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Caring for the sickest COVID-19 patients: An ICU story

Early in the pandemic, with few clues about how to treat critically-ill COVID-19 patients, Stanford’s ICU team developed and shared expertise to save lives.

When the coronavirus pandemic first took hold in the United States in early spring, there were so many unknowns.

"It was nerve-wracking," said Dwayne Free, one of the front-line respiratory therapists who treated the first patients to arrive in the Stanford Hospital intensive care unit. "There were so many questions around how the virus was spread. People were scared. Were there going to be enough ventilators? Enough personal protection equipment? Are we doing everything right?"

In an article for the latest issue of Stanford Medicine magazine, I provide a glimpse into the journey Free and his front-line Stanford Health Care colleagues took -- from Day 1 through the following weeks and months -- to provide the best care for patients who were severely ill with the mysterious new disease.

Starting from scratch

As the story describes: "No one on the ICU had cared for patients with this illness before. There were no standardized treatment guidelines, and very little reliable research existed. Mostly, there were just rampant rumors of high mortality rates and even higher levels of contagion. The ICU team had to start from scratch."

Respiratory therapist Dwayne Free and Chiara Stetson, RN, in Stanford Hospital's ICU.

The obstacles were many and the quest for answers kept them up at night.

The extremely contagious nature of the disease meant family members had to stay away from their loved ones, further complicating care and recovery.

The personal protective equipment -- more than most health care workers had ever worn -- slowed them down, kept them overheated and separated them from the human-to-human contact that is so helpful in patient care.

Many of the health workers feared bringing the disease home to their families. And they faced a constant barrage of new, and untested research about treatment.

But these obstacles also brought the health professionals closer as a team, to debate best practices and share firsthand experience learning as they went. Caregivers all brought their own levels of expertise, and they needed to listen to each other if they hoped to succeed.

Sharing expertise to find solutions

A team of 50 health care workers, including physicians from a variety of specialties, nurses and respiratory therapists, began to meet via video conference in the early mornings to share new information and research. Those meetings continue today.

Along the way, the team has found reasons to celebrate and mark successes big and small -- moments of joy that have kept them going.

In the article, Maureen Fay, a registered nurse and director of clinical services for Stanford Health Care, talks about the deep sense of camaraderie among the ICU staff that grew out of a shared mission to save lives during the pandemic.

"For those first couple of patients who made it out of the ICU after 30 or 40 days, everyone -- nurses, respiratory therapists and doctors -- lined the hallway," she said. "They were cheering. They were so proud."

Images by Steve Fisch. In top photo, anesthesiologist Javier Lorenzo, MD, checks on a COVID-19 ICU patient.

Read more of Stanford Medicine magazine's special coverage of COVID-19 here.

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