It was one week in November. Every day, Illinois nurse Jacob Forsman had a COVID-19 patient. And every day, that patient died by noon.
“That was for three days in a row,” he said. “That one just broke me.”
Nearly a year later, he had hoped to be finished with COVID-19 body bags. But Forsman, an intensive care unit charge nurse at Northwestern Medicine Lake Forest Hospital, is one of the many hospital workers who continue to treat severely ill COVID-19 patients, a year and a half into a pandemic that many knew would be a slog but most had hoped would ease by now.
“I think the reality has sunk in for me that we’re shifting into the year 2022, and it’s called COVID-19,” Forsman said.
Doctors and nurses and others who help treat and, hopefully, heal, virus patients are still working daily. They still help people breathe, they still hold iPads connected to family members unable to see sick relatives, they still call relatives to summon them for a final goodbye.
“We’re still intubating people, when you can walk into any Walmart and they have signs that you can get any of the vaccines for free,” Forsman said.
All of this has taken its toll.
The American Association of Critical-Care Nurses recently created a “hear us out” campaign to speak about the “sustained and extreme demands of the last 18 months,” including a survey noting 66% had considered leaving nursing.
“At the beginning, it was fear,” said Dr. Michelle Prickett, a pulmonologist who has worked in Northwestern’s COVID-19 intensive care unit throughout the pandemic. In the spring, vaccines offered hope only to be crushed by delta and slowing vaccination rates. “We’re feeling the strain. It’s just frustrating and exhausting.”
Amid colleagues quitting and continued COVID-19 hospitalizations, health care workers feel burned out.
‘We are just trying to do everything’
Even as they themselves are vaccinated, and in many ways things have improved, multiple Chicago health care workers said they feel this time is the hardest.
“I feel like I’ve been running a marathon and as I approach mile 25, someone moves the finish line,” said Whitney You, an OB-GYN at Northwestern Memorial Hospital. “I’m learning to accept that reality, but it still makes me tired and anxious about what waits around the corner.”
Last fall, amid mask arguments and pandemic fatigue, hospital workers expressed frustrations and even Illinois Department of Public Health Director Ngozi Ezike became emotional while talking about the nearly 10,000 lives lost at that point in Illinois.
Now, however, nurses are working not only with the effects of COVID-19 but also routine appointments like knee replacements or shoulder surgeries that were postponed during shutdowns.
“Everyone’s resources are stretched far thinner, because we are just trying to do everything,” Forsman said. “We’re trying to be there for the people that need the outpatient resources. We’re trying to treat people that couldn’t be treated before, and treat the COVID population.”
Meanwhile, COVID-19 cases keep coming. This summer, Forsman said they saw multiple people hospitalized in a family after all attended a wedding. Not everyone left.
“Everyone came in together. They get sick at the same time, and you’re going to discharge three out of five of them,” he said. “That’s something that’s super hard for us as nurses, and something that we just don’t get over.”
Chicago psychologist Saloumeh Bozorgzadeh, who created a group to help mental health among workers during COVID-19, said she is seeing health care workers even getting physically ill, reporting things like gastrointestinal problems or eye infections, along with mental health challenges like feeling numb, disengaged, apathetic and anxious.
“Some have symptoms similar to PTSD,” she said. “I think many people may not know that these can be the effects of burnout, and some may not know how to cope with it. People think of burnout as just being tired, but there is so much more to it.”
For some, stepping away is the solution.
Doris Carroll retired after 38 years in nursing earlier this year. She moved to Florida to help her mother, but she’s honest in admitting that COVID-19 contributed. “I am relieved to be out,” she said.
Adding to her decision were what she called “dangerously low staffing levels,” and the grief of losing fellow nurses at the University of Illinois at Chicago hospital to COVID-19.
“I didn’t sign up for this,” she said. “Nor did my colleagues.”
UI Health has faced staffing challenges, but those challenges “have not significantly impacted patient care,” said Michael Zenn, CEO of University of Illinois Hospital and Clinics, in a statement.
It’s not only those in COVID-19 units feeling strain. Last year, pediatricians were asked to help provide staff and services for overwhelmed adult wards. This year, with rising RSV cases and young children unable to be vaccinated yet, “I worry that we may have it the other way,” with other staffers asked to help out children’s wards, said Chicago pediatrician Deanna Behrens.
Airica Steed, Sinai Chicago chief operating officer, said as many as 20% of Sinai Chicago’s workers aren’t coming in on any given day because of the mental and physical exhaustion of working through a pandemic, as well as child care challenges and exposure to COVID-19. In normal times, about 5% to 10% of Sinai’s workforce was absent on any given day.
Fighting delta and vaccine hesitation
Last year, health care workers were fighting the virus. This year, they face additional opposition in delta, the strain that has complicated the recovery from the pandemic, and vaccine hesitation and misinformation.
By the time patients arrive in an intensive care unit, many are unable to speak. But Forsman said many express regret about not having gotten vaccinated. Nurses say many people assume they are healthy and will be fine even if they get the virus; others simply think precautions like staying home or wearing masks will be enough.
As someone who became a father during the pandemic, Forsman said it is hard to see patients in their 40s and 50s, parents of young children, with people’s “whole world just crashing around them.”
“That was the hardest, to see families,” he said. “You feel like you’ve let down multiple people when someone passes away.”
Even some who lose family members still do not seek vaccination, said Lindsey Gradone, a Northwestern nurse practitioner who has worked in Northwestern’s COVID-19 unit since the pandemic began.
“To be facing this wave with so much vaccine hesitancy and almost every one of our patients that came in was unvaccinated, or they had been compromised, it’s just been really hard,” Gradone said.
Both situations are difficult. With unvaccinated patients, it is hard to see patients panic and family members grieve as they realize how sick they are, and knowing patients did not get something that could have helped. For those vaccinated but with health conditions that still made them vulnerable in a persistent pandemic, “They did everything right,” Gradone said. “It’s gutting.”