Hospital staff continue to walk often deadly road with COVID patients, ‘prepare for chaos every day’

Local Coronavirus Coverage

KINGSPORT, Tenn. (WJHL) – Angel Light has been a nurse for nearly 20 years. For 12 hours a day, she oversees the nurses in the emergency department at Holston Valley Medical Center (HVMC).

As the pandemic peaked and then peaked again, health care providers at the Kingsport hospital became experts in treating COVID patients. Some described vaccinated versus unvaccinated patients as different as day and night.

News Channel 11 spent two days observing the current normal at both the emergency department and the intensive care unit specifically for patients diagnosed with the virus.

‘We prepare for chaos every day’

Light told News Channel 11 that the novel coronavirus is no longer a distant whisper of a problem somewhere in China, but is prevalent in her small Appalachian community.

“We prepare for chaos every day,” she said with a voice full of emotion.

The young emergency department staff was easily overwhelmed when the second wave of COVID-19 hospitalizations burgeoned in late August.

“The second round has been extremely rough — long wait times because the patients are sick, they can’t get upstairs, because there’s no staffing, there’s no beds. Critical patients upstairs, critical patients in here. The patients in the emergency department, though, they don’t stop,” Light explained. “We ran out of space, so some of these really sick patients got to be put in hallways.”

The veteran nurse said she and colleagues share several lingering concerns as the pandemic’s pressure continues to strain resources. As the winter draws near, what will flu season look like? What if a new variant occurs? What if more and more nurses quit?

“It is draining. It’s something we prepared for but not to this extent ever. I mean I’ve been a nurse for almost 20 years. It’s amazing that it’s still going on to this day and we don’t have a cut-off switch, anytime soon, it doesn’t seem like.”

Light described the tension ED nurses face as wait times increase and sicker patients get preferential treatment due to their level of criticalness.

“They don’t see what goes on back here when you have patients coming through the front door, patients coming through the back door … They just see patients come in and go on and they don’t understand,” she said.

Light said her job has become a constant battle against misinformation among unvaccinated COVID patients.

“We’ve had multiple patients who don’t think that the vaccine is real, that COVID is real. (They say) ‘it’s just the flu, it’s just a cold,’ it is not just the flu or just a cold. I mean this is death … Every single day it is, patients dying who, in a perfect world, should not be when it’s preventable. I mean it’s not 100%, but I mean, your chances are much better with a vaccine,” she said.

What comes next — head upstairs

COVID-19 patients may not know what lies ahead in their treatment when they step foot in the emergency department, but for those who suffer severe symptoms, it starts with a potential 24 to 48-hour wait in the ER, waiting to get upstairs when an ICU bed does become available — which is not often.

Standing in front of what he called “a unicorn,” Dr. Matt Krolikowski, an infectious disease specialist at HVMC, pointed at the empty ICU bed vacated by a patient who had recovered just enough to be transferred to the medical-surgical floor instead of the special COVID ICU.

When a COVID ICU bed becomes vacant, frontline workers have to thoroughly clean the room. After the room has been disinfected and the previous occupant’s effects have been removed, hospital protocol stipulates that a new patient may not be moved in for at least one hour.

Rooms rarely remain empty for longer than that mandated one-hour wait time.

“I’m sure that there’s someone waiting in the ER for a bed, unfortunately, and I don’t think we’re anywhere near past the surge yet that we could safely say there’s not an occupant waiting for space,” Krolikowski said.

Light said those who do end up hospitalized are fighting a disease that layers loneliness on top of its physical symptoms. Patients with a positive COVID diagnosis must isolate to curb the infection rate.

“Your mom can’t be with you. So, I have to be your mom. I guess I’m gonna have to hold your hand, I’m gonna have to hold on to you just because there’s nobody else to do it. Your family can’t be there,” she said.

Patients who are vaccinated against COVID-19 have a better shot, health care workers told News Channel 11.

You can almost tell the vaccinated individuals right away

Krolikowski said while he sees vaccinated patients occasionally, when he does they are invariably better able to fight the disease than their unvaccinated counterparts.

“You can almost tell the vaccinated individuals right away,” he said of his experience making rounds on the COVID units. “They have better color, they look like they have more energy.”

An animated speaker, Krolikowski gestured as he illustrated one stark difference. A person breathing room air is essentially “on” zero liters of oxygen.

A graphic from Ballad Health showing the portion of hospitalized, ICU and ventilated patients in its system Oct. 6.

It’s a different story for hospitalized COVID patients — and much different for the unvaccinated.

“About the same timeframe that I’m seeing vaccinated on two liters, the unvaccinated is typically around 50 to 66,” he said.

“And when you hit 60,” he added, placing his index finger about an inch from his thumb, “you’re about that close to the ventilator.”

Krolikowski said a difference that tells him many of the severe cases are preventable is frustrating after having spent the first half of the pandemic treating only unvaccinated patients.

With the delta surge in full swing, he said he’s now treated more than 6,000 COVID-19 patients.

What does a COVID ICU patient go through?

Logan Elswick is a phlebotomist who collects blood samples from patients not only in the COVID ICU but from several floors in the hospital each shift.

He said several frontline experts might order laboratory samples for him to gather from different areas of the hospital all at once, creating a very stressful environment. However, he said he takes just a few moments sometimes when he encounters isolated COVID patients.

He said showing a moment of kindness is why he went into the health care field.

“A lot of patients … have to remain quarantined. They’re kind of isolated. They can’t see many of their family, and, sometimes, they just want somebody to talk to,” Elswick said.

Amanda Montgomery is a registered respiratory therapist at HVMC. She explained that when patients are transferred to the COVID ICU from either med surg or the ER, she is one of the first specialists to be called because of the respiratory nature of the disease.

She said it is difficult to go to work every day for 12 hours a day, knowing she has to strictly monitor each and every patient as if they were at their worst because she said a patient’s condition can change for the worse in minutes.

“It can affect you if you’re healthy, or if you’re not healthy. And I have seen patients decline so rapidly that they’re begging us to do something – that they can’t breathe,” Montgomery said.

As a respiratory therapist, Montgomery is often the last person patients who die from COVID-19 talk to. She recalled one particular patient who is the reason for her avid support of the COVID-19 vaccine.

“I have had a gentleman specifically look at me and say ‘I would do anything to go back and take the vaccine, and I’m so sorry I didn’t believe it. I’m never gonna see my children again.'”

She said the disease’s unpredictability makes it not only difficult to treat, but difficult for her to accept it is still prevalent in her community.

“It does tend to flip within a matter of minutes and when there’s no warning, and we don’t know. They’ll just become extremely short of breath, and there’s no rhyme or reason to it and you just have to be able to be prepared and act quickly to help them as fast as you can,” she said.

The one common thread most COVID ICU patients who don’t have good outcomes have is that they remained unvaccinated.

“I don’t think I’ve had a single vaccinated individual die. I had three unvaccinated die yesterday,” Krolikowski said.

Light had a solemn warning for those living in her community who choose to remain unvaccinated — drawing from nearly two years of experience with COVID patients.

“If you would see that it, it’s your grandparents. It’s your mom. It’s your dad. Every single day, it’s your grandkids that are coming in that are extremely sick. And some of them don’t make it home. I mean, there’ll be no Christmas. There’ll be no Thanksgiving.”

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