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Preparing for a surge

A nurse at the University of Utah spends a shift getting ready for what may lie ahead.

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Lynn Burke, 25, poses for a selfie during a shift at the University of Utah hospital, where she’s a cardiovascular ICU nurse. She recently worked a shift in the “surge ICU” — an area set up just in case “we do have a big surge, just to help us plan,” she said.

Courtesy of Lynn Burke

SALT LAKE CITY — It’s still bright outside when Lynn Burke arrives for the night shift. She enters through a tent where she stands 6 feet from her co-workers and submits to a temperature check and some wellness questions. Once she’s cleared to go in, she walks past vacant tables and an empty Starbucks. A sign forbids touching the piano that volunteers would normally play to lift spirits, but like everything else at the University of Utah hospital, the piano is clean and sanitized. 

Normally, Lynn would report to the cardiovascular ICU, on the second floor. But today, she’s headed to the fifth floor and a unit she hopes will never be needed. As the number of COVID-19 cases in Utah continues to rise, with a record 641 new cases on June 19, a section of that floor has been converted into a “surge ICU” — overflow for COVID-19 patients in case the hospital is overrun. This week, a handful of COVID-19 patients are here to test out the space and the staff — the hospital’s last front line to combat the virus.

She takes a special elevator designated for the surge unit. In the locker room, on the “clean” side of the floor, she changes into baby blue scrubs. Scrubs usually identify the wearer. Nurses wear black, navy or red pants with white tops. Health care assistants wear all black. Respiratory therapists wear gray tops. But up here, everyone wears baby blues, issued by the hospital and laundered on-site. “People don’t really know who anyone is,” Lynn says.

She had only worked with one COVID-19 patient before, in the medical ICU on the fourth floor. He was hooked up to the extracorporeal membrane oxygenation machine, or ECMO, for 40 days. In his case, it was basically used as an artificial lung. She’s trained to run ECMO, so she and some of her colleagues pitched in.

After placing her phone and other personal items in a plastic bin, she pulls on a battery-powered belt and hood — a device that looks like a space helmet, called a PAPR. The belt blows air into the hood, generating pressure that keeps germs from reaching her face. Her face is also covered with a surgical mask and goggles. And she wears a gown and disposable shoe booties. 

Looking like a surgeon-beekeeper hybrid, she pulls open a heavy door. The surge ICU is pressurized with negative pressure, meaning it lets air flow in but not out. Lynn soon falls into a familiar rhythm, distributing medications and assessing patient conditions and chatting with them — save for the one who’s intubated. But the equipment is different, and when she enters a room and wakes up a patient, the lack of friends and family members is jarring for both parties. Now she’s also doing it in a big white hood.

In her regular unit on the second floor, individual patient rooms —rather than the whole floor — have negative pressure. “So when you come out of the room,” she explains, “you can take off your gear.” But here, she must wear her PAPR at all times. Between the hum of the fan and the air rushing past her face, she has to yell to be heard.

The surge ICU is not comfortable, but it could become essential. “I’m thankful,” Lynn says, “that we haven’t really had to use it yet.”