The man’s head, shoulders and chest jerked 18 times a minute with every pump of oxygen pushed into his lungs as Allie Wegener, the Salem Hospital nurse at his bedside, introduced herself.
“I’m going to take care of you,” the 25-year-old said to the unconscious COVID-19 patient, who was about her same age. “I know you’re uncomfortable.”
The patient had been in the intensive care unit for three weeks. He had a fever. Thin, transparent tubes pumped five sedative drugs into his veins to keep him from waking up and tearing the ventilator tube from his throat, like he did the last time staff reduced the dosage.
Allie Wegener cares for an unvaccinated patient at the start of her 12-hour shift. Previously, Allie worked three consecutive days a week in the unit. Six months into the pandemic, feeling the effects of the work on her mental health, Wegener modified her schedule to reduce the number of consecutive days. “I just needed some time,” she said. “I mean, you look around and you know,” she said, pausing. “Everyone here is going to die. Everyone.” “Especially with the delta variant there’s this weird knowledge of, ‘I know you’re going to die.’” That knowledge, she said, is exhausting. October 4, 2021 Beth Nakamura
“Can you give me a squeeze?” she said, holding the man’s right hand Monday morning. “Sorry,” she continued, as she pinched a toe, making sure he was unconscious, before securing the white wrist straps to ensure that if he did wake up, he wouldn’t be able to reach the tube with his hands.
Wegener has spent nearly half of her four-year career as a nurse working through the pandemic, so she understood the reality. Even as she cleaned the sores on his lips and replaced the wet washcloth on his forehead, she knew the unvaccinated man was unlikely to survive.
This week, The Oregonian/OregonLive got a rare glimpse inside the battle over life and death inside an Oregon intensive care unit largely filled with unvaccinated COVID-19 patients.
Allie Wegener, 25, a nurse in Salem Hospital’s ICU, cares for Sheila Ball, a vaccinated COVID-19 patient. “Without our nurses, we’d be in hot water,” Ball said. Salem Hospital has been among the hospitals hit hardest by the delta wave. October 4, 2021 Beth Nakamura
The visit revealed the exhausting toll on health care workers as they tend to the sickest patients and the brutal effects of the disease on patients facing all-but-certain death. Patients from the record-breaking summer surge fill most beds, with a few others unfortunate enough to be in the ICU.
Peak COVID hospitalizations last month reached nearly 1,200 statewide, double the previous high from December, with patients in the ICU topping 300 and people on ventilators nearing 200. More than 1,000 Oregonians have died since July, a three months span responsible for 25% of all COVID-19 deaths, as September became the second-deadliest month of the pandemic.
Now, the hospitalization numbers are receding. That’s because infections have slowed and fewer Oregonians require medical care, while the people with COVID-19 already filling hospital beds are dying.
The ICU at Salem Hospital is a microcosm of what has played out for the past 15 weeks across Oregon. With more than 90 COVID-19 deaths since July, Salem Hospital has been among the hospitals hit hardest by the delta wave.
Outside the glass window to her patient’s room, Wegener fought back tears as she thought about the virtually endless stream of unvaccinated patients dying from COVID-19.
Allie Wegener wipes tears while talking to Sue Best, left, a social worker specializing in palliative care. Best says her role has been to provide support to staff as well as patients. “No matter what we do, it’s not really going to change the outcome,” Wegener said. “That feels defeating.” Three patients in the area where Wegener was working that day were dying. And one had just died, sooner than the staff had expected. “When another patient dies it just kind of hits you that everyone is dying. It hits you.” October 4, 2021 Beth Nakamura
“No matter what we do, it’s not really going to change the outcome,” Wegener said. “That feels defeating. We’re doing all this work, and we fight as hard as we can. And we’re continuing to do that. It just feels like it doesn’t really matter.”
Vaccines against COVID-19 – developed in record time and proven to be highly effective at preventing infections, severe illness and death – were expected to spare Oregon and the rest of the country from prolonging the pandemic. But the coronavirus and vaccines became so politicized and shrouded in misinformation that thousands still refuse to get shots, despite the deadly toll of their collective decision.
“People that are sharing all this stuff, you don’t know the damage that you’ve done,” Wegener said. “You don’t know how many people have died from that, because you said those things.”
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The denial can even come from patients’ families, some of them furious with nurses for not giving a patient unproven medications such as hydroxychloroquine or ivermectin, which is typically used to treat parasitic worms in humans and animals. And while health care workers were lauded for their sacrifices early in the pandemic, now they are accused of lying about COVID-19, or worse.
“‘This is the hospital, you killed them,’” Wegener said she’s heard from family members who didn’t believe COVID-19 killed their loved one.
But behind the scenes, the nurses talk to their unconscious patients as if they can hear everything. They console coworkers when patients die. They share a common trauma.
“The vast majority of patients need us to do everything for them,” said Kevin Carlin, 50, the lead nurse on Wegener’s shift Monday. “That requires a vast amount of effort, which requires more teamwork.”
“You’re not going to get this done alone.”
Charge nurse Kevin Carlin, center left, speaks with staff on the unit. Carlin said teamwork, always essential in the ICU, has increased in the pandemic. Because of their level of acuity, Carlin said, it’s “very rare for a COVID patient to be independent. At least in the ICU. The vast majority of patients need us to do everything for them. That requires a vast amount of effort, which requires more teamwork.” “You’re not going to get this done alone,” Carlin said. October 4, 2021 Beth Nakamura
‘Very bleak outlook’
Hunched over a piece of paper around 6 a.m. Monday in a small office with a framed picture of Crater Lake hanging on the wall, Carlin took notes as the night shift charge nurse read through the roster of 29 patients in the Salem Hospital ICU.
COVID with acute kidney failure. A Benadryl overdose. A “pretty sick” COVID patient connected to a ventilator running at 80% capacity.
Carlin, the day supervisor, went through each patient and decided which of the 17 nurses would provide care, walking to the ICU reception area to announce assignments. Backpacks on and coffees or water bottles in hand, the nurses peeled off toward their respective rooms at the start of their 12-hour shifts.
The fourth-floor ICU, shaped like a horseshoe and lined with patients’ rooms bisected by a walkway, was a strangely quiet place most of the morning and afternoon. Beeping of various tones and volumes interrupted nurses’ morning conversations and intermittent laughter.
Several hours into her shift, Allie Wegener laughs with respiratory therapist Juan Carlos. “There is no way I could have made it through without them,” Allie said of her teammates. “We honestly have the best team. We have laughed, cried and supported each other through the unimaginable. We are bonded from this trauma and we are the only ones who truly understand the depths of this virus. Going through this has made us much stronger.” October 4, 2021 Beth Nakamura/Staff Beth Nakamura
The rooms with COVID-19 patients were made obvious by the signs attached to the glass windows warning that anyone entering had to take precautions, as well as metal racks with patients’ intravenous fluids – kept outside so nurses wouldn’t have to go in each time they needed to replace them or change the dose.
Carlin assigned Wegener the unconscious and unvaccinated patient, and a vaccinated and conscious patient in a nearby room.
Handing off the two COVID-19 patients to Wegener with a 20-minute download about their conditions, the night nurse asked her if she had any other questions.
“Nope, I don’t think so,” Wegener said, then yawned, and stretched her arms forward.
Growing up, Wegener was often in and out of hospitals while a grandmother and aunt fought cancer. She moved to Oregon in 2013 from Northern California to go to the George Fox nursing school, then settled down in Newberg. Wegener said she witnessed bad nurses and good ones while in the hospital with her family, and decided she wanted to be the latter.
As Wegener got started on this Monday morning, her tasks seemed to bleed one into the next, every action routine and to the point, but careful. She addressed the beeping of an emptying IV bag machine. She carefully put on her respirator, gown and gloves before walking into a patient’s room. She poured a patient’s pills into a cup, humming along to The Beatles’ “Hey Jude” playing from a TV hanging on a wall.
Wisps of hair are seen from behind through the window into the room of a COVID-19 patient at Salem Hospital’s intensive care unit. October 4, 2021 Beth Nakamura
Of the 30 total beds in the intensive care unit, all but one was occupied, and 20 were filled by COVID-19 patients.
“For our unvaccinated patients, it’s a very bleak outlook,” Carlin said, standing outside the room of a patient who would die within an hour. “And that is difficult. We keep trying. We don’t give up.”
‘I’m not the only one here’
Lying in the hospital cot, so weak her voice was barely audible, Sheila Ball was one of the few sources of hope for the nurses on the intensive care unit.
The 51-year-old got vaccinated against COVID-19 but got sick anyway, one of the unlucky 1,200 Oregonians out of 2.5 million who are fully vaccinated to end up in the hospital with a breakthrough infection. Yet she was conscious, not intubated, and the nurses believed she was likely to survive.
“It’s nice to have a patient that’s doing better,” Wegener said after helping Ball get started on her long-awaited breakfast, and laughed.
Wegener, shown here caring for COVID-19 patient Sheila Ball, says she hasn’t seen this much death in her entire career. “I mean, you look around and you know,” she says, pausing. “Everyone here is going to die. Everyone.” Ball, however, is different. “That’s why it’s so nice to take care of her, because she said, ‘I know I did everything I could and I know that if I hadn’t, I’d be dead.’” Ball, Wegener said, is “amazing”. October 4, 2021 Beth Nakamura
Ball likely wouldn’t have been in the ICU if it wasn’t for a heart condition exacerbated by the infection. While she was doing better than the unvaccinated patients, she still had tubes running into her nose connected to an oxygen tank to help her breathe.
She was getting frustrated waiting for her breakfast but, after she dug into her toast, hash browns and orange juice, mentioned some of the things she was grateful for. The nurses work hard, she said, and the patients would all be “in hot water” without them.
“I get mad,” Ball said. “Then I remember I’m not the only one here.”
Sheila Ball, 51, was one of two patients Allie Wegener was charged with caring for during her 12-hour shift on the ICU. Ball was the only patient on the unit who had been vaccinated prior to coming down with COVID-19, Wegener said. She was in the unit because of a pre-existing heart condition that was exacerbated by the infection. Ball was conscious, not on a ventilator, and responsive to treatment. In many ways, her story, along with the story of Wegener’s unvaccinated patient, are a tale of two outcomes. October 4, 2021 Beth Nakamura/Staff Beth Nakamura
Most of all, Ball said was glad she got vaccinated against COVID-19.
“If I wouldn’t have gotten vaccinated, I would have died,” Ball said.
‘Right in front of our eyes’
The man in his 50s lay in a room with the lights off. Outside the window, four men in helmets and harnesses worked on the roof of another Salem Hospital building. A crow prowled along the ledge.
The man’s nurse got off the phone with a member of his family, promising she would stay by his side when he died.
Wearing an air-filtering helmet, the nurse leaned in toward the unconscious man around 4:30 p.m. and held one hand on his and the other on his forehead. Time and again, she walked to the glass door and motioned to Carlin, who was standing in the hall, to change the settings on the IV to deliver him more fentanyl or benzodiazepines to ease the patient’s pain.
Kevin Carlin, left, helps Stacy, an ICU nurse, adjust settings on IVs used to deliver more medications that provided comfort to a dying patient. “I think there’s always been some truth to the idea that people don’t truly understand what we deal with. It’s a very guarded industry for the privacy and protection of our patients,” Carlin said. “People don’t see what we see. In COVID that’s become heightened. In the past no one ever argued that their grandfather had septic pneumonia. But they will argue that they don’t have COVID. No one really understands that but our fellow teammates. No one else can really understand what that’s like to stand outside a room where a patient is literally dying and people are arguing that they shouldn’t have to wear PPE even as their relative is dying in real time right in front of them. To be dealing with that for 18 months, it does become rather exhausting.” October 4, 2021 Beth Nakamura
In the 16 minutes after the nurse removed the ventilator, the man’s oxygen level dropped from 95% saturation, to around 45%, where it hovered as his heart raced in an attempt to pump more oxygen into his blood.
“The fact of the matter,” Carlin said, “is this patient is dying right in front of our eyes.”
The man held on for more than half an hour, as the nurse came and went from the room, putting on and taking off her protective equipment. When she saw that the screen revealed the man’s heart rate and oxygen levels plummeted for what she assumed would be a final time, she rushed in to keep her promise.
A COVID-19 patient whose family was unable to be present is carefully guided through his final moments of life in Salem Hospital’s ICU. “Your mother loves you so much,” said Stacy, the dying man’s nurse. “It’s okay for you to stop fighting and go to heaven.” October 4, 2021 Beth Nakamura
“Your mother loves you so much,” she said to the man, leaning in to his ear. “It’s OK for you to stop fighting and go to heaven.”
Then, she checked the man’s heartbeat with a stethoscope, reset the vital monitors, took off her gown and left.
Standing outside the room, she confirmed the man had died, in what was, ultimately, the expected outcome ever since he was intubated.
At nearly the same time, a few doors down, a different nurse quickly stepped out of a COVID-19 patient’s room.
A family member of her COVID-19 patient had been scheduled for a conversation with staff Tuesday about next steps – most likely about turning off the patient’s ventilator and moving him to comfort care as the oxygen left his body.
But the patient had instead died within an hour of the family member’s visit Monday.
“I’m so tired of losing people,” Shay told Dr. Elizabeth Windell, left, after one of Shay’s COVID-19 patients in the unit died suddenly. Windell hugged Shay after she emerged from the room. October 4, 2021 Beth Nakamura
“This sucks,” Wegener said to the nurse as they embraced.
Standing in the hall, the nurse willed herself to take a break before helping her other patient for the day.
But family of the other patient overheard what had happened.
“I want to come in and jump in right away,” the nurse explained to the family member, tears in her eyes. “But … "
The man put his hands on her shoulders and gave her a hug.
“Thank you,” she said, and left.
‘Everything we can’
By 7 a.m. Tuesday, three of the 20 COVID-19 patients had died. But not the unvaccinated man under Wegener’s watch.
Members of the hospital’s housekeeping staff clean and disinfect a room in the Salem Hospital intensive care unit. Three COVID-19 patients died by 7 a.m. the day after The Oregonian’s visit inside the unit. October 4, 2021 Beth Nakamura
Wegener had spent part of her shift Monday reassuring the family they would keep fighting for the man and were by no means giving up. But she had to be honest, and they scheduled a meeting for Thursday with the man’s physician and social worker to discuss their options.
“He’s not likely to come out of this,” she warned them. “But we will continue our treatment until we have our meeting.”
“Emotionally, I’m trying to prepare,” Wegener confided later. “I know that that’s going to be a difficult conversation.”
Following the Thursday meeting, hospital workers will now see if the patient’s lungs are strong enough to qualify for a specialized surgery to help him breathe more safely and without being sedated.
“There’s always a part of you,” Wegener said, “that wants to be a tiny bit hopeful.”
Do you have a tip? Call or email the reporter.
— Fedor Zarkhin
503-294-7674; fzarkhin@oregonian.com
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