- Associated Press - Saturday, November 7, 2020

GREAT FALLS, Mont. (AP) - Phones are always ringing.

Patients who need help are pushing call lights.

Families are calling looking for updates.

Nurses working 12-hour shifts, sweating and dehydrated wearing personal protection equipment, sometimes break down in tears.

Patients are recovering.

Some aren’t as lucky and never leave, dying as they gasp for breath.

Beds are quickly filled by more patients waiting in the wings.

That’s a sampling of what it’s like to work on the COVID floor at Benefis Health System in Great Falls, which is bursting at the seams with patients who are struggling to breathe and sometimes live, Katie Janus, a registered nurse, told the Great Falls Tribune.

Janus compares each day on the job to being on a roller coaster and “constantly fighting fires.”

The full force of COVID-19, she adds, has finally arrived in Montana, with the vast physical distances between people and cities in the nation’s fourth-largest state unable to stop its deadly march.

“Back in the day, early COVID, we all heard about New York,” Janus said in an interview, referring to the first COVID-19 wave in the spring on the East Coast. “It was easy to ignore because you weren’t in that world and at that time Montana was very safe. We had so few cases so you just went about your day, being like, ‘Alright, COVD is here, but it isn’t real.’

“Versus now. It is real and it’s a nightmare. We are living a nightmare here in Montana, a state that is socially distanced naturally,” Janus said.

Montana has had 37,947 total COVID-19 cases and at least 419 deaths.

Cascade County has reported 35 deaths, not all of which are yet included in the state total.

As of Nov. 6, Cascade County had 1,848 active COVID-19 cases.

“It is basically indescribable unless you are in it,” Janus said on Oct. 27 of working on the COVID floor, when she was on the backside of another 12-hour shift.

Janus removed her goggles in a conference room on the main floor revealing red raccoon-like marks under her eyes from the pressure of the eye protection.

“We are filled to the brim,” Janus says. “There are patients waiting in the ER. They are keeping our COVID patients until somebody discharges.”

This map shows Montana at risk for active or imminent outbreak by Covid Act Now, a volunteer-driven nonprofit, built by a team of technologists, epidemiologists, public health experts and public policy leaders to provide data analysis on COVID-19.

Located on the eighth floor, the COVID floor is sometimes called the penthouse.

On Oct. 27, 27 patients were fighting for their lives in its 20 rooms. It’s so full several rooms are occupied by two patients.

Kevin Langkiet, director for Emergency Services and Critical Care at Benefis, told the Cascade City-County Health Board this week that Benefis is “overflowing” with 50-plus COVID patients who are not only being cared for on the COVID floor but also in the intensive care unit, progressive care unit, emergency room and even hallways.

“It’s not a pretty sight,” he said.

Janus is the “charge nurse” of the COVID floor.

It’s her job to know the status of every patient.

She decides which room is best for a patient and handles issues brought to her from other nurses. That could be a question about discharge plans or getting an IV started.

Janus has her own patients as well.

She tries to lead by example. She also attempts to be positive by “spreading a little sunshine in a very interesting situation right now.”

Spreading sunshine on the COVID-19 floor isn’t easy.

Janus, 35, says she seen more death in the past three months than she has seen in her entire two-year nursing career.

“Every other day some staff on the floor is crying,” Janus says. “Every other day, somebody is having a difficult time with what’s happening.”

On that very day, a nurse who was caring for two patients in the process of dying was having a difficult time with the situation.

“This nurse is like, ‘I don’t know how much longer I can personally do this,’” Janus said. “They are run down by the people who aren’t getting well.

“But I’m trying to focus on small success. The people who are going home. The people who are getting better,” Janus said.

In most cases nurses got into nursing to help people return to health and go home, Janus said.

But in caring for COVID-19 patients, they’ve had to shift their mindset, because they are using skills of hospice nurses such as keeping deteriorating patients comfortable, and talking to families and offering support.

“Coping with that I think is the hard part for a lot of nurses because that’s not necessarily why they go into nursing,” Janus said.

Recently, during Janus’ three days off, four people died, bringing the death toll on the floor, as of Oct. 27 to about 15 since it opened as the hospital’s designated COVID floor Sept. 10 with 10 patients. It reached 27 patients 15 days later and has remained over capacity ever since.

Once, said Janus, recalling her toughest case, a COVID-19 positive patient was admitted breathing “room air” and was dead three days later.

“We have had multiple family members on our floor at one time,” Janus said. “We play like bed roulette to get sisters in the same room together, or husband and wife in the same room together. One is admitted and two days later here comes the spouse.”

If a family member gets COVID-19, others in the family are bound to follow, Janus said. One time, three family members were on the floor at the same time and two died.

“You hear about people dying from the flu. It happens,” Janus says. “But people are dying from COVID. People’s lungs are so scarred for a lack of a better term because of COVID that their lungs are not getting better. And that’s the biggest thing I’m seeing. It’s like … people are dying. That for me and my team is the hardest thing.

“At the same time, people are getting better and people are going home. More people are going home than are dying. Don’t get me wrong,” Janus says.

As for her own scheduled, Janus tries to schedule 14-day “stretches” - working six days in a row followed by eight days off.

Some nights after her shift, Janus talks via facetime with the families of a patient.

“One day somebody said, ‘Why are you still here,’ and I was like, ‘I can’t hardly say to the person on the facetime that I need to go home so they need to stop talking to this person when we don’t know how much longer they will be here,‘” Janus said.

Sometimes facetime talks involve family members saying goodbye to loved ones.

COVID-19, the disease caused by the new coronavirus, can cause lung complications such as pneumonia and, in the most severe cases, acute respiratory distress syndrome, or ARDS, according to Johns Hopkins Medicine.

Monitoring and intervention to ensure patients do not “desat” - oxygen desaturation - takes up a lot of time of nurses working the COVID floor, Janus said.

“We’re constantly checking oxygen,” she said.

The majority of the patients at the Benefis COVID floor are on oxygen.

When they arrive, they may be OK breathing room air or breathing oxygen through a basic nasal cannula, a lightweight tube with a split end that delivers supplemental air through the nostrils.

Keeping each patient above 90% oxygen saturation is the goal.

In a matter of hours, Janus has watched patients escalate from needing oxygen through the basic nasal cannula to progressively more invasive and high-flow oxygen delivery forms such as Bilevel Positive Airway Pressure, or BiPAP.

“That’s the thing about these patients,” Janus says. “They are fine one moment and then they’re not.”

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A BiPAP, one step before a ventilator, is a large machine that forces air into the lungs of patients via a mask to help them breathe. It’s difficult to ween patients off of oxygen, Janus said.

“Once these patients are getting on the BiPAP or the ventilator, a lot of times they are not getting off,” Janus said.

She’s seen patients requiring 20 minutes of recovery time when they get back to their bed after walking 10 steps to the bathroom.

“Imagine how scary it is if you can’t breathe,” said Janus, describing the distress of patients. “That, to me, would be the scariest thing.”

Janus’ mother was a nurse but she followed her own career path initially earning degrees in exercise science and psychology, then going to an EMT school and working in the hospitality industry for 12 years.

Then the St. Charles, Minn. native decided to attend nursing school at Colorado Mountain College in Glenwood Springs.

Benefis is her first nursing job.

“I love my job,” she said. “I like it way more than I thought I ever would.”

She finds helping people rewarding and stressful. A simple “thank you” note from a patient means the world to her. She saves them all.

The pandemic has not caused her to rethink her career choice.

“I feel like it’s that much more important,” Janus said. “The only people these patients are seeing every day is you and the rest of the staff working on the floor.”

Patients are monitored 24-7 by day and night shifts of nurses who get to know them.

Doctors, certified nursing assistants and respiratory therapists also work with the patients.

These days, Janus said, she is basically living at Benefis.

She had 72 hours of overtime on her last paycheck.

“I personally have embraced it and just accepted it for what it is,” she said of working during the COVID-19 pandemic.

Working in the COVID-19 floor sucks and nobody likes it, Janus has told her team.

Janus, who went to college on a track scholarship and played volleyball and basketball in high school and continues to play on a traveling rugby team, has encouraged them to “embrace the suck.”

“So just together we need to embrace the suck and find positivity in each day,” she said. “We’re learning so much together. We’re an amazing team. Everyone is helping everyone out.”

Five nurses and, in a perfect world, and two certified nursing assistants work a shift together.

The 20 nurses who work the floor are normally the “patient flow team” that floats to other floors in the hospital but now they filling the need to treat COVID-19 patients.

Each shift begins with a positive quote for the team. Janus recently began “positivity pals” in which nurses, if they want, team up with somebody who understands the daily stresses so they can talk and offer encouragement.

“I think we do for the most part we have a positive environment given everything we see,” she said.

Nurses wear shoe covers and isolation gowns, gloves, N-95 masks, which offer more protection against airborne particles, goggles and/or a face shield.

“We are more than adequately protected,” Janus said.

To her knowledge, nobody has gotten COVID-19 from working on the COVID floor.

Wearing all that personal protective equipment does add to the challenge.

Nurses move around a lot from bed to bed giving medications. Dehydration is a problem. It can be a pain to take off masks and gowns, which is necessary to get a drink.

“I’ve lost 10 pounds in the last month,” Janus said.

If she has a message for the community it’s that COVID-19 is not like the normal flu.

Wash your hands.

Stay away from people who are positive.

Don’t have big Thanksgiving and Christmas gatherings, she said. Wear masks and stay 6 feet apart if you do and don’t go if you are feeling sick.

Many healthy people do fine after getting COVID-19, she noted.

But many of the people struggling on the COVID-19 floor have preexisting conditions such as diabetes or chronic obstructive pulmonary disease.

How long patients are kept varies from a day to two weeks.

Patients stay until they have not had a fever for 24 hours and need less than three liters of oxygen a day. Rest and exercise tests are performed to determine if they will need oxygen at home.

Besides the battle to breathe and general fatigue, residents with COVID-19 also face the challenge of social isolation, Janus said. Most patients are placed in a room by themselves to protect the staff and other patients, with the door closed, and no visitors are allowed.

“We don’t know how much longer it will go on,” Janus said of the pandemic. “Hopefully not much longer.”

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