I’ve been an ICU nurse for ten years. I’ve worked in many specialties including pulmonary infectious disease, cardiac and trauma. I’ve taken care of the sickest flu patients requiring full cardiopulmonary support. Now I am working in COVID ICU. This is not for the weak.
Part 2 – The patient’s experience with COVID-19
Nurses are told to cluster their care to eliminate exposure to the virus. Some hospitals have placed IV pumps outside the rooms so nurses can manage medications and titrate drips without entering the room. We must remember that minimizing exposure to the virus also minimizes exposure to its host, which is a human being.
Patients infected with COVID-19 are isolated, alone, scared, and feel miserable. They have high fevers. They can’t breathe. Self-proning (the patient laying on their stomachs) has anecdotally shown success in avoiding intubation in COVID-19 patients. This is very uncomfortable for patients, but they do it to avoid a ventilator. They know they are the victim of a global pandemic, and tomorrow is not promised. They are navigating these feelings alone.
One of my favorite things about my job is waking a patient up from being sedated. Many patients on life support don’t have memory of what got them there. Over the days after they wake up, we rehash the event and help them fill in the gaps about what happened. We remind them what day and month it is. Their family, who have been by their side the entire time, reassures them that everything at home is fine and they are so happy they are getting better. Patients with COVID-19 who come off the ventilator, do so alone. I took care of a gentleman who was intubated for 12 days. I took care of him his first night off the ventilator. He had so many questions. “Jen, am I going to live? Should I plan on leaving the hospital?” But I couldn’t be present. My other patient was decompensating fast and needed to be put on a ventilator. I had to choose. It broke my heart to not sit with this patient and reassure him and answer his questions. He had a nice family. They belonged at his bedside reassuring him. I felt like I failed that patient.
Many patients are in the hospital alone, knowing others in their communities also have COVID-19. Many families have several family members infected, spread across multiple hospitals. I took care of a patient who experienced this. She cried our entire shift. She was infected, she had other family members hospitalized, and one had already died. “I’m depressed,” she said over and over. “My spirit is broken.”
I feel horrible when giving phone updates to families. They are scared. The last time they saw their family member was when they dropped them off at the hospital. They aren’t allowed to see their sick family member. If the patient is on a ventilator, they can’t talk on the phone. We are bridging the gap with video conferencing but it isn’t the same as being in the same space as their loved one. When I give updates about a patient who has had a heart attack or stroke, I know exactly what to say. I’ve done it hundreds of times. My words feel empty with COVID-19. I say, “They are responding to therapies exactly how we want them to right now.” That’s all I can do. Will they still be responding in the morning? We don’t know.
Everyone is quarantined. Families have nothing else to do, so they watch horror stories on the news. They search the internet and the media looking for any information they can, any semblance of hope that their loved one won’t succumb to this monster. They belong at the bedside with their families. They belong next to them, in their space, being reassured by seeing them alive, sharing their energy. They are robbed of this. They are asked to limit their calling the unit because we are so busy. When we can’t answer, is it because we are delivering care, or because something is wrong with their family member? Will they see them again? Our reassurance on the phone is so empty. Families need to see and be in the same space as one another. As well meaning as we are, we will never suffice for that closeness.