She had no idea what was coming.
But that was OK, Melissa Takata thought. Because uncertainty is standard in her professional life. She’d worked as a nurse for 23 years, starting as a surgical nurse and then moving to intensive care nursing. She’d been a charge nurse, a team leader, and then she took her current role, nurse manager at the St. Elizabeth Fort Thomas Hospital intensive care unit.
“You might have a good day. You could have just a catastrophe,” she said. You simply had to be ready for anything.
But even for Takata, the 2020 novel coronavirus pandemic presented an unfathomable level of uncertainty.
“There was a lot of fear for the unknown. We had such little information about how to treat it and how it spread,” she explained. Turns out, she and her team had no choice but to find ways to manage and do it rapidly. They were in the center of COVID-19 caregiving in Northern Kentucky.
St. Elizabeth Healthcare officials centralized the hospital system's pandemic care for patients at one location, the Fort Thomas hospital, in early 2020.
On March 18, the St. Elizabeth Infectious Disease Response Team headed into the hospital to take the lead in showing staff how to safely provide care. Takata began to arrange for nurses to train with the team on protocols that included masking, triple-gloving, double gowning and more. The hospital’s primary infectious disease expert, Dr. Dora Savani, arrived at the ICU. She would pilot patient care from Takata's seat, in the middle of the hub.
“Our unit was the location,” Takata said.
She understood why she had to take an outside office. Even so, she said, “I felt out of touch."
Awaiting unspoken signals of distress
But again, Takata had to be flexible. She learned to manage from afar, expanding her usual job with additional duties. She tracked personal protective equipment (PPE) and ensured a supply to meet the demands of the infectious disease team, staff and anyone else permitted in the ICU. She monitored training, recording who was trained with the infectious disease team and helping to identify who should learn next.
As a nurse and a leader of nurses, she’d already mastered listening. But now, Takata had to fine-tune her skills to watch closely for what might be unspoken signals of distress from her staff.
Some were confident: “They’d say, ‘I want to be a part of this. This is my unit, and this is my home,’” she recalled. But others could not imagine working in such ambiguity. “Some were fearful. Some wanted to work somewhere else,” Takata said. “I wanted to support my team no matter what.” She'd find them a place.
Tracey Williams, an ICU Team Lead nurse, said Takata was there for her nurses, even though she wasn’t physically in the unit.
“She’d bring EAP (the Employee Assistance Team) to team meetings. She’s always taking care of her own, She trusts our judgment,” said Williams.
Takata also took care of the patients' emotional and social needs from her new location: "I gathered supplies for patient entertainment – coloring books, novels, games – so patients could occupy time while they were alone in the rooms. I worked to get (tablets) in the department so families could facetime each other through Microsoft Teams."
Things also changed outside the hospital for the St. E staff, including her.
A mother of four including twin 7-year-olds, Takata said she had to maintain strict precautions to keep her children safe from the virus.
After her 12-hour shifts, which often rolled into 14 or 15 hours, she’d come home, leave her shoes outside the door and step inside. She’d drop her work clothes into the washing machine right by the door and get in the shower. “My kids knew that they could not touch Mommy” until given the signal that it was safe.
The next day, she’d return to her hospital, prepared, she hoped, for whatever would come next.
'The patients were just getting worse'
The Infectious Disease Response Team left the hospital on July 23, 2020, having trained dozens of the St. E staff, and Takata moved back to her office in the ICU, where, she said, “I felt like I was more part of the team."
Her newest role included helping the nurses communicate with patients' families by phone. It was a tough job, she said. At that time, all of the COVID-19 patients were on life support. None of the families could visit them.
“It was crucial for the ICU team to make, at least twice a day, phone calls to the families,” Takata said.
“The patients were just getting worse."
Some patients had skin that became blotchy from the disease. Many were losing weight, she said. The tablets helped families communicate with or at least see their sick family members, Takata said.
Even so, it seemed impossible to convey to families their loved ones' conditions, Takata said. She recalls one time, when an elderly man was permitted into the hospital to see his critically ill daughter. The father thought he’d be able to visit bedside, but that was not permitted. Instead, he could look through the room's window.
Takata tears up when she talks about the father's pain. "His daughter's just out of reach. You want to be right up next to them and touch them, like a parent.’’
No return to routine in ICU
The rest of the hospital was back to its usual routines, caring for people the way they’d done before COVID-19, she said.
“Our unit, they didn’t go back to normal,” Takata said.
“We have never experienced losing that many patients in such a short period of time,” she said. “Never.”
“The whole process was exhausting. You couldn’t ever get away from work. It consumed my life. Even if I wasn’t physically at work, I was thinking of work."
She worried about her staff.
But members of Takata's ICU staff say their manager led them through the chaos in a way that seemed almost effortless.
“I always feel like I am supported,” says Barbara Hammann, the ICU Team Leader. “Melissa’s always had my back."
Earlier this year, Donna Parsons, system director of St. Elizabeth ICUs and Takata’s supervisor, recommended Takata for a community "hero" award for her role at St. Elizabeth's ICU during the pandemic. “She is very hands on. She connects to people," Parsons explained.
And on May 21, Takata was honored by nonprofit Mentoring Plus at its annual Seeds of Hope Gala at the Newport Syndicate,
After pandemic, focus on self-care
Takata said that, even though she'd been through nearly a quarter-century in various nursing roles, she learned something new while leading her staff during the pandemic: The value of self-care.
Today, the St. Elizabeth Fort Thomas hospital ICU still has some COVID-19 patients, but they are in the single digits. But Takata said the chaotic days during the height of the pandemic are still front of mind.
“I tell my (staff), make sure you are appreciating your team, acknowledging people publicly or even privately," she said. "I'm telling people, use the time they have, take time off. Go and enjoy yourself."
“Sometimes," Takata said, "work needs to go on a back burner for a bit."
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