Dr. Jonathan Richards tapped on a square of glass as the blue-gowned people he was watching called out for sedatives and started to move more rapidly. The patient who arrived less than 15 minutes ago was already struggling to breathe. He was writhing in the hospital bed, blood staining his gown.
Normally, the team of ICU specialists at Our Lady of the Lake Regional Medical Center would have the time and resources to order a chest X-ray and to send several more people into the patient's room to figure out what was wrong.
But coronavirus had changed that: It demanded immediate problem-solving from the three people surrounding the patient’s bedside, with backup from Richards and several others trying to communicate through the window pane.
Richards tried to make out the muted voices of staffers trying to calm the patient, their lips unreadable because they wore masks. The doctor cracked the doorway of the negative-pressure room and handed off a syringe. The man in the hospital bed was ill enough to have landed in the 20-bed unit for the hospital’s sickest coronavirus patients. A month ago, it was a trauma and neurosurgery critical care unit.
“Turn the vent screen toward me,” Richards repeated once, twice, three times before the team on the other side of the glass could make out what he was saying, and someone was able to spare a hand to swivel the screen.
They were lucky, Richards thought, that only one patient was going south at the moment. Often, lately, the staff had to juggle multiple crises at once, given COVID-19’s vicious course. His email inbox was filling up with requests to sign death certificates. In the room across from him, a white sheet was draped over a patient who had died that morning, the machine that should show vital signs instead blinking green, yellow and blue question marks.
Most other patients in the ICU were on ventilators, BiPap machines or oxygen masks, their families far away because of concerns about virus spreading. The best anxious relatives could hope for was a phone call from Richards’ team, or potentially a video chat with their loved one.
Health care workers across Louisiana and across the nation are facing daunting questions about whether they will be able to treat the crush of coronavirus patients filling up their hospitals, a circumstance made more stressful by a global personal protective equipment shortage. More than 2,000 patients have been hospitalized in Louisiana; they are among tens of thousands hospitalized across the country, though many states are not releasing hospitalization figures.
The Times-Picayune | The Advocate asked several large health care providers in New Orleans and Baton Rouge for permission to watch firsthand their efforts to deal with the coronavirus crisis. Our Lady of the Lake was the first to agree to the proposal. Hospital officials allowed a reporter and photographer to spend several hours inside of the hospital Thursday. They witnessed these accounts in-person, and also interviewed staff throughout the day. The newspaper agreed not to publish any identifying information about patients, which included slight alterations to photos.
The tsunami of patients was what Richards had spent years training for as a critical care doctor. Suddenly, his world was of great interest to those who had hardly heard of a ventilator before.
He’d known he wanted to be a doctor since he was a teenager and witnessed a head-on collision, and couldn’t stomach the feeling of helplessness that overcame him. He’d suspected coronavirus was going to become a global crisis in late January, when he was taking an Antarctic cruise with his family and they had to go through temperature checks in Argentina over virus concerns.
“I like the sickest of the sick,” said Richards, 40, a Ruston native. “I like being the person who’s called when you’ve called everyone you can call and you don’t know what else to do.”
Inside of Our Lady of the Lake’s Baton Rouge-area hospitals on Thursday, 242 patients were either confirmed coronavirus patients, or suspected of being infected and awaiting test results. The regional medical center on Essen Lane — an 800-bed giant — housed most of those. They made up nearly half of the hospital’s 553 patients. Fifty-three of the most seriously ill patients were on ventilators.
The hospital’s size and purchasing power has made it easier to secure masks, gowns, gloves and other PPE that many hospitals are struggling to keep on hand, Our Lady of the Lake administrators say. But they’re still concerned, especially if coronavirus counts keep growing. For now, the hospital is also offering employees a fresh set of scrubs each day, so workers can change when they arrive at work and toss their dirty ones into the hamper when they leave. Many hospitals don’t have the resources to do that.
Back in Richards’ unit, a palliative care doctor, Mary Raven, held up the phone for a patient near the end so that a family could say goodbye. Her services have also been skyrocketing in demand: Her team normally oversees 16 to 20 patients, but their load that day was twice that big.
Raven said staffers have put aside their fears and reservations, calling on the courage and intensity that coronavirus demands of them.
“You can dwell in the sadness of it,” she said. “But you’ll be paralyzed if you do.”
Potential coronavirus patients across Louisiana keep encountering the same problem: They visit a hospital, receive a coronavirus test and then…
Some patients survivors, others up and down
A few weeks earlier, Richards had been knocking down shelves in patient rooms on the third floor, where a unit that once housed children was transformed into a coronavirus unit for adults. Staffers kept bumping their heads, and he took it upon himself to do something about it.
“By the time I walked out on a Sunday night, 11 p.m., after a 14-hour shift, I was like, ‘I have done all I can do here, shelves and all,’” he laughed.
He’d moved onto another unit, while Bud O’Neal, a pulmonologist and critical care doctor, oversaw the 14 beds in the old Children’s Hospital area. As he paced the hallway, O’Neal pulled his black-framed glasses off and on, using his phone to take photos of the ventilator screens so he could zoom in.
“You’re back for more, huh?” O’Neal asked as he strolled by the nurses’ station.
“After one day off,” said Marla Heintze, a surgical ICU nurse who is adapting her specialty to take care of coronavirus patients.
Technically, Heintze shouldn’t have been at work — she was supposed to get married April 4, in a chapel with wooden pews and stained glass windows. But coronavirus postponed her wedding festivities and honeymoon in Barbados. She opted to get married in her living room instead, with a friend as the officiant.
“Everyone keeps asking how newlywed life is,” she laughed. “I’m like, ‘We stay 6 feet away from each other at all times; we don’t sleep in the same bed.’”
She hopes to finally show off her wedding dress at a public celebration in August. The only gown she was putting on Thursday was a bright blue one. Before she entered a patient’s room, she twirled her hair from a ponytail into a bun.
O’Neal described one patient who had been intubated and made enough progress to be extubated as a “survivor,” and another as “up and down.” He explained the delicate balance between keeping a patient comfortable and making sure that they are as awake as possible to preserve their brain function.
He expected at least one patient to be ready for a spontaneous breathing trial, a method of weaning patients off ventilators that he likened to teaching a baby bird to fly.
“We’ll be there if you fall,” he said.
A few doors down, a patient’s blood pressure spiked, machines whirred and a nurse inside called out for medicine. In another coronavirus innovation, drips and IV pumps are now kept out in the hallways and fed through the doorways into patient rooms so that staffers can limit patient interactions and save equipment by changing out meds without gowning up over and over again.
Gabe Landreneau, a nurse anesthetist now working with coronavirus patients, prepared a drip in the hallway for cardene, which helps to dilate blood vessels and relieve high blood pressure, the most common preexisting condition in Louisianans who have died from coronavirus. He fed the tube through the doorway and pushed on a hand-sanitizer dispenser on the wall.
Anne Cerniglia set up an iPad at the bedside of a dying coronavirus patient so her family could see her one last time. She placed her hand on …
Hail Marys and small victories
In normal circumstances, months could go by at Our Lady of the Lake without any patients being “proned,” an intricate, Hail Mary option in which patients on ventilators who are still struggling to breathe are turned face down in the hope they’ll breathe better.
But proning is now an hourly occurrence here. Corrie Presley, a director of nursing, could tell immediately when she walked into a room that staffers were about to prone a patient.
The nurses’ station was empty. Everyone in the room huddled next to two glass sliding doors with a patient on a ventilator behind them. Five nurses entered the patient’s room, while seven others watched from the outside.
Adam Ferguson, a physician assistant who works closely with Richards, stood at a crack between the two sliding glass doors as he coached those on the other side of it. He had helped prone so many patients lately that he lost count.
The nurses stripped off the man’s hospital gown, pulled a sheet over him, added a layer of pillows and a second sheet on top. The patient was getting close to the edge of the bed, those watching through the glass warned. He was sedated, paralyzed and maxed out on ventilator capacity.
“Slow, deliberate movements,” Ferguson instructed.
They counted one, two, three, then used the sheets and pillows to gently and quickly flip the man over.
“That looks about perfect, y’all,” Ferguson called back through the door.
It would take some time before they could tell whether the patient was improving. But it was worth a shot.
On the seventh floor that day, nurses Lacey Miller and Morgan Babin were basking in a small victory. A patient who had a heart attack and tested negative for coronavirus was being wheeled to another floor. Miller and Babin’s unit — once meant for cardiac patients — was now exclusively for coronavirus patients.
“You’re looking good!” Miller yelled out as the patient left.
“I know!” he smirked back.
“Those success stories, they’re what’s keeping us going,” Babin said.
Working together through the pandemic has bonded Babin and Miller, a special procedures nurse and a trauma and brain injury critical care nurse who had never met before they started working together in a coronavirus unit. Miller’s mother sewed them caps to cover their hair — one purple, one blue, both sprinkled with a pattern of vintage nurse’s caps. With the caps, they don’t have to wash their hair every day — a chore that Miller explained left her long, brunette locks perpetually wet — and they get an extra layer of protection against coronavirus.
They take joy from lighthearted moments, like when their nursing director, John Wilson, accidentally faxed their Curbside Burgers lunch order to the hospital’s supply provider. And they laughed when Wilson explained how he uses a hose and a bar of Irish Spring to give himself a 66-degree, makeshift shower when he gets home to try to keep coronavirus out of his house.
They have to enjoy the highs, because the lows are devastating.
Babin still can’t talk about her worst day without tearing up. An elderly patient of hers declined a ventilator, and Babin prayed with her before she slipped away. The woman’s family couldn’t be there.
“I could see courage in her,” she said. “And that tears me up inside.”
‘Leprosy of our time’
Down in the ER, Mark Laperouse leaned on the nurses’ station and reached beneath the V-neck of his scrubs to pull out a tau cross he’s been wearing since a February retreat with the Franciscan missionaries who run Our Lady of the Lake.
Laperouse, an emergency medicine doctor, said he’s Catholic but “not an avid churchgoer.” Lately, though, he said he’s drawn inspiration from the example of St. Francis of Assisi, who ministered to lepers while they were outcast from the world.
Laperouse sees it as his mission to make sure that the ER staff is comfortable treating coronavirus patients and educating the public that, although it’s a contagious virus, most people who get it won’t wind up on a hospital ventilator. He was pushing to set up a separate ER for those with suspected coronavirus, which opened Friday the 13th.
“This is the leprosy of our time,” he said.
Once Our Lady of the Lake’s patient load has peaked and then starts to dwindle, the hospital will have to work to help staffers recover from the changes they experienced in the crisis, said Scott Wester, the hospital’s CEO. He expects Our Lady of the Lake’s front-line workers to tell their grandchildren one day about their service in a time of crisis, both a trauma and a badge of honor that health care workers will carry with them forever.
Back on the second floor, Richards sat in a dark room, trying to fill out patient charts on his computer while an indie-rock playlist played in the background.
“You have four to five hours of monotony, and then you have like an hour of frustrated insanity,” he said.
Raven, the palliative care doctor, and Ferguson, the physician assistant, teased him about the bag next to his desk.
Restaurants and donors had been sending food nearly every day, giving staffers something to look forward to in their rare downtime. But what they send usually doesn’t jibe with Richards’ vegan diet, so he carried a banana, an avocado, a salad, an acai bowl and plant-based chili with him. He had a moment of weakness a few days earlier when Ferguson’s wife sent banana-chocolate-chip cupcakes with peanut butter frosting.
Richards said he tries to take out his stress from work on a Peloton, laughing off stereotypes about “Peloton people.” Coronavirus has changed his routine, though: He works extra hours and found himself in the first few weeks struggling to fall asleep early enough to wake up before 5 a.m. for a workout.
When he goes home, he keeps distance between himself and his husband, along with their two rescue dogs. He tries to call his doctor friends on his drive home to see how they’re doing.
When Bishop Michael Duca steps to the pulpit to deliver his Easter Sunday homily, he will gaze into a starkly empty St. Joseph Cathedral. For …
The longer it’s gone on, the more normal it’s starting to seem, he said.
In his unit, they’d detected a collapsed lung in the patient who had been struggling to breathe that morning. By the afternoon, the patient slept quietly in his bed. He was back to breathing on his ventilator. They weren’t sure what would happen to him next.