Frontline Workers Series: A 12-Hour Shift in the COVID ICU with Katie Casey

June 10, 2020 by
Courtesy of Katie Casey
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It’s 6 am in the ICU, nearing the end of her 12-hour night shift.

Katie Casey is trying to communicate to a very sick COVID patient through her N95 mask and a face shield. The ventilation system — there to create negative pressure to avoid cross-contamination between rooms — is so loud it feels as though she’s inside an HVAC, and is making it especially hard for Casey to hear.

In the background, she can hear another health care provider shouting at their patient through a closed door. The policy is to limit the number of times you open and close doors in the COVID ward, so sometimes yelling through the crack of a door is the best option.

As she tries to connect with her patient, Casey, a nurse practitioner at Emory Healthcare in Atlanta, GA, thinks about what he must be going through.

  • “Normally in the ICU, visiting hours are wide open, family members can be by the bedside and can bring them belongings, and we can discuss things about the patient. But during COVID, visiting hours have been totally shut down, so the patients have nobody. We’re the only ones who can provide comfort, and it has been really challenging,” said the 33-year-old Casey.
  • “We convey so much through facial expressions, but it’s hard to show patients how much you care with a mask and goggles or a face shield. I can’t imagine what it’s like for them when all they see are your eyes. So the human side of it has been the hardest and most sobering — trying to make the patients feel comfortable and that they can get through this.”

To make communication easier, Casey’s team started using baby monitors to create a walkie talkie system to reduce shouting through doors. And to help patients feel more comfortable, they acquired an iPad specifically for patients to FaceTime with their loved ones.

  • “We try to let everyone FaceTime with family members at least once a day, or whenever they request. One family created an encouraging video for a patient, so in the evenings, even though he was sedated, we’d play the video for him,” she said.

Sometimes, it has been difficult to watch, but at least it provides comfort, Casey explained.

  • “I watched a father say goodbye to his daughter via FaceTime before getting placed on a ventilator. I held up an iPad for a wife to repeatedly (say), ‘Be strong. Come home.’ I listened as a family member said their final words to a patient via speakerphone,” she said.

Through the many heartbreaking moments, Casey has also witnessed glimmers of happiness.

  • “I also got to see the joy in a fiancé’s smile the first time she got to FaceTime with her loved one (after being) liberated from the breathing tube,” Casey said.

Being able to facilitate this type of communication for her patients has been the most important part of her job during the pandemic, she explained.

  • “We at the bedside are the only bridge between (patients and their loved ones). Providing that human care has felt like the most pivotal part of being a frontline provider during the pandemic,” she said.
Courtesy of Katie Casey

Casey, who has been working from 7 pm until 7:30 am, said most of the time she has been too busy to stop to process what she has seen. She has simply gone on autopilot: work, sleep, eat, work out, repeat.

And as always, the member of CrossFit Dwala in Marietta, GA said working out has been her COVID coping mechanism.

  • “I love that in the middle of the workout when you’re going so hard, it’s mind-numbing. All you can do is count your reps and breathe. For an hour or two, you enter a different space. It has always been a coping mechanism, but especially now it is,” said Casey, who competed on a team at the 2018 CrossFit Games.
Courtesy of Katie Casey

As for her COVID ICU experience, she said she feels like the worst is over.

  • “Things have slowed down. We have started a recovery plan, but of course, we’re prepared to ramp back up again if we need to,” she said.

And if that happens, she knows her team will be prepared — a team she said she is grateful to be a part of.

  • “The unity and togetherness to fight this virus has been the biggest takeaway for me,” she said. “There’s a lot of hope about how we’re dealing with this in the healthcare system.”

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