Front-line Faces: Tales from the COVID ICU

Editor’s Note: This is part of a series of profile stories of MUSC Health front-line health care workers who are providing medical care and support to patients with COVID-19.

Throughout this COVID pandemic, health care workers have risked their lives daily to save lives and care for others.

There’s a special sense of duty and compassion in the hearts of nurses, physicians, therapists and specialists who work directly with the hospital’s most critically ill patients. This is certainly true for 4C nurse leader Melanie Brooks.

Brooks has been a nurse for 11 years, most of that time working in the Surgical Trauma intensive care unit at MUSC. She was among a team of health care workers that volunteered to work in MUSC Health’s original 8-bed COVID-19 ICU (5C), which was deployed in March and operated until May. In mid-June, as coronavirus cases in the Lowcountry were on an upswing, Brooks returned to work in the hospital’s secondary COVID ICU (4C), an 14-bed unit, which opened in mid-June.

She volunteered to work with the COVID-19 medical response team, care for the hospital’s most critically ill patients as she felt that somebody had to work there, realizing that some hospital co-workers, especially those with families, weren’t comfortable working in the COVID unit. 

“As a critical care nurse, volunteering to work in the COVID ICUs was an opportunity for me to work with a different patient population while providing the best patient care,” she said. “The teamwork I experienced first in 5C and now 4C is exceptional. It’s been wonderful to see everyone coming together and working hard for our patients.”

Brooks also said that while the patients aren’t as sick as they were in March, there are more critically ill patients to care for. Fortunately, they have better treatments and more options than they had in March. 

Nursing leadership is continuously focused on making improvements that works best for staff and the patients. “We’re learning what work’s best for everybody involved to help things run more smoothly and as safely as possible,” she said. “It’s been an every day learning experience for sure.”  

In turn, Brooks and others working in these special COVID units are able not only to teach new skills but to learn critical care practices from others – building and improving upon best practices.

 

She and her colleagues have enjoyed learning new techniques and information, especially as it relates to respiratory complications associated with the virus. One shared best practice that Brooks has learned while working with COVID patients is the value of prone positioning, or proning, which means placing patients on their stomachs so they are lying face down – a practice typically used by critical care colleagues working in the medical ICU but not in her home unit, the STICU. COVID inpatients may have high oxygenation requirements, with or without the use of a ventilator. Rotating the time patients spend on their backs and stomachs can improve expansion of the lungs, help to remove secretions and improve breathing.

Hospital policies changed during the pandemic to safeguard the health and safety of patients, physicians and staff. The no-visitor restriction was especially tough for COVID inpatients, who not only struggled alone fighting an invisible virus but could not have the support of their families around them. Instead, nurses and health care team members stepped in to fill special roles to support their patients and families.

One situation will forever remain with Brooks. In the early days of the pandemic, a mother and daughter were admitted to the unit. Both patients were extremely ill with COVID. Unfortunately, the mother succumbed to complications from the virus and died, while the daughter, who was intubated and struggled in her own fight against the disease, never got to say her final goodbye. Brooks helped to facilitate a final phone call between the dying patient and her family. She recalled her own sad feelings, tears rolling down her cheeks while she sobbed behind her N95 mask and face shield. “I can’t describe how hard it was to watch that,” she said.

Brooks never imagined a time like this. Every shift, she goes home physically and mentally exhausted. During this recent uptick in cases, she and nursing and hospital leaders manage daily concerns, like staff shortages, equipment needs and physical demands, while monitoring psychological strain and signs of burnout. 

Like her colleagues, she’s particularly careful with her actions and PPE so as not to contaminate herself, as she still is involved with caring for her parents. That type of personal safety is yet  another adjustment she’s made working on the front lines of the pandemic. It’s difficult, but she purposely avoids or limits time spent with family and friends because of her work and admits the loneliness during quarantine can be tough. To destress, she spends time relaxing with her Australian shepherd mix, Jethro, which she adopted last fall. “Jethro’s helped me through some of my tougher workdays,” she explained.

“It’s hard not to be able to see people when you want to,” Brooks said about the psychological adjustments people learn to adapt and adjust to during times like a pandemic. She knows of other colleagues who are struggling with the self-isolation, as their families live separately or out of state. 

But Brooks, like her colleagues, are motivated by the passion they have for their jobs. She’s proud to be part of a health care team that chose to dive right in to help others. She also feels that her efforts have contributed to the supportive work environment they initially established and have continued to foster in the five months since the coronavirus hit the Lowcountry. Brooks is also grateful for the public recognition of health care workers during this period – the community’s Health care Hero appreciation parades, public donations of PPE supplies, meals and other donated items. 

“It has boosted our morale for sure,” she said. “It was nice to be recognized in these many ways. It made all of us feel appreciated.”