CORONAVIRUS

UIHC nurse offers care and compassion as COVID-19 deaths worsen

'No patient should have to pass alone'

Intensive care unit nurse Nick Klein stands for a photo Thursday outside the University of Iowa Stead Family Children's
Intensive care unit nurse Nick Klein stands for a photo Thursday outside the University of Iowa Stead Family Children’s Hospital at the UI Hospitals and Clinics in Iowa City. (Andy Abeyta/The Gazette)
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IOWA CITY — No one should die alone. So Nick Klein stayed.

For hours by the bed of one of his first COVID-19 patients, the 31-year-old University of Iowa Hospitals and Clinics nurse sat and held the patient’s hand.

He played music. He didn’t know what to say.

“So I just was present,” Klein told The Gazette. “I think presence says a lot.”

Even after months of sitting by COVID-19 patient bedsides, holding phones so family members can say goodbye, squeezing hands and listening for last breaths, Klein said he still doesn’t have the right words.

“Presence has been something that I’ve kind of leaned on,” he said. “I simply held their hand and just reassured them their family loves them.”

Klein is among hundreds of UIHC nurses who — day in and day out since March — have tied on gown after gown, mask after mask, and scrubbed their hands raw caring for patients suffering from a virus that leaves some people unfazed and others fighting for every breath.

For three years, Klein has worked in the UIHC medical intensive care unit, home to 26 of the campus’ now 228 ICU beds. Before recently converting 10 more beds for intensive care patients as part of its COVID-19 surge plan, UIHC had five adult ICU units with a total 103 beds and two in the Stead Family Children’s Hospital with 115 pediatric beds.

The campus, like thousands of other health care centers nationally, has been scrambling for enough nurses to handle spikes in COVID-19 patients. As of Sept. 30, it had 3,231 registered nurses, including 414 in its ICUs.

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Of that total, 312 — including Klein — are in adult ICUs and on the front lines of the response to the pandemic, which has grown exponentially worse this fall.

Iowa confirmed another 62 COVID-19 deaths Saturday morning, bring the total in Iowa since the beginning of the pandemic to 2,665. In just the first five days of this month, the state has confirmed 262 COVID-19 deaths — including two days in a row of record-setting death tolls from the disease.

Statewide COVID-19 hospitalizations, which hadn’t topped 600 until Oct. 29, saw a sharp spike in November — surging to 1,527 nearly three weeks later on Nov. 18. They have dropped since but still remain far higher than the peak of last summer’s surge.

UIHC’s coronavirus inpatient count started November around 30 and soared to a peak of 91 on Nov. 20 — representing a 65 percent spike from a week earlier when UIHC reported 55 inpatients.

Although the campus’ COVID-19 inpatient total last week dropped back into the 50s, Klein said he has experienced no letup since summer.

“It was kind of after the Fourth of July that we started seeing more cases come to our unit,” he said. “And it really hasn’t slowed down.”

He’s seen patients young and old, with and without preexisting conditions, cycle through his space sometimes needing ventilators, other times therapeutic medicine, but often desperate for oxygen — and hope.

“I can’t imagine what the patients and family are going through firsthand,” Klein said, despite his intimate view of their struggles. “I can’t really put myself in their shoes, or go through what they’re going through.”

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In trying, though, Klein has found himself compelled to shepherd those destined to die on his watch through the experience of passing — if no one else can.

“It’s just kind of been my philosophy as a nurse — even before the pandemic — that no patient should have to pass alone,” he said, thinking back to the first COVID-19 patient lost in April on his watch.

“I ended up sitting with this patient for a couple hours while they passed,” he said. “That’s something I’d done before the pandemic, but this was just so so much tougher. I don’t even know if I can really describe it — hearing somebody say their goodbyes through a phone.”

‘They were all alone’

Hospital visitor policies for all patients — not just those with COVID-19 — have varied and shifted across the state and throughout the pandemic as hospitalizations ebbed and flowed, care givers learned more about the virus, facilities shored up protective equipment and gained experience with the disease.

Although UIHC for months prohibited COVID-19 patients from receiving visitors, it has updated its policy to “accommodate a visitor for hospitalized patients with COVID-19,” according to spokeswoman Laura Shoemaker.

“We recognize many patients benefit from having a loved one present to provide comfort and help with the recovery process, and patients with COVID-19 are no different,” according to a UIHC statement. “For added protection, visitors are required to follow strict safety protocols, including wearing appropriate personal protective equipment; limiting the length of visits; and exiting the building immediately following their visit.”

Klein noted the import of those allowances.

“We do our best to get family there,” he said, “because we know family presence is one of the biggest things to patient healing and to family healing.”

But earlier in the pandemic, nurses like Klein often had just a phone to connect families with those they were losing.

“That’s what made the death really hard,” he said. “They were all alone.”

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Klein said that he’s seen plenty of death already in his six total years as an ICU nurse — graduating from Kirkwood Community College with a nursing degree in 2014 after an adviser steered him in that direction as a high schooler interested in medicine.

“It’s part of being a nurse,” he said. “You’re going to have to deal with death.”

But this has been different in its scale and intimacy. One patient he sat with was the same age as his mom.

“I kept thinking to myself, what if it was my mom or another family member?” Klein said. “I couldn’t imagine them passing away alone. That’s the cruel side of this novel coronavirus.”

That patient knew he was dying, so Klein got the man’s family on the phone and stayed with him “because it broke my heart.”

Taking mental toll

Even as COVID-19 procedures and routines have become more familiar, Klein — and the rest of his care team — is weary after months of long and emotionally draining days that have only intensified.

“It’s hard being a health care worker,” he said. “I don’t think people are understanding the mental toll it’s taking on us on.”

It’s more of a challenge to leave work at work.

“There are definitely some nights that I do not sleep very well,” he said. “I am up at night thinking about my unit or thinking about something that happened, or somebody who’s not doing so well. What’s going to happen with them?”

Klein said he’s thankful for his fellow nurses who are with him in his anxiety, who hold the same fears and who have seen many of the same things. But he wishes more of the public had that understanding.

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“I wish I had a camera that everybody could watch how my day is, to get a more realistic (view) of what COVID can do to you,” he said. “Then I think we’d see more people willing to wear a mask, and more people willing to stay at home and avoid social gatherings.”

Comments: (319) 339-3158; vanessa.miller@thegazette.com

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