Every time registered nurse Kelly Stettmeier checks on a patient with a severe case of COVID-19, she must complete a complex "gowning" process that involves donning a thin, blue, disposable gown over scrubs, covering exposed skin with extra gloves and placing an air-purifying respirator over her face. 

The 10-minute procedure required before visiting patients in isolation is the stark reality that has become routine over the last year. 

Since the first COVID-19 patient came into Marian Regional Medical Center's intensive care unit nearly one year ago on March 19, 2020, staff have seen the worst of the virus' effects, experienced the devastation of increasingly larger surges, and relied on one another as they cope with feelings of loss and isolation. 

"The day starts out with a lot of anxiety, when you start with a lot of critically sick people. This COVID course is long and hard and it’s exhausting, and it’s a lot of work with the gowning," Stettmeier said. "There’s not a lot of victories in the day, but you have to celebrate the little wins, like when someone drops down on medication."

On Wednesday, there were seven COVID-19 patients in the unit, including a couple breathing with the assistance of intubation. The nurses are grateful for this period of something like calm, following the nightmare three months ago.

The first surge of patients in spring of 2020 left staff scrambling to meet local demand, with little respite before another surge in the summer. However, both of those surges were only run-ups to a third surge in December — the biggest and most brutal to date. 

From December to January, an ever-growing number of patients crowded the unit until a line of beds snaked down the hallways. More patients needed the assistance of breathing apparatuses than ever before. 

"We had our surge in the spring, then we had a minute to breathe. But then it got so much worse [in the winter]," Stettmeier said. "At one point we had up to 40 patients in the ICU, and they were all COVID." 

Since the early days of the pandemic, Santa Maria has been a hotbed for the virus, and as a result, hospitalizations and deaths. By the fall, the city had half of Santa Barbara County's total cases, despite comprising only a quarter of its population.

Marian Regional Medical Center has consistently held the most COVID patients out of Santa Barbara County's three hospitals, sometimes taking patients from southern San Luis Obispo County and other areas of the state in addition to local cases.

Dr. Barry Feldman, the ICU's soft-spoken medical director, struggled to find the words to describe the past year, before landing on one: endless.

"It's kind of like a big blur," he said. "The biggest thing is really … the way the staff rose up, and things we never thought could be done were done. Everybody was really terrified in the beginning, and you saw the best in people come out."

For many, the worst part has been witnessing countless patients die, without their families able to be by their side.  

Loss

Due to the risk of contracting the virus, patients receiving ICU treatment for COVID-19, especially those in isolation, are not permitted to have visitors except under specific circumstances, hospital spokeswoman Sara San Juan said. 

"If it's end-of-life, we'll sometimes allow it. Some of them want to have a family meeting," San Juan said.

Most of the time, nurses are charged with setting up communication between patients and families via phone, or over video via iPads donated by the Mark and Dorothy Smith Family Foundation. Even if the patient is unable to speak, families still can express love, well wishes and sometimes goodbyes.

"Experiencing that grief with their families every day on the phone, that was the hardest part. Sometimes you finish your day, get in the car and just cry," critical care nurse Allison Youngern said. 

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Even when patients do recover, the long road toward recuperation can be grueling to witness.

Tim Wendling, a physical therapist who helps patients focus on mobility, said those recovering from COVID-19 treatment in the ICU are slowed down by a significant toll on their bodies and lungs.

"The nature of this disease is it takes a long time. There’s some people who have weeks and weeks of recovery … even some that were semi-mild [cases]," Wendling said. "We had a person who was here almost a year ago and is still feeling the effects of it."

For many, initial therapy sessions focus on the simple act of sitting up in bed and breathing on their own. With little existing research about the duration and magnitude of mobility impacts from the virus, Windling said it's often a game of wait-and-see. 

"We don’t have much research done on this and mobility yet, so we’re learning as we go," he said. 

Healing

As Marian staff focus on healing the sickest patients that enter the facility, many also are taking time to ensure their colleagues are persevering through a national initiative called "check you, check two." 

"It's a campaign to help increase support, to have staff check in on themselves and two other people," Director of Critical Care Service Lauren Whitmore said. 

Several nurses wear this reminder to check in with themselves and others in the form of orange buttons pinned to their scrubs, along with visiting the hospital's in-house therapist or finding a quiet place to be alone. 

Whitmore said she is comforted by the arrival of COVID-19 vaccines, which the majority of health care workers now have received, but said she has to be prepared for further spikes.

"We've prepared for things to fluctuate. We take it in stride, and hope it continues to go down with things like vaccinations. We’re cautiously optimistic," she said.

Until the pandemic is over, critical care nurse Rose Nelson said extending comfort to one another during an unimaginable time is invaluable, especially when it can be hard to communicate the impacts of daily loss to family members who aren't experiencing it firsthand. 

"For the first time in a while, we’ve had an opportunity to reflect back … I don’t know if any of us have gone through something like that in our lives. I personally don’t think I can go back to the person I was before. I just need to find ways to move forward," Nelson said. "I don’t think there’s any way to help someone really truly understand unless you were in those rooms."

Coronavirus: Impact, response to COVID-19 on the Central Coast

We are working hard to get answers about the impact and reaction to the coronavirus in Santa Barbara County, this is a collection of those stories.

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Santa Maria City Reporter

Originally from the Pacific Northwest, Laura Place covers city government, policy and elections in Santa Maria and Santa Barbara County. Follow her on Twitter @itslaurasplace

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