I remember those crazy early days when everything was so confusing and chaotic. I had just started a new job at our small, rural community hospital. We had moved in Fall 2019 and I had taken a few months to find a house and get settled and I was ready to get back to work. Those early days of orientation (which ended up being cut short) were equally chaotic-we were inundated with Covid patients, supplies and resources were limited, staffing was short, and administration was doing their best but it seemed like every shift policies and procedures changed. I cringe just recalling it.
But I’m a pretty calm, adaptable person and thankfully not a new nurse so I just kind of settled in and went to work. I was PRN so my schedule was kind of crazy. There were plenty of shifts to pick up so I dove head long into it, picking up both day and NOC shifts. At first, I mostly worked on the non-Covid hall(s). The hospital has a 30-bed Med Surg unit-3 halls with 10 beds each shaped like spokes on a half-wheel with the nursing station in the center. When it first started we had one designated Covid hall. Within short order it became two when there was an outbreak at a local nursing home.
Covid-19 Exposure
My first Covid exposure came in late June with the admission of a patient from that nursing home. Patient A was admitted for seizures and tested negative for Covid on admission. As such, I used only universal precautions. (Because of severe supply limitations N95s were only allotted to designated Covid nurses). My shift was uneventful but later that night the patient spiked a fever and was retested as positive.
My second exposure came just a few days later. I was on one of the Covid halls. Patient B was from the same nursing home and known positive. B had dementia and kept taking the oxygen mask off so the monitor was continually sounding. We had a camera system set up and could monitor and speak to B but repeated pleas for B to leave the oxygen on were ignored. I was in and out of B’s room a lot. By mid afternoon, B was going into respiratory failure and even though I was in full PPE, I was exposed to a prolonged aerosolizing procedure. B was transferred to ICU and later passed. (As did patient A).
A Few Days Later, I Had Covid
In the two weeks prior to this, I had worked 10 shifts in 14 days (nine 12 hour & one 6 hour). It was a combo of day & NOCs so to say I was exhausted, is an understatement. I had done little else except work & sleep and after my NOC shift Monday July 6-7th, I was ready for bed! I got home not feeling very well-tired, achy and sore. I showered, did a few things around the house, and blissfully settled in bed with my ‘mean little chihuahua’ Taz curled at my feet. About 10:30am I woke up shivering. I’m often cold so I grabbed a blanket, jokingly texted my husband saying, “this better not be Covid!” and went back to sleep. An hour later, I woke up with a 101.3 fever. I called my boss, the house supervisor and employee health. Mandatory 72 hours off and then testing if symptoms persisted. My exact thought was “Well crap! Here we go.” Even though I knew Covid could get bad, I was relatively healthy. I have an autoimmune condition (Sjogrens) and a neuro-inflammatory condition (CRPS) but both were under very good control and I was the healthiest I had been in over a decade. I really had this idea that I’d be sick a few days, have to quarantine for 14 days (guidelines at that time) and I’d be back at it in two weeks. Boy was I wrong!
The First Few Days Weren’t That Bad
I slept a lot. Had fever and chills, body aches, headache, was nauseous and had a scratchy throat. My chest felt heavy but I wasn’t congested or coughing. By Friday, I was feeling pretty “crummy” so I called my PCP and did a telehealth visit. He sent me for testing and started me on a medrol dose pack and albuterol inhaler as needed. I had been watching my vitals-especially O2 sat. By Friday evening I was in the low 90s with occasional dips into the 80s. I kept telling my husband my pulse oximeter must be wrong because I didn’t feel short of breath. Still no cough or congestion. I changed the batteries and had him test it on himself (yes, I know-poor infection control. BTW, he never got Covid. He has tested negative through out. I think he’s one of those lucky naturally immune.). By Saturday morning my sats were in the mid/upper 80s with drops into the 70s. I knew I needed to go to the ER but I still was thinking it had to be wrong but I just didn’t feel that short of breath. And I’m stubborn and we all know nurses make horrible patients! My husband called my PCP and they convinced me to go. My sats were indeed that low (silent hypoxia). My CT showed significant ground glass opacities throughout both lungs. I was admitted with severe Covid pneumonia.
"The Talk"
I still kinda had this idea that it wasn’t that bad but it would get real really quickly. One of the moments that still bothers me most was when my doctor sat us down for “the talk”. I’ve spent most of my career in inpatient oncology. I’ve heard the talk, been present for it countless times, answered questions about it. But when you are the one “the talk” is about, it’s a whole new ball game. Did I want to be put on the vent? CPR? Who could make decisions for me if I was incapacitated? Do I have an advanced directive? Can you get us a copy? We need it in the chart. The look of horror on my husband’s face is etched in my memory and I don’t know if I’ll ever get over it.
Transfer to ICU
Initially, I was on the MedSurg floor but in very short order was transferred to ICU in respiratory failure. I never had to be put on a vent but was on 60 liters high flow oxygen. I really don’t remember much of my time in ICU, in fact my whole hospitalization is a bit of a blur. My husband, unfortunately remembers all of it. I was so sick I couldn’t communicate with him very much. One, it’s hard to talk with a leaf blower up your nose and in your face. And proning made it difficult to text and honestly, I was just too sick to manage more than an occasional blurb here and there. So he was left at home, quarantining, and wondering what the hell was happening. He did get updates from the nurses each shift and talked with my doctor as necessary-those were his lifelines.
You have to remember, this was still pretty early on and doctors were still scrambling to figure out how to best treat this. I’m grateful I have an excellent PCP who is Chief of Staff and Covid-19 task force chairman in this area. Remdisivir was just coming on scene (in fact, I gave the first dose given in our hospital on the Sunday before I became sick) and he was able to get emergency authorization. He also pushed for convalescent plasma, which had not been done at that point, but was unable to get it approved. Thankfully, after Day 4 of remdisivir I started to turn the corner. My hsCRP levels leveled off and started to fall.
Discharge Home: The Next 13 Months ...
I spent 13 days total in the hospital and was discharged on home oxygen. I’d like to be able to say my story ends there (I got better and went back to work) but it doesn’t.
They next 13 months would take me on a journey that has been tough and frustrating. I was on oxygen 24/7 for about 3-4 months and then had to use it for exercise and activity for another 9 months. In fact last week, I finally passed my six minute walk test and was able to call the medical supply company to come get the concentrators! Yay!
It’s been a year of doctors appointments, labs, tests, procedures, medications, & treatments. My small medical team of a PCP, rheumatologist and interventional pain mgt doctor has grown to include more -ologists than I can count. (Pulmonologists, cardiologist, neurologist, endocrinologist, nephrologist, & gastroenterologist. I’ve added diagnoses of interstitial lung disease (fibrosis), pulmonary hypertension, secondary adrenal insufficiency, POTS (esp tachycardia/SVT), chronic gastritis/ulcers, acute kidney injury/failure, temporary liver inflammation and PASC.
It sounds like a lot. And, it is! But now 13 months out, I’m doing good about 80% of the time. Not great, but good. I’ll take it.
My lung function has slowly improved (as I mentioned above). CT still shows some small persistent GGOs, some interstitial thickening and slight mosaic attenuation but it has improved significantly. Still having occasional bouts of tachycardia/SVT but it’s mostly controlled with a combo of beta blockers and Corlanor. Kidney and liver function is back to normal. Cortisol levels are still low but I’m slowly weaning off steroids as my adrenals continue to wake up. Still some GI issues but mostly controlled with carafate & protonix and diet. Fatigue is still an issue but also improving. I’m not ready to take on a 12 hour shift yet but most days I do OK if I pace myself. I can manage one big thing a day-going to the gym, housework, projects, etc., and then have to rest. Still having some neuro issues (awaiting an appointment for that). The scariest and most annoying is a sudden (and thankfully brief) period of not recognizing where I am, especially if driving/riding in a car. It’s not the same as when you go on autopilot and zone out and think did I already pass my turn? This is a feeling of I don’t know where I am and nothing looks familiar even though I’ve been here hundreds of times. It usually only lasts a 15-30 seconds, occasionally longer, and is accompanied by an equally long intense moment of panic. Other things like phantom smells, hand tremor, mixing up words, name/word recall, being able to follow a plot of a book or movie, connecting ideas and extrapolating information are annoying but minor in the grand scheme of things. Oh, another one; the inability to type on my phone. Somehow the connection between the button my brain says push and the one my hand actually hits is lost. It’s extremely annoying, LOL.
... And, Beyond
I don’t know when (or if) I will go back to nursing. It likely won’t be beside (PCP is adamantly against it) due to my health issues and the current environment. I’m fully vaccinated but it’s just too big a risk. I’ve done several things in nursing over my almost 20 years, but I enjoy direct patient care the most. I’ve done administration and it isn’t my cup of tea but I’m considering case management or perhaps professional writing. (If you’ve gotten this far you may be opposed to that last one!)
