It’s quiet here. Just the sound of the nurses murmuring, carts of equipment easing down the hall. Most of the patients are intubated and sedated for comfort. And there are no visitors, no bursts of laughter through open doors, as in other parts of Harborview Medical Center.
Carly Misenheimer has gotten used to it, working for the last several weeks in the COVID-19 intensive care unit (ICU) at Harborview, where she has served as a spiritual care resident — a chaplain.
At 26, and just 18 months out of graduate school, Misenheimer is diving into the deep end of daily life at the hospital, tending to the sick and dying and their families during the coronavirus pandemic, which has seen 5,259 confirmed cases and 358 deaths in King County according to data released Monday.
Misenheimer said she is prepared to care for patients. She has been spiritual — and calm in the face of chaos — since she was a child, and received a master’s of divinity from Vanderbilt University.
“I know that wisdom comes with age,” she said. “But there’s something intuitive about it. I do believe there are old souls in this world, and it feels right for me to be in this profession.”
Her greatest gift, she said, is that she is drawn to intensity, which arrives every day at Harborview, a Level 1 trauma center.
She also prides herself on her ability to be “present” for people.
“Sometimes that looks like conversations, sometimes silence, sometimes humor and storytelling,” she said. “One of my greatest strengths is allowing people to feel comfortable in my presence.”
Misenheimer sees her role as being a “muscle” for those in crisis.
“I have the ability to metabolize grief,” she said, “to name and understand people’s own feelings, and to relate them to the divine. The muscle is actively burning the calories of feelings. It is doing the work, but a lot of our work is pulling up a chair, being present, making a connection between two human beings.
“That’s where I see God.”
Part of Misenheimer’s job is creating a space for people to heal, she said.
“We see there are things that medicine doesn’t touch,” she said. “And that’s where we come in.”
Dealing with the COVID-19 pandemic means dealing with a certain suddenness that is business as usual at Harborview, the only Level 1 adult and pediatric trauma center for Washington, Alaska, Montana and Idaho. It is a place that regularly stands at — and crosses — the threshold of mortality.
“Every death comes with some suddenness, so that doesn’t feel new,” Misenheimer said.
But COVID-19 has caused a demand for the kind of distance that is counterintuitive to the care of human beings. Doctors and nurses work shrouded in masks, gowns and gloves. Family members can’t be there to touch, comfort, witness and mourn. Health care workers hold smartphones up to eyes and ears with gloved hands. Any warmth comes through a layer of safety.
“The things I feel now are how distanced families are from their loved ones,” Misenheimer said. “COVID forces a mirror, or a door between a family and a patient who is imminently dying.
“We are spending time with families on the phone, trying to connect them with their patients,” she said, adding that she hasn’t been in the room with a dying patient, or held the phone with their family on the other end.
“The real connection is happening from the nurses in the rooms who are gowned up and wearing PPE [personal protective equipment],” she said. “Our work is more on the front end, about, ‘How will we live if our loved one dies?'”
But Misenheimer and her colleagues also tend to the health care workers on the front lines.
“Spiritual care is so vital to our team, especially with COVID,” said Carrie Ferrulli, the nurse manager on the unit and a 32-year Harborview employee. “It’s really difficult. Our patients’ families are not here, so we all have to work just to keep them connected.
“The spiritual care folks take care of our team, as well, debriefing us or checking in,” she continued. ‘”We don’t know what we’re dealing with, so when they ask, ‘Is your team OK?’ … “
Her voice broke with exhaustion, frustration and gratitude: “It’s really hard work and we couldn’t do it without them.”
Many of the patients are sedated and not aware of the measures being taken by health care workers, spiritual care residents and their families.
Misenheimer doesn’t try to comfort patients by telling them that they are not alone; that the coronavirus is claiming lives around the city, the country, the world. There may be strength in numbers at other times, she said, but that doesn’t matter now.
“I want each family to feel that what they are experiencing is unique,” she said. “So I make sure they know that we are doing everything we can to make this the best experience for your loved one that I can.
“We are trying our very best to help them fight this. That is the comfort I am conveying, and it’s over the phone. I tell them that their grief is valid and that they are brave to let themselves feel their feelings.”
For those in the ICU, Misenheimer is there with families as they are told of a patient’s status, “and hearing what is going on in the other room, and how to bring home in.”
She spoke of a patient who has been in the ICU with COVID-19 for 10 days. Misenheimer recruited her friends to create the Easter decorations he would have put up in his church in Guatemala.
“We would have done it before [the pandemic],” she said, “but the distance demands creativity.”
And then there are those who make it out of the hospital, spirits intact.
At Harborview, Misenheimer connected with 90-year-old Geneva Wood, a resident of Life Care Center in Kirkland, where some of the first cases of the coronavirus in the U.S. occurred.
When Wood turned a corner in the ICU, she asked for a copy of the Bible, a spiritual care provider — and a Sprite.
Misenheimer first conferred with Wood’s family to talk about her recovery and how they think she was able to do it.
She learned they called her “Aunt Tootsie,” and that she was tenacious, a straight shooter and that you always know where you stand with her. Misenheimer used that information to talk with Wood about carrying on once she was released.
“There is something supernatural about how strong and resilient our bodies are,” Misenheimer said. “In gathering stories about a person, I just want to celebrate who they are, and that their body and their mind is doing the work to stay alive.”
Doing so, she said, keeps hope alive.
“Hope, for me, is always found in human connection,” Misenheimer said. “I share hope with being present with people. When I am looking into the face of someone who is fighting the fight, I feel it.”
Misenheimer, too, becomes exhausted and often leaves Harborview feeling heavy with all she has absorbed. So she finds strength for herself, and others, in the Bible. On this day, it is Ecclesiastes: “The message is that we are returning to dust, that we are just humans. It says, ‘Eat, drink and be merry for tomorrow, we may die.’ So I do the things that make me feel most alive.”
She runs, she spends time outside and is an instructor at a barre studio. And she has her own spiritual practice.
“There is nothing more sacred to me than being with someone as they watch a loved one pass away from this life,” she said, “or as they celebrate every update from the doctors, which gives them a little more hope for days to come.
“I see God in human connection,” she continued. “So when I see people love one another, when I get to be part of that, that’s the most beautiful and hopeful thing to me.”