Exhaustion in the ICU: Doctors reflect on state's nearly 5,000 COVID-19 deaths - Albuquerque Journal

Exhaustion in the ICU: Doctors reflect on state’s nearly 5,000 COVID-19 deaths

Lovelace doctors Michel Boivin and Teri Heynekamp, a married couple, walk through the intensive care unit at Lovelace Medical Center in Albuquerque. They and other doctors shared their thoughts last week on New Mexico nearing 5,000 COVID-19 deaths.(Eddie Moore/Journal)

Copyright © 2021 Albuquerque Journal

Deep inside the towering Lovelace Medical Center, Dr. Teri Heynekamp walked past room after room of intensive care patients.

Then a nurse asked for help.

Heynekamp stepped in as the nurse and others gripped bedsheets and tugged hard to shift an intubated man’s position in bed — an effort to ensure oxygen reaches every part of his lungs.

It was Day 587 of the COVID-19 pandemic in New Mexico, just another brief hospital scene amid 19 months of loneliness, fatigue and grief.

“We feel exhausted,” Heynekamp said in an interview, “like a type of exhaustion that I’ve never experienced in my life.”

As New Mexico approaches 5,000 COVID-19 deaths, doctors and other health care providers say their workload has hardly let up. Besides coronavirus infections, providers say, patients are showing up sicker with all kinds of conditions after having delayed their care earlier in the pandemic.

Even the arrival of safe, effective vaccines, some doctors say, has provided little relief, introducing a new dynamic instead — the knowledge that most of today’s COVID-19 deaths are preventable. People who weren’t fully vaccinated accounted for 96% of the deaths in a recent four-week period.

“We feel like they didn’t need to die,” said Heynekamp, a pulmonologist and critical care physician who works in the intensive care unit at Lovelace.

In interviews last week, Albuquerque doctors made it clear that, for them, the 5,000-death threshold is more than just a number.

It’s a reminder of traumatic scenes played out over and over again — straining to turn a sedated patient in bed, watching someone die alone, loved ones saying goodbye over a video call.

“We’re prepared for sick people,” said Dr. Jason Mitchell, chief medical officer at Presbyterian Healthcare Services, the state’s largest private employer. “What we’re not prepared for is to have people die alone and be the only person who talks to the family.”

‘Moral injury’

The trauma adds up.

Dr. Steve McLaughlin, chairman of the Department of Emergency Medicine at the University of New Mexico School of Medicine, said hospital leaders throughout the country are trying to address burnout among their workforce and “moral injury” — a concept usually applied to refugees and soldiers in wartime.

In health care, moral injury refers to the distress endured by doctors and others as they’re forced to provide less care than normal.

Dr. Teri Heynekamp, left, Bayley Legarreta, a patient care technician, center, and Woody Payne, right, a registered nurse, tend to a patient who had to be shifted in bed Monday to ensure oxygen reaches all parts of his lungs. The patient was suffering from the aftermath of a COVID-19 infection and receiving treatment at the intensive care unit inside Lovelace Medical Center in Albuquerque.(Eddie Moore/Journal)

Patients might face delays in receiving care or die as they await transfer to a bigger hospital.

“After 19 months of this, to be honest, everyone’s tired,” McLaughlin said. “COVID was terrible, and it’s not over. At the same time, we’ve moved into another phase where the hospital is also busy with other kinds of patients.”

Steve Nuanez, director of Employee Well-Being at UNM Hospital, said some providers report feelings of failure or inadequacy as they try to accommodate patient loads beyond the hospital’s normal capacity.

“Over the last four to five months,” he said, “we’ve seen more and more people reaching out for help, and more and more leaders reaching out and saying, ‘Our staff, they’re struggling.’ ”

In the early days of the pandemic, Nuanez said, health care workers were incredibly busy and focused on the task at hand. Later, he said, they found optimism in the knowledge that vaccines were nearing approval. But now many providers are simply exhausted.

“Health care workers — last year, they were heroes,” Nuanez said. “This year, there’s also this controversy around vaccines and so many different things. They’re not always viewed in the same light.”

‘Above water’

The stress on health care providers goes well beyond coronavirus infections.

New Mexico has had a long-standing shortage of doctors and nurses, especially in rural areas, and fewer beds per capita than the nation as a whole.

But the pandemic has increased the pressure.

Dr. Michel Boivin, a critical care physician at Lovelace, said a key challenge now is the scarcity of space available in larger hospitals to accept patients from smaller ones.

“I had a guy who needed a pacemaker,” Boivin said, “and he was sitting in a rural New Mexico hospital for a whole day with his heart barely beating.”

Before the pandemic, he said, there would have been no wait for a pacemaker-related transfer.

The state Department of Health last week issued an order allowing hospitals to activate crisis standards of care. The move provides some legal protection for doctors called on to work outside their normal scope of practice and standardizes decision-making at hospitals for how to ration care when demand exceeds the supply of beds or other resources.

New Mexico has been stuck in a six-week plateau — perhaps even a gradual rise — in new COVID-19 infections detected each day. State officials had hoped a late-summer surge fueled by the delta variant would have receded by now.

The outlook for hospital capacity is unclear.

Mitchell, the Presbyterian doctor, said health care leaders will be closely watching for a wintertime rise in flu and RSV, a respiratory virus that often spreads among children.

“We’re at a plateau right now,” Mitchell said. “We are able to keep our heads above water, but barely. We could tip over very fast.”

Lies, sadness

The preventable nature of most COVID-19 deaths, some doctors say, has added to the psychological toll.

Heynekamp and Boivin — who are married and work at Lovelace — said they and other providers have faced patients and family members who doubt the severity of the disease. Some families ask for a specific medicine, such as ivermectin, an anti-parasite drug not approved for COVID-19 treatment.

A recent ICU patient, Heynekamp said, insisted his COVID-19 infection wasn’t worse than the flu. Others want to go home against medical advice, she said, and some families reject vaccination even after a loved one dies.

“There’s so much anger toward health care providers,” Heynekamp said. “There’s so much animosity. There’s so much mistrust.

“We’ve never dealt with that before.”

Boivin put it this way: “The way that social media rewards disinformation and spreading lies at the expense of people’s lives has been unbelievably frustrating, as well as time consuming.”

McLaughlin, the UNM physician, said he recently cared for a middle-aged man about his own age. The patient had a COVID-19 infection, hadn’t been vaccinated and was having trouble breathing.

“Really the feeling is just one of sadness that the person is sick and that it was preventable,” McLaughlin said.

Vaccines, masks

It was once shocking to think hundreds of people could die of COVID-19 in New Mexico, much less thousands. Skepticism greeted an early statistical model that projected 500 deaths in the pandemic’s first few months.

But as the state prepares to pass 5,000 fatalities, the doctors who talked to the Journal urged New Mexicans to reflect on the magnitude of the loss and take steps to limit spread of the disease.

They urged people to get vaccinated, wear masks indoors and wash their hands.

“I feel a lot of empathy for the families who are still losing their loved ones,” McLaughlin said. “I think it’s important to remind people that the pandemic is not over, and we have to continue to focus on the things we know can keep people safe and prevent additional deaths.”

As Heynekamp walked through the seventh-floor ICU at Lovelace, she noted that she had stood in many of the rooms and watched patients say goodbye, often through a video call to loved ones.

It was, she said, a lonely way to die.

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