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The man sitting in front of nurse practitioner Cara Wolf was demanding ivermectin, and when she turned him down, she watched as his eyebrows knit together and his chest puffed up with anger.
The patient who’d arrived in her Utah urgent care clinic hadn’t really wanted a coronavirus test in the first place, even though he was the perfect candidate: unvaccinated, sick and coughing.
Her heart dropped as he then shifted to asking for ivermectin, an anti-parasitic drug that right-wing personalities have touted as a potential COVID-19 therapy. Wolf’s dog takes the drug once a month to prevent heartworm, but it’s rarely prescribed for humans, and the Food and Drug Administration has warned against using it to treat coronavirus. She told the man she’d risk losing her license for prescribing the drugs and refused to do it.
The man erupted in rage, she said. Most of the diatribe is a blur to her, but Wolf said she does remember him calling her the vulgar c-word.
“It’s the first time in my career when I’ve been truly afraid of a patient,” said Wolf, who was speaking as an individual and not as a representative of her employers.
Wolf, a smidgen over 5 feet tall, was dwarfed by the burly man. What if he was armed? What if he came after her when she left work?
That night, she made sure security was there to walk her to her car.
Wolf and other health care workers interviewed by The Salt Lake Tribune say this type of hostility has only intensified as the pandemic has worn on. In the beginning of the public health crisis, it generally felt like everyone was on the same team, they say. Now, many people walk through hospital doors carrying COVID-19 conspiracy theories and misinformation — and these individuals often view caretakers as the enemy.
Patients are insisting on taking unproven and potentially harmful treatments, walking out of hospitals against medical advice or tearing out their own IVs because they’re terrified that someone will slip an unwanted medicine or a government surveillance device into the tube, Utah’s health care workers say.
A group of Utahns under the sway of misinformation gathered outside Intermountain Medical Center over the weekend to “protest” health care workers. And some patients or family members are lashing out with verbal and even physical attacks against the people entrusted with their care.
At the urging of hospitals around the state, a Utah lawmaker is looking to toughen penalties on assaulting health care workers, hoping to curb this violence. State Rep. Robert Spendlove said in a recent hearing that he’d heard about one patient who attacked another patient and health care workers, punched a security officer in the head 13 times and then bit a hospital employee hard enough to draw blood.
It wasn’t clear from Spendlove’s account what set off that particular conflict. But Dr. Wing Province, medical director at Park City Hospital, described growing tension between health care workers and their patients during the pandemic.
Health care workers are familiar with abuse from patients who are suffering from a psychiatric crisis or a medical condition that alters their mental state, he said, and they are used to “turning the other cheek.”
But the aggression health care workers are subjected to now is different, driven by distrust in the medical system and misinformation about coronavirus. Though hospital workers are committed to caring for patients regardless of their beliefs, Province says, these clashes do grind them down.
“If you use the analogy of our cups being filled every time we make a positive impact on someone’s life, when someone is not necessarily as grateful or they’re verbally or physically abusive to you, it just lessens the amount of refill to that cup that makes us feel whole in our jobs,” he said. “But we still continue to do it.”
‘They’re so convinced’
Toward the beginning of the pandemic, the COVID-19 floors felt like a “war zone,” Wolf said. Nurses were spending 12-hour shifts sweating inside the personal protective equipment that kept them safe from the novel, little-understood virus that floated in the air around them.
Some nurses got headaches or nose bleeds from wearing the air-purifying masks, and many dealt with the fear that they’d carry the disease home to their spouses or children. They had to watch patient after patient die without anyone to hold their hands and families who stood outside ground-floor hospital windows so they could hold up signs for their loved ones.
One respiratory therapist estimated she’d intubated about 150 COVID-19 patients over the course of the pandemic. Of those, only three recovered enough for her to remove the breathing tube — one a COVID-19 denier who woke up still not acknowledging he’d had the disease.
“He didn’t even realize he was a miracle,” said the Taylorsville respiratory therapist, who was granted anonymity by the Tribune because she was worried her job might be at risk.
These hard days, Wolf says, were survivable with the camaraderie of colleagues and support from a grateful community.
Early last year, Utah House representatives raised money to buy health care workers lunches, local firefighters and police held a parade of lights and sirens to honor hospital employees and businesses donated pizzas and chocolate bars by the thousands.
But even in this moment of rallying against an emerging crisis, some people were wary of medical staff, she says. One shocking encounter, she said, came last spring when a patient’s wife lashed out at nurses and doctors who were racing her husband to the intensive care unit as he was rapidly deteriorating from COVID-19.
They were trying to steal his organs, she screamed down the hallway. They were killing her husband on purpose. She’d heard hospital workers all over the country were doing that.
“Obviously, my first, immediate reaction was defense. Like, wow, we would never do that,” the Salt Lake City health care worker said. “And you’re trying to calm this person down, but they’re so convinced that that is what is happening. And how do you talk someone out of that?”
Health care workers say the problem has only gotten worse through the pandemic. As one of the nurses staffing a COVID hotline, Becca Thomas has heard more and more anger creeping into people’s voices as the pandemic has worn on.
At the outset, many callers would express gratitude. She’d answer their questions about whether they should get a COVID-19 test, how long they should quarantine and if masks would protect them, and they’d tell her she was doing a great job.
“I love taking care of people, and I love making their lives better,” said Thomas of Bluffdale. “And I love reassuring scared people and letting them know it’s going to be OK.”
But the thank-yous are rarer now. In their place, Thomas has been hearing a lot of yelling, by people angry their surgeries had to get postponed amid a COVID-19 surge or mad that she’s encouraging them to get vaccinated.
“I’ve been yelled at and told that I’m part of a conspiracy theory because I’m pushing my Big Pharma vaccines, and how do I enjoy those paychecks?” she says. “And I’m like, I shop at WinCo, what are you talking about?”
Thomas said her plan has always been to keep working as a nurse “until I’m 90.” At this point, though, she said she’s close to giving up. She’s tired of living a split life, one of them as a nurse immersed in people’s anger and terror and another out in a world that seems oblivious to the pandemic.
“I don’t know that I can do it,” she said. “And I’m tired of getting yelled at. Really tired of being yelled at.”
‘We’ve never seen this’
David Gessel, executive vice president at the Utah Hospital Association, said health care workers absorbed the initial waves of COVID-19 last year buoyed by the hope that a vaccine was on its way to end the pandemic.
Now — between the disease’s resurgence among the unvaccinated, antagonism from some segments of the population and exhaustion — hospitals around the state have been losing employees, he said.
Registered nurse Krishna Shove of Payson said those departures represent a huge loss of institutional knowledge and career experience.
“When you or your family member is crashing and nearly dying, there is a big difference between having an experienced nurse versus having a brand-new nurse that has been out of school for a month,” she said.
Many of the veteran health care workers who remain “have developed PTSD, depression, anxiety and just overall horrible mental health” because of the pandemic-induced stress and hostility from those influenced by misinformation about COVID-19.
The Taylorsville respiratory therapist interviewed by the Tribune said health care workers at her hospital joke about leaving their stressful medical jobs and getting hired together at a Ross Dress for Less.
“One wants to work in a fitting room, one wants to be the door greeter, one wants to be a cashier,” she says.
She’s been threatened with legal action from a patient who was demanding ivermectin, while others have gotten so mad they tried to use their phones to video record everything the respiratory therapist was doing.
Spendlove’s proposal, which would broaden the criminal penalty enhancements for assaulting health care workers, wouldn’t address all of these situations. But Gessel said he hopes it would act as a deterrent to the wave of violence against front-line employees.
“I don’t want to oversell it like it’s happening every day in every hospital. ... But it’s an uptick. I’ve been doing this 26 years,” he said. “We’ve never seen this.”
Spendlove, R-Sandy, presented his legislation to fellow legislators on Wednesday, joined by hospital representatives, the Utah Medical Association and the Utah Academy of Family Physicians, whose executive director said they’d seen a “significant and disturbing increase in aggression towards our health care workers.”
Maryann Martindale, the academy’s executive director, said one physician recently told her about a patient who’d thrown a stapler at a nurse, who was barely able to dodge it. A representative of St. George Regional Hospital said patients are striking providers in the head and face, pushing them and spitting on them.
“I hope that we can act with a sense of urgency,” said Mitchell Cloward of the St. George hospital. “To show our caregivers that we have their back.”
With votes of opposition from two state senators, the Legislature’s Health and Human Services Interim Committee declined to put its collective support behind the drafted bill. Spendlove can still advance the legislation as an individual lawmaker.
Jenelle Waite, a respiratory therapist, estimates she’s intubated about 50 people during the pandemic as a final resort, after maxed-out oxygen levels are no longer enough to sustain a patient.
Treating someone who’s in respiratory distress with COVID-19 feels like watching a “slow-moving train wreck,” as the person’s decline starts to feel like it moves with an inevitable force.
That’s even more challenging because she and her colleagues at times have difficulty getting some patients to cooperate with basic care, she said, adding that some people refuse even to lie on their stomachs to help maximize the oxygen levels in their bloodstream.
“It seems like such a simple thing to do, but patients are very hesitant to do that,” the Woods Cross resident said.
More extreme are the patients who refuse to accept they have coronavirus at all or who demand to leave the hospital even though they’re dependent on oxygen. Waite has to tell them it would be unsafe to send them home — and that they probably wouldn’t make it far out the hospital’s front door.
Patients or families have sworn at Waite, resisted health precautions and visitation rules and even been “borderline verbally abusive” to her and her co-workers.
Shove said in one case, a COVID-denying patient and spouse even banned hospital caretakers from their room because they were upset about the medical treatment they were getting. Health care workers couldn’t touch any of the drips or the BiPAP breathing machine “until it was too late and we had to code the patient,” she said.
The person died, Shove said.
Patients in droves have arrived demanding “Facebook cures,” she added. There have been requests for ivermectin, people who wanted to inhale nebulized hydrogen peroxide — and a patient who asked for an intravenous infusion of bleach, she said.
“For obvious reasons,” she said, “these are all incredibly unsafe and not a good idea.”
Each of those supposed coronavirus therapies has blossomed on the internet and in social media, even as medical experts warn they’re dangerous with no proven efficacy against COVID-19. But health care workers say people are often too entrenched in their misinformed beliefs to hear sound medical advice.
“Oftentimes it gets patients really upset, feeling that because we’re declining that medicine, we’re trying to kill them,” Wing of Park City Hospital said. “We’ve even had patients who have left hospitals against medical advice because we declined to give them that medicine, and then they went home and died.”
COVID-19 patients have also pushed away life-sustaining oxygen, he said, and pulled IVs out of their own arms because they don’t trust their medical providers.
Intensive care unit nurse Christine Toone said the hostility and skepticism toward health care workers feels to her “like betrayal.”
Year after year, polls say nursing is among the most trusted professions. Somehow, without any reason she can understand, all that trust seems to have evaporated. Now, patients are acting as if a few hours of internet research or a dive into conspiracy theories on Facebook outweighs years of medical education and training.
And at this point, Toone — a Sandy resident who left her Utah-based hospital job during the pandemic and is now a traveling nurse — is worn out.
“The despair when patients realize the ‘facts’ they were led to believe are untrue is devastating,” she said.
Still, Wolf takes comfort from the fact that showing up in a hospital at all means a person still has a sliver of trust for health care. The people she’s most worried about, she says, are the ones she never sees.