bedsides.
“The patients, it’s so hard because they can’t have any visitors whatsoever. There’s nobody there for them on site to make decisions for them if they’re really sick,” Herron said. “And when patients die, there’s nobody with them. There’s just us with them.”
Trying to leave COVID-19 behind
Work continues for these nurses even after their shifts end, as they take precautions to avoid bringing the COVID-19 virus home where it could be transmitted to their loved ones.
One prevention method involves disrobing in the garage or just inside the house, dumping work clothes into the washing machine, and making a dash to the bathroom.
“I don’t wear the same clothes from work to home, but I still strip in my mudroom and run into the shower,” Herron said. “I wear a mask in my house until I get my shower done.”
Before Victor-Castleberry goes inside to greet her husband and their 5-year-old daughter, Ansling, she goes through a two-step procedure. First, she sanitizes her car interior, her work badge, phone and other items.
She changes clothes inside a kind of sanitation station that her husband, Troy Castleberry, constructed in their garage. The plastic film enclosure, suspended from the ceiling, has a table, chair, wastebasket, laundry basket and garbage bag, for her clothes.
“My biggest concern is not knowing whether I’m bringing this home. As many precautions as you take, you don’t know if it will be enough,” Victor-Castleberry said.
“You have to change your way of life, your way of movement. I can’t hug my family when I get home. I can’t kiss my child when I see her. I’m worried about every doorknob I touch in my home, that I might leave something behind.”
Why they stay committed
Since he’s also a nurse, Castleberry understands why his wife is committed to her work. They met as trauma nurses working at St. James Hospital in Chicago Heights; now he works as a nurse for a railroad. Part of his job involves clearing employees to return to work after injury or illness, and he’s now working from home.
Being so close to the end of her career, Herron said her husband has encouraged her to quit, and not take the chance of catching COVID-19.
“He keeps telling me to quit, but if I quit, who’s going to do it?” Herron said. “That’s the weird way nurses think. Somebody’s got to do it, and it’s got to be me. I’ve been there 33 years, I can’t imagine just leaving.”
Though she’s healthy, Thomas already had a major scare when she was unknowingly exposed to COVID-19 in March, working in her normal hospital unit.
A patient she treated for an unrelated illness was diagnosed later with COVID-19, a fact Thomas learned only after spending more than 24 hours at home with her boyfriend and two young children.
Despite the incident, she feels a commitment to keep working.
“It’s a huge ethical dilemma. Do I sacrifice my family to be someone’s ‘hero?’ I don’t know,” Thomas said. “I thought about quitting. But then I also thought about the oath I took when I became a nurse. I thought about the family members who can’t help their loved ones. I’m the one they came to for help. I can’t turn my back on the world because I’m afraid.”
