KC Cherveny, a Duke Regional Hospital ICU nurse, knows it’s time to intubate critical COVID-19 patients long before medical test results say so.
“You can see it in their face, and you can see it in their whole body,” she said.
A year into the pandemic, Cherveny has learned all too much. She started speaking louder to be heard through astronaut-like protective hoods, heeded advice to take time for herself and found a way to handle so much death.
But among the many lessons and traumas, the moments before intubation linger most in her mind. She can’t count the number of times she’s assisted with this last-ditch step to try to save people from COVID-19.
Patients frequently ask if they really need a tube inserted into their airway so a ventilator can breath for them.
“The answer is always yes,” she said.
Often Cherveny’s next step is connecting with their family, on an iPad.
“It’s hard when they’re basically saying goodbye to their loved ones and sometimes they may not know that,” she said.
As people getting vaccines makes things start to feel more normal, Cherveny has a message for those who can’t see inside a hospital ICU: “We’re definitely not out of the woods yet.”
Inside the ICU
COVID-19 has killed 12,224 North Carolinians. In Durham County, the virus has taken 215 lives.
Duke Regional had 12 COVID-19 patients on March 30, including four in intensive care, according to Duke Health spokesperson Sarah Avery. The hospital’s coronavirus cases gradually decreased over the last few weeks. Still, the severity of illness and level of attention patients need in the hospital’s 22-bed intensive care unit remains at an all-time high, Cherveny said.
As the unit’s palliative care liaison, Cherveny keeps track of sobering metrics. Her unit faced a COVID mortality rate around 80% in January, she said. On a single day that month, she said, seven patients died.
“It’s astonishing. I mean, we have never seen this level of death, and the amount that we’ll have in one day is sometimes unbearable,” she said.
The pandemic has physically altered her unit. Drips hang in the hallway, connected to patients inside rooms via tubes threaded through holes in the wall. That allows nurses to more easily manage medication and risk less exposure.
The environment that intubations occur in has changed too. The procedures take place behind closed doors now, Cherveny said. A downsized team inside the patient’s room coordinates medication and supplies with supporting staff in the hallway via walkie-talkies, one of many innovating steps, she said, that Duke Health took to make patients and medical workers safer.
Of course, the challenges ICU nurses face has also changed. It’s hard to not feel hopeless sometimes, she said.
“We deal with critical patients all the time. I think this is such a different level of critical,” Cherveny said. “We want so badly to be able to fix it and be able to tell these patients that everything’s gonna be okay.”
In response, Cherveny started a nurse support group in her unit, where she is a charge nurse in addition to caring for patients.
At the meetings she and other nurses, especially those new to the work, discuss the death and damage they see and how they’re coping.
“We’re the only ones that get it and understand what each other is going through,” Cherveny said. She relies on family too, and is trying to take more personal time. “We’re caretakers and we go into it for that reason. A lot of times it’s very easy to lose sight of ourselves,” she said.
In her role leading palliative care, she also preps fellow nurses for COVID-19 deaths. The patient will have air hunger, she tells them.
“It’s something that’s so difficult to watch. And it’s so sad. But it’s a humbling experience for me to be able to provide that level of care for somebody in those final moments,” Cherveny said.
Just being there is a service, she says.
Cherveny dims the lights and plays music in dying patients’ rooms. She gets loved ones who can’t be there on the iPad.
“It can be hard to shift that mindset when you’re in ICU and you’re used to treating, treating, treating,” she said. “We tried everything we could, we know that we did, but now we are the ones that can provide comfort for these patients and give them a death with dignity.”
Talk of the end
Cherveny’s fellow nurses have helped her get through these many months. Every morning, Duke Regional ICU nurses huddle up. Each shares two good things and something funny, an early injection of positivity.
“The capacity that nurses have to take care of such a severely sick population is just amazing to me,” she said.
She recently created a “dove award” for compassionate end-of-life care in her unit. There’s been so much of it this year, and it too often goes unrecognized, she said.
It hasn’t escaped her notice that community gestures of gratitude for the “front-line worker” have faded away. Maybe people have forgotten, she said. Or maybe they’re just not paying attention.
“It’s not that we’re seeking that, but when we do get it we feel a little more valued,” she said, “and know that that recognition is there that we’re still fighting this virus.”
In the last month, the Duke Regional ICU has seen more success saving people afflicted with COVID-19 than it did in the pandemic’s worst moments, Cherveny said. The improvement fits a national trend: hard-earned experience, demographic changes and reduced strain on ICU caregivers are leading to lower death rates.
Still, “as hospitalizations continue to be the rate that they are, I won’t be able to say it’s getting better for a while,” she said.
For this reason, Cherveny is discouraged by what she sees outside her hospital, where people are returning to more normal lives, traveling, going unmasked, not social distancing.
Vaccination and adherence to coronavirus safety guidelines will eventually bring rates down enough, she said. But we’re just not there yet.
“More than anybody, I am so ready for this to be over,” she said. “We’re a lot more used to doing this, but it doesn’t make it any easier. I wish people understood that more.”
9th Street reporter Jake Sheridan can be reached at email@example.com
At top: Nurse KC Cherveny has a message for those who can’t see inside the Duke Regional ICU: “We’re definitely not out of the woods yet.” Photo by Sho Hatakeyama