Hospitals Are Hoping For The Best, Preparing For The Worst

MELROSE, MA — “Foam up.”

You’ll hear those words early and often at MelroseWakefield Hospital. There’s a foaming antibacterial station when you walk in either of the two entrances the hospital funnels people through — it’s next to where the repurposed athletic trainers and physical therapists are handing out masks and asking if you’ve had a cough lately — then another station around every corner.

Dr. Steve Sbardella foams up at least a few dozen times a day. His knuckles are red. That’s the least of his problems.

“It’s COVID all the time,” the hospital’s chief medical officer said. “There’s no break.”

The hospital’s bones don’t try to hide it. Some hallways have been repurposed as makeshift wards, to put it nicely. They are littered with beds, a toilet and a food cart. Half of the ER waiting room is ready to house nearly a dozen patients mere feet from each other. The hospital’s patient capacity has been increased from 134 to 196.

It’s crisis mode.

The hospital is living by an old adage: Hope for the best and prepare for the worst.

As Massachusetts announced confirmed COVID-19 cases were nearly 19,000 and the death toll topped 500 on Thursday, Sbardella was explaining how the hospital has been planning based on what happened in hotspots like China, Italy, Spain, Seattle and New York City.

“We’re preparing to be in the same situation they found themselves,” he said. “If we are, we are. But if we’re not, fantastic.”

The hospital isn’t winging it. While COVID is new, there are always disaster plans. Though the plans around here are often for fire, snow or hurricanes, contingencies are in place for a wave of patients. The hospital has spent weeks tweaking those plans to best suit this particular threat.

The preparation goes beyond the 46-percent capacity increase. Hospital engineers have used the building’s smoke exhaust system to create negative pressure wings. Negative pressure means the air in an area is sucked out so it isn’t shared with the rest of the building.

Where there was once six such rooms in the hospital, there are now entire floors that have as many as 34.

What that means is the influx of patients with potential COVID-19 infections can be treated in negative pressure environments. Meanwhile, medical workers can change and use personal protection equipment in vacuum-sealed rooms, sort of like the decompression zones in science-fiction movies.

Some of the adaptations are more crude.

The long hallways connecting sections of the hospital — the “spines” — are usually eerily empty during a normal hospital visit. Now they are eerily full.

The spines in the top three floors each have nine beds up against the wall. Two beds are on either side of a curtain that offers token privacy for a toilet.

The nursing station is a folding table next to a window, a decision made so the nurses get to look out and see there’s more than COVID.

The hallway beds could hold patients for the entirety of their stays.

“This is going to be like World War II,” Sbardella said.

Other changes are old-school.

One worker, whose eyes and hair bun were the only things that could be made out behind her scrubs and mask, was sitting on blue tape — the usual carpet would keep too much bacteria — in what used to be the ER waiting room, shuffling through a few dozen papers.

The hospital’s computer system might not be able to handle the surge of COVID patients. So, just in case, she was working through hard copies.

“Back to the ’70s,” Sbardella said.

Meanwhile, the pharmacy department is making its own hand sanitizer for the hospital to lessen its reliance on a strained supply system. Thanks to innovation and elbow grease — workers are stretching supplies to last — the hospital hasn’t seen the shortage of supplies everyone reads about in other parts of the country.

“Not yet,” Sbardella said. “Right now we’re OK.”

Scroll through social media and you’re lucky to make it 15 seconds without a post about an overwhelmed medical worker, eyes soaked in tears, flirting with their breaking point.

And that’s OK, Sbardella said. Because, fair or not, they keep bouncing back.

“We’ve been in this state for six or eight weeks, working this way,” Sbardella said.”There’s no break [from COVID.] And that is draining for people.

“I’m so proud of people who come back to work the next day because everyone, at every level, you gotta take a break. You gotta turn off, you gotta close your eyes, you gotta cry, you gotta laugh, whatever you gotta do. Then go back to work.”

It’s not just the stress of the job. It’s the fear of getting an illness that has a stranglehold on life itself.

“The emotional side of this is strong, because they’re afraid, too,” Sbardella said. “But they’ve committed to being here. This is your job. This is what you chose to do. You walk into it every day. Like how they say firemen run to the fire, health care workers run to the hospital. They’re afraid. But they hold it together.”

Just as the workers take care of the patients, the hospitals take care of the workers. The employee assistance program has been dialed to 11, with online meditation groups, behavioral health help and therapists.

“We’re trying to give people as many avenues as they can so if they want to talk to someone, we can provide it,” Sbardella said.

The community can help.

“It’s sounds cheesy,” Sbardella said, but few things carry more weight than receiving a note from the outside world.

“People tear up when they get them,” he said. “They’re at the emotional fragility state. They’re inside these units, they don’t even know what the weather is outside. So to have someone say ‘thank you’ — if there’s anything that can be done in the world, that is the best.”

Sbardella shows up to work every day at 6 a.m., then spends nine or 10 hours dealing with issues around patients that have or could have COVID-19.

“Then you go home and you think your day’s gonna be over,” he said. “And all you see on the news is COVID, your family members talk about COVID, you get text from family members about COVID, every email is about COVID.

“It’s COVID all day long,” he sighed. “That is tiring.”

Shortly after, his beeper goes off.

“I’ve got to escape,” he said.

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