In glass-walled rooms at Oregon Health & Science University Hospital’s medical intensive care unit, patients are sedated and on life support.
They are all here suffering from respiratory failure or other life-threatening complications of COVID-19. They are much younger than the people sickened by the coronavirus’ earlier waves — middle aged, or people still in their twenties or thirties.
Among the youngest in the unit is an unvaccinated dark-haired woman in her 20s. She is on a form of life support known as extracorporeal membrane oxygenation, or ECMO.
Her lungs are too damaged to be inflated by a ventilator. Instead, she’s on something that’s like dialysis for the lungs. The ECMO machine pumps blood out through one large tube, infuses it with oxygen, and then returns the blood through a second tube for her heart to pump back into her body. Two stuffed animals are propped up on the window next to her bed.
“We have had people in their twenties die in this unit. We have had mothers lose their babies in this unit,” Erin Bonai, the charge nurse on duty, said on Thursday.
“People always think it can’t be them because they are fully functioning in their lives and that’s just not true. And the real truth is that we don’t know who is going to be impacted,” Bonai said. “We can’t look at five people on the street and say, oh that’s the one who would get critically ill. That’s just not how it works.”
About one of every three intensive care unit hospital patients has COVID-19 in Oregon. That’s 232 people statewide.
Many of the sickest have been transferred to OHSU, which invited OPB to see how the strain is affecting its hospital.
OHSU has four intensive care units, including a 16-bed medical ICU that has been converted into a unit dedicated to COVID-19 patients. All four ICUs are completely full, so some patients who need intensive care been moved to other areas of the hospital.
Julie Kleese, one of the nurses, said OHSU is short on both staff and physical places to put the sickest patients.
The highly trained doctors and nurses working in this unit support smaller hospitals across the state, providing advice and accepting transfers from hospitals that can’t handle more complex patients.
Now there are no beds left — but the phone calls asking for help keep coming from rural Oregon hospitals.
“This patient is 26 and dying. This patient is 21 and dying. This patient is a father of four and dying. You know, can you help us? Our rural partners are struggling. They’re at the limit of their capabilities and that’s when they turn to us — and the inn is full,” Kleese said.
Many of the nurses and doctors who remain feel like they never had time to recover emotionally from the COVID-19 surge in the winter. And now it’s happening all over again.
Even before the COVID-19 pandemic, Oregon and the U.S. were facing a nursing shortage. With the additional stress of the pandemic, more nurses are burning out and leaving the profession altogether.
The doctors and nurses who remain on staff at OHSU use all the tools at their disposal to try to save each life — a demanding effort that often requires one nurse per patient.
Some simple but powerful interventions that can help a person’s lungs recover do not require costly equipment. Rolling patients onto their stomachs, a practice known as proning, can help the back of the lungs open up more, for example.
It sounds simple. But it can take four people working with a sling and a mechanical lift to do it, because it’s risky to move a patient who is on a breathing tube and ventilator.
At many smaller hospitals, interventions like these aren’t an option. They just don’t have enough staff. So COVID-19 patients may be more likely to die because no one is available to move them onto their stomachs.
And health care workers expect it to get worse. OHSU is preparing to accept more COVID-19 patients next week. The hospital is taking steps toward what’s known as “crisis standards of care.” Nurses may be assigned more patients to care for, or people may be put in parts of the hospital that aren’t normally used for ICU patients.
Unvaccinated
All but one of the patients in OHSU’s COVID-19 intensive care unit last week were unvaccinated.
For the medical professionals trying to save their lives, that can be one of the hardest parts of working through this crisis: caring for people suffering and dying of a syndrome that has no cure, but that’s preventable with a vaccine.
Kleese said she primarily feels grief that her patients and their families are suffering unnecessarily.
“I think there can be misplaced anger for people who simply don’t have the right information,” she said.
“Sometimes they will say, ‘I was wrong, when can I get the vaccine?’ Sometimes they’ll deny it to their dying breath, and sometimes they don’t get to ever know what their outcome is because they die too soon.”
Their work is exhausting. Frustrating. Sad. Overwhelming. And endless.
Each nurse said camaraderie and a sense of supporting each other is what keeps them showing up day after day.
But that won’t stop the pandemic or keep people from dying of COVID-19 in their ICU. More people getting vaccinated and wearing masks is the only way out.
“10 years down the road, I think I’ll be really proud of the nurse I was these couple of years,” said Kristen Roach, who picked up an extra shift to help her colleagues this week. “I think we need to think about our future selves and how we would look back on this moment. And to feel like you did everything you could to limit the transmission of delta would be something that you could feel really proud of.”
Kristyna Wentz-Graff contributed to this story.
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