Tim Noonan remembers going to the Park City InstaCare with a high fever and shortness of breath last March. He remembers being rushed onto a helicopter and touching down at Intermountain Medical Center. He remembers being afraid. But beyond that, the clarity stops.

“The next three weeks were pretty much a blur,” said the 61-year-old Park City resident, who became one of Utah’s earliest COVID-19 cases. “They put me in a medically induced coma. I didn’t know where I was. I had these horrible, horrible nightmares and dreams. I remember seeing my family via videoconference a few times when they’d bring me out of the coma a little bit.”

After more than three weeks in Intermountain Medical Center’s Shock-Trauma ICU and a month in the Respiratory ICU, and after surviving respiratory failure and kidney failure and liver trouble, Tim was moved to the rehab unit this summer. Before his illness, he was an avid skier, biker, and weightlifter. After, he had to learn to walk, shave, and feed himself again.

Tim believes that if more Utahns knew what he and other COVID patients go through, they’d take the virus more seriously. But like Tim during the earliest touch-and-go weeks of his treatment, most of us have little awareness of what life is like in an ICU caring for COVID patients.

“This illness is exceptionally hard on the people it brings to us,” said Sean Talley, RN, nurse manager of the Shock-Trauma ICU at Intermountain Medical Center. “A lot don’t make it out. Looking at our staff who usually are happy-go-lucky — you can tell how hard it is. You can see it on their faces. Our ICU deals with trauma a lot. We get the sickest of the sick. We’re used to people dying. But when you see COVID take the life slowly out of someone, it’s hard to watch.” 

Most of the COVID-19 patients have breathing difficulties when they arrive and are on high-flow oxygen. But for many, it’s not enough. 

“It’s very hard to watch someone struggling for breath. It requires every muscle in their body,” said Michelle Bryce, RN, who’s been a nurse for 22 years, half of that time in Shock-Trauma. “Before they’re put on a ventilator, they’re straining to get each breath. It feels like they’re suffocating. It’s hard to watch. I’ve never seen anything like it. These are some of the sickest patients we’ve ever seen.” 

Many patients must be placed on ventilators and sedated like Tim was. The nurses turn them and move their bodies regularly to prevent pressure sores and stiffened muscles. The job is complicated by the number of tubes and pumps each patient is hooked up to. Nurses must make every move carefully so they don’t pull out a line. 

COVID patients require drugs in higher doses than any other patients Michelle has seen. “Their bodies just burn through the medication.” So caregivers are constantly changing IV bags or adjusting meds up or down as vital signs change.

But what might be a quick change for a regular patient can be a lengthy process for patients who have the virus. Every time a nurse enters the room, she must put on a protective gown, helmet, PAPR hood - which purifies the air a healthcare worker breathes, and gloves. Every time she leaves, she has to take it all off and sanitize the PAPR hood. The whole process takes about 10 minutes, and might be repeated many times a day. That can add up to hours spent just dressing and undressing.  

Those minutes are especially costly when a patient is in crisis.

“We’re wired to run into a room in an emergency,” said Michelle. “If a patient stops breathing, you stop everything and run. But lifesaving processes like intubating a patient make exposure more likely. In the beginning we had a few exposures when people ran in to take care of a patient. They really pounded into our brains that we couldn’t just rush in. It’s like being on a plane when the oxygen mask drops. You have to take care of yourself first.”

Caring for a patient with COVID is more stressful because the work is isolating, said Michelle.

“We call it COVID Island,” she said, describing the geographic bubble in Shock-Trauma. Patients are clustered together in one section of the ICU so their caregivers don’t have to pass through the rest of the unit, where non-COVID patients are being treated. 

It’s hard on the caregiving team because they worked collaboratively before the virus. Now, nurses aren’t able to call on a coworker to help them turn a patient. Sometimes a nurse will suit up and stay in a single room all day because it wouldn’t be practical to change every time she’s needed. In those cases, she’ll communicate with her co-workers by whiteboard through the glass walls.

ICU staff miss the camaraderie of their regular team, and they also miss the personal interactions with their patients and families.

“Even if the patients are awake and not intubated, it’s hard to communicate,” said Sean. That’s because the rooms have been converted into negative-pressure areas with loud fans that prevent the virus from escaping when someone enters or exits. “It’s like a constant ringing in your ears. That personal connection with the patient is much harder.”

Family and clergy members aren’t allowed to visit for their own protection. The nurses communicate with family every day over videoconference to give updates. 

“It’s hard for the families when they see their loved ones and we’re all wearing all the protective equipment. It looks like a scary movie. You can see it on the families’ faces: They’re scared.”

The rooms are loud, the nurses busy, and families so far removed that the ICU staff often aren’t able to learn the personal details of their patients’ lives the way they would have before the virus. But more personal interactions, when possible, are healthy for both the patient and caregiver.

Michelle, who speaks Spanish, remembers talking to one family when she volunteered to help in New York City at the height of the COVID crisis there last spring. They were so happy their mother’s nurse — the person who cared for her — spoke Spanish to them without a translator. They asked her to whisper their names into their mother's ear. “They wanted me to tell her to fight, that they loved her, they wanted her to fight for each of them,” she said. Michelle returned to Utah without knowing if the mother would make it, but she knows her messages were a comfort to the children.

The toll on patients and families is devastating, but ICU workers are struggling, too.

Most COVID patients are in the ICU much longer than a typical patient. "People do get better, but it takes longer,” said Sean "It feels like you’re in a marathon. You’re tired. You’ve put all this work in, but you don't know when the marathon is going to end. I regularly have people in my office in tears on the couch."

Unit members are extremely careful about COVID protocols, both in the hospital and at home.  There’ve been a few positive cases among the staff, but the virus is believed to have been contracted away from work, when someone let down their guard for just a minute. 

"We all have lives outside of here," said Sean, a husband and dad to three daughters.  "If you’ve got a nurse with a child at home with symptoms, we always err on the side of caution. We get them tested and they quarantine. It leads to a much heavier workload. Just today, I've got two people out of the schedule being tested for COVID.

"I call the staff, and they have to rearrange their lives. It's not a simple thing. Normally they have a set schedule and can plan their lives around it. Now they’re getting called to fill holes every couple of days."

Twice in the past week, Sean has worked as a manager during the day and pulled a shift as a caregiver overnight. He's not complaining; it's just what needs to get done.

"I feel like I've aged 10 years in the past year just dealing with the schedule changes. Other units are going through the same thing."

Sometimes Michelle, a mother of five young children, comes in to pick up a shift. Sometimes she can't. "I feel guilty on those days. And I worry about what I'm walking into on my next shift," she said.

Like everyone else, these caregivers are trying to manage children doing school at home and coping with the financial consequences of loved ones being out of work. All while they're caring for the most vulnerable patients they've ever seen.

Despite the tremendous strain, the COVID caregivers at IMC are providing exceptional and selfless care.

Tim, the former COVID patient, said, "I’ve never had that many people care about me. It was quite astounding. There were so many people, so many PTs, the respiratory therapists, the nurses, the CNAs, the PAs, the doctors — they were all wonderful. Everyone pitched in and saved my life. When I left the hospital, they were all so happy for me. They loved me. I was their little miracle."

Today he’s walking and lifting weights again. His friends have bought him a special backpack to hold his oxygen when he's ready for cross-country skiing. He still suffers from lung problems, 40 pounds of weight loss (much of it muscle), and memory problems. But he's alive.

The caregivers who make the ICU run every day, despite the challenges of COVID-19, have a message for the rest of us: Don’t underestimate this disease.

“People don’t think masks, handwashing, and social distancing make much of a difference, but I’m a big proponent,” said Michelle. “I’ve come to see COVID as a much more preventable disease than I first thought it was. We come to work and we put ourselves and our families at risk. We do the best we can and take precautions and hope the community will too. We don’t feel like it’s a big deal to ask everyone in our community to take these steps.”