The good fight: At RI Hospital, an ICU nurse battles the COVID surge – The Providence Journal

Its 7 p.m., the start of Ifeanyi Ofokansis 12-hour shift as an ICU nurse at Rhode Island Hospital.

In a worsening time of coronavirus.

Ify, as everyone calls her, is 25, grew up in North Providence, and now stands by the nurses station in the fourth-floor Medical Intensive Care Unit, checking the board for her assignments.

Because of the nonstop need for care, she is usually given just two patients.

On this recent day, one is a 60ish woman hit so hard by COVID she is intubated.

Soon, Ify enters the room. To add a human touch to her protective gear, she has written her name on her face shield, followed by the pronunciation: Ee-Fee.

The ventilators background hiss is so familiar, she barely hears it.

Although the patient is unconscious, Ify talksto her, hoping her words might register.

Hi, my name is Ify. Ill be your nurse for the night.

It is by now a familiar ritual to her, speaking to the unconscious.

Ify was at work here in this ICU around March 1 when the hospital admitted its first COVID patient. Today, she and others who fight the disease just marked the battles eighth month.

View Gallery: Ifeanyi Ofokansi, RI Hospital ICU nurse

She saw the worst of it, when coronavirus cases filled all 18 Medical ICU beds, with spillover into other hospital ICUs.

She saw more hopeful times a few months ago, when her ICU had just a handful.

Lately, it has gone up, with the gravest statistic hospitalized patients with ominous breathing issues increasing statewide from 80 in mid-September to 140 this week.

Throughout, Ify Ofokansi has been in this epicenter of the toughest cases.

She will tell you that today, the battle is getting worse again.

Ifeanyi Ofokansi still lives in her hometown of North Providence, with her mom, Felicia, who came over from Nigeria and raised Ify and her older brother Obi here.

Ify ran track and played tennis at North Providence High, and was inspired by her mom, a teacher in her native country who became a nurse in America.

Felicia is now a clinical manager at Rhode Island Hospital and worries about her daughter in the ICU, praying for God to protect her each time she leaves for work.

Ify, a UConn nursing grad, usually does three 12-hour overnight shifts a week at the ICU, the pace so relentless that for a change, she works another few days at the Rehabilitation Hospital of Rhode Island in North Smithfield.

Before entering the ventilated patients room, Ify had gotten a handoff report from the day nurse.

The patient, Ify was told, at first isolated at home after testing positive, but was brought here earlier in the week when her breathing grew strained.

Although ICU teams have learned not to rush to ventilate, within a daythere was no choice.

She even had to be proned at one point turned on her stomach to help with lung capacity.

Ify had done that countless times by now, an arduous process for intubated patients, three nurses on either side with a doctor and respiratory therapist assisting to keep all tubes in place.

The day nurse updates Ify on the patients numbers, and then the two gear up with gown, mask, face shield and two pairs of gloves.

Inside, the woman is unconscious on her back as the nurses do a room safety check, making sure things like the Ambu bag resuscitatorare nearby to help reopen the lungs if the ventilator gets clogged.

Then it is just Ify. She talks to the patient as she checks her vitals and sedation levels, convinced that supportive words, on some subconscious level, can calm.

Most with COVID in the ICU are older, as is this patient, but not all. Ify has treated severe cases in their 30s. There was even atwentysomething who had to be intubated.

He survived, but the greatest heartbreak for Ify have been the souls who havent.

Sadly, in these eight months, she has personally seen the loss of dozens.

The ICUs COVID patients are all in isolation rooms, but unlike the worst days in late spring, there are now a mix of illnesses in the unit.

So Ify now has non-COVID patients too, including ailments like end-stage renal failure, drug overdoses and cardiac arrests.

But shes found that acute COVID is the most difficult to manage.

With other patients, progress can be steady. In COVIDcases patients often, suddenly, go backward.

The ICU team has also found there are no universal treatments certain therapeutics help some patients but not others.

More: 'We are in a bad place:' Raimondo to announce new COVID restrictions

And there are unexpected twists, like COVID patients with end-stage renal disease clogging the dialysis machine more often because of clotting issues.

Its a challenging disease.

Still, Ify has seen the ICU team get better at COVID -- more mindful, for example, of proning patients early.

And doctors have become careful about the ventilator, knowing it can be hard to get patients off it, especially those with other conditions.

Ify had had one such patient, a mid-aged woman, whose oxygenation suddenly went down dangerously, but doctors tried holding off on intubation, and it paid off. The woman turned a corner without the risks of a vent.

As Ify heads out of her COVID patients room, she holds back from promiseslike, Youll be fine. She worries that could come off as dismissive, and indeed, she has seen COVID patients, ones who got better and then worse, grow frustrated at assurances that all was well.

Instead, she tells the patient simply, Well take good care of you.

She puts her gown in a cart by the door, then pauses at a cleaning station to disinfect her face shield.

More: Patinkin: Her unlikely journey from poverty to U.S. diplomat

Although the 50 or so MICU nurses have been mostly lucky, Ify knows three who came down with COVID.

Her own mom did earlier this year, enduring fever and body aches, but fortunately, no respiratory issues. It went for two weeks and left her fatigued for longer.

Ify had to quarantine during that time, and felt bad at being away from the battle.

She even texted her boss, MICU Clinical Manager Laura Wodecki, to apologize for it.

Im sorry, Ify wrote, I should be there for my team.

That still impresses Laura.

Her dedication to this unit and our patients is remarkable, she says.

Laura says all the nurses there are as committed. She has been touched at the way theyll hold the hands of patients in their final hours, bringing solace that families are unable to.

They have all agreed, Laura says, that no ICU patient at lifes end will die alone.

Soon, the doctor making the rounds talks with Ify at the nursing station about how to handle her patients overnight care.

If her carbon dioxide rises, they could go higher on the respiratory rate. If she still has declining oxygenation, they might have to discuss proning her.

But as the hours grow late, a lot of the adjustments are up to the nurse.

Ify keeps her mother in mind as she treats this and other patients. She strives to bring them the care she would want her own mom to get.

Around 1 a.m., she notices the woman is stirring a bit, a sign of restlessness.

Ify decides to test the status of the womans paralytic. To do so, she places a patch similar to the ones used with an EKG on the womans skin usually thumb, wrist or forehead. It delivers a small electrical impulse. If there are four skin twitches instead of one or two, that means the paralytic needs to be increased to make the lungs more compliant to the ventilator.

At other times, she listens to both sides of the womans chest to make sure air movement is good. If it isnt, she might suggest an X-ray to confirm whether the COVID is worsening the air space disease.

All the while, she talks to the woman.

I know the tube is uncomfortable, she says, but its helping you breathe.

Ify works hard to keep her patient stable, her mind at times flashing back to what shes fighting against.

Like the patient in his 40s who didnt survive.

He came in conscious, so mindful of being a family provider he tried to work from his bed.

Ify told him to let that go and focus on himself.

Then he began to decline, his breathing growing labored. They put in a thin tube called a nasal cannula for direct oxygen, then added a non-rebreather mask over his mouth and nose to push in even more.

But he continued downhill and finally was vented. He held on for a month but his systems gradually failed.

In the end, it was Ify sitting by his side, holding his hand as she knew the family would have done.

She prayed for him to find peace, afterward weeping at yet another loss.

But shell tell you that in the ICU, one has to grieve in small bursts because theres always another patient or crisis to tend to.

She says she could not get through this emotionally without her fellow nurses, who understand the COVID battle invisible to most people.

Ify also draws strength from memories of her grandmother, Mercy Edozie, who was like a second mother raising her in North Providence.

Mercy died at age 90 in 2014 after a bad fall. Ify had cared for her, another part of her decision to embrace nursing.

As she treats patients now in the ICU, she feels her grandmother is with her in spirit.

Lately, Ify has been alarmed at signs COVID cases are increasing.

On a recent night, there were three ICU admissions during Ifys shift, one only in their 30s. Another was crashing so quickly they had to be ventilated in the Emergency Department instead of the ICU.

Case manager Laura Wodecki fears the upswing will continue.

Were worried, she says.

Laura hopes it wont surge as high as the first peak that filled Rhode Island Hospitals ICUs.

But she understands part of whats driving it.

I think people are tired of all the precautions, Laura says. Its isolating. I feel it in my team. They have parents in nursing homes they cant visit. Family in other states they cant visit.

But the nurses are reminded every moment of the price.

We see the sickest of the sick, says Laura. We know how it can kill.

Ify, too, feels it will get worse as cooler weather puts folks more often indoors, where exposure is higher.

Im nervous, Ify says.

They all are.

But morale among ICU staff has been boosted by cards and gift baskets from the community.

It lets the nurses know they arent fighting alone.

And now her overnight shift is over.

Around 7:30 a.m., Ify returns to her car, and for a few moments, just sits there.

She often does that, processing the difficult moments, at times getting emotional.

That has been her life now for eight months.

But she has no thoughts of moving on to some other nursing job.

She will stay in the COVID fight at Rhode Island Hospitals Medical ICU.

Nurse Ifeanyi Ofokansi wants to bewhere she is most needed.

Mark Patinkin is a Journal columnist.

Read this article:
The good fight: At RI Hospital, an ICU nurse battles the COVID surge - The Providence Journal