When the hospital shut down elective surgeries in the beginning of March, Hilderbrand moved to the frontline, working directly with COVID-19 patients on the intubation team.
We chatted with him about his experience.
Source Weekly: I think a lot of our readers are interested in an insider’s perspective from someone who is working on the frontlines of this pandemic. So first of all, how are you doing and feeling right now?
David Hilderbrand: There’s a cautious optimism mixed with an inevitable anxiety. Anytime there is a pandemic, you know you’re going to be on the receiving end of the most affected patients in the community; that’s where the anxiety comes from.
But on top of that, because this is a new contagion, CDC [Centers for Disease Control and Prevention] guidelines and hospital guidelines are changing every day. But we’ve also seen caregivers, community and hospital partners work together to limit the number of patients that we’re seeing who require hospitalization. That’s the optimism.
SW: There’s been some talk among epidemiologists about the inaccuracy of the low numbers of official positive COVID-19 cases... The numbers both released by hospitals and the Oregon Health Authority. Given that testing has been so limited in Central Oregon, do you think the low number of COVID-19 cases reported in Deschutes County (59 as of April 17) are a reflection of the reality of the spread in this area or are we only testing the very sickest cases?
DH: Our inpatient numbers are reflective of reality. The internists and physicians I have spoken with at the hospital have said there has been an increase in the number of people with a pretty classic presentation of COVID-19 that have come into the hospital or who need hospitalization. We might not have an accurate number for how many community members are sick. But if you are sick in the hospital because of a respiratory illness, we are prioritizing, testing and quarantining these cases.
SW: What is your day-to-day like at the hospital?
DH: I am one of 11 nurses that have been taken into the intubation team to work with COVID-positive or suspected-positive patients… we’re a group of nurses and anesthesiologists. We have been trained specifically and wear maximally protective equipment.
SW: You’re right in the center of this pandemic here in Central Oregon. What is that like?
DH: I am one of the nurses that sees these patients, absolutely, but I’m also provided with really good protective gear and a very strict protocol. The nurses, the anesthesiologists and the hospital [administration] researched [this illness at the beginning] and came up with good protective measures.
SW: There’s been some critique of hospitals—not just St. Charles—but hospitals all over the U.S. for forcing their staff to work without personal protective equipment, or the appropriate kind of PPE. Every hospital has different constraints, but there remains a universal shortage of PPE. Do you think St. Charles has protected your team adequately?
DH: They are matching the level of protection with the level of exposure. We’re doing that as appropriately as we know how. If everyone had the level of protection that the intubation team has, we would burn through so much PPE. The hospital has provided us with airborne precautions. The staff has cloth masks at the very least, and those have filters in them that make them more appropriate. As you get closer to patients, people are using single-use masks.
SW: What is your perspective on St. Charles and the administration and how they have handled the coronavirus pandemic?
DH: One of the weaknesses of the whole country in the beginning is that it was difficult to tell who was taking it seriously and who wasn’t and when that began to change. The strength of the decision-making at the hospital is most represented by their willingness to listen to people on the frontline. That came from a request from nurses in the operating room to stop elective procedures, to stop surgeries, to save PPE. St. Charles was the first system to stop elective surgeries in the state.
They listened to nurses and partnered with us and took the most conservative approach. At the time [that the hospital stopped elective surgeries] Deschutes County already had a few cases, but there were no inpatient cases in the hospital, so we stopped before we even had an inpatient case here. The Oregon Nurses Association put pressure on the administration to start providing masks to staff in places that were thought to be low-risk. It was soon after that, the hospital allowed everyone to wear masks and began partnering with community members to make homemade masks with a filter.
But I’d like to make it clear, [homemade masks] are a good way to supplement our PPE, but it is certainly not meant to supplant the guidelines established prior to the pandemic. Different masks need to match the standards to the situation of which the mask was made. You shouldn’t be using masks over and over in some situations, shouldn’t use a cloth mask when guidelines say to use a surgical mask… the right equipment for the right job...
SW: How has the hospital dealt with PPE shortages?
At certain times during this pandemic, it’s not “should we use it,” it' “if we use it here, is it going to be available at another time.” This was when we had the expectation that our numbers would be a lot higher. Luckily we haven’t gotten to that point.
SW: Speaking of that, how do you feel when you hear news of politicians and elected leaders making plans to reopen the economy?
DH: Here’s where the sense of impending doom comes back in. If social distancing has been the thing that worked, what happens when we end social distancing? It’s just a logical calculation. We can’t go from having the lights off to having lights on. We need to slowly turn them back on, while still limiting movement and contact between people. Almost certainly we would see a surge otherwise, maybe one that surpassed our numbers for previous projections.
SW: It sounds pretty heroic that you are doing this kind of work, directly serving the sickest people during a worldwide pandemic: the frontline of the frontline.
DH: It is stressful. But I wouldn’t categorize myself as frontline of the frontline. Yes I’m in the thick of it, but I don’t think anyone in this field wants to be singled out for their contribution. I would say the ED [emergency department] nurses, they are seeing everyone coming into the hospital… the ED, the ICU [intensive care unit], the floor nurses… they are in an equally tough position. It has been amazing to see how these nurses are still treating these patients with a tone of compassion. In the beginning, we had conversations—not just about how to protect ourselves—but how can we provide holistic care, provide a connection for people and keep talking to their families, given all the precautions.
SW: What is the environment like at the hospital?
DH: It is certainly a different environment. A lot of things that were therapeutic, high fives, pats on shoulders, whatever encouragement we were able to give each other, it is very different, still there, but taking different forms.
SW: Are there a lot of hypochondriacs coming into the hospital? I ask this because St. Charles has tested around 1,000 patients so far, and Deschutes County’s official count is under 100 COVID-positive cases.
DH: The census is relatively low [at the hospital] so we can be ready for a potential surge. We’re not seeing any panic, chaos and disorganization. Things are very regimented and organized.
SW: Have teams moved around, or is everyone pitching in to help other departments? What changes in the organization have been brought on by the pandemic?
DH: Nurses have been very flexible in learning new skills and going to different areas to make sure we’re prepared to serve in a different application than is normal for our day-to-day. It is part of our emergency management plan.
SW: Is this voluntary?
DH: The hospital has set up a program, and it’s very clear that nurses that are trained to be extenders in this way won’t be taking primary responsibility for a patient outside of their expertise. They are trained to assist other nurses in their primary area.
SW: What has your experience working in the center of this epidemic taught you?
DH: The point of anxiety for me was recognizing that this virus didn’t seem to discriminate only to the elderly population. Being someone that is supposed to be in a low-risk group… knowing that… and then caring for patients that are also supposed to be in a low-risk group… this provides a different perspective.
When I hear people say things like, “let’s turn the economy back on, the cure can’t be worse than the disease,” the people that are saying this seem to be in the low-risk group, or they assume I’m just going to live through it [as a frontline caregiver], someone else can be the sacrificial lamb. I wish people that thought like that had exposure to see the people I am caring for who are low-risk, but still struggling and fighting to survive.
SW: The pandemic response has turned into a partisan issue. As someone who is living the experience of COVID-19 every day, do you feel like the governor has acted appropriately?
DH: Absolutely shelter-in-place when it was made was the right decision. We can’t look at the low number of cases we have—which were the intended result of precaution—and then say, “we were too cautious.” There’s no winning in that solution. We put in procedures to protect the community and got the intended result. Going back and removing protective measures, we should expect to see the result that we had initially anticipated [a spike in cases that overwhelm the health care system]. Until we have a vaccine that can be mass-produced and given to the community, we’re not rid of this.
SW: What is the health care worker’s consensus on lockdown? I know you can’t speak for everyone…
DH: We have to have some level of lockdown until we get a vaccine. Not exactly this level, but we can’t just open up the floodgates. We have to be patient, analyze the results, use the scientific method by limiting variables within this experiment [of reopening]. It’s a scientific problem and we should solve it in a scientific way. Not just responding based on the economy, impatience or financial interests.
SW: Any last words to people out in the community routing for you and your colleagues?
DH: Well I hope these are not my last words, given the situation.
SW: Oh my gosh, so sorry, I can’t believe I said that.
DH: That’s OK! I would say I’m thankful for the people in our community who have been listening to the governor’s orders. I hope that people who aren’t would start to listen. I would ask for the community to have patience and stay guided by reason. This has been a moment in history where caregivers from each discipline, and hospital administrators have had to really work together. And working together has really looked like listening to people doing the work and responding to what they ask.
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