I was looking forward to March 2020. My boyfriend and I had a long-awaited vacation to Aruba we were looking forward to. Everything is packed, plans are finalized, and the world shuts down three days before our trip. Frustrated, we refuse to believe that a “virus” is worthy of shutting the world down. “What’s the difference between this and anything else?” “Who cares? It’s just a virus?!” “I am still going away; they can’t really shut the world down” were all things I said myself. I went out that St. Patrick’s Day weekend and was in an apartment in Boston with probably 50 others sharing drinks and having a great time. There was no concern. The pandemic didn’t exist.
I work as a rapid response nurse through our ICU. I went into work that week without a mask for the last time, probably ever, unbeknownst to me. That was the beginning of the hysteria. The fear of the unknown was starting to creep into the hospital walls, and talks of disaster plans were starting. Those “just in case” plans seemed so ridiculous. It humored me. I am a good nurse who routinely cares for sick patients. This won’t be any different.
Come April, our ICU turned into what looked like an abatement zone. Plastic walls up around the nurse’s station, allowing for those in the “clean zone” to see the shadows on the other side, bustling around, banging on the walls, and trying to yell through their masks and over the HEPA filters, vents, CRRT machines, and cooling blankets when they needed supplies, help, or a sip of water. We thought, “This can’t last long,” “This is overkill.” But then our first COVID patient died, making us all second guess our preconceived notions around the virus.
Those rooms became filled, and with no other choice, our single-patient rooms were turned into double rooms. No curtains, second call bell, second TV, or space. It didn’t matter, considering they were all on life support anyway, so we were told. This meant that there was also no second central monitor. Transport monitors were set up at the bedside for the “less sick” patient in the room. I laughed. They were all sick.
One day I went into the “hot zone” to see if anyone needed any last-minute help before the day shift came in. “Yes, please, I haven’t peed all night!” I hear from Rebecca. I sat in her room, cleaning up, taking the trash out, while whistling along to keep myself awake after a long night. I hear the bedside monitor alarm for the patient in bed 2 and see that their heart rate went from 120s to 30, 20. I watch the a-line go flat. I couldn’t reach the code button because it was blocked by the other patient, the two vents, and one CRRT machine. I jump on the bed and begin chest compressions. I’m yelling through my mask for help, sweating under the PPE, feeling the seal of my mask breaking. I’m scared, and I don’t get scared. “Why is no one coming? Can’t they see what’s happening?” but then I realize they couldn’t; this patient was not on central monitoring. No one knows this is happening but me. The opaque wall prevented anyone from seeing in. The ridiculous noise in the hot zone meant no one could hear my screams. Anxiety settles in.
After what felt like hours, Rebecca came to the room, climbed over the prone patient in bed 1, and pressed the code button. No one came. They couldn’t even hear the alarm. The emergency room staff and ICU charge nurse ran into the ante-room to gown up and help me. Everyone in the COVID ICU was confused, considering they could not see or hear what was happening behind those opaque walls or over all the noise. Once they got in, I jump off the bed, my arms shaking and my breathing heavy. I lean up against the wall and watch as they get a pulse back. I feel relieved.
This situation was a prime example of the unsafe and traumatizing environment we were forced to work in, at no fault to anyone. These measures were put into place to protect us while we care for some of the sickest patients I have ever seen. But the fear behind those walls was real. The isolation you felt as you gowned up and stepped back there was overwhelming; limited supplies, limited help, and difficulty communicating in such a crazy environment. Not only was it stressful to care for COVID patients, but the “hot zones” that were created to allow nurses to stay in PPE while walking from room to room did also more mental trauma in the long run.
It felt like the trauma followed me even out of the hot zone. Working as the rapid response nurse at night in a community hospital, I felt like the angel of death. If you saw me in your patient’s room, something bad was happening. If you need me, it means your patient was decompensating. Rapid response after rapid response, I run up to the COVID telemetry units to attempt to stabilize patients that needed it. Usually, this meant I was the one caring for them with no orders, help, or resources. The hospitalist was nowhere to be found, caring for others that may need it or simply refusing to step into the precaution rooms, “If you think they need to go, just take them” they would text me as I am begging them for help or guidance as it’s just me in the room with these other scared floor nurses looking to me for answers. I had to buck up and stay confident, composed, all while being arguably more scared than them, considering I knew what kind of path was headed for this patient. I would lie: “You’re going to be okay, I am from the ICU, I will help” “We just want to watch you a little closer” “Stay calm I will make sure nothing bad will happen” as you watch their face full of the fear that comes with true shortness of breath.
I saw these people when they were admitted maybe on room air or a little oxygen via nasal cannula. I talked to them night after night. I watched them decline until they were proven sick enough for me to transfer them to the ICU; tachypneic, hypoxic, tachycardic, febrile. Nothing we did helped them. I felt their fear and their pain that I could not relieve. I would take them to the ICU just in time to go back to the floors for another person who needed me. Only to come back and find the patient intubated and sedated.
I think about them often. It haunts me: Should I have taken them sooner? Did I do something I shouldn’t have? Should I have given them the false hope that I did on our elevator ride down?
I tried my best, but I was the angel of death.
Emily D’Amelio is a rapid response nurse.
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