We are family: COVID-19 brings Hershey Medical Center front-line workers together
Martha Jansen studies a bank of computer monitors in a makeshift COVID-19 Unit in Hershey Medical Center. Jagged lines and flashing numbers track patients’ pulse rates, temperatures and oxygen levels.
After a moment, Jansen produces a cordless phone and dials a number.
“Hi, it’s Martha, your nurse,” she says. “I’m out here looking at your numbers, and they look great. Did you call your wife?”
Jansen pauses and a faint smile plays across her face.
“Oh, she’ll love you for that,” Jansen says.
She looks toward a door a few feet away. Inside, a man is on the other end of the line, speaking to her from a hospital bed. Glass and steel block Jansen, a registered nurse, from caressing the man’s brow and squeezing his hand to salve the worry.
Talking with COVID-19 patients who are still capable of conversation over the phone is a Jansen innovation designed to limit room visits. Walking into a hospital room and treating someone in the classic patient-nurse style would mean, at best, meticulously donning a pile of equipment tall enough to make an astronaut blanch. At worst, it could mean exposure to a virus that has transformed the world and taken her profession along for the ride.
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Such is nursing in the new normal. Over the first few weeks of the pandemic, Hershey Medical Center has made use of its unique qualifications to manage the crisis: It’s one of several academic hospitals in the country that have received funding for infrastructure and specialized training to offer care during the outbreak of a seriously lethal contagion and help minimize its spread. Unorthodox techniques like Jansen’s phoning a patient with a minor update are the result of hours and hours of classroom training and drilling.
But as the hours and weeks have dragged on, much of what the staff at Hershey has learned has been unexpected. Some of the lessons have been simple – what’s the safest way to take a patient to the bathroom? Others have been painful – how can you allow a family to say goodbye to a dying loved one when it could mean risking their lives?
And through all the highs and lows, staff members from departments as different as pediatric care and kidney dialysis have transformed into something they never could have foreseen – a family.
The plan
In 2015, in response to worries that an outbreak of the Ebola virus in Africa might cause serious repercussions on U.S. shores, Hershey Medical Center became one of a select group of hospitals to be designated as an Ebola Treatment Center by the Centers for Disease Control and Prevention and the U.S. Department of Health. Assisted with federal grant money to launch the program, the hospital built isolation spaces and simulation rooms. Dozens of health care workers from throughout the hospital volunteered to take special pathogens training.
Every three months, Hershey’s Special Pathogens Team updates its training. Members practice putting on and taking off protective gear, consider how to keep equipment sterilized and protect patients and themselves from deadly germs. Lessons lasting anywhere from one to eight hours take place in the hospital’s Clinical Simulation Center, in spaces designed to approximate hospital rooms or in drills involving the entire Hershey-area community.
The team never had to use their training to stop something like Ebola from spreading in their home town. Then came the coronavirus.
Dr. Jennifer Cooper dons personal protective equipment before checking on a patient in the COVID-19 unit.
Quickly, Hershey Medical Center developed a plan to handle its portion of the pandemic. While its work preparing for Ebola helped, COVID-19 required reinvention and a philosophical shift.
Even the airflow had to be rerouted. Most patient rooms at Hershey are “positive-pressure” environments, designed to protect the patients inside from potential infections in the hallways. For COVID-19, the hospital needed the reverse ― negative pressure to keep the germs inside the rooms from getting out, where they might infect doctors and nurses. Hershey was equipped with a few negative-pressure rooms, but engineers from facilities had to build many more and find additional space to retrofit.
Medical Center officials also had to reroute personnel. At first, it seemed there wouldn’t be enough staff to cover everything. Dr. Ami DeWaters, associate division chief for internal medicine, and her team developed a plan for doctors to shift from different departments to handle the usual 140 patients the Medical Center was expecting in addition to the untold numbers of COVID-19-positives that would soon start filling rooms.
But that didn’t happen. In part because the Medical Center worked to postpone inessential procedures and in part because patients opted to stay at home to follow social distancing protocols, non-COVID procedures began to fall off. “We’ve been very fortunate,” DeWaters said, “that we’ve been able to staff all of our teams without having to outsource to other divisions.”
Now, there’s a waiting list to join the Special Pathogens Team, and volunteers are flowing into the spaces converted into the hospital’s COVID-19 Units.
The first one commandeered the Medical Center’s Surgical and Anesthesia Intensive Care Unit (SAICU). A second one has opened in the Pediatric Emergency Department. Others could open elsewhere at Hershey if the need arises. Hopefully it won’t, says Dr. Muhammad Khalid, chief of the Division of Hospital Medicine.
Among the influx of health care workers and patients, the Special Pathogens Team has played an important role.
Perhaps the important role.
“Every hospital has a pandemic plan,” Khalid says, “but we actually have had the training. That has meant the whole difference for us.”
COVID-19 Unit
One day, in the SAICU’s newly converted COVID-19 Unit, Khalid was putting on his protective equipment when Jansen stopped him.
You’re doing it wrong, she told him.
Jansen, a quick-witted nurse from Penn State Cancer Institute, was part of the initial class of Special Pathogens trainees
“I also laid down the law on his hand-washing,” she said, laughing. The trick: sing a song in its entirety as you wash – “Happy Birthday,” for example. Wash both sides. Don’t forget your nails. Jansen gently needles her colleagues in a not-so-serious (but serious, just the same) way, peering at them through windows and air-washing her hands.
Khalid chuckles about the corrections, but appreciates their value. Members of the Special Pathogens Team are the experts. They understand the equipment. They know about properly sanitizing ventilators, chest X-ray equipment, the proper methods for entering and leaving rooms.
Personnel volunteering in the COVID-19 units often don’t have special pathogens training, so coaches from the team share knowledge. On a recent Tuesday, representatives from six different departments worked in the unit in the Pediatric Emergency Department.
The sealed glass doors line walls of the main hall in an L-shape. Patients’ rooms are arranged from least serious – persons under investigation, or PUIs, to most serious – COVID-19-positive patients who might soon be taken upstairs to critical care. On this day, 12 are in residence. Catching a glimpse of them requires looking around large block-type room numbers, each one marked with the room’s phone extension (Another Jansen innovation. It makes phoning her patients easy).
There are also magic marker drawings of Winnie the Pooh and Mike Wazowski of “Monsters, Inc.” to raise spirits. Anyone is welcome to draw, but most are the handiwork of a laconic float nurse named Stephen Supernavage.
Members of the Infectious Diseases team receive an update in the COVID-19 unit.
Family
Classic job roles go out the window in the COVID-19 Unit, Khalid says. In one moment, he’s helping with treatment and diagnosis, and in another he’s carrying lunch trays or helping someone go to the bathroom.
“We are all a family,” he said. “And we look out for one another.”
The bonds formed fast despite departmental boundaries, and the rapid ties have enhanced the treatment. Health care workers from different corners of the hospital have different ways of doing things, Jansen explained, and sometimes solutions are hidden in the rifts. One section of the hospital has toilets in rooms. Another doesn’t. Finding the best method for allowing patients to relieve themselves was a multiple-day discussion with lots of trial and error.
Such discussions can lead to better policy, said Dr. Jennifer Goldstein, the Medical Center’s associate chief medical officer, who regularly stops by the units to handle requests.
“As we set up the units and started to care for patients,” she said, “we were able to rapidly identify gaps that needed to be addressed and make appropriate adjustments rapidly and incorporate those processes as we expanded and opened other areas for surging patients.”
Everything, DeWaters says, is heightened on the frontlines. The highs can really soar. When a patient is discharged, the celebration can move you to tears.
“You feel it,” she said. “You really do.”
But the lows can be unbearable. When the first person died from COVID-19 at Hershey Medical Center, hospital policy, geared to protect people from infection, wouldn’t allow all the grieving family members on the outside to visit.
“That day was probably the hardest day of my life,” Khalid said, “because I had to go out and tell someone that they couldn’t be with their loved one.”
Jansen and Khalid both worked that shift. They comforted one another.
“We have become a family,” he repeated.
For some, the COVID-19 Unit family has taken the place of another. Many of the health care workers haven’t gone home since the crisis began weeks ago. Many sleep a few hours between shifts at the Hershey Lodge. Some are afraid of infecting their families with the virus, opting to speak with them through glass storm door windows or on cell phones.
For nurses like Jansen, giving comfort is second nature. The constraints placed upon her and her colleagues by the virus sometimes make her feel twisted in knots.
“When you feel sick,” she said, “you want people in there rubbing your brow. Everyone here is just like…” she pantomimed, gripping the edges of a desk in frustration. Nurses want to walk into a room and help their patients, she explained.
Instead, she holds her phone and stares at the glass door.
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