Guest post: The emotional toll of CDI during the pandemic

by Marlene Goodwin-Esola, MSN, CV-BC, NE-BC

When I first entered the CDI field, I received feedback from someone who left this specialty expressing that her reason for leaving was that CDI was “too sad.” Her rationale was that as a CDI specialist, you might be reviewing a chart of a patient with a chief complaint of abdominal pain, and within a few days after the diagnostic workup was complete, that patient would be diagnosed with metastatic cancer. Her previous experience as a bedside RN was on a telemetry unit, which she explained often did not have the frequency of a grim prognosis. I put her view of CDI in the back of my mind, knowing that the reasons I had passion for a new career in this field was my clinical curiosity, my proclivity for understanding pathophysiology, and my fascination with seeing the whole multidisciplinary clinical picture of so many patients.

A CDI specialist sees the whole team and the many moving parts of a healthcare facility in the care of the patient. We recognize opportunities in the system and get to share them with the leaders that can make a difference, and we get to spend time rounding with the team—from physicians to nurses to physical therapists to case management to registered dieticians to whoever plays a role in the patient’s stay—with the goal to obtain an accurate severity of illness. It is truly an intriguing and appealing avenue for nurses to consider in their professional journey.

The original intent of this blog was to realize the reality of how the profession of CDI can be “too sad.” I have been responsible for reviewing most of the charts of the patients with COVID-19 since the pandemic hit our geographic area in March of 2020. My role as a CDI specialist reviewing these charts was part of the original influx of patients diagnosed with COVID-19 at our facility. While rounding on the units during this time to discuss some of my documentation findings with the healthcare team, I was able to feel the fear and uncertainty of our clinical team at the bedside doing the best they could with the continually evolving treatment plans and the everyday research recommendations for the plan of care of a patient with COVID-19. 

Then, I saw the care evolve to less frequent ventilator use, the use and discontinuation of hydroxychloroquine and ivermectin to name a few (although some ID physicians continue to use this medication), the addition of remdesivir and convalescent plasma—the list of what the science proposes would work in the treatment of this virus continues today. The use of ECMO, insertion of an Impella device, CRRT, and even lung transplant is still considered in some of the most critically ill patients with COVID-19. Then came the messenger RNA vaccination, and we all felt hope.

Here I am 17 months into the chart review of this population, and now we are caring for the variant of the SARs-CoV2 virus. I realized that I often find myself sad when we are caring for the younger unvaccinated patients and wonder how we can move forward with a standard of care in our society that could reduce the numbers of these newly admitted patients when the science is often ignored. Three weeks before I began this article, my hospital had a census of one patient with COVID-19, and as I write this our census of this diagnosis is much higher—many in their 20s, 30s, 40s, 50s, mostly unvaccinated. The intent of my blog is not political, it is to express sadness that the virus is still winning.

A true example of how a CDI specialist can face sadness in our role was in my three-week review of a 54-year-old patient who was a first responder and was just about to get his first vaccine when he was diagnosed with COVID-19. I reviewed his chart almost every day—from his admission to the COVID-19 unit, then transfer to ICU. From BIPAP to a ventilator, CRRT, an Impella device and multiple vasopressors—to his ultimate demise. I had trepidation when I opened his chart on the last days of his life, and I felt the resignation of the ICU team as they knew they tried all that they could. I felt like I knew the patient so well. I reviewed entries from all specialties and took special note of conversations with his family as he neared the end. The irony is that although a CDI specialist does not have hands on care of our patients, we actually get to know them on an intimate inside look of their whole being and I found myself wanting to whisper in the patient’s ear that we tried our best, but our best could not beat the virus.

Yes, this is a sad entry, but I also feel privileged that as a CDI specialist, I got to be a part of this patient’s care, although it was often in front of a computer just steps from his bed in ICU.

Editor’s note: Goodwin-Esola is the CDI director at Jupiter (Florida) Medical Center. Contact her at marlene.goodwin-esola@jupitermed.com. Opinions expressed are those of the author and do not necessarily reflect those of ACDIS, HCPro, or any of its subsidiaries