In the emergency rooms and intensive care units at Peconic Bay Medical Center and Stony Brook Eastern Long Island Hospital, the days are often long, physically and emotionally exhausting and, for some on the staff, excruciatingly sad.
Last winter and spring, COVID-19 was a brush fire that refused to go out. Positive virus cases rose, deaths were commonplace; then summer arrived and things slowed down dramatically.
Now, the fire has restarted from embers that never fully cooled. COVID-19 numbers — positive cases and deaths — are mounting. For Tara Anglim at PBMC and Shota Mamukashvili at ELIH, this means dealing with patients and their families and, in some cases, helping family members say their final goodbyes to people they love.
“For me and my team, we have pivoted back because of the surge,” said Ms. Anglim, who is PBMC’s senior director of patient- and family-centered care. “We call family members every single day in order to make sure their questions and concerns are being answered. This supports the nursing and physician staff who are providing care at the bedsides.”
When a family member can’t talk to a loved one, the hospital staff brings in an iPad or tablet to allow them to connect.
“Sometimes the family member can’t answer the phone because they are too sick,” Ms. Anglim said. “In other cases the family member may not have the respiratory strength to have that conversation.
“We are in that surrogate space so families can talk to the people they love and also see them when possible,” she added. “Sometimes it is to say goodbye.”
Often, she said, the staff member at the bedside is asked to hold the patient’s hand while they talk to their loved ones on a phone or tablet, knowing it could be the last time. “It’s very hard, but it is also an honor to be doing this, to help make that final connection,” Ms. Anglim said, her voice slowing as her emotions swelled. “It is an honor.”
At ELIH in Greenport, Mr. Mamukashvili is an RN and the emergency nurse manager. Like Ms. Anglim and her team, he is often the connection between a person in the ICU who is intubated and family members on the outside looking in, whose fearful hearts are in pieces.
He recalled that so much was unknown when the virus first arrived. At times, hospital staff would be on the phone with a family member seeking permission to treat a father, for example, and a few days later the mother would be admitted and die.
“That anxiety and fear was very tough,” said Mr. Mamukashvili, who started at ELIH in October 2019. “Some came in and they watched as their loved ones or housemates or friends passed away in a short amount of time.”
Early on, most of the patients were intubated, he said, adding that improved treatment has now lessened the need for intubation.
“I was here in the thick of it,” he said. “And, yes, there is a spike now. The treatments are better; we don’t intubate as readily. But it’s here again.”
A motorcycle accident led Mr. Mamukashvili into the health care field, he said. He knew what to expect and understood that death becomes part of the norm in emergency rooms.
“You become so used to dealing with death that you have no time to grieve,” he said. “You finish with one patient, move on to the next. You would never think it would come to this.”
As the number of COVID cases increases, the effects can be felt in other aspects of health care. Mr. Mamukashvili described incidents of cardiac arrest during the time of COVID. In one example, a man was brought in via ambulance with cardiac arrest. His wife had ridden along.
“So they were both exposed if there was COVID,” he said. “So she could come into the emergency room. As she was saying goodbye, she turned to the physician to ask when could she see him again. That was the last time she saw him. That has happened … You see the tremendous sadness. You see the family that patient is leaving behind. It breaks your heart.”
In the spring, Ms. Anglim and her team at PBMC facilitated about 1,000 virtual visits between family members. They try to do them every day, making do in some cases, such as recently, when the team provided an iPad for an elderly woman who didn’t have the necessary technology. She was able to sit in her car in the hospital parking lot and talk to her husband in virus quarantine in the ICU.
You see the tremendous sadness. You see the family that patient is leaving behind. It breaks your heartShota Mamukashvili
“Most often people can’t come in because of the fear of community spread,” she said. “But it’s essential families connect. Those virtual visits are vital, even when the patient is so sick he or she can’t connect.”
Ms. Anglim said it was important for that patient’s care that his wife could see him.
“She had no other option,” she said of the woman seated in her car. “We were so glad to do that … We wish we didn’t have to this. We want the hospital to be safe for family members to come in but that isn’t the case right now.”
The conversations can be one-sided at times, when a patient is too sick to hold a phone or to speak, she said.
“The hardest part for my team is that others outside of work don’t believe this is real,” Ms. Anglim said. “That part we don’t understand. We have such a hard job to know how real this is. I am not blaming anyone. It is very different world inside a hospital than outside.
“We think, if that is my family member, what would we want? I have a lot of hope. But I wish we didn’t have to go through this again. It’s hard when the family asks one of us to hold their loved one’s hand. We are committed to being with the patients until the end.
“We will all be happy when this isn’t the work we do,” she said. “But it is an honor to do this. An honor.”