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.
3 – The nurse’s experience with COVID-19
I’ve never taken such care in getting dressed for work before. I admit, my usual morning (or evening, if working night shift) routine is to roll out of bed, let the dogs out, put on whatever is at the top of the laundry pile, and leave. Now, every decision is painstaking. COVID-19’s biggest threat is the unknown. How long can it live on surfaces? On which surfaces can it live? What about my shoes? Will I infect my family? My pets? We simply don’t know.
Not leaving anything to chance, we are taking every precaution we can think of. I wear a surgical cap. There’s a lot of hairs on my head and that’s a lot of surface area. I wear it over my ears because when it’s behind my ears, some hair is still showing. It hurts my head and my ears and I can’t hear, but it’s better than contracting COVID-19. We wear a N-95 or PAPR on the unit and a surgical mask everywhere else. If I want to leave the unit to eat, use the bathroom, or take a drink of water, I go to a doffing station that is staffed by a safety officer. I wash my hands, remove my N-95, place it in a paper bag, wash my hands again, put on my surgical mask. I go through several doors and hallways to leave the negative pressure area where I can safely eat and drink. I repeat the process in reverse to return to the unit. We are reusing N-95’s, so we wear a surgical mask on top of the N-95. We wear eye protection with a face shield over top of that. The air filters in the room are loud. There is no air movement and the rooms are hot. With the caps over our ears and the air filters, we can’t hear well. With our eye protection, we can’t see well. My eye protection and face shield fog easily with the heat, my sweating, and the streaks from wiping it with sanitation cloths between rooms. With our masks, no one can hear us. Our voices are muffled and we can’t read lips. My throat hurts and my lips are chapped from talking in a raised voice for 12 hours with a dry mouth. We wear isolation gowns that are hot in a room that is already hot with a febrile patient and a hot air filter. We are busy, hot, and dehydrated. It is so time consuming to leave to get water, we often don’t.
There is no downtime in COVID ICU. When you aren’t in a room, you are circulating to help your fellow nurses. When we are in a room, we are in the room. We are told to cluster our care and enter the patient room only when necessary to reduce exposure to the virus. When entering a room, you better have all your supplies. Inevitably, we don’t. We have to enter the room with everything we will need for the next two hours. We just aren’t used to it. We know this, so we circulate. We knock on the windows and ask if our colleagues need anything. We communicate with thumbs-up signs or writing on the window or whiteboard with a dry erase marker. Units have deployed “runners” to run supplies, medications and labs to try to ease the burden on the staff.
The hardest part about COVID-19 is the unknown. As an experienced ICU nurse, I can confidently state how a patient is doing, predict how they will respond to therapies, and give anticipatory guidance to the patient and their families. I can’t do this with COVID-19. The patients who I think will do poorly, get better. The patients I think will do well, don’t. There’s no defined protocol; no predictable course. This is wearing on our nurses. I walked into a COVID ICU shift and another nurse saw that a room was empty and shrieked. The charge nurse ran over, “No! They’re fine! They’re downstairs!” The nurse saw the empty room and thought the patient had died, but really, they had gotten better and moved to a non-ICU unit. This happens often. Patient condition changes so quickly. We don’t know what to expect.
Being a nurse is hard. You are with people during their darkest times. You deliver bad news. You ease pain during disease and death. Over time, you develop a very comfortable relationship with death and suffering. Nurses often say, “The only thing worse than death is a bad death.” This is true. Standing eye to eye with death over the last decade, I have learned to view it as a beautiful part of life. Nurses pride themselves in ensuring comfortable, dignified death. A patient peacefully dying surrounded by loving family is a beautiful thing. We are all robbed of this with COVID-19. Patients are dying alone, saying their goodbyes over an iPad. Dying with a nurse at the bedside is still dying alone. We are strangers. These people need their families. There is nothing dignified about this virus.
We are lucky in Maryland. We have enough beds (barely), and we are maintaining our patient ratios. Through this pandemic, I have never had an unsafe assignment. New York City is another story. I talk to my friends in New York often and they all say the same thing. The volume is just astounding. There aren’t enough nurses. ICU nurses are taking care of 3-5 patients. One told me the hardest part is watching patients die who could have been saved given adequate resources. The morgues are full, so patient’s bodies are being placed into refrigerated trucks in the parking lot. In the United States. In the 21st century. There is no dignity here.
Despite the devastation, we press on. Nurses are really amazing. They draw faces and messages on their masks and shields to make them more personal. They sit with patients longer than they should. They use their personal phones to facetime with families and give updates and reassurance. They bend the rules at end of life because they can’t stand how this virus is robbing us of literally everything. Nursing is about humanity. When nurses need to do right for their patient, they will find a way.
Nurses are fearless. Many of my colleagues have gone back to the bedside even though they didn’t have to. They have jobs. Very comfortable jobs. They knew their colleagues needed help, so they answered the call. When a patient goes into cardiac arrest, staff are mobilizing the way they always did. There is a significant risk during CPR because chest compressions can forcefully mobilize the virus out of the mouth or endotracheal tube. This doesn’t stop the staff. If nothing else, they’ve been moving faster.
We all live with the burden of knowing we could, and possibly already did, contract the virus. Our exposure is very high. Even with proper PPE, the threat is there. Again, the burden lies with the unknown. With a 14-day incubation period, what if I have it right now? Nurse suicides globally have been occurring when nurses learned they had the virus and were transmitting it without knowing. Transmission is so easy. The symptom-free incubation period is so long. We are always wondering. The burden is present in every corner of our lives.
The community support is overwhelming. On behalf of nursing, I thank you from the bottom of our hearts. Every shift I walk into is full of donated food. I don’t know where it all comes from or where it all goes. There is so much food! We don’t always have time to eat it, but it’s made with love, and we appreciate it. One particularly hard shift I was running until 5:00am. I didn’t eat or drink or use the restroom. There was a plate of cookies that I ran past and just shoved them in my mouth and kept going. I don’t know where they came from, but they kept me vertical that night. At 5:00am I sat down with a bowl of cold chicken and rice in front of a computer to try to remember and document everything I had done the last ten hours.
Despite the pain, the fear, and the sheer exhaustion, there isn’t anything else I’d rather be doing during this. I love being a nurse. I love my nurse colleagues. Nurses are strong and courageous. They have been training and preparing for this moment. Seeing how nurses have come together, deployed, and maintained composure during this is incredible. This is an amazing community. I can say with absolute certainty that we will always take care of you.