Hospitalization rates for COVID-19 in California are reaching new record highs almost every day. Across Southern California, ICU capacity is essentially nonexistent, with state numbers showing the 11-county area as having no ICU beds available.
Hearing that jarring statistic is one thing, but living it is another. The pain, trauma, and rollercoaster of the pandemic has been the daily life of critical care nurse Erin McIntosh for months. As she and her colleagues tend to some of the sickest patients at Riverside Community Hospital in the Inland Empire, she says nurses around the country are being pushed to the brink.
“Honestly speaking, I don’t know how I’m still standing,” McIntosh says. “We have gone months and months and months without breaks, and taking on more than we can safely handle.”
McIntosh sounds weary as she describes the overwhelming fight. She knows the struggle nurses are grappling with isn’t just an issue at Riverside Community but at medical facilities around the country. She says there’s the physical exhaustion from the long and hectic days, but also a painful emotional drain.
“We’re seeing a lot of suffering,” says McIntosh. “A lot of the suffering we’re seeing is patients alone without a family member nearby. I was there with a patient that we had to intubate, and I’m sure as you know, anyone with COVID, when you’re going to intubate them, the likelihood of them surviving is very slim. I’m often the last person that people talk to before they pass.”
McIntosh sighs. Having faced that difficult reality over the course of the pandemic, she says before a patient is intubated, she does all she can to connect them with loved ones so they can have a final conversation and say goodbye.
“Today I had this gentleman, and I asked him if he wanted me to call somebody,” McIntosh recalls. “He said he had nobody. I was his only person, and I just held his hand and we cried together. I know this is not uncommon, it happens all the time. I just don’t know much more we as nurses can endure alone.”
The daily pageant of tragedy that’s repeated itself for months has deeply shaken morale at Riverside Community Hospital.
“I’ve seen a complete mass exodus of nursing,” McIntosh says. “What we’re seeing, it feels like war. Like Vietnam, the nurses are not hailed as heroes. If anything, we’re told we’re liars. Even some of my own family members still continue to not wear masks and get together. It’s very hard. That has killed our morale along with the suffering we see.”
Throughout the pandemic, Riverside County has chafed at the guidelines and directives coming from Sacramento. The County Board of Supervisors looked into drafting its own reopening framework and ignoring the state’s roadmap, and Sheriff Chad Bianco criticized moves like stay-at-home orders. Bianco has said appealing to people to do the right thing is the correct strategy and has refused to enforce pandemic health policies like masking.
As local cases of coronavirus reach new heights, the nurses at Riverside Community, along with two other facilities, are threatening a 10 day strike that would begin Christmas Eve. The health care workers cite contract issues, unsafe working conditions, and staffing as among the reasons they may walk off the job. The nurses say management company HCA, Hospital Corporation of America, is making record profits during the pandemic. They want assurances that once the current health crisis passes, they’ll adjust nurse-patient ratios and maintain high levels of safety.
“Morally and ethically I really really hope, and I pray every single day, that we don’t come to a strike,” McIntosh says. “But many of my nurses that I work with and myself included, we have gone 20-plus hour shifts without breaks for months in order to fill the gaps in care. Again, I am understanding that this is a pandemic and everyone is going through this situation, but this has been happening long before COVID, and we want it stopped when COVID is over.”
Riverside Community Hospital has responded to the proposed strike. It says an interruption at this unprecedented time would force it to limit the scope of services available to ensure nurses can take care of the most critically ill patients. The hospital says it’s “unconscionable” that the nurses would “abandon the bedside.” However, the facility maintains it’s negotiating in good faith to avoid a strike because “too many lives in Southern California depend on the vital services our hospitals provide.”
Data from Riverside County shows that ICU capacity has been maxed out like the broader Southern California region. McIntosh says that a handful of beds are still open in her hospital, but that it takes quite a while to find room for someone.
“Oftentimes I think that a lot of the public only thinks about beds, but it’s more than beds,” says McIntosh. “If there’s nobody to take care of you, a bed means nothing. People don’t realize how much nurses are needed to take care of a patient.”
Should the hospital truly run out of ICU beds, McIntosh believes Riverside Community will begin converting non-traditional areas into emergency facilities.
“I think the next step for us is opening a recovery area for the surgical patients into caring for ICU patients,” she says. “Even right now we’re holding many ICU patients in the ER just waiting for a bed.”
Nurse Erin McIntosh (right) poses with some of her colleagues at Riverside Community Hospital on the frontlines of the pandemic. Face masks, face shields, and even respirators have become part of their daily uniform as they treat people with the deadly and highly transmissible virus. Photo courtesy Erin McIntosh
This week, the Pfizer vaccine started going into the arms of health care workers across the nation, and an FDA advisory panel gave its blessing to a second vaccine candidate from Moderna. After months of waiting to reach this point, the rollout has injected some much needed hope into a bleak situation. McIntosh says she’ll definitely get the shot, but she fears disinformation about vaccines may have already poisoned the public well.
“I have little hope anymore,” McIntosh says dejectedly. “Just seeing so many people on social media anti-mask, I think it will be a long time before we come to that level in which everyone gets the vaccine.”
She reiterates how tired she and nurses everywhere are. With Christmas just around the corner, she doesn’t mince words about the risk individuals pose to their family if they decide to travel this holiday season.
“I would tell them to look at their family members and think about Russian roulette,” says McIntosh matter-of-factly. “It’s a game that you play that you shoot a gun and it has a bullet in it. At random, one of your family members that you’re spending time with could die at any moment because of COVID. It’s so unpredictable, it’s so unforgiving, it’s just not worth the risk.”
“I’ve made multiple phone calls with families telling them that their loved one is no longer with us, and there is just nothing worth that. Celebrate Christmas next year.”