Episode 50: Hospital Social Work During the Coronavirus Pandemic

NASW Social Work Talks Podcast

Episode published April 14, 2020

Greg Wright:
Social workers such as Rosanelly Garcia are on the front lines of the battle to overcome the coronavirus pandemic. Rosanelly, who is a member of NASW, has been a trauma and emergency room social worker at Mount Sinai Hospital in Chicago for three years. Illinois has reported more than 18,000 cases of the virus. Rosanelly is here to tell us about what she's seeing every day, on the front lines of this pandemic. Welcome to Social Work Talks podcast.

Rosanelly Garcia:
Thank you for having me.

Greg Wright:
We are wondering if you could tell us more about your work at Mount Sinai Hospital in Chicago?

Rosanelly Garcia:
So, my role here at Sinai is I oversee the emergency room, our trauma unit, and our surgical ICU. Part of my responsibilities here at the hospital are to be in the emergency room for any trauma cases that come in. Those can be anything from gun shooting, to a fall, to a car accident, or a stabbing victim. So, it's kind of a little bit of everything. Overseeing the other units, the ICU, which is our critical patients, all the way through our Two North, which is our trauma surgical unit. That's more of the patients who are not as critical, and really focused on assessing their social needs and discharge planning.

Greg Wright:
How has the coronavirus pandemic affected your work?

Rosanelly Garcia:
Well, it's actually really shifted it, and I say more so in the ICU specifically. When we have our end of life conversations, it's a lot of family meetings, a lot of working around the family coming in, and being able to see their loved one, being able to talk to the doctor. Sometimes it's having a family meeting in the room, so that the doctor can say, "Look, this is where your loved one is breathing, they're not breathing well with the ventilator." Or, "They're very ill, you can see this." And pointing certain things out to them, make it more understandable.

It's just shifted so dramatically, because we went from really focusing on making sure we're meeting with the families, letting them know in person, medical updates, to everything is done over the phone, it's done remotely. This week, especially, it's been really difficult, and it's been difficult because we can no longer have family members come in. It's a toll emotionally for the family, as well as for me, because what we're having to do is ... We had a COVID patient this week that was very critical, really end of life at this point, the virus just took over. Unfortunately, the patient passed away without family at the bedside, and that's just because it's so risky.

So, what we had to do is we had to have them FaceTime him, the day before he passed. It's these hard stories to tell, but we just want to do anything that we can to make sure that ... It's hard, but we can give you a chance, an opportunity to see your loved one, one last time in our hospital, we want to do anything possible. So, as you can see, it's so dramatically different from meeting with the family in person, them spending time with their loved one, to we have to do everything over the phone.

The thing that we're seeing here at Sinai is we're starting to see more patients with possible corona, or corona rule out, which is basically saying, "We have some symptoms, but I'm not really too sure if I have it." We're trying to do the tests to find out if you have it or not, so we're seeing a surge of those patients than we have been. We're seeing less medical patients, and we're seeing a surge of those corona patients, every day.

Greg Wright:
Are there adequate tests available to know who actually has this virus, and who doesn't?

Rosanelly Garcia:
I think us, as well as any other hospital, really faces a shortage with having full access. So, we are mindful when we do these tests, because we want to make sure we're utilizing them effectively. It starts really from the beginning of we have a tent setup in front of our emergency room, and that's the entrance for a patient who we think, or the patient thinks, that they might have COVID. We want to utilize these tests as best as possible, and what we have is working for us right now. But, I think that if we continue to see this surge, I know that we're going to really need to get more of those resources into the hospital.

It's difficult already, simply because we want to limit how many people, even essential workers, nurses, doctors, we want to really limit the people that are going in and out of these rooms, because they're so isolated and we want to make sure that the patient, as much as the worker, is protected. But, our role has really changed over the last, I would say, month at this point because not only is it how are we discharge planning, what we're finding is we're seeing a lot of patients who have homes, and are not able to go back to their home because they tested positive.

Greg Wright:
Yes.

Rosanelly Garcia:
Now, we're having to find appropriate housing, appropriate discharge planning options for a patient not because they're previously homeless, or because substance use, but because they've tested positive and have children at home.
So, that really makes it different because they may not be appropriate for nursing home placements, so we find ourselves at a crossroads where we have somebody who is on the road back to health coming from a COVID place, but you're just finding it difficult to see where do I send you, I don't know where you go. Family doesn't want to accept you in, because they're afraid. So, we've had to really become creative with what we're doing with our discharge planning.

Greg Wright:
Yeah, so when you say that you're being creative, what are the housing options that you're finding for these folks?

Rosanelly Garcia:
So, really looking at extended family members. One of the initiatives that Chicago's doing is setting up hotels for patients who are either homeless and have COVID, and they want to make sure that they're isolated, or patients who maybe are not homeless, but are not really able to return back home. So, those patients are accessing the hotels, that now have contracts, I believe, with the city so that they can be in a place, away from their family, so that they're able to quarantine themselves. They needed to quarantine themselves and be away from family, to reduce the spread of it.

Greg Wright:
I'm also wondering how do you work with the family members, back home? They are worried, others are grieving, others are feeling a guilt because they aren't able to be at the hospitals with them. How are you addressing that angle of this?

Rosanelly Garcia:
It's really difficult to be on the front lines as a social worker, especially in a setting like an emergency room, or a SICU, a surgical ICU, when we're dealing with COVID patients, because we have to keep them away from people, again, to reduce the risk of it spreading. So, I'm dealing a lot with family members who are grieving, and what I'm feeling from them is not really able to get that closure because they're not able to be a part of this person's last moments. Where, in any other situation, in any other time, they would have been. So, I think what I'm seeing is guilt from families, I'm seeing that families are finding it really hard to not be present, physically, for the person.

It's just taking a really emotional toll on, I think, the workers as we see these patients coming in, and maybe rapidly declining. Declining just because the COVID becomes so complicated with their breathing, and their respiratory, so it just becomes really difficult to continue to have the family come in. Because everything's background done remotely, it's really hard to say to a family, "Look, I know your family member's passing away, but I can't have you come in." It's really, really hard to relay that message, because you put yourself in their shoes and you'd say, well what would I do if I was in their situation? You're kind of powerless in that sense, because it's essentially such a risk to have you in the hospital. But, I can understand for my families, that's all they want to do is be with their loved one. It's really difficult.

Greg Wright:
Yeah, wow. Rosanelly, what are you and other social workers doing there for self-care? Because you're in a Chicago area, there is a lot of gun violence there. This is a different thing, so how are you handling this, emotionally?

Rosanelly Garcia:
I think it's really difficult for all of us. I know for myself, because I'm still working the traumas that come in, so it's a hard balance. This week, I had a couple individuals that came in from injuries of gun shootings, and unfortunately this week, with the doctors we had to tell two different moms from two different situations that they're sons passed away from gun violence. So, then you go and you have these patients that are so critical, that are COVID positive, and you can't even have their families come in and say goodbye in person.

I think it's difficult on everybody, and not just social work, but I think anybody that's in the hospital setting, it's taking such an emotional toll on us. Really, I think right now, what's helping us get through this, and part of our self care is that even before this COVID pandemic is happening, it's about family. I think when you've experienced so many traumas, with so many people in a hospital and your team, you can't help but to be a family with them. So, self care, I think self care for us right now is sticking together, is being able to be a shoulder to cry on when we have to walk away from a really hard phone call, where we have to tell a family member that, unfortunately, they can't come in and spend the last moments of their family member's life with them. It's being able to know that, hopefully, good days are coming, and it can't rain forever.
Really, the self care here is just staying hopeful, and being a family with one another, and knowing that we're going to get through this.

Greg Wright:
Wow. Are you wearing PPE, is that what it's called, Rosanelly?

Rosanelly Garcia:
Yeah.

Greg Wright:
PPE?

Rosanelly Garcia:
Yeah, we are.

Greg Wright:
Yeah. Is it available readily, or are there problems getting it?

Rosanelly Garcia:
No, it's available. It's available. At least for us, we're always on the hunt for donations, and whatever people can give us from their hearts. Not all of us can just come out of pocket, and pay for 100 masks. But, we're all working together, if we ask for a mask we'll get one. It's not like impossible to get the things that we need. I think we're just trying to be mindful that you never know when you're running low, so you want to make sure that you take care of what you have.

Greg Wright:
Gotcha.

Rosanelly Garcia:
I mean masks, and gowns, and the head covers, and stuff like that, you just want to be mindful of how you're using these things. I think everybody in the hospital is making that effort to be mindful.

Greg Wright:
What do you think folks need to do, to help us overcome this pandemic?

Rosanelly Garcia:
Well, I think one of the biggest things that people can do is ... I think I'm going to sound like every other commercial right now, but washing your hands, making sure that are being mindful of if you're using your gloves, not throwing them on the ground, appropriately disposing of them. Constantly watching your hygiene, and making sure that you're really being mindful of the things that you do, and wearing a mask when you go out.

I think one of the other things that people can do is stay inside. I know that everybody knows that we need to stay inside, but I'm seeing people aren't really following that. So, I think people need to take this seriously, we're not going to be able to flatten this curve if we're still going to the park, we're still doing things outside, we're still hanging out. We're not going to expedite getting rid of this, if we don't really start taking, and heeding the warnings that are being put out there.

Greg Wright:
I've also heard from a few social workers that they are isolating themselves from their families. So, if they are working with a client, or a patient who has had this virus, they aren't actually going home themselves. So, they're being isolated from their families, loved ones. Are you seeing that, too?

Rosanelly Garcia:
Yeah, I'm actually doing that myself. I lost my dad a couple years ago, and so I make a point to see my mom every single weened. I haven't seen her in well over a month, and I FaceTime here every single day. But, it's hard because she's a little older, and I just don't want to risk me being in a hospital setting, and unknowingly bring something, and having it pass onto her. So, I'm not necessarily isolating myself from my husband or my child, but I haven't seen my mom in well over a month. I probably won't see her, maybe, until May if things keep going the way they are. It's heartbreaking.

I have a really good friend, she's actually a nurse and she hasn't seen her husband in, I think, about a month and a half because she's self isolating as well. It's just hard on everybody. I don't hug anybody, my husband, I don't hug my kid when I get home. I don't do any of that until I've made sure that I've washed my hands, I've taken a shower, I've brushed my teeth. It's like getting ready all over again, in the afternoon when I get off work because I just don't want to run the risk of spreading it.

Greg Wright:
You've worked with flu patients before, so this is more spreadable than a flu is, even?

Rosanelly Garcia:
I don't know if it's more spreadable, but I do know that we definitely take extra precautions. The rooms for our COVID-positive patients are labeled, you cannot go in there without being gowned, literally from head to toe. Even your shoes have booties on them, you have your mask, you have your cap. If you don't have a face shield, you have glasses. You have multiple layers of masks, you have a gown. So, you're going in there with your PPE fully armored, because you just need to make sure that you are protecting yourself from every angle.

Greg Wright:
Is there anything else you would like to add?

Rosanelly Garcia:
I know that social workers, we work in so many different capacities, not everybody's in a hospital. In no matter what capacity, social workers are making big differences in the world, and we're facing a big struggle right now. Times are hard, but we need to keep the hope alive, and we need to be the strength for a lot of our patients, and a lot of our clients, and the people that we work with.

Greg Wright:
Thank you, that's amazing words. We are so happy that we're going to be able to share those, we really are. Rosanelly, we really appreciate the hard work that you're doing, and we also thank you for giving us a few minutes of your time. Thank you for being on our podcast.

Rosanelly Garcia:
Thank you so much for having me, I really appreciate it.

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