2 Weeks Ago
About 2 weeks ago (the second week of March), a friend asked me how work was with all the COVID stuff going on. I said, “Imagine having someone scream ‘COVIDDDDD’ at the top of their lungs until it’s hard to even think and you start gritting your teeth trying not to scream back... for about 13 hours”.
That was two weeks ago, before I’d had to take care of a positive case. At this point we were just in prep-mode and finding our footing dealing with all the rule out cases. I’m a travel nurse working in an ICU at a regional hospital on the east coast. Two weeks ago, we were sorting out our protocols and PPE. We were seeing our new “Droplet Plus” isolation labels in EMRs and taping up our newly laminated “Droplet Plus” signs on doors. We were playing musical rooms to make sure the rule-outs were far away from our cardiothoracic post-op patients. We only had 2 true negative pressure rooms with antechambers so, given the recommended precautions, we were struggling with options there as well...but again, that was 2 weeks ago.
My First Covid-19 Patient
We had a presumptive positive patient come in this week, who was confirmed positive 24 hours later. That call came in for that (my) patient about an hour or two into our night. Nothing had changed physically - the patient was already on a ventilator in a negative pressure room with us utilizing droplet-airborne precautions. I’d been in and out a couple times already in a PAPR/gown PPE combo...but at the same time, everything changed on the unit. We had already designated the pod of 8 rooms I was in as the COVID pod. The majority of the rooms had already been converted to “negative pressure” (which involves knocking out windows, plyboard, tape, caulking and rigging up an air-cycling system)...but for everyone there, the air on the unit instantly changed after that phone call. No longer was there this “screaming in your ear” feeling. It changed to a grave, deafening silence. Suddenly it was like someone was standing next to you holding their breath for 13 hours and you had to breathe the air in the COVID room.
I knew I was getting in my head about it. I mean, I’d worked with our novel disease team before I was a traveler. I’d actually helped take care of an Ebola rule out patient years ago. COVID-19 isn’t technically airborne precautions and this patient was already on a vent - effectively keeping the transmission into the environment even lower than pre-intubation. We knew now, though.
This is Not a Drill
The doffing protocol and cleaning of my PAPR became particularly intense. We’d initiated CRRT (continuous dialysis) on the patient due kidney failure, so over three nights I’d sit in my anteroom at least once an hour wiping down my respirator and hood. Try not to miss any spot. Get every surface. ***, did it just tap the used PPE bin? Wipe it again just to make sure. It became compulsory to make sure every inch of material was glistening in disinfectant. I feel like I truly understand how Lady Macbeth felt when she says, “Out damned spot! Out, I say!” in Macbeth.
Holding My Breath
My nose and eyes started stinging because of the intensity of the fumes. I found myself holding breaths for as long as I could while cleaning because of the smell, and more than once I found myself a bit lightheaded after doffing (likely because of holding my breath, I didn’t see any warning about fume toxicity on the wipe’s container).
The stress was most intense on the first two nights. By the third night I’d become very neutral on my current lot in life. I’d equate it to that feeling right before you do something crazy dangerous (like skydiving) or difficult (that exam that you’ve been dreading)...it was basically a shift from hyper alert stress response to an eerie calm - I’m here and this is happening, nothing’s going to change it. The ventilator tubing popped off the patient’s endotracheal tube and blasted COVID air onto my gown (at chest level) on that third night. I only had a mild Welp, I’m ***ed now, sense wash over me for about fifteen minutes then scrubbed the *** outta all my gear, hands and arms as usual.
What doesn’t change though is the strain outside of my own nurse-patient world. On night two, a patient coded who was a rule out and I suddenly have people banging on my window telling me to get out and wipe down the respirator part of my PPE so they get more people into the code to help. There is the gut-wrenching feeling of talking with my patient’s spouse on the phone, who is thanking me for calling and updating them on the patient’s condition because they are under quarantine themselves. The frustratingly difficult process of assisting each other in patient care because of the need to don/doff/disinfect for even the simplest things (getting a patient on a bedpan). There is already burnout I can see and personally experience that is hard to describe. I feel like I have on lead boots now. I can’t get things done at a pace I’m used to. Being pissed “at” a patient because of all the extra steps you now have to take in order to actually go into the room, and then beating yourself up about feeling like that because it’s a lot of *** that the patient has no control over.
After three shifts with a COVID patient, my attitude had changed. I don’t think it’s any secret we compartmentalize well in the medical field and I guess I’ve made some shelf space for this pandemic. I still had this giddy energy to strip my scrubs off as soon as possible, throw them in the washer, and get in the shower. I literally hold my breath as I strip off my scrubs. I consciously made sure my beard had hot water running through it for several minutes in the shower. I’d drink a cup of hot water before I got into bed.
Feelings of Guilt
I secretly have this thought too...a bitter thought. I feel *** for even thinking it but I’m going to share it because maybe other people in healthcare are feeling the same and that might quell the feelings of guilt:
I’m already frustrated that, by the end of this - months of this - there will be celebrations, parties, socials, and festivals celebrating the end of the pandemic and I’m going to be at work. There is no future reprieve because people can’t put off getting sick so we can have a break, nor will they postpone any sort of elective procedure that has already gotten pushed because of the pandemic. We’re here for the duration and beyond, and there is no “relief unit” or “change of guard” that will be sent in so we can all take some time off, rest, digest, decompress and recover. We’ll be here when everyone comes back because we have to be. We will take breaks in shifts and as availability permits, but more than likely there will be a surge of patients when this all calms down...not any sort of respite. It’s a thought I keep trying to kill and bury six feet under...
So I’ll see y'all on the other end....ready or not.