As published in Columbia Journalism

Family Ties in Intensive Care Nursing

Marissa Guiang

Dan Houchins had the day off from work, but quickly came to the hospital when his brother called. There was urgency in his voice. It was early March and the COVID-19 pandemic was just on the cusp of an explosion. As an intensive care unit nurse, Houchins, 28, was accustomed to high-pressure medical situations, but didn’t grasp the magnitude of what was to come.

“My brother called me from inside the hospital and said, ‘I need to meet with you, I have something for you,” Houchins said.

Unsure of what his brother needed to give him, Houchins rushed to meet him on the 7th floor of the hospital.

“You’re gonna need this,” his brother said, motioning to a large cardboard box on the floor. His brother then bent down, took out a big dual-pan respirator with two cans, and handed it over. Houchins inspected the device — it reminded him of the type of gas masks seen in war movies.

“Things are gonna get really bad in the next few months,” his brother said as he picked up the box, carrying an extra respirator to their sister who was working on another floor.

“When he handed me that mask, it really hit me. That was the moment I knew,” Houchins said. That same week, the University of Chicago Medical Center, one of the largest hospitals in Illinois with over 800 beds, transformed into a giant COVID-19 ICU. This was where Houchins and his siblings worked and battled the pandemic from the frontlines.

Houchins comes from a family of nurses. Not only are his brother and sister nurses, his parents also have nursing backgrounds. Now, Houchins’ father is the director of women and children’s health at Northwest Community Hospital, while his mother is the director of infection control at the Joint Commission, the nation’s largest standards and accreditation organization in health care. To round out an all-star family on the frontlines, Houchins’ younger brother is in nursing school at Loyola University Chicago.

Each member of the family was taking on the pandemic head-on on a daily basis. Alongside Houchins, they understood the pressures of being a nurse as hospital beds, personal protective equipment, and other medical resources became scarce. There was only one unit at Houchins’ hospital that was designated for non-COVID patients, and that was the cardiac ICU — his unit.

Starting in mid-March, every uninfected patient got reassigned to Houchins’ unit.

“All these different patients automatically came to us — neuro, bad bleeders, gunshot wounds, trauma. All these people my ICU unit doesn’t normally take,” he said.
Everyday, the cardiac ICU’s 32 beds were at capacity and the unit was bursting at its seams.

“Someone would die, we’d quickly clean up the room, and then in 15 minutes, a new person was in there,” he said.

Houchins remembered the period between May and October 2020 being the hardest his unit has ever had to work.

Houchins started his nursing career in the impatient cardiology unit at the University of Chicago Medical Center. But down the sterile, brightly fluorescent-lit hallway was the unit he yearned to work for: the cardiac ICU. With 32 beds and 120 nurses on staff, it’s the largest unit at the medical center and is known for its intensity.

After networking with other people in the cardiac ICU, going through multiple rounds of interviews, and ultimately proving himself with the work he did with his first unit, Houchins became a newly minted, 26-year-old ICU nurse in 2019.

The learning curve was steep, going from impatient care to ICU care. It took Houchins several months to learn the ropes from fellow nurses, but only so much training and technical repetition could prepare him for what his day-to-day work life would be for the next few years.

“You deal with a lot of death,” said Houchins. “I didn’t see much death prior to the ICU, and there’s no preparation for it in school. It’s just something you learn on the job.”

Houchins’ experience in the cardiac ICU ranges from peaceful monitoring of transitions, which is the unit’s word for death, to highly-stressful life-or-death situations. The latter is most common when the hospital has a code, the term for when a patient is in need of resuscitation efforts.
“A bunch of people come to the room and it gets pretty messy,” said Houchins. “And it can last for hours. You get ’em back and then they die again — it’s just on and off.”

After a code, he can sometimes be covered in sweat, blood, and other bodily fluids. “It can be crushing,” said Houchins. “But you have to accept that these things are part of your job.”

With a broad build and thick beard, Houchins gives off a tough presence. But like any other guy in his twenties, his Facebook photos show him having fun at parties and music festivals, surrounded by dozens of friends. He has a big smile and often makes silly faces at the camera.

Houchins grew up in Tinley Park, a south suburb of Chicago about 30 minutes from the city by car. After finishing high school, he moved to Peoria, Illinois to attend Bradley University, where a majority of his coursework was in business.

Houchins said his parents were supportive of him paving a different path for himself. But, in addition to being constantly exposed to his family’s experiences as nurses, Houchins credits his best friend and former roommate for his eventual interest in nursing. He eventually left Bradley University and enrolled at Chamberlain College of Nursing.

But just a few years after making that pivot, Houchins experienced a loss that shook him.

“My best friend, the one who got me onto this path to nursing, he died,” he said. The cause of death was an overdose of fentanyl, a synthetic opioid pain medication that can be up to a hundred-times more potent than morphine. Houchins’ friend was taking drugs from the hospital and used them for himself.

“After that happened, I had a really hard time giving my patients fentanyl at work,” said Houchins. “It just got to be too much, so I decided to go to therapy.”

Forming a barrier between work life and personal life can be very difficult at times. Houchins, as much as he tries to form that barrier, admits that it’s an ongoing challenge to keep the two separated, especially since statistically, someone dies in the cardiac ICU in his hospital every day, even in non-pandemic conditions.

“When I first started in the ICU, of course it was tough. But even now, nearly two years later, it’s still tough,” admits Houchins.

As much as working in the ICU is about saving lives, it’s also about letting life end in the best way possible. While saving lives is what Houchins strives to do in his career, he also says that being an ICU nurse is also about knowing when to let go of life.

“You go in there, you’re all gowned up, and you’re sweating your ass off the whole time, but you hold their hand and be there for them,” said Houchins. “You share that very moment together, right before death.”

The dying process in the ICU is standardized. The patient is usually hooked onto a morphine or fentanyl drip to reduce pain and increase sedation so that they aren’t gasping for air while they’re dying. Once the patient is no longer living, nurses pull out any old IVs, clean the body, and place the deceased in a body bag.

“I go through the motions once there’s no longer a pulse,” said Houchins. “But the dying process itself can take hours, even days. That’s when I really need to be there for the patient.”

And being there for the patient also means being there for the family.

“People deal with death differently, and oftentimes they don’t deal with it well, especially if they don’t understand what’s going on,” said Houchins. “Sometimes the best type of communication is allowing for silence, space, and processing. You have to know how to read the room.”

During the height of COVID in 2020, hospitals across the country had strict rules around visitors to protect patients, families, and hospital staff. At times, Houchins had to let his patients borrow his personal cell phone so that they could call their family members to say their goodbyes.

No one was an exception to those rules at the medical center. Last year, Houchins found himself in a situation where his own aunt was in the ICU, and his brother wouldn’t allow an exception for their own family.

“My brother’s decision was a testament that everyone has to do things they’re uncomfortable with in the ICU,” said Houchins. “Even when they don’t want to.”

While his aunt was not his officially assigned patient, Houchins assisted with her ICU care throughout her time in the hospital. He also served as her next of kin and was in charge of making end of life decisions on behalf of his aunt.

Despite his siblings working at the same hospital and his parents being within close geographic proximity, Houchins and his aunt’s son were the only relatives who were able to see his aunt before she died.

While the visitor rules in the hospital were not ideal due to the pandemic, Houchins and his family were still able to find some peace in an otherwise difficult situation. “I’m honestly kind of blessed that I had the privilege to take care of my aunt like that,” he said.

Through his experience in the ICU, Houchins has found a certain level of acceptance and comfort when it comes to “transitioning” a patient. To him, the decision to move from life-saving mode to comfort mode is when the care team has thoroughly exhausted all available options and resources.

“Dying doesn’t have to be this horrible, miserable thing,” said Houchins. “What’s worse is continuing to keep someone alive who shouldn’t be.”

At times, Houchins questions his decision to pursue such a career path.

“On a pretty regular basis, everyone in the ICU probably asks themselves, ‘Why the hell do we do this?’” said Houchins.

But every time he questions his career path, he remembers, “When I take a step back and see other people filling little juice cups, I’m reminded why I’m not doing that. I didn’t become a nurse to hand out juice.”

Houchins doesn’t intend to stay in the ICU for the rest of his career. His plan was always to do just five years in the ICU, two of which are already behind him. After he hits his 5-year mark, he aspires to either become a clinical support specialist or go back to school to become a certified registered nurse anesthetist.

While the work Houchins does is emotionally difficult as it is physically exhausting, what he’s gained from ICU nursing at the University of Chicago Medical Center is what he refers to as a type of fraternity — a brotherhood.

“We’re all suffering together in a weird way. It’s a tough job, but we’re really doing it together,” said Houchins. “It’s that unity that keeps a lot of us around.”
He says it’s hard for people outside of that circle to understand what ICU nurses go through on a regular basis.

“I often have friends who’ll text me, saying, ‘Hey how was work?’” Houchins said. He immediately has flashbacks of being covered in a patient’s blood or calling security on a patient’s family member after they’ve gotten violent towards staff, out of grief.

As someone who lives by himself, Houchins comes back to an empty apartment after a tough shift at work, day after day. But while he might be alone, he still has his family who knows what it’s like — just a text, phone call, or short drive away.

“They understand what I’m feeling and talking about, even if I don’t say much,” he said.

And that understanding is oftentimes all he needs.