Courage in Action, Part 2

Erica Ruppert, MSN, CNS, ANP-BC, chronicles her experience in a NYC intensive care unit during the height of the COVID 19 pandemic

Mallinckrodt employee Erica Ruppert spent four weeks volunteering in the intensive care unit at a large public hospital in New York City during the peak of NY’s coronavirus outbreak. She sat down with us for an interview prior to her first shift, and again while in quarantine, following the end of her four-week journey.  Don’t miss her video message below.

How would you characterize your experience at the hospital? 
It was interesting from day one. When I arrived, I immediately met with an orientation advisor, an ophthalmologist assigned to onboard the volunteer staff. We sat at a table for a brief time going through some of the administrative details. Luckily, I had entered the hospital wearing a mask that Mallinckrodt sent me, because an hour after we met, she spiked a fever. Shortly after, she tested positive for COVID19. Right then I realized that the biggest threat to my health wasn’t going to be from patients (because I would be gowned and masked when treating them), butrather, from the healthcare providers who didn’t know they were exposed or hadn’t been tested. From that moment on, I knew I had to be diligent about wearing my mask from the moment I entered the building until I left.

What was the hospital environment like when you arrived? 
I arrived at the height of the surge, so it was quite intense. The first two weeks were like Armageddon….a living hell really. The hospital normally has three teams of staff dedicated to the ICU, but they had eight in place when I started. They had converted several areas of the hospital including an endoscopy suite, portions of the emergency department and some operating rooms into make-shift ICUs. Each day, I was assigned to whichever team had the greatest need. Almost everyday day I was working next to a physician who had COVID or who was coughing and was sent home with a fever. In those early days, we were losing 7 to 8 patients per shift, morning and night. The same thing was happening at other hospitals throughout the city.   

What were some of the challenges you and your colleagues faced?
One of the biggest challenges was managing the unknown. Some days we ran out of certain medications, other days there was a shortage of IV pumps and other supplies and equipment, so we constantly had to improvise. At one point, there weren’t enough dialysis machines, so we could only do peritoneal dialysis on some patients. This process uses the lining of the abdomen to filter the blood. It was the best we could do at the time.

Was there a shortage of personal protective equipment?
The hospital gave out one N-95 mask per day, but many of us felt that wasn’t enough because they stretch out after a few hours of use, becoming less effective. Fortunately, I had the masks MNK sent me, and I was able to wear one of those over the N-95 mask and change it out as needed. I was also able to distribute the gowning from MNK to the nurses whose roles required them to go into the patients’ rooms more frequently than others. Many of them were taping garbage bags over their pant legs to cover the skin between their pants and shoes to prevent contaminants from entering. So I gave them all of the bunny suits Mallinckrodt had sent to me.

Did your desire to be there wane at any point?
No. There were certainly difficult days, but given the situation, I actually felt extremely lucky.  With so many people sick, dying or losing their livelihood, I felt fortunate to have a job and to be supported by my company and my colleagues to do this work. There was also a strong sense of community among the hospital staff. It was an all hands on deck approach, which meant we had doctors and nurses from other areas of the hospital, many who had never worked in the ICU, but everyone took on a role and worked together quite efficiently.   

Were there any other bright spots along the way?
It was nice to hear from so many of my colleagues around the country who sent words of encouragement via email, text and phone calls. Some were from people I’ve never met or worked with, including a pulmonary sales specialist who sent lunch for the staff during one of my shifts. Internally, the staff was gracious and receptive to ideas from the volunteer providers and, as one of the few in the unit with previous experience in a critical care setting, I was able to step up and support the team in many different capacities.

What was the most difficult aspect of treating COVID19 patients?
Going in, I suspected that the ethical component would be the most challenging. Fortunately, we ended up having enough beds and ventilators to avoid having to make the types of decisions I was anticipating, but there were still many other, multi-layered ethical issues. Not having the patients’ families with them in the ICU was probably the most challenging. Normally, as a nurse or a doctor in the ICU, you develop a relationship with the patient’s family or loved ones because they are there often, and you are able to talk in person and provide regular updates. In this situation, the family was not allowed to be there except for a one-time “compassionate” visit by one family member to say goodbye when a patient was actively dying. It was difficult to reach out to the families to tell them their loved one was dying. It was also difficult for many of the families to accept. Many were in denial. Although we had young doctors on what we called “the iPad team” trying to keep the families updated, it’s just not the same as being there to process the stages of death as it is happening. It was hard to get people to understand that we were doing everything we could for their family member. They were so far removed, it was really difficult for them to process what was happening.

I’ll never forget the wife that couldn’t accept that her 55 year-old husband was going to die from this virus. I called her, and she came in for the compassionate visit, talked to her husband through a glass wall and then left, adamant in her belief that he would survive. He passed away 5 minutes after she left.

Did things change over time? Did you get to experience patients getting better and leaving the hospital?
Fortunately, the situation did get better gradually. By the fourth week, the number of new hospitalizations was decreasing and dozens of new volunteer providers were arriving from across the country. Because I was in the ICU, I didn’t get to take part in the celebrations when patients were discharged, but I was able to extubate a patient who did well and was downgraded to another unit. I did hear the music the hospital played when patients were extubated or discharged. By the last few days I was hearing the song 4 or 5 times a shift. It was a good feeling and once I saw that things were improving, I felt like I could leave and get back to my family and to my role at Mallinckrodt.

Would you do it again knowing what you know now/what you experienced?
Yes, in a heartbeat. But I hope I will never have to experience that much death in such a short time again. When I first started, there were ten refrigerated trucks outside the hospital to collect bodies. Every day as I drove in, I would look at those trucks, and whenever I saw one pulling away, my heart would sink to my stomach because I knew it meant the truck was full. I’ve seen death throughout my career, but never so much at once. As difficult as that was, it would be worse to watch a crisis like this unfold and not step up to help out. So yes, I’d do it again without hesitation.

Do you think this experience changed you? If so, how?
I think it might have changed me for the better. I have a type-A personality. I’m precise, and I strive to do things perfectly. But, when you are thrown into a situation where you can’t always perform as you’re used to, you have to adapt quickly. Who knew I could work alongside of a cardiologist, an obstetrician and a podiatrist in the ICU and get the job done? The way we worked through this epidemic made me stronger as a person and as healthcare provider because I realized I could be flexible and still succeed. I realized I could be less rigid. As a result, I think I will have less anxiety in the future when faced with uncertainties. I think I will be more flexible and better able to adapt to difficult circumstances.    

To end our interview, we asked Erica if she had a message she wanted to share with her MNK colleagues. Watch the video below to hear her poignant response and check out our social media campaign #TogetherIs on Twitter and LinkedIn to learn how other colleagues around the company are stepping up to make a difference.