All things considered, the request didn’t seem unreasonable.
Understaffed and overworked in some places to the point of collapse, hospitals struggling with a summer surge of delta variant COVID-19 infections reached out to the state for some relief.
As reported by the Virginia Mercury’s Kate Masters on Oct. 5, they sought an emergency waiver of state regulations that would allow hospitals to quickly boost the number of beds and add professional staff, among other things.
In August, the head of the Virginia Hospital and Healthcare Association, Sean Connaughton, wrote to top health officials in Gov. Ralph Northam’s administration asking for reinstatement of a waiver that had been in force through the pandemic until it expired July 1.
“Staffing levels at these facilities are severely strained by a shortage of health care workers and trained health care professionals, exacerbated by fatigue, personal illness and family needs stemming from this long-term pandemic event,” he wrote.
True enough, Sean. But drill down into those professionals’ lives and the full story really unfolds.
In the world of lobbying and brokering public policy, things get boiled down and desiccated into dry statistical summaries and bullet points. While they may present an accurate overview, they miss the pain, fatigue, sorrow, dedication and hopelessness that are the stuff of daily life for people like Mesha Jones and Ashley Apple. They are nurses, the sturdy common thread without which the nation’s hospitals and extended care facilities would have unraveled over the brutal past 19 months.
If you want to persuade senior administration officials and even Northam himself – a pediatric neurologist – maybe sit them down for an hour with front-liners like Ashley and Mesha.
Stories? Theirs, told first-person in voices weary and sometimes raw with sorrow, are tough to hear but impossible to ignore.
“They would show up at the emergency department, young, showing mild symptoms, and within an hour they were unable to breathe and were being intubated,” said Ashley, who worked primarily at St. Francis Hospital in the Richmond area through most of the pandemic before becoming a nurse practitioner in pediatric urgent care.
“It was shortly after the first wave started and I had patients (siblings) that were members of the same family. I was caring for both and they both had COVID, and another member of the family showed up in the emergency department to inform them that their parent had just died of COVID at another hospital,” she said, describing one of her most devastating shifts.
The nurses described a soul-twisting cycle that sets in for nurses and others with prolonged and unmatched proximity to those gravely ill and dying of COVID-19. Stricken patients quickly deteriorate. As the disease suffocates them from within, panicked eyes search desperately for some sign of hope, an assuring word, a loved one’s face or touch.
Somehow, nurses had to embody all of that. Or at least try.
When the end arrived for patients whom they had treated and sustained through many 12-hour shifts, it was not next-of-kin but Mesha, Ashley and frontline nurses like them who, because of strict quarantine protocols, held their hands as life flickered out. Afterward, they gathered themselves, moved on to the next patient, and the cycle repeated itself.
It was a moment commonly repeated several times during shifts indifferent to the dark of night, holidays, weekends, birthdays or family occasions; shifts often so busy that lunch and even restroom breaks were elusive, Ashley said.
“It makes you feel helpless. It’s such an intimate moment when someone leaves this earth. The ones who are supposed to be there are their loved ones, their closest friends and family,” she said in a telephone conversation last week. “It’s defeating. It feels defeating to face those types of situations and not be able to give patients what they would want in those final moments and the families what they would want, which is comfort and connection.”
Nurses persist because they must, internalizing the emotional and psychological trauma so they can perform their jobs, both women said.
“When you go through experiences like this day after day, you have to develop a tough shell, a place to stuff it all down, because you have other patients that are relying on you,” Ashley said.
The burnout shows in the shrinking corps of nurses as many exit the profession or find other specialties within medicine, as Ashley did.
“We have a lot of nurses that are leaving the bedside to go to other areas because of the stress of seeing patients die of COVID day after day after day,” said Mesha, a nurse at the University of Virginia Medical Center in Charlottesville.
“And with this current surge of (the) delta (variant), the patients are younger, and they’re getting sicker faster, and it takes a toll on you,” she said.
In 18 years at the UVA hospital, including the last six as a nurse, she has never seen her profession pushed to the brink as four waves of COVID-19 have done. Nurses are trained and paid to alleviate patient suffering, and they develop coping mechanisms. What they’re not prepared for is the unprecedented magnitude of suffering they encounter daily among their peers, Jones said.
“As a nurse, you have your tough days. But the worst is when I see my colleagues struggling mentally – some of the strongest colleagues I’ve ever worked with. Just seeing them crying, seeing them go hopeless because they can’t … ,” Mesha said, her voice stilled for a moment.
“As nurses, we want to fix everything,” she continued, “and it’s rough when you can’t fix this.”
The hard days don’t end when they clock out. They go home at the end of a shift, shower, maybe eat a bowl of cereal, and then fall into bed, pulling the covers fully over them – a brief respite before it begins again in a few hours; a cocoon away from everything, everyone, even family.
“I have nothing more to give,” Mesha said.
But collateral damage from the pandemic manifests itself everywhere they turn in our coarsened society: the kids’ schools, in stores and public places where people bicker about distancing, vaccinations and masks.
“You never get away from it,” she said.
These are just two health care workers. There are many thousands more with stories very similar if you care to seek them out and are lucky enough to find some with the courage Ashley and Mesha had to speak their truth to a stranger.
Their stories need to be heard, especially in the chambers of power. That’s particularly true when there’s something those in authority can do, as nurses say, to alleviate suffering.
So I wonder why our doctor/governor and his administration didn’t grant a waiver that hospitals could use to augment their besieged medical personnel and the facilities they needed to do their work.
As Kate reported, the governor’s chief of staff, Clark Mercer, said that reissuing the waivers would require Northam to declare another state of emergency even though not all hospitals were feeling the same stresses from the summer delta variant surge.
The governor’s 2020 emergency orders were not without consequence. Northam came in for some scathing criticism from the political right last year for orders that curbed or even closed many non-essential businesses and prescribed home isolation and masking in public. Those steps, however, eventually helped Virginia drive down its pandemic metrics and contain the disease sooner than many other states.
Mercer also rightly noted that high delta surge hospitalization rates strongly correlated with low regional vaccination rates. His boss, after all, is a medical professional — a proven believer in science and full-throated advocate for vaccinations.
But hospitals aren’t just coping with COVID-19 patient loads, which are finally receding. During months when the disease accounted for most every available bed in some hospitals, chronic health care problems that needed care were deferred. Now, sicker than they should have gotten, many find that hospitalization is no longer elective.
It’s beyond dispute that easy availability of free, safe and effective vaccines made this latest COVID-19 surge avoidable. It’s also vexing that, perhaps influenced by malignant misinformation and a pathological strain of politics, some regions rejected science, refused vaccinations and consequently suffered proportionally more and worse illnesses.
None of that, however, was the fault of Ashley Apple, Mesha Jones or thousands of their colleagues who truly needed a break. It’s a shame the governor couldn’t give them one.
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