Jordan Kofler knew what she was walking into this past July.
Kofler is now a nurse on the medical floor of Providence St. Mary Medical Center. But when the COVID-19 pandemic began in the U.S., the Walla Walla native was in her senior year of nursing school at Oregon Health & Science University.
With a bachelor’s degree under her nursing pin, the young woman could have avoided some of the angst of the historic moment by choosing, say, medical office work.
She applied only to St. Mary, Kofler said with a smile.
“I did my clinicals here … I wanted to work here. My whole family is here.”
While Kofler was just learning the nursing ropes, the first local COVID-19 patient was admitted to the hospital. Kofler was among those who watched staff don the protective gear then recommended by the Centers for Disease Control and Prevention.
Practices and requirements have evolved since that first encounter, but the patients with the virus have not. Isolated from family and fearful of what’s to come, each person who gets admitted needs all the support Kofler and her colleagues can muster.
Before they can do so, there are steps to take.
So many steps.
Every employee starts his or her shift with protective eyewear and a face mask. Any time staff enters a COVID-19 patient’s room, a specific and mandated safety routine must come first, Kofler said.
“You put on a gown, you put on shoe covers, everyone wears head covers now,” she said.
“We’ve all got pretty ones now.”
Then comes two pairs of gloves and the “PAPR,” an air-purifying respirator used to protect healthcare workers who can be exposed to pathogens in the air while doing patient care.
Or, as Kofler and others call it, “the beekeeper getup.”
“It’s a regimen, how you put it on. I probably do it 15 to 30 times a day … And always, sure enough, you need something while you’re in there, and you can’t step out of the room or you’re contaminated.”
Once finished with a patient, Kofler goes through a systematic removal of all the garb and a handwashing routine.
“When you walk away, you always second-guess if you did it right. I try not to touch my skin all day.”
These are not the most demanding parts of Kofler’s job. She, like others at St. Mary, fulfills many roles per patient. Maybe it’s telling someone who came for a different medical issue that they’ve tested positive for COVID-19.
That takes everything in a new direction, Kofler said.
Or caring for a person suffering memory and cognitive loss and, now, the coronavirus, she said.
“Those patients really depend on a regimen and social interactions, so we do our best to set up Zoom meetings and phone calls. We take an iPad into the room.”
It hits staff in the heart to watch the emotional trauma elderly patients go through, Kofler said, and they do as much as they can to mitigate that.
“I’ve met families in the lobby and showed them how to set up a Zoom account. They go home, and then I call them.”
Most of the time, the efforts pay off, and a useful connection is established.
Not always, though, she said.
“Some people don’t have anyone to call.”
With long-term care facilities on lock down since March, sometimes families rush to the hospital to see an elderly loved one when he or she is admitted for COVID-19. There is finally enough personal protective equipment on hand to allow a patient at the end of life to have an in-person visitor, St. Mary spokeswoman Kathleen Obenland said.
Decisions about visitors are made on a case-by-case basis for a number of care levels, according to Providence’s current policy.
Kofler has watched patients with the virus begin to improve, even grow close to discharging, only to be headed to the intensive care unit the next time she turns around — a most disheartening moment for all, the nurse said.
“I know they are going off to get all the ‘big guns,’ one-on-one care, but it’s hard to see people decline who you thought were on the mend. It happens fast.”
It seems recently for every COVID-19 patient who does go home, another three are coming in, Kofler said in December.
Right now, teamwork is the lifeblood of the hospital operation, she said.
“I love the team I work with, and honestly I don’t know if half the team could do this without this kind of support.”
It has always has been this way, she supposes, but typically it’s muted under daily routine.
“Everyone had their different patient load, they worked independently. You asked for help if you needed it, people had your back, for sure. But now working together is the overarching theme.”
Maybe that means goofing around with the hardworking cleaning staff, Kofler said, and for sure it means talking through the tough times with others on the floor.
In this first year as a nurse, Kofler has watched medical professionals advance as a united force in tackling the pandemic.
“When we’re at the hospital, we don’t judge anybody. We don’t think about if they wore a mask or if they went to the wrong place. We’re just there to heal,” she said.
Off shift can feel otherwise.
“Inside, we’re a team fighting COVID to keep everyone safe. But out in the community, it’s like a different world. I thought everyone would be so on board with making sacrifices for us as a community, as a society, to get through it. I just thought there would be more compliance,” Kofler said.
“Then I go gas up my car, and three people walk into the gas station without masks on. They (health officials) put the information out there, it’s science-based, it’s real, but somehow it gets lost in translation.”
Coming to nursing during a pandemic isn’t what Kofler anticipated, but it has forged her resolve, she said.
“It doesn’t matter what’s going on out there. If you come into my hospital, I’m going to give you the best care I can. Even with that lack of control, I’m still going to do what I do.”