The sleek, windowed face of the Ohio State University Wexner Medical Center is a landmark on the Columbus skyline — but its shiny exterior hides a darker reality from the public during the COVID-19 pandemic.
Behind those reflective glass panes are a team of doctors, nurses and therapists working non-stop, as they always do, to treat patients with a novel virus that proves especially deadly to them. Intensive care beds, located on the the 10th and 11th floors of the hospital, are full of COVID patients. Another ICU wing has been opened and it, too, is full of COVID patients. Both have been sealed off from the cancer intensive care unit and others, to prevent the spread of a virus that has leveled an unprecedented death toll on its unit.
In normal times, 40% of patients who enter this medical ICU with severe respiratory illnesses eventually die, but the patients there are usually not all fighting severe respiratory illness.
During the COVID-19 pandemic, all of the ICU patients are COVID patients suffering from severe respiratory illness — so now, 40% of all patients there die.
"When they get to the ICU, they're coming there because they need to be put on the ventilator," says critical care nurse Lori Lang, who spends at least three 12-hour shifts on this unit every week. "We have 24 beds. On my last shift, every bed was COVID and every patient was on a ventilator."
Lang is a leader on the medical ICU at Wexner Medical Center. She has spent the entirety of a three-decade career working in this same unit, at this same hospital. This year is the hardest of them all.
"Usually in an ICU before COVID, you'd come in and say 'Oh my god what's going on? It's busy, everyone's in the hallway,'" Lang explains. "Now it's like that all the time. You don't come in and say, 'oh it's been a busy night.' It's always a busy night."
"I've never experienced anxiety in my job. But with COVID, I have," says Lang, who now uses a meditation app to calm her racing thoughts, and regularly parks far away from the ICU in order to take long walks and decompress after shifts.
It's not only the nurses who are having trouble coping.
"I've just never experienced anything like this before. I've never seen so many medical patients in the hospital, ever," says respiratory therapist Lauren Sanders, who works on the same unit as Lang. "I've never had insomnia like I've had (during COVID) before."
Sanders is a 15-year veteran on her job, and worked throughout the H1N1 influenza pandemic more than a decade ago. That pandemic also featured a respiratory disease that affected patients' breathing.
"With the flu, people either get better pretty quickly, or they don't," Sanders says. "This isn't like that. People are on the ventilators for over a month. If they cough once, their oxygen level in their blood goes down — and it can go down significantly with one cough."
Sanders is regularly administering inhaled medication through patients' ventilator tubes. Lang's nursing team has moved machines that administer intravenous medication into the hallway, to avoid having to suit up in extensive personal protective equipment every time a drug needs adjusting.
"And you've probably heard about us having to prone (patients)," says Lang, speaking about the process of turning an intubated patient on their stomach to help their lungs do the work of breathing.
"You're taking five or six people away from all the other patients, to get this patient turned on their belly," says Lang. "We get (them) turned, and then (sometimes they) don't do well...it's physically exhausting."
Sanders suffers more leg and back pain than she ever has, from being on the teams that "prone" patients.
"It feels like you can turn your back, and all of a sudden their oxygen level is low," Sanders explains. "When we are able to try and get someone off the ventilator, more often than not they have to go back on."
Both women have families at home they worry about infecting. Sanders runs to the shower before embracing her husband and two young children; Lang stresses that she might pass the virus on until it reaches her 86-year-old mother-in-law.
Doctors on the unit, who lead the decision-making efforts to save patients, are dealing with similar anxiety.
"The fear in the patients' eyes is something that has gotten to me this year; before now I didn't notice that as much," says pulmonologist Dr. Rachel Quaney, who often works as many as 16 straight hours between the medical ICU and her other responsibilities.
"And really being able to do almost nothing to assuage that fear...it adds up over time," she says.
Dr. Quaney has resorted to medication to ease her anxiety; at one point during the pandemic, she awoke in the middle of her sleep, saying the name of a patient.
"The moral injury, the emotional injury of this year — not only in the actual patient care, but feeling like you have to defend your job and career and actions to a whole host of people — it is burdensome and it wears on you, definitely," she says.
All three women have been thrust into the role of a surrogate family member, as the units are locked down with no visitors during COVID-19, which is also a first.
"Being able to bring a loved one into a bedside and then sort of pat them on the back as you step into the background, is a very different feeling than literally standing between a screen and a person that probably doesn't fully look like themselves," says Dr. Quaney.
"My last patient who was dying had his daughter on FaceTime so she could say her goodbyes," recalls Lang.
Sanders is often there from the time the decision is made to come off a ventilator until the patient passes away.
"I'm the one taking the breathing tube out, and helping them transition from curative care to comfort care," she explains. "If it's a quick death, then often times I am in the room. Sometimes I'll be the one holding the phone (on a video call) so the nurse can titrate the medications to make sure the patient is comfortable.
"I hear those goodbyes from family, and it's just heartbreaking," she said.
Sometimes the steady job and even the fear of oppressive medical school loans that keep the three coming back during these difficult conditions. Beyond that, each feels a sense of duty to their patients — and to each other.
"I feel like I can make an impact, on the good days at least. And those good days are enough to bring me through the bad days," Dr Quaney shared, which Lauren Sanders echoed.
"I come back for the patients and to be their voice when they don't have one," she said.
Lang, with thirty years of service under her belt, is more realistic about her remaining time in the medical ICU.
"I've been talking about retirement a lot; believe me, it's coming close," she said. "But this is my family...I just feel like this is where I belong."