PHOENIX (AP) – They saw the ominous pictures: crowded hospitals, exhausted nurses, bodies piled up in morgues. It was far away, in New York, northern Italy, and other faraway places.
Now, after three months of anxiously waiting and preparing, Arizona nurses and doctors are on the front lines as the coronavirus migrates through the state, making it one of the world’s hot spots. The trickle of a few virus patients in March became a steady stream two weeks after Arizona Governor Doug Ducey finished a home stay order in mid-May and allowed most businesses to reopen, and is now an endless plague in sight.
A nurse in the intensive care unit on the Phoenix subway, a nurse, said she cries when she thinks of all the people who died from the virus in her hospital, or when she held the hands of a frightened patient during an intubation . Medical personnel describe busy emergency departments where patients are put on fans, waiting for a place in the intensive care unit to open. A goodbye is said through a window in Tucson.
Angela Muzzy, with 31 years of experience, said she tells younger nurses that they will remember how they helped people during a historic national crisis.
“We take care of doctors who have contracted this, we take care of mothers. Last week we withdrew the life support of a 48-year-old mother and I stood there with her 17-year-old son when she died, “said Muzzy, a clinical nurse specialist at Tucson Medical Center in southern Arizona, where all 20 of the 36 ICU beds for virus patients are full.
Hospitals across Arizona, a state of over 7 million people, spent a six-week blockade and a nearly two-month ban on elective surgeries to prepare for the wave that is now emerging. They have prepared emergency plans that allow them to increase capacity by 50%. They have stocked masks and coats and trained professionals who normally work in operating rooms or other areas to care for virus patients. Dr. Lisa Goldberg, director of the emergency department at Tucson Medical Center, said her staff did exercise, training, and preparation.
Meanwhile, a Republican Ducey argued that the closures he ordered had delayed the spread of the disease and that hospitals were now much better prepared. While emphasizing the need for social distance, he opposed wearing a mask himself in public, even if there were cases where he dismissed the calls from some cities so that they needed masks.
When the wave of business could no longer be ignored, Ducey turned around on June 18, allowing cities and counties to demand masks in public, but did not issue an order for the entire state. Most have, including Phoenix, Tucson and Yuma and the counties that surround them.
Today, hospitals around the world are filled with patients, some of them seriously ill. The state had over 66,000 confirmed cases as of Friday, up from just over 20,000 on June 1. Thousands are reported daily and 1,535 people have died.
More than 2,400 people were hospitalized this week with coronavirus, compared to about 1,000 three weeks ago. This week, more than 600 ICU beds were filled with virus patients, two thirds of which were on respirators and anesthetized.
Arizona has just over 200 empty ICU beds, out of the approximately 1,600 in the state. More are added when hospitals brace themselves for a flood of patients, while newly infected people slowly become sicker. Traveling nurses are hired from other states to support overworked personnel.
“This is not a sprint, this is a marathon. In fact, it’s an ultra marathon, “said Goldberg.
Death is always present on ICUs, but it is even more common in virus patients, and often debilitating and long-lasting.
Ventilator patients are brought into an essentially medically induced state of floating animation as machines breathe for their virus-infested lungs. They are connected to multiple IVs and drains, with a breathing tube down their throat. They can stay at the ICU for weeks or months.
Nurses enter their ward 12 hours a day, put on their gowns, respirators, gloves and goggles, and enter an otherworldly environment. Patients are cut off from their families and often all become reality. They are often slapped on their bellies for hours, a move called proning that has become a way to help those patients breathe, but it’s a grueling task that requires six to eight nurses, respiratory therapists, and doctors.
For younger nurses, some of the worst deaths are from young, previously healthy patients, including a woman less than 25 years old who died in Scottsdale.
She deteriorated quickly, said Caroline Maloney, a nurse at HonorHealth’s Scottsdale Osborn Medical Center with 28 years of experience at ICUs. “And it was very emotional,” she said, “I know a nurse couldn’t even talk about it.
“They see this firsthand and it’s unnerving to see when their peers are in a hospital bed and they have to take care of them,” said Maloney.
However, she said her hospital is seeing ‘great results’ and that most of her IC patients are recovering.
For most people, the new coronavirus causes mild or moderate symptoms, such as fever and cough, that disappear within two to three weeks. For some – especially older adults and those with pre-existing health problems – it can cause a more serious illness, including pneumonia and death.
Families of virus patients are generally not allowed to go to bed, leaving care providers to arrange phone calls and FaceTime links via tablet computers. The hospital in Tucson is a rare case where families can visit their loved ones – at least through a window. That’s because it’s an older facility and mainly one floor, with all of its ICU rooms on the ground floor. Each has a small patio with windows.
It’s where Muzzy often leads family members when they say goodbye to their loved one after making the decision to end the care.
“I’m saying it’s physically, emotionally, psychologically, spiritually exhausting,” she said. “Our nurses, those who do the 12½ hour shifts, endure them day after day. They are great. They are very strong. ‘
But not unbreakable.
An ICU nurse who said emotionally during an intubation that she was holding the hands of a frightened patient during an intubation described conditions to The Associated Press about her overwhelmed ICU in Phoenix, provided her name is not used because her employer is talking to the media is limited.
She has facilitated FaceTime conversations with distant relatives and faced constant nursing of patients, taken from the overcrowded emergency room to the ICU, and then back to the general nursing unit if they show improvement, or to the morgue if they don’t.
Like Maloney and Muzzy, she said her managers have robust staff safety procedures in place and adequate protective equipment, but she says the toll of the sick and dying patients is starting to become a burden.
“I don’t think there is a shift where people don’t die,” she said. “It’s awful. The nurses are just stunned.”
“I’ve never seen so many people die before. Every day.”
In one case, a woman in her forties with coronavirus symptoms went to the emergency room, was tested, and then sent home. Her family also fell ill and she returned to the ER as her condition deteriorated. Then she was taken to the ICU. She initially resisted intubation, and the nurse called the patient’s sister and friend to provide updates.
She said “I’m really scared to be intubated.” I said I know. She said, “Do you want to stay here, hold my hand? Promise me I’ll be all right. Said the nurse. “And then she lasted two and a half weeks and we did everything … We did all things and she died eventually. It’s such things all the time, all the time. ‘
Hoffner reported from Yankton, South Dakota.
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