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Burnout, loss and 'little victories': Health care workers reflect on year with COVID-19

Duluth News-Tribune - 3/5/2021

Mar. 5—When COVID-19 struck the Benedictine Living Community-Duluth in October, Shanda Anderson, the long-term care facility's infection control nurse, knew what it would require to battle the outbreak.

They had done it once already.

"We had a little bit of PTSD (post-traumatic stress disorder) because we've been here. We've done this. We've seen this. We know that we can experience loss," Anderson said. "There are things that we'll never be able to talk about publicly that affected us, that will always affect us because we'll have those visions in our minds and in our hearts."

Two months after the second outbreak flamed up, the facility was still struggling to clear the virus from the building no matter what interventions they had in place. Around Christmas, staff hung stockings on a wall to honor each resident who died from COVID-19. Cindy Elmgren, nurse manager at Benedictine, choked up when remembering how quickly the wall filled up.

Now the facility has received vaccinations and hasn't had a case since Jan. 18. Fifty-five residents have survived COVID-19 and they have the T-shirts to prove it.

This weekend marks one year since Minnesota health officials announced the state's first confirmed COVID-19 case. Since then, the virus has claimed the lives of more than 6,500 Minnesotans — 21 of whom lived at Benedictine.


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Many more acts of support and sacrifice have taken place in health care settings behind the scenes since the pandemic's start, from nurses and doctors making alternative living arrangements to avoid bringing COVID-19 home to the little ways in which people have supported each other in the face of so much stress and tragedy.

Gail Yeaton, 69, was one of the Benedictine residents who survived the illness.

"Twenty-four hours a day, someone was with me," Yeaton said.

Sam Lewis turned 66 in the COVID-19 unit.

"They knew what they had to do and I thank them for that," he said of his caretakers.

Elmgren, the nurse manager at Benedictine, said she and Anderson did whatever they could to make the job a little more bearable for the nurses who work in the isolation unit. They kept their fridge stocked and brought them dinner during shifts, which increased to 12 hours in order to minimize exposure to COVID-19. And they sought out the best personal protective equipment for them.

To cope with the tragedy, Elmgren said she liked to walk her dogs after work, meditate and practice deep breathing as a way to purge out the stressors from that day and prepare for the next, but it was hard to leave work behind when she wasn't there.

"We had to do so much tracing. So your mind never shuts off," Elmgren said. "You're thinking, 'Oh, my God, did so and so talk to them? Did I get all the people in the tracing?' And then your phone was ringing, you're getting texts saying, 'We got another positive (COVID-19 test).' You just lay there waiting for the next one. It just didn't stop."

As supervisors, Elmgren and Anderson needed to stay strong for residents, families and the rest of the staff. So they leaned on each other when the burdens they carried became too much to bear alone.

"There were moments where we would break down together and cry. That was OK," Anderson said. "Everybody needed to be able to have that time to work through whatever they were feeling."

Sunnyside Health Care Center, the long-term care facility attached to Community Memorial Hospital in Cloquet, lost seven residents to COVID-19 in November.

During the three-week outbreak, isolation carts sat outside the residents' rooms. They held the personal protective equipment staff had to put on before entering isolation rooms. The facility celebrated when the last resident came off isolation by getting rid of the carts, said Toni Hubber, director of life engagement at Sunnyside.

"We got the instruments out, we got drums and shakers and people screaming and 'woo-hoo-ing,'" Hubber said. "Just to get the isolation carts out of the way was a big moment. That was one piece of normalcy back."

Eighteen residents recovered from the illness, Jenn Capra, Sunnyside's director of nursing, said.

"If somebody was sick and they tested negative, we celebrated," Capra said. "We just tried to really look at the small victories and just look out for each other."

Staff are still struggling with the people they lost, Capra said. She, too, wonders if what her staff is experiencing is PTSD from the outbreak.

"We know we'd be able to get through it as a team, but it's a scary thought to think if it came back," Capra said. "It's hard."

While reflecting on the last year and managing an outbreak, Capra said having a reliable team made all the difference. Whenever they needed something, someone was ready to help. When they needed isolation carts, the purchasing director went out looking for them.

"When you're in something like this, to know you're going to be OK with the resources," she said. "If he had to go to Walmart or Menards in Hibbing he would go."

For the last few months, Josh Solberg, a registered emergency department nurse at St. Luke's in Duluth, has been administering monoclonal antibody treatment to patients who are in the early stages of their COVID-19 diagnosis. The treatment is for those at risk of developing severe symptoms in order to decrease their chances of becoming hospitalized.

"It's quite amazing to look back and see how well we got through this," Solberg said. "The grind is still going on."

Hearing COVID-19 patients express confidence and hope when receiving the antibody treatment has helped lift Solberg out of pandemic-related burnout. He added that a simple "thank you" can go a long way, too.

"It reminds you why you got into health care. It gives you that little boost to kind of get through that burnout," Solberg said. "It can really make your day."

Tab Baumgartner, a chaplain at St. Luke's, recalled the first COVID-19 death he clearly remembers being present for. It was early spring and the nurses had called for a chaplain. He arrived to five nurses standing around a dying patient's bed.

"When family members couldn't be present, we were the ones who had that privilege of representing them," Baumgartner said. "It was a profound moment that stuck with me about the heart that was a part of caring for people."

From late May until September, Dr. Sonja Bjerk, a critical care physician at Essentia Health in Duluth, intermittently stayed in a Yeti ice house trailer during her weeks caring for COVID-19 patients in the intensive care unit. She did so to avoid indirectly transmitting the virus to her parents.

They were helping with child care and her mother was also undergoing chemotherapy at the time.

"I didn't want to be one of those asymptomatic carriers and give it to my kids who would have given it to them," Bjerk said.

At the beginning of each week, her husband stocked the ice house with breakfast supplies. During 12- to 14-hour shifts, she ate the rest of her meals at work.

Asked what it was like to be separated from her children, Bjerk said it was a nice break for a day. Sometimes she watched her three children, all under age 4, through Nest surveillance cameras.

"It's hard, but I was excited to see them," Bjerk said. "It was always a little reunion when I came back in the house again."

Dr. Christina Bastin De Jong, another critical-care physician at Essentia Health, worries about the other staff in the COVID-19 unit because of how much death they saw in the last year. She wonders how many of today's health care workers will leave the field due to exhaustion.

"There's a lot of talk about burnout and mental illness in health care right now. They think the next pandemic will be mostly mental illness because of the stress people are under," Bastin De Jong said.


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As for herself, Bastin De Jong said she's worked hard to implement mindfulness strategies into her own life in an attempt to avoid crippling fatigue, especially since she knows critical care doctors experience the highest rates of burnout among physicians.

"I still love what I do, but there were times when I was just like, 'Wow. This is exhausting,'" Bastin De Jong said.

She anticipates it will take years for anyone, including herself, to fully process the toll of living through a pandemic.

What she does know now that for the past year, health care workers have continued to step into caring for patients and each other. Sometimes that support was as light as playing puppy videos on a computer monitor for others to see when they walk past.

"Those things help with resiliency and recovery and processing," Bastin De Jong said. "We're not robots doing this work. So bringing in those types of things, I think it's been helpful for people."


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