Special COVID-19 Episode with Courtney Petersen

Todd:                           We also share some insights and some awesome things that are happening on the front lines as people come together, in both the community around Denver and the teams servicing the patients every day in hospitals in the Denver area.

Todd:                           Please keep in mind that things are changing day to day with this COVID-19 outbreak, and that if you want the most up-to-date information, go to the CDC at cdc.gov. Enjoy the conversation.

Todd:                           Courtney, I really wanted to start off this interview by asking a simple question that I think a lot of people are thinking about when it comes to healthcare and hospitals, and that is healthcare workers, how has their job changed since COVID-19 or the coronavirus has come to the US?

Courtney Peters…:       I think the first thing that comes to mind with what my team’s experience is fear. I think a lot of healthcare workers across the country, and definitely across the world, are just afraid. First we were hearing protective equipment is going to run out.

Todd:                           Right.

Courtney Peters…:       We heard that weeks ago; we didn’t actually feel it until now. I can tell you this week, we are feeling it as a hospital. We are feeling it as a team. We are being asked to reuse our N95s, so at perfusion, we’re all just hanging onto our masks.

Todd:                           Yeah. And so just to kind of clarify what that is for the audience, those are the masks that are designated to prevent this specific virus. Because they’re not just regular surgical mass, right?

Courtney Peters…:       Correct. But even the regular surgical masks are running out as well.

Todd:                           Oh wow, okay.

Courtney Peters…:       N95s are very specific. If you are entering a COVID-positive patient’s room, you should always have a N95 mask on.

Todd:                           Right.

Courtney Peters…:       Just to back up, my team is a team of five. And one of the first things was, “Well what are we being given to protect ourselves?” We’re now being asked to take care intimately, in the same ICU room, or in the same OR as a COVID patient, to be taking care of them, to be spending hours and hours with them a day.

Todd:                           Right.

Courtney Peters…:       So a lot of fear with things running out because it’s actually already happening. Things are getting scarce. People are starting to stockpile gowns in their corner of the ICU, or hide block masks in drawers. So nurses are only given one mask a day, per shift. And if it gets soiled, you get a second one but that’s really hard to come by. So things are just getting very different. Just something I never thought I’d experience. Gloves are running out. Masks are running out. Cleaning wipes are running out.

Todd:                           Wow. So that surprises me some because the COVID-19 has a very specific mask you have to wear, but I’d imagine the gloves and the gowns are the same. So is it just because of the increased patients? Is that what’s causing … Those other ancillary protective equipment, is that what’s causing those to run out?

Courtney Peters…:       Yeah. So we don’t always have to gown up, or even mask up to enter a room. Lots of patients [inaudible] on isolation for other reasons. But COVID patients are treated with isolation, protective equipment, and we have nurses and perfusionists going in these rooms and going into ORs 2030 times a shift, and we are inundated with COVID patients. To give you a number, on Monday I think our hospital went through 500 masks in a day.

Todd:                           Wow, okay.

Courtney Peters…:       By Tuesday we went through 3000 masks in one day.

Todd:                           Wow. So that’s a huge increase in just one day. Was that because of a huge increase of COVID patients?

Courtney Peters…:       I think it’s a big increase in COVID patients. It’s also a big increase in people, again, feeling afraid, wanting to protect themselves, wearing masks just walking down the hall, and just really getting over cautious. Which isn’t a bad thing, but it then, in turn, uses more materials. So that’s a big change.

Todd:                           Absolutely.

Courtney Peters…:       On top of just the feeling of fear, we are a small team and we do have something we call ECMO, which is a life support system that’s able to take over these patients’ lung functions.

Todd:                           And let me just say this: COVID specifically is attacking people’s respiratory systems, right? A lot of the symptoms show up as a respiratory illness, is that correct?

Courtney Peters…:       Exactly. Exactly. So a lot of patients who are failing ventilator support, their next step ,and their only next step, is to go on something called ECMO, extracorporeal membrane oxygenation.

Todd:                           So that is literally the last step for these patients. Ventilators have failed them, and now your team is acting, through ECMO, as sort of the oxygenator for their body, like what their lungs is would do.

Courtney Peters…:       Exactly. There’s no other option after ECMO.

Todd:                           Right. So you guys are like the last line of defense for these patients who are in the most need?

Courtney Peters…:       We are at the moment. Yeah, definitely.

Todd:                           So with a small team of only five, is that putting stress on how many hours you guys are working? And what are you guys doing to combat that?

Courtney Peters…:       Yeah, so that’s another big change for our team. I know across the country a lot of elective OR cases have canceled, which for some of our colleagues has made their days quite slow. But on the flip side, we are very grateful for that because we are working at the moment eight-hour shifts, three eight-hours throughout the day, and then someone’s available for OR emergencies as well. So most of us, if we’re not actually doing a shift that day, we’re call or backup call, or we are OR emergency call. So there are very few days off or any of us get to go home and really just shut it down at the moment.

Todd:                           Yeah, and to sort of relax and recoup before your next shift.

Courtney Peters…:       Exactly. John, my big thing is I want everyone to be able to go home, even if it’s just for eight or 16 hours, and decompress as much as possible because they’re going to be asked to come right back. And it could be in the middle of the night, or it could be by their scheduled shift the next morning. Things are just very up in the air for everybody.

Todd:                           Yeah, it sounds sort of like everyone’s on call, whether they’re at the hospital or not.

Courtney Peters…:       Exactly.

Todd:                           So what are some ways that you are, as that clinical manager who’s over that team, what are some of the ways that you are coming together to, I guess, still provide the support that is required of you, even though it’s a lot more support than you guys normally are capable of?

Courtney Peters…:       Yeah, it’s very challenging to keep the morale up. I think it would be for any team who’s experiencing something so uncertain. We don’t know where the end is. We don’t know when this is going to let up. So how we’re dealing with that as a team is constant communication. We have conference calls because we’re not seeing each other face to face quite as often if we don’t have to, keeping them totally up to date on the plans, on the scheduling. But “if” and “whens,” I’m always planning Plan B in advance, because there could come a time where we actually are running two perfusion teams in-house simultaneously, if we have that many ECMOs running at a time.

Courtney Peters…:       So I try to ease the uncertainty, or the confusion, or the lack of expectation awareness for the team, and hope that can take some stress and some fear off their plates as much as possible. And then we reach out to the company and seek any travelers that are willing to travel during a time like this, just to allow us a couple of days off anytime during the week. So we actually do have a traveler coming to us hopefully today, and that might just give all of us one day off in the coming week or two. But that’s more than we would have in autumn, so that’s a huge help as well and gives people kind of a mental break and an emotional break as well.

Todd:                           Yeah, absolutely. Let me just ask this, just to sort of clarify. That traveler, is that another SpecialtyCare perfusionist that is flying in from an area that maybe isn’t as impacted by COVID, so they have a little extra time to come out and help?

Courtney Peters…:       Yes.

Todd:                           Oh that’s awesome.

Courtney Peters…:       Yes. That’s a huge relief that is obviously taken very well by the team. It feels good to know that something is coming, even if it’s just temporary.

Todd:                           Well, yeah. And to feel support outside of your team. I mean, I realize SpecialtyCare is a very big company and there’s a lot of perfusionists that work for SpecialtyCare. So you don’t feel so isolated in Denver because you have someone from, and forgive me, I don’t know the city, but from somewhere else, to come in and help out. It’s got to help with that morale that you’re struggling with.

Courtney Peters…:       Absolutely. And I try to keep saying, and others are echoing the same feelings, we’re just very grateful to still have work. We still have paychecks. We have very meaningful jobs that we’re going into, albeit very stressful, but we try to look at it like this is not just a terrible time, but it’s an opportunity for us to work hard and give back to as many healthcare workers around us, and patients, as possible, and try to see any positive in this chaos makes it easier to get up and go to work every single day.

Todd:                           Absolutely. So let me ask you a few questions about the hospital specifically because you mentioned that the hospital is rationing the protective gear and stuff like that because of shortages. Is there any hope in the future of getting more protective gear?

Courtney Peters…:       I think the hope that the hospital has been giving us just in this last week is this idea of recycling masks. There are companies out there saying that they can take old masks, whether they are just the regular surgical as we discussed, or the very specific N95s, and they said that they can actually refurbish, re-sterilize, whatever they do, and recreate them and give them back to the hospital. So in that regard we have a little bit of hope there. We don’t know how that’s really going to play out, but it is a plan.

Todd:                           Yeah.

Courtney Peters…:       As far as you know, some of the other equipment, gloves, gown whites, wipes, I really can’t tell you. I just know that everyone is aware that they’re running short, and so we’re all trying to be as mindful with our use as possible.

Todd:                           Sure, trying to be as strategic as possible. Let me ask this because I know on the outside, people who don’t work in hospitals like myself, we are asked to just stay in our homes and social distance if we go out. So say six feet away from everybody whenever we can, if we do go out. You guys having to go into the hospital, which is a high-risk area on a normal day anyway, are there precautions that you guys are taking in the hospitals that are sort of similar to what we’re being asked to do on the outside?

Courtney Peters…:       Yes. So in the hospital we have units, we have wings, we have areas of the hospital where we try to consolidate our COVID patients.

Todd:                           Sure.

Courtney Peters…:       And when you are there working in those wings, you don’t just freely walk around the hospital from wing to wing, going from a COVID to non-COVID. We try to stay as consolidated as healthcare workers as possible. As soon as I enter the hospital I put a mask on because I don’t know my exposure risk to other people, and that’s a good point I wanted to bring up.

Courtney Peters…:       The CDC has outlines three types of risks exposures, low, medium, and high, and what you do if you’ve had any of these exposures. So I can tell you, everyone on my team has had a low-risk exposure, and we do every single day we come to work. And what this means is the COVID-patient is wearing a mask, or is intubated, and we also have our face mask on, or our N95, but we’re in the same room as a COVID patient. That is considered a low risk exposure.

Todd:                           Right.

Courtney Peters…:       And so we’re all walking around as those individuals, which is very important for me to not go out in public. I haven’t gone out in public. I won’t even go to the grocery store. Thankfully I have a partner who does that for me. But I don’t know what I could be carrying just by virtue of my job.

Todd:                           Right. So your precautions extend even outside of the hospital. So you obviously take the precautions when you’re in the hospital wearing the masks and whatnot, but also when you go out and are heading home. It sounds like you pretty much just go from the hospital to your house and back.

Courtney Peters…:       Yeah, I do. I’m too fearful that I could be a carrier and not know it, so I don’t take any risks if I don’t have to. For others, not for myself. I think a lot of us feel that way, and it’s important to try to stay home as well.

Todd:                           I think that’s absolutely a very, very good point to make. Also, I’ve been seeing reports from the CDC that up to 17% to 20% of people that have COVID-19 express no symptoms, so they have no idea that they’re carrying it. So that’s a very good point to bring up and drive home: if you don’t have to go anywhere, don’t; if you do need to go into the hospital, try and make that the only place you’d go. I think that’s a great way to help sort of stop the spread and really support what you guys are doing at the hospital because the more people that get sick, the more people that have to come in, and the more strain it puts on you guys.

Courtney Peters…:       Yeah, definitely. And it sounds like our hospital is into less than double digits of ventilators, and so we are really hitting our numbers already. And I think a lot of people feel that we still have quite a long road ahead of us.

Todd:                           Yeah, I think we are at the early stages of what they’re saying is the curve, right? So we’re trying to mitigate how high that curve goes by isolating, as we have as a company, and things like that.

Courtney Peters…:       And the patients that are put on ventilators, or put on ECMOs, or these really, really advanced supports, obviously … Not every COVID patient ends up in this situation, but a lot of them are and there’s more and more every day. But these are not short-term supports. You’re not going to be on the ventilator for a week and then you’re going to come off and be fine, or you’re not going to be on ECMO for a week and then come off and be fine, these can be going for three, four, five weeks, where that device, that ventilator, that ECMO machine, is going to be used up on one patient. So they’re in it for the long haul, and this equipment is then going to be even harder to find because no one’s coming off the equipment they’re being put on very quickly.

Todd:                           I mean that makes sense. If you have eight patients that need to be on ECMO for an extended period of time, that’s eating up eight ECMO machines for a month perhaps. And if you only have 10 at the hospital … And I’m just throwing out numbers because I really have no idea what those numbers typically are. But, I mean, you only have two and that’s going to be scary when you get down that close to the end of the supply. So I think that’s very, very understandable.

Todd:                           So a lot of what we’ve been talking about as sort of the negative of what’s happening around the COVID-19, and there’s a lot of scary things that we’ve been talking about and people in the news have been talking about. But are there any stories of inspiration that are happening, or some things that you maybe didn’t expect that are sort of heartwarming that have been happening with your team or at the hospital that you guys service?

Courtney Peters…:       Yeah, so the first thing that comes to mind is just last night we were approached and provided, actually a ton of people in our hospital, were provided free meals from a nonprofit in Denver called Lunches or Clinicians.

Todd:                           Now that’s awesome.

Courtney Peters…:       And I don’t know if this was just built around this COVID outbreak, or [inaudible] something that’s been around for a while. But what they’re doing is there collecting money from the community, and they’ve already collected almost $2,000.00.

Todd:                           Oh wow.

Courtney Peters…:       They’re just taking that money and using it at a local restaurant in Denver to buy a ton of meals for a group of workers, healthcare workers, at a hospital, and then they’re delivering that food to the hospital. Every day, they’re doing that.

Todd:                           Wow, that’s awesome.

Courtney Peters…:       So by taking donations from the communities, they’re giving back to the restaurants who are struggling, and then they’re providing free food to health care workers. It’s just really amazing,

Todd:                           Yeah, I was going to say that. That has more of an impact than just feeding hungry clinicians, even though that’s very important. It’s uplifting for the team as well. They feel valued and appreciated, but it also supports the small businesses in the area who are undoubtedly struggling right now.

Courtney Peters…:       Exactly. And, I mean, they did it with coffee, pizza, so they’re reaching out to small businesses and getting money into their pockets, and then in turn, giving some happiness to the worker. So I love that. That just happened last night during my shift, and I thought it was just one of the coolest thing.

Todd:                           Yeah, you actually took some pictures and sent those to us. And if you’re okay with it, I’d love to actually share those in the video of this.

Courtney Peters…:       Absolutely.

Todd:                           So if people want to go to the video and those pictures, I’d love to share those. So is there anything else that’s going on that has been uplifting at the hospital?

Courtney Peters…:       Yes. Well at the hospital, everyone’s just having each other’s back. But even within SpecialtyCare, our neuromonitoring colleagues in Denver, who we really don’t have any interaction with whatsoever, and none of us probably know each other, one of their clinical managers reached out and just offered to help in any way they can. They’re like, “Can we come in and clean your machines? What can we do for your team?” And so just getting that from the companies from a different service line was very uplifting, and I shared that with the team. And then it just means a lot to know that people are trying, even if there’s not much they can do. So that was a fantastic kind of reach-out, feel-good moment. And even our CEO, Sam Weinstein has reached out and asked if he could send along encouragement to the team. And that just shows a lot of support within the company that we are all feeling, and very grateful for as well.

Todd:                           I know that Dr. Weinstein is very passionate about helping everyone feel supported and communicated to. We’re working as a team to get as much communication out as possible during this time so that people aren’t wondering, “What’s going on? What should I be doing?” Those kind of questions, we’re trying to answer all those up front. Because clinicians in the field have enough to worry about without having to wonder what’s going on with their employment status, or that kind of stuff.

Todd:                           So what else is going on out there?

Courtney Peters…:       You know, just even as a team, we’re a small team, just last night … I’ll throw Alison out, under the bus. It’s something so small, but she brought me … She’s a colleague and I went and relieved her yesterday at 2:00, and she took me back to the lounge and she handed me a box of donuts. And she just said to me, “This is for you to take home or to share with the nurses this evening.” It’s just such a small thing. But she came in at 6:00 that morning and I don’t know where in the world she found time to grab donuts for me first. But it was just a very small act of kindness that just brought … You know? It just made the shift that much better. It was just a great way to start that day, and so appreciated, and … Everyone is doing little things like that for each other all the time, which really adds up.

Todd:                           That is awesome. So I know we’ve been exchanging emails before we did this, and you had told your team that you were going to be doing this podcast. And did they have any messages that they wanted to pass along on this forum that we have?

Courtney Peters…:       They did. So I do want to share one email that I got from one of my perfusionists, Casey Baumgartner, that she’s wanted me to share with you guys if that’s all right.

Todd:                           Yeah, absolutely.

Courtney Peters…:       Fabulous. Okay. So she says:

Courtney Peters…:       “As a perfusionist, I think most of us have this innate response to run towards the fire. And this is exactly what this pandemic feels like: a fire, putting yourself in danger to care for those who cannot care for themselves, a sense of urgency. You’re a part of their lifesaving team, their last chance. This innate urge puts everything else on the back burner, home life, relationships, family time, because it’s all consuming. Making sure patients are safe, making sure cases are covered, pulling overnighters, all while having frustrations with the system but complying anyway because it’s the process, the right thing to do. In the end when we overcome, this will be one in the history books in new perfusion [inaudible 00:00:19:01]. And we have an opportunity to continue to refine our practice, to again come up with creative ways to push our equipment limitations and supply issues.”

Courtney Peters…:       She really ended it there, but I think it was just really well said.

Todd:                           Yeah, absolutely. And I do think that this is a trial for the ages for all of us here, and especially for our healthcare workers. So just from all of us on the outside, I just want to send a big, big thank you for those of you on the inside of these hospitals. It means a lot to us.

Courtney Peters…:       Thanks, Todd. It’s really appreciated to be able to talk about it, and get feedback from you guys, and just having the support that everyone’s trying to show in such a confusing time has been really great.

Todd:                           Absolutely. Well, thank you so much for being on the podcast. We really appreciate it.

Courtney Peters…:       Thank you. Thanks for an invite.