Inside the ICU: COVID-19 pandemic as seen through the eyes of a patient, nurse, doctor
Amid the political whirlwind surrounding the COVID-19 pandemic, it’s easy to forget the real battle isn’t being fought at the Sedgwick County Commission, or the Kansas Statehouse, or on Capitol Hill in Washington.
It’s being fought all day, every day, in Intensive Care Units at hospitals in Kansas and across the country.
It’s a struggle that takes place out of the public eye. Even close family members are barred from having access for the safety of all, given the contagious nature of the coronavirus and the many special precautions needed to prevent its spread when caring for the sick and in too many cases, the dying.
The front-line soldiers of this conflict are the patients who struggle alone to breathe and maintain hope while their bodies try to fight off the effects of a contagion that has no definitive cure.
. . . And the nurses, who in this extraordinary emergency serve not only in their usual role as caregivers, but also as substitute family and their patients’ daily reminder there’s a world outside the walls of the ICU.
. . . And the doctors, called on to fight COVID with weapons that are at best marginally effective.
There have been, at last count, 5,213 cases of COVID-19 identified in Sedgwick County since the pandemic came here.
This story focuses on one case that’s played out over the past several weeks at the Ascension Via Christi St. Francis hospital in Wichita.
One patient, one supervising nurse, one doctor.
This is their story.
The patient
Having suffered from COVID-19 and double pneumonia at the same time, Angie Mooneyham said her life reminds her of a cheap horror movie.
“I can’t just have one thing,” Mooneyham said. “I have to do it the hard way.
“You know, it’s like ‘Why don’t you take this road and go straight to the highway?’” she said. “No, let me take that old crappy road over there and have a blown tire and have a wreck and almost get eaten up by some ‘Hills Have Eyes’ people. And then I’ll get back on the highway.”
Mooneyham spoke with The Eagle by telephone from the Intensive Care Unit at St. Francis about a week ago.
Age 45, she’s a mental health counselor with her own practice and a mother of four children ranging in age from 18 to 27. She also helps out in her sister’s salsa business and serves as a captain in the Kansas Army National Guard.
In the COVID unit, she couldn’t have visitors, so she missed out on her son Grant’s 22nd birthday.
She missed helping her daughter Karley, her youngest, move away from home and into the dorm at Butler Community College.
Instead, she was hooked up to oxygen and an IV, taking steroids and she doesn’t even know what all else.
Mooneyham’s COVID journey started about a month ago when she was having trouble breathing and went to her family doctor.
“I’ve had pneumonia before and I felt very similar,” she said. “I went to my doctor and got the COVID test and that actually came out negative.”
Her instructions: “Go home. Rest. Stay in bed unless your fever gets, you know, really high and you absolutely can’t breathe.”
As her condition worsened and breathing became increasingly difficult, her fiance told her she needed to go to the emergency room.
Instead, she tried to tough it out.
She has military health insurance through the Guard, but because she’s not on active duty, it’s not a top-level plan.
And because she runs her own business, if she’s not working she’s not getting paid.
“I’m kind of stubborn, I’m not going to lie,” she said. “I was like, honestly, who wants an ER bill, right? I was like, I can’t do that. So I kind of held off one more day.”
Finally, she went to the emergency room in Derby.
A CAT scan later, “They’re like, ‘Oh yes, you have double pneumonia on each side . . . and you know, we’re going to test you again for COVID. So they tested me again and of course it was positive . . . two compartments of my lungs had collapsed.”
She has no idea where or how she got infected with COVID.
“I masked up, I haven’t been to work in weeks because I’ve been sick, I was just at home, you know?” she said. “Really didn’t go anywhere. It’s just baffled me. I have no idea. Everybody else in my house is fine.”
She said she doesn’t think her first negative coronavirus test was wrong, but that having pneumonia already made her more susceptible to COVID-19.
Mooneyham said she has several friends on social media who have been infected with the coronavirus and they’re all at home with flu-like symptoms.
She’s the only one she knows who actually had to be hospitalized.
“I think that’s what’s scary about this disease . . . you don’t know,” she said. “You could just have body aches and be fine, or you could end up in intensive care. It’s kind of gambling. It’s like a crap shoot.”
Mooneyham was discharged to home this week.
One treatment she never got was plasma infused with the antibodies of patients who have gone through COVID. There’s not enough of that to go around.
She said as soon as she’s able, she’ll start donating her plasma to help others.
The nurse
Jenifer Phelps says Mooneyham’s positive attitude helped her bounce back faster than many of the ICU’s other patients.
Phelps is a registered nurse who supervises the other nurses in the COVID unit of St Francis, a regional hospital that draws patients from throughout southern and western Kansas.
“Angie just seems to me to be a positive person,” she said. “She never did once complain about anything. She was open and honest about everything, but Angie has this hope. And I think that’s kind of what kept her going.”
Like most COVID patients, Mooneyham’s primary challenge was to keep enough oxygen in her bloodstream to maintain critical organ functions.
That’s the main thing nurses look for when caring for COVID patients, essentially trying to keep them alive long enough so they can develop their own resistance and fight off the disease.
ICU nurses are used to dealing with death, but not at nearly the level they’re seeing in the pandemic, Phelps said.
Ordinarily, it’s about one a week, maybe every two weeks. But with the COVID situation, it’s been running seven or eight a week, Phelps said.
And because the unit can’t allow visitors, nurses have had to step in as kind of a surrogate family for their patients.
“You know, you have nurses that literally have held a patient’s hand until they died, because the family member could not be there or maybe the family member was out of town,” Phelps said. “And the patient (declined) so quickly that the family member wouldn’t even have been able to make it. It’s those calls (that) are rough.”
Sometimes, the COVID is so bad that patients can’t be off oxygen or breathing machines even momentarily without their blood-oxygen level falling to the danger zone, she said.
“I recorded a guy the day before yesterday, he was getting ready to be intubated (for a ventilator),” she said. “I recorded him saying his wife’s name and that he loves her. I won’t say what her name is, but he said her name and he said, ‘I love you’ and I have that recorded on my phone. Because I don’t know if he’s going to make it. And if he doesn’t make it, then I will reach out to her so she can have that.
“That’s my new way of thinking. Do we do that with people that are (going) on the ventilator? Do we try to record them saying something so their family can have that piece of keepsake? That’s something that I would have never dreamed that I would have to do, but I’m doing it.”
Prayer is also part of the process.
“Being a Catholic-based hospital, and me personally, I’m not Catholic, but I am a Christian, I asked these people — they’re scared — I asked them if they’re believers in Christ and if they’re not, you know, I respect their faith.
“But if they are, I pray with them. I prayed with someone today. I prayed with someone yesterday, because they need that comfort to know that Christ has not forgotten about them. So those are the things that we are are faced with and dealing with. We do have the Face Time, (for family contact) but it’s totally different to look at somebody through a TV screen than to touch them, feel them, feel their kiss, feel their hugs.”
Nurses don’t get their usual downtime to decompress.
“It’s a totally different world now that we’re having to wear the PPE (personal protective equipment) for such a long time,” she said. “You got the masks, you got the face shield, the gown, and things are hot. You’re in there, these patients are so very sick, you can’t get away a lot.”
Because COVID is so contagious, the hospital had to create a special unit just for those patients to decrease the chance of spreading the disease throughout the facility.
While that doesn’t sound difficult, it is, because the COVID staff has lost access to a lot of common spaces.
“We lost our entire break room, we lost our lounge area, we lost our huddle area,” Phelps said. “I’ve got 80 employees. They all just lost their lockers, their personal space.”
They’ve had to adapt other spaces within the COVID unit to compensate.
“Our family waiting area is now our lunch area,” Phelps said. “We have a separate area there for our (PPE) donning area. We have an area where our employees can keep their masks and we now have a small locker area.”
She said the teamwork that’s been instilled over the years among the intensive care staff is what’s carrying them through the pandemic.
“We are called, at this moment at this time,” she said. “And we’ve been chosen to take care of these people. So let’s make the best of what we can do to take care of the people, because one thing that we have to look at too is that (unlike the patients) we have the privilege to leave at the end of the day and go home to our families.”
The doctor
Dr. Dennis Oyieng’o is no stranger to fighting diseases without the right tools in his toolbox.
He was born and educated in Kenya and became a doctor just as the AIDS epidemic was sweeping the continent in the 1990s and early 2000s. Medication to treat it effectively was in short supply in developing countries.
“I remember being in the medical wards in Kenya and feeling kind of the same way we are right now — a lot of frustration, a lot of tough days and tough nights and losing a lot of patients,” he said. “It is frustrating that we don’t have the right treatment . . . to try and have some rapid recovery from this disease.”
COVID treatment is mostly a combination of support and encouragement.
“What we want is for them to stay alive long enough to recover from the disease,” Oyieng’o said. “But unfortunately, some of them cannot sustain themselves, so you have to put them on life support. And when they get on life support, they don’t seem to recover from that.”
It’s hard on everybody involved.
“Despite what you do, they still seem to progress and eventually die,” Oyieng’o said. “And the lack of proper treatment is frustrating to the patients, to the family, to the physicians and to the nursing team as well. There’s a lot of mental strain to get through this every day. It takes a lot from you.”
There are so many patients, he said, he can’t spend as much time as he’d like with each one to offer moral support and encouragement. Depression and withdrawal are common co-conditions to COVID, he said.
“They’re mostly lonely most of the time,” he said. “We try to substitute and bless and try to be encouraging, but we can never replace what families can offer.”
And even the doctors and nurses are separated from the patients.
“When we go in there, we go in with masks and gowns, so even (then) the social contact is not normal,” he said.
Communication with those on the outside is also an issue.
When families have daily access to their loved ones in the hospital, they generally get a sense of how they’re doing and what their prospects are, Oyieng’o said.
It’s hard to convey that through words alone, he said.
“People who are home, who are trying to understand, they can only imagine what’s going on with their (family) members,” he said. “You can try to give them a picture about how the patient is doing. Sometimes they might be more hopeful than you want them to be, and sometimes they look like they might have more despair” than was intended.
Oyieng’o said a hopeful attitude can make a big difference in the medical outcome. Those who push themselves the hardest seem to be those who generally do the best.
And Mooneyham is a fighter, he said.
“The bigger thing is just her mental strength,” he said. “When she came in, she was very positive. She was looking forward to getting better. She was willing to get out of bed and move and she was willing to try and eat.
“A lot of patients, when they’re depressed and they’re withdrawn, they don’t even want to move out of bed, which actually works against them,” he said. “They get more and more deconditioned, they get weaker, they lose strength and eventually they succumb to the disease.”
The best treatment for COVID, he said, is not to get it in the first place. He strongly encourages everyone to follow the rules and wear protective face masks and practice social distancing in public spaces.
”If you can avoid the disease and delay you getting the disease, I think you’ll probably do better down the line because there will be more options, more things that we can do to try and you know, keep you alive compared to now,” he said.
While African-Americans were disproportionately affected by the first wave of the disease in April and May, Oyieng’o said now he’s seeing a lot fewer Black patients and a lot more Hispanic individuals.
“If someone can get the word out to them, that they need to take more precautions and be more cautious about the disease, that would make a big difference,” he said.
