NH COVID care nurses pushed to limits. An inside look.

Jennifer E. Engen

DOVER — Russell Howard of Rochester didn’t think it would happen to him.

So, he never made the time to get vaccinated against COVID-19.

After more than a month in Wentworth-Douglass Hospital’s Critical Care Unit and weeks on a ventilator, Howard told a reporter who visited the unit he’ll get the vaccination as soon as he’s able.

“I just didn’t get around to it,” he said. “I wish I did.”

Howard, 63, was admitted to Wentworth-Douglass Nov. 29 and intubated Dec. 4. He was extubated again Dec. 18 and intubated again the same day, before being extubated Dec. 21. He was still pretty sick the next day, but he was breathing without the help of a machine and was able to eat soft, bland foods. His voice, because of long exposure to the breathing tube, was soft and raspy.

He came to the hospital when he was having trouble breathing. He had bought not one, but two COVID tests — they both came back positive.

In his hospital bed, Howard said he was never philosophically opposed to the vaccine. 

Now he’s telling anyone who will listen: “Go out and get vaccinated. You do not want to go through what I did.”

Because of his condition, it will be a while before Howard can receive the vaccine.

Registered Nurse Becky Roy said he will likely be moved to a rehabilitation facility to continue his recovery.

“I would tell people the same thing the doc told me,” Howard said. “It’s not always about you and what you want. It’s about the effect you can have on the public’s health. I had COVID for three or four days when they asked me to sign advance directives, I was really scared then and I saw the seriousness of it. That was when I wished I had done the vaccine.”

Most of Howard’s family are vaccinated, including his daughter, a nurse.

Did she yell at him?


Howard asked his nurse, Megan Boucher, to tell him some good news. 

“You are the good news this morning,” she said, in reference to his breathing tube being removed. “You are the only good thing in here today.”

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Howard was one of the lucky ones. Only 24% of people who are intubated live and most face a long road to recovery, with many related illnesses to cope with, according to the National Institutes of Health. Ongoing health problems, often referred to as long-haul COVID, are also a concern.

In late December, nurses and other Wentworth-Douglass Hospital staff gave a reporter and photographer unprecedented access to the Critical Care Unit. While they could not enter the rooms of severely ill COVID-19 patients, the staff answered questions about the care they give, the odds of survival and the death toll they are seeing. 

They also helped arrange an interview with Howard. Extubated (having had his intubation tube and ventilator removed), he might live, and if he does, he will have beaten the odds. Most patients sick enough to be intubated die.

A study done by the National Institutes on Health, concluded “76% of critically ill COVID-19 patients died after non-resuscitative intubation and IMV support. Non-survivors had more comorbidities than survivors. Mortality after non-resuscitative intubation in critically ill COVID-19 patients is associated with the disease severity at the time of IMV initiation.”

Nurses in COVID care: ‘See what we are doing’

Nurses caring for COVID-19 patients at Wentworth-Douglass Hospital’s Critical Care Unit want people to get vaccinated and see their daily reality.

Deb Cram, Fosters Daily Democrat

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Nurse manager Michele Clark, who has been a nurse for 45 years, said the death toll is unlike anything she has ever seen.

“In a typical year in a Critical Care Unit, we might lose 15 patients,” Clark said. “We lost 15 people in the past two weeks alone. Most of them were unvaccinated.”

Two deaths were people who were vaccinated. Both were older and had other comorbidities that contributed to their death.

Registered Nurse Becky Roy’s shifts are 12 hours long beginning at 5:30 a.m. As she gets ready for the morning report, the North Berwick, Maine, resident stashes her street clothes in a locker adorned with pictures of her children, Griffin, 6, and Ellie, 4.

Becky Roy, a registered nurse, clears the area surrounding a COVID-19 patient at Wentworth-Douglass Hospital.
Deb Cram/Fosters.com and Seacoastonline

“They are too young to really understand,” she said of her children. “Griffin kind of does. He has to wear a mask at school and he calls it the virus. Ellie has no idea. I used to be afraid for them, and I still am, but now we know more about how I can protect them.”

Donning and doffing PPE 12 times a day

Every time a nurse, or anyone else enters a room, they must suit up at the “donning” stations distributed liberally around the unit. It includes gowns, surgical masks, N95 masks, face shields, hair coverings, gloves and shoe coverings.

When they come out, they “doff” the PPE, and it becomes trash.

“We do it at least 12 times a day, at least once every hour,” said Brooke Lawler, RN. She is a first-year critical care nurse and her preceptor, the veteran nurse she will shadow for a certain period, is Roy. 

On a regular 12-hour shift at Wentworth-Douglass Hospital, a nurse can expect to get in and out of personal protective equipment about 12 times a day.
Deb Cram/Fosters.com and Seacoastonline

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Because of this need to use so much PPE, a “MacGyver” solution was created. The cart where all the IVs and meds are hung is now outside of the patient’s glass fronted room. They can see the patient and the patient is connected to the cart by wires hung through the glass. 

This innovative setup saves on PPE.

We are patients’ ‘eyes, ears and voices’

A nurse since 2004, Roy said she loves critical care because it allows her to be an advocate in the care of patients who likely are not able to advocate for themselves. 

“We are their eyes, ears and voices,” she said. “Now, I want all people to see this, because the COVID pandemic, the numbers of cases are the worst we have ever seen, worse even than when the pandemic began in March 2020. We want everyone to understand what we see every day. We are seeing younger patients. We are seeing sicker patients, and this could have been prevented.”

“We want people to know we are here fighting and we want people to get vaccinated,” Roy said. “We want to raise awareness and we need everyone to help by doing the right thing. This is real and it’s here right now.

Registered nurse Kristen Hallinan waits for the rest of her team to help flip a COVID-19 patient in the Critical Care Unit at Wentworth-Douglass Hospital.
Registered nurse Kristen Hallinan waits for the rest of her team to help flip a COVID-19 patient in the Critical Care Unit at Wentworth-Douglass Hospital.
Deb Cram/Fosters.com and Seacoastonline

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Four days after Thanksgiving, a surge of patients began to arrive at the hospital. The hospital expanded the COVID unit into the PACU (Post-Anesthetic Care Unit).

They were bracing for the expected next big surge following the holidays. They don’t just think it’s coming. They know.

“People are going to have big group gatherings,” Roy said. “If they were all vaccinated; it would be safer, but that’s not going to be the case in many situations. If people are not vaccinated, it is a huge risk right now, with delta, with omicron.”

They also know more people are going to die, no matter how hard they fight to care for patients.

This is data captured on Dec. 22.

COVID case surge in New Hampshire

Hospitals across New Hampshire are seeing the same pressures as Wentworth-Douglass.

“This past year has brought the heart-breaking loss of nearly 2,000 family, friends and loved ones to COVID-19 with hundreds of others experiencing very difficult stays in hospitals and many on ventilators,” said Steve Ahnen, president of the New Hampshire Hospital Association. “Our hospitals and clinical teams are extremely tired from what soon will be a two-year battle against COVID-19.  We need Granite Staters to understand the severity of the situation we are facing and consider getting vaccinated against COVID-19. It protects you from serious illness, hospitalization and death, and we’ve lost too many to this virus, so all of us need to do our part to end this pandemic.”

The daily staff report at Wentworth-Douglass is given in a room laden with candy. People bring them so much candy they would need to eat it all year long to make a dent. 

“Don’t discount sugar,” joked one nurse.

Signs on the walls are visual pep talks like “You are doing a freaking great job,” “We see you, we love you” and “This is not a poster: It’s a hug, It’s a prayer, It’s a reminder that you are enough.”

A tree and other holiday decorations adorn the nurses’ stations, small signs of hope. 

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It sounds upbeat but the report — where all the nurses on a shift gather to hear what went on the previous shift and to be assigned their daily patients — offered up the sobering news another woman had died the night before. 

The woman who died was a local teacher, and she was not vaccinated.

“When the first surge happened, elderly people were the population most affected. Now, most of them are unvaccinated,” Roy said. “We are seeing a lot of younger people. We are seeing 40 to 60, but we recently lost a 27-year-old man. Many people are in denial. They don’t think it will happen to them. I feel for them, but also for the family they are leaving behind because it didn’t have to be this way.”

Registered Nurse Becky Roy holds the arm of a COVID-19 patient after Respiratory Therapist Philip Hosmer, left, and a team of nurses and staff flipped the patient to help his breathing.
Registered Nurse Becky Roy holds the arm of a COVID-19 patient after Respiratory Therapist Philip Hosmer, left, and a team of nurses and staff flipped the patient to help his breathing.
Deb Cram/Fosters.com and Seacoastonline

“We are seeing more than one death in a family,” said Clark, the nurse manager. “The rest of the family gets to watch as they die, and they cannot visit, at least not until the situation has become so degraded that it is inevitable.”

Clark said people think it can’t happen to them. Some believe misleading comments from certain politicians, televised reports by people claiming to be experts, and the Internet, promoting Ivermectin and Vitamin C as “cures.” Others want to stick with holistic remedies that don’t work. Then they come to the hospital.

Among the very sickest patients in critical care at Wentworth-Douglass is a homeless woman who has a substance use issue. She is diabetic and was likely not managing her care well, exacerbating her condition. 

There is a 61-year-old man who looks like he’s sleeping peacefully. Actually, all the intubated patients look like they are sleeping peacefully.

“We keep them pretty sedated,” Roy said. “In some cases, we paralyze them. We do not want them to wake up and pull out the tube. We also do not want them to remember this, if they live.”

Patients are sedated using fentanyl and Propofol, both serious narcotics.

“Proning,” a skill critical care nurses mastered during the coronavirus pandemic, means placing an unconscious person on their stomach for up to 16 hours as it sometimes helps them to breathe better. It has to be balanced by laying the patient supine, on their back, for four hours, and a patient’s head must be moved left to right at intervals, to help prevent pressure sores. Roy said they call it swimming as they put one of the person’s arms up so they can better track the direction they need next to turn his head. 

Roy showed X-rays of a healthy lung and a COVID-infected lung. The first is a healthy looking black, while the COVID lung is fibrous, with white edges and strands crossing the lung area.

An X-ray shows a COVID-19 patient's lungs are seen at Wentworth-Douglass Hospital in Dover.
An X-ray shows a COVID-19 patient’s lungs are seen at Wentworth-Douglass Hospital in Dover.
Deb Cram/Fosters.com and Seacoastonline

It takes a team of three to five people to “flip” a patient. Each nurse has two to three patients of their own, so teamwork is required.

“We take care of each other,” Roy said. “We are in a lot of texting groups and we have a closed Facebook group where we can talk and de-stress. We used to go out together, but now we don’t do that. My time away from here is spent with my family.”

Clark said she watches her team carefully.

“I check on them, make a personal connection,” she said. “I send an email, a text. I watch their body language to see when they might be a little down. I make that human connection we all need.”

Clark is losing nurses. She said one left because she was told she could not see her grandchildren if she kept working on the floor. Others are burned out and looking for different career paths.

“It’s hard to lose senior nurses,” she said. “And I worry about the new ones.”

Philip Hosmer, who has been on the job for 33 years, at several area hospitals, is one of numerous respiratory therapists on the floor.

“I am in charge of the vents,” he said. “I check them every four hours. I assess the patients and help with intubation. I help flip the patients. You don’t realize how much a head weighs until you need to move it.”

Becky Roy, Registered nurse at Wentworth-Douglass Hospital
These patients are the sickest I have seen yet. When they decline, it can happen quickly. If we take them off ventilators, they can’t breathe or they are breathing very badly. We lost a 27-year-old man, to cardiac arrest. COVID makes them septic and their body’s organs begin to fail.

Visitors are not allowed, with only special circumstances receiving exceptions like end of life. 

“Then we will dress up the family in PPE and let them sit with their family member,” Clark said. “We still have so much compassion, but we need to take extreme precautions. By then it is palliative care. Often the family must make the tough decision to withdraw care if there is no chance for recovery.”

Nurses will hold the phone to the ear of the patient, on the chance they can hear their loved ones’ voices. They stand and cry for patients, and cheer small victories.

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‘Our hospitals are overwhelmed’

“People come in here and expect science to save them,” Hosmer said. “Sometimes it is too late because they should have listened to the science sooner. Is it because it’s politicized? Vaccines have been a part of our lives for a long time. So why are they coming into critical care? Why not just get the vaccine? Some people say they don’t want mandates, but our hospitals are overwhelmed. People having a heart attack might have to wait. There are so many reasons to just do the right thing.”

Staff shortages are a problem so the unit “borrows” nurses from other floors, the emergency department, telemetry floors, and they even have a traveling nurse. They also currently have FEMA paramedics sent by the state to help out. 

COVID care at Wentworth-Douglass Hospital

A respiratory therapist at Wentworth-Douglass Hospital explains his frustration.

Deb Cram, Fosters Daily Democrat

Bed shortages are handled creatively, like musical beds. In the Critical Care Unit, each room is a single, private room, until it isn’t. Sometimes the rooms need to fit two beds. Other areas of the hospital like the Post Anesthesia Care Unit are used for COVID beds as some elective surgeries are deferred right now. Critical COVID rooms are negative pressure rooms, so that’s a requirement if patients are moved.

Negative pressure rooms are used to contain patients who have infectious diseases, like COVID. Air exchange is isolated to the room, keeping it away from others in a facility.

‘The sickest I have seen yet’

“Last week we had 13 people intubated and on vents,” Roy said. “These patients are the sickest I have seen yet. When they decline, it can happen quickly. If we take them off ventilators, they can’t breathe or they are breathing very badly. We lost a 27-year-old man, to cardiac arrest. COVID makes them septic and their body’s organs begin to fail. One man, if he survives, will be on dialysis for the rest of his life. Most retain fluids and are endemic, meaning COVID will likely become a factor of their life in one way or another.” 

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Roy said family members get angry at them. She said they yell and are frustrated. It is not easy for the staff who are doing all they can, but they get it.

“I am blunt with my patients,” Hosmer said. “I tell them to believe what science says, not what social media says.”

“As a new ICU nurse, I can tell you it’s quite overwhelming,” Brooke Lawler said. “I am definitely learning so much, but a new nurse is not usually put with patients this sick. But we do what we have to.”




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