KINGSPORT, Tenn. (WJHL) – During her 12-hour shift in the Holston Valley Medical Center Emergency Department as a charge nurse, Angel Light sees an average of 10 COVID-19 patients — five of whom she said require “a lot of resources.”
She explained that “a lot” means resources that the staff on duty may not have and are pulled from other patients.
“I mean, one COVID patient takes hours to stabilize enough to come out of the rooms,” Light said.
The details of COVID-19 hospital treatment probably aren’t often discussed around the dinner table. But frontline health care workers still in the throes of the Delta surge hope the graphic images they see every day could persuade some in their community who choose to remain unvaccinated to get the shot.
‘It’s a very difficult thing to watch‘
Usually, by the time COVID-19 patients enter a hospital, like Holston Valley Medical Center (HVMC), it’s likely because they cannot breathe or have severe shortness of breath.
“If you’ve ever watched anybody struggle to breathe, it’s a very difficult thing to watch. We try different things before we actually have to intubate them and try putting them on different masks to try to help their breathing, and they can’t breathe. And they’ll look at you and say ‘I can’t breathe,'” Light explained.
After thousands of similar experiences, Light said she cannot help but wish the vaccination rates in her small Appalachian community were just a little higher to prevent such instances.
“You know in your heart that if you’re taking a vaccine, maybe this would not be the outcome, maybe. I mean, we can’t guarantee that, but you would have a much better chance,” she said.
Unfortunately, that’s most often not the case.
“Then we intubate them.”
Light said the patients during the winter surge and the Delta surge are much different. And the sad part, to her, is that it is now preventable.
“The younger population this go-around has been significantly impacted. Whenever you compare the two, we see it every day, they’re younger and younger every day. They have a whole lot of life to live if they would just- if families would just get vaccinated. Yes, it’s very preventable,” a dejected-looking Light said.
Light’s experience in the emergency department is echoed through the hospital, especially in the intensive care unit designated specifically for COVID-positive patients.
These patients are treated by experts like Dr. Matt Krolikowski, an infectious disease specialist, who has treated over 6,000 COVID patients.
“My job is super exciting. I’m like a fancy bookkeeper,” Krolikowski said.
He works through each COVID patient’s chart, spending hours calling other doctors to find out where exactly each ICU patient is in their treatment because most of the patients are too sick to be able to inform him themselves.
During the Delta surge, he said the patients who do not turn around immediately likely spend a month or more in the hospital.
“Usually, we can tell pretty quickly that that’s going to happen. I try to warn patients upfront I say ‘listen, you’re on 10 liters (of oxygen), you’re probably going to be here for at least another week,’ and tapering that expectation because people think they’re feeling better, so they can go home, but ‘COVID is not done with you,'” he explained. “You can’t predict it, and that’s the most frustrating part.”
The unpredictability of who he treats and how they respond to that treatment hits him like a bus, Krolikowski said.
“We had at one point, a mom, a dad, the son, the daughter-in-law, and another daughter, all in the same 24-hour period, all admitted to the COVID ICU,” he said.
“And then what, to me, the real horror is — some live and some die. And I do the same thing to both. I do everything I know to do,” he said.
Responsibility for administering those treatments is spread among several frontline health care workers, including Registered Respiratory Therapist Amanda Montgomery.
“We get all our tools together and there’s a team of us that will assist in the intubation and put you on the ventilator, and you’ll be put to sleep and intubated,” Montgomery explained.
As alarms sound across the ICU, hospital staff jump into action, holding a collective breath in the hopes that the patient coding will be able to breathe again.
“It’s overwhelming, we work 12-hour shifts, and we see a lot of devastating results,” Montgomery added.
‘Our Hail Mary pass‘
News Channel 11 asked Dr. Krolikowski to describe one patient that has stood out in this pandemic. Of the thousands, he chose a woman in her early twenties.
The young woman was the mother of a 3-year-old, the same age as Krolikowski’s own child.
“She had gone to urgent care and had gotten some antibiotics and came in and just was not doing well and quickly made it to the ventilator and I gave her – there’s a medicine called Actemra or Tocilizumab — it’s $15,000 a dose, but is basically our Hail Mary pass. If you’re going to live, this is the medicine that’s going to make you do it. And if you don’t live, we’ve done everything,” he explained.
Krolikowski, overcome with emotion, said that the woman was treated in his COVID ICU for three weeks.
“She had two tubes in her chest, and she had the breathing tube and a feeding tube and rectal tube and a urine tube, and she was proned and she had breakdown of her skin from being in the ICU for three weeks on her belly trying to just keep her oxygen up enough that she survives.”
“When the family decided to pull the plug,” Krolikowski said, the woman did not survive.
Data from the Tennessee Department of Health (TDH) show COVID deaths among younger patients (those under 60) have accounted for more than three times the percentage of overall deaths than they did before the delta surge.
Since Aug. 1, more than half the total deaths among people in their 20s and those in their 30s have occurred as well as 42% of the total deaths among people in their 40s.
For people over 70, only 13% of total COVID deaths have occurred since Aug. 1. While those numbers are much higher overall, the rapid increase in deaths of younger COVID patients during the delta surge is evident in the data.
In the 16 months through July 2021, 448 people in their 40s died of COVID in Tennessee. In the less than three months since, another 318 have. So have 615 people in their 50s, where only 1,145 had died in the 16 months up to August.
Those trends are much different for older patients. Through July, 4,656 patients in their 80s had died of COVID — only 526 have died since Aug. 1.
Vaccination rates are much higher among older Tennesseans, and Krolikowski said the experience solidified his belief in the COVID-19 vaccine. He believes that if this patient had been vaccinated, she – like so many thousands of others – could have survived.
“How many more moms? How many more dads? How many more brothers and sisters do we have to say, ‘this is it,’ for people to pay attention?”
Hospital staff from all departments are overwhelmed by the wave upon wave of COVID-19 patients.
Logan Elswick, a phlebotomist who collects blood samples from patients in the COVID unit, said safety is his number one priority.
“We’ve actually been given very good training on our PPE – personal protective equipment – you know, the equipment that we have to wear so you have like your N-95 respirator protects you from any aerosolized particles. You’ve got your face shield, sometimes you’ve got goggles, you’ve got your gowns,” he said.
But the stress of being at risk of contracting COVID in the event that he does not properly don his PPE was only one thing Elswick said was on his mind during his shift. The sheer volume of patients that required critical care – and thus needed lab work done – increased dramatically during the pandemic.
“I remember sticking an average of 35 to 40 people a day. Now, we’re sticking upwards of like 60 to 70, some of my co-workers down in the ER stick like 100 people, 90 people. So yes, our workload has doubled,” he said.
With the workload, comes the staffing issues.
Elswick said that during some shifts he has been responsible for collecting lab samples from up to three separate hospital floors – some COVID specific, some not.
“You really get your steps in, like walking around from floor to floor, and sometimes the stress of there’s a doctor that needs this lab and he needs it immediately on this floor STAT and then there’s another doctor on another floor and they need this lab STAT. You just, you can only be in one place at one time,” he said.
Despite the pressure from people higher up the chain, Elswick his primary motivation for working in health care is to provide the best service to patients, and sometimes, that means stopping for a beat or two when an isolated COVID patient needs a “moment of humanity.”
“I’ve been there with people in their more vulnerable moments. And you know, I’ll just kind of take just a moment, because I’ve got like 50 orders at one time, or I’ve got a ton of places I need to be, other patients that need to be seen as well but even if it’s just like a minute, really getting to stop and talk to somebody who’s, like I said in a very emotionally vulnerable place.”
That, he said, makes his job worth every drop of sweat.