Saturday, April 24, 2020:
“BEEP BEEP BEEP”
At 11:47pm, my pager chirped again.
As an ICU charge nurse, I am summoned when the health status of someone in the hospital changes for the worst. And this particular weekend, it had been happening a lot more frequently than normal.
The anesthesiologist on-call and I had just finished intubating and stabilizing a second patient with COVID-19 pneumonia who we had to move to the ICU. And now, it seemed, we were going to be tending to a third. It wasn’t even midnight yet. Still early, by the standards of any night-shifter.
I took off my isolation gown that was now drenched in sweat and headed quickly up the stairs to the room listed on my pager’s display. I kept my N95 in place, uncomfortably tight over my nose and cheeks. I was fairly confident it would be necessary for the next patient.
It was very early in the COVID-19 pandemic, but already the scene was becoming familiar. The patient for whom I was paged was maxed out on high flow oxygen but their oxygen saturation was only a measly 80%. He was breathing quickly, sweating heavily, and looking exhausted and frightened as hell. During the night, his pneumonia caused by this new virus had worsened to the point that the only way to give him enough oxygen was to place a breathing tube and apply positive pressure to his lungs. He was going to the ICU too.
As our space-suited team assembled around him to plan his emergent transfer, I asked him, “Where is your phone?”
He looked at me curiously with scared eyes and pointed to the window sill. I grabbed it, explained to him what was going on, and ask him who he wanted me to call.
In the short period of time that no visitors had been allowed in the hospital, I really came to understand how important and meaningful even short video calls could be to patients and their loved ones.
We called his wife. I held his phone up for him with one hand while I held a wash cloth with the other to dab away the sweat from his forehead and tears from his face as he offered her reassurance and love.
He spoke through his breathlessness, one word at a time:
“I’m … okay.
I’m … strong.
Don’t … worry.
I … love … you.”
I envied his bravery and hope. I had already seen people die of this disease, and many of the patients we had intubated were staying on a ventilator for a long, long time. His path was uncertain. I knew that. Deep down, he may have known too, but it was apparent that he was going to fight like hell to survive.
We rolled his bed up to the ICU, gave him drugs through his IV to sedate and paralyze him, and placed the breathing tube that we hoped would help him through the worst of this.
Our team got an X-ray to confirm tube placement, fine tuned the ventilator and IV pumps, and settled him on fresh sheets. His oxygen saturation improved steadily, but he had a long road ahead of him.
I plugged his phone in and left it at the foot of his bed. I thought about how tomorrow, we would call his wife again so she could see him. But this time, one of the nurses would have to do the talking.
“BEEP BEEP BEEP”
My pager interrupted my thoughts. No time to dwell. Not now anyway.
January 30, 2021:
A lot of time has passed since that long April overnight shift in the ICU, but I revisit that night frequently: the uncertainty of it all, the fear in the eyes of my patients, and the courage of my coworkers. Since then, some days were better and some were worse. I left my nursing job in the ICU to start graduate school pursuing nurse anesthesia. It felt kind of like jumping ship, but it also gave me an opportunity to reflect on what COVID-19 meant to me as a nurse–an opportunity that my relentless pager didn’t afford me. And I know there are a lot of nurses out there who are still waiting for their next page or next patient, so I thought I’d share my reflections here. I broke them down into three categories: the good, the bad, and the ugly.
Infection control is a huge issue in health care. About 1 in 3 patients who are admitted to a hospital acquire an infection during their stay. Many of these infections can be avoided simply by improving hand hygiene practices and using personal protective equipment (PPE) appropriately. COVID-19 has brought these practices back into to the spotlight. Because of the fear of taking the virus home or contracting it, the nurses I worked with in the COVID ICU were fastidious about washing their hands and following proper donning and doffing techniques with their PPE. I hope the improvements we have made in adhering to infection control measures cross over into other areas and help us to prevent infections and improve patient outcomes. I’m optimistic that it could be one of the major positive consequences of COVID-19.
It takes a higher level of teamwork to care for critically ill patients with COVID-19 than most other patients I have seen. From fetching supplies and delivering them to the negative-pressure isolation rooms to working with a team of 6 or more to safely place a patient on a ventilator in prone position (on their belly), the demands of care require a team that works collaboratively and continuously. In a time of unparalleled struggle, I was encouraged by the unity, teamwork, and commitment that I saw in my fellow nurses and healthcare professionals. These lessons of working together in new and different ways will serve us well in the future.
The supply shortages in the Spring of 2020 led to many hospitals and organizations recommending unsafe PPE practices that put patients, nurses, and other healthcare workers at risk. That is not okay. Supply chain should not drive our infection control policies. Thankfully, my hospital learned their lesson. They provided more PPE education, restocked supplies, invested in reusable N95s for each staff member, and replaced the old positive air pressure respirators (PAPRs), so we were ready for the second wave when it happened. I only hope other hospitals and organizations did the same.
Whether they knew it prior to getting sick or not, nearly every patient I saw in the ICU with COVID-19 had a chronic condition that put them more at risk for having a severe case. Hypertension, diabetes, and lung and heart disease all bolster the virulence of coronavirus, and these preventable, chronic conditions are rampant in the US. 50% of Americans have hypertension and 20% have diabetes. If there was ever a time that we need to take a better look at health maintenance and preventative medicine, that time is now. Preventing these conditions in large portions of our population could save countless lives if there is another pandemic down the road.
The inequities within the realm of healthcare have also been brought to light by this pandemic, and I got to see that first hand. 18% of Colorado Springs’ population is Hispanic, but this population accounted for nearly half of our ICU patients with COVID-19. It is not going to be easy and it will likely involve huge overhauls in public health, education, primary care, and healthcare policy, but we need to do better in taking care of all Americans.
Finally, you are probably aware of roughly how many people have died of COVID-19 in the US. The number gets thrown around a lot, and at the time I am writing this, it is up to 440,000 people. That is a huge death toll, but unfortunately, it only tells part of the story. For every person who died of coronavirus, there are likely 2 or 3 people who survived after long hospital stays and will have to deal with the physical, emotional, and economic consequences of the disease for years to come. They will lug portable oxygen tanks to and from physical therapy. They will wake up in a cold sweat, gasping for air when they have nightmares about their days in the ICU. They will be inundated with bills to pay, but they might not have a job to go back to. As a nurse, I think about these people often, and I hope that you will think a little bit about them too. Death, although it may be the most dramatic, is not the only consequence of this pandemic.
After an incredibly tough year, these bedside reflections are mostly a catharsis for me. Maybe they will be helpful to you too. And sure, some of them hold lessons to learn from and goals to work toward.
Life is far from back to normal. We have a long way to go, but we can get there together.
Until then, think about the people who are sick, those who have died, those who are recovering, and those who care for them.
Ask yourself what you have learned and how you can move forward.
And mostly importantly: wash your hands, wear a mask, and when it’s your turn, get a vaccine.