Critical care nurses like Amber VanBramer are confronting challenges they've never faced before, with about 3,500 people in Massachusetts hospitalized with COVID-19, and about a quarter of them in intensive care.
After another day caring for a very sick patient at the end of April, VanBramer, 33, walked out of the Berkshire Medical Center plumb tired.
"I just got finished with my shift," she said. "I was in my COVID-positive room a good majority of my shift. The patient was not doing well, and then started [to] deteriorate."
Most of VanBramer’s COVID-19 patients don’t survive. But she keeps trying to help people get better and prevent the spread of the highly infectious virus.
She starts each shift by donning her first layer of defense: a set of hospital-issued scrubs. Then she covers her shoes, nose, mouth and eyes.
"Now, we actually wear a face mask, and a pair of goggles, all the time," she said. "We wear them in the hallways. We wear them when we're sitting at the desk. Pretty much, these are part of our attire the entire shift."
VanBramer fortifies this battle dress every time she enters a room with a COVID-19 patient — starting by swapping out the surgical mask she uses in the hallways with one that is supposed to block at least 95% of minute airborne particles.
"You put your N95 on, which is the tight-fitting mask," she said. "You now add your face shield over the goggles, and you put on your gown, and you put on your gloves."
VanBramer said a lot of staff members wear hats.
"So that way, at the end of your shift, you're trying to bring home as less as possible," she said.
VanBramer goes home to her two sons: a 10-year-old, and a 6-year-old who has asthma.
"I always wonder: Did I wash my hands good enough? Do I have anything on me? Am I going to bring home anything to my kids?" she said.
VanBramer said all of her colleagues worry about this, or about getting sick. As a single mom, she said she can’t afford to get the virus.
"I'm my only income for my household," she said. "And then if I get sick, how do I properly take care of my children, so that way they don’t get it?"
And yet, back at the hospital, some of the protective gear is reused, over and over — like the N95 mask.
"The first mask, I had for about nine to 14 days. I had that one mask," VanBramer said. That was for about six shifts — or 72 hours.
The Berkshire Medical Center said staff can get a new mask if they request one. But the hospital asks they use them until they can no longer be reused.
VanBramer doesn’t blame the hospital for the shortage, but rather the government.
"For me, I think it's unsafe, because you can't see if there's anything on that mask," she said. "And I can't see if it's working to its best ability."
Typically, in the critical care unit, a nurse will care for two patients at a time. But because COVID-19 patients can decline rapidly, and because nurses have to "gown up" each time they enter a room — for the most part now, it’s one nurse to one patient.
Most patients in the unit are heavily sedated, breathing through a ventilator.
VanBramer said the already-small rooms feel even smaller with as many as six IV pumps, the ventilator unit, a monitor for things like heart rate and blood pressure, and a machine that filters and sucks the air outside so it doesn’t leak into the rest of the hospital.
"It can be very crowded in these rooms," she said. "Imagine not having a lot of room to move, needing multiple people in the room to help you. So it can be quite cramped."
Despite all the machines, VanBramer said health care workers can feel helpless against COVID-19.
"It's like, 'OK, well, we're going to try this today [to] see if it works,' or, 'We're going to do this tomorrow, and if that doesn't work, we'll try something new,'" she said. "But it's like a trial-and-error. It's not like I know how to fix this person, because I don't."
When a patient nears the end of life, the hospital doesn’t allow visitors because of how infectious the virus is. Instead, VanBramer holds an iPad up to allow people at home to see their loved one, and talk to them.
"It's not as comforting [as] when you have, you know, your husband, or your kids there, holding your hand and telling you, 'Mom, it's gonna be OK. I'm here.' They have to do that over Facetime," she said.
VanBramer said she tries to let the family take their time to say what they need. Then, medications that keep the patient alive are stopped, and the ventilator is turned off.
"And then we just sit there and I just talk to them, just try to tell them that they're not alone during this," she said. "Their family loves them and that, you know, I hope they are comfortable, and that they are OK to pass away. I am the last voice that my patient hears."
There was one week about a month ago when VanBramer lost a patient day after day.
"Three shifts in a row. Every day, I left, and every day, my patient had died," VanBramer said.
At the end of tough days like these, with her kids at home now, she doesn’t get much down time.
"We're just stuck in the house," she said. "Unfortunately, there's nothing that I can do to help mentally get through this, besides talk to some fellow co-workers. But we all have the same story."
When asked what the public can do to support her, VanBramer said they could stay home as much as possible, and wash their hands, so there’d be fewer COVID-19 patients in the hospital.
