Dark Days and Long Nights – On the Job with Stony Brook Nurses
It was 1979 and Carolyn Santora had just started her career as a nurse in New York City when she came across an advertisement in a nursing journal: “Once in a lifetime,” the ad read. “A university hospital opens!”
She loved her big-city lifestyle, but the ad called to her. The opportunity to help open Stony Brook Hospital was one she couldn’t pass up. When the $150 million, 504-bed hospital admitted its first two patients on Feb. 18, 1980, Carolyn Santora was there – one of 800 employees who joined up during that year-long hiring blitz.
Now, more than four decades later, Santora is the chief nursing officer (CNO) at the hospital. “I’ve been here from the beginning, I’ve watched the growth,” she said.
Indeed. Stony Brook University Hospital now employs more than 7,000 people and was recently named one of America’s 100 Best Hospitals by Healthgrades – a Denver-based company that rates physicians and hospitals – for the third consecutive year. Santora oversees a staff of 1,600 nurses and is responsible for all day-to-day nursing care.
“But never in all of my years of nursing,” she continued, “did I ever imagine what this last year was going to be like.”
It was the year of the coronavirus.
As COVID-19 held much of the world in its grip, nurses stood on the front lines, shouldering the responsibility of treating hospitalized patients while risking their own health and safety and that of their families. According to the Centers for Disease Control and Prevention’s (CDC) frequently updated COVID data tracker, there have been more than 554,000 confirmed cases of the coronavirus among health care personnel nationwide and at least 1,759 deaths.
“In the beginning, everyone was scared. We were scared for ourselves, we were scared for our families,” Santora said. She explained that some nurses chose to move into their basements at home. Others moved into guest houses or guest rooms, all for the sake of protecting their families from the virus they were exposed to at work every day. “It was their mission. It was their passion to take care of these patients.”
Some nurses who lived on their own faced the mental stress of distancing themselves from their families during the holidays. Samantha Gross was a nurse who originally worked at Stony Brook Medicine’s Cancer Center, but was redeployed during the pandemic to the COVID unit. Since the start of the outbreak last year until this spring, she wasn’t able to visit her parents in New Jersey.
“If you’re going in and out of COVID rooms, you’re not going to go hug your mom and then kill her. That wasn’t going to happen,” she said, shaking her head as she fixed her bright pink eyeglasses over the bridge of her nose.
But having seen so many people die alone at the hospital without their loved ones by their sides, she was grateful that her parents were safe and alive. “My parents got vaccinated, so I just went home last weekend and gave my mom our first hug in thirteen months,” she said in April. “It was just insane. There’s something so normal, it feels so normal, but you also understand its been so long.”
There have been more than 1,400 positive cases among Stony Brook Medicine employees since the start of the pandemic, according to the university’s COVID-19 dashboard. This number includes hospital employees, clinical providers, and related health care support staff.
Kristie Golden, the hospital’s associate director of operations, explained some of the efforts taken to ensure the safety of both health care personnel and patients. “Various means of communicating with patients and staff were put in place using technology, telephone consultations, video conferencing and telehealth. In addition, we had recently opened up the new Pavilion, which gave us some much needed space within the hospital towers to spread out patients into single rooms.”
The first months of the pandemic were filled with more unknowns than knowns. The CDC and the World Health Organization (WHO) were constantly updating their websites with incoming information about the coronavirus – what it is, how it spreads, symptoms to watch for, underlying health conditions that can make the virus more deadly, and more. Then New York Gov. Andrew Cuomo held daily press briefings to inform and reassure viewers.
The university hospital had to adapt to new information every day as phone lines were bombarded with callers from across Suffolk County asking questions about COVID-19 – questions about symptoms, about testing, about wearing masks, about traveling out of state, about quarantine protocols, about what to do if they test positive.
It was Susan Robbins’ job to find the answers. She’s the assistant director of nursing and she was assigned to start and manage a COVID hotline at the hospital.
On March 19, Robbins opened a call center in an empty room in the basement that conveniently housed computers and telephones. She staffed it with 24 nurses who were redeployed from departments in which functions were temporarily paused, nurses who were at risk because of underlying health conditions that prevented them from working in the COVID unit, and nurses who were pregnant. In its first week, the hotline received almost 1,200 calls.
“As the CDC added new symptoms – this was an evolving disease – we added them to our triage of questions to be able to address those problems with the patients,” Robbins said, referring to a Powerpoint that served as a timeline of data gathered from the hotline. During the first wave of the pandemic, those symptoms included the loss of taste and smell, headaches, sore throats and muscle pain.
With the flood of information coming in, it was also important to keep nurses updated. Danielle Curry, the nursing manager at Stony Brook University, is responsible for hiring as well as performance programs and patient satisfaction, among other duties. She also became the liaison between the hospital administration and nurses, and her first priority, she said, was to reassure nurses that they were not alone.
She implemented daily “staff huddles,” meetings in which nurses were given the rundown on COVID patients – how many there were, what level of care they needed, how many staff members were on the floor, and what they needed to do to keep their patients and themselves safe.
“I put on scrubs, and I was in the rooms with the patients, working alongside frontline nurses,” Curry said. She washed and toileted patients, performed physical therapy to clear their lungs, and with a specialized team, conducted a series of slow, synchronized turns called proning that moved patients from their backs to their sides to their stomachs to relieve respiratory distress.
“I didn’t just talk about teamwork,” she said. “I lived the teamwork model. It helped them realize that it was not just me dictating from the top down, and that I was really working alongside them to support them. We were all in this together.”
Many hospitals around the country faced shortages of ventilators and Intensive Care Unit (ICU) beds as COVID-19 created a surge in demand. This posed ethical challenges for hospital management when making decisions about withdrawing ventilators from certain patients and reallocating them to others.
“Thank God we never had to look at that,” Santora said. “We came close.” She closed her eyes, as if recalling the days she spent routinely counting and recounting the number of unoccupied ICU beds and unused ventilators. “At one point, we were at 90 percent utilization. That was scary.”
Later that same day, she received a call that ten more ventilators had been secured for the hospital. She reenacted the relief that washed over her in that moment, clutching her chest and sighing as her shoulders relaxed. “We never had to make those kind of tough decisions,” she said.
The first-wave surge in COVID-19 cases also resulted in a critical need for nurses. Already, Suffolk County – where to date more than 218,000 positive cases have been recorded – was a hotspot. Santora knew she was going to need more nurses than she had. So she called Nancy Page, her counterpart at the State University of New York Upstate Medical University – a public medical school in Syracuse more commonly known as SUNY Upstate – that was not as hard hit as Stony Brook Hospital. At first, Santora asked for personal protective equipment (PPE) and other supplies.
When Page asked if she needed anything else, she knew asking for nurses would sound absurd – but she asked anyway. “I think I chuckled,” she recalled, “because it was such a ridiculous thing that anyone would send me nurses in the middle of a pandemic.”
But sure enough, the next day, Santora received a call back– 20 skilled ICU nurses would be on their way to Stony Brook within days. “These nurses left their families, they left their homes to come work side-by-side with our nurses in these COVID units,” Santora said. “It was an incredible show of collegiality and of dedication.”
The upstate nurses who volunteered to work at Stony Brook University Hospital came in waves from Syracuse and would stay for two weeks at a time, residing at a nearby hotel during their deployment.
One of those nurses was Suzanne Bucko, 35-year veteran who didn’t think twice. “It was our choice to go. We were there to do one thing, and that was to help these patients and nurses, and to help them get through this time,” she said.
Another upstate nurse, Julianne Crisafulli, was shadowing a respiratory therapist at her hospital for a review of how ventilators worked. She overheard a conversation about a group of nurses from the emergency department and ICU going to help out on Long Island.
“There was no question in my mind that it felt like exactly what I was supposed to do,” Crisafulli said. “It was almost a comparison that others have used – a September 11th situation with regard to health care. It felt like it was my duty to help, be a part of and serve those in the direst need.”
Every front-line nurse lives with that one unforgettable experience with a COVID patient. Maybe it was a pastor with young children or a patient who loves to swim in the summer or someone who rides horses. For Bucko, it was a kind, elderly woman who ended up passing away. She worked with another nurse, who stayed at the woman’s bedside in her final moments.
“I’ll never forget the sight of Jennifer in there holding onto her hand until she passed,” Bucko said of her colleague. “That’s what we were there for – we were there to be with these people who didn’t have anyone, or couldn’t have anyone.”
For Gross, it was a 29-year-old woman with a long, black braid that fell neatly against the white sheet of her hospital bed. The rest of her was swollen and unrecognizable; she had four holes in her chest with tubes to help her breathe.
One nurse at the hospital came up with the idea of putting “About Me” posters in the rooms of COVID patients. Families would send in pictures of their loved ones in better days, in their happiest and healthiest moments. Gross explained that usually nurses would get that kind of information and insight from the families – the details about who this person was before becoming a patient, unconscious and medicated and on a ventilator. While it helped some nurses, it hit Gross the opposite way.
“There was a picture on the wall of her a few months before, unbothered, with her three-year-old. I just stopped, looked up and started crying in the room because, what am I doing for her and for this kid who now doesn’t have a mom? What can do this to this otherwise healthy young woman?” Gross said.
What was most heartbreaking for her was not just the knowledge that this woman was not going to survive, it was seeing
that beautiful, long braid – a testament to the life she had before the pandemic.
“All of it sort of hits you at once.”
And when patients did end up recovering from COVID, the ICU nurses didn’t always get the chance to experience it firsthand.
“The patients come to us, they’re intubated – unfortunately, a lot of them ended up not surviving,” Hailey Kuzow, a nurse specialist, said. “And the ones that do survive, once they get better and they don’t need intensive care, they were moved off of our units. So, we never got to really see success stories.”
In the thick of things, Carolyn Santora came up with another idea – this time to mark the successes. “When a patient gets extubated successfully,” she said, referring to the process of removing a breathing tube, “we played chimes overhead for everybody in the hospital to hear. And everybody cheers. It’s rewarding to walk around the hospital and hear a chime, ‘cause that means we made someone better.” And whenever a COVID patient was discharged, a snippet of the Beatles song, “Here Comes the Sun,” sounded through the halls.
Inside and outside the hospital, community support boosted morale. Donations of PPE and food poured in and people who lived nearby stopped to leave uplifting messages and chalk drawings on the sidewalk outside.
The past year was an unforgettable one at Stony Brook University Hospital. As Carolyn Santora looked back, she also looked ahead to embrace the hard-won lessons she and her nurses learned during a global pandemic. “One, always understand that there is an end in sight. Two, you are not in this alone.”