BOONE — The conversation often starts with “I’m sorry.”
“There’s nothing else that we can do,” said Watauga Medical Center Dr. Kevin Wolfe. “All of the treatable things have been treated, all of the fixable things have been fixed. We just can’t get enough oxygen into your patients’ lungs and despite what we do, the inflammation from the virus has overwhelmed the body and they don’t have much longer to live.”
Wolfe was speaking at a care vigil in front of WMC on Sept. 2 that featured seven medical care providers telling their experiences caring for COVID-19 positive patients.
Wolfe, a lung specialist, talked about what happens after he and his staff have done everything they can do, but it still isn’t enough.
“That’s a horrible conversation to have with your family,” Wolfe said. “Yet, we have to do this on a daily basis almost. If that conversation isn’t bad enough, then we have to talk about how are we going to keep this patient comfortable? How are we going to keep this patient as pain free as possible during the final moments of their life here on this earth?”
During those final moments, Wolfe said doctors are removing the very equipment that kept them alive for so long.
“It’s a tough situation,” Wolfe said. “It’s a tough conversation. We deal with this in the intensive care unit day in and day out.”
And that brought Wolfe, along with the other six speakers, to their main point: asking the community to get the COVID-19 vaccine.
Before ICU nurse Amy Hempfling and her colleagues intubate a COVID-19 patient, they let them speak to their families via video call.
“When they speak to their family, I many times fear that those will be their last spoken words,” Hempfling said. “Lately, this has rang true many, many times.”
As a nurse, she said it’s hard knowing that those will be the patient’s last words. And as a nurse, she has to communicate those last moments with family.
“I have to tell them, your loved one — they have now stopped breathing. Your loved one — their heart has stopped beating. They’ve stopped breathing. They have passed,” she said.
Most of her patients are healthy, young and unvaccinated. She said that a lot of people do just get sick and don’t go to the hospital. She said that the number of COVID-19 patients in the hospital may seem small, comparatively, to some people, but won’t if “it’s someone you love” lying in that bed.
“Then those numbers that you see in the media that felt so small — they’re not small anymore,” Hempfling said. “They’re big. They’re all consuming. Then it’s about life and it’s about death.”
And when it’s about death, Melanie Childers, director of spiritual care for ARHS, is the one who works with the families who are suffering.
“Never in my 23 years have I encountered anything so horrific as the last 18 months,” Childers said. “Illness and death during the course of the COVID-19 pandemic is qualitatively different.”
She said with COVID-19, staff often face overwhelming numbers of very sick patients, a lack of resources, exhaustion, extreme fear, pain, anger and regret.
“We often see multiple members of the same family, or the same faith community, hospitalized simultaneously, yet still isolated from each other,” Childers said. “The ones who survive are not necessarily the ones who you might think.”
She said an elderly woman might be discharged while her son dies.
“I sit with patients who are wracked with guilt when they realize they unintentionally infected their parents or grandchildren with the virus,’’ Childers said. “I facilitate video calls almost daily, allowing COVID-19 patients and their family members to see and speak to each other. In some of these calls, the patient expresses a desire to die while the family members plead with them to keep fighting.”
Health care providers, she said, are tired.
“We have witnessed heart wrenching tragedies that left our entire staff in tears,” she said. “And yet we can’t stop long enough to grieve or support each other because that bed is already being filled by another person in dire need.”
In the Appalachian culture, Childers said, faith and spiritually are a strong component. From where she stands, Childers said her faith says, “You are your brother’s keeper. Yes, love your neighbor as yourself.”
“Our priorities, political persuasions and spiritualities vary wildly from each other, but we are in this together,” Childers said. “We are interdependent. There is no success, no win, without caring about each other. Please get vaccinated. Please wear your mask. Masks and vaccines are temporary inconveniences for most of us, but they can make the difference between life and death.”
Dr. Jennifer Nelson is an emergency room doctor at WMC. She said the impact COVID-19 has had on her and other health care providers is hard to describe in words, but she tried.
“The first wave broke our backs, but I’ve never been more proud to stand beside my brave colleagues facing an unrelenting foe,” Nelson said. “This wave has broken our spirits.”
Nelson said they are seeing more patients who are sicker and younger. The vast majority, she said, are unvaccinated. Those patients express to her, right before speaking to their families for what could be the last time, profound regret as they get placed on a ventilator.
But even dealing with the hardships of COVID-19, Nelson said the hardest challenge for her as an emergency room doctor is having patients who need services that aren’t available in the High Country.
“These patients are often in the emergency room for what can be days waiting for a bed at an outside facility,” Nelson said. “I personally have called up to eight hospitals in two different states looking for beds for my patients that need emergent specialty surgery. This is 100 percent because of COVID-19. I see the fatigue on my colleagues’ faces, many cannot do this much longer.”
She told those in the community that feel their personal liberty is at stake, that they are not asking them to do anything against their will, but are asking them to voluntarily step up and do the “right thing.”
“The vaccine has been out for nine months now and it’s been proven safe and effective,” Nelson said. “This is supported by the very institutions whose sole purpose is to extensively study the safety and efficacy of vaccines, drugs (and) foods.”
There have been patients who have presented to the emergency room with vaccine related side effects and symptoms, Nelson said. However, she said those cases are generally very mild. There are currently no patients admitted at WMC with vaccine related side effects or symptoms, according to Nelson.
“Those that feel this is about some political agenda, I can guarantee you I have no political agenda,” Nelson said. “What I can guarantee is that my colleagues and (my) agenda has always been, and always will be, about saving lives. I hope you can see the sincerity in our voices.”
Dr. Lisa Kaufmann, medical director of the hospital medicine group, talked about how to make a wise decision related to the COVID-19 vaccine, community members need to understand what is happening to people who get severe COVID-19.
“We cannot bring you into these units because we have to respect the privacy of our patients,” Kaufmann said. “Unvaccinated people we have admitted are often pretty healthy before they got COVID-19 so they did not believe they would get sick. If they did have health problems, they were often things like high blood pressure or being overweight that didn’t interfere with their lives much.”
The few vaccinated patients that Kaufmann and her staff see are often those who have a severe chronic illness and have been admitted to the hospital in the past for their underlying disease.
Compared to someone else the same age, the unvaccinated person is 15 times more likely to die of COVID-19 than a vaccinated person who is the same age. She said many patients who are in the hospital express their wish that they had gotten the vaccine.
“This is a hard illness and if you’re sick enough to come into the hospital, it is not quick and painless,” Kaufmann said.
Jimmy Phillips, the assistant director for cardio pulmonary services, has been a respiratory therapist for 35 years. In that time, he has never seen patients as sick as he sees now.
“These folks are just debilitated by this disease,” Phillips said. “I care about all my patients, my coworkers, my family and the community that I work and live in. This virus has taken a toll on almost everyone in one way or another.”
He and his coworkers work shifts that are 12 to 16 hours long in full protective gear. He said they do everything they can to keep everyone alive. During those shifts, they barely get time to use the bathroom or even eat.
“Please know that just doing a few simple things will make a large impact in the fight against this terrible virus,” Phillips said. “Wear a mask. Get your vaccine. Wash your hands and stay distanced from folks.”
For Dr. Beverly Womack, an OBGYN, her motivation is to protect moms and babies from suffering. She said that if someone is unvaccinated at the time of conception, she recommends getting the vaccine while pregnant.
According to Womack, if a pregnant woman gets a vaccine, her baby will have protection against COVID-19 when it is born. She said the vaccine is not causing infertility, miscarriages or birth defects.
Womack wants those who are still unsure about the vaccine to talk to someone they trust.
“Talk to somebody you trust that’s taking care of you for years — they’re not going to steer you the wrong way,” Womack said. “If you’re listening to me, you know that I love you. I only want what’s best for you. If you’re unvaccinated, get over your fear, get over your anger or get over the apathy — just waiting until I really have to do it — and let’s get vaccinated and protect our community.”
More information on how to find a vaccine or about COVID-19 can be found at apprhs.org/vaccine/.