Rising to the call
April 30, 2020
As the clinical director of critical care medicine for Chesterfield, Missouri-based Mercy, Dr. David Tannehill is the physician lead for all the critical care medicine specialists at the 11 intensive care units at Mercy hospitals. The Mercy system has more than 40 acute care, managed and specialty hospitals in four midwestern states.
In addition to his administrative duties, he treats ICU patients at Mercy hospitals in St. Louis and in Washington, Missouri. Since the COVID-19 pandemic hit, his work in both of those areas has expanded, leaving little time for family. He slows down enough to spend extra minutes with patients who are often lonely and afraid and to celebrate with patients who come off ventilators on their way to recovery. He shares responsibility for making sure Mercy ICUs are appropriately structured, staffed, equipped and stocked to provide optimal care to patients and writing protocols to protect coworkers from contagion.
Tannehill spoke to Catholic Health World's Julie Minda in mid-April about how his team found the courage to face down initial fears of the unknown, what it's like for ICU patients combatting the virus and the emotional lift staff gets when a patient pulls through.
When it comes to the mood of the ICU teams I'm working with, I think in the beginning people were scared but ready to face the challenge. I think we did a nice job of putting together what was needed to help people feel prepared and I think we did a really nice job of accepting that fear and telling people it's ok to be scared. One of the things that I would tell people is — if you're scared, then you're going to do a better job of being prepared, and focusing on that and viewing that fear in a positive light. I think everybody really took that to heart.
Dr. David Tannehill is suited up in late April to care for COVID-19 patients at Mercy Hospital Washington, in Washington, Missouri, one of the Mercy system intensive care units he oversees.
I think that the folks who are taking care of these patients in the ICU, they know that there is risk, but they know what they need to do to minimize those risks as much as they can. And the mood now — I think the mood is positive, focused on the work that needs to be done — but I do think that we need to be honest and admit that there is a lot of stress and people are really feeling that stress and that stress is both at work and at home.
I was pretty intentional in trying to not limit what I'm doing with direct patient care. In other words, the first priority was taking care of patients and then I sort of fit the administrative role around that. That's why those were even longer days – 7 a.m. to 7 or 9 p.m. My wife and kids — they are 13 and 16 — have been unbelievably supportive. My appreciation for this cannot be overstated. There have been times where I'll maybe be able to spend just 30 minutes with them, and they have been unbelievably supportive of what it is I feel I need to do. They've been encouraging, and I can't tell you how much that has meant to me.
The patients we're seeing in our ICUs who have COVID-19 are the ones who are very, very sick, on a very high level of life support. Their care is very, very complicated. And it's made that much more challenging because of what is needed as far as the coworkers' personal protective equipment and the precautions that have to be taken in caring for those very severely ill patients. What this disease can do to those that get really, really sick is pretty scary.
I think one of the things that is a challenge is that these patients get very sick and they stay that way for a long time. The average amount of time that somebody is on a breathing machine can be 10 to 20 days and that is a little unusual in the ICU. As an example, the average length of stay in the ICU is usually about three and a half days for normal ICU patient populations. But for this disease process it is much longer than that and so that carries some challenges. The PPE brings some challenges and hinders communication, and for those on the ventilator there is other noise pollution in the room and so that person being able to hear you is a challenge.
When I and other clinicians go into the rooms, the patients are so happy to see you, because they feel very isolated. They are behind closed doors and everyone who comes in has all this crazy gear on and they are happy to see you and interact with you. Their families can't visit because of visitor restrictions in the hospital to prevent the spread of disease. And that actually inspires you to spend a little bit more time than perhaps you normally would just because you know that that person is feeling a little bit lonely. In a weird way it's actually pretty gratifying in that way because the perspective is just different.
Because COVID carries with it so many unknowns, people are worried, and it's hard for me to be able to give them definitive answers a lot of times. But we just try to be there with the patients, hold their hand, and listen to what they have to say, hear their questions, help reassure them and then do our doctor thing.
We've had a couple of patients who were very, very sick, got better and came off of the ventilator and that's what we do in the ICU, that's kind of routine. However, because of what everyone has seen and read and heard about this disease and some of the emotionality around how scary and unknown it is, and some of the other things people have seen and heard on the news and in social media about patient deaths, the celebration of getting one of these patients off the ventilator is pretty cool to see.
That was an experience that I had last week — it was a patient with a lot of underlying health problems. This would be someone who definitely met the criteria for not doing well. And, she got better and got off the ventilator and had a full conversation with us. We asked her what we could do for her, and she looked at us and said she wanted ice cream! And so, we got her some ice cream, and that was a pretty cool moment and it kind of brightened everybody's spirits. That was actually a pretty happy day in the ICU.
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