What to Expect When You (or a Loved One) are Expecting to be Hospitalized with COVID-19
With the holidays in swing, we’ve all heard the CDC’s warnings to stay away from family gatherings this year. But, surprise, over a million people took to the skies to gather for Thanksgiving last week. Maybe they think the virus is a hoax, maybe they are tired of more isolation, maybe they haven’t personally seen someone get sick. I can guarantee they will soon. As the virus spreads to more communities, people who have been living as though the virus is everyone else’s problem will get a rude awakening,
Last week, nearly 230 people in 100,000 were hospitalized with COVID-19. Epidemiologists expect that number to skyrocket in the weeks after Thanksgiving, even as hospitals are bursting at the seams. Many institutions are operating at or above capacity. Times are scary, for healthcare workers and patients alike. As a nurse, I’ve taken care of COVID-positive patients on an intermediate unit and on the critical care level. I’ve seen the fear, the gasping for air, the intubations, and the goodbyes. If you or your loved one has to be hospitalized with COVID-19, here are some things to know.
No Room in the Inn
When we say hospitals are full, we aren’t just talking about rooms. The most important commodity, putting aside beds, ventilators, and medication, is staff. Without doctors, nurses, respiratory therapists, healthcare techs, pharmacists, janitors, and so many others, all of that equipment is useless.
With that in mind, know that healthcare workers are overburdened by being understaffed. The alternative is to turn patients away.
On the patient side, this means longer wait times for everything except emergencies. We won’t be able to spend as much time with you as we might like to. Your bed may be in the hall. You might be in the Emergency Department for hours or days, waiting on a bed to open on a unit. You might not be in a brick-and-mortar hospital at all, but in a mobile hospital or parking lot.
Expect to wait longer for medications and tasks to be done. When a nurse or tech comes in your room, try to group your needs. Every time we come in we go through an elaborate choreography of protection, and having to come in and out repeatedly wastes our protective equipment (which we are still short on).
Be patient. Know that we are doing our best. But if you are experiencing changes, like new shortness of breath, chest pain, or confusion, let us know fast.
Being Sick is Uncomfortable; Getting Better isn’t Fun Either
In western medicine, we all but expect treatments to be painless. While your healthcare team will try to make you as comfortable as possible, here are a few of the most common discomforts in our hospital associated with COVID-19.
Nasal Cannulas: This is the most routine oxygen-delivery device. It is a long tube with two prongs that fit into your nose and shoot in a prescribed concentration of oxygen. They feel surprisingly weird, and may be intolerable for some people.
Opti-Flow (Nasal Cannula on steroids): These are used when you need more oxygen than a typical cannula can deliver. Think bigger tubing, bigger prongs, connected to more equipment. These are typically only seen in the intensive care setting, but as more ICUs fill we are seeing them used on intermediate units. They shoot more concentrated oxygen at higher pressures, and are heated and humidified. Again, most people can tolerate these, but they wrap around your whole head and bother your nose.
BiPAP (Bi-Level Positive Airway Pressure): These fit over almost your whole face and people generally don’t love them. With COVID patients we often use them as a last-ditch effort before intubation, but some people can stay on them for longer. The biggest problem they pose is that since they shoot pressure down your airway, if you vomit with one on, stomach contents can go backwards and down into your lungs.
Intubation & Ventilators: If wearing a mask is uncomfortable, you are in for a rude awakening. When you can’t get enough oxygen using our other equipment, we have no other options but to stick a large, hard tube down your throat.
Most people cannot picture how horrendous an intubation is, and patients are sedated and paralyzed beforehand for that and other reasons. Once it’s down, we hook the tube up to a machine that breathes for you. This is not the vacation it sounds like. One of our Respiratory Therapists compared the physical work of being on a ventilator to running a marathon every day.
If you wake up in the hospital on a ventilator, your first reaction will be panic. It is terrifying to not have control over your own breathing. The only thing you can do is to try to stay calm. Your doctors, nurses, and respiratory therapists will do their best to make you safe and comfortable. Their goal is get you off the ventilator as soon as possible. With COVID, we are seeing patients need to stay on ventilators much longer than we used to. Recovery and healing is a slow process, and it’s important to be patient with yourself.
The Hospital is not a Hotel
As much as we try to make patients comfortable, the hospital environment under these conditions can be a nightmare. You are afraid and alone. Staff rotates, and you’re surrounded by strangers. Alarms are constant. Bright lights make sleeping difficult, and staff often have to wake patients up throughout the night for assessments, medications, and other tasks. On our intermediate floors, phlebotomists come by around 3am to wake patients up and stick them for labs. You have no control over your own schedule.
Often all of this disruption can make patients very confused due to sickness, lack of sleep, mismatch of day/night schedules, and other factors. Your nurse will frequently ask you what may seem like dumb questions (What’s your name and your birthday? Where are you? What year is it?) just to be sure you’re not confused.
COVID patients typically cannot have visitors unless they are nearing death and care is being withdrawn. As someone who has held up Facetime calls for patients, I find this part especially difficult. Think of your Mom, your Dad, your Grandma, being scared in the hospital and not being able to be with them. Being sick is frightening enough without feeling cut off from everyone you love. We’ve been with so many people who die without getting to say goodbye. This is the nightmare.
From a “Frontline Worker”
It’s hard to take care of patients as they die from a disease, then go home and see people denying that this disease even exists. Some patients’ last words have been claims that COVID-19 is a hoax. Let me assure you, just because you don’t believe in it does not mean it won’t kill you or someone you love. I think if more people could see what patients go through in the hospital, maybe they would think twice about getting together in big groups and going without masks. For many people with long-term health problems to begin with, this disease was the last straw. For others with little or no health history, COVID hit them harder than anyone could have expected.
It’s frustrating to know that other countries with better healthcare systems and science education have had so much more success with this disease. They listened to the scientists and took action before their numbers skyrocketed and it was too late. I wish our country was as smart.
As we lean more and more on healthcare workers, our “heroes” are tired. Our healthcare system was fractured before this virus, and the cracks only widen with increased pressure from COVID. Our ratios get worse, we and our families are put at risk, and we’re scared of what is to come. We don’t have endless energy. As for myself, I am a daughter, a sister, a friend before I am a nurse.
I believe these are historic times. If we make it through 2020, we will be asked about this year for the rest of our lives.
Where were we?
Who did we know who got sick?
Who died?
What did we do?
Think about how you want to answer.
