There has not been one event that illustrates this team's extraordinary care but many events that deserve to be shared and recognized. In early 2021, the unit faced the harsh reality that COVID-19 was here to stay. It included high patient acuity, long hours, extra shifts, and the enormous emotional toll that comes along with caring for COVID-19 patients. With the odds stacked against us, our MCC team has remained cohesive and steeled against daily stressors. We have continued to provide excellent care and work as a unified team through pure determination. We learned to provide clustered but companionate care for our isolated patients early on.

For long hours, we wore full PPE (Personal Protective Equipment), to the dissatisfaction of our faces and ears, but learned to minimize waste by clustering care. The physical exhaustion of wearing an N95, shield, and plastic gown for hours is brutal, but it is nothing compared to the emotional toll. The hardest part of caring for these patients has been the number of deaths we have witnessed. Most often, there were no visitors to the COVID-ICU. So, we became their hand holder, encourager, and reassurer for isolated patients. Our nurses went above and beyond to include families by utilizing FaceTime, Google Duo, and Facebook to give the illusion of time together.

In full PPE, a team leader went to the parking lot and showed a COVID positive spouse how to use Google Duo to see his wife. He was incredibly grateful for the help as he did not have any family nearby. Without his wife at his side, he was alone. He cried when he saw his wife’s face on the phone. Many of these conversations were our patients' last words, and each one of us has a phone call that still haunts us to this day. It has not been unheard of for three or four patients to pass in a shift, and sometimes the unit would run out of body bags. The scars worn by our COVID-ICU team cannot be measured, but this team would not be so strong without each other's support and camaraderie.

In June 2021, our unit developed the process of sending sympathy cards to patients' families. We found that the practice of sending sympathy cards helped team members achieve a sense of closure, particularly when families were not present to bear witness to the death. Each of these incidents demonstrates MCC's ability to work together as a team and deliver exceptional care to our patients and families. Many times, spouses were hospitalized at the same time and required ICU care. A husband and wife were diagnosed with COVID-19. They were managing their symptoms at home with the help of their son for the first week, but the husband was struggling increasingly to breathe so an ambulance was called. The husband was admitted directly to the ICU from the emergency room because he was requiring high levels of oxygen through his nose. He was not able to talk to anyone over the phone because it took too much energy and caused his oxygen saturation to drop. The bedside nurses became his voice. They would update his spouse and his son over the phone and via video chat. Two days into his admission, he required intubation. The wife was admitted to the hospital the following day, but only required a moderate amount of oxygen support on an acute care floor.

Unfortunately, the wife's oxygen requirements increased to the point that she required more care and was transferred to the same ICU as her husband. After a week, the medical providers, the nurse, and the palliative care provider had a face-to-face conversation with the son to let him know that there was a high probability that his father would not survive the admission. The nurse gave a detailed account of the admission, reviewing the highs and lows so that everyone in the room understood what the patient had been through. The son took the information back to his mother, who was still in the ICU, and together they decided that comfort care was the best option for their husband and father. Later that night, the primary nurses for the patient and his wife coordinated with two respiratory therapists to bring the wife into her husband's room to visit him before he was liberated from the ventilator. Both nurses had a three-patient assignment. They asked team members to watch the other patients in their assignment while they focused on the couple. They positioned the beds so that she could hold her husband's hand one more time and look at his face. Their son was also in the room, allowing the family to be together one more time.

Later in the Delta surge, other adjoining rooms were opened to be double occupancy, allowing us to bed spouses next to each other. They drew strength from seeing each other and encouraging each other to get better. Other times, one spouse was in the ICU and the other on an acute care floor. We coordinated visits regularly. A team took a comfort care patient from the ICU to the acute care to spend the last minutes with his COVID positive wife as he passed. Since the beginning of this global pandemic, nurse turnover has been at an all-time high, but if you come to our unit today, you will see many of the same faces that continue to show up, advocate, and provide excellent care to our patients at UTMC. Only a small fraction of the dedicated staff is mentioned in this submission, but every staff member has gone above and beyond for our COVID patients.