Nurse Erin Borland cares for a patient on Shapiro 9 East.

Nurse Erin Borland cares for a patient on Shapiro 9 East. Photo credit: James Rathmell, MD

A global pandemic. Widespread shortages of personal protective equipment and supplies. An anticipated surge in COVID-19 patients requiring hospitalization. Fear of getting sick and spreading the virus.

The teams on the front lines at the Brigham faced unprecedented challenges as they worked to care for COVID-19 patients and protect themselves. Through it all, many staff say what they will most remember is how everyone came together to support one another.

“This experience with COVID-19 has shown me that we are so much stronger together than we can ever be apart,” said NaTasha Washington, RN, of the Medical Intensive Care Unit, who was among many nurses who relocated to care for COVID-19 patients. “I had so much support from my team and the people I work with. With them, I felt invincible.”

Zara Cooper, MD, MSc, FACS, shared a similar sentiment. “What I will probably take away the most from the experience is the sense of pride and unity and how people came together,” said the trauma surgeon, surgical intensivist and the Kessler Director of the Center for Surgery and Public Health. “I don’t think anyone was prepared for this, but we were ready to be there when people needed us.”

Preparing for the Unknown

NaTasha Washington

NaTasha Washington was among many nurses who relocated to a different unit to care for COVID-19 patients during the crisis.

With so much unknown about the novel coronavirus that causes COVID-19, and the extent to which it would spread locally, care providers had to adapt to rapid changes in policies, procedures and technology as the situation evolved.

“It was a different disease, especially the tempo and the pace,” said Cooper. “People got sicker faster. They had this longer course. Some people got better when you didn’t expect them to. Some never did. Others got better after long, long periods of time — durations that, in other circumstances, we might have never expected them to recover.”

Emergency Department (ED) nurse Jillian Baker, BSN, RN, recalled how quickly — and how often — staff needed to adapt to new policies and processes in response to evolving needs.

“In the beginning, it seemed policies were changing hour to hour. It was hard to keep up with the information flowing through our emails,” Baker said. “It made for long and difficult shifts, but it was rewarding work. I think most nurses choose this work because they like to help people. This was a time when our patients were at their most vulnerable and needed our help, and I’m glad I had the opportunity to do so — and to have been surrounded by colleagues who felt the same way.”

Special Pathogens Units and Intensive Care Units were opened in the Shapiro Center, Braunwald Tower and Connors Center, with support from nurses, physicians, physician assistants and other staff from many units and services. To accommodate the launch of these areas, some units caring for non-COVID patients were relocated.

ED nurses

From left: Sisters and ED nurses Jillian Baker and Tama Baker

“For anesthesiologists, the influx of patients with coronavirus into the hospital felt like a call to action,” said Louisa Palmer, MD, of Anesthesiology, Perioperative and Pain Medicine. “We were involved with the care of these critically ill patients in so many ways, from caring for them as intensivists in the ICUs, forming specialized intubation and line teams, to providing anesthesia when they needed procedures in the operating rooms.”

It was difficult to predict how many patients would require hospitalization at the peak of the pandemic. Brigham Incident Command leaders planned for the worst-case scenario, creating a surge plan that would, in its final phase, enable the hospital to convert areas that aren’t designed to be inpatient units into SPUs if needed.

Fortunately, the surge plan for critical care was not activated beyond phase 1. At peak volume, 171 COVID patients were admitted to the Brigham. Intensive care units saw a total of 86 COVID patients, and more than 100 patients hospital-wide were on ventilators during the height of the surge.

“I was shocked at how many patients were critical enough to require ventilators and ECMO,” said Suzanne DeDominicis, RRT, of Respiratory Care. “The teamwork that I experienced in the SPU was inspiring. From my fellow respiratory therapists, to the nurses, patient care assistants, doctors and observers, I felt like we all came together to do what was best for our patients.”

By mid-March, the Brigham deferred most routine care and non-urgent procedures to accommodate the anticipated surge of COVID-19 patients. But many areas of patient care never stopped, and staff continued to deliver expert, compassionate care while navigating new policies and strict infection control guidance.

Providers meet outside a patient room.

Providers meet outside a patient room during the patient surge. Photo credit: Max Esposito

“Our biggest challenge of all has been supporting our families through all of the changes that have come with COVID,” said Ali Colarusso, BSN, RN, a nurse in the Neonatal Intensive Care Unit. “The visiting limitations are especially hard on new parents. Babies and families need extra love from us right now, and we have all come together to make sure that our new moms and dads feel that love, whether they are holding their tiny miracle in their arms on the unit or at home, away from the single thing they love most in this world — in which case we, as nurses, provide the snuggles as often as we can.”

Protecting Patients and Each Other

Those on the front lines worried not only for their patients, but also about getting sick themselves and spreading the virus to their loved ones at home, especially children and aging parents. “It took a huge personal toll on my family and me,” said Cooper. “There was a lot of fear and a lot of uncertainty.”

Palmer shared similar sentiments. “I will remember the very mixed emotions of walking into the COVID ICUs,” she said. “These included pride in every single member of the care team and the way everyone pulled together, fear of being exposed to an infectious disease that I worried I could take home to my family, the anxiety of trying to provide best practice to such sick patients when we had such little data to guide us, sadness for the patients dying without their loved ones beside them and awareness of the socioeconomic and racial inequalities that influenced the makeup of our patient population.”

Numerous measures were put in place to protect staff and patients. These included the strict use of personal protective equipment (PPE) and a new observer role to ensure that staff donned and doffed PPE correctly upon entering and exiting patient rooms.

“Patient care and safety have always come first, but this virus required us as health care providers to focus on protecting ourselves first by making sure we always wore the proper PPE,” said DeDominicis.

Environmental Services staff

From left: Vladimir Tejeda and Maria Centeio, housekeeping aides in the ED, empty biohazard bins.

Rigid cleaning protocols were also implemented to sanitize patient rooms, units and all areas of the hospital, requiring immense efforts from the Environmental Services teams.

“I wanted to do everything right for the patients,” said Maria Centeio of Environmental Services, who works in the Emergency Department. “People depend on me and my job because it is my responsibility to clean and help stop the virus from spreading. When I am needed to clean something, I am always right there.”

Interactions with outpatients changed dramatically, especially at the drive-thru testing sites that were set up at ambulatory locations.

“Instead of treating patients one on one in an exam room, we were greeting them car-side and counseling them through this new and unnerving process of testing,” said Katelyn Monroe, PA-C, who served as clinical director of the ambulance bay testing site. “As the pandemic evolved every day, our team had to to adapt to the influx of patients needing to be tested, and new staff who needed training, while allocating PPE safely and efficiently.”

The Need for Human Connection

New restrictions on visitors changed the experience of patients and staff in every unit and patient care area throughout the hospital. To help patients remain connected with loved ones, staff turned to technology, including iPads and tablets equipped with Zoom and FaceTime.

“COVID-19 created an unprecedented need for connection: a need to help patients and families to feel connected even when they could not be together at the bedside,” said Stephen Nicholson, SJ, resident chaplain in Spiritual Care Services. “From a patient care perspective, the pandemic made clear to me how all of us — patients, families, doctors, nurses, PCAs, chaplains and so many more — need to know that we are not alone, to be reminded that we are part of a network of care that is both human and spiritual.”

ED nurse Andrew Dundin, MSN, RN, took extra care to make eye contact with patients or touch their shoulder to maintain connection and show compassion during a frightening time for patients.

“Even with isolation and physical barriers, we never lost the determination to connect with our patients and families and provide them with the care that they need,” he said. “What’s remarkable is that although we have many new processes and workflows in place for safety, the feeling of camaraderie, compassion, family and commitment are still the binding forces that exemplify the ED team and the Brigham community.”