Trisha Brazeal, BSN, RN, I6-Neuro Stepdown Unit – Henry Ford Hospital

Looking back now, it all seems like it was a bad dream. I remember hearing about COVID on the news and thought to myself, “It will never get bad in the US.” I would soon realize how wrong I really was. I was an assistant manager for a stroke/neuro stepdown unit. We had two units, one with 18 beds, and one with eight. We had some critical patients at times, but typically they would be transferred to the Neuro ICU. But we were nowhere near prepared for what was about to unfold. My manager had left for vacation, and I was ready to take on the challenge of leading the unit for the next two weeks. By the end of the first week, we transformed our eight-bed unit into a COVID GPU, requiring a whole new medical team that what we were not used to. The patient population was also much different. The staff was learning about COVID, proper PPE, and working with new physicians. It was an adjustment, but the unit was up for the challenge. After a week, we seemed to be getting the flow down. Everyone was well-versed in proper donning and doffing of PPE. It seemed like we were ready to fight the strong fight.

About 10 days later, after learning my manager would not be returning for an additional two weeks due to quarantining, I received the meeting invitation in my email titled, “I6 ICU.” They had mentioned the possibility of utilizing our 18-bed unit as an ICU. I truthfully thought it would not come to that. I sat in the boardroom waiting for the meeting, with my manager and educator on the phone. I remember when my administrator came with the news: “We will be turning your unit into an ICU by tomorrow morning.” So many emotions flooded in. “What staff are going to work there? What supplies do we need? How are we going to do this?” I felt sick and scared. I have an extensive ICU background, but nothing could have prepared me for what was to come. That day we hit the ground running. I had the best team behind me to get everything in place. Phone call after phone call for supplies, respiratory, clinical engineering, pharmacy, the ICU physician needs; it seemed like a never-ending list of preparation. I held a huddle with both shifts that evening before leaving. I made the announcement about the ICU opening the next day, I offered reassurance that support would be provided, and the neuro ICU nurses would be there to help as well. I looked around at them and many of their faces turned pale. I promised them I would do whatever was in my power to make sure that they were supported. I went home scared and nervous for the next day. As I walked on the unit the next day, I felt optimistic. The night shift nurses helped get the stock together; all the PPE was stocked up and ready to go. People kept showing up to help, and I felt like the unit ready to go. Then we heard the code blue called overhead for the floor below us. The ICU nurses jumped into action, training the step-down nurses along the way. The patient was on the cusp of needing life support. What felt like moments later, the next code blue came overhead. We took that patient as well. The nurses were having to learn about vents, drips, and running their own codes, things we never had to do before. Not only were we turning into an ICU, but with some of the sickest patients ever. Emotions were high, stress levels were rising, but we made it through the first day. When I left that evening, we had admitted six patients. I went home ready for the next day to come. I thought, “We can do this!” The next day will last in my memories forever.

We admitted around 10 patients, intubated eight, and placed lines on almost all of them. I looked around at the faces of my nurses and saw tears. They all were completely terrified and stepping out to cry in between care. I didn’t know what to do, it was one of the most challenging times in leadership I have ever faced and will ever face. I walked up and down the halls all day, jumping in to help, offering reassurance and emotional support, and helping educate the staff. Then an employee was admitted. Three nurses came into my office and cried. One of our own was slowly making their way to needing life support. I remember looking at my educator and saying, “It’s like a nightmare I can’t wake up from.” After looking around, and seeing some of the sickest patients I had ever seen in my career, I called my husband and mom. We had to make the difficult decision for my son to live with my mom until everything settled down, I was scared; I was scared for anyone to be around me. What if I brought COVID home? I couldn’t risk my son or my mom’s health. Later that day, the staff physician approached me about proning patients. We had to start proning. Thinking back on my career in MICU I can only remember a few times having to do this. I remember being nervous about it then, and that was with a lot of experienced ICU staff around to help and support me. Now I was expecting my nurses to help facilitate this when they had never even seen this done before! But they amazed me. We were able to prone six patients by the next day! When I finally convinced myself it was time to go home that evening, I remember walking through the hospital feeling horribly defeated. I told myself, “Don’t cry until you get to your car.” I didn’t want the staff to see me cry. I knew they were barely holding it together and I needed to stay strong for them. When I got to my car the tears started flowing. I cried until I just decided I cried enough, I was going to stay strong. Crying was replaced with a constant knot in my stomach. Always wondering what would happen next. I didn’t cry again. These patients needed us more than anything right now, and I had to stay strong for them and the staff.

Over the next several weeks, it became easier and easier. The staff became more confident, my manager returned, and the hospital did a tremendous job. We never ran out of PPE. We were able to get ICU nurses redeployed to us to help. The nurses began learning a new skill set. It felt like the new norm for our unit. This experience will live with me forever. It helped me grow as a nurse and a leader. I am forever grateful for all that helped and supported through that difficult time. I could not have asked for a better team than my unit – they were courageous and amazing.


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