Inside Sinai-Grace ‘war zone’: ‘We started to run out of body bags’
Detroit — Medical workers at Detroit Medical Center's Sinai-Grace paint a grim picture of the hospital's emergency department these past weeks as they scrambled to care for coronavirus patients: patients dying in hallways and nurses searching for body bags and places to put the dead.
"Walking into work last Thursday, it was a war zone, there were patients lying everywhere," said Jeff Eichenlaub, a weekend day-shift emergency room nurse for the past six years.
Accounts of conditions inside the for-profit hospital were given to The Detroit News by five nurses and doctors — some of whom requested anonymity after a nurse was fired for posting on social media last month — as their reports suggest Sinai-Grace is among the hardest-hit hospitals by Detroit's surge of COVID-19 patients.
About five patients die from the virus each 12-hour shift, and there aren't always enough body bags or refrigerators to accommodate them, said Eichenlaub of Troy.
"All three coolers are filled, the morgue and the viewing room next to the morgue are full and right now, we're taking bodies to the sleep lab to store them," he said. "We initially had to double bag each patient, but we started to run out of body bags and began scrambling floor-to-floor to find places to take them."
Eichenlaub said workers held a sit-in on April 2 and told administrators "there are only 10 day-shift nurses, and we need more people."
"We’ve been told by the administration that we are replaceable," he said.
The growing number of dead at Sinai-Grace has caught the attention of the federal government. Detroit Medical Center officials had a conference call with the Centers for Disease Control and Prevention last week because of concerns that Sinai-Grace had the highest COVID-19 mortality rates among hospitals in the nation, Dr. Vinay Pallekonda, a DMC chief medical officer, told staff on Wednesday.
Pallekonda attributed the high mortality rates at Sinai-Grace to about 14 nursing homes in the neighborhood and a number of patients with hypertension, heart disease, obesity and diabetes, who are at higher risk for severe coronavirus infections.
Pallekonda declined Thursday to discuss the mortality rates with The News.
Another DMC official reported to be on the call with the CDC also declined to comment Thursday. The CDC did not immediately return an email seeking comment.
Detroit leads Michigan in per capita coronavirus cases and deaths. The city had 6,083 confirmed cases as of Thursday and 272 COVID-19-caused deaths.
And COVID-19 patients have flooded Detroit's emergency rooms — many with serious complications and underlying health conditions such as hypertension, diabetes, heart disease and obesity that put them at greater risk of getting severe coronavirus symptoms and dying.
A DMC representative didn't directly comment on the conditions at Sinai-Grace but did issue a statement Thursday.
“Our top priority is the safety of our patients and our staff," spokesman Brian Taylor said. "Out of respect for the privacy of patients and their family members, we don’t provide any details regarding the care of any particular patient."
The crush of patients seems to be causing special duress at Sinai-Grace, a teaching hospital that opened in 1953 and traditionally handles indigent patients. The hospital is the only one in northwest Detroit and happens to have the highest amount of EMS traffic, Taylor said.
"Among the patient population served by Sinai-Grace, there are extremely high rates of underlying medical conditions such as hypertension and diabetes, which puts people at higher risk for COVID-19," he said.
"In addition, there are a large number of nursing homes in the area surrounding the hospital. The spread of respiratory illness and COVID-19 among that population places even more pressure on hospital resources as those patients are sicker and in many cases require ICU level of care."
Seniors line hallways
On a normal day, the emergency department receives patients with complaints that range from "zero to 100," from a trivial complication to a gunshot wound to a brain bleed, a doctor said. But COVID-19 turned that situation on its head.
"We’re hardly getting any patients who are zero to 50," said one hospital doctor, who requested anonymity. "Right now, patients are all 80 to 100. They’re all very, very sick.”
Many of those lining the hallways are seniors from the surrounding nursing homes, according to the health care workers. When medical personnel realizes there's nothing that can be done to improve their lives, they call families to get permission for a do-not-resuscitate order, they said.
"The 'non-breathers' sitting in the hallway are a lot of our DNRs dying by themselves, and there are times where it’s so busy we don’t have time to even call families to inform them they've passed," Eichenlaub said. "Their families would call two days later and we'd have to say 'let me find a physician for you.'
"It’s disheartening because you can almost see someone and know they're going to die. Then have to tell a family member 'I know they were completely fine when they came in, but now they’re dead because the virus is so rampant.'"
Communicating with families over the phone is "unbelievably difficult," but the doctor said any suggestion that families were being pressured into do-not-resuscitate orders was "absolutely, unequivocally untrue."
The doctor described Saturday in particular as "chaos" but said conditions have since improved.
"I marvel at the ingenuity of how the nurses were able to keep track of the patients," the doctor said. "I guess that's the Sinai-Grace way. With little resources, they always find ways to make it work."
Eichenlaub, who has been an emergency room nurse for 15 years, said he expected an internal disaster order to be declared so leaders could come in, help move patients around and organize logistics. It never happened — perhaps because the unit does not have a program director, he said.
"It’s almost like a military hospital, people are gasping for their last breath, and you just move on taking care of someone else who is deemed more critical," he said.
Conditions take toll on workers
While it's important to highlight what's happening in Detroit emergency rooms, the physician expressed fear about the toll the conditions during the pandemic take on personnel.
"The people that work there don’t have to work there," the doctor said. "We choose to work there because we love the community we serve. These stories that are coming out hurt the morale of the people who have to go into work today, tomorrow, a week from now.”
A group of night-shift emergency room nurses and attendants were told to leave Sinai-Grace late Sunday night after they staged a sit-in to demand more support to treat a surge of COVID-19 patients.
Sal Hadwan, an emergency room attendant who was asked to leave, told The News the department has been getting 110 to 120 coronavirus patients daily for the past three weeks. He said staffing levels are inadequate.
"They need oxygen, ventilators and multiple medications drips just to keep them alive and stable," said Hadwan, a DMC nurse three years. "It’s unsafe for patients to have one nurse tending to 25 or more patients. It's unrealistic and dangerous to try to keep up."
After calls from his manager to hospital administration, Hadwan and the nurses returned to work and never wanted to leave, he said.
"All we want to do is care for our patients. People are dying who honestly shouldn’t be in those situations if only we had enough nurses to help," Hadwan said.
Nurses have been holding sit-ins for the past two months without a union.
After the sit-ins, administrators assured nurses they would no longer accept ambulance traffic and help was on its way, Eichenlaub said.
"They told us the people who control EMS denied our request, and we didn’t receive help for another eight hours, even with multiple patients in the hallways, no one could come," he said. "Nurses from Children's are coming to help. No physicians are available, and they page in-house doctors who are just as busy as we are."
The health care workers try to put the situation in perspective since Sinai-Grace has always handled difficult cases.
"Sinai-Grace was never an easy place to work," Eichenlaub said. "This is heightened during the pandemic and when the entire night shift walked out, which the day-shift nurses supported, we were forced to stay on for 24 hours. I'm sure we all went home and started sending out our resumes."
The eight-hospital system is contracting with staffing agencies, reaching out to nearly graduated nursing students and using other resources to assist with care, DMC's Taylor said. The hospital system would not provide details on deaths or nurse staffing.
The TCF Center in Detroit has been retrofitted to handle mild-symptom COVID-19 patients and will start accepting some of those patients from Detroit area hospitals on Friday.
Dealing with death
Nurses said severe patients typically have flu-like symptoms and can progress to bilateral pneumonia. In some cases, respiratory failure can then develop within six hours, and patients are typically intubated. Some die within 12 hours, nurses said.
Health care workers are administering Plaquenil, the brand name of hydroxychloroquine, along with antibiotics to every patient they can. President Donald Trump has touted hydroxychloroquine as a potential treatment and has reduced barriers to ensure greater supplies of it reach Metro Detroit.
The Detroit-based Henry Ford Health System is doing the first large-scale clinical trial of the anti-malaria drug on 3,000 volunteers to find out if it can treat COVID-19.
Despite optimism about certain treatments, nurses such as Aimee DeLine, a fill-in DMC nurse at Sinai-Grace, said they still have seen too many deaths.
On the night of March 31, DeLine said six patients died in the first eight hours of her 12-hour shift, three of whom she was caring for.
"Two of the three, I had just gone into their rooms, took vitals, they were good, nothing about their vital signs gave me the impression that they were about to crash," she said. "One patient had even thrown their shoe at the closed glass door to get our attention."
The patient, who denied having any pain and was just waiting for a bed, wanted to make sure the oxygen mask was on correctly and dropped the call light on the floor, DeLine said. She took their vitals and went on to help others.
"Less than 30 minutes later, the monitor started alarming," DeLine said. "I along with another RN and the (respiratory therapist) ran into the room. ... The doctor arrived a few seconds later. ... This patient had coded, and there was nothing we could do to bring this person back to life."
With the emergency room overcrowded with patients, she said she and other nurses in the intensive care unit had between six to nine patients at a time, most of them on ventilators.
"As soon as one patient either got admitted and went upstairs or expired, EVS was in there cleaning, and within 15 minutes, a new patient would come rolling in, sicker than the patient before them," she said.
"My heart aches for patients and their families calling to check on them ... only to call them back a couple hours later (or less) and tell them that their family member has died. The worst part is not being able to give them a reason as to what happened, and why so quickly."
A traveling nurse at Sinai-Grace told The News since she started her contract in February, the emergency rooms were at maximum capacity with some patients in stretchers and others in chairs who aren't readily visible — which is not a common practice.
"Last week," the nurse said, "I did witness one patient who had expired that was on a stretcher bed in the hallway next to someone in a chair."