Intubating COVID-19 patients in a Connecticut hospital, nurse anesthetist Michael Wilhelm ’98, DNP, reflects on working in one the most dangerous jobs in medicine and how he got there
INTERVIEW BY SEAN MARKEY
Michael Wilhelm, of Southbury, Connecticut, holds doctorate in nursing practice and serves on the Board of Fellows for the NU School of Nursing. He works for the University of Connecticut John Dempsey Hospital in Farmington and is the owner of Alpine Anesthesia Services. The following account, edited for length and clarity, is based on a telephone interview he gave to the Norwich Record on April 7, 2020.
I think it was the end of December, beginning of January, we heard about this one doctor, I think he was actually in China. He came back, didn't think anything of it because COVID-19 was not as big of a problem yet. He was in the hospital, and he tested positive for the virus. It was starting on the west side of the state. We knew then that we were going to start getting some cases. We started to see things coming a little bit at a time. People weren't too worried. But now we’re getting to the point where we’re getting busier. We’ve been doing a lot of 16- and 24-hour shifts.
We feel right now we’re still on an upslope. We haven’t plateaued that peak yet. We’re preparing for a worst-case scenario. We have a 20-bed ICU in our hospital, which is a 137-bed university hospital. We have more than enough ventilators. But we’re already preparing to use our recovery unit as an ICU if need be — even using anesthesia machines as ICU ventilators. It’s not what they’re really designed for. But that’s our game plan.
I am a nurse anesthetist. If you go in for surgery in the United States, you’re most likely getting anesthesia by a nurse anesthetist — not a solo anesthesiologist. With COVID patients right now, since this is a droplet virus, we have the greatest exposure. Because we slip in a tracheal tube to protect your airway during surgery, we’re getting all those secretions that are coming from the lungs. So, we’re considered the most exposed. If we have to do emergency surgeries, we are trying to view every patient as potentially COVID-19 positive.
At our hospital, we have a separate team each shift right now that all they do is intubations on COVID patients. When the COVID patients get to a certain point of oxygen deprivation, we respond to the emergency. I’m on that rotation. In order to intubate and prepare them for a ventilator, you have to paralyze the patient. But first you have to give them some kind of anesthetic, some medication to put them to sleep. We give them the paralytic agent, so the vocal cords can’t close and then we can slip the tube past. I’ve already directly worked on six COVID patients. The pace is increasing. More and more patients are winding up on a ventilator. That’s how we know we’re on an upswing. We’re thinking that possibly by next week, probably around Easter time, we’re thinking we may have to start bringing people to backup ICUs set up in what had been our recovery rooms.
For whatever reason, my wife, who is also a nurse, and I have always been pretty fearless. I don’t know what it is. We’ve been following the recommended guidelines. I only go out when I need to go out if I’m home. My kids are home from school. So on top of dealing with all this, I have to deal with them being schooled at home at the same time. My boys are four and six years old. So it’s not like, “Hey, go do your math homework.” It’s like you got to actually go through it with them.
When I come home from work—and my wife does the same thing—we just go into the basement. We have a separate bathroom there. We take off our clothes and take a shower down there. All the laundry goes right into the washing machine. We have a sanitary cycle. I’m pretty sure it’s going to shrink all our clothes. That’s what we’re doing to prevent it from spreading at home.
At the hospital, it all depends on what I’m doing. Typically, if I go in to intubate a COVID patient, we put on what’s called a PAPR, a powered air-purifying respirator. It goes over my head. It’s like a mini-space helmet. It filters the air that’s drawn into it. We also wear an N95 mask underneath that. We also wear gowns. We actually wear two, because they open in the back. We put one on one way and one on the other way. That way, we’re completely covered. We cover our neck, put on two pairs of gloves, and go into the room. Once you enter, you don’t leave until you’re done. When we do come out, we have a little section where we can take everything off. Everything gets wiped down. Somebody comes and wipes you down, and that’s that.
Now, a situation happened the other day when I was working. There was a guy — they’ve been using the term “patient under investigation,” which means that they have symptoms of COVID; so they’re being tested, but they’ve not tested positive yet or the test didn’t come back yet—the guy was in cardiac arrest. In cases like this, you don’t have time to put on your PAPR and all this other stuff — because the guy is arresting. You need to be in the room. So, I went in in just an N95 mask and gloves and a gown. One of my colleagues was concerned for me afterwards. I said, “That’s why we change afterwards.” You go back down to the locker room, get a new pair of scrubs, dump the old pair. Some of our guys take a shower in between. That’s what we’re doing right now.
A couple of colleagues had a few scares, where we thought they were positive. They turned out to be OK. So, that’s a good sign. Whatever we’re doing is working right now. Whereas in the other hospital systems, I know there’s one hospital in Connecticut, they have 20 anesthesia providers that were infected by the virus. That’s what we’re trying to prevent. We don’t want there to be an exposure, and then find that half our department has taken ill.
It works as long as you have the right protective equipment. That’s the problem that we’re hearing about in New York City, that people don’t have the right equipment. The CDC has recommended at this point that surgical masks are enough. But surgical masks only help prevent the spread of the virus. I think if you’re directly taking care of these patients, I think that the N95 mask is critical. So are goggles. You don’t want anything to get in your mouth. You don’t want anything in your eyes or your nose. But we’re still not 100 percent sure exactly how the virus works and spreads.
The thing that’s kind of funny is that I’m not that worried. I feel that the guidelines that are coming out are good. I think that we’re doing the best that we can. It’s obviously scary when you read about it. But there’s just something about me and my wife, that we just don’t have that fear factor. I don’t know what it is. Am I worried about getting it? Sure. But I also know that I’m young — I’m 43 — and healthy, relatively healthy. I worry more for people like my parents. I told them to get out of New York City and go to our property in upstate New York. They went upstate for three days. They were like, “We’re going to head back down.” I said, “No, no, no!”
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How I became a nurse is kind of an interesting story. My family is from Queens. I grew up there. I went to Norwich and graduated with an electrical engineering degree. I did that for many years. Loved the job, loved the thought process behind it.
In 2001, I was working for Siemens as an engineer in New Jersey. I had also just started with the Glendale Volunteer Ambulance Corps. I always love telling this story, because people don’t believe it sometimes. I still remember on the morning of 9/11 — when we saw that planes had hit the towers of the World Trade Center — how I told my bosses, “I got to leave.” They said, “You’re not going to be able to go anywhere.” I go, “Well, I got to leave.”
I was in New Jersey driving home. Just before I got onto the George Washington Bridge, I pulled over and there’s a Port Authority building. I walked up and I asked if I could help. I wound up going in with a group of paramedics from Newark-Passaic. We first went to an area where they had the ferry services bringing people over from Manhattan. Then we went to Chelsea Pier, where we were staged until the last building came down. Then it was deemed safe for us to go in. So we went in. It was kind of funny — everybody else is in their EMS garb, and here I am in a shirt and tie and pants walking around. I remember a couple of times I got stopped by people. The other guys were like, “No, no. He’s with us.”
It was a sad time. I still remember going down the West Side Highway and everyone’s cheering and everything. Signs up thanking all the first responders for what they are doing. It was a tremendous, amazing experience. I remember when we went in there thinking, all right, we’re going to save some people. Then hours pass and you’re like … all right, maybe we will give families some closure. That didn’t happen for a long time.
It wound up getting to the point that we were just running a triage station for the people that were digging. Another situation where no one had masks, no one had protective gear. All these guys were getting corneal abrasions from the dust and everything. For hours we were just washing out people’s eyes, so that they could go back out.
Then about two to three days later, we got back to the Port Authority station. I was involved with some volunteer work with the NYPD. I had called the captain of the precinct that I lived in. He got on the phone with a state trooper from New Jersey, and I got an escort over the bridge. I was driving really fast, over a hundred, and I still remember the state trooper pulling ahead of me. Then I got home. I don’t think I worked my regular engineering job for days, weeks after that, but I continued to volunteer and help the community.
After Siemens, one of the companies that I worked for did all the rebuilding for the PATH train. I was down there for another two years doing that, got laid off, had another job, got laid off. Around that time, I felt that there was just a void in my life. There was something more that I needed. I wanted to give back to the community, especially after 9/11. I thought to myself, it’s time for a change. My wife was my biggest advocate for going into health care. She was an accountant who had gone into nursing herself.
My GPA at Norwich was not the best. Probably some of that was down to trying to balance the Corps and education and everything else. Our electrical engineering program was not easy. My GPA suffered a little bit for that. But in the long run, the problem was I didn’t think I was smart enough to get into nursing school. But I wound up getting accepted at NYU’s School of Nursing, which I never thought was going to happen in my life. They had an accelerated program and I finished in 15 months. My experience on the ambulance helped a lot. I wound up getting a job right away. I got an ICU fellowship for a year, which was an amazing experience. There was a lot of classroom training, mentoring, and patient experience. Then I worked in an ICU for about three years. I still wanted to do more. A conversation with my wife led me to discover nurse anesthesia. It was one of the best things that’s ever happened to me. It’s one of those jobs where I wake up, I look forward to going to work. I’m happy about what I do. I enjoy it. In fact, sometimes I even work too much.
One of the things that I always felt guided me in everything that I’ve done — from 9/11, going into nursing, going into nurse anesthesia, even now with this COVID thing — is the idea of the citizen-soldier, which was central to Norwich founder Alden Partridge. I want to say that philosophy always sticks in my head. I’ve always been the type of person that wants to help and try to help and try to do and be the best that I can.
One of my friends, my best man at my wedding, described me as, “Mike’s the guy who jumps into a pool without checking that there’s water in there first.” He said that at my wedding, and I still think about that. He’s right. That’s absolutely how I am. I don’t think I ever think about myself first. I always just do whatever I can. Even with this pandemic situation, with potentially bringing the virus home, I try to be safe. I try to be professional about it. I do what I can do, and I just hope that everyone will be safe — in my household and in my community.