Brianna Luebbers has started hearing the sound of ventilators in her dreams.
Luebbers, a respiratory therapist at the St. Luke's Hospital intensive care unit in Chesterfield, has spent eight months caring for the sickest coronavirus patients. She works practically nonstop, monitoring machines, repositioning people to help them breathe and checking oxygen levels.
“Alarms! Every day I go home, it constantly alarms, it never leaves!” she said. “I’ve been working in the ICU, and I feel like I hear alarms that aren’t actually alarming. It’s my life.”
St Luke’s has turned into a planet that revolves around the coronavirus. As at other hospitals in the St. Louis region, patient techs, nurses and therapists are working twice their normal hours and trying to avoid burnout during a pandemic with no end in sight.
Hospital leaders say that they soon won’t have enough staff to care for patients. Luebbers and other workers have been pushed to their emotional and physical brink.
When asked how she's doing, Luebbers loses her upbeat demeanor. Her grandfather recently died of COVID-19, and her grandmother is infected, too. Her father died of cancer six weeks ago, but she hasn’t been able to see her family much.
“Emotionally and on a personal level, I’m not doing the best,” she said. “I try to separate home life from work life, I do my best, but when you come in here and have to deal with it every day, it takes a toll.”
She’s confounded when she sees people not taking the pandemic seriously, getting together with friends or calling the coronavirus an elaborate hoax.
“I get asked all the time. ‘Is COVID a real thing?’” She shook her head. “It’s like, if I could walk you through our ICU right now … some days, we just can’t keep up.”
Surrounded by death
All but four of the 18 ICU beds at St. Luke’s are occupied. The unit has the atmosphere of a beehive, with dozens of respiratory therapists, nurses, residents and patient techs all dressed in color-coded scrubs.
Patients in the ICU are so sick they require nearly constant attention from multiple people.
The rooms in the unit have glass walls. Curtains usually cover the windows. But now, workers keep them pulled open, so workers can keep an eye on patients all the time. They could crash at any moment. Most of them are unconscious, with tubes or masks covering their faces. Their chests rise up and down with shallow, shuddery breaths.
“When we come to work it’s like you’re going into a different world, into a movie, into a nightmare really,” said Kelsey Butler, a nurse case manager in the ICU. She helps connect patients and their families who can’t visit due to pandemic restrictions, usually through FaceTime or videoconferences.
“Day after day, all I would feel like all I did was give people bad news,” she said.
Workers in the ICU are used to seeing people die. But the past year has been different.
“We see so many more deaths now,” Butler said. “More than I’ve seen in the past seven years as a nurse altogether, I’ve seen in the past eight months. It doesn’t make it any easier.”
Many of the patients are on ventilators to help them breathe after the virus ravages their lungs. Others have masks covering their entire faces that direct air into their noses.
A woman with mauve toenail polish lies sedated in one room as her chest quickly heaves up and down. A television monitor above her bed plays a loop of nature scenes that she can’t see.
Preparing for disaster
Emergency Department Nurse Instructor Heather Freund recently set up a “meditation station” for ER workers inside a tiny corner in her office. There, people can put on headphones and listen to the sounds of the ocean as they watch a video of fish swim around a coral reef on a computer. A little shelf holds an assortment of essential oils to sniff.
Most staff members are working double their usual hours, she said. Some say they feel guilty when they take a day off.
“It’s tiring and it's emotional, because it's just constant hard work,” Freund said. “We go all day long for 12 hours with masks on, and gowns. And it's hot in the gowns and you can't breathe in the gowns and it's wearing on the staff.”
On a recent afternoon, hospital workers cheered when an administrator wheeled a cart of Domino’s pizza, a gift from an anonymous well-wisher, down the hallway.
About half of the patients arriving at the St Luke’s emergency room have coronavirus symptoms, Freund said. The hospital has constructed an enormous white tent — with stretchers and a porta-potty — outside the ER to expand its capacity in case of a surge in patients.
The hospital is working on expanding its capacity in other ways. Other floors that normally treat patients sick with cancer and other diseases have been converted into floors for COVID-19, with industrial fans blowing potentially infected air out the windows.
A morgue full of bodies
Because most coronavirus patients are not allowed to have visitors, workers in the ICU also support the patients emotionally, said Paige Hankins, a patient tech who assists nurses and helps feed patients and change their bedding. Every time she enters a room, she dons a yellow paper dress over her purple scrubs and puts on a mask and plastic face shield.
Even with all the equipment, her job is still intensely intimate.
“I’m someone where I can’t choose to not get emotionally attached to these patients,” she said.
After Hankins goes home for the day, she still finds herself thinking about her patients. One reminds her of her grandmother. Sometimes she dons all that protective equipment to hold her hand.
That makes it even harder to see people die, she said.
“I’m the person who takes the patients down to the morgue, and I had to help the security guard rearrange the morgue to fit more bodies,” Hankins said. “I mean I was standing in a freezer for 30 to 45 minutes with these dead bodies, moving them to make room for more.”
If admissions continue to climb, area hospitals could reach capacity this month.
Hankins, Luebbers and other workers are dreading the day the hospitals need to decide who gets a needed ICU bed. People shirking public health guidelines to gather for Thanksgiving and Christmas could mean a wave of sick people coming in the next few weeks.
Whenever those thoughts cross Hankins’ mind, though, she pushes them away. She tries to take each day as it comes.
“I think some people don’t realize how serious this is,” she said. “And it takes a toll on you.”
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