Kristen Nemoto Jay
Some of O‘ahu’s health professionals sat down (via Zoom) with The Hawai‘i Herald and shared what this pandemic has been like for them this past year and a half and what they hope will happen in the near future.
It’s an understatement to say this past year and a half has been unlike many have ever experienced. No matter who you are, the COVID-19 pandemic has affected your life in one way or the other. It’s currently killed 4.5 million people worldwide, including over 700,000 Americans and 842 people from Hawai‘i. Those of us still here are left with the sudden shock, grief and memories that had been made with those who perished not too long ago. That’s how vast this virus has spread. So swift, almost unbearably swift. As if everyone was quickly spun around in a circle and then left to figure out how to immediately walk straight thereafter. Only to find the life that was there before the spinning no longer exists. It’s gone. And the ones who are left can only describe what has happened in their own dizzying version of events.
The following collection of stories comes from those who’ve seen the pandemic up close and continue to see it on a daily basis. They are our healthcare workers whose job it is to help, save, revive and — many of times — say goodbye to our loved ones. Their struggle this past year and a half has not been easy and yet they continue to show up because they feel it is their calling. Although their recollections are just a handful of 59 million healthcare workers around the world, it’s important as a community to try to understand the weight that’s been left on their shoulders. For in order to move forward, there must be a collective of what we all can do to help fight and ultimately win against this virus. Our healthcare workers cannot do it alone and yet that’s what it’s felt like for all of them. That despite the hashtag shout outs of being real life #superheroes, they’re mere mortals with families, and the same worries and heartaches as the rest of us. These are their stories.
In February 2020, Dr. Young Soo Rho was in Los Angeles with his wife celebrating her 34th birthday when they discussed how far-fetched it seemed that the COVID-19 pandemic would make its way over to the United States. Even as health professionals at The Queen’s Medical Center — Dr. Rho, a hospitalist, and his wife, a cardiology fellow — the thought of a worldwide pandemic seemed like a nearly improbable factor to them.
“We were in Hollywood surrounded by people,” recalled Dr. Rho. “I remember thinking ‘this would never come here.’”
Soon after their trip, the new graduate of University of Hawai‘i at Mānoa’s internal medicine program, whose specialty was to train as an oncologist, was supposed to attend a medical oncology class at the National Institutes of Health in Bethesda, Maryland. When news of the COVID-19 pandemic started to ramp up red flags worldwide, and in Hawai‘i, Dr. Rho’s plans to travel were quickly nixed then veered to help the Department of Health with research on the handful of cases that arrived on O‘ahu.
A few months prior, Daniel Ross, a registered nurse at Queen’s and president of the Hawai‘i Nurses Association, was already beginning to worry. Like the rest of the world, he had seen news reports about the then known novel coronavirus spreading slowly but aggressively through parts of China. Unlike many who dismissed the idea of the pandemic taking over the states, let alone Hawai‘i, Ross knew it was only a matter of time.
“I wrote a letter in late January to all our major hospitals in Hawai‘i asking them what they were going to do to prepare for this virus,” said Ross. “Sadly, I was ignored by every single hospital.” Ross states it wasn’t until cases started to rapidly rise in Hawai‘i when communications with him started to take place. By then, Ross said, it was too late.
“I had to fight to get enough personal protective equipment for my nurses … nurses had to reuse surgical masks … there were a lot of missteps early on so it was very frustrating.”
Janice Nakatani-Cuyno, a self-proclaimed “realist” and registered nurse in Queens’ trauma department, also knew early on in the year that COVID-19 would be a problem. She started to shut down her own social engagements once she heard about the crisis of cases in Italy and New York.
“I remember my kid got sick after this pool party we went to [in February 2020] and I was in a moral crisis from then on,” said Nakatani-Cuyno, a wife and mother of two. “I then started to wonder if we had it, if were asymptomatic, and if we spread it somewhere. There was just so much fear.”
Fear of the unknown is what crippled many hospital responses in general, not just in Hawai‘i. Dr. Rho, who is among the younger resident doctors on Queens’ COVID-19 unit floor, said other seasoned doctors described dealing with their first COVID-19 patients as they once did with their first HIV or AIDS patients 30 years ago. “We just didn’t know what the patients were like,” he said. “We didn’t know what to expect and we had very little things to treat them with.”
Kelly Johnson, who began her role as Queens’ chief nursing officer last November, was at Stanford Children’s Health at the time of the pandemic outbreak when she was researching and preparing how the virus would affect children. When dire cases started to report that more elderly or adults with chronic health problems were at risk, she and her team, and the leadership at UCSF, sent several groups of nurses and physicians to New York to help with the overflow of cases. What she saw when the nurses returned were defeated bodies and broken spirits.
“They were traumatized when they came back,” said Johnson. “The description of all the death and just the feeling of helplessness and hopelessness … people dying alone without visitors. It was the most horrible lived experience for them.”
Serena Okita, an intensive care unit nurse at Queen’s, said it has been and continues to be a stressful situation for her and her family of five.
“I have three kids ages 2, 6 and 17 years old,” said Okita. “I didn’t know if we were going to end up getting [COVID-19] from work and bringing it home to our families. It was definitely stressful.” More so, said Okita, was trying to figure out the best way to treat the patients and then have to change the workflow accordingly. “It was frightening because no one knew anything about it. No one could help us. It was scary.”
When Nakatani-Cuyno described what it was like during the first surge of the virus on O‘ahu, all she could remember is that it was the worst days of her 16-year nursing career.
“I had almost two admissions in four hours and for us that’s fast,” she said. She further describes when she had to help her co-worker hold the door of a COVID-19 patient’s room because they were trying to escape in the middle of admission. “I thought ‘Is this what is between the safety of the public?’ Myself and my co-worker holding this patient’s door? It was nuts. Absolutely nuts.”
She also recalls it was the rapid rate that infected people were coming in to the hospital that caused her to pause and turn to her colleagues for help, only they were equally confused and panicked. “We were all just sort of looking at each other like this is absolutely insane.”
The added factor to the insanity of infectious persons entering the hospital — of a virus that was still unheard of at the time — was that there was literally not enough time to do anything. Nakatani-Cuyno said she was getting flooded by so many COVID-19 patients that she didn’t have time to do her normal pre- and post-assessment of each patient. A recipe for “a logistical nightmare.”
“I was just in survivor mode at that time,” she said, as she also remembers feeling rushed to put on and take off her PPE, a method that, if done incorrectly, could immediately cause infection. “You do your job because you have to do it but man that kind of nursing was not what I signed up for. I signed up to be a healer but it didn’t allow me to do the kind of care that I can go home and feel good about doing.”
In general, Dr. Rho understood the scope of care that he would have to tend to as a health worker. Phone calls to family members about the passing of their loved ones or researching terminal cancer in adolescents — his original training in internal medicine — doesn’t get easier. What’s different with COVID-19 that many don’t understand, said Dr. Rho, is the extreme isolation that comes with the virus. If there is another person in the room with a COVID-19 patient, it’s either a masked and gowned up health professional or, in some cases, another COVID-19 patient due to the lack of space in the hospital. When the surge hit, the chaos that consumed most of Dr. Rho’s COVID-19 patients’ rooms became all too familiar but never easier. Flashbacks that Dr. Rho still sees are of him and his team of nurses, the anesthesiologist, the intensivist, all huddled in a negative pressure room, tending to a patient who’s lying on their stomach — a technique that’s used to take the weight off of a patient’s lungs. While barely able to talk, and about to be connected for ventilatory support, the patient is vulnerable, scared and mostly at will to the virus’ next stage of infection. What happens next for Dr. Rho is the worst part of his job: seeing his patient’s say goodbye to their loved ones through a phone screen.
“I can still hear families crying,” said Dr. Rho. “While there’s all this commotion of getting things ready to get them on a ventilator … [my patient] asks me, ‘Am I going to survive this?’ … A lot of them don’t make it. They have these lines in their arteries to measure blood pressure … feeding tubes going in them. I think if you saw something like that happening, no matter who you are, you would not want to be in that situation. That’s something that’s really graphic that nobody talks about.”
Stories of loved ones having to prematurely say goodbye to their family member has been the most devastating part for many frontline workers. When the nurses union was in their contract negotiations this year, and some nurses voiced stories that they had to endure while working with COVID-19 patients, Ross still can’t get used to the fact that each story he heard is just one of many cases in Hawai‘i.
“One nurse talked to me about when she had to perform CPR on a patient who was a father of three,” said Ross as he looks away with tears in his eyes. “It’s just doing that day in and day out … You’re just supporting and helping them to try and survive through it, it’s not like you’re curing them. We’re trying to help people but it’s limited what you can do.”
Even now with treatments such as steroids or antivirals, the side effects can cause more complications. For many health workers, it’s therefore a gamble and waiting game on what works and doesn’t work to help their patients pull through.
Unfortunately, Okita is used to seeing the worst cases of COVID-19 patients in the ICU. By the time she sees them, they’re intubated, sedated, unable to talk, and very few recover. What has been especially troubling for her is having to also treat some of the patient’s underlying health conditions that coincide with their COVID-19 symptoms. It’s a constant balancing act of assessment and treatment, and being able to change the course of action in a second.
“It was every single day,” said Okita. “That’s just all I’d see are [COVID-19] patients. It’s exhausting. It still is.”
Prior to the pandemic, Okita looked forward to going to work. Today, she says she’s never felt so stressed out or dreaded work so much. “I don’t know how much longer I can do this. That’s just honestly how I feel. I think a lot of us are over it.”
Despite the constant and steep trajectory of reported COVID-19 cases on island, and healthcare workers striving endlessly to provide optimal care, much to everyone’s surprise, a growing collection of people were denying the virus’ validity. While COVID-19 patients spilled into hospital parking lots, many were still in denial, still gathering by the dozens at the beach or socializing maskless in large crowds. When Hawai‘i’s Department of Health expanded the COVID-19 vaccine eligibility for O‘ahu residents aged 16 years or older this past April 19, again, there was resistance and growing mistrust in the care that doctors and nurses were providing for their patients.
“I’m learning so much about generational trauma especially within the Native Hawaiian community and the overall pushback that some may have towards the government,” said Johnson. “However, I do not understand why people are combative and flagrantly putting other people at risk.”
She respects everyone’s choices on what works best for themselves regarding virus protection. It’s when folks share a common space is when she asks for everyone to be more aware that their actions will have an impact on others.
“We know this virus is highly contagious so therefore when we’re gathered up in a group, it’s probable that it will spread,” said Johnson, who’s reported an uptick in workplace violence — especially among visitors who refuse to comply with the state’s mask mandates — which includes both physical and verbal abuse towards her staff members at Queen’s. “I have very little tolerance for people being just flat-out rude to the point of violence, especially when it involves nurses that are bedside, working and sacrificing.”
Dr. Rho, who often corresponds with his medical peers on the mainland, says cases of combative and argumentative COVID-19 patients — and sometimes their family’s — who mistrust their care in the hospital are much lower in Hawai‘i compared to other states but still doesn’t care for the confrontation when it arises.
“It’s good to ask questions and learn more about what treatments they’re getting when they are admitted into the hospital,” said Dr. Rho. “But do realize that all of us that care for a COVID-19 patient have genuine intentions in helping.”
Dr. Rho states his care is no different than what he would provide his own mother — who had contracted COVID-19 last December. He’s especially disheartened when someone doesn’t trust his intentions. “I’m just more sad than anything. There’s a lot of emotions but ultimately, it’s just ‘how can I convince you that I am trying my best,’ right? All of us here. We wouldn’t do anything different for our loved ones. I just don’t know how to convey that more.”
Included in the struggle and pushback from the public is the overwhelming amount of information that’s found online. Johnson advises many to turn off the noise by listening to their healthcare providers and understanding that they too are learning and adapting as quickly as the virus changes and mutates.
“There’s still so much more to learn about this virus,” she said. “It doesn’t mean there were false beliefs about anything we’ve said in the past. It means that we’re advancing our knowledge with the virus. The virus itself is mutating and changing and therefore we have to change our way of approach each time it does. We have to make the best with the given amount of information that we have at that moment in time.”
Not included in Dr. Rho’s 12-hour shift, seven days a week, is the amount of research that he and his colleagues do on the side, which for him happens in bed before he sleeps and as soon as he wakes up for work. “We read the newest articles every day,” he said. “We look at different trials and drug utilizations all because we want to offer the best and the newest care treatments. But we cannot give that treatment without the trust that we’re doing our best. Being accusatory or thinking that I’m not delivering care is not helping anybody.”
According to Okita, her experience with COVID-19 deniers is that many of them do not know what hospitalization looks like. She believes if more people saw what she saw every day, there would be more caution and consideration of virus prevention. Her fear of the public seeing daily updates of COVID-19 case counts is that people will become normalized when they see a slight dip in hospitalization numbers or, worse yet, deaths.
“To be hospitalized as a patient is most definitely not a normal thing,” said Okita. “That means you’re sick and you’re requiring medical care in a hospital that you cannot receive elsewhere. I think people don’t take it seriously because they don’t know what that looks like. So I think those numbers really don’t mean anything to them for those who are not in healthcare.”
Like many healthcare workers who are tired and frustrated with the public’s denial in COVID-19’s lethal force, Nakatani-Cuyno’s struggle this past year and a half has been to find balance and separation from what she does for a living and her personal life.
“It’s hard because you’re in the middle of a pandemic and yet you want to take time off because you’re so burned out,” said Nakatani-Cuyno as she wipes away tears from her eyes. She didn’t take bereavement even when her mother passed away this past August 24, in fear that her colleagues would suffer with the load of COVID-19 patients that still needed care in their unit. “I saw how hard my team was working. That was my own choice but it’s been so hard for us, you know?” It wasn’t until she got sick — not from COVID-19 — when Nakatani-Cuyno didn’t feel bad about staying away for a couple of weeks to get better, mostly because it was their new work policy. Though current case numbers are slowly going down, Nakatani-Cuyno finds herself struggling to have compassion with some patients who did not attempt to exercise virus prevention such as mask wearing, vaccination, or social distancing.
“I’m not going to lie, I still get super mad,” laughs Nakatani-Cuyno. “When they were coming in so fast, I could not keep up with that compassion. I couldn’t. I struggle for it every day that I live but I also can give myself a break because I’m no saint. I’m only human.”
The importance of virus prevention still remains the same. Handwashing, quarantining while sick, social distancing, mask wearing and vaccinations have all proven to be the winning solution in curbing the spread of the COVID-19 pandemic. When prevention is consistently practiced, healthcare workers will be able to treat their patients efficiently and hospitals will not have to turn away those who are in need of any type of medical care. It’s a concept that seems simple and straightforward but was not the case prior for the state of Hawai‘i.
Ross, who is vaccinated, sympathizes with the public’s hesitancy in getting vaccinated and personally does not agree with vaccine mandates. However, he says, given the choice and option to get vaccinated, he would encourage many others to do the same.
“Every person needs to do what’s best for themselves, yes, but they also need to take into account of other people’s safety,” said Ross, who does not understand the vitriol of anti-maskers. “There’s a line between freedom and responsibility. In your own home, don’t wear a mask and do whatever you want. But when you’re out in public, you do a service to everyone around you. Responsibility can trump your personal freedoms when you’re in a public space.”
“I think people forget that we live in a society,” said Dr. Rho. “We are not individuals. We all live together. We all need to take some onus of what’s happening here.”
Dr. Rho says part of the solution therefore means vaccination or not getting in large groups when numbers start to climb. Whatever the prevention method, Dr. Rho says it’s each of our responsibility to keep the cases from skyrocketing and help hospitals from overflowing.
“Statistically speaking, yes, your hospitalization chances and death is ultimately low but what people don’t realize is the big picture. We’re still seeing a gigantic number of patients coming in to the hospital. Being cognizant by actively practicing prevention can help the situation.”
When the community rallies together to help, it makes all the difference and the reason why Johnson says she specifically moved to O‘ahu. Last summer, she, her husband, and two grown sons decided to move from California to O‘ahu after discussing their options and goals during the height of the nation’s social unrest and pandemic shutdown. As a family of educators and health professionals, they wanted to find ways that they could be of most service within a community. Johnson’s oldest son’s experience on O‘ahu prior was enough to convince the entire clan to plant their family roots in the Gathering State. She wanted to instill the teachings of love and the “aloha spirit” with her family, especially her three grandchildren. Compared to mainland hospitals, as she’s still in contact with other pediatric hospitals for updates and sources, Hawai‘i continues to be the embodiment of what she’d like other states to emulate in terms of understanding virus prevention and consideration towards others.
It’s still a struggle, she admits, after seeing a protest and anti-protest in Waikīkī during a recent staycation with her family, but she’s hopeful for the community to step up and understand that it’s the virus we’re all fighting against and not each other.
“This virus has put so many things into perspective around family and friends for me,” said Johnson. “I had high school classmates who died from COVID-19 … people can be gone in a second. It’s important that we look for the good in people. That we all have our best intentions.”
“It’s like the whole world has tripped and we’re trying to help everybody up,” said Nakatani-Cuyno. “We’re all struggling and lashing out to each other and that’s what makes it so tragic.”
Prior to the pandemic, part of Nakatani-Cuyno’s social routine was hosting a book club, which she hopes to get started again with her girlfriends. The book that she’d like to cover is “What Happened to You?” by Oprah Winfrey and Dr. Bruce D. Perry, which befittingly covers the effects of trauma and how a community can help support or hinder one’s recovery. If there are any life lessons to be learned from this pandemic, Nakatani-Cuyno says it should be to understand that everyone’s been through trauma, not just on her unit floor, this past year and a half. That we all need to be there for each other and stop before we react.
“Let’s learn that otherwise, what is this all for?” she said. “The next thing may not be COVID-19, it may be something else that divides us and then make life not worth living.”
Ross agrees that there needs to be a sense of wholeness in order to move forward in a world that’s been forever tainted by COVID-19. Though the virus will not go away, there are ways to overcome it by each person taking ownership in both their individual and social responsibilities. It’s not up to the health professionals, he says. Their work is already full.
“Unionism is about working for the good of the majority,” said Ross. “That’s what democracy is about. To be a part of society if we want the society to be worth living in. Nurses are already burned out. [They] don’t want to be called heroes. They want to be supported and enabled to do their jobs in a safe way.”
In current time, since the write up of this article, the number of COVID-19 deaths in the United States has progressed to 721,541. That’s nearly three quarters of O‘ahu’s population. What’s worse than healthcare workers seeing patients die from a virus that could have been prevented is the public’s dismissal of death and despair that they’ve seen and continue to see on a daily basis. That the last patient they tried to save would mean something for the public to take notice. Instead, they’re met with disdain and called fear mongers. How many more deaths will it take? Though Hawai‘i’s numbers are relatively lower in comparison with the mainland, our healthcare workers want to prevent social workers from having to place their deceased patient’s kids into foster homes. They want to be able to tell more family members that their loved ones have recovered and can go home. They want the public to understand that we each have the power to steer the direction of the pandemic. What more each of us can do is already known. It’s up to us to act as individuals, but, more importantly, individuals who know they are part of the complete solution.
The views and opinions expressed are those of the individuals in this article. They do not reflect the official policy or position of Queen’s Medical Center or The Hawai‘i Herald. Any content provided by the interviewees of this article are of their opinion and are not intended to malign any group, club, organization, company or individual.