I’m awake before my alarm goes off. I make coffee, wash my face and put deodorant on twice. The deodorant is never enough to stop the sweat and smell, but I try. My husband and kids are still asleep. I try to eat. My stomach turns as I imagine what today will bring, though of course I know. It’s always variations on the same theme: Critically ill patients who all have been given the same diagnosis, COVID-19.
I’ve started to refer to the time before this as peace time. Because this feels like a war. I grudgingly respect our enemy’s tenacity. Unseen, ruthless, random.
I am one of the many thousands of nurses who work in intensive care units in New York. We are not handmaidens or angels. We are professionals in our own right. We turn treatment plans into action. We question when things don’t make sense or aren’t going to work. We find solutions that work for our patients. Nurses assess and observe, question and console. We stand between the patient and the enemy. We are the front line.
Subway or Lyft? I ponder this before every shift. I don’t feel safe taking the subway. It’s too eerily quiet now. So Lyft it is. I pick up my work buddy on the way. We discuss our enemy, our talk inflected with dark humour and good-natured digs at colleagues. “If I end up here,” I say as we arrive at the ICU, “promise me you won’t let Chad see me naked?”
Looking after these patients is a team effort. We are all scared and heartbroken. But we have our triumphs: A patient improves and can be moved out of the ICU; we come up with an idea that saves time and preserves our precious PPE.
We arrive at work and are both assigned to the COVID ICU. We are always here now. This is the first COVID ICU opened in our hospital. We feel a sense of ownership.
We have a quick huddle to confer about patients: who’s the sickest, who’s about to “crash,” whose family has been calling and needs an update. We assess what supplies are low. We don N95 masks. We wear them all day now.
I don’t have a specific patient assignment yet. I’m the “float” nurse, doing a range of things. My first task is to help with post-mortem care on a COVID patient we just lost. We had watched her slowly die over the past few days. We did everything we could. It’s just me and a nursing colleague in the room.
It’s a grim affair. We wrap the patient’s body securely, stroking her brow and wishing her well on her next journey. My colleague removes her jewellery carefully; we know her daughter will want it. I have to collect her belongings because security isn’t allowed to come into the room. It moves me to see her wallet, her planner, her toiletries. Only a week ago she was a person with a future, with plans, with cherry-flavoured lip balm.
Hacks we’ve devised to stay safe
I spend the next few hours helping to figure out how to double our ICU capacity. How will we fit two beds, two ventilators, two monitors in each room? Where will we get more monitors? Do we have enough ventilators? One of my doctors jokes about the feng shui of the room. It’s all wrong, I say.
We get three COVID admissions back-to-back. A nursing colleague and I each add a gown, double our gloves and put a face shield over our N95 masks. This is our personal protective equipment, or PPE.
We begin a familiar and elaborate choreographic sequence. We move one of the recently admitted patients from a stretcher to an ICU bed. We strip him and while I do a full body assessment, my colleague hooks him up to the cardiac monitor and gets a set of vital signs. We place a urinary catheter and two intravenous lines.
We wash the patient and check his skin for wounds. We pad his heels and lower back with foam adhesives to prevent painful pressure areas forming while he is bed-bound. We place an oral gastric tube so he can receive nutrition while he is intubated and on a ventilator.
I walk into my apartment backward, leaving my shoes at the door, spraying Lysol behind me, headed for the shower. The kids are asleep. My husband gives me a smile...we keep our distance, sleeping in separate rooms.
Nursing colleagues outside the room set up our IV pumps with long extension tubing, so that we can manage our drips without donning our PPE. It is amazing what kinds of hacks we’ve devised to stay safe.
Finally, it is time to doff our PPE. We carefully clean our face shields and place them in a paper bag for reuse. An hour has passed. We are both sweating, our faces striped with marks from our N95s. The same worry haunts me every day now: Was I careful enough when I removed my PPE? It’s the only mask and shield I have for the rest of the day. Did I wash my hands well enough, for long enough?
Next, I check in with the doctors to discuss the treatment plan, changes and additions. I call the pharmacy to check on a medication. I need a piece of equipment I can’t find; our nursing assistant reads my mind and finds it without my having to ask.
I start some documentation while one of our nurse practitioners dons her PPE and goes in to place an arterial line — a special catheter that helps us monitor blood pressure and arterial blood gases, so we can know how well a patient is breathing. I discuss the results with our attending ICU doctor. I need to go back in the room to change the ventilator settings.
Nursing is a 24-hour profession
I’m still there an hour and a half after our shift change. I want to go home but it’s hard to leave. There is so much still to do. We always have to remind one another that nursing is a 24-hour profession. We hand off to our night nurses.
I remove my shoe covers and bleach my shoes. I change and bag up dirty scrubs to wash at home. My work buddy and I share a car home. We don’t talk much. I stare outside at the Brooklyn Bridge, at our beautiful city, and wonder how the patient in Bed 8 is doing, and if we will ever get back to peace time.
I walk into my apartment backward, leaving my shoes at the door, spraying Lysol behind me, headed for the shower. The kids are asleep. My husband gives me a smile but knows we won’t greet each other till I’m scrubbed, head to toe. Even then we keep our distance, sleeping in separate rooms.
Sometimes the day doesn’t go this smoothly because the patients are crashing, or we are short-staffed. But we do some version of this with every patient, over and over, day after day. They keep coming. And they are sick. Some of them die. Some are old, some are young.
Looking after these patients is a team effort. We are all scared and heartbroken. But we have our triumphs: A patient improves and can be moved out of the ICU; we come up with an idea that saves time and preserves our precious PPE.
The teamwork right now is inspiring. ICU nurses are tough; we fight for our patients; we have one another’s backs. Doctors may be the architects of what happens in the hospital. But we are the builders. And so we build, even amid chaos and disintegration. We build, even as a silent enemy attempts to undo everything we’ve done. We build and we build, shift after shift, as fast — and as best — as we can.
— Simone Hannah-Clark is a nurse in an intensive care unit in New York City.
