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Diaries from the frontline: Fighting COVID-19 in East Tennessee

A nurse practitioner, on the frontline of East Tennessee’s fight against COVID-19, takes us behind the scenes for a raw look at what she’s experiencing in the ICU.
Published: Sep. 16, 2021 at 8:38 PM EDT
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KNOXVILLE, Tenn. (WVLT) - Daily diaries, created by East Tennessee Nurse Practitioner Devan Fox, reveal her experience fighting COVID-19 at what she describes as an overwhelmed hospital. Fox specializes in pulmonary critical care but tells WVLT News she is being contracted to work at hospitals across the region that are inundated by unmanageable case loads caused by a spike in COVID cases.

Before becoming a nurse practitioner, Fox worked as an intensive care unit nurse for 13 years. She also was part of a COVID response team that worked in New Jersey in 2020 and in Texas in August. She says those experiences afford her the ability to compare differences between pre-pandemic and pandemic ICU conditions.

Fox said in the last five weeks, she’s lost 30 patients to COVID and all but one of them were unvaccinated. She says the vaccinated patient who died had an underlying condition.

For privacy reasons, Fox is not disclosing which hospital in East Tennessee she’s currently contracted to.

She started recording the diaries on September 11 and began sharing them with WVLT News. Her unedited versions are posted below.

In some of the videos, Fox refers to BiPAP machines, which offer non-invasive ventilation therapy to assist breathing. The machines operate like other ventilators, using pressure to push air into the lungs, improve the amount of oxygen in the blood and decrease the amount of carbon dioxide.

In other videos, Fox makes mention of non-rebreather masks, devices that help people who need extra oxygen even though they can still breathe independently.

Vapotherm is another therapy Fox mentions in her diaries. Vapotherm is a mask-free non-invasive ventilator that uses a high velocity flush instead of pressure to help with breathing.

Diary Entry 1, September 11

Fox began logging diary entries and sharing them with WVLT News on September 11. Her first entry, seen below, reveals concern for the age of patients seeking treatment in the emergency room for severe COVID. On this day, she reports that two men in their late 40′s arrived at the ER and immediately were placed on BiPAP machines. She reveals there were plans to place one of them on a ventilator that afternoon.

“The hardest part of all of this is listening to him call his wife and tell her he doesn’t want to die. He’s only been here less than 12 hours. I just don’t know.”

Devan Fox, Nurse Practitioner

Diary Entry 2, September 14

Fox’s second entry, seen below, was recorded on September 14. In this video, she describes the circumstances inside the ICU and ER as dire.

“Today is a complete zoo in the ICU. Nurses all have four to one. The ER nurses are five or six to one and they have vented patients, they’re not just your typical ER patients hanging out waiting on ICU. These people have been holding for days waiting for an ICU bed.”

Devan Fox, Nurse Practitioner

Diary Entry 3, September 15

In Fox’s September 15 entry, seen below, she explains that her hospital ran out of BiPAP machines and Vapotherm, and only had three ventilators left. She says patients in respiratory distress or failure who need oxygen are normally put on a non-rebreather, then Vapotherm, then a BiPAP, which is used to hold off ventilation as long as possible. But with no BiPAP machines and no Vapotherm, Fox expresses worry that options are becoming limited.

“Unfortunately, at this little hospital I’m at right now, there’s no more. So, if someone comes in in severe distress tonight, they’re going to have to wing it and hopefully survive on a non-rebreather or they’re going to get vented.”

Devan Fox, Nurse Practitioner

Diary Entry 4, September 16

In Fox’s September 16 diary entry, seen below, she says the hospital was able to secure an overnight shipment of BiPAP machines but that several young people were still fighting to live.

“The hardest part of this entire process for me as a provider is that some of these people will not leave this hospital, some of them are really young with kids at home. With all that is shared about COVID, it’s really easy to think of a patient as a number, but they’re not just numbers, they are all someone’s loved one. They’re all very important to other people, to people in this community, and if they pass away or they die, that’s going to change a family’s world forever.”

Devan Fox, Nurse Practitioner

Fox continues with a fourth diary entry on September 16 explaining that more of her patients are dying each day. She describes the emotional burden as becoming difficult to carry despite her vast experience in the field and exposure to tough situations.

“It’s not easy to deal with and it’s hard to explain from the inside to an outside world that doesn’t have to see this everyday.”

Devan Fox, Nurse Practitioner

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