Inside a Georgia hospital’s ICU, medical staff wages war against omicron

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The AJC is given access to the ICU at NORTHEAST GEORGIA MEDICAL CENTER where medical staff are waging war against COVID-19. Video by Ryon Horne

The numbers tell a story. But, from what the critical care doctors and nurses at Braselton’s Northeast Georgia Medical Center can see, the public isn’t listening.

Since the omicron variant came roaring onto the pandemic scene two months ago, the state has set records for new infections. While the variant appears to cause a more mild illness in most people than previous strains, especially among those who are vaccinated, the sheer numbers are staggering. Even though a smaller percentage of people are getting critically ill, it’s enough to overwhelm intensive care units.

At the Braselton hospital, all 24 hospital beds in the ICU are filled, 18 of them with COVID-19 patients.

Yet, when many Georgians size up omicron, they say this latest wave hasn’t been as bad as earlier ones.

Haley Clement, a registered nurse at the Braselton hospital, only wishes they could see what she sees.

Once a patient is sick enough to be admitted into ICU, there’s little difference between the delta variant and the omicron variant, health care workers say.

”I feel like it’s the same,” said Brandy Harris, also an ICU nurse at the Braselton hospital. “The patients are just as sick with omicron as they were with delta and the original COVID-19.”

ExploreHow hospitals are dealing with the coronavirus pandemic

Under a maze of machines, tubes and wires, patients are wrestling with everything from dangerously low oxygen levels to heart problems to organ failure. Some are on the brink of death.

And even though there are experts who say the number of new diagnoses may have peaked in the state, the patients keep coming. Clement thinks that would surprise many of the Georgians who aren’t as worried about omicron.

“You wish you could take people along with you for one just day,” she said as she paused to talk to an Atlanta Journal-Constitution reporter who was allowed to observe a day in her ICU, “so they could see the devastating reality that COVID truly is.”

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Registered nurses Brandy Harris confers with Kari Ruis, right, at the Intensive Care Unit. "It's super busy," said Harris, who has been a nurse for 21 years. "Wearing this mask all day, it is warm. In and out of the rooms all day. Gloves and gowns, and cleaning each piece of equipment you use with a Covid patient. Lots of procedures. Putting a permanent airway in a patient today because he's been intubated for some time. . .The patients are just as sick with omicron with delta, and the original COVID-19." (Hyosub Shin / Hyosub.Shin@ajc.com).

Credit: HYOSUB SHIN / AJC

Registered nurses Brandy Harris confers with Kari Ruis, right, at the Intensive Care Unit. "It's super busy," said Harris, who has been a nurse for 21 years. "Wearing this mask all day, it is warm. In and out of the rooms all day. Gloves and gowns, and cleaning each piece of equipment you use with a Covid patient. Lots of procedures. Putting a permanent airway in a patient today because he's been intubated for some time. . .The patients are just as sick with omicron with delta, and the original COVID-19." (Hyosub Shin / Hyosub.Shin@ajc.com).

Credit: HYOSUB SHIN / AJC

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Registered nurses Brandy Harris confers with Kari Ruis, right, at the Intensive Care Unit. "It's super busy," said Harris, who has been a nurse for 21 years. "Wearing this mask all day, it is warm. In and out of the rooms all day. Gloves and gowns, and cleaning each piece of equipment you use with a Covid patient. Lots of procedures. Putting a permanent airway in a patient today because he's been intubated for some time. . .The patients are just as sick with omicron with delta, and the original COVID-19." (Hyosub Shin / Hyosub.Shin@ajc.com).

Credit: HYOSUB SHIN / AJC

Credit: HYOSUB SHIN / AJC

‘We feel pretty defeated’

Roughly a dozen registered nurses and two doctors are assigned to the Braselton hospital’s second-floor ICU wing. Most of the time, it’s oddly quiet except for the sounds of hissing oxygen, beeping monitors and Chuck Beckman.

Beckman, a therapeutic musician, sits in a chair, his back against a wall, and softly strums a guitar to provide comfort as the medical staff move in and out of rooms.

On this day, Clement is a support nurse, helping administer medication, bathe patients and attend to other needs. She came into the medical profession shortly before the pandemic started.

She feels the frustration that many health care workers have expressed — that too many people are still debating whether it’s worth it to get vaccinated, even though the best evidence shows it is; that too many people are balking at wearing masks; that too many people still aren’t taking the virus seriously.

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Registered nurse Haley Clement feels the frustration that many health care workers have expressed — that too many people are still debating whether it’s worth it to get vaccinated, even though the best evidence shows it is; that too many people are balking at wearing masks; that too many people still aren’t taking the virus seriously. (Hyosub Shin / Hyosub.Shin@ajc.com)

Credit: HYOSUB SHIN / AJC

Registered nurse Haley Clement feels the frustration that many health care workers have expressed — that too many people are still debating whether it’s worth it to get vaccinated, even though the best evidence shows it is; that too many people are balking at wearing masks; that too many people still aren’t taking the virus seriously. (Hyosub Shin / Hyosub.Shin@ajc.com)

Credit: HYOSUB SHIN / AJC

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Registered nurse Haley Clement feels the frustration that many health care workers have expressed — that too many people are still debating whether it’s worth it to get vaccinated, even though the best evidence shows it is; that too many people are balking at wearing masks; that too many people still aren’t taking the virus seriously. (Hyosub Shin / Hyosub.Shin@ajc.com)

Credit: HYOSUB SHIN / AJC

Credit: HYOSUB SHIN / AJC

“It’s a battle that you’re not quite sure how to conquer. We feel pretty defeated,” Clement said. “We’ve worked really, really hard over the last two years to try and cure these people, keep these people alive. And we have not been as successful as we would like. So, when another surge comes around, you just feel defeated. You want to give it your all, but you know you know your all hasn’t always been good enough.”

The rate of COVID-19 hospitalizations and deaths slowed after the delta wave died down. But it didn’t last long. Every day for the past week, the state has reported an average of 75 confirmed or suspected COVID-19 deaths.

Before the pandemic, a code blue emergency — which means a patient is in cardiac or respiratory arrest — would take place maybe two times a week in the Braselton ICU. Now, with the unit overflowing with COVID-19 patients, it’s more like twice a day.

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Dr. Hisham Qutob rushes to check on patients at the Intensive Care Unit of Northeast Georgia Medical Center in Braselton. "I think for physicians, nurses, and non-medical people, we are all just about ready to be done with this," he says. "But I think the question that is out there and I have an answer for this, is what does a post-pandemic life like look like if this virus never goes away?" (Hyosub Shin / Hyosub.Shin@ajc.com)

Credit: HYOSUB SHIN / AJC

Dr. Hisham Qutob rushes to check on patients at the Intensive Care Unit of Northeast Georgia Medical Center in Braselton. "I think for physicians, nurses, and non-medical people, we are all just about ready to be done with this," he says. "But I think the question that is out there and I have an answer for this, is what does a post-pandemic life like look like if this virus never goes away?" (Hyosub Shin / Hyosub.Shin@ajc.com)

Credit: HYOSUB SHIN / AJC

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Dr. Hisham Qutob rushes to check on patients at the Intensive Care Unit of Northeast Georgia Medical Center in Braselton. "I think for physicians, nurses, and non-medical people, we are all just about ready to be done with this," he says. "But I think the question that is out there and I have an answer for this, is what does a post-pandemic life like look like if this virus never goes away?" (Hyosub Shin / Hyosub.Shin@ajc.com)

Credit: HYOSUB SHIN / AJC

Credit: HYOSUB SHIN / AJC

‘They are in disbelief’

Dr. Hisham Qutob, a pulmonologist and critical care physician, has worked seven days straight, from 6:45 a.m. to 8:45 p.m. At times during surges like this, he’s been on for as many as 21 days straight. Right now, he’s left with little time for his own family.

It often feels like he’s in a war, constantly triaging, constantly delivering hard-to-hear news.

Patients and their loved ones are often surprised that omicron packs such a wallop, said Qutob.

“I think there is sometimes this feeling of ‘It can’t happen to me,’” he said. “They are in disbelief.”

Overall, unvaccinated patients make up about 70% of the intensive care unit admissions at Northeast Georgia Medical Center’s hospitals. The ICU patients who are vaccinated tend to be people who are immunocompromised – meaning their immune systems were already weakened by diseases such as cancer, autoimmune disorders or by immunosuppressant drugs.

Unvaccinated COVID-19 patients are far more likely to end up on life support, Qutob said.

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Registered nurse Kari Ruis works on a computer as she monitors her patient at the Intensive Care Unit. This past year during the pandemic, she took up long distance running to help fight the stress from the job. She sometimes runs with her colleagues. She recently ran a half-marathon. "It's just a good way to go and get it all out, my frustration and put it into exercise and running," she said. (Hyosub Shin / Hyosub.Shin@ajc.com)

Credit: HYOSUB SHIN / AJC

Registered nurse Kari Ruis works on a computer as she monitors her patient at the Intensive Care Unit. This past year during the pandemic, she took up long distance running to help fight the stress from the job. She sometimes runs with her colleagues. She recently ran a half-marathon. "It's just a good way to go and get it all out, my frustration and put it into exercise and running," she said. (Hyosub Shin / Hyosub.Shin@ajc.com)

Credit: HYOSUB SHIN / AJC

caption arrowCaption
Registered nurse Kari Ruis works on a computer as she monitors her patient at the Intensive Care Unit. This past year during the pandemic, she took up long distance running to help fight the stress from the job. She sometimes runs with her colleagues. She recently ran a half-marathon. "It's just a good way to go and get it all out, my frustration and put it into exercise and running," she said. (Hyosub Shin / Hyosub.Shin@ajc.com)

Credit: HYOSUB SHIN / AJC

Credit: HYOSUB SHIN / AJC

“Still hard”

ICU nurse Kari Ruis is typically assigned to two critically ill patients at a time. But, this day, she’ll be concentrating on one: a middle-aged man facing multi-organ failure.

He’s undergoing continuous renal replacement therapy, a special type of dialysis for unstable patients. The around-the-clock treatment removes waste and fluid from the body.

Days earlier, the otherwise healthy man was at home, weathering what seemed like relatively mild cold-like symptoms. But he took a sharp turn for the worse. By the time he got to the hospital, his condition was already dire.

“We hope he’s going to get better,” said Ruis. “He’s not on a ventilator, so that’s a positive.”

She paused. “Still hard,” she said quietly.

The patient developed a gastrointestinal bleed that required a blood transfusion.

COVID snapshot: a statewide breakdown

5,060 — The number of patients hospitalized for COVID-19 statewide. The pandemic peak was more than 6,000 in September during the delta surge.

29.3% — The percentage of hospitalized patients classified as COVID-19 patients.

87.9% — Inpatient beds in use statewide.

89.3% — ICU beds in use statewide.

77 — The seven-day daily rolling average of confirmed and probable COVID-19 deaths reported in Georgia as of Wednesday, up 157% since Dec. 1

In Northeast Georgia Medical Center Braselton

88 — Number of patients hospitalized for COVID

24 — Total ICU beds in use (18 for COVID-19 patients)

100% — ICU beds in use

Note: The statistics above are based on state data available on Wednesday.

Wearing shiny black clogs and a yellow face mask, she is in and out of his room, all day, checking vital signs that aren’t improving as quickly as she would like.

Ruis is getting to know her patient. He’s awake and alert. He talks about his family, especially his children.

Connecting with COVID-19 patients in the intensive care units is often tinged with sadness.

“I try to get to know things about their family and just talk to them and just find common ground and build that good relationship,” said nurse Jordan Davis. “And in the back of your head, you know that things aren’t looking good.”

In the ICU, problems can mount quickly – cardiovascular issues, blood clots in the lungs, kidney shut-downs.

ExplorePhotos: Inside an ICU during the omicron outbreak

Just as it has been throughout the pandemic, the ICU family waiting room is empty.

Because the virus is so contagious, visiting restrictions remain in place at hospitals, though exceptions are made for end-of-life care.

“It’s really hard for patients to be alone,” said Ruis. “Before the pandemic, they would be able to have families for support. They could lean on us. Now it’s Zoom calls and FaceTime and phone calls, and you hear the family members crying over the phone. It’s really hard to be the one to tell family members you can’t come in, it’s a policy. It’s hard to watch people suffer alone.”

A special calling

For Davis, who is 23, her induction to the nursing profession coincided with the pandemic. When Davis was planning her career, this is not what she expected.

At times, with some patients, “nothing looks good,” she said. Even if they are placed on a ventilator and given supplemental oxygen to help them breathe, “We can’t give them enough oxygen in the world to be able to help them. The ventilator only goes to 100%. That’s all that exists,” she said.

ExploreComplete coverage of COVID-19 in Georgia

She feels a special calling and purpose in nursing. She was inspired to become a nurse by her mother, who has dedicated 35 years to the profession.

She and the rest of the staff take solace in the victories when patients leave ICU to go into regular hospital rooms and are released to go home. She said it’s gratifying, and it’s also proof of “why it’s so important to work as hard as we do.”

And they steel themselves for the cases that won’t end well.

As Ruis’ shift comes to an end, she shakes her head when asked about her patient.

He’s not doing well, she said. He may not make it to her next shift.

Staff writer J. Scott Trubey contributed to this story.