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All the little trivialities

  • Published at 05:52 pm May 6th, 2020
Nurse covid-19 stress
Photo: REUTERS

An ICU nurse’s account of what it’s like to really fight Covid-19 every single day

Long, arduous journeys have begun with a small step. This is the time in our lives to share our discomforts, meditate, and seek forgiveness. I am sharing a disturbing account of a friend, who wants to remain anonymous. 

I will refer to her as “Ken” -- a nurse on duty at a hospital in New York. She shares her experiences of the “trivialities” of our lives.

Another day in the ICU

Yesterday, like many other days lately, I couldn’t fix my patient. Sure, that happens all the time in the ICU. It definitely wasn’t the first time. It certainly won’t be the last. What makes this patient noteworthy? 

A few things, actually. He was infected with Covid-19, and he will lose his battle with Covid-19. He is only 23 years old. I was destroyed by his clinical course in a way that has only happened a few times in my nursing career. 

It wasn’t his presentation. I’ve seen that before. It wasn’t his complications. I’ve seen that too. It was the grief. It was his parents. The grief I witnessed yesterday was grief that I haven’t allowed myself to recognize since this runaway train got rolling here in early March. I could sense it. It was lingering in the periphery of my mind, but yesterday something in me gave way, and that grief rushed in.

I think I was struck by a lot of emotions and realities yesterday. Emotions that have been brewing for weeks, and realities that I have been stifling because I had to in order to do my job effectively. My therapist tells me weekly via Facetime that it’s impossible to process trauma when the trauma is still occurring. 

It just keeps building. I get home from work, take my trusty companion Apollo immediately out to pee, he’s been home for 14 hours at a time. I have to keep my dog walker safe. No one can come into my apartment. I’ve already been very sick from my work exposure, and I’m heavily exposed every day that I work since I returned after being 72 hours afebrile, the new standard for health care workers. That was after a week of running a fever of 104 even with Tylenol around the clock, but thankfully without respiratory symptoms. I was lucky.

Like every other health care worker on the planet right now, I strip inside the door, throw all the scrubs in the wash, bleach wipe all of my every day carry supplies; shoes and work bag stay at the bottom of the stairs. You see, there’s a descending level of Covid-19 contamination as you ascend the stairs just inside my apartment door. 

Work bag and shoes stay at the bottom. Dog walking shoes next step up, then dog leash, then running shoes.

I dodge my excited and doofy German Shepherd, who is bringing me every toy he has to play with, and I go and scald myself for 20 minutes in a hot shower. Washing off the germs, metaphorically washing off the weight of the day. 

We play fetch after the shower. Once he’s tired, I lay on the floor with him, holding him tight, until I’m ready to get up and eat, but sometimes I just go straight to bed.

Quite honestly, I’m so tired of the death. With three days off from what has been two months of literal hell on earth as a Covid-19 ICU nurse in NYC, I’m having an evening glass of wine, and munching on the twizzlers my dear aunt sent me from Upstate NY, while my dog is bouncing off the walls because I still don’t have the energy to run every day with him. 

Is it the residual effects of the virus? Is it just general exhaustion from working three days in a row? Regardless, the thoughts are finally bleeding out of my mind and into a medium that I’m not sure could possibly convey the reality of this experience.

There’s been a significant change in how we approach the critically ill Covid-infected patients on a number of different levels over the last two months. We’re learning about the virus. We’re following trends and patterns. We are researching as we are treating. The reality is, the people who get sick later in this pandemic will have a better chance for survival. Yet, every day, working feels like Groundhog Day. 

All of the patients have developed the same issues. This 23-year-old kid walked around for a week silently hypoxic and silently dying. By the time he got to us, it was already far too late.

It’s like fire

A lot of people have asked me what it’s like here. I truly don’t have adequate descriptors in my vocabulary, try as I might, so I’ll defer to the metaphor of fire. We are attempting to put out one fire, while three more are cropping up. 

Then we find out a week or two later that we unknowingly threw gasoline on one fire, because there’s still so much we don’t know about this virus. Then suddenly there’s no water to fight the fire with. Oh yeah, and the entire time you’ve been in this burning building, you barely have what you need to protect yourself. 

The protection you’re using, the guidelines governing that protection, evolved with the surge. One-time use N95?

That’s the prior standard, and after what we’ve been through, that’s honestly hysterical. As we were surging here, the CDC revised their guidelines, because the PPE shortage was so critical. Use anything, they said. Use whatever you have for as long as you can, and improvise what you don’t have.

Decisions can kill

One routine suction pass down the breathing tube could kill someone, or leave their body and vital organs hypoxic for hours after. Well, now they’re plugged. We are then faced with a choice. 

Both choices place the respiratory therapists, nurses, and doctors at extremely high risk for aerosolized exposure. We could exchange the breathing tube, but that could take too long, the patient may die in the 2-3 minutes we need to assemble the supplies and manpower needed, and it’s one of the highest-risk procedures for our providers that we could possibly carry out. 

Or we could use the clamps that have been the best addition to my every day carry nursing arsenal. You yell for help, you’re alone in the room. Your friends and coworkers, respiratory therapists, doctors, are all rushing to get their PPE on and get into the room to help. You move around the room cluttered with machines and life sustaining therapies to set up what you need to stave off death. You move deliberately, and you move FAST.

The patient is decompensating in the now-familiar and coordinated effort to intervene. Attach the ambu bag to wall oxygen. Turn it all the way up. Where’s the PEEP valve? God, someone go grab me the PEEP valve off the ambu bag in room 11 next door. We ran out of those a month ago, too. 

Their heart rate is slowing. Their blood pressure is tanking. Max all your drips, then watch and wait while this patient takes three hours to recover to a measly oxygen saturation of 82%, the best you’ll get from them all shift. These patients have no pulmonary reserve. All of our choices to intervene in this situation risk our own health and safety. In the beginning we were more cautious with ourselves. We don’t want to get sick. We don’t want to be a patient in our own ICU. We’ve cared for our own staff in our ICUs.

We don’t want to die. Now? I’ve already been sick. I am so, so tired of the constant death that is the ICU, that personally, I will do anything as long as I have my weeks old N95 and face shield on, just to keep someone alive.

I’ve realized that for many of these patients in the ICU, it won’t matter what I do. It won’t matter how hard I work, though I’ll still work like a crazy person all day, aggressively advocate for my patients in the same way.

My co-workers will go without meals, even though they’re being donated and delivered by people who love and support you. Generous people are helping to keep local restaurants afloat. We can always take the meal home for dinner, or I can devour a slice of pizza as I walk out to my truck parked on the pier, a walk I look forward to every day, because it gives me about eight minutes of silence. To process. To reflect. I’ll chug a Gatorade when I start feeling lightheaded and I’m seeing stars, immediately after I just pushed an amp of bicarb on a patient and I know I have at least five minutes of a stable blood pressure to step out of the unit, take off my mask and actually breathe. 

Nurses in procedural areas that were closed have been repurposed to work as runners. To run for supplies while the primary nurse is in an isolation room trying to stabilize a patient without the supplies they need, runners to run for blood transfusions. Physical therapists, occupational therapists, speech and language pathologists being repurposed to be part of the proning teams that helps the nurses turn patients onto their backs and bellies amidst a tangled web of critical lines and tubes, where one small error could mean death for the patient, and exposure for all staff.

Anesthesiologists and residents are managing airways and lines when carrying out these massive patient position changes. Surgical residents are all over the hospital just to put in the critical invasive lines we need in all of our patients.

The travel nurses who rushed into this burning building to help us are easing a health care system. The first travel nurse I met came all the way from Texas. Others terminated their steady employment to enlist with a travel agency to help us. Every day there are more travellers arriving. 

A nurse from LA came to me after she found out I was part of the home staff, in my home unit, where this all first started in my hospital what feels like a lifetime ago, and said, “I came here for you. For all of the nurses. Because I couldn’t imagine working the way you guys were working for how long you were working like that.”

During our surge and peak in the ICU, we were 1:3 ratios with three patients who normally would be a 1:1 assignment. And they were all trying to die at the same time. We were having to choose which patients we were rushing to because we couldn’t help them all at the same time. 

The overhead pages for emergencies throughout the hospital rang out and echoed endlessly. Every minute, another rapid response call. Another anesthesia page for an intubation. Another cardiopulmonary arrest. A hospital bursting at the seams with death. Refrigerated trailers being filled. First it was our normal white body bags. Then orange disaster bags. We ran out of those too. Now, blue tarp bags.

The heartbreakingly unique part of this pandemic, is that these patients are so alone. We are here, but they are suffering alone, with no familiar face or voice. They are dying alone, surrounded by strangers crying into their own masks, trying not to let our precious N95 get wet, trying not to touch our faces with contaminated hands. Their families are home, waiting for the phone call with their daily update. Some of their loved ones are also sick and quarantined at home.

Can you even imagine? Your husband or wife, mother or father. Sibling. Your child. You drop your loved one off at the emergency department entrance, and you never, ever see them alive again. Families are home, getting phone calls every day that they’re getting worse. Or maybe they’re getting better. 

Unfortunately, the ICU in what has quickly become the global epicentre for this pandemic is not a happy place. We are mostly purgatory where I work, so this snapshot may be more morbid than most.

But these people are saying goodbye to their loved ones, while they’re still walking and talking, and then maybe a week or two later, they’re just gone. It’s like they disappeared into thin air. 

God, if they can’t afford a funeral with an economic shutdown, their loved one will be buried in a mass grave on Hart Island with thousands of others like them.

Yesterday, I was preparing for a bedside endoscopy procedure to secure a catastrophic GI bleed in this 23-year-old patient. 

It was a bleed that required a massive transfusion protocol where the blood bank releases coolers of uncrossmatched O negative blood in an emergency, an overhead page that, ironically, I heard as I was getting into the elevator to head to the fourth floor for my shift yesterday morning; a massive transfusion protocol that I found out I would own as a primary nurse, as I desperately squeezed liters of IV fluids into this patient until we got the cooler full of blood products, and then pumped this patient full of units of blood until we could intervene with endoscopy.

Before the procedure, I stopped everything I was doing that wasn’t life-sustaining. I stopped gathering supplies to start and assist with the procedure. I told the doctors that I would not do a required “time-out” procedure until I got my phone out, and I Facetimed this kid’s mom because I didn’t think he would survive the bedside procedure. She cried. She wailed. She begged her son to open his eyes, to breathe. She begged me to help her.

Ayudame. Ayudame. She begged me to help him. She sang to him. She told him he was strong. She told him how much she loved him. I listened to her heart breaking in real time while she talked to her son, while she saw his swollen face, her baby boy, dying before her eyes through a phone.

Later in the day, after the procedure, his mom and dad came to the hospital. He survived the securement of the bleed, but he was still getting worse no matter what we did. He’s going to die. And against policy, we fought to get them up to see their son. We found them masks and gowns that we’re still rationing in the hospital, and we let his parents see him, hold him. We let them be with their son. Like every other nurse would do in the ICU here, I bounced around the room, moving mom from one side of the bed to the other and back again, so I could do what I needed to do, setting up my continuous dialysis machine, with the ONE filter that supply sent up for my use to initiate dialysis therapy.

This spaceship-like machine, finicky as all hell, and I had one shot to prime this machine successfully to start dialysis therapy to try to slowly correct the metabolic acidosis that was just ONE of the problems that was killing him as his blood pressure lingered in the 70s. Continuous dialysis started. You press start and hold your breath. You’re not removing any fluid, just filtering the blood, but even the tiniest of fluid shifts in this patient could kill him.

You have no choice

His vital signs started to look concerning. I could feel the dread in the pit of my stomach, this was going south very quickly. Another nurse and the patient’s father had to physically drag his mother out of the room so we could fill the room with the brains and eyes and hands that would keep this boy alive for another hour. She wailed in the hallway. Nurses in the next unit down the hall heard her cries through two sets of closed fire doors. We worked furiously to stabilize him for the next four hours.

This is one patient. One patient, in one ICU, in one hospital, in one city, in one country, on a planet being ravaged by a virus. This is the tiniest, devastating snapshot of one patient and one family and their unimaginable grief. Yet, the weight is enormous. The world should feel that weight too. Because this grief, this heartbreak is everywhere in many forms. Every person on this planet is grieving the loss of something. Whether that’s freedom or autonomy sacrificed for the greater good. Whether that’s a paycheck or a business, or their livelihood, or maybe they’re grieving the loss of a loved one while still fighting to earn a paycheck, or waiting for government financial relief that they don’t know for certain will come.

Everyone is grieving. We’ve heard plenty of the public’s grief. I don’t blame anyone for how they’re coping with that grief, even if it frustrates the ever-living hell out of me as I drown in death every day at work. It’s all valid. 

Everyone’s grief is different, but it doesn’t change the discomfort, the despair on various levels. We are at the bottom of Maslow’s hierarchy of needs. Basic survival, physiological and safety needs. I’ve been here before. I know this feeling. How we survive is how we survive. 

But now that I’ve had the time to reflect and write, now that I’ve let the walls down in my mind to let the grief flood in, now that I’ve seen this grief for what feels like the thousandth time since the first week of March as a nurse in a Covid ICU in New York City, it’s time you heard our side. This is devastating. This is our reality. This is our grief.

Do we need to hide our grief, or share this? 

Nazarul Islam is an educator based in Chicago.

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