Shannon Queen spends much of her 12-hour shifts at Baltimore’s Good Samaritan Hospital carefully putting on and removing gowns, masks and gloves so she can tend to COVID-19 patients that have pushed her unit to capacity in the past couple of weeks.
There is a balance, the veteran nurse said, in protecting herself and providing care and support for patients.
“We try and cluster care, like taking vitals and delivering food at the same time we’re doing something else,” she said.
“But I had a patient yesterday who was having a bad day because he just tested positive,” she said Wednesday. “I heard him tell a family member on the phone he was scared no one would treat him.
“I had to do a lot of hand-holding and reassuring that we wanted to take care of him.”
As the coronavirus continues to spread — and nearly half of Maryland hospitals are already 90% full — Queen’s months of on-the-job training have given her a crucial measure of confidence in tending to patients. But she said each one adds emotional weight to a staff stretched and fatigued by the pandemic’s long tenure.
Queen wakes repeatedly during the night before her shifts. She worries about how much the health care system and its workers can bear.
The disease caused by the virus already has infected more than 200,000 in Maryland. It has killed more than 4,600 here.
Gov. Larry Hogan said this winter is expected to be the worst time of the pandemic. He is calling on hospitals to add space for patients and expand their medical staffs with students, out-of-state workers and retirees.
Hogan said the first doses of vaccine are expected soon but will be a small fraction of what’s needed. Most of the public will wait months. He implored Marylanders to continue wearing masks and stay home to avoid COVID-19.
Queen said a dozen people were waiting in the emergency room for beds in her acute care unit one recent day. A large portion were COVID-19 patients, and others had a range of maladies that still require such care.
She and others on the front lines say they will take what comes.
Queen described how she learned to cope during the initial wave of cases in the spring. “I started calling another nurse on the ride home,” she said.
“Yes, I’m doing that again.”
Alie Cavey, nurse
Alie Cavey is one of the people who decide when a COVID-19 patient needs intensive care.
The nurse, 28, has worked in the University of Maryland’s Baltimore Washington Medical Center in Glen Burnie for more than six years. After treating hundreds of COVID-19 patients in recent months, she’s learned to pay closest attention to the breathing.
COVID patients need the aid of a machine when they can’t get enough air, a process that involves inserting a tube down people’s throats into their lungs. Doing that can send tiny droplets of the virus into the air and put health care workers at risk.
“The good thing is we had practice with this,” she said. “The first round, we didn’t know much about it. The third round we know what we’re doing.”
Cavey said she’s better at the mechanics of her job, such as suiting up in protective gear and helping patients onto ventilators.
But she also knows ventilators won’t save everyone. And with restrictions on visitors, it’s hospital staff that must offer comfort at bedside. That’s what she thinks about at the beginning of every shift when she goes looking for patients she sent to the ICU, to see how they are faring.
There was one otherwise healthy woman in her 60s or 70s who needed a tracheotomy, a hole in her neck where a breathing tube can go. The woman was restless and depressed. Cavey held an iPad so her daughter could talk to her.
“Just let me die,” the woman repeatedly mouthed.
Everyone was crying. But the woman rebounded and went home after a few weeks. Cavey recalled her in her street clothes telling hospital staff how thankful she was.
Cavey reminds herself of such successes and tries not to dwell too much on the losses that are again climbing.
At home in Stevensville, she said she’s a lot like everyone else, scrambling for open day care for two small children and coping with less income due to her husband’s reduced work schedule. She takes it out on an exercise bike that she often rides in a virtual group with other nurses. Then it’s back to work.
“I couldn’t keep doing this without the support of my family,” Cavey said. “But I find I can work only so long. After 14 hours, there really is nothing else substantial I can do because I get so drained.”
Carl Mouzon, psychiatric nurse
Months into the coronavirus pandemic, Carl Mouzon, a psychiatric nurse at the University of Maryland St. Joseph Medical Center, has figured out new ways of communicating.
His patients, some on video monitors from home, can’t see much of his face behind the mask and goggles. The tone of his voice and movement of his eyes have become more meaningful. He must look and sound engaged and empathetic, never disconnected.
Another thing, harder to fix or accept, is that treatment for mental health disorders isn’t the same, especially on the phone or computer.
St. Joe’s suspended the in-person group therapy sessions that people with mental health and substance use problems relied on for support because of the pandemic.
“We have to realize that we can only do so much, that people are not going to be well in these conditions when they are isolated,” said Mouzon, who has worked at the Towson hospital since 2014. “We have to be realistic in helping people bounce back and be better.”
The pandemic is not just a physical barrier to mental health care — it’s become a principal reason care is needed. Some have lost loved ones or recovered from illness, and all have fears. They feel the strain of separation from friends, family and routine. Many lost their jobs or their homes, while others are on the verge.
They are stressed, depressed and filled with anxiety they have never felt before.
“I find myself telling everyone that others are going through this, you are not weak,” he said.
But Mouzon finds his advice not as clear-cut as it once was. He understands people are fatigued, even sickened, by orders to wear masks and keep their distance. He has become more gentle in urging compliance.
“It’s hard to be afraid of something for so long,” he said of the virus.
Mouzon, 33, finds himself fatigued by the public health restrictions. He can’t go to his gym or go out to eat. He tried to take his own advice to find something that is safe and soothing.
“I cook more,” he said. “I go for a lot of walks with my dog.”
Shannon Queen, nurse
It’s not been all bad this year for Shannon Queen. She welcomed two new grandchildren. And she’s learned to sew, a skill she uses to make personalized caps for her colleagues at MedStar Good Samaritan Hospital in Northeast Baltimore.
It lets her bring a little joy to the job that has been so full of sickness and death since the coronavirus pandemic hit Maryland in March.
Queen works on a unit that’s between the emergency room where people enter the hospital and the intensive care unit where some do not survive. She helps care for those who need treatment for serious COVID-19 symptoms or close monitoring but can still breathe on their own.
“A lot of the anxiety was because of the unknown — the guidance from the CDC and state were changing all the time,” Queen said. “We still have a lot to worry about, but we know more now.
“Some people get sicker,” she added, “but the majority walk out.”
The volume of patients is still overwhelming. In recent days her hospital has sent patients to other facilities because it’s out of space, a process the state has turned into a formal program among dozens of Maryland hospitals at risk of running out of beds.
She hopes people drop the politics and deal with the fatigue and wear their masks.
“That’s a lot for those people, and this is all a lot for this country. Too many lives lost.”— Shannon Queen, nurse
“Had we known a bit more about it earlier, maybe we could have bent the curve a long time ago and the numbers wouldn’t be where we are now,” Queen said.
She thinks about a patient who died in the hospital. The woman’s daughter also got infected with COVID-19.
“I took a step back and imagined the effects on this family,” she said. “The daughter didn’t pass away, but she got very sick. That’s a lot for those people, and this is all a lot for this country. Too many lives lost.”
Dr. Vikram Gunnala
At the onset of the pandemic, Dr. Vikram Gunnala was working night shifts at a Prince George’s hospital, in the county with the most COVID-19 cases in the state. Those nights were long and daunting, he says, especially with all the uncertainty and the shortage of personal protective equipment.
But Gunnala, an internal medicine specialist who works at several medical centers, said he’s “more prepared and more confident” heading into this wave of the virus. He said hospitals have become more streamlined and staffers are better resourced and educated than late April, when hospitalizations reached an initial peak in Maryland.
Medical centers also have beefed up staffing, allowing for longer breaks between shifts, Gunnala said. And several have set up “COVID units” to isolate sick patients, which many did not have at the start.
In the spring, Gunnala took shifts at a short-staffed hospital in Cumberland, a two-hour drive from his home in Montgomery County. He’d stay there for several days at a time doing patient intake before coming home to stay in the basement so he wouldn’t transmit the virus to his wife or kids. He remembers limiting his interactions with them and only venturing upstairs when he knew they weren’t around.
His wife works in a nursing home and also has long, demanding hours. The family relies on a nanny, who’s in her 60s, but asked her to stay home the first few months. Their kids, 9 and 11, have had to adjust to “Zoom school” this fall, without their friends, teachers and normal routines.
”I’m also tired and fatigued, but on a different level that some people may not understand unless they’re in the medical field,” Gunnala said.
Adding to his weariness, Gunnala said, it’s been challenging to watch the politicization of masking and social distancing outside the health care system, two concepts that remain well-agreed upon in the scientific community.
Charlene Busman, nurse practitioner
A nurse practitioner who specializes in addiction treatment, Charlene Busman worked from her home in Frederick from March through mid-November. But now that her employer needs her back at work, she’s had to weigh the costs and benefits of staying in her job and managing her asthma and autoimmune deficiency.
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Busman, 58, takes a biologic drug to prevent her condition from worsening, which suppresses her body’s immunity. She has decided to stop taking her medication so she will have a better chance of surviving COVID-19 if she contracts it.
”I’m terrified. It’s engulfing my entire waking moments,” she said. “It’s a very scary situation, and I’m very frightened about going back to the office.”
Busman said she had been able to serve patients online from her home, which she shares with her 70-year-old husband. She fears transmitting COVID-19 to him.
When she goes to work at Outreach Recovery in Frederick, she can talk to her patients on a monitor from a separate room, but when the internet connection fails she has to bring them into her office. She said she pushed her employer to check patients’ temperatures at the door.
Still, she said she is grateful to have spent the past nine months working remotely, an opportunity not afforded to many others in the health care system. And she’s relieved that President-elect Joe Biden already formed a COVID-19 advisory board and has committed to seriously quashing the virus.
”I do feel battle-weary, not for myself, but for my colleagues, including my medical assistant who sees 50 to 80 patients a day and all she has is gloves and a mask,” Busman said.
“I wonder how long we’ll be able to sustain this.”