‘This is What COVID Looks Like’

On a July day this past summer, Victor Howell eased into his favorite chair, settling in to watch an afternoon of golf, mindful of a few sniffles he had been recently experiencing.

Two hours later, Howell was in the Our Lady of the Lake Regional Medical Center in Baton Rouge emergency room, with doctors asking him if he had a living will.

Howell’s first thought was “How did I get here? Two hours ago everything was good.”

Howell’s sudden health crisis was emblematic of how rapidly COVID-19 can strike and quickly become a death sentence.

“This is what COVID looks like,” Howell said during a remembrance service for coronavirus victims on March 18 at Our Lady of the Lake. 

Similar scenarios have been repeated at OLOL and hospitals worldwide during the pandemic, which announced its presence in the Baton Rouge area in March, 2020.

“All of a sudden we started getting hit with tons of very sick patients, sicker than we’ve ever seen, and dying really quickly,” said Dr. Mary Raven, medical director of Palliative Care at Our Lady of the Lake.

Death seemingly became a daily companion, with patients being admitted one day, “crashing” on the second and dying on the third, Raven said. “Critical care doctors said they have never seen patients this sick. We’ve never seen patients this critically ill where it is just irretrievable.”

Raven admitted even the staff experienced a bit of a panic in those early days, wondering if the disease was so infectious that they could walk into a COVID ICU, get infected and die. “But you show up for work, do the things leadership is telling us to do, and you go into the unit and you see six to eight nurses taking care of patients all day long. They are doing it so by God I ought to be able to do it,” said Raven, who survived what she called a mild case of the virus in December. 

Lillian Tate, who works in the COVID-19 units, remembers how 12-hour shifts turned into 14 and 16 hours. She recalls nurses encouraging each other, comforting each other, praying together and changing their PPEs perhaps more than 30 times a day. 

“Nothing can prepare you for being on the frontline of a COVID unit,” she said. “It is emotionally and physically draining.”

Initially, Raven said her team’s focus was how best to support the ICU physicians, noting the skill set of she and her staff is centered around end of life care, talking to family members in difficult times. Since it was apparent early that families would not be able to be present with their loved ones, priority shifted to how to talk to family members via phone or Face Time about a loved one in deteriorating health. 

Raven’s staff, along with other doctors and nurses, made three phone calls a day to the family of each COVID-19 patient to update their loved one’s condition, including relating data points such as vital signs and meds. At least one of those calls would come from a doctor. 

“The goal was to try to be (the family’s) eyes and ears and to help them understand day by day what was happening, and if things were not going well to help them understand things were not going well,” Raven said.

She would often rehearse what she would say prior to the call, especially if the news was devastating.  

“None of this is easy if you can make eye contact and hold a person’s hand and they can see your face and see that you care,” Raven said. “You lost that attribute so you are really left with (your) voice. You have to use your words carefully. It’s not the way we like to communicate.”

State Sen. Regina Barrow, whose lost her husband of 36 years in December, said she was grateful for the daily updates, which would come in the morning, midday and in the evening, clinging to a lifeline of hope. 

“We were all excited,” she said after one particular call “but suddenly that changed.”

Even though her husband did not survive, she and her family have “no doubt they were doing everything they could to make sure he would return home.”

During those first few months Raven and her partner would be seeing from 13 to 20 patients during the morning and spending the afternoon calling families. 

In total, her team has treated about 200 patients, with the majority having died. 

“This is what we do every day,” Raven said of her staff of herself, three nurse practitioners and three additional physicians who are specially trained in caring for patients in their final days. “It was just more of it.

“We do a good job of taking care of each other, and it also helps to disconnect from work when you go home to turn the switch off and turn it back on when you go to work.”

She said the redeeming value was knowing their work was important and making a difference in the lives of families suffering. 

“If there was ever a time for palliative care it was this year,” she said. 

Raven said as the summer wore on, the number of deaths declined as front-line physicians gained an increased understanding of how to provide better supportive care for patients. But her team still cares for patients who have survived the acute phase of the disease but have not been able to mount a strong enough recovery to function off of life support.

“When we are called in now, it’s usually somebody who survived the first two to three weeks but is still critically ill and seemingly not able to survive the overall burden of the disease,” she said.

One year after the hospital admitted its first case, Raven said she is encouraged by declining numbers in cases and deaths. Two of the COVID-19 units have been able to close, which she called a “great sign.”

“The mood is more upbeat, optimistic around the hospital,” she said.

Her unit only has one active COVID-19 patient and another who has had the disease for more than three weeks and is in the traditional ICU.

Raven said the staff was well prepared to treat COVID patients because of the hospital leadership, PPEs and other necessities before the first case even arrived. 

“The leadership here has been very strong,” Raven said. “We always had what we needed but the disease is just so bad no matter what you did (some patients) were going to die.”

She also praised Dr. Katie O’Neal, an infectious disease expert who was appointed chief medical officer shortly before the pandemic struck.

“It really was almost like God’s will she was put in the right position at the right time,” Raven said. 

She noted that faith has also played a role in helping cope with the horrors of the pandemic, saying that about 99% of the families she has seen have strong belief systems. 

“That gives me comfort and we try to tap into that to help families find comfort in death,” Raven said.

During the remembrance service candles were lit in honor of those who have died from the virus.

“We lost many staff members and loved ones but by the grace of God we are still here,” Raven said. “We are vessels of God to care for those most in need.”