WORCESTER — Nurse Christine Keidan suited up — two masks, a hairnet, a face shield, gown, and gloves — and clutched an iPad as she went to see her patient. When she opened the door, a beeping alarm warned that she was entering an isolation room in the COVID intensive care unit at UMass Memorial Medical Center.
Keidan stroked the patient’s dark hair while she held the screen for the woman to see her daughter. This has become a heart-wrenching part of Keidan’s routine; visitors rarely are allowed here.
After a few minutes, the nurse returned to the hall and peeled off most of her protective gear. It’s a process she would repeat many times that morning, and every day she goes to work during the winter of COVID.
“Just as you’re getting one off, you’re donning up for the next one,” said Keidan, who has worked in the ICU for 20 years. “The more you do it, the quicker you get.”
As the resurgent coronavirus rages across Massachusetts, intensive care units like this one again are filling with COVID patients. Many will stay for weeks, mostly alone, too ill to move, talk, or breathe on their own.
Nurses and doctors on the front lines are more confident in their ability to help these patients now, after enduring the surge in the spring, and are armed with more knowledge and treatments to combat the disease. But that doesn’t diminish the enormity of the challenge at hand. They are weary from the work, frustrated that it’s happening again, and worried about how bad it will get this time.
Keidan used to think about her work day on her drive home, but tried not to dwell on it when she walked in the door. “That’s hard now because COVID is everywhere outside of the hospital, and everybody has had to deal with it in one way or another,” she said. “I’m sick of thinking about it just like everyone else.”
UMass Memorial allowed a Globe reporter and photographer to visit the unit known as 7ICU, which treats some of the sickest patients in Central Massachusetts. It is one of at least three ICUs that hospital officials have designated for COVID patients in the second surge. Another COVID ICU has remained open since March.
This is not Boston, with its several big hospitals in a few city blocks. UMass Memorial is the largest medical center for a broad swath of Massachusetts. The weight of the pandemic in this central part of the state is uniquely felt at this institution.
By the beginning of the week, UMass Memorial’s two Worcester campuses were treating 44 critically ill COVID patients — more than any other hospital in Massachusetts, according to state data. That remains below the last peak in the spring, when UMass Memorial rapidly opened eight new ICUs and retrained staff to treat the flood of sick patients.
As they battle the pandemic again, nurses and doctors here wonder if people outside these walls truly understand the harsh reality they face day after day.
“I’m not sure people do,” said Anne Morrissey, nurse manager of 7ICU. “If they realized how sick they could get, the impact that it can have on you, and the length of recovery it can take — some people take weeks to months to get over COVID — maybe they would take it more seriously and comply with wearing masks and social distancing.”
In November, hospital officials moved 7ICU from one part of the campus to another, where the air flow in patient rooms could be better contained to help prevent the spread of the virus.
A Christmas tree stands in one nook of the unit, as it does every December. But the ornaments are different this year. Instead of shiny baubles, there are green balls stuck with thumb tacks — meant to resemble the coronavirus — and at the top of the tree, an angel wearing PPE.
By mid-December, most of the unit’s 18 beds were filled with COVID patients. About half were sedated and breathing with the help of a ventilator, a tube in their airway sending oxygen to their lungs.
For several hours a day, doctors discuss each patient’s condition and their next course of treatment. It’s not straightforward — sometimes patients get better and then worse again.
The typical regimen for critically ill COVID patients here includes the anti-viral drug remdesivir, steroids to reduce inflammation in the lungs, and blood thinners to prevent clots.
To improve oxygen flow, many patients are turned onto their bellies for 16 hours a day, a technique called proning. Sometimes patients are awake and able to rotate themselves into position, but most cannot.
So six nurses and a respiratory therapist carefully turn the patients in their beds. They do this many times each day.
“It takes a lot of coordination,” nurse Mary Davis said. “While we’re flipping, you can potentially lose the breathing tube, so there’s somebody always manning those, and the tubing having to go with you to the opposite side, and coordinating where the pumps are going, and IVs.”
The work of caring for COVID patients has been demanding in other ways, too.
For patients with the virus, caregivers are the only link to the outside world. Families cannot visit — except for some patients at the end of life — so nurses provide what comfort they can, including the virtual visits.
In ordinary times, nurses move in and out of patient rooms constantly. But with COVID patients, they try to do as much as they can during each visit, to minimize their own risk and conserve protective equipment.
From inside the room, nurses write notes on a white board and tap on the window to get the attention of colleagues outside. These staff, called runners, bring the tubing or blankets or other supplies that the nurses need, and discreetly hand them off.
This kind of care takes planning. But sometimes alarms sound, or vital signs fluctuate, and nurses need to rush in. They may have to visit hourly, or even more frequently.
“We do try to limit our exposure, but that’s not always feasible with the multiple drips and the machines running,” said Davis, an ICU nurse for 17 years.
She protects herself at work, as all the nurses do, but there is a lingering worry about the possibility of getting infected and bringing the virus home to her family.
“It is the unfortunate risk of the job,” Davis said. “It is a risk that we take, especially being nurses. We are the ones that are in the room for countless hours.”
The staff of 7ICU were among the first at UMass Memorial to receive the new coronavirus vaccine, but they will continue wearing protective equipment when they interact with patients.
Some wear respirators and face shields. Others don hoods called powered air-purifying respirators, the kind of equipment seen in Hollywood movies about pandemics.
The cumbersome headgear is necessary, but it becomes an obstacle for nurses trying to offer a gentle touch, or a reassuring smile, or words of support.
“When you’re sick, it can be scary,” said Jason Eisenmenger, another nurse in the ICU. “It’s not the normal interaction. It’s another barrier that kind of isolates the caregiver and the patient.”
At least patients can see his eyes. “You always try to smile with your eyes,” Eisenmenger said.
An elevator ride and a long corridor away, a few senior hospital executives in business suits and face masks gather daily in the command center — a windowless conference room — to review the newest details about how many patients are in the hospital, and how many more may be on the way. Other officials join on the phone.
Dr. Michael Gustafson, president of the hospital, carries a stack of charts, graphs, and handwritten sticky notes with him in a purple folder. They show the numbers of people testing positive for COVID and the numbers hospitalized in Worcester, in the region, and in the state. Hospital officials absorb these and other figures every day and use them to plan their next moves.
“We’re literally trying to predict what’s going to happen,” Gustafson said. “The reality is nobody really knows the answer to that.”
Every day they track the number of employees out of work because of a COVID infection or exposure. Lately, it has been more than 200 at a time.
Some of the staff in 7ICU have tested positive for COVID, according to Morrissey, the nurse manager. They appear to have been infected in the community, not on the job, she said.
Some of the staff have lost family members to the disease. All the nurses have seen patients die.
“If we’ve done everything that we can do, the next best thing we can do is to let them die with dignity and be able to pass away peacefully without pain,” said Keidan, the longtime nurse. “No one ever dies alone in the ICU.”
So much now depends on how the public, weary of the pandemic, acts in the days ahead — whether people follow the public health guidelines to curb the spread of the virus.
Dr. Nicholas Smyrnios, medical director of the medical ICUs, is tired of watching some make trivial choices that put others at risk when he and his colleagues are fighting to keep people alive.
He repeats the simple message that everyone has heard but not all are heeding: wear masks, wash hands, avoid gatherings, and practice social distancing.
“This pandemic needs to end,” he said.