Rising to the call
May 8, 2020
Ray Devlin is the chief nurse anesthetist at Our Lady of the Angels Hospital in Bogalusa, Louisiana, part of the Franciscan Missionaries of Our Lady Health System. He and his anesthesia team intubate COVID-19 patients struggling for breath. In March, Devlin contracted the virus. After his recovery and a brief quarantine, he was back at work.
Devlin talked to Catholic Health World's Lisa Eisenhauer in late April, just as a surge of patients with the virus was easing at Our Lady of the Angels and just before the hospital and others in Louisiana resumed nonemergency surgeries. Here, in his own words, is what his job has been like for the last few weeks.
Our CRNA (certified registered nurse anesthetist) group of six provide 24-hour anesthesia coverage throughout Our Lady of the Angels.
Ray Devlin, a nurse anesthetist, is back at work after recovering from COVID-19.
We have three operating rooms, two endoscopy suites, and a labor and delivery unit. We provide 24-hour labor and delivery coverage that includes epidural analgesia, subarachnoid blocks and, if needed, general endotracheal anesthesia for cesarean sections.
When the COVID-19 epidemic began, our surgery schedule really dropped off to only true emergency cases. That probably went on for about six weeks and today we are just starting to pick back up again with elective cases. During the peak of COVID-19 cases the anesthesia department had to function with a lighter staff and we all used vacation time when we were slow.
During the busiest times of the COVID-19 pandemic the role of the CRNA's transformed into providing initial care for suspected COVID-19 patients. Throughout this time, when a patient with suspected COVID-19 needed airway support, they would call us. After inducing anesthesia with an IV induction agent followed by a paralytic agent, we would place the endotracheal tube (which is connected to a ventilator to flow oxygen to the lungs). Following this, we would place an ultrasound guided central line and then an arterial line. We would spend about an hour and a half in a patient's room providing all three life-saving interventions. Since we had one CRNA doing all those three interventions, there was less exposure and less PPE (personal protective equipment) being used.
Even though we're not doing as many surgical cases, we have been really busy in the other units in the hospital, such as the emergency room and intensive care unit, caring for these critically ill patients. On top of all this, we still have the labor delivery unit to cover, which as everyone knows can be the most unpredictable unit in the hospital. On many occasions, we would be back and forth from the ER, ICU and labor and delivery unit.
When we get called to assist a patient, things are not looking good. When the patient's condition has deteriorated to the point of needing airway support, the possibility of survival has decreased. It's sad because we've had so many here in this situation. I think a few have recovered to the point that they could be weaned off mechanical ventilation, but I know that for the majority of intubated patients, survival rates were not good.
At one point all of our ventilators were being used in the hospital, even to the point where our anesthesia machine with a built-in ventilator was made available for overflow patients. So, if another patient needed a ventilator, we had another one available. Luckily, we did not get to that point.
On Friday, March 27, I worked a 24-hour shift. I was called to the ICU that afternoon for a suspected COVID-19 patient requiring intubation. I remember this particular patient because she was burning up with fever. I could feel her body radiating heat when I touched her. She was anxious and in severe respiratory distress. I spent about an hour and a half in a room in full PPE and successfully performed all three interventions.
My shift ended the next morning on Saturday, March 28, at 7 a.m. My wife and two daughters were at home and for about three weeks my mother-in-law has been staying with us. My mother-in-law is 82 years old and had suffered a stroke two weeks prior. During the COVID-19 pandemic I would come home from work and remove my shoes and clothes before coming in the house. I would also wipe down anything else that I had. I would shower and try my best to make sure I didn't bring the virus home with me. On this particular morning, I remember going for a run before I came in the house.
I definitely felt a little sluggish when I was running, but thought it was just because I worked all night and was tired. I showered, took a quick nap that morning and when I woke up, I had a really bad headache and body aches all over. At no time did I have any breathing issues, but I remember having a slight cough and I just did not feel well. I did have a slight fever of 99.8 but it felt much higher. I kind of knew something was not right and with all the patients we had been recently caring for, I called one of the physicians at the hospital and arranged to be tested for COVID-19.
I went back to the hospital, was tested and came back home. I quarantined myself in a separate room immediately and felt really bad all day Saturday. Sunday, I felt just about the same, low-grade fever, body aches, and fatigue. Sunday night going into early Monday morning, my temperature spiked to 101.4, I had severe body aches and chills. When the temperature broke, I felt much better. From that point on, each day I felt better than the day before. For the next three days, I remained fever-free. I received the test results on Wednesday, stating that I was positive for COVID-19. I had an appointment with a doctor here at the hospital on Friday and he declared that since I had been symptom-free for three days, I could go back to work the next day. The next day would be Saturday, exactly one week from my first symptoms. This was also another 24-hour shift.
I really don't think that I contracted COVID-19 from the patient I cared for (March 27). I feel like the symptoms started too soon after that exposure for me. I think I picked it up two weeks before at another hospital where my mother-in-law was being treated for the stroke. That 24-hour shift on that Friday, March 27, I still felt fine, symptom-free, but my mother-in-law and my wife were starting to feel sick. They went to the hospital that Sunday, March 29, and were tested. I was already quarantined and they were getting nervous. They both ended up being positive for COVID-19 as well. For them it lasted two weeks. They are both totally recovered.
Both my 15-year-old and 14-year-old daughter never developed any symptoms at all.
Many people do not take this virus seriously and many will compare it to the flu. My experience is that this does not compare to the flu. This virus spreads much easier and it really impacts patients more than I have seen with any flu case. It also has a devastating effect on patients who have other comorbidities such as obesity, hypertension and diabetes.
I don't think the public realizes everything that is happening within our ICU's. After I recovered from COVID-19, I remember going to pick up dinner from a local restaurant being that my wife was still sick. At the restaurant, some people had masks, some people didn't. They had markings on the ground where they wanted people to stay six feet apart. But I remember this one gentleman who walked right up next me, way too close, inquiring about his food. I had a mask on, but he had no idea that I recently had COVID-19 and I could still be contagious. I fear for those that contract this disease and will not be as fortunate as my family and I were.
Copyright © 2020 by the Catholic Health Association
of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.