Tag Archives: coronavirus

The Fourth Floor

15 Apr

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About a week and a half ago, I got a phone call from my educator telling me that I was being moved from the ER to a makeshift Covid floor that they had installed on the fourth floor above the emergency room. I knew something like this was likely coming as most of my other nursing friends around New York City have also been shifted around to units that exclusively treat Coronavirus patients, but I was still nevertheless heartbroken. I had been training for 8 months to be an ER nurse, and in the matter of a day, all of my hard work felt like it was pulled from me. I was to be given one day of training into a whole different type of nursing. Oh, and I was being moved to the night shift.

It’s grim. It’s bleak. There are moments of light that I grasp onto and try to repeat over and over to myself in my mind, but the image of watching people struggle for air as they slip closer to death without family or friends by their side is haunting. On my first night, a couple of hours into my shift, I was given a transfer patient who was DNR (do no resuscitate) and was completely unresponsive. Her head was contorted backwards with her mouth open as she gasped for air. As I was instructed to do for a new admission, I took vital signs on her and listened to her lung sounds, roiling with the sounds of fluid as she slowly drowned.

I remember thinking, “How do I process this? How do I deal with this and with all that is still to come?” And I realized I can’t. I just have to do my job, and I’ll work through the trauma at a later date. Neither me nor any of my fellow healthcare workers have the luxury right now to take a mental health day or to see a therapist. It’s the first time that this whole pandemic felt like actual war to me. What it must be like to be on a battlefield, surrounded by death and the only option is to keep going, to keep fighting, because that’s the only way through. No end date. No idea when the resolution will come. Just keep fighting.

I love being a nurse, but right now, I dread my job. I never wanted to be an inpatient nurse (which is what I am now), especially not dealing with hospice care. I have a deep well of respect for those nurses, but I always knew it was not the type of cloth that I was cut from, that my heart was not built to endure or sustain this kind of work. But I’ve been drafted, and I don’t have a choice. I ride the lonely subway to work. I put on layer after layer of protective gear. Masks that make me gasp for air throughout my shift, gowns that trap heat and make me sweat, face shields that cut into my forehead. I try to do the best job I can and offer as much compassion as I have stored within me to each patient, then I go home to my lonely apartment and try to sleep through the daylight until the night comes, and I have to go back again.

Moments of light, though. Brief, beautiful, savory moments of light. My schizophrenic patient who is often confused and disoriented and asks me repeatedly if she can stay in bed (she’s homeless and used to being kicked out of places.)
“I’d be very happy if you stayed in this bed until you feel better,” I told her.
“Oh good,” she replied, relaxing a little. “Then I’m going to go back to sleep, and I wish you luck doing whatever you have to do in all that gear. Good night. I love you.”
“I love you too.”

An elderly dementia patient who asked another exhausted nurse to put on a ballgame for him. She explained there is no baseball and that it was the middle of the night. I got one of our iPads for him and pulled up the 1986 world series games for him on Youtube. I set it up on the table in front of him.
“I just wish I could bring you a hot dog,” I told him.
“Oh, I miss hot dogs so much.” He looked at me. “I know I keep asking you, but I’m waiting for your answer on my marriage proposal.”
I laughed awkwardly, not knowing what to say.
“It’s just that you are the most beautiful woman in the world,” he continued. Remember that I am wearing two masks, goggles, face shield, bouffant, gown, gloves.
“You can’t see me under all this gear!” I remind him.
“But darling, you look beautiful no matter what outfit you’re wearing.”

Moments of light. Moments of light. Long 12-hour night shifts with brief moments of light before I walk out into the early morning sunlight and head home to try and sleep.

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March 30, 2020

30 Mar

Working in healthcare right now is full of a lot of highs and lows. I feel lucky that I’m working in a facility in Manhattan that hasn’t been overwhelmed and that my healthcare organization has been able to provide us personal protective equipment thus far. But we still work with the stress of the situation we are in and for what is coming. My nursing union sent an email yesterday to tell us that projections look like we are at “the beginning of the middle” with patient numbers growing rapidly and reaching their apex in about 10 days from now. The hospitals are already overwhelmed, and we don’t know what life will be like in 10 days. We do expect to run out of the supplies that protect us. We are currently required to reuse our mask for 5 shifts. But even as the rubber bands of the mask carve sores into the tops of my ears and cause bruising on the top of my nose and cheeks, I’m grateful for my little mask, because I don’t know how much longer I’ll be able to have one.

I showed up to my ER the other day to find a giant truck parked along the side of the building, about the size of the back of a long-haul semi. It’s a refrigerated space to hold dead bodies, and it sits outside of the building as a reminder of how dire things are becoming. Also, outside the ER, scribbled on our sidewalk, are messages of encouragement and love from the neighborhood. I’ve seen videos of people cheering for healthcare workers out their windows. News of the deaths of nurses and doctors in New York City have stricken us with a cruel uncertainty of our own fates. My co-workers and I talk in somber tones about the 28-year-old who had to be intubated in our ER. One of our doctors who had the Coronavirus is recovered and visited us yesterday, warming our hearts to see how healthy he looks after 2 weeks of being home and now Covid negative. We gathered around him like children at story time. Tell us what it’s like. Tell us you’re okay. “Every single breath I took was painful and burned my lungs,” he told us.

It’s dizzying highs and crushing lows. Historically, there is animosity between ER nurses and med/surg nurses. They don’t like us, because we send them our sick patients, and we get frustrated when they give us push back. Calling report to a floor nurse is usually a snarky experience with a lot of sass thrown back and forth. All that is gone. When I call to give a floor nurse report the conversation now starts with sincere “how are you guys doing?” and sharing of compassion and care for one another. My friends from nursing school keep checking in on each other since we all feel so lost to be caught in this storm during our first year of nursing.

I woke up at 3AM t a couple of nights ago with my heart pounding, and I started crying, heavy long sobs born out of anxiety. I’m frustrated that I can’t do more. I’m angry that we are running out of protective equipment. I’m scared for myself, my friends, and my family. I’m nervous about what the next couple of weeks are going to look like and what I’ll be asked to do. And it all hit me in the middle of the night, because my days are spent trying to help people stay calm so that they can breathe a little easier.

Governor Cuomo put a quote on Instagram that struck me.

“Courage is not the absence of fear, but rather the assessment that something else is more important than fear.” -Franklin D. Roosevelt

Healthcare workers are just as scared as everyone else, if not more so, because we first hand know what it looks like to not be able to breathe. But we have to keep going. That’s just all there is to it.

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A Post from the Frontlines

23 Mar

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The world is a different place from the last time I was able to write a post. That is an understatement and obvious enough. It’s a time when we are all reaching out more than ever to the people we love and care about to check in. But I find myself reminded that I am in a different position in this global pandemic than most. I’m a registered nurse working in an emergency room in the heart of one of the most affected places on Earth, New York City.

It’s humbling and encouraging and strange to receive messages from family members and friends saying how grateful they are and how “heroic” me and other medical professionals are. I think it’s an odd thing for us to comprehend, because our worlds are still operating. I still go to work, clock in, do my job, eat my lunch, clock out, go home, and rest up for my next day of work. I understand the curiosity and interest in life at the frontlines, and I hope to give some insight into it.

I was told that the first year of being a nurse is the worst and the most difficult. I was obviously not expecting this on top of everything. My biggest frustration at the moment is the very fact that I’m still considered a “new grad” nurse with under a year of experience. I’m technically still in the training phase of my fellowship, and I’m not supposed to pick up shifts. I asked management if maybe we could work around that since these are extraordinary circumstances. They are still on the fence and leaning toward no. So even though I have a nursing license and 8 months of experience, I’m not allowed to pick up shifts within my hospital system. I’m not sure if that will change, but I’ve been in talks with other hospital systems and the state of New York about being on emergency surge lists. Right now I’m trying to use the days off that I have to rest, eat healthy, and exercise. Working on getting my immune system in the best shape it can possibly be in.

When I think about how this thing has unfolded over the last couple of weeks, I know that everything changed for me when I started hearing the stories coming out of Italy. Like most Americans, I had heard of Covid-19 and didn’t want to buy into the panic of it. The panic didn’t make sense. There’s only a 2% mortality rate, so why are we so nervous? I’m a part of a couple of different nursing forums online, and I started to see desperate pleas from Italian nurses. Their healthcare system was collapsing beneath the weight of this virus. Doctors were having to choose which patients could live or die due to the lack of resources, and cities were unable to find space for the dead bodies that were piling up. From across the globe, nurses were begging us to take this seriously, to prepare for what was coming, to avoid their mistakes. It was the first time I realized this was going to get bad and fast.

The cases started to pile up at my ER. Not confirmed cases, of course due to the unconscionable lack of testing, but patients were showing up with tell-tale stories. “My chest just feels tight.” “I felt better for a couple of days, then everything got worse.” “I just can’t seem to get better.” The news articles I read on my phone began speaking of social distancing and working from home. In Italy, people were locked down in their homes, and I wondered if it would come to that. About a week ago, on my lunch break, I left the chaos of the ER to grab some food and saw the park across the street teeming with people. Everyone was smiling and laughing and enjoying the warmer weather. I stared in disbelief. After an exhausting shift, when I got on the subway to go home around 8pm, the train was packed with people in their 20s, most already a few drinks deep. Their laughter caused them to throw their heads back and whoop. I thought of the petri dish of a train car we were sitting in.

The next day was when they began shutting bars and restaurants down. I felt as sad as anyone to watch my vibrant city be shuttered, but I also knew it was the only way. Something horrible is coming. Or more accurately, it’s here. It’s likely on most surfaces, in most bodies, in thousands of homes, and it has the capability of crumbling everything down. I still look to Italy and hope we’ve done enough to avoid the horrors they are seeing, but only time will tell. As I write this, the country of Italy has 63,927 confirmed cases. My city has 12,305.

The spirits among my co-workers are mixed. Some are in a panic, frustrated and stressed about our lack of PPE (personal protective equipment) and dizzy from the hourly protocol changes from the CDC. Some of my co-workers shrug their shoulders and say that we have to keep going and just get through this, and we will be okay. Regardless of reaction, everyone still shows up every day and puts on the masks that we have, the gowns, the gloves, the goggles, and we do what we can. It’s not an ideal position to be in, but it is our job. I think of my professors from nursing school who talked about working through the AIDS epidemic. I think of nurses of the past that treated typhoid fever, tuberculosis. I think of the mother of modern nursing, Florence Nightingale, who founded nursing as profession by volunteering to go to Crimea and help treat the wounded soldiers in a war zone. It’s the legacy of our profession, and I’ve always felt deeply honored to get to do it, especially at a time like this.

I fear for my city. I fear for my fellow nurses. I fear for my friends that no longer have jobs. I fear for all the small businesses that I love in my neighborhood who now have an uncertain future. I fear for what my life will be like in the coming weeks, the uncertainty of what I’ll be asked to do. While I know things are going to continue to get worse, I also know that things will eventually get better. I’m looking at Italy as a worse case scenario of what comes next, but I’m also looking to China as to how to get through. The number of new cases there has dramatically dropped off, and they’ve begun to close their emergency hospital facilities. Our time for that will come too.

 

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