Disaster

[covert75, BSN, RN]

One of my former coworkers posted this today on FB....?

"What does a day on the COVID-19 unit look like from the eyes of a seasoned ICU nurse? That’s a question that you could probably imagine the answer to already; to a degree. The PPE is hot and encumbering, the unit is chaos, the patients are each close to death in a different way, the support is minimal, and the real care that the patients receive is limited. That seems simple enough to understand and imagine, but what if I told you that you couldn’t possibly imagine the degree to which those things encumbered our daily attempt to save lives? What if I told you that the fight to meet basic nursing care is at times more difficult than taking care of a patient on the brink of death? Let me explain.

I start my day by standing in a line to enter the hospital where my temperature will decide if I will be allowed to work today or not. The question of whether or not I will be able to work hangs upon my mind as I stand there questioning if I had my heater on too hot this morning on my way to the hospital or if I drank my morning coffee too fast and elevated my temperature. Upon attempting to scan my temperature, I notice the attendant is using a thermometer with tape barely holding a battery inside the small device. “Questionably reliable is an understatement” I think to myself as the attendant has difficulty getting the thermometer to work for the third time scanning my forehead. Each time she scans a different temperature popping up on the screen. Reporting to the Neurological ICU is my next step for the morning to be given my PPE for the day.

Making my way across the hospital I am given a small bag of PPE that is to be treated as my only lifeline for the entirety of my shift. Within the bag is almost everything I will need. I check to see if I was given the proper PPE to ensure my safety against a virus that is killing the very patients I take care of. The bag is different every day and something is often missing or not supplied in the correct size due to supply limitations, but I make do with what we have.

The N95 mask is comfortable at first, but after two hours it will become painful with the straps and nose-ridge slowly starting a pressure ulcer on the places it touches my face. After 6 hours I avoid bumping the mask, as the sites where it touches my face have become undeniably painful. After my entire 12-hour shift I am left with actual pressure-lesions on the tops of my ears and across the bridge of my nose. These sores, after one day of use, will take several days to heal.

I take the XXL scrubs that I am given to change into and I roll the waist and ankles several times in order to make sure they don’t fall off of my small frame. Once I am minimally comfortable with my clothes not falling off I move on to finding disposable glasses that have been reused for the past week and wipe them down with disinfectant and hope that when I place them upon my face I have covered every inch so I don’t contaminate myself before I even see my patients.

Immediately, the glasses begin to fog up and I can barely see as my breath begins to obscure my vision. This effect does not go away and will stay with me throughout my entire day; only getting much worse when my breathing quickens as my heart races while I attempt to save a life or prone a patient with three layers of thin plastic gowns covering me from neck to knees.

The PPE is immediately hot and only gets worse as I move and the sweat builds up inside of the gowns much like the effect that happens when you see drops form on your bathroom mirror while you shower. I am now just ready to walk into the unit where I will begin my day.

I enter the COVID unit to be met with chaos. The patients are too sick for the nurses to keep up with and what you see is a unit of nurses frantically running from room to room just trying to keep the IV pumps fed and keep up with new critical situations that are slowly unfolding in front of them with no end in sight as the patients die slowly against all measures. The patients are so sick that they are simultaneously being ventilated, sedated, chemically paralyzed, pronated, placed on hemodialysis, and receiving vasopressors to keep their heart pumping.

On a normal ICU a singular patient that is as ill as this would take two nurses to attend the patient to meet all needs. In this unit, every nurse will have two, or even three, of these patients. These three patients each are on the brink of death. Each one requiring more care than a single nurse can accomplish. This leaves the singular nurse frantically attempting to meet only the basics that are necessary to keep the patient alive and moving on to the next crisis similarly to how a combat medic would move from wounded soldier to solder in a warzone. Deciding which value is important enough to measure a response or should I respond to the critical alarm that just went off in the next room. You find yourself constantly in a state of alert-panic wondering which alarm indicates that the patient next door is dying more than the one you are currently responding to.

Nurses begin yelling into the hallway from partially closed doors to see if anyone is outside of a room to run and fetch something needed urgently. Often, there is no one that is available as they are all in the same situation. In this situation, the nurse is forced to leave the room and remove the excess PPE that took 30 solid seconds to properly be donned and run to find the supplies that are needed to accomplish my goal.

They enter the store-room where the supplies are kept, only to find that the supplies are running low and the item they needed is replaced with an empty shelf. This is due to the fact that supplies are both running low from sicker patients, but also due to the fact that supply visits have been scaled back, so that the exposure risk is minimalized to support staff. This leaves the nurse without what they need to accomplish basic parts of their job.

The nurse is then forced to decide if it’s worth their precious time to find the supply or make do with an improvised solution. If the item is necessary, the nurse will have to stop everything and call a support department to find the item and request it three times to find the item. This is consistent across every department.

For basic supplies the nurse will call four times and the device/supply will arrive outside the department doors up-to four hours later. For life saving drugs and IV bags that are currently the only thing keeping these patients alive, the nurse will call once an hour before the bag runs dry, then will call two more times when the bag runs dry, and then will have to call once more to the pharmacy, but this time the nurse will be yelling angrily at the pharmacy staff about how they have someone minutes from death and somehow the pharmacy has failed to complete the STAT medication replacement order within four hours. Then, in many situations, the drugs will have been sent to another department by accident. All of this time spent trying to get supplies and medications is taken away from that nurse’s ability to keep these patients alive and this whole-time real people are suffering.

Walking down the hallway you see trash bags lining the ground against the walls. There are mangled boxes of empty supplies lying on every counter as a nurse found what they needed and ran back into a room to attempt to save a life. You look as you pass three empty rooms with the doors closed to contain the contaminated air within them. These rooms are dirty. They once housed a COVID positive patient that has now deceased.

These rooms have been dirty for days as the cleaning staff has also been scaled back to only enter the unit as necessary. Supplies and trash litter the floors of these rooms, masking dried drops of blood and tears as nurses and a single physician were unable to save another life or even clean up the aftermath of yet another death. In many cases, the staff is forced to code a patient knowing that it will do nothing to stop the impending death of a patient they fought days to keep alive. This body will lie there, still warm, while the nurses and single physician tear off their contaminated PPE and move as a herd to respond to the next impending crisis that is happening only rooms away.

The shifts are long. A singular break is found in the evening for a half-hour if you are one of the lucky people to have relief sent your way. Throughout the day you can’t eat or drink. There is no time to doff your PPE. To leave the unit takes ten minutes of removing your PPE and hoping that in the process you don’t contaminate yourself while doffing. Clocking out records your entry. By the time that you have sat down and removed your PPE, drink a can of soda and gluttonously inhale a small sandwich, you must re-enter the ICU and clock back in for the remaining hours of failure and frustration in attending these individuals who more-than-likely will die here. The shift goes on like this for 14 hours from start-to-finish.

By the time I get home at night, I am exhausted. My willpower is gone. I force myself to shower and clean myself, hoping that I don’t bring the virus home with me. Hoping I don’t infect those that I live with and make them suffer as my patients do. Hoping that I didn’t touch my face by accident earlier that day and become ill myself.

I will lay there in bed for no less than an hour that night trying to sleep, but my mind is still traumatized from the emotions I felt that day. Sleep has become fleeting as I toss and turn to nightmares I did not have before this crisis. Stress I felt that day lingers in me as I feel my muscles tense and sore in both reaction to that day, but also anticipation of tomorrow. That morning I woke up at 4am to get ready for a shift I knew would be difficult. That night I got home at 8:30pm, showered, and went to bed. Tomorrow I wake up at 4am to go back and start over again.

What frightens me is that this is what my day is like and the outbreak has only begun. It will get worse. We are failing. Most of these critically ill will die. Some will die needlessly because of our failure in supporting the nurses."