I Am Not Ready to Die!

COVID 19, Frontline nurse on a medical-surgical floor, how to bring hope when you are hoping not to be the next infected case!

I Am Not Ready to Die!
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I am not sure if Noel is still alive!

I will know tomorrow when I go to work.

With my minimal PPEs, I was nervous entering the room on my first day on an unfamiliar unit in the hospital. All clinic nurses had been deployed to the hospital. No training, just show up and plugged in where the need was. I told the charge RN that I would assist them in any possible way.

I saw Noel when I first went in to do his vital signs. He looked pale and sick and was short on breath even though he had a non-rebreather mask on. He was spiking a temperature of 102F. I informed his primary nurse who went in with the Tylenol. When I went back to retake his temperature an hour later, he was surrounded by a team of doctors telling him that his condition was worsening and that he may not be a good candidate for CPR as he was a do not intubate (DNI) and had multiple other conditions.

"Do you understand what we are saying? If your heart stops, it's better not to do anything as your heart will stop again even if we revive you".

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Noel looked heartbroken and whispered "I want to live!"

I stood there holding his hand, a giant lump in my throat, my eyes looking straight at his black eyes clouded with tears. He was shaking with sobs once they left. I squeezed his hands gently and softly spoke to him. I told him to continue to fight, never give up, no matter who said what. His temperature had come down and I got him to get two sips of water in. I then gently removed his colostomy bag from which the feces had overrun his sheets, cleaned and put a new bag on. With the help of the Nursing attendant, we cleaned him thoroughly and put clean sheets on his bed and a fresh gown. He was sleeping like a baby when we left.

It bothered me that the patient was not given a choice. Instead, the doctors called his nephew and explained the "situation". In my mind, unless a patient had a DNR, DNI everyone is a full code but now they pick and chose based on viability. Many units are told not to code futile cases even if they are full codes as the risk of spreading COVID-19 during chest compressions is greater to the health team and the chances of getting most of these patients back especially if they had Acute Respiratory Distress Syndrome, minimal.

The isolation these patients face is not just worrisome to them but creates a kind of hopelessness in them. I would walk into rooms and some patients would be sitting with glazed looks, extremely short of breath. Their tray from the previous meal left untouched, as they are too sick to attempt to eat. There are two nursing attendants for 46 patients. Who would they feed? So I would talk to them, cajole them to eat and drink even if it was two sips of soup and exhort them to get better so they could go home.

A patient who was on the mend showed me her four year old on face time trying to hug her. I promised him that I would make sure mummy came home safe. She left the next day crying as she thanked me and promised to pray for all nurses and other healthcare workers who put themselves at risk to take care of the patients. I quote her:

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You nurses are the only ones who show up in our rooms!

My heart goes out to the nurses and the nursing attendants. Donning and doffing the PPES, medications, dressing, vents, suctioning, narcotics, vitals, blood sugar checks, feeding, changing, emptying garbage, moving patients on /off stretchers, calling pharmacy, calling families, calling team members for help, paging providers-----the list goes on and on. The fear of infecting themselves and their families, the isolation away from them, the guilt of ignoring call-bells, the futility of care in some cases, the call outs and worry, anger and grief about sick or dead colleagues, the emotional and physical toll especially when support is not perceived from management. So, I am girl Friday helping wherever I can and self-appointed call bell queen! One of the patients who had a stroke, is positive for COVID 19 and is actively dying, asked me a very pertinent question

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Where do I go when I go to the other place? Will I fall off a cliff? Is it hot there?

I intuitively knew she was talking about death. I asked her if she believed in God. When she said she did I told her to call on Jesus and that He would keep her safe. She shared with me that she had seen a green angel a few years ago!

"Well I hope Ms. Smith that the angel keeps you company always so you won't feel lonely!"

"You are nice!" she announced.

Meanwhile, her roommate was getting ready to go home. I told her nurse that I would take a last set of vitals and remove the hep-lock for her. When I went in and saw how short of breath she was, I immediately checked her oxygen saturation which was 90% on 4 liters of oxygen. Her pulse was 130 per minute and her breathing labored. I immediately upped the oxygen, sat her in high fowlers and informed her primary nurse. Her discharge was held. She looked much better the next day and thanked me for speaking up for her. Her quote:

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I am glad you stopped me from going home yesterday. I would have died as it got worse last night.

In this time, when we are hit very hard, we have two choices in life. To follow our calling safely or to refuse. My personal opinion is that most nurses will put up with hardship and take good care of their patients once they know that they have adequate PPEs and management that cares and checks in to see how they can assist their nurses. We are today in a unique position of being the literal frontline staff and have an ability to laugh and cry with our patients, help them during their health crisis and sometimes being the last person they see as they leave this world. While continuing to speak up, fight for our PPEs, ability to protect our patient rights, our rights, and our family's rights; let us not forget to be the light that dispels the darkness and show the world that the other name for intelligence, advocacy, compassion, caring and hope is NURSING!

To all my fellow nurses ...

Thank you for each day that you put your life on the line to serve others! Your bravery may not merit speeches or awards in this world but somewhere in the world will be a grateful patient, a proud spouse/child, a coworker that is thankful for your life! We are the most trusted profession for a reason!

Stay safe.

Stay calm.

We are nurses, we got this! God is in control of every storm!

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As for Noel, he is still alive!

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spotangel

About spotangel, DNP, RN, NP

Chronic Care Coordinator

RN for 31 years with inpatient, outpatient, home care, management and teaching experience. Author of Sightings After Death, a book with 25 real life stories of hope and comfort. Mother of three beautiful children, wife of a serious, kindhearted man who loves my jokes. Coffee lover, nerd, loves books and have trusted girlfriends!

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Specializes in Travel, Home Health, Med-Surg.

Thank you for the heartwarming and inspiring article. Stay safe out there!

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Reading this just brought me back to my last shift. I go back in tomorrow but I just enjoyed 6 lovely days off and was able to explain to my family how things are, but I didn't dare go in deep with them (they are already worried sick about me).

You said all of the things that I couldn't. In fact, I was at a loss for words last Friday and in tears driving mind you. This is tough and hard and I NEVER had to make some of the decisions that I was forced to. I mean, honestly, how much care do you want to provide in these situations. Do you want to spend so much time in those rooms. These questions may seem like no brainers to some people but for the ones who are taking care of 3 to 4 covid patients, changing in and out of gowns, masks, face shields, head covers, for 12-13 hours straight with no break, it is tough. Some of them are NOT just there for COVID. There are wounds, colostomy bags, combative AMS, active CP, SOB, the list goes on... Yes you have your standing orders and sometimes the doctors aren't even close unless an active code. My hospital even told us that they didn't want our techs in the room because of risk of exposure so all shift long the RNs were in those rooms doing EVERYTHING alone. Yes we are on the front lines and No I don't think I'll be totally okay after all of this calms down. But I'm glad to have this forum.

I didn't do any of this for any praise from anyone. I feel responsible to give good care each and every time. Ethically and emotionally it's hard but I take it one breath at a time and I'm hoping I stay safe and well.

I pray that all of you do the same...

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Specializes in RN.

Nurses didn't sign up for pandemics to die. They signed up to take care of patients. If hospitals are not properly equipping their HCW's then its time to resign. A job is replaceable, life isn't

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Thank you for the heartwarming article.

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HiddenAngels, this may sound like a stupid question, but if the hospital does not want the techs to go into the rooms, then what are the techs supposed to be doing?

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Specializes in ED, Tele, MedSurg, ADN, Outpatient, LTC, Peds.

I want to know too! It is too much on a nurse!

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On 4/9/2020 at 9:26 AM, caliotter3 said:

HiddenAngels, this may sound like a stupid question, but if the hospital does not want the techs to go into the rooms, then what are the techs supposed to be doing?

They are answering the call bells if patient rings and TELLING THE NURSES what the patient wants. They are setting things up outside the rooms for easy access. Stocking the floors... that sort of thing.

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On 4/9/2020 at 12:02 PM, spotangel said:

I want to know too! It is too much on a nurse!

It is! It's not right. You see them sitting around talking to each other or doing something on their plastic wrapped phones and you're hustling... But, they are still responsible for the assigned patient rooms; they sort of act as a hand to get you supplies you may need if something is not in the room. You press the call bell for them to leave it outside the door but that's the extent it..

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Specializes in ED, Tele, MedSurg, ADN, Outpatient, LTC, Peds.

Why is that OK should be a question for your manager from all nurses? Where is the rest of the team ? I hope your place has a nurses union.

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What rest of the team? Things have change drastically because of this pandemic. The nurses really are the ONLY ones that are hands-on... Respiratory comes but only when they have to and not right away. I saw one respiratory therapist snap on a patient because she was saying I don't want to take this home to my family etc...(what in the world!, that patient is not there for that, but anyway)... Like I said above the techs don't go into the rooms because the managers want to limit exposure. And the managers, they're in their offices or off the floor or in some meeting, and there are many very very important strategic planning meetings (cap)..

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Specializes in ED, Tele, MedSurg, ADN, Outpatient, LTC, Peds.

That is so upsetting! Nursing management need to stand up for nursing. In my hospital, the union is strong and has a very active media presence. So we went from one N95/week to one N95 a day which is still unsafe.Our NA's go into the rooms and so does phlebotomy and PT. The docs are in and out! We are filing out daily COVID diaries and Protest of assignments. The work is overwhelming but we try and support each other and keep abreast of what's happening. We try very hard to help our pts and keep their spirits up! And NOEL is still alive! Last week he was eating rice and chicken! I told him that he is my inspiration!

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