Inside Cincinnati's hospitals: COVID-19 puts healthcare workers in 'PTSD-like situation'

The doors are all closed on 3C. Every patient in the pulmonary unit at St. Elizabeth-Edgewood Hospital has COVID-19.

Every day and often into the night, Melissa Schumacher, the unit's nurse manager, is texting, emailing, calling nurses, even nurses whose usual job is education or quality control or informatics, asking them to take shifts so that, maybe, 3C can have a full nurse staff.

"Every day is stressful. We never know how much staff we’re going to have. Because we have a lot of staff get sick and have to be out," she said. "And a never-ending list of patients that need to come in."

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What Schumacher is facing now is the routine at hospitals throughout the Cincinnati region and the United States. The impact of the delta variant of COVID-19 followed by the omicron variant – a form some experts predict is as "transmissible the virus can get"  – is stressing health systems to the max. And front-line health care workers are carrying the load. 

As of Thursday, 1,032 patients were hospitalized with COVID-19 in the region's 40 hospitals; 212 were being treated in the intensive care units and 140 were on ventilators. Put another way, 4 of every 10 patients in the region's 40 hospitals had COVID-19.

Patients wait for up to 15 hours

Michele Hodge, an emergency department nurse who serves as the clinical manager at the University of Cincinnati Medical Center in Corryville, said caregivers are doing all they can, working outside their normal schedules, some seven days a week, others 16 hours a day. Meanwhile, patients seeking care depending on the severity of their illness, may have to wait in a lobby for upwards of 15 hours to be seen because of capacity issues.

"I've been in health care for over 13 years and I've never seen anything like this," Hodge said. "You go into this field because you want to help and heal people, and it's challenging when you're unable to care for all patients in a timely manner due to overcrowding and wait times."

"At times you feel helpless," she said. 

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Hospital workers are fatigued. Abnormal schedules and workdays are normal now. The 2020 to 2021 pandemic rush was hard, followed by a lull. Then, Schumacher said, it hit again. "When delta and omicron started coming," she said, "it was very much a PTSD-like situation. I feel like my team bonded in that."

But as nurses have connected through the most challenging period of their careers, the reemergence of the virus in rapid-spreading form has taken an emotional toll on their lives. They often feel overwhelmed. Defeated. 

Solace of a quiet commute after a whirlwind hospital shift

"It's tough. These people are really sick and uncomfortable," said Brooklyn Fette, a step-down unit nurse at TriHealth's Good Samaritan Hospital in University Heights.

Fette drives 45 minutes from work to her home in Dearborn County, Indiana, every day. And after a day full of beeping, scrambling voices, telemonitors buzzing and phone conversations with patients' families about their relative's worsening condition, she drives in silence.

"I don't call anybody, I don't have the radio playing," she said. Her drive home allows her to slow down and process everything. "I kind of replay my day, I think about my patients. I've definitely cried more this time around." 

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There is no such thing as full in the emergency departments, said Missy Miles, director of system emergency services for St. Elizabeth's Northern Kentucky hospitals. People with COVID-19 waiting to go to an inpatient department are placed in negative pressure rooms, in which air flow is directed through a filter and out of the window – away from other patients and staff.

"Every day is hectic and every day is different," said Mary Rosenhagen, assistant nurse manager at the St. Elizabeth-Edgewood Emergency Department. "We have staff that are out with COVID. We share staff amongst the other EDs, depending on which is busier. We are just trying to work as a team all the time."

'I've fallen out of love' with nursing

The nurse managers see the toll that the work has taken on their staff.

Schumacher worries about her staff. "One nurse told me, 'I’ve fallen out of love with the profession I’ve dreamed of and worked so hard to enter. 'The things I have seen, heard and witnessed in the past two years give me nightmares.' "

Dr. Steven Feagins, Mercy Health's chief clinical officer, who spent time in the military, compares the ongoing battle with COVID-19 to war, noting that health workers simply wake up every day and fight. 

"For the public, it's kind of out of sight, out of mind, and we're still fighting," he said. "There are nurses and physicians who have physically seen more deaths in a year than they've seen in their careers."

Sometimes, Rosenhagen said, the drumbeat of COVID-19-infected patients is just too much.

She recalled a day when every patient that one of her ED nurses cared for had COVID-19. And for every patient, she had to gown up. That meant gowns and gloves and a mask and shield again and again. "And she just had to cry it out," Rosenhagen said.

Schumacher, like many nurses, makes sacrifices to cover the workload. 

"I work until my family calls me to come home or whatever time I think it’s OK to leave," she said. She has twin 9-year-olds who text her to come home for dinner or when they want help with their homework. “It just breaks my heart when I’m not able to do it.”

Julie Harris, a medical intensive care unit nurse at the Christ Hospital, said staffing can be challenging, but nurses have taken the call to action to help their communities. 

"I wouldn't be here if it wasn't for a purpose and if it wasn't for what I love to do," she said. 

'COVID does what COVID wants'

But even with those sacrifices, the systems are being affected by capacity issues. Hodge said UCMC has been at capacity, a designation that notifies emergency medical services to limit emergency intake, more in the last two months than it has in years combined. From Jan. 1 through Jan. 5, the hospital was at capacity for up to 16 hours a day. Last week, the hospital was at capacity for nearly a day beginning at noon on Wednesday. 

"What that means is we are requesting EMS to divert patients except for trauma, strokes, burns and labor cases for (obstetrics)," she said. 

Miles is in charge of directing the flow of patients for St. Elizabeth hospitals. "There’s always a patient that we need to move from one location to another," she says. Day and night.

And nurses are bouncing back and forth between patients, too. 

"I always say COVID does what COVID wants, because you never know," Good Sam's Fette said. "You leave a patient's room, they're fine, they're set up, they're comfortable. You go to the next patient room and all of a sudden you get a phone call that's like, 'Hey you've got to go back, their oxygen's dropping, they're not feeling well, they're having chest pains.' "

And at any moment, the worst can happen. 

"Today we lost somebody, and it just breaks your heart," said Schumacher, tearing up. "Because we are healers, and when we can’t, we feel like failures, though we’re not."

'Every death means something to us'

The healthcare workers worry that people do not understand the calamity at hand.

"They are not all old," Schumacher said, referring to her pulmonary patients. “We are seeing 20-, 30-, 40-year-olds not being able to breathe."

"They are scared and they are lonely. We see people who are in denial. We have people who are angry about it," she said. "I’ve seen more death in one week of this pandemic than I saw in 15 years. And every death means something to us. We get attached. We are invested in our patients."

The hospital caregivers ask that people wear masks, socially distance, get vaccinated, get a booster. And remember this, said Miles: "If you had it and it wasn’t severe, the person that (you) may give it to may be one of those people who come to the ED that can’t breathe."

Caregivers see no end in sight, Miles said, adding, "I think we’re scared to think that it is, but right now, it isn’t.

“We just keep going.”