Physical therapist Piper Daulton

Physical therapist Piper Daulton normally works in the Trauma and Surgical ICU providing physical therapy to people who’ve had car accidents or received spinal surgery. Last April, she volunteered to work in the ICU COVID unit for the Prone Team at Banner – University Medical Center Phoenix.

The Prone Team, a hodgepodge of different disciplines, including nurses, physical therapists, occupational therapists, and techs, came together to work specifically in the COVID ICU to turn patients onto their stomachs in order for them to breathe better, said Daulton. She explains how they would turn intubated patients onto their stomachs for eight hours then every two hours would turn their head and arms to prevent pressure sores. 

She worked around 64 hours a week in packed ICU COVID units at the height of the pandemic, when resources and labor were scarce. 

“At the time no hospital had the proper amount of PPE, but now we do and now we’re ready for if something were to happen again,” said Daulton.  “But I definitely think that, in retrospect, everything was done that could have been possibly done for us.”

Daulton was one of many health care professionals who pivoted to battling COVID when the outbreak hit Arizona, finding themselves in unexpected roles as COVID patients filled general ward rooms and ICU beds. Arizona twice became a global hot spot in 2020, pushing the healthcare system to the limit.

Daulton worked as part of the Prone Team until the end of July last year when the numbers of patients in the ICU that needed to be prone declined; however, she volunteered again in December, following the second wave of COVID-19. 

Unlike other physical therapist colleagues, Daulton is a young, healthy 28 year old, with no children, and no comorbidities (which would make it more likely for someone to be severely ill from COVID-19), so she felt she could volunteer to work in the COVID Unit. 

“Not to say by any means, had I contracted COVID it wouldn’t affect me or I wouldn’t have lasting effects from it. Not at all, but it was just something, kind of a risk that I took, because I wanted to help these patients,” said Daulton. 

She remembers a particular COVID patient, a “younger gentleman,” who passed away while on his stomach. His wife was able to arrive in time to say her last goodbyes, then they had to flip him onto his back when he was deceased. 

“I’ll never forget that. It’s something that I’m happy that I was able to do, just to kind of put life into perspective, and to be with that gentleman and his last moments and for that family, but definitely that’s kind of weighed heavy on me. It’s hard to talk about. It’s hard to think about,” said Daulton. “No amount of schooling can prepare anybody for what us healthcare workers have gone through over the last year and a half.”

On the morning of July 2, while taking a report from the night shift Prone Team, Daulton’s father said her grandmother unexpectedly passed away from complications of leukemia alone in her home in Indiana. The previous month, the doctor had confirmed her grandmother had leukemia. 

“I talked to her so many times almost daily throughout this whole pandemic and she was just so happy and proud that I was doing what I was doing for these patients,” said Daulton. 

She recalls her grandmother reposting her Facebook post and said she would tell people, “It’s real. Phoenix is getting hit so hard. Just trust and know that this is no conspiracy. My granddaughter’s battling this in Phoenix.”

Daulton wears a silver necklace with angel wings, a birthday gift her grandmother gave her. The necklace helped her get through last year.

“Since July 2 I’ve had it on, and it just gives me some hope and peace knowing that she’s proud of me,” said Daulton. “She was a woman of faith and integrity and of science. She couldn’t wait to get the vaccine.”

As of February, Daulton has returned to treating her regular patients, as the hospital reopened elective surgeries and as people feel more comfortable. 

“I don’t want to say some sense of normalcy because I feel like right when I say that, something could happen, but we’re just so thankful that the vaccine is rolled out in Arizona,” said Daulton. 

Daulton hopes people will get vaccinated, and said she convinced her 70-year-old neighbors as well. 

She told them, “‘I can guarantee you, you will want to get this vaccine, as opposed to me having to turn you over onto your belly in the ICU,’ and that kind of resonated with them. I was like please get it. If not for me, get it for your daughter, get it for your 3-year-old grandson that you watch every week.”

Daulton hopes people will be able to put politics aside to come together and “listen to the doctors, listen to the science, get your vaccine and stay healthy.”

Phillip Bullington, 31, a doctoral student in the UA’s Nurse Anesthesia program, worked as a nurse prior to beginning his doctoral project and has experience dealing with people who are severely ill, but what he experienced as a student registered nurse anesthetist in the ICU during the pandemic was beyond his expectations. 

“We never really expected the way everything happened and then it just got crazy,” recalled Bullington. “Where there’s people on ventilators just taking up all the ICUs. We’re turning other floors into ICUs and we’re running out of places for patients to go. And then they would get sick, but they were healthy enough that they would still live for a while, but they weren’t getting better. So just a pile of people who would get more sick and there was nowhere for them to go.” 

They would receive weekly alerts about the availability of ICU beds, the amount of supplies, and what they had done, said Kristie Hoch, program administrator of the Nurse Anesthesia Specialty at the UA College of Nursing. While she says things are better now, they were on high alert for a while without enough beds or ventilators. 

For around 150 years, certified registered nurse anesthetists (CRNAs) have been ensuring the comfort of their patients, normally preparing patients for anesthesia before surgical procedures, said Hoch.

“We ensure patients are safe and comfortable during their anesthesia and this piece for us is part of ensuring our community is safe,” said Hoch, referring to vaccinations as part of that work. 

Since the onset of the pandemic, CRNAs have found themselves outside of the operating room. 

“We’ve been called to take care of patients who are acutely and chronically ill with COVID,” said Clinical Assistant Professor at the College of Nursing Charles Elam, who said he along with his partner were consulted to manage acutely ill COVID patients in Green Valley. They were tasked to install central lines, big IVs that go into the neck or chest, or arterial lines that go into the artery as well as managing ventilators and sedation for patients.

“This was above and beyond what we typically do, but because we are airway experts we were called upon and stepped up to do what we needed to do,” said Hoch. 

She commends her students who completed their clinicals working in the COVID ICU wards, despite their heightened stress levels. 

“Here they are, a year and two years into their nurse anesthesiology residency, and wondering well what happens if I get sick? 

What happens to my family?” said Hoch. “I’d have students calling me frequently throughout the week, crying and scared because they had just lost another patient. And trying to help them and trying to get to the point where I’m telling them, ‘It’s going to be okay.’ when I wasn’t so sure myself.”

Hoch expects ICU nurses especially, who were working sometimes 12-hour shifts for 30 consecutive days to experience some PTSD. 

“They didn’t really take time to cope with it. At that point, they’re just going through doing what they can to save lives,” said Hoch. 

To help students cope during the pandemic, Hoch held weekly meetings to check in, but as the number of ICU beds became increasingly available, they are currently holding one monthly meeting since October. As the Regional Director for the American Association of Nurse Anesthetists, Hoch would also host zoom meetings with nurse anesthetists across 13 states to share how they were, how to help them cope, and what they were feeling.

“Many of them were being furloughed, because there were no surgeries going on. Many critical access hospitals had turned everything into ICU beds and so ‘adapt, improvise and overcome.’ That was the phrase that many of us were using throughout the first few months of the pandemic,” Hoch said. 

Like Daulton, Bullington is cautious about the future and thinks the situation could return to how it was during the height of the pandemic. 

“It could always still go back the way it was,” said Bullington. “With the new variants, I don’t think there’s any reason that it’s completely over.”

He said it’s important for people to remember “just how bad COVID really is and how severe it can get, and you never know who it’s gonna be worse for.”

For Bullington, getting vaccinated is the “safest course of action.”

“It’s not a live virus, you can’t get the virus from it. So it’s better to be safe to be vaccinated than to take the risk of getting it or giving it to your family or your grandparents or your kids,” Bullington said.

Bullington volunteered to assist with vaccinations at a clinic run by the UA College of Nursing faculty. Led by Hoch, volunteer CRNAs and student registered nurse anesthetists administered vaccines to people at the drive-thru. 

Hoch said the event not only serves the community, but also honors the memory of her family members who passed away due to COVID-19.

“My father-in-law and brother-in-law both passed away due to COVID-19 at the beginning of this year. To me, playing a role in the vaccine rollout is my way of honoring their memory and ensuring others do not suffer their fate,” said Hoch. “It’s heartwarming to see my students joining the effort. As ICU practicing nurses, they’ve seen the effects of COVID from the frontlines, and share my passion for putting an end to the pandemic.”