It’s eerily quiet in the halls of the intensive care unit at Humber River Hospital, except for the beeping and ringing sounds of the many patient monitoring machines.
There are no family members visiting. Many are either home in isolation, or sick with COVID-19 and unable to come and see their loved ones.
Outside each patient room sits a critical care nurse, almost like a security guard keeping watch.
The care is constant and it is complex.
On this day, critical care nurse Laura Mailling is caring for a COVID-19 patient in his 40s.
“He is on the maximum amount of settings on a ventilator that we can put him on. One-hundred per cent oxygen. He’s also unstable with his blood pressure because of the other medications we’re giving him. So he’s quite young and extremely sick,” she explained.
Mailling will spend her shift focused only on this one patient.
“We give them sedation and we have to manage their blood pressure. And giving medications like that can only be given here in ICU. So that’s why we need the specialized training to to deal with all of that,” she said.
The shifts are grueling and the caseload can feel, at times, hopeless, because despite the team’s best efforts, some critical COVID-19 patients will not survive.
They will die, sometimes, with only a nurse, like Laura Mailling, at their bedside.
“Last time I was here, my patient was very young, in her 40s, and she passed away of COVID,” said Mailling, adding, “We felt so helpless because we were doing everything we can and it still wasn’t enough to fight against this virus.”
Laura said it has been a “hard year,” but this third wave has been the most difficult.
“We’re seeing a lot of younger patients with this third wave. In the initial wave, it seemed like a lot of the older communities were affected and the nursing homes. This time it’s a lot scarier that you’re seeing 20, 30, 40 year olds intubated on ventilators with COVID … it’s so scary to me, treating patients who are younger than me,” she said.
Laura is weeks away from maternity leave.
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She has spent her pregnancy working in the ICU caring for the severely ill.
Filling her shoes will be challenging because critical care nurses are in short supply.
“It does require special knowledge, skill and judgment to be able to care for these patients,” explained Justin Moreno, also a critical care nurse at Humber River Hospital.
He started his ICU nursing career right when the pandemic began.
“It can be really heavy mentally … emotionally exhausting having to witness multiple deaths,” he said, adding, “It gets to a point where it’s really depressing because you don’t really see the light at the end of the tunnel.”
Moreno said he has seen his colleagues experience burnout, and others who have left the job.
Typically each critically ill patient requires “one to one ICU nurse ratio,” explained ICU manager Raman Rai.
She pointed out the unit has never had enough nurses with critical care expertise.
“The pandemic has definitely shone a light on us needing way more … in order to manage the patient’s care,” Rai said.
“Critical care nurses are so pivotal to providing care to patients on life support interventions. They’re specially trained to be able to manage a patient hemodynamically, looking at their vital signs and also being able to manage and be able to speak and communicate with the rest of the interdisciplinary team about what the patient needs and being able to monitor the patient on the life support.”
The hospital has redeployed staff to help assist the nurses in providing care, but more than a year into the pandemic, they’re all stretched thin.
“We are the lowest RN population in Canada, so of course you won’t have ICU nurses and now you layer on that a crisis of mega proportions,” said Registered Nurses Association of Ontario (RNAO) CEO Doris Grinspun.
She has long warned of a major nursing shortage in the province and now, in the midst of a health crisis with a system on the brink, it’s become clear this precious health-care resource is lacking.
“Eight hundred new beds multiplied by four each, four RNs each with ICU specialty … and you’re going to deplete every other unit from anybody that has some skills that can help the ICU nurses,” she said.
Grinspun said she is worried about how hospitals and medical staff are being impacted during the third wave.
“I vacillate between numb for my colleagues who are in the trenches and furious that the right actions are not taken,” she said.
As Mailling gets set to leave the hospital and focus on expanding her family, her absence will be felt in the ICU, as these critical care units become ground zero during the third wave of the pandemic.
“We’re just treading water here in the ICU … we’re just managing, we’re just getting by as well as we can,” she said.