One Morning as an ICU Nurse on a Covid-19 Unit
4 a.m. — I haven’t even tried to go to sleep tonight. Why? Fear I guess, fear of being late specifically. I have to leave my house at 5:15 a.m. in order to get to work on time. I have to clock in by 6:45. I don’t need over an hour to drive the 35 miles to work but I still need to get there early. There are a few extra procedural steps these days between arriving at work and beginning to care for patients. For now, I’m eating a bowl of oatmeal, something to hold me and the baby I’m carrying over until I get a second breakfast from the cafeteria around 9 once I’m at work. There’s always the chance that something will come up and I’ll miss the cafeteria hours, so going in with an empty stomach is a risky game.
6 a.m. — After parking, I’ll walk across a bridge that goes over a major street in downtown Atlanta. I like walking across the bridge. I practice taking deep breaths; these are my last few moments of peace before the inevitable chaos ensues.
It takes about seven minutes to arrive at the threshold of my hospital, but before I can enter they will screen me for symptoms of a respiratory infection and check my temperature. So long as it’s less than 100 degrees Fahrenheit, a sticker with today’s date will be placed on my badge, giving me the okay to enter the building for the day.
I travel down the meandering hallways that are just now becoming familiar to me until I arrive at my unit. All the signs say neuro-ICU. I was hired as a neuro-ICU nurse just over a month ago. That has been my specialty for eight years now.
Arrows point visitors in various directions toward bathrooms, waiting rooms, and cafeterias. But there are no visitors and this is no neuro-ICU. The hospital is on lockdown due to the Covid-19 virus and the unit has been transformed into a dedicated Covid unit. It’s officially being referred to as the “Special Pathogens Unit.”
Before I can enter the double doors to my unit I sign out a pair of surgical scrubs, an N95 mask, goggles, and a brown paper bag to store the mask in for reuse. I wait my turn and then squeeze into a tiny bathroom the size of a closet to change into my scrubs. I’ll turn them in when the day is over to help reduce the risk of carrying any contaminants out of the hospital with me.
These are size 2XL. I only weigh 115 pounds. The drawstring on the pants is broken. I manage to tie them enough, though I know they’ll fall down all day. I don’t complain; I’ve seen what other health care workers are dealing with. I’ve seen the trash bags being used as isolation gowns by nurses in New York City. I think I can handle pants that are five sizes too big.
After this, I go back to the main nursing station to be present for our morning “huddle,” a briefing on what has happened overnight and any updates the CDC or hospital may have to share. Lately, changes have been coming every few hours. I listen closely.
Because of the geographic and clinical layout, my floor of the hospital has been chosen to be transformed into this “Special Pathogens Unit.” We admit both patients who are positive for Covid-19 as well as those being referred to as “PUIs” or “persons under investigation.” These are patients who are symptomatic but have undetermined test results.
This transformation occurred essentially overnight. All neuro patients were transferred downstairs to the trauma unit and any new neuro patients will automatically be shunted there. All rooms were modified to accommodate negative pressure conditions. I’m impressed by how fast medical engineering was able to pull that off.
It’s time to place another 35-year-old on a ventilator.
7 a.m.— It’s now that I learn that the patient I have been caring for throughout the week has just had a cardiac arrest and passed. While he had symptoms upon arrival at the hospital, his Covid-19 test is among those suspected to have been lost in transportation and the second set of testing has yet to result.
It’s a weird thing when you walk into work to get your assignment of patients and one of them is already deceased. The post-mortem duties are passed onto me. I’ll ensure the funeral home is notified, speak with the family to get necessary information, bathe the patient, remove any invasive lines or tubes, place him in a shroud, transfer him to a stretcher, and then transport him to the morgue.
While I’m no new nurse, this is uncharted territory for everyone, so I’ll work closely with my charge nurse to ensure all proper protocols are followed to prevent the potential spread of infection.
I take report from the night shift nurse; she is beside herself with fear. It’s suddenly much more real. This is the first death of a patient suspected to have the virus on our unit so far. The other patient I will be caring for has become increasingly unstable overnight as well. It’s going to be a busy day.
9 a.m.— I’ve spent the last two hours preparing my patient for transport from the unit, performing all of the aforementioned tasks while trying not to think of my friends and family, many of whom are also in their thirties with no past medical history to speak of, nothing to place them at increased risk of contracting this virulent virus. And yet it happens nevertheless.
On the way to the morgue, the nursing command center calls. The results are in — my other patient is officially positive for Covid-19. I can’t remember what the total count is at now.
As I’m walking out of the morgue, my charge nurse calls. I need to prepare to admit another patient who will likely need to be placed on a ventilator as soon as he arrives. I hurry back to the unit to care for my other patient while the first room is being decontaminated. I hope we understand this strain of the virus well enough to clean the room properly. This feels even more real. When will it stop?
10 a.m.— I hang Levophed, an IV medication meant to help augment a person’s blood pressure when it is too low. I hang phenylephrine, a similar agent. Both of these are on the same patient. She is decompensating. I feel nervous. Her breathing has become labored enough and her lab values critical enough that I know before the physician says anything — it’s time to place another 35-year-old on a ventilator.
I’ve missed my chance to run to the cafeteria. My stomach growls, my baby kicks. I keep going.
Speaking with my patient, I try my best to explain what being on the ventilator will be like. I assure her that we will keep her sedated and free from pain as much as possible. She is understandably scared, but most of all she just wants to say goodbye to her children. There is a chance she’ll never be able to come off the ventilator and speak to them again; there is a chance she will die.
11 a.m. — I do something I’ve never done before. Because there are no visitors allowed, I facilitate a mother saying goodbye to her children via FaceTime. It takes everything I have not to break down. I want to speak with my own daughter. It’s been two weeks since I’ve seen her and viewing this mother and her children express their love for each other over a phone for what is potentially the last time nearly pushes me over the edge. I stay composed; it is not the time for me to break down. I keep working.
Now with the physician, respiratory therapist, and an extra nurse in the room to help, we begin the process of placing this patient on the ventilator. At this point in my career this feels very routine; all personnel have their jobs and usually, the process goes smoothly. That’s not true this time. Maybe there was an underlying condition or abnormality. Maybe the virus was strong enough on its own to take this previously healthy woman down, but due to unknown reasons, her heart stopped and even after several rounds of CPR, we could not save her.
I’ve missed my chance to run to the cafeteria. My stomach growls, my baby kicks. I keep going.
12 p.m. — I can hear the helicopter approaching. I know it’s my new patient arriving. After two deaths, I almost forgot about this one. I confirm that the first room has been fully decontaminated and is ready for a new admission. It has. I set up the room with the necessary materials. Fortunately, we don’t have any major shortages yet.
My stomach growls. I feel a bit weak. I missed breakfast. It’s now lunchtime but I have no time for that. I realize how badly I have to pee. My baby kicks harder. If I could just have some coffee. The other nurses would help, they really would, but their days are not much different than my own and there is no time for anyone to spare.
I feel tired already and begin to feel sorry for myself considering I have two open beds and have dealt with two deaths already. I have a sick patient landing now and another will surely show; it’s just a matter of time. I don’t know how to handle this much work. The patients have been cared for but I have had no chance to document more than the most minimalistic and necessary things.
I walk to the break room and literally shake my head to snap out of it. This is not about me. Sure, self-care is necessary for longevity as a nurse and once someone figures out how I can do that while simultaneously completing this shift I hope they let me know the secret. How can I feel sorry for myself after watching a mother die? After seeing the beautiful faces of her children?
I take a swig of milk as I watch the helicopter land. I inhale a graham cracker and go back to my duties. I have just enough time to take the deceased mother to the morgue before my third patient of the day arrives. I look at my watch, only eight more hours before I’ll be able to walk back across the bridge.
Once you find your calling you can’t pick it apart, choosing only the pieces you feel to be most pertinent or most comfortable for you. It’s yours and you have to own it. If you don’t, it’s time to step away. Nobody ever likes all parts of their job, the complicated mixture is what makes us appreciate the high points even more. So I say: Embrace it, all parts of it.
But what does that mean for a nurse during a global pandemic — a nurse who has her own family at home to protect? Well, as it does for many health care providers, it means making sacrifices. Sure, there are the obvious challenges: the dangers of exposure on the job, the increased stress and patient load, the lack of proper personal protective equipment — but none of those are the hardest part.
I am willingly exposing myself to an environment infiltrated with the very virus other people are staying at home to avoid. The hardest part has been my decision to have my daughter stay with a close friend because they are able to fully isolate. The hardest part is facing the unimaginable question: What if something happens to me and I have to say goodbye to my daughter over FaceTime after having already spent weeks or months apart?
The hardest part isn’t the work. The hardest part is the fear.