- Unsplash / Kevin Kobsic
I sit in my car in the parking lot and psych myself up before shift. The uncertainty and chaos of the coming hours, the reality of what's happening—12 hours feel like 20 these days.
I'm a nurse in the intensive care unit of a midsize community hospital an hour north of Chicago. For two months, our unit has been overrun by COVID-19. That's when I made the gut-wrenching decision to quarantine myself in a hotel, away from my husband and daughter, and send my son to live with his dad, just days before his birthday. I haven't held my kids, kissed my husband, or slept in my bed since March 30, since we had our first positive patient.
There aren't zombies running around or piles of dead bodies in the street, so I understand why it's hard to grasp just how bad this virus is. Let me take you through a day in the life of a nurse working the front lines in the intensive care unit.
I get my temperature taken as soon as I walk into the hospital, and then head to the unit. Alarms ring, overnight nurses wrap up shifts, and IV poles stand outside closed glass doors so we can manipulate medications with less exposure.
We gather for our morning huddle. The medical surgical nurses stand by us, just as scared as we are. Forget the information we told you yesterday. Be careful, be safe, be smart. Remember, there is no emergency in a pandemic. We disperse.
Every bed has a COVID patient and more are in a second unit that we've taken over. Some are old, some young and previously healthy. Some patients in their 30s and 50s have breathing tubes in their lungs. Despite what you may have heard, this virus knows no bounds. Patients came in with flu-like symptoms, tested positive for COVID-19, decompensated, and were then intubated. There's no real treatment. We try medication to sedate them; medication to paralyze them and let the ventilator do the work; medication to thin their blood. This isn't just a virus that attacks the lungs—it attacks the blood, the heart, the nervous system, the kidneys. They suffer without their families.
I sign out my N95 mask for the day and place it in a brown paper bag that will keep it safe. I gather medications for my two patients, and put on my protective equipment: gown, gloves, mask, hairnet, face shield. I take a deep breath and enter my first patient's room.
Patient 1 is a 47-year-old female who was brought in almost two weeks ago for flu-like symptoms. She tested positive. Two days later she was intubated and moved to the ICU. Her vital signs are stable for now. I listen to her heart, lungs, and stomach; turn her off her backside so she doesn't get a pressure ulcer; and check her tubes. Is she awake? Is she coherent enough to hear and understand me?
Can you squeeze my hand? I wait with my hand gently resting in hers. She starts to awaken, restless and coughing, opening her eyes. Her breathing increases and her blood pressure goes up. I explain that she's in the hospital and that the tube is helping her breath. I stroke her hair as she continues to cough and fight the tube. I ask a nurse passing by to increase her sedation, since the IVs are all outside, and let her rest again.
Breathing is getting harder and harder in my mask. Sweat drips down my back. I've been in this room for more than 45 minutes. I take off only my gloves, open the glass door, use the hand sanitizer outside, and gather the medications I set aside for the next patient. I put on new gloves and go into the room.
Patient 2 is a 52-year-old male, with no significant medical history. He was admitted to the hospital one week ago and was intubated that day. He was started on Plaquenil and Azithromycin. His oxygen saturation is dropping. I suction down the endotracheal tube—the tube that goes down his throat and into his lungs. Nothing comes up. His ventilator settings are already at max support. I listen to his lungs. They sound like a washing machine, junky and wet. The physician comes by and cracks the door open just enough to be heard. He decides we need to prone this patient—that is, manually turn the patient from his back onto his front side. I make sure he's sedated enough that he will be comfortable laying on his stomach for up to 16 hours. It takes five of us to flip him on his belly.
I can't leave now. He's too critical. I log on to the computer that's in his room and work on my charting. His saturations still haven't improved and now his blood pressure and heart rate are falling. It's been about an hour since he was flipped. Take a deep breath, I tell myself, don't panic.
Nothing has changed after another 30 minutes. Blood pressure and heart rate are steadily declining. The physician decides to give Patient 2 another hour before we flip him onto his back again. He lets me know that if this patient codes, we won't be doing CPR—it's too risky for the staff. The doctor will call to update the Patient 2's wife.
I check through the glass door of Patient 1's room. Her vital signs are steady. She looks calm. I get a small drink of water and gather myself.
I'm late for unit rounds, where we update status with the doctors and charge nurse. I bring the doctor up to speed on both patients.
Patient 1: Waiting for her to wake up; oral medications have been started for her to reduce the use of IV medication.
Patient 2: Already on maximum support. There's not much more we can offer him but time. Going to leave him prone for the full 16 hours; we confirmed his code status per a conversation with the family: no CPR.
I enter Patient 1's room again. She is coughing. I suction down her tube. Thick phlegm comes up. This time, when I ask, I get a little squeeze. I need you to relax and let the ventilator do its work, I tell her. You're doing good. I'm right here with you.
She calms down when I hear beeping from Patient 2 next door. I remove my gloves and rush into his room. I call for help. We have to turn him back onto his backside. Patient 2 isn't going to make it to the end of my shift. OK, on the count of three. Everyone ready? One, two, three, go! His saturations are plummeting, along with his heart rate. The doctor is at his bedside now. The crash cart is outside the room. A nurse hands me the medications the doctor orders through the door. It helps for a minute. I place my hand in his. Did he develop a pulmonary embolism? Is there too much fluid around his lungs? What else can we give him that will help him now?
It's too late. We listen for heart tones. Nothing. He's gone. Gone too soon.
Outside the room, I take a deep breath, and find the number for Patient 2's wife. I'm taking care of your husband in the ICU. I'm so sorry to tell you, but your husband just passed. We tried our hardest, but unfortunately this virus is just too strong. Sobbing on the other side of the phone. He wasn't alone in the last moments. I held his hand. He wasn't in pain. He went peacefully. I am so sorry for your loss.
I call the coroner and report a death. I ask another nurse to help prepare the body for the morgue, or the refrigerated semitruck that is holding the increasing number of corpses we have. We remove all the invasive lines, clean him up, and roll him into the body bag. We gather his belongings and call for transport to take his body off the unit.
I have 15 minutes to eat lunch. Another gracious donation from a local restaurant. I can't wait until the gym opens back up. I stuff my face and get back to work. My phone rings. It's Patient 1's husband. I let him know she's resting comfortably and that we will continue to wean her off the ventilator in hopes that the breathing tube can come out soon. It's already been a week. I can hear the fear in his voice. He tells me, "Please let her know I love her so much. She can't leave me yet."
I walk down to the ER to get the person who will take Patient 2's old room. This may be my only time to walk slowly today.
Patient 3 is 59 years old, and came in this morning with shortness of breath. We suspect COVID; he's been ill for two days, though he hasn't encountered anyone positive. When he arrived in the ER, his oxygen saturation was low on room air and he couldn't talk in full sentences. We intubated him right away.
We unhook all unnecessary monitoring and take him upstairs. The doctor asked the anesthesiologist to place a central line and arterial line. I have to call the wife for consent before any invasive line procedure. I remove my PPE to leave the room. I steal another sip of water on my way to grab a consent form. Patient 3's wife answers the phone. I can hear the panic in her voice. The central line is a large IV that goes through a large vein, usually in his neck but it may have to go into his groin. We also would like to place an IV in his artery.
I listen to Patient 3's heart, lungs, and stomach. You're in the ICU. Can you squeeze my hand? He coughs, wrestles in bed, and tries to grab for the tube. I get a little squeeze. I explain to him what is going to be happening, that I spoke to his wife and that she is thinking of him, and I give him more medication to sedate him. It begins again.
The next shift will be in soon. I sit for just a minute. This is the first time I've had a minute to think all day, and I need a snack. There are some granola bars. What could I have done differently? Was there something I overlooked with Patient 2?
Finally. I feel such relief that the day is over. I rack my brain to make sure there's nothing I missed. Nothing left to do but clock out. I get to my car and let out a big sigh. The fresh air feels so good.
I finish up my conversation and get ready for bed. I have a few minutes to myself. Emotionally, I am spent. I think about those going to the streets to fight for the "freedom" to reopen businesses, to protest the right to get a haircut or the right to go to a bar, and I want those people to understand that this is about more than your right to day-to-day life. This is everyone's right to health and safety. I close my eyes and rest for tomorrow. v