My friend flew into New York City to work as a nurse in mid-april. This is some of their writing on their experiences so far.
***OK to share by copy and pasting but for privacy reasons and my personal safety, I can't make public, & please leave my name and pics out. Thanks & stay safe, everyone!💝😽***
Almost every inch of this hospital has become an ICU. My section is a converted conference room and library in the basement of the hospital. The library is the staging area, where we put our brown bags and N95s with our names on them, to reuse for a week. Once you gown up and enter the double doors to the converted conference room, you are on one of the many Covid units here at this facility. There was no organization when I arrived. I was told to put on my PPE and get to work. I will never forget what I saw the first time I walked through those doors.
It was like something out of a dystopian sci-fi novel. The patients all lined up next to each other, every single one of them on a ventilator, maxed out on vent settings and sedatives, each with a multitude of drips, a central line and an arterial line. Some of the patients are proned, a disturbing sight that has been having some degree of success. Alarms are beeping left and right. I can still hear the vent alarms now several hours after leaving work. The site and sounds of it are all consuming. Once you enter the unit, it feels like you're swimming in a nasty sea of Covid.
I am laughing now at all the talks I had with my experienced ICU RN friends who were prepping me on how all my drips would be behind glass, so I didn't have to interact with the patients when changing them out. They were giving me advice on how to safely remove my contaminated PPE. They just care about me, and their facilities are not overwhelmed as they are here in NY. At their hospitals every Covid patient they have is separated in their own negative pressure room, possibly with an antechamber room.
My reality is so drastically different. Put your PPE on, enter the Covid unit and that is where you stay circulating around 20 Covid positive patients in that same gown for 6 hours prior to lunch. I spent all day running my ass off, and only sat down once on my lunch break, only used the bathroom once on my lunch break. Eat lunch, briefly remove your N95, then come back to the unit for 6 more hours of Covid. The mask is uncomfortable and the plastic gown feels hot. My only real PPE at this point seems to be that I've been an athlete all my life and spent the last few weeks before this hiking up mountains and sleeping at high altitude, maybe that will help me.
No time for orienting nurses here. I'm thrown into a pretty heavy assignment from the get-go, one of my patients a bit sicker than the other. It is a literal sink or swim environment. I'm surrounded by other travel nurses. We all jump in to help each other out. The disease process seems to have no specific prototype type as to who will develop severe complications. These patients are of all different races and body types and varying ages too, and for the most part not as old as I thought they would be. As the day progresses it becomes clear that one of my patients is more and more unstable, and I wasn't sure he would make it until the end of my shift, but as nightshift rolls around patient is still precariously hanging on.
I leave work and the tears start flowing. I start thinking about the moment I was finally able to grant a wife's request, just to talk to her husband. The morning was a dizzying bluster of OG tube feeds, drawing labs, and refilling drips and medications. Pharmacy is backed up, critical drips have to be ordered 2 hours + in advance. If you don't stay on top of your drips running out, your patient is literally left high and dry. The charge nurse could seen how busy I was with my 2 heavy patients, and she firmly let the wife know how busy I was. In my mind I was just trying to keep my patients alive and there simply wasn't time to chat.
Finally, I am slightly caught up and able to grant her request. She tells me she is aware of how sedated he is, she just wants me to put the phone up to his ear. I do so. She tells him she loves him and what they will do when he comes home. She talks to him for about 3 minutes. When she is finished I get back on the phone with her and she tells me this was the best 3 minutes she has had since he'd entered the hospital several weeks ago. She told me just how grateful she was to me for doing that. I promised to take good care of her husband. Imagine if you're loved one was fighting for their life on a ventilator and all you could get were those 3 minutes. It absolutely broke my heart. At the end of the day, I honestly felt that this phone call that I kept putting off all morning was the only truly important thing I did all day.
We are doing everything for these patients, and nothing is working. After all the hard work, I left with the feeling that both of my patients were getting worse. The unstable patient very nearly coded at the end of my shift, and I stayed late to help out the next nurse. As medical professionals we appreciate progress and results. As an ER nurse my instinct is get you in and out asap. That doesn't happen here. My patients yesterday had both been in the hospital for over 2 weeks now.
The nightshift nurses had to tell me to go home. You just want to stay and help, even though it won't really matter. There's no end to how much work these patients need in their fragile state, but the reality and prognosis is grim and disheartening.
On the way out I stop by the office as I still don't have my schedule for the week or know if I even have to be up to work again the next day. I find out that I have the next day off, part of me is extremely relieved, but another part of me wants to be with my same patients again. Now I know I will likely be floated somewhere else, maybe not in the basement this time, and I won't see my patients again. As I walk out of the hospital a hopeful message, my hospital has discharged 637 Covid + patients.
I walk out into the dark and start towards home. Its a 30 minute walk and kinda cold, and my feet are already so sore, but I am scared of contaminating an Uber with my dirty scrubs and my phone battery is only on 2%. About 5 minutes into my walk I hit a cab stand. I tell a driver I am coming from the hospital and that if its ok with him I will ride with my mask on and then wipe down the seats with my viricidal wipes afterwards. He said that'd be great. He drops me at my hotel and I wipe down the seat and he asks, "Mind getting the door too?" I smiled and wiped down the door and he said thanks.
Go up to my hotel room and my parents have sent me flowers. Called my mom and told her about my day, and we both cried, especially when I told her about the phone call with the wife. I tell her how heartbroken I am but also glad to be here, that I am learning a lot, and that I thought I hung in there OK with these critical patients. Here for this now, here for these people, and I'm not giving up on NY. 🗽🌇💝
Today I cared for a patient that was several years younger than me, with no pre-existing medical conditions, fighting for their life on a ventilator.
Despite the gravity of this, I do feel more hopeful at this moment. I made it out of the basement! The unit I was placed on today had much more resources and equipment. The strength of the nurses around me and the teamwork is lifting me up. & I do feel strongly that my patient from today is going to pull through. Hitting the hay now so I can wake up and work again tomorrow. Goodnight! 👩⚕️💊💉💜
I’m happy to find myself back on the same unit as Day 2. The familiarity of knowing my way around this 30 bed unit is a welcome feeling compared to how chaotic everything else seems. The unit is staffed with both permanent staff of the hospital and travelers like me thrown into the mix. The ICU nurses tell me over and over again how grateful they are to have the “traveler army” here. Our hospital hired several hundred extra nurses to meet the demands of the influx of high acuity patients.
The staff tells me that us being here has made such a huge difference and the morale has improved. Before our arrival when the wave hit at full force, these nurses were taking on 3 of these insanely sick ICU patients at a time. It is unfathomable to me. They said people were dying left and right. The permanent staff are the real heroes to me, working through this crisis in their hometown, putting themselves and their families at risk to get through this.
Now we are riding out the Covid wave and the hospital is fully staffed with travelers to assist with care for these high acuity patients. It takes detailed work and getting the balance between sedation, the vent, and a pressor medication to keep their blood pressure from becoming dangerously low, just right. Today I am trying to titrate this pressor down on one of my elderly patients, but they are so fragile I have to go very slow. Just when I think things are peachy, code brown. 💩💩💩We have to clean and change the patient who’s sitting in a river of poop. Moving her at all causes her oxygen Sats to drop. She’s asynchronous with the ventilator. We have to give her more sedation, and now of course her blood pressure tanks. I’m worried she’s about to code. Back up we go on the pressor. This cycle happens to me again later in the day. She’s sending my adrenaline up too with these episodes.
I keep thinking to myself, “This is someone’s grandma.” It’s a tough one for me because as someone who lived with my grandmother while she was on hospice, I know there is a point in medicine where we need to stop. Conversations need to be had with the family, but for now we continue doing everything.
Out of curiosity I check my chart for the status of the two patients I cared for on Day 1, expecting that at least one of them might be gone. I’m surprised and relieved to learn that they are both still trucking. I turn over to nightshift and give the nurse the run down on grandma. I tell her to be extremely careful with the pressor weaning and also let her know what to do when she needs to be turned. The nurse is grateful I gave her the run down. It feels like we are all working together in this battle, rather than trying to eat each other alive as I have seen some nurses do.
I’m happy to get out of work early enough to pick up dinner from my favorite Italian place on the way home. They know me there now. As the guy brings out my food outside to meet me he says, “We don’t usually do deliveries but next time if you get out of work late just let me know and I can drop it by your hotel after we close at 8.” He hands me the bottle of wine I ordered, and I’m trying to make sure in the transfer that I don’t touch his hands and in the process drop this nice bottle of wine and it shatters on the sidewalk. Before I can say a word, “I’ll get you a new one!” I’ve often found that NYers will go above and beyond if they assess that you are a person with good intentions. Nice knowing NY has my back too. 🗽🌇🍷💜
Imagine you’d magically been transported from the end of March until today, and you’d mentally skipped out on all that’s happened in the world during that time. Suddenly you wake up in a hospital bed, with tubes coming out of every orifice of your body and weird people with face shields, gowns and masks staring at you. Your whole body is atrophied and you barely have the strength to lift up your arms. This was my “good” patient. One of the few who will make it out of the ICU. I was there when he spoke and heard his own voice for the first time in a month. Let me tell you, real tears guys, real tears.
That day we probably Facetimed the family about 15 times. It was really something for me and the family to explain to him that he wasn’t the only one who had skipped out on work for a month. That virtually the whole country had been shut down because of a viral outbreak. My patient kept having anxiety attacks about finances, as the family provider he was extremely concerned about the status of the family business. We talked with the family all day so they could explain to him that everything had been taken care of while he was out.
At one point my patient appeared angry and said, “My wife really needs to do me the common courtesy of coming by to see me. Geez.” I laughed to myself. It seemed quaint. Of course how would someone understand that we had the hospitals on lockdown with a no visitation policy unless it was really the end? I stopped to explain to him more about the virus, and how we wouldn’t want to put his family at risk.
On my lunch break I remove my face shield and mask to wipe it down and set it on the table with the others during break. As I put the shield down I am horrified. A different name is on the face-shield. This is a huge “Oh shit” moment. I remove the N95 and realize that the strap in the back is different than my usual. I’m wearing someone else’s dirty PPE. I find my own stuff is still sitting on the table from when I took a shorter break earlier in the day. Someone had moved it to the other side of the table, and when I came back I put on the wrong mask. I throw the wrong one away and feel like a complete idiot. The other nurse had to get a new N95, something that has become a locked up precious commodity on these units. I have never been given one since my assignment started, always coming to work with my own. We are told to continue to place them in brown paper bags and reuse them for a week. One day is my limit with those, and I’m thankful that friends and family have provided me with some so I can continue that trend.
On lunch breaks I get to hear more about what the regular staff have experienced. One of the staff members has a 1 year old that she hasn’t seen in months. Another had to get an apartment on the other side of town from her husband. She said sometimes they will meet in the front yard of their house and talk to each other from 20 feet away. The staff express frustrations about not receiving crisis pay, a situation that seems incredibly unfair to me, as these nurses are the ones who made true sacrifices and were exposed to the most risk. They have lost coworkers who were near and dear to them. Just last week, I saw several breakdowns as people informed each other that one of their favorite physicians assistants had passed from the virus.
Day 4 was one of the most overwhelming and stressful days I have had in years and I would prefer not to recount it. Some days as a nurse it just feels like you are up against a tidal wave, and nothing is going right. Small details that need to be attended to are piling up, it’s impossible to catch up to all of it, and at the end of the day what’s most important is making sure your patients are still doing ok. That was Day 4. Luckily by the end of the day my patients and I both made it out alive but I felt like I was run into the ground.
After days 4 and 5 I tried to sit and write something but realized that I won’t be able to write about every single day. I’m not used to sharing bad news on Facebook, and the grim reality of this is just something that I will not always want to recount. From a realistic standpoint as a nurse I don’t see much hope for some of these patients and it is extremely heartbreaking. From a numbers standpoint, it feels like we are riding out the plateau. The new cases are dropping. I heard they even closed the basement that I described from Day 1. Outside my hotel window, I heard sirens about every 30 minutes during my first week here. Now, I rarely hear them.
Day 6 gave me a new hope, to see my patient finally progress from ventilator to trach-vent to trach collar, and hear himself speak, was nothing short of amazing. The family were so elated, and I needed to see that someone could recover. On the way home I’m riding in the rain but feeling motivated after what I saw that day. The new cases are dropping, and if we can get a few survivors out from the main wave of this horrible virus, I will have done my part. I stop by the Italian place again to pick up dinner and some wine, and raise my glass to the survivors.
Had a breakdown after work the other night. It wasn’t because of work itself. I’ve seen a significant turnaround since I arrived. We have great staffing at our hospital now with the travel nurse army, and I am still feeling more hopeful for NY. My home unit is no longer packed to the gills, the basement unit has closed, and other areas that were converted into ICUs overnight such as the cath lab, endoscopy, and PACU are clearing out to become procedural areas again. What this means is that many patients have moved on, either to the next realm or have progressed and gotten better and the lucky ones have eventually gone home or to rehabilitation centers.
One of my patients this week was up there with favorite patients I have ever had in my 6 years of nursing, and I was lucky enough to be assigned to him for 3 days in a row. As of last week, everyone on my unit was pretty convinced he was nearing the end. At one point there was concern for stroke, as when we lifted his sedation his neuro status appeared compromised. But his CT looked ok thank goodness. I think grandpa just needed more time to lift the ICU delirium from all the hardcore drugs we’d be pumping him with when he was on the ventilator. As he became more alert, his personality started coming back, and my goodness he is really something. The first patient I’ve had here to be well enough to express gratitude for the care. He would always mouth the words “thank you” to me whenever I would change a drip or clean him up. I would reposition him and he’d give me a head nod or a wink, as he was still to weak to lift his arms. I was amazed at his compassion for me and his patience with the process of recovery, as we were doing so much to him and he was just so sweet about it all.
In the 3 days I had him, I watched this man make great strides in his recovery that almost appeared miraculous to me. It truly gave me hope. I kept showing him photos of his grandkids, and took extra time to explain to him what was happening in the world. He remembered that there was a virus going around, but didn’t realize that he’d been afflicted by it. On my first day off, I texted my friend on the unit to ask how he was doing. I was relieved to know that she was assigned to him because I trust her judgement and work ethic as a nurse and knew she would give him excellent care.
Back to my mental breakdown. It was after coming home from 3 shifts in a row and finally getting to peruse social media and seeing this rising tide of discontent with social distancing, calls to take off our masks, for America to reopen and go back to business as usual. I am not even talking about the insane protestors. I am talking about competent people that I respect, insinuating that this has been an overblown media hoax.
It is clear to me that Americans are currently grieving over the loss of life as it once was. Many are jumping to the conclusion that this has to be an overblown hoax portrayed by the “liberal media.” “It could not be real, the numbers are inflated. Only the very worst hospitals in NYC are being shown in the news.” They are in the grief stage of denial, they refuse to believe that this could be happening here and that life as they know it will be different now. For some the denial has progressed to anger.
We need to consider that reopening without modifications, ceasing to wear masks in places like the grocery store, ceasing to distance ourselves, and going back to life as we knew it before is exactly what the virus wants us to do. If we allow it to continue to jump to new carriers, it will continue to mutate into different strains, the way the flu does. It is possible that if we allow it to continue to exist, we will never be able to catch up to it, kind of how people still get the flu despite having the flu shot because the strains mutate each year and stay one step ahead of us. If this gets as bad as it could, getting a shot will be the least of our concerns and won't even be an option.
I don’t know if this analogy really holds up but keep thinking back to something my dad told me once. He said when he came back from his first tour in Vietnam as a young Navy Seal, he was shocked to discover that the whole nation had been protesting the war. & I’m not condoning what we did in Vietnam, Lord knows I would have been out protesting the war too. But I can’t imagine what it felt like to return from that level of intensity, seeing many of your friends die, expecting to be greeted as a hero, only to realize your country didn’t want you to be there fighting in the first place.
It terrifies me to think about a resurgence. I don’t want to be a Covid nurse forever. I would rather see us kick this thing for good than become lax in our precautions and have another go around of this combined with the flu in the fall. I wish those who were calling this a hoax could just spend one day in an open Covid unit like mine to see how devastating this disease process truly is. As long as refrigerated trucks and tents remain outside the hospitals here, we are not through with this yet. It is disrespectful to those who are still dying from this to be out spreading conspiracy theories and stating that this is a hoax. Thank you to all who have been taking the time to read my posts. Your willingness to continue to remain vigilant and aware really means a lot and makes me feel that these patients are not suffering in vain.