Kirstin Brainard’s daily rounds as a floor nurse at University of Iowa Hospitals and Clinics’ medical intensive care unit are a mix of reviewing how patients have done the past 24 hours, helping treat those patients and taking new admissions. Brainard is part of an 8-person team, which has to be ready to deal with any emergency on the hospital floor. Her patients include those with COVID-19.
We talked in mid-January, just after the Christmas holiday season, about helping patients deal with heartbreaking end-of-life matters and coming to grips with the coronavirus. Listen as she talks about setting health care goals with patients and their loved ones but not being able to do so with everyone in the same room.
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Kirstin Brainard: More recently, you know, a lot of times that a lot of our work in the ICU is called goals of care. And that generally means just having family discussions with patients and their loved ones about, you know, what their goals are of whether they want to keep trying to get better, or if we should reach some other sort of goal.
IowaWatch: And when you’re talking about another goal, not to get morbid, are you talking about the end of life decisions?
Brainard: Yeah. Yeah.
IowaWatch: Is the typical day different now than it would have been before the COVID era?
Brainard: It is, it’s probably the change that I’ve, I’ve disliked the most since COVID started. And the biggest reason for that is, goals of care are very dependent on, you know, being able to speak in person to families. Because often when we’re doing these meetings, the patient’s themselves are not, they’re not able to be a part of the discussion, which is a very unfortunate thing. But because of COVID, we have so much restrictions on visitors and family members coming to the hospital. So often I have to do all of those conversations over the phone.
IowaWatch: Does that add to tension? Or do you feel, let me back up. Not tension. I’m more interested in if you lose that personal touch?
Brainard: Yeah, absolutely. Um, I think a lot of, you know, having good bedside manner, and being able to have these very meaningful, but yet sad discussions is having that in person, like nonverbal communication. And when you’re having to talk about things and describe things over the phone, it’s very hard for, you know, a loved one from, you know, however long away to understand what we’re talking about. And I think that not only has to do with, they can’t see their loved one, so they don’t see all of the things they’re hooked up to, you know, how they look in their critical illness. But it also means they can’t talk to us directly a lot of the time.
IowaWatch: One of the things I’m thinking about is that you also might lose the weight to convey empathy. Is that true?
Brainard: Yeah, I feel I yes, I strongly feel that that’s very hard to put into words. And so, when they can’t see that I, you know, I’m, I’m tearful and sad about having to tell them this, you know. They’re just hearing me over the phone, and then it’s, it’s more sad to think about that. When I leave them off the phone, I don’t know what I left them with, you know. And so I feel, you know, that saying it across the phone is just a very sad and unfortunate way to deliver very bad news.
IowaWatch: What type of reactions do you get from people?
Brainard: It’s a variety. And, you know, most of the time, I’d say it’s sadness and crying. And you know, people often don’t want to cry over the phone and in front of, in front of, you know, me. So I can, I can kind of tell that people are choking back tears and kind of trying to keep it together while they’re on the phone. But that’s, it’s very difficult. Some people are very angry. And not necessarily with with me, or, you know, my, my colleagues that I work with, but just at the situation in general, and especially when I, you know, there, especially at the beginning of the pandemic, we weren’t allowing any visitors for COVID patients. And so I’d often have to tell them that and the patients would often die alone.
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Kirstin Brainard is from Postville, Iowa, originally. She attended Allen College in Waterloo for her nursing degree. She has been at University Hospitals in Iowa City a little more than nine-and-a-half years, the last six in internal medicine.
Brainard spends a lot of time bedside, talking with patients. And, yes, one of her patients at the beginning of this year died not believing COVID-19 was the culprit.
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IowaWatch: What’s the hardest thing you have to deal with when you’re bedside with someone who’s suffering like this?
Brainard: Um, I think it’s, it all has to do with you know, not having that support night and I feel for these patients that can’t, you know, they might not realize exactly what’s happening. But I think people know when there’s someone at their bedside. And so, when it’s when it’s me, and it’s me or a nurse that I’m working with that are there, and that’s the only people that can be there, that’s often very hard.
IowaWatch: You run into people who don’t believe they have COVID?
Brainard: Yes. I actually just experienced this this week.
IowaWatch: Were they able to survive?
IowaWatch: How do you process… I’m sorry, go ahead.
Brainard: …I was just going to comment: that was after a very large gathering for Christmas as well.
IowaWatch: In Iowa?
IowaWatch: Have you seen many patients who did family gatherings, and then that’s the explanation when they come into the unit?
Brainard: I haven’t personally taken care of a lot of patients that have had that, you know, that that’s been the case. You know, many of our patients have been there for a month or longer. And so some of these patients were there before Christmas. And so I can only presume that a lot of the people that got sick after Christmas might be elsewhere as well, because we were already full.
IowaWatch: I’m going to get into the public’s perception, but I just want to ask one question. What are your thoughts when someone dies, and they didn’t think they had COVID? I mean, they’re, you know, death is bad anyway. But there’s just there was this lack of realization of COVID?
Brainard: You know, It’s hard to know what they thought right before death. Whether it ever actually came to them that they maybe have this sudden, you know, realization that it was real. I honestly don’t know what people think they’re dying from if, if it’s not that, you know, health care providers, by nature, very trustworthy individuals. And I feel that, you know, we want to do right by patients, and we want to be honest with them, and, and so there’s no reason that we would have to not be honest about what we’re seeing.
It’s very frustrating, and sad that people are, that even people that are sick, that are ending up in the hospital, just don’t believe why they’re there and to have families not believe it is is also equally as difficult.
IowaWatch: Do you have any perception of whether the general public still understands what’s going on on a COVID unit?
Brainard: I mean, I think definitely having discussions like we’re having have definitely helped, maybe make it more real. But I think until you’ve actually seen it, there’s, there’s just a lot to understand. And I don’t think, I think like many people, you know, not believing that COVID was causing significant illness until it affected them in some direct way.
IowaWatch: There’s been a lot of reporting, at least in the last couple of months that has shown what’s going on, you feel it’s not connecting, or people seeing this.
Brainard: I think people are probably seeing it and do have a better understanding since the reports have come out. And I think that’s definitely helping a lot. It’s hard, I think, as a health care provider, when since we’ve been going almost a year, of this to describe accurately how stressful and tiring it is. You know, I was just saying to somebody yesterday actually that, you know, we’ve all been, we’ve all become, you know, our stress levels maybe started at a certain point, and now they’re, they’re much higher. And, they’ve been that high for months. And so, now we’ve just, you know, become used to that high level of stress and anxiety and sadness that, which is unfortunate, you know. There’s a lot of things, there’s a lot of little things that we’d like to change, and get back to, but we’ve become used to this new, this new level of stress.
IowaWatch: How do you cope with that?
Brainard: You know, that’s probably one of the most difficult things for me to answer only because a lot of the typical things ways that I’ve coped in the past is to be with family and friends and and often during the pandemic, I haven’t, you know, I haven’t seen my friends in a year. And so my closest friends that you know, live only about an hour away I haven’t seen in quite some time. So those sorts of little ways that we’ve done that to cope in the past aren’t working but I would say that, you know, there’s like, you know, lots of little ways at home. like reading, doing puzzles and different things to take your mind off of, of everything at home is a good way.