'Slow-rolling disaster': A look inside the coronavirus units at an Indianapolis hospital

Dana Hunsinger Benbow and Mykal McEldowney
Indianapolis Star

INDIANAPOLIS — The yellow N95 mask on Dr. Steven Roumpf does a terrible job hiding the concern on his face. His eyebrows give it away: They are furrowed. His eyes give it away: They scream despair.

A woman wallows on a gurney as she's wheeled toward Roumpf. The EMS worker pushing her wears a gas mask, as if she's entered a chemical warfare zone.

The woman on the gurney starts grimacing.

She's terrified because she suspects that she is COVID-19 positive. That's why she is here, at 9:41 a.m. on this Thursday, in this newly constructed unit in the emergency department of IU Health Methodist Hospital.

It's made for coronavirus patients, rooms designed with negative air flow to suck in the disease rather than allowing those devastating droplets to seep out into the surroundings. These droplets have spread into a worldwide pandemic.

A team of nurses jumps into action, grabbing yellow isolation gowns, blue gloves, goggles and face shields. They enter to assess the patient.

A doctor stares into the room through the glass. She isn't going inside.

A medical worker inside comes to the glass and talks into an intercom, his voice blaring through a speaker on the other side. "She's been short of breath since yesterday," he says.

The team inside surrounds her, taking vitals, asking questions. The woman wails a few mumbled words. A nurse soothes her. "You're OK. You're OK."

Methodist, a Level I trauma center for decades, has seen plenty of tragedy and mass casualties. But this, this is different than anything ER nurse Teresa Czaplinski has been through in her 33 years at the hospital.

One by one, people stream in. Steadily. Day after day. Sick, sicker, some dying.

"It has been like a slow-rolling disaster," said Czaplinski, a shift coordinator in the emergency department who works solely with COVID-19 patients. "We're waiting. Just waiting for a disaster that's going to go on and on and on."

'Remarkably sick, so, so quickly'

The first novel coronavirus patient was brought to Methodist March 17. As of Wednesday, the hospital has treated 367 COVID-19 positive cases. About 38 have died, and 297 have been discharged.

A total of 74 coronavirus patients were inside Methodist when IndyStar was given exclusive access to the wards where these patients are treated on April 30.

To get ready for the coronavirus spread, Methodist prepared for a worst-case scenario. It revamped spaces all over its building, adding those negative airflow rooms and deploying employees to different areas. It set up tents outside the emergency department for overflow spaces and created an operations command center. Beds were added, ICU rooms increased and an entire hospital came together, said Liz Linden, vice president and chief nursing officer of patient care.

"The numbers haven't reached the surge the hospital prepared for," said Linden. "Thank God."

It's still startling and bizarre to see all of this unfold, Roumpf, the emergency department's medical director said.

Forty minutes after the woman was wheeled in on the gurney, another patient is in the emergency room. Short of breath. Minutes later, he needs two liters of oxygen. Then four liters. Then he is lifeless in a bed. Code blue. Time of death: 10:22 a.m.

"They get remarkably sick," Roumpf says shaking his head, "remarkably sick so, so quickly."

These patients decompensate. It's a word used by doctor after doctor inside Methodist. "We just don't know how rapidly these patients will decompensate."

"Healthy people are decompensating."

It's the word they use to describe a patient deteriorating with coronavirus.

Dr. Warren Gavin's job is to follow coronavirus patients from the time they are admitted through, hopefully, discharge. "One of the hardest things for us is to determine who's going to do well and who is going to decompensate," he said.

Upstairs and a few deserted hospital corridors away from the emergency department, it's happening again.

A nurse takes in new linens into a COVID-19 patient’s room inside IU Health Methodist in Indianapolis.

The 13 beds of 6 East

The official name is Unit 6 East, and usually it's a multi-specialty critical care space. But now, it's the hub of Methodist's most dire coronavirus patients, dubbed a COVID ICU.

This is a place of anguish. Thirteen beds are encased in glass, all of them filled with patients. Tubes and IVs and ventilators do the work for the exhausted patients here.

It's 10:02 a.m. and three pharmacists are gathered around a screen filled with drug names and doses and schedules. These patients need many medications, said pharmacist Rachel Kruer.

"The biggest change is that we're sort of treating the same disease state for every patient," said Kruer. "It makes it both more straightforward but a little bit more challenging because we are at risk of running out of some of the drugs that we use for patients consistently."

Patients who are mechanically ventilated are on sedatives and opioids for pain. Some are on neuromuscular blockers so the ventilator can breathe for them. Their bodies desperately need to rest.

These patients are getting stress ulcers, stomach ulcers and are at risk of gastrointestinal bleeding. They are getting blood clots. The pharmacists work to prevent them. Many are on medication, sometimes to bring down their blood pressure, sometimes to bring it up. Some patients are on antibiotics for superimposed pneumonia.

Still, it's a good day on this unit. Several of the patients are about to be extubated, allowing them to breathe on their own. Those are the victories.

When they awake, they will be told by the medical workers all they've been through.

Most patients on 6 East have been dropped off by a loved one. And those who don't leave Methodist take their last breath without a wife or a child or a father or a friend by their side.

Still, they will be comforted in their last moments.

"We never let anyone die alone," said Mary Youngs, a nurse on 6 East.

She and her fellow nurses sit by the bed for hours, holding a patient's hand and playing their favorite song on an iPhone as they die.

"Just the toll that these types of patients take on us," Youngs said, "that's been hard."

At the start of the pandemic, Youngs would get into her car for a 7 a.m. shift and it would hit her. The pit in her stomach.

"Now...," she said. "Not that you want to get used to this environment, but every day gets a little easier."

"These are negative air flow," said Liz Linden, vice president and chief nursing officer of patient care services, on Thursday, April 30, 2020. "It means they pull the air out of the room to recycle it. 

'Up and down and backwards'

Scrub colors, usually a telltale sign of who does what job at Methodist, don't mean anything anymore. The hospital is providing them to workers, so they don't have to wear their own. Methodist has set up temporary showers so employees can drop their scrubs and wash down before heading home. For those not comfortable going home, IU Health has teamed up with a hotel.

"Overall, everyone that is in the hospital, they are happy to be here, they are proud to be here," said Linden, "and they know they need to be here to take care of the patients."

Patients like the man who walked last week. He had been in the ICU for 30 days.

"So we saw him where we didn't think he was going to make it. Then he woke up," Carlye McGaughey, a team leader on Methodist's 8th floor ICU COVID unit, said. "Then he walked for the first time last week. Now he's talking."

That's what is so unpredictable about this disease. People who don't seem like they should make it, do.

People who seem like they should, don't.

"They're just all so sick, and there is no prediction so our normal course (of care) is so much different," said McGaughey. "Lots of ups and downs. You see things start to trend the right way and they go up and down and backwards. So that's hard."

Cassie Ban, a nurse on the unit with McGaughey teared up when asked about the journey of caring for these patients.

"There are some really, really sad days," she said. "But there are a lot of victories, too."

'We are their person'

Sad days and victories are playing out where the babies once were.

In March, LifeLine ambulance transported the babies from the neonatal intensive care unit to Riley Hospital for Children. Methodist subsequently transformed the floor into a 35-bed critical care area for COVID-19 patients.

There, nurses have come from all disciplines to care for patients. Sherrie Cook came from Riley.

"Some patients are terrified and that is heartbreaking," said Cook. At Riley, she is used to having parents in the room with her and her patients.

Now, her patients have no one. "We are their person," she said. "And it is a privilege to be there for them."

Much like on 6 East where patients don't die alone, the nurses on this unit have a rule that the sickest patients are surrounded.

"Nobody is ever alone in those moments," said McGaughey. It's not easy, of course. Tears flow. Sleepless nights follow. But so do the thanks and gratitude.

"There is not a day that goes by that we don't get cards in the mail, cases of Diet Coke, coffee," said Melissa Pruitt, a nurse on the 8th floor COVID unit. "We have just been able to feel the love and know that we are supported."

A mix of Riley Hospital for Children and ICU nurses talk inside a COVID-19 unit inside IU Health Methodist in Indianapolis on Thursday, April 30, 2020. 

'It takes a toll'

That's what keeps the front line workers inside Methodist going. Those workers like Dr. Gavin, the hospitalist.

"I think myself and a lot of my partners, we just keep going and I don't know if we've had a lot of downtime to stop and think the kind of toll that it's taking," he said. "Just how cautious we have to be with these patients and with ourselves, it takes a toll."

Gavin is optimistic. He believes outcomes are improving.

"It's all we've done for a month or a month and a half," he said, "so I feel like we are getting better at treating these patients."

And they are learning so much.

Usually a physical therapist, Hilary Nuest's job now is to connect with COVID-19 patients who "are feeling isolated."

They might not have their cellphones or may be too weak to answer. She will see missed calls and help them connect with family. "What I've seen is a lot of patients just want someone to talk to," she said. "They're alone in their rooms most of the day."

Last week, Nuest saw that a man's sister had called. When she helped him call her back, he was also connected with his daughter.

"I helped the communication because he was a little bit slow to think," she said. "But we were joking." The man told his family his goal was to be home in three weeks for his birthday, how he wants barbecue, how he's going to grill out for them.

"It was really sweet," Nuest said, but it was also good for his recovery.

Nuest takes an oxygen level reading when she enters a room and another after the patient connects with family or friends.

"After they've had that experience or that moment," she said, "we've seen like 3% to 5% improvement (in their oxygen levels)."

'We are the happy endings'

It's just before noon. Kari Malloy is teaching a coronavirus patient how to make a mask out of a T-shirt. She's going over hand-washing techniques.

"This is happy endings," she said. "We are the happy endings."

Malloy is a nurse on the medical-surgical unit, now a space for COVID patients who are improving, but still positive. They might need IV antibiotics or other care, but they are not intubated.

"Med-surg is the place where they go home," said Linden.

Malloy said she was frightened when she learned her unit would fill with coronavirus patients. "But we didn't even blink an eye," she said. "It was a little overwhelming in the beginning, you know, but it's what we do."

The nurses are truly the warriors of this pandemic, said Linden.

"They are seeing stuff they shouldn't have to see in life," she said. "They are seeing all kinds of stuff they haven't seen."

Like what is happening over on 6 East. Manager Gloria Wiser is standing surrounded by those 13 rooms, their huge glass windows giving a peek inside as her patients struggle to live.

At night when Wiser goes home, she said she stops and thinks. She is grateful for what she can be grateful for.

"I feel good that we got through another day," she said, "when we didn't lose a patient and a staff member didn't get sick.

"That's where the gratitude comes in these times of the unknown."


Nurses suit up in personal protective equipment as they prepare to enter a COIVD-19 patient’s room inside IU Health Methodist in Indianapolis.