EXCERPT of Virus City from Big Shoulders Books
Sharon Hollivay-Wheeler, CLINICAL NURSE SPECIALIST
Interviewed by Camryn Beaco
On March 11, 2020, the World Health Organization (WHO) declared the COVID-19 virus a global pandemic. Many healthcare workers across the globe have been laid off or have quit their jobs due to pandemic-life obligations or fear for their safety. According to The Hill, nearly one in five healthcare workers in the United States quit their jobs during the COVID-19 pandemic.68
Working in the COVID-ICU unit for John H. Stroger Jr. Hospital, the public hospital serving Cook County and also the busiest emergency room in Illinois,69 Sharon Hollivay-Wheeler has been on the front lines of the battle for survival against COVID-19 as significant numbers of her healthcare peers exited their positions.
During this interview in early November 2021, Hollivay-Wheeler asserted her belief in the power of education. As an Advanced Practice Nurse, in the role of Clinical Nurse Specialist, she prides herself in educating her fellow nurses on the necessity of critical thinking and nuanced care in the ICU.
MY MOTHER USED TO TELL ME that I should either be a nurse or a teacher, because I was always taking care of people from a really young age. She told me that if I wanted to be a nurse, I needed to work at a nursing home. So, when I turned 16, I applied to the nursing home. They turned me down, like, eight times.
But the ninth time that I applied, the lady called me and said, “I’m sitting here looking at nine applications from you. Why don’t you come in and let’s talk about it?” Then she hired me as a nursing assistant. After that, I went and got training as a nursing assistant at the Chicago Medical Institute70 downtown. From there, I worked my way through nursing school.
When I was younger, I expected to be able to take care of people. I think I always expected to learn the skills to be able to help people to get from A to B. So, as I grew into nursing, I saw that my education is the tool that I administer when people come and get help. I have those resources mentally, I would say, to be able to administer care.
Part of administering care is absolutely mental, because not only do you care for the patient, you care for that patient’s family. You have to have some kind of skill to deal with people’s different emotions. It’s not just giving a shot or giving a pill.
I don’t believe I thought about it initially; I just wanted to take care of people. But as I’ve gotten older, after getting my master’s [degree] and wanting to teach, I think I can look at it in a different way. I’ve always practiced that way, or should I say, I kind of grew into practicing that way. Nursing can be pretty exhausting, because it can take all of you.
***
Pre-pandemic, I would go to work, and I would just have my regular scrubs on. I still wear my regular scrubs, but you’d be able to just walk on to the unit without worrying about the whole unit being on isolation.
Initial assessment is extremely important because our patients can change within five minutes. The minute you get there, you got a history, and you got a full assessment. There would be certain people who were identified as being on isolation, and there would be a card in front of their door stating that. And you were prepared before you went into the room.
You have to review the patient’s history and determine what procedures or plans they would have that day. I go through and look at the test results, and I always read the doctor’s plan of care to see which direction we were going in.
My basic principle for my patients is airway breathing circulation. So, first off, are they breathing? Do they have a clear airway? Most of our patients are on a ventilator or have breathing issues; we have to make sure that they’re getting the set volumes and set rate71 that they’re supposed to get—the set oxygen. I listen to the lungs and make sure their airway isn’t blocked. If it is, I’d have to suction. Behind the tongue accumulates a lot of mucus, so you’d have to make sure you suction back there. Sometimes you may come across a person who’s not intubated, and they sound really hoarse, so you’ve really got to inspect their airway. They may need to be suctioned.
Once you get past the breathing, then it’s circulation, cardiac. Is their rhythm normal? Is it a fast rhythm? Am I giving medication according to the rhythm? For cardiac, you have to check pulses, all the pulses that you can feel. And you always want to check urine flow. Do they have a Foley?72 Are they peeing? When did they pee last? Circulation also includes gastric: are they getting enough feeding? Do they have a tube feeding? Did they have a bowel movement?
Then, you also have to look at skin: skin tone, skin turgor,73 and touching. The skin is also an organ, so you have to make sure no tubes are pressing on the skin. If a patient can speak, I interview them about how they’re feeling and specifically ask them, is this going on or is that going on?
Then I make sure to see what’s ordered. For some medications, let’s say if the doctor ordered them potassium, I’ve checked the labs already. I might say, “You know that this patient’s potassium is such and such. Are you sure you want to give it to them?”
Sometimes our doctors are very new, and they need a little bit of guidance. They may just impulsively order stuff, but it’s up to us at the bedside to be an advocate for that patient. We inform the doctors that this patient has this and that going on, or that this [treatment] may not be appropriate. Or, “Doc, do you think the patient would benefit from this test or from this medication?”
All of this comes together in an assessment on a note. All through the day, you document from there. We are very dependent on blood pressures, heart rate, oxygen saturation; we’re monitoring all of that. And we document every hour.
Usually, when I go in, it’s like I’m doing all this stuff at the same time, but I’m also making sure the patient is comfortable. Most patients can’t move; they’re sick and don’t feel good, so I make sure that their bed is comfortable for them, repositioning them with care.
***
Going into COVID, you can imagine it’s much worse. It was scary. We actually had a lot of people quit. A lot of nurses retired immediately when they found out it was coming. Before the pandemic was announced, [the Cook County Health Department] started telling us that there was this bad virus coming, and we’re going to have to treat it like we treated Ebola.74 Nurses did not want to take care of those patients the same way they didn’t want to take care of COVID patients.
Staffing was horrible because people didn’t—and don’t—want to work. We had so many call-offs, and we lost so many nurses. I’m in the union, and they complain that the hospital should have seen this coming, but who saw this coming? Who saw a pandemic coming and nurses just leaving? And quitting? Nobody saw that.
Before you go into the room, you have to put on an N95 and a mask that covers the N95. I like to wear head coverings, so everybody started wearing head coverings too. People also started putting on two or three gowns and double gloves.
Heading into COVID, the hospital administration offered most of the nurses the chance to wear scrubs, so this hit the surgical department hard. Most of the nurses were very afraid. They didn’t want to take anything home, so the majority of the nurses started wearing surgical gowns. And the administration was like, “We’re running out of surgical gowns. We really need to offer these nurses scrubs.”
You have to get all this stuff on while you got a patient in the room who’s having trouble breathing, so I found that to be extremely stressful.
Let me just say, for me, that’s when my assessment skills came in, because it’s important to do a great assessment. If you get a handoff and that patient has been having trouble all night, you can’t wait to go in there. You got to go and check that patient out right away, because when our patients get into trouble, they can go downhill really fast.
It all comes with establishing that baseline, making sure you know what’s going on with your patient and what kind of trouble they can get into. You need to know where they are. We have to pay attention to body systems and what’s going on with that patient.
All of a sudden, our unit turned into a COVID unit, which I knew was going to happen anyway. But staff would refuse to work on the COVID unit. We have two eleven-bed units, “MICU-A” and “MICU-B,”75 and we would rotate every thirty days. So we would spend thirty days on the COVID side.
It was very stressful. You have staff who are sort of controlling, so we had some charge nurses who decided, “OK, you’re going to take care of this patient all the time.” And that’s really stressful and unfair. So when the pandemic started, you can imagine they didn’t want to assign themselves to COVID patients, and the nurses who floated into our unit didn’t want to take care of COVID patients either. Everybody was afraid to go into COVID patients’ rooms.
At first, if a patient coded, we didn’t know what to do. Now it’s starting to ease up, but with the [Delta] strain, it’s picked back up again. We had COVID patients down to just one side [of the MICU], and then they started filling up the other side again.
Currently, we have potential COVID patients who come and are called a “patient under investigation.” Which means that patient has been around somebody who’s caught COVID and they’re experiencing symptoms, but they haven’t tested positive for COVID yet. So, they have to come to the COVID unit.
If they rule it negative, then we hurry up and get them to a place where they are with other negative patients. For us, since we have mostly COVID patients, the other ICUs have had to bear the burden of our negative COVID patients, which I think was a really smart decision, even though the other units don’t like it. That’s the surgical ICU, neuro ICU, cardiac ICU, and burn ICU. They would take our patients who didn’t have COVID, and they hated it. They still hate it. They’re like, “We don’t want them ICU patients,” because our patients are pretty intense. We take care of all the systems: cardiac, neuro, and surgical, so we’re normally the dumping ground.
***
A couple of months ago, I got a patient who refused to get the vaccine. She said she’d just come back from a trip to Las Vegas, and when she got on the plane coming back, she started feeling really short of breath. She thought that maybe it was just the altitude. But when she got home, she developed a cough and was extremely fatigued. When she got worse, she came to the hospital, and she tested positive for COVID. Her entire family tested positive as well. She ended up on a ventilator, with a tracheostomy.
I felt so bad for her because she told me she hadn’t gotten vaccinated, and her kids weren’t vaccinated either. She was so scared that she was going to die. I told her, “We’re going to do the best we can for you, so let’s take it step by step.” I think the hardest part was that her family wasn’t allowed to come see her; the doctors could only do video chats with the family. Eventually, she got over it; she did well. She’s a success story.
I remember her asking me, “Do you think I can go ahead and get the vaccine now?” Before she left, I do believe she got the vaccine.
***
Through learning, we’ve been able to treat our COVID patients better. Now we see a lot of people getting better. I think that there’s a population of people who are more cautious, but there’s still a big population of people who don’t want to get the vaccine. The patients we’ve had come in that didn’t get the vaccine prior, and they come in so sick, by the time they leave, they’re speaking for the vaccine. And, when this new strand [Delta] first started, a lot of people passed away, a lot of unvaccinated patients. Vaccinated patients’ symptoms were not as bad, and they did, I would say, quite well.
COVID is highly contagious, and some people show no symptoms. That’s the problem. Then they spread it to somebody who’s very sick, like Colin Powell.76 He just passed away from COVID, and they said it was because his immune system was suppressed. So you don’t know if you may have caught it, are carrying it and passing it on to others, to somebody who can die from it.
That being said, it’s OK if you don’t want to get vaccinated. I think we still have a moral obligation to wear a mask, wash our hands, and prevent it from being spread. It’s just similar to the HIV virus. If you know you have HIV, you don’t go and have sex with everybody; you’re cautious to prevent spreading the virus. With COVID, like HIV, you don’t always know if you have it, but there are proven ways to prevent the spread. It cannot be taken lightly.
I think that’s where thorough education is going to have to be applied. We all have self-preservation instincts, but there are few of us who really care about mankind. So we have to help exemplify that you can’t have behavior that’s going to put others in danger.
We have a long way to go until we’re all at least somewhere on the same page, for sure. Even if we’re not on the same page, we should get to a point where we’re at least thinking about each other.
68 Source: https://thehill.com/policy/healthcare/575209-almost-1-in-5-healthcare-workers-quit-jobs-duringpandemic-poll
70 Information about the Chicago Medical Institute was not available, but it appears to be closed.
71 The respiratory rate for delivery breaths per minute on a ventilator. Source: https://www.ncbi.nlm.nih. gov/books/NBK441856/
72 A type of catheter. Source: https://medlineplus.gov/ency/article/003981.htm
73 Skin elasticity, a way to check for dehydration. Source: https://www.healthline.com/health/skin-turgor
74 The 2014-2016 Ebola outbreak in West Africa caused more than 11,000 deaths worldwide. Eleven cases were confirmed in the United States. Source: https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/ index.html
75 Medical Intensive Care Unit
76 The former chairman of the Joint Chiefs of Staff and secretary of state under George W. Bush died in October 2021 of COVID-19. Source: https://www.nytimes.com/2021/10/18/us/politics/colin-powell-dead.html
The interview above is an excerpt from Big Shoulders Books’ Virus City, a collection of interviews that capture the oral history of Chicagoans during the COVID-19 pandemic. Click the above cover for more info!
BIG SHOULDERS BOOKS and SLAG GLASS CITY are projects of the DePaul Publishing Institute.
SLAG GLASS CITY · Volume 8 · November 2022
Header image— Electron Microscopic Image of a Coronavirus: Original Image Source— U.S. National Institute of Allergy & Infectious Diseases
Leave a Reply