Jason Pagaduan has seen victory and loss during the COVID-19 crisis, sometimes in the same coronavirus patient.
Take the 67-year-old man upset because doctors wanted to take a blood sample as they tried to determine his exposure to the virus. According to Pagaduan, a respiratory therapist at Beaumont Hospital Farmington Hills, the man complained to his wife about the request.
Within 12 hours, the man had to be intubated, and was still that way three weeks later.
“It’s draining to watch (patients) deteriorate,” said Pagaduan, who’s been a respiratory therapist for 12 years. “We watched him for 18 days and thought we’d lost him. Doctors at one point called his wife and said there wasn’t anything to do.”
Then came the victory. Two days after that call to the patient’s wife, his lungs started improving. Not long after that, Pagaduan said, he was waking up “and we were able to pull the tube out.”
“There’s more downhill than uphill,” Pagaduan said. “There’s victory at the same time.”
Pagaduan has seen his share of both. Because of the nature of the virus, Pagaduan has been working directly with COVID-19 patients from the beginning – “If there’s a COVID-19 patient, right next to him is going to be a respiratory therapist,” Pagaduan said.
The fact they’re having trouble breathing – it’s one of the key symptoms of the disease – is what Pagaduan says typically brings patients in. RTs have to determine patients’ needs as fast as possible. The RT is responsible for determining what level of oxygen or type of medication can be used.
But there are always questions.
“We’re right there ready from the first second we see them,” Pagaduan said. “But that’s where some of the challenges started right from Day 1. We were unsure at first how the virus was transmissible, droplets or airborne. We had to figure out how to contain and not spread the virus as quick as possible.”
The job has its professional challenges. Before COVID-19, Pagaduan said he’d see 20-40 patients a day, normally, but once Beaumont started taking COVID-19 patients, Pagaduan said the patient volume ratcheted up – he figures he’s treated more than 300 himself – in the 170-bed hospital.
The hospital’s intensive care unit has 20 beds, Pagaduan said, and the entire hospital only had 35 ventilators – “We’ve managed this far without having to use all of them,” he said – and the staff in the early days was “quickly running out” of gowns and masks, “so that was a challenge from Day 1.”
But it also has its personal – often incredibly emotional – challenges. The front-line workers – doctors, nurses, the RTs – are “right in the face” of patients, who generally are coughing in very close proximity to the staff.
“Respiratory really gets dirty, with intubation, and we’re right there with the doctors,” Pagaduan said. “Our face is right there, near their mouth. That’s why proper PPE (shields, gowns, caps, etc.) are all necessary.
“It’s like a machine gun coming right at you,” Pagaduan added. “You’re hoping your little ‘bunker’ is going to stop the bullets.”
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And there are emotional challenges on several levels for these frontline workers. One of the biggest for Pagaduan was the risk he may have been causing to his family. His wife, Jennifer, is a nurse currently in the CNRA program at Macomb Community College.
Because she’s focusing on school, Jennifer hasn’t been exposed to the virus the way her husband has. But it’s still a big concern for Pagaduan.
“I just don’t know if I bring it home or not,” he said. “(Jennifer) kind of feels she dodged a bullet in the sense that she doesn’t have to be in front of the virus, but there’s a pull that she should be helping.”
The disease really hit home when the Beaumont Farmington Hills staff lost one of its own in phlebotomist Deborah Gatewood, who worked at Beaumont for more than 25 years. Pagaduan called Gatewood “well-known and likeable,” and said her passing was a “sad weekend at our hospital.”
And then, of course, there’s the inevitable suffering he sees in his patients, many of whom Pagaduan says don’t “feel like they’re sick” when they come in, but then begin deteriorating. Then doctors see the bloodwork and it turns out they have the virus.
Pagaduan said the sickest patients they’ve seen run in age from the early 30s to the late 80s. Nearly 900 COVID-19 patients had died in the Beaumont Health System hospitals at press time, the toughest part of the job for Pagaduan largely because many of them died without family beside them due to COVID-19 restrictions.
“The ones we know are going to pass away, the nurses and the doctors have to call them and the families have to make that decision while their loved ones die alone,” Pagaduan said. “That’s the hardest part. There’s a ton of suffering.”
IMANA ‘MO’ MINARD, RN
When Imana Minard saw the coronavirus creeping in, and saw the pressure begin to load up on the nursing staff at Beaumont Hospital Farmington Hills, she asked herself the question she figured any good leader would ask.
“How can I help lighten their load?”
Minard – everyone calls her Mo – realized dealing with the families of an ever-increasing load of patients was an emotional burden the staff didn’t need. So Minard, the director of nursing at Beaumont Farmington Hills, came out of her office and took on that responsibility.
“When I saw the amount of patients we were getting, I knew I’d no longer be the nursing director,” said Minard, in charge of the emergency and trauma care unit, the CCU/ICU and respiratory care. “I had to figure out how I could serve the team. What can I do to ease the load off of them?”
The answer came to her pretty quickly: Families. With the patient load growing by the day, and knowing that dealing with family members can be a difficult, emotional and often time-consuming process, particularly with this disease, because family members weren’t allowed into the hospital with their loved ones.
“(Nurses) are wearing PPE all day, their workload has changed, we had patients everywhere with this horrific illness,” Minard added. “We had patients passing away, their loved ones couldn’t be there for them, so I started talking to the families.”
Luckily, she had the training for it. Minard was an EMS paramedic for the Detroit Fire Department (her husband, Charles Minard Jr., is a lieutenant in the department now) for 11 years before she got into nursing. That’s a role that brings a paramedic into nearly constant contact with family members, whom Minard began to view as “partners” in the treatment of their loved ones.
“To go into someone’s home and be in their most intimate space … it lets you know no matter how bad you think you’ve got it, there’s always someone worse off. That job taught me so much about life, about people.”
She went into nursing at the Detroit Medical Center, where she spent 10 years. She’s been at Beaumont Farmington Hills the last two, working herself from staff nurse to director of nursing.
Her EMS training, and subsequent nursing career, taught her the value of working with family members of the patients they were treating. It was tough because family members couldn’t be with their loved ones, even those who were passing away.
Those conversations are tough for nurses and other medical professionals. That’s why Minard felt she needed to step into that void.
“When I became a nurse, I was already prepared to deal with families because of my EMS training … Families didn’t really get to me like that, because I was used to dealing with them,” she said. “Patients are sick, families don’t always understand what’s going on medically, you have to make sure they’re comfortable after your conversation. You don’t want them to walk away lost, or having questions.
“I was in the department all the time … I became the emotional support,” Minard added. “That job taught me so much about life and about people.”
While Minard has thrown herself into helping co-workers get through it all, COVID-19 has stripped Minard of one thing she cherishes: Her radio show.,
Minard hosts “MO-Tivation Nation,” from 10 p.m. to midnight Mondays on WHFR 89.3-FM. The show, housed at Henry Ford Community College, plays music to uplift, inspire and encourage others and includes interviews with local business owners or “anyone who has a story that uplifts or inspires someone else.”
Because of the stay-at-home orders, the college has been closed and Minard can’t get in to do the show. The plan is to resume as soon as they can.
“I love it … I always crack a joke that I’d leave nursing if the radio show could provide the compensation,” she said. “I miss it very much; as soon as we can get back in I’m running with it.”
Her positive attitude has attracted attention. Minard was part of a television report on frontline workers in the pandemic, and her forthrightness caught the attention of state officials. The Michigan Department of Health and Human Services asked her to do a 30-second public service announcement, and Minard was happy to do it.
In the PSA Minard, lamenting the deadliness of the virus, said it “separates patients and families where loved ones don’t have a chance to say goodbye,” and talks of holding phones and playing recordings to give patients a chance to hear their loved ones’ voices.
When she calls family members, the caller ID function shows the call coming from Beaumont Health, and families immediately think it’s the “call of death.”
“I was talking to the wife of a patient and she started crying, so I started crying,” Minard recalled. “I told her, ‘I hate that you can’t see your husband.’ Families are important for healing. When you remove the support system you’re delaying the healing process.”
Minard recalls one husband sending a recording to play, and she played it “several times” in the patient’s room.
“Her husband called me to let me know she had ‘transitioned,’” Minard said. “It meant a lot to me that her husband trusted me to do that for her.”
DR. ZAFAR SHAMOON
Dr. Zafar Shamoon saw this coming.
The medical director for the emergency department at Beaumont Hospital Dearborn, Shamoon – who graduated from medical school at Michigan State University – had been keenly observing the events surrounding the coronavirus from their beginnings in Wuhan, China.
Sure the virus would eventually hit the United States – “I didn’t think there was any way to avoid it,” he says now – Shamoon began studying everything he could find about it. When the NBA suspended its season on March 11 – the day after the first two cases were reported in Michigan – Shamoon and his colleagues started getting ready.
“The day they cancelled the NBA season was the day I knew this was going to be bad,” Shamoon said. “If they were willing to cancel that, somewhere along the way someone told a billion-dollar industry you need to cancel your season. I started researching and studying it as best I could.”
“Going to be bad” turned out to be a huge understatement. In Michigan alone, there had been more than 55,000 cases and nearly 5,300 deaths from COVID-19. Nationally, the U.S. had seen more than 1.7 million cases at press time and, on May 27, passed a tragic milestone: More than 100,000 deaths.
Not long after the 45-year-old Shamoon saw the virus coming, it came in a very real way. Shamoon says he treated the very first COVID-19 patient Beaumont Health saw and, without much knowledge about how the virus presents, Shamoon saw her without the right protective equipment, and paid for it.
“I was the doctor that day, and this girl comes in and didn’t look very sick,” Shamoon recalled. “This was at the very infancy of all of this, and I walked in without a mask, and immediately got sick.”
But he, like all the frontline workers, has been trained to deal with the virus. As chief of the emergency department, Shamoon’s the one who sets up protocols and procedures and helps with everday operations of patient flow (for good measure he’s also the corporate sepsis team leader and the associate residency director for Beaumont Dearborn and Trenton).
As part of his daily responsibilities, Shamoon does a little bit of everything, spending a third of his time on administrative duties, another third seeing patients and the other third teaching.
All of that experience came in handy once got here. At press time, Beaumont Dearborn had seen more than 1,500 patients (the number surely has climbed) and discharged nearly 1,400 (that number has climbed, too). In one 12-hour stretch, he admitted 10 COVID-19 patients.
As the pandemic grew, Shamoon said, Beaumont Dearborn staffers began securing medical equipment, figuring out processes for the floor, and determining how to separate COVID patients from other patients – “Obviously, you don’t want to expose the two,” he said — in the emergency room.
“I think we were a little ahead of the game compared to most systems and most sites, because we had a lot of it ready to go,” Shamoon said. “That doesn’t mean we were 100% ready, I don’t think anybody was. But the way we adapted at Beaumont Dearborn … I’ve never seen this.”
The one thing he wasn’t necessarily ready for was the fear, particularly when he got the virus himself, with a pregnant wife and 6- and 3-year-old children at home. His wife, Nadia Yusaf, is a radiologist for St. John Macomb and Oakland, was in her third trimester.
“That was the one thing that really scared me,” Shamoon says now. “I wasn’t really worried about me, but I was worried about my pregnant wife, because we don’t know how (COVID-19) interacts with pregnancy.”
Throughout the pandemic, the frontline workers have had a lot to deal with. While much of the attention had gone to COVID-19 patients, other patients still needed care. The medical staff often careened from one situation to another.
“I can vividly remember one patient who died in one room, and then I had to run to the next room to deliver a baby,” Shamoon said. “That’s the beauty of our profession. We can handle anything.”
The other source of anxiety – aside from watching patients struggle with the virus day after day – came from watching his colleagues deal with the pressure of the moment, with the possibility of getting the virus themselves or even taking it home with them.
Shamoon knows that ER staffs are like family, and takes great pride in watching his “family” deal so professionally with the pressure.
“What I find the most pride in is when I take a second to look back and see our team doing phenomenal work, staying over shifts knowing they could be exposed and bring it back to their families,” Shamoon said. “When you see family members sacrificing for the better, that’s a source of pride. The pride I see on a daily basis is what really pumps me up to get back in there the next day.
“That’s what drives me to keep going,” he added.
JUSTIN MCWHERTER, RN
Justin McWherter’s temperature soared, his heart rate was high, there was tightness in his chest with shortness of breath and he was dizzy. A lot.
Like many frontline healthcare workers on duty caring for patients with the coronavirus McWherter, a registered nurse with Ascension St. John Hospital in Grosse Pointe Woods, became a COVID-19 patient himself.
But, like many others, he stayed in quarantine for about 10 days, missed only three days of work and was right back at his station, fighting the disease.
“I was sick myself, and it wasn’t fun,” said McWherter, the hospital’s clinical leader on cardiology. “I’m just (recently) starting to feel myself all the way back.”
McWherter and his colleagues got an early start in treating COVID-19. His floor was one of the first to switch to being a COVID-19 floor. The 36-bed unit, he said, was “full every day” in the beginning. Other floors were also taking patients.
But it hasn’t always been easy. At the beginning, when testing wasn’t “quite as good as it is now,” McWherter said, there was a learning curve, “like with everything.”
“It was pretty busy,” McWherter said. “We were full every day. We’re still busy, but there’s a light at the end of the tunnel.”
One of the hardest parts was making sure his family stayed safe. In quarantine, he obviously stayed separated from his wife, Heather, a teacher for Warren Consolidated Schools, an 18-year-old son and a niece and nephew for whom he cares.
He set himself up in a separate bedroom, and when at home practices social distancing, sitting on another couch while watching TV.
“I wanted to be certain I wasn’t bringing it home,” said McWherter, who’s been a nurse the last eight years after two years as a tech on the trauma unit. “It’s tough, but it’ll all be worth it when this is all over.”
That likely won’t be for awhile. While the state’s numbers of both cases and deaths are slowing, there’s no real end of the pandemic in sight.
Because McWherter’s floor can take more patients, he and his colleagues are likely to be dealing with COVID-19 patients for the foreseeable future.
“I think our floor will be in it for the long haul,” McWherter said. “We can handle more than the other floors can handle, so they’re probably going to keep us a COVID floor for the duration.”
McWherter was a tool-and-die designer in the automotive industry “until it crashed in 2008.” That’s when a few family members recommended he take up nursing.
“I would never have thought of it,” he said. “I took a few classes at Macomb (Community College), and I fell in love with it.”
He’s even more in love with it now, watching the nursing community deal with all of the sickness and death of the pandemic. People have lost loved ones, he acknowledged, but he’s been impressed with how supportive people are being of each other.
“All we can do is be there for each other, and be there for the patients,” McWherter said. “The patients not being able to see loved ones has been the toughest part. We’re doing everything we can to make it possible so they can talk to their loved ones — personal cell phones, iPads, holding hands, sitting with patients.
“That’s nursing in a nutshell, being there for someone when others can’t,” McWherter said. “It’s one of the rewards of the job. It’s just second nature, just trying to be a decent human being. It’s just second nature, just trying to be a decent human being.
“Emotionally it can be tough,” he added. “But it’s also rewarding.”
DR. JOEL FISHBAIN
U.S. Army veteran Dr. Joel Fishbain was working in infectious diseases at the Walter Reed Army Medical Center in Washington, D.C. (it later moved to Bethesda, Md., and was renamed the Walter Reed National Military Medical Center), when the SARS outbreak came in the early 2000s.
So Fishbain, a retired Army colonel now serving as the medical director of infectious disease and epidemiology at Beaumont Hospital Grosse Pointe, understands why planning to corral and treat the coronavirus earlier this year was so difficult.
His biggest SARS lesson? You can’t plan for it.
“When SARS came out in 2003 while we were in the midst of a war, we had to plan for this,” said Fishbain, who graduated from St. Louis University medical school in 1987. “It was interesting, if you look at this and ask, ‘how do you plan for this?’ The universal answer was, ‘you cant.’
“How do you truly pretend to plan for something like this? It’s really not possible,” he added. “That became really evident in 2003.”
Fishbain, who went to college on an ROTC scholarship, did his internal medicine residency at Madigan Army Medical Center and a fellowship at Walter Reid from 1993-1996. He retired as a colonel in 2008.
“We had a lot of fun the last few years,” Fishbain said. “The Army was very good to me.”
Fishbain said life began to change, professionally, when the first COVID-19 cases began appearing in early March. His job, he said, is 90% clinical, which means his patient load can be heavy. It got heavier when COVID-19 started showing up.
A normal patient load for him and his partner, Fishbain said, is perhaps 20 patients a day. Since COVID, that number sometimes exceeded 60.
“That’s double, sometimes triple the daily work we would have to do,” Fishbain said. “That’s busy, but I actually like being busy.”
There was some early frustration, Fishbain said, because no one knew exactly what they were dealing with or how to treat it.
“The frustration is starting with a new disease that has no scientific basis for diagnoses or treatment, and you start to hear dribbles of information, and you try all these things,” Fishbain said. “It’s the frustration, unlike bacterial pneumonia or a good old-fashioned urinary tract infection where we can give them antibiotics … (with COVID) you’re just watching people.”
He said a Beaumont officials convened a meeting about possible treatments early on that was helpful in producing “some standardized guidelines.”
“That was useful,” Fishbain said. “There were people 10 times smarter than I hope to be.”
With COVID. Fishbain said, it “isn’t so much the virus, it’s the inflammation the virus causes.”
“You have to treat it a different way,” he said. “That’s why you’re going to read about drugs that shut down viral replication, but also those that affect the immune response. We do what we can. This is really a disease managed by pulmonary and critical care teams.”
Like medical facilities everywhere when COVID-19 was really gathering steam, Beaumont Grosse Pointe had concerns about acquiring enough personal protection equipment – masks, gowns, gloves, face shields, etc.
The hospital had enough equipment for normal operations, Fishbain said, but that changed with COVID-19. What really changed, at least for awhile, was the length of time PPE had to be used. Frontline workers used to using a mask for one patient and then discarding it suddenly found themselves having to use it over and over for multiple patients.
“We always had equipment, but then the rules sort of changed, when we talk about using some of the PPE over and over again, that’s new, that’s different,” he said. “Most of what we’re used to doing for the patients in the hospital that need it, you’re talking one-and-done. When you’re talking 100 patients with 10-20 contacts per day, you can’t afford to be one-and-done.
“The challenges for the user … use (PPE) as long as you can,” he added. “That’s a little weird. Of course there’s angst.”
Frontline healthcare workers have frequently become victims of the disease, leading to some anxiety among them about either contracting it themselves, or carrying it home to their families.
Fishbain said that hasn’t necessarily been a concern for him, although he allows as how his wife has been concerned with how the disease spreads. At a healthy 58 years old, Fishbain isn’t in one of the high-risk categories, although he admits he has a bit of high blood pressure.
“I don’t worry about that as much,” he said. “I have a lot of faith in the PPE, the hand hygiene, I’m not a big worrier about the inanimate object carriage. If you looked at the numbers early on, there is a very significant risk population. Those are the people we worry about.
“I take it in stride,” he added. “You can spend all day worrying about it, but that doesn’t get the work done. I don’t think there’s any utility in spending your energy worrying.”
Not everyone in the hospital feels the same way, Fishbain knows. Although he said “there’s very good data to show when you put someone in isolation, the amount of contact time and exposure decreases.”
“But everyone who goes in has to spend time putting (PPE) on, and that adds time. It changes the whole work environment,” he said. “The fear – lots of people are afraid. A nurse was crying, I’ve never seen that before. You see things that you don’t usually see.
“Nobody likes the unknown.”