By Léo Azambuja
The fight against COVID-19 is far from over, with the virus continuing to kill indiscriminately and to throw communities into financial chaos. For those who fall ill, there is no knight in shining armor to save them. But there are knights, real knights without armors. They wear scrubs.
“From a very young age, I understood that physically caring for people during their most vulnerable moments was incredibly important work,” said Kaitlyn Issler, a board-certified registered nurse and family nurse practitioner. Her mother was a hospital pharmacist, and as a child, Issler would often visit her at work during dinner break. “I knew I wanted to work in healthcare from a young age.”
Issler has been a nurse for eight years, and is currently an emergency room nurse and a Life Flight nurse. She also works on elective surgeries, but those types of procedures are on the backburner during the pandemic.
Asia Kellerman has also been a nurse for eight years. She is currently working at Mahelona Hospital in Kapa‘a, but she also works as needed at Kaua‘i Veterans Memorial Hospital in Waimea and Wilcox in Lihu‘e. Like many nurses on Kaua‘i, she has been doing overtime during the pandemic.
“I’m not scared of myself becoming infected but of bringing it home to my family,” said Kellerman, adding she also has a “huge fear” of spreading the virus to the community. The pandemic, she said, is affecting her in many ways, including straining her family life. But she is still working for a reason. “I just feel obligated out of my love for the community I serve.”
Kellerman said the most gratifying thing in her career is resuscitating someone, and then seeing them reach out to thank her. “It doesn’t happen often, but that is when I truly feel I have made a difference.”
Virginia Beck joined the very first registered nursing program at Kaua‘i Community College, graduating in 1975.
“I always wanted to help people. My mother was paramedic on the ambulances in London during the blitz in World War II. It went on for months,” Beck said. “Horrific fires, millions of homes destroyed, millions killed. Such raw courage.”
In 1989, Beck moved to California for work, and stayed there for nine years. During that time, she earned her women’s health nurse practitioner’s degree at San Jose State University. Back on Kaua‘i, Beck worked at Kaua‘i Veterans Memorial Hospital in Waimea, pioneering a women’s health program. Together with a group of five providers, she helped to build the Family Birthing Center an OB department in the Westside. She retired in 2015, but continues to do some private wellness consulting and Trager® body movement practice.
“It was fun being one of the first women’s health nurse practitioners on Kaua‘i, and we wrote a family planning grant so we could do reproductive health for teens. This was super gratifying,” Beck said.
The history of nursing on Kaua‘i goes back more than a century, and there is a little bit of defiance in it. Mabel Wilcox wanted to be a nurse, but her father, Samuel Whitney Wilcox — a wealthy sugar planter and Kaua‘i’s sheriff for 25 years — didn’t want such an unladylike career for his daughter. He eventually agreed that if she still wanted to become a nurse when she turned 25, she would then be allowed to attend nursing school. Mabel Wilcox did just that; and became a pioneer at it. In 1911, she became the first Hawaiian to graduate as a registered nurse from the prestigious Johns Hopkins School of Nursing in Baltimore, Md.
When World War I broke out, Wilcox served as a head nurse for the American Red Cross in Europe. She spent a year and a half in France and Belgium, often putting herself in harm’s way. In recognition of her services, she received medals from Elizabeth of Bavaria, queen of Belgium, and from the mayor of Le Havre in France.
Wilcox returned to Kaua‘i in 1915 to work for the Territorial Board of Health. She founded the Tuberculosis and Health Association and also the Kaua‘i Nurses Association. She was also instrumental in raising funds and securing land for the Samuel Mahelona Memorial Hospital in Kapa‘a. The hospital first opened in 1917, as gift from her uncle Albert Spencer Wilcox and his wife Emma Mahelona to the county of Kaua‘i. Samuel Mahelona, Emma Mahelona’s son from her first marriage, died in 1912 from tuberculosis. The hospital was one of many public health projects initiated by Emma Mahelona.
Mabel Wilcox passed away on Dec. 28, 1978. Her house in Lihu‘e is now a museum administered by the nonprofit Waioli Corporation. As fate would turn out, Wilcox, at the end of her life, would meet Beck, at the beginning of her career. Between 1976 and 1977, Beck took a job caring for Wilcox whenever her main caretaker needed a break. Beck got to know Wilcox better, and still remembers her as an amazing woman.
While Beck has already retired, after nearly 40 years of service to the community, Issler and Kellerman are still part of the many nurses still putting their lives on the line day in and day out, with barely a day off.
“I have gone through flu seasons, numerous tuberculosis exposures, verbal and physical assault on the job, etc. This is what we sign up for as healthcare workers — the good, the bad, and the ugly,” Issler said.
Kellerman said her daily procedures at work start with a screening process as soon as she enters the hospital. It includes hand hygiene, temperature checks and screening questions.
“Then we report to our designated department and don hospital provided scrubs and hospital provided PPE. Then patient care and copious, copious, hand washing,” Kellerman said.
Aside from additional measures to avoid COVID-19 contamination, Issler said her job is never boring, as every day is different, whether it’s in the ER, at flight nursing or even at surgical recovery. But she also fears becoming infected with the virus.
“I feel like the only way to cope for me is to manipulate the variables I can actually control. I try to eat as healthy as possible, exercise and get proper rest — all things I believe significantly strengthen my immune system,” Issler said.
As a young girl, Beck lived in Pakistan, and said she was surrounded by every disease known to man in refugee camps with millions of people.
“Once you have seen the devastation of leprosy, smallpox, typhoid, cholera, tetanus, chronic malnutrition from diarrheal, illnesses killing babies and toddlers, the reality of how harsh the world is never leaves you,” Beck said.
Her family was vaccinated against everything, but her mother still caught a wild polio virus. It was in Pakistan, she said, that she learned the life-saving benefits of hygiene and boiled water to keep disease away.
“Our medical surgical nursing instructor had spent a lot of time in South America, and the core of her teaching is that Florence Nightingale basically brought hygiene and cleanliness to health care,” said Beck, adding that washing, cleaning and sterilizing saved the lives of thousands of injured military and civilians.
Across the world, communities are quickly running out of hospital beds to care for the critically ill. Kellerman said her worst fear at work would be not having enough ventilators for those who really need it in case the number of patients increase dramatically.
“We are such a small island with such limited resources. It is vital that we all make good choices right now,” Kellerman said regarding measures to avoid spread of the virus.
Issler agrees, saying her worst fear at work is a scenario compared to what health practitioners call Mass Casualty Incident.
“This is where we must decide who receives life-saving interventions based on their realistic chances of survival. This fear, as it relates to the pandemic, would be having to ration these lifesaving interventions due to the demand outpacing the supply of equipment and adequately trained staff. Especially here on Kaua’i, I am acutely aware of how quickly resources can run out,” Issler said.
Thankfully, Kaua‘i’s leadership has adopted decisions early on that might have been seen as unpopular, but have also spared the island from full-scale contamination. At the time of this writing, there had been only 21 confirmed cases of COVID-19 on the island, and all have already recovered or returned to the Mainland.
Beck credited our success to “three saving graces,” the ocean that isolates us, Mayor Derek Kawakami’s astute leadership in making tough decisions to keep us safe, and the aloha of Kaua‘i’s ‘ohana.
Issler said she believes the most important measure was the travel restrictions, followed by social distancing. She said that perhaps the single scariest characteristic of COVID-19 is its ability to spread from an asymptomatic carrier.
“I know it seems silly to avoid your friends and family who are seemingly well, but assuming someone is well could be the one mistake that leads to an outbreak,” Issler said.
Kellerman said she is really proud to be a part of this community.
“The working-class people have come together in such powerful ways,” said Kellerman, adding the census in all ERs has been down, meaning people are empowering themselves and staying informed on CDC guidelines to stay home, unless they have a true emergency. Additionally, many masks have been generously handmade and donated throughout the community.
“Our numbers have stayed low and controlled due to the people of this island working together,” Kellerman said. “I am so grateful for their strength, intelligence and aloha.”
When the pandemic is over, we will likely have learned more on how to deal with pandemics, including prevention and education.
“I don’t remember any training for something like this in school,” said Kellerman. However, in her first ER job she practiced twice a year for mass casualty and biological warfare. Additionally, having been through the Ebola outbreak years ago, she said she feels knowledgeable on how to handle something like this. “I definitely think nursing students should have at least one drill where they practice care on mass casualty and biological warfare.”
Issler said she was lucky to do a clinical rotation with the department of health at Salt Lake City, Utah when the H1N1 pandemic was still fresh in people’s memories.
“My clinical instructor was part of a task force that regularly met to assess and mitigate the risks related to another possible outbreak,” Issler said. “Didactic classes taught the history of several specific pandemics, especially those eradicated by vaccines.”
Still, she says it’s hard to have imagined even four months ago that what is going on right now could have ever happened. Going forward, Issler said she doesn’t think nursing schools can avoid incorporating pandemic history into their curriculum.
“Pandemics have shaped so much of how we care for patients — from universal precautions following the HIV/AIDS pandemic to the importance of vaccines like those which eradicated viruses entirely from the human population like smallpox,” Issler said.
Unfortunately, pandemic preparedness is hard to teach, she said. Teaching preparedness to fight an unknown pathogen and clinical disease course seems nearly impossible. There are task forces around the world that dedicate their work to emerging infectious diseases, but it is still impossible to completely prevent new pathogens from infecting humans or mutating into different pathogens.
Issler said losing a patient unexpectedly is the hardest part of her job, and it takes a lot of mental work to avoid getting emotionally detached or burnt out while dealing with death on a recurrent basis.
“It is easy to become consumed with the idea of death and dying, or even feeling responsible for it. Everyone’s coping strategies are completely different but mine include being outdoors and exercise to keep my mind healthy,” Issler said.
She thinks this pandemic has affected every healthcare worker mentally. There is the fear of becoming infected and infecting others, the fear that healthcare employers do not value the lives of their employees as far as rationing and withholding appropriate personal protective equipment, news outlets perpetuating fear and anxiety through attention-grabbing headlines, the list goes on and on, she said.
“With that being said, my heart goes out to all of my old coworkers in New Jersey and New York facing incredible mental, physical and emotional challenges at work every single day. The stories they have shared are absolutely heartbreaking. There is some guilt involved when I think of my friends dealing with the worst of this pandemic head on,” Issler said.
Being of service to people during the absolute worst moments of their lives — and doing this in the small community of Kaua‘i where that feeling of making a difference in someone’s life is profound — is the most gratifying thing about her career, Issler said.
She acknowledges it is hard to keep following strict social distance guidelines, especially when we are not personally affected. During those times, she said, we should consider our fragile healthcare system and think about our most vulnerable population; our kupuna and those with underlying health conditions.
“It’s OK to be scared, angry or sad right now, but take comfort in knowing this will end. Until then, look for the silver linings. Go for the bike ride you never had time for, make those phone calls to friends and family you’ve put off, bake that intricate carrot cake from Pinterest,” Issler said.