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‘A true crisis situation’: Local nurse recounts assignment at New York hospital

Around the beginning of this year, Garland Munns had moved back to his hometown and namesake of Garland, and was working as a nurse at Intermountain Bear River Valley Hospital in Tremonton when he got a call from a friend in the Salt Lake City area.

Within a few days, Munns was on a plane, heading for an assignment in the epicenter of the COVID-19 outbreak in the United States.

A couple of friends and former coworkers at Intermountain Medical Center in Murray had tracked down a four-week assignment at a hospital in Brooklyn, New York, where the staff was being overwhelmed with patients infected with the new coronavirus.

Four weeks is a relatively short assignment for travel nurses, who typically enter into eight- or 12-week contracts, but with the situation in New York as dire as it was, hospitals there were willing to offer shorter stays.

As northern Utah wasn’t being hit too hard by the outbreak, Munns decided the right thing to do was to go where he was needed most.

“I knew I had the ability to help,” Munns said by telephone last week during his last day in New York. “We weren’t too busy (in Tremonton) and these guys were getting hammered. If I had the ability and skill set to do something, I felt like I needed to do that.”

He said his boss at the Tremonton hospital, Leslie Garn, was told him to “100 percent go for it,” even though the staff there were concerned for his welfare.

“I called her on a Sunday and said I had already signed the contract,” he said. “On Thursday, we were getting on a plane and flying out. She fully supported me and helped me.”

The airline JetBlue provided a free flight for Munns and two former coworkers, Kyle Carlson and Felix Salomone. Munns had never been in the heart of New York City, and his first impression was certainly not what a typical tourist might see.

“It just seemed empty,” he said. “We got an Uber and I was expecting New York traffic, but there were minimal cars on the road.”

• • • • •

Even if he had been familiar with the city, nothing could have prepared Munns for what he saw on the first day he, Carlson and Salomone walked through the doors at Maimonides Medical Center in Brooklyn.

He arrived at the hospital at 8 a.m. to begin two days of orientation, on a day when about 90 other travel nurses also arrived. Two days before that, another group of similar size had showed up, and there were around 300 to 400 temporary travel nurses working at that hospital alone.

When Munns arrived, an estimated 90% of the hospital’s patients were COVID-19 patients, with the rest being mothers about to give birth.

“The only other people allowed in the hospital were moms that were delivering,” he said. “This hospital delivers more babies than any other in New York.”

Munns arrived after the peak of the outbreak, but the situation was still hectic. During his orientation, one of the educators at the teaching hospital said that during a single week, the hospital went from its usual 700 beds to about 1,400. That included five to 10 makeshift intensive care units set up in areas that would normally be post-anesthesia recovery areas for people getting out of surgery, but were converted on the fly specifically to deal with the influx of COVID-19 patients.

“They already had the monitors to hook people up to, so that’s how they set it up,” he said.

While the actual peak had already passed, demand was still so high that Munns and his roommates received a phone call at 5:30 a.m. the day before their first shift was supposed to begin, asking if they could come in and work.

During his first day on the job, someone would come on the loudspeaker approximately every 30 minutes saying “Code 3,” which meant someone had gone into respiratory arrest and needed to be intubated and hooked up to a ventilator. The ventilators were in such short supply that many patients were connected to portable units that are typically used only in ambulances.

The shortage of medical personnel was also evident, as nurses that would typically be handling one critical patient at a time were racing back and forth between four or five patients. Floor nurses were taking on about 10 patients at a time — double their usual workload.

“The patient ratio was just complete insanity,” Munns said.

Sometimes a patient would code, and couldn’t be moved to the ICU because there was no room, he said. Patients that were on continuous renal replacement therapy (essentially emergency dialysis) were having share machines, with nurses switching them from one patient to the next every eight hours — definitely not ideal, considering that the word “continuous” is literally part of the name of the therapy.

“It was just doing whatever you had to do to keep the patient alive,” he said.

He couldn’t confirm it, but said there were rumors circulating that some patients had died because there simply weren’t enough ventilators to around.

• • • • •

Munns was assigned to an ambulatory surgery area that had been converted into an ICU. He was fortunate that another group of travel nurses had arrived a couple of days before, so he was able to shadow someone who had already learned the ropes.

Before he and his colleagues showed up, the nurse he was shadowing said she was working with one other nurse to handle 14 patients who were on drips and ventilators, all in one large, open room with no partitions.

“They were lucky to see three nurses walk through the door,” he said. “I never had more than two patients, and even those two were some of the hardest and busiest work I’ve ever encountered as a nurse. It was a true crisis nursing situation.”

Dressed in full protective gear from head to toe, it got so hot while working that Munns requested to be transferred to another area where he didn’t have to wear the full body suit.

“To be honest, I couldn’t hang,” he said. “I’m already big as it is, so you put me in a garbage bag, it was so hot, it kicked my ass. You couldn’t take any gear off in that room.”

He was talking with some other nurses on his first day who said that only one of their patients had made it out after being put on a ventilator, and that was a 24-year-old trauma case.

“Everyone had died or was still on a ventilator,” he said. “Basically, if it came to where you were on a ventilator, you weren’t making it out.”

Maimonides Medical Center alone had more than 1,000 patients diagnosed with COVID-19, many of them with a history of other medical issues, “so if you needed the ICU, you were already super sick,” Munns said. “Put the COVID on top of that, and …” his voice trailed off.

• • • • •

By the time his last week on assignment came around, things had slowed down a lot. Munns’ last two patients were not even COVID-19 patients, and the makeshift ICUs had begun to revert to their normal functions.

As things slowed down and the nurses were able to stop and catch their breath, Munns was able to talk to more of them about their experiences.

“Some had been travel nurses whteir whole careers, and they said this is like nothing they had ever seen before,” he said. “It was nothing remotely close to the norm.”

He said he’s done things that were tougher physically or mentally, “but it was emotionally one of the toughest things I’ve had to do. Seeing the condition those patients were in, and knowing they weren’t allowing visitors in, so the family doesn’t have those last moments to be with them, it was hard.”

Munns flew back to Utah last Friday, where he was waiting in quarantine for coronavirus test results before returning to work at Bear River Valley Hospital. He will turn 32 this year, and is getting ready to go to Arizona to become a certified registered nurse anesthetist and continue his medical career. But the experience he gained in only a month’s time in New York is the kind of thing that can’t be learned in the classroom.

“I’m definitely glad I did it,” he said. “I didn’t have an excuse not to. The way I see it now, you think you’re coming out to help patients, and I don’t know if I helped that many, but the reason I came out here was to help the nurses. My job was to take the stress and workload off of them. Maybe that’s the good I did.”

Signs of togetherness

Teachers, administrators and supporters of Garland Elementary School organized a parade on Monday, May 11 to express their gratitude to students and their families during the school closure of the past two months, and to show how much they have missed the kids. A line of vehicles drove past and waved to supporters lining the streets and holding signs along a route that covered some 15 miles, beginning in Garland and moving through the north end of Tremonton, out west through Bothwell and Marble Hills, then returning through Thatcher, down Tremonton’s Main Street, past the fairgrounds and ending at the school. Other schools, including McKinley Elementary in Tremonton, have held similar events while classes have been canceled.

A Q&A session with Thomas Wright and Rob Bishop

Utah gubernatorial candidate Thomas Wright and running mate Rob Bishop stopped by the Leader office recently to answer some questions about their their plans if elected to the state’s top office.

How did the two of you come together in a run for the governor’s office?

TW: We met a few times, talked about the issues and got to know each other better. In January I decided I was going to run. I really felt convicted. So I got into the race, and a week later, he called and said he’d love to endorse me. It didn’t take long to accept that, from somebody I respect and admire as much as him. After that, I thought “who would I rather run with than somebody as qualified, knowledgeable and well-rounded, having been a public schoolteacher, having experience in state government, and having Washington D.C. influence, and knowing so much about rural Utah and public lands, than Congressman Bishop?” It was just a natural fit.

RB: As I looked at the field of potential candidates, I recognized that he had the outside skills. He’d never held elected office before, so he brings a new perspective into it, especially a business background.

But at the same time, having been the chairman of the party, national committeeman, elections commission, board of regents, he understands politics, so it’s not like he’s a neophyte about all this stuff. He has the exact skills the state needs. He started his business in a recession and made it work.

How do you feel about the state’s response to the coronavirus, and what would you do differently?

RB: The only thing that is sure that we know is that all of the decisions that have been made so far have been done by executive order, and that’s what scares me. Even if these executive orders are appropriate, there’s going to be another time when there’s going to be another crisis, and someone will decide they need to do something by executive order. The one thing we have to do after this virus is over is to go back there and make sure that for the future, that with any executive orders, there has to be some kind of check and balance. The legislative branch has to be part of the decision making.

TW: for me, when I started this campaign, the economy was great. Things were going well. The thought of a recession was almost unthinkable. The thought of economic challenges or a challenge like this didn’t really cross anyone’s mind, and here we are, four months later, and we have a serious challenge ahead of us with the coronavirus, not just in real time in understanding what it is and who it affects and its growth, but also how are we going to recover from the consequences of that?

It’s our belief, a businessperson like myself that’s come from the private sector, who has built a successful company during tough economic times, is a perfect fit to be our next governor. I know how to bring people together to create results. I know how to collaborate and listen, and I understand uniquely what small businesses need. Small businesses are the key to our economy, and they will be the key to our economic recovery as we ask ourselves the question “How do we get 135,000 people back to work in Utah?”

How would you address the needs of Box Elder County and rural Utah?

TW: You’re seeing a contraction of the population in rural Utah, and that’s going to be an even bigger challenge because we’re finishing up another census, then we’ll go through the reapportionment and redistricting process here again in a couple of years, and when that happens, I believe rural Utah will have even less representation in the legislature than they have right now, which is already too little. We need to make sure that the next governor and lieutenant governor are uniquely connected and understand rural Utah and want to help them.

RB: The next guaranteed growth is going to happen at Hill Air Force Base. I’m grateful for my relationship with the base from my years in Congress, but the state also plays an important role in making sure that Hill Air Force Base is significant. With the new programs that are coming in, there will be probably around 5,000 new jobs that are coming to northern Utah, and it’s not all going to be centered at the base. They can do and probably will do a lot of work out here in Promontory. There’s going be a lot of growth that needs to have housing, transportation, everything else, and it could very easily slip up here into box elder county. We could be playing a significant role in that, and we need to be prepared for that.

How would you approach the issue of public lands?

TW: Sixty-five percent of our state is owned and controlled by the federal government, which puts us at a great disadvantage. The PILT (payment in lieu of taxes) is a joke, so we don’t generate revenue from those lands, which disadvantages our public education system and our state revenue. But more than that, it takes away the traditions and the local control and use of public lands. We will continue to assert our state’s rights for our public lands, and we will do everything we can to wrestle control of them from the federal government, and that honestly is one of the four main reasons I wanted to have Congressman Bishop on the team. I don’t think anyone in this state knows that issue as well as he does.

RB: What is different now, we have tried to put some legislation through that allows for greater local input, and we need to start pushing that from the state level. What we have now is a window of opportunity, especially if trump wins reelection, to start doing some things administratively. What’s important is that there is plenty of land out here for recreation and economic development and conservation.

What is your plan to deal with the current recession?

TW: The first thing you have to do is look at where you’re spending the money that you currently have. Before you start talking about anything, you have to look at resources you have and where they’re being spent. There needs to be a complete look at the budget in every single department and you have to ask two questions: Is what we’re spending money on a priority, and if it is, great. Then two: Is there any fraud, waste, or abuse in any of these line items where we can save money and deliver this more efficiently?

For Thomas, this would be your first time holding public office. What was the moment when you decided to run?

TW: I’ve been a grassroots volunteer in politics for a long time, and I’ve knocked on a lot of doors helping other people get elected. I used to knock on doors and talk to people about issues, and they would be very vocal about a lot of issues, but sometimes the people that had the loudest opinions were the ones that voted the least. And I remember walking away from those homes saying “I think you have to earn the right to have an opinion,” and as a businessperson, I have a lot of opinions about how we can make state government better. And if I want to have those opinions, I believe I have to be the change that I want to see in the world.

For Rob, how do you feel about leaving Congress, and do have a vested interest in the person who takes over your seat there?

RB: Yes to both. I won’t tell you who I endorse for my seat.

I’m not really ready to quit Congress, But I realized that by 2020, my ability to have an influence for the State of Utah would be at its highest point, and would never be greater than that. So to be fair to the state of Utah, I needed to quit. Somebody needs to replace me to start building the seniority so they can actually fill those jobs again. If I were just taking that space, I would be retarding Utah’s efforts trying to bring in somebody who can start gaining that experience. For all the lands issues, Hill Air Force Base, rural Utah, that were important to me, I needed to step aside.

It’s going to difficult for me when it’s time to go, but it was the right thing to do for the state of Utah. Fortunately, Thomas gave me lifeline here in which I think I can still do some things of service being a lieutenant governor with some specific responsibilities. I still think I have something to give, even though this is not a stepping stone to some other office. I just want to be able to serve and assist him, and then go to assisted living.

Tremonton adjusts water rates for outdoor season

As summer approaches and outdoor watering picks up again, city officials have adjusted the rates that residents are charged in an effort to make prices more equitable for users.

After a series of lengthy discussion, the Tremonton City Council approved new rates for the summer watering season in which customers will see a 30% hike in the base rate and higher usage rates for indoor water, but lower rates for secondary water use.

Under the new structure, which officials plan to revisit at the end of the outdoor watering season, customers will pay a $13 per-month base rate for culinary water, up from $10 previously. Culinary rates based on the amount of water used are also going up, with prices 10% higher for most users, including commercial users.

At the same time, the base rate for secondary water is staying at $10 per month, while the usage-based charge for outdoor water is 25 cents lower for each tier of use.

Customers who have secondary water available to their homes but choose not to use it will still be a charged the $10 a month base rate during the six-month outdoor watering season.

Officials said the new rates make it so secondary water is noticeably cheaper than culinary water, while still allowing the city to bring in enough revenue to cover its debt obligations on bonds issued to finance construction of the secondary water system.

City leaders will use the data gathered over this year’s watering season, which typically runs through the end of October, to determine whether future changes to the rate structures are needed.

“This is the place to get in and get going on it, and if we need to adjust it we can,” Mayor Roger Fridal said.

Based on projections, city Finance Director Curtis Roberts said the new rates will allow the city to cover its debt obligations at least on a temporary basis until a more permanent structure can be put in place, but how much the city brings in depends largely on the weather, which is the biggest factor in how much water people use on their lawns.

“If there’s a heat wave in June, we’ll see a lot more water consumption,” Roberts said.