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| And note that for brevity, I didn't even talk about getting all geared up, entering the COVID-pit patient's bubble, doing my thing, and then peeling out of it to care for any non-Covid patients. Or worse, living in the hospital equivalent of MOPP Level IV (military guys know what I'm talking about) for hours upon hours all day or night. Braying jackasses that think I have time to deal with bedpans are morons living in the 1930s, with IQs in the low 40s. "Hey Maverick, what was the name of that school? Truckmaster??" |
Adaptive Curmudgeon at Middle Of the Right blog asks, Do They Really Need ICU?
Fair question, and I assume he's genuinely asking it.*
And thank a merciful deity, what I'm describing below was mostly how it was where I am last February, Not how it is is where I am , now. Yet. At least most nights. But sometimes, it is.
But it may be exactly what's going on in Florida or the Gulf Coast states today, or anywhere where things are getting congested.
What follows, it needs to be said for the small-minded, is not me bragging nor complaining. I knew the job was tough when I took it, I'm damned good at it (after 20 years, I'm starting to get the hang of it) and I sincerely love what I do, just as much as Lebron loves dunking, or a fighter pilot loves sending his opponent down in streamers of flames. (Now see if you can guess, when busybody lackwit 40-IQ governors want to prevent me from doing that job, in order to get injected infected with the poison not-a-vaxx, why I want to give them a few hundred raps to the forehead with a 12-pound sledgehammer, to jar their heads out of their own rectal exhaust pipes. I may or may not be speaking metaphorically.) But what I'm telling you here, and why I'm telling you, is for the benefit of those who have no wild idea, how it simply is. Neither more nor less.
Yes, they really need an ICU bed.
I’ve been a nurse for 25 years, 20 of them in Emergency, and not just “I don’t feel good” Emergency, but the busiest trauma centers and mega-hospitals in not just Califrutopia, but the busiest ERs in the entire civilized world, in the most densely populated region of the United States. Depending on where you ask, between 10-15% of the entire US lives in my county or the bordering ones.
120 hospitals in L.A. and Orange County. Almost as many as there are in the entire states of Oregon, Nevada, New Mexico, and Utah, combined.
What happens to that system which usually runs right on the ragged edge of capacity 24/7/365 in normal times, when you throw a pandemic at them?
In the ICU, they have an intensivist MD right there, most of the time. (The floors seldom have a doctor anywhere, for anything.) The patients are either 1:1, or 1:2, which means the nurse can handle 1 patient, and at most 2, at once. I do 4 in the ER normally.
But If I have ICU patients, and there’s no bed for them there, I can now only do 1 or 2 as well.
I had one last month, who was on 7 different medication drips, which all had to be titrated multiple times per hour to fine tune keeping the patient alive, and in certain parameters of vital signs.
I set my monitors to go off on the dot on the hour, and at :15, :30, and :45.
On the hour, I logged my vital signs. Then began doing the literally 57 things for that one patient I needed to be doing. Including not just doing everything I had to do, but charting that it was done. Picture Han Solo flying the Millenium Falcon through an asteroid field. Blindfolded. By the time I was finished, it was usually :50 minutes past the hour, or more. Meaning I had 2-10 entire minutes to do all the less-than-immediate tasks for that one patient that needed doing. Then it was top of the hour, and start all over again. Lather, rinse, repeat.
For an entire shift.
I wasn’t the only nurse so burdened with ICU patients who couldn’t get to the ICU. Which means if anything happens (like someone’s heart stops) there’s no one free to help anyone else. (A cardiac arrest or a major trauma can suck in 3-6 staff members just from the nursing staff alone, for an hour or more). But with all of us being ad hoc ICU nurses, that ain’t happening.
So a nurse is supposed to bag the patient, do chest compressions, start an IV, pull meds, give them, record all the interventions, all simultaneously and single-handedly? Sh’yeah, when monkeys fly outta my butt. That patient? They came in dead, and they’re going to stay that way. And even if, by some miracle, you get a pulse back, that’s another ICU patient, which you don’t have a bed for, or a nurse for, who’s shortly going to be on 2-7 medication drips, and on a ventilator, leaving the nurse scrambling to keep up the rest of the night…stop me if you’ve heard this one.
Which means my other 3 beds were empty, because there was no one to staff them. That turns a 32-bed ER into an 8 bed ER.
Which closes the hospital to ambulances.
Which sends the ambulances to other hospitals, which closes them.
You understand how one overload takes out a sector of the power grid, which can cascade into taking out an entire region over multiple states, right?
So now, imagine that with sick and injured people.
Except now, a blackout means people die waiting for care they cannot get.
And makes people wait in the waiting room until they’re literally trying very hard to die too, just to get into a bed.
If you’ve just sunk the Titanic or anything like it, and you have lifeboats for 2000 people, but 3500 on the ship, at least 1500 are going to die. But if, each time a lifeboat gets overloaded, all those people swim to the next lifeboat, you swamp each next boat in turn, and everyone dies.
That’s where we were headed when the last COVID wave broke, just about exactly 3 weeks after people all got together for New Year’s Eve and New Year’s Day get-togethers, and until they started acting like maybe we weren’t fooling about this thing being a problem.
And with my decades of ER experience, I’m a critical care nurse. I don’t like ICU, but I can pull it off, rough around the edges (meaning it isn’t pretty, but I don’t kill anyone or let them die through negligence or inexperience), for a shift or three.
But there were ICU patients on telemetry floors ( a lot less intense than the ED, and two levels of severity below the ICU). And ICU patients on Med/Surg floors (three levels below ICU). Where nurses never titrate a single drip, let alone 7 simultaneously, for an entire shift. And almost never manage ventilator patients in any way. They literally don’t know what they don’t know. Because they’re not supposed to be doing the most critical patients in the entire hospital on the least severe wing of the hospital, with the newest nurses.
Some of those nurses were freshly graduated nurses weeks before COVID kicked into high gear last fall.
And they normally handle 6 or 8 far less serious patients, not 4, 2, or 1.
So now their 40-bed floor ward can handle 5 patients. That means you’ve just wiped 80% of the hospital’s capacity on those floors out, from the get-go.
1,000 beds is now 200 beds.
200 beds is now 40 beds.
And it’s put the most seriously ill, critical patients, into the hands of the least-experienced nurses in the hospital.
Imagine throwing 5 year-olds into the 40-foot waves on Oahu’s North Shore with a pool noodle, and you’re not too far off.
Now see if you can figure out why some of those 600,000 people died from COVID in the last 18 months or so.
The nurses who regularly care for the sickest ICU patients are freaking rock stars, and they can only handle at most, 2 at once.
In the last serious COVID wave, from about Labor Day to the end of last February, half the nurses who worked in our ICU said “F**k it, I’m out!“. Forever. Burned out by 1 or 2 mega-critical patients like I had, every shift, every day, for weeks and weeks on end, understaffed, under-equipped, and under-supplied with basic equipment and supplies. No lunches, no breaks, just a 12-hour endless slog from 7 to 7, every day or night, and the same thing tomorrow, and the next day, and the next day, ad infinitum.
The ER and other floors lost upwards of 1/3 of our staff, for the same reasons.
Replacements can’t be whistled up, and they can’t be trained in less than years, to a minimum level of competence.
So hell yes, people die because we’re out of beds, out of supplies for the patients, out of PPE for the staff, and out of the staff to even show up.
In simple terms: how many games are the Dodgers or Yankees going to win in a season if they can only put 6 or 4 players on the field?
And what you’re asking, I assume legitimately, is “But do they really need 9 guys on the field? Do they really have to be major league players? Can’t the kids from Little League, high school, or maybe even Single-A suck it up and pull the load instead?”
So, my sincere question back to you is, what do you think the answer to that question is?
{And I didn't send this to my reply at that site, but I forgot to mention: In the ER, as in the ICU, I have a critical care monitor over nearly every patient bed in the department, so I (and others) can see my patient's heart beat, oxygen level, blood pressure, and respirations instantly, in real time. The telemetry floors are only monitored at the main nursing station, NOT the bed side. The Med/Surg floors have no monitoring anywhere, just portable vital signs machines, usually 2-4 for 40 beds. That's flying a plane at night, without any instruments installed, in the mountains. With a student pilot. You guess where the pitfalls in that approach are, and how well it's going to work, and for how long.}
*But I was wrong: he was just being a jackass, and virtue-signalling his Dunning-Kruger credentials.
Here's his reply to the above at his site:
Aesop: I let this get posted so others would understand why I hold you in such contempt.
You told us all how important you were, and how much smarter and better trained than everyone else but you really didn’t say all that much.
Nor did you really answer my question.
But hey, you got to blow your own horn again, so I guess you made yourself feel special.
Please, next time you comment, let it be either in answer to the post, a useful comment to the post, but please not so self serving, MMKAY?
No, I told you about 40 different ways that the patients who need ICU are sick as hell, and need the specialized care that only the ICU, and nurses trained to operate there regularly, can provide, which AIN'T ME, and that this is already kicking THEIR asses. But Reality doesn't comport with your ignorance or prejudices, so you honked your own horn and blew all that information right out your ass. Which was why I didn't wait for your gracious permission, and posted it myself.
Your disingenuousness is noted.
Don't waste time asking rhetorical questions you're manifestly too stupid to process when you get the answers. And good luck with that plan for the rest of your life. Like with undertakers, and for the same reason, that sort of intelligence is why I've been fully employed for 25 years, and people like you are my best customers.
Sorry to disturb your navel-gazing with the answers you couldn't handle. Go back to your beer and chemtrail websites. And by all means, don't wear a mask, lick the handrails, and pee on the electric fence. What could go wrong with that life plan?
Thanks again for reminding me why dealing with you honestly and giving you the benefit of any doubt is a complete waste of time, except as an object lesson to others.
Not having learned his lesson, and after getting picked on in Comments, he now doubles down, and takes another swing:
You mean, when Fauci and the head of the CDC both said Ebola would never get here, and I said it would?
When Fauci and the head of the CDC said we had protocols that would deal with it, and I said we didn’t?
When Fauci and the head of the CDC said our first world medicine would triumph and stop it cold, and I said it wouldn’t?
When Fauci and the head of the CDC told you any hospital could handle Ebola, and I said that only the four BL-IV hospitals were trained or equipped to handle it?
You mean when, after they were both 100% wrong, and I was 100% right, on every one of those predictions, and Ebola in a Dallas ICU, using the CDC’s protocols, multiplied at the exact same rate it does in the wild, with no precautions, they ended up moving every Ebola patient in America – including the two ICU nurses they managed to infect with it in exactly 21 days, just like it multiples in the wild – into those exact BL-IV beds, taking up all but one of the only 11 such beds in North America, leaving us a red hair away from becoming West Africa?
Yeah, I remember that pretty well, since you mention it.
Everything I posted then (summer to winter 2014) is still up on my blog, in case you care to check it.
Now, tell me about your local weatherman with a 100% accuracy rate on his predictions and prophecies.
I haven’t made many predictions, as such. But the ones I have have panned out pure gold.
Please, B, for the love of God, stop stomping on your own junk with sharp cleats on.
So far, Aesop’s record is slightly poorer than Fauci and the CDC. Remember the Ebola thing? And many other of his predictions?
I mean, he makes a TV weatherman look like a prophet…