Covid-19 – One Nurse’s Personal Battle

It’s been 9 months…COVID-19 has been the bigger test in my life time.  Largely because it is outside of me, bigger than me; I was not here for the outbreak of the flu pandemic, or Ebola, or WWI or WWII, and so I have not before this been part of something of this magnitude, something that shook the construct of every aspect of society, that affected everyone…I mean, everyone…on some level.   When I first wrote about it, it had just become a public health emergency, but it quickly escalated. So much has transpired since. A pandemic!  COVID-19 has brought to sharp focus everything we’ve ever taken for granted – life, health, family, friends, travel, a job, a way of life.  The uncertainty of what will come next adds to the list. Some wonder if they will be able to open their doors for business the next day; whether they will be laid off or furloughed the next; whether they will be able to pay their bills next month; when they will see their loved ones again…if they will see them alive.  I wonder whether my kids will go through another week of school before they have to stay home – again.  Every industry, every field of endeavor, has suffered.  Everyone knows of someone who’s been affected. My experience has been no stranger than many others but has had a profound impact on me.

I joined the health field in the Medical-Surgical unit which is the largest specialty in the hospital system because it offers general medicine and houses patients hospitalized for illness, testing, observation, post or pre-surgery. I was used to patients getting better and walking out of the unit. I had maybe four deaths in my entire tenure in Med Surg that lasted about 2.5years. And then I took a job as an ICU nurse because I wanted that advanced level nurse experience that constantly tests your critical thinking skills. September of 2020, I started working at the ICU and in just my first two months there, I had the same number of deaths, in rapid succession, that I had throughout my time in Med-Surg.  Even worse, in every situation, I had hope…to the end, I had hope that the patient will turn around and eventually walk out of the hospital, and each time, I was proved wrong.

Some nurses on my unit had formed what they termed “a coping mechanism”.  One said: Jacky, I love your optimism…it is refreshing. These nurses did not believe their vent patients will make it and preferred to be surprised than to have their hopes dashed again and again. It seemed almost a mechanical way to function, but it was their way to cope with the frequent deaths that registered.

The first few times, I cried, I’d stand there when the vent was turned off and my goggles will fog over with my tears as I tried not to sniffle as I stood there respectfully and watched while the patient struggled to catch those last breaths, while his/her heart beat faster/harder, faithfully trying to do its job to keep the person alive.  And afterward, in private I’ll hit a cabinet in frustration, and sometimes I thought of my patients all night while lying in bed at home. I still do. And then I’ll take a few moments to compose myself, muster a smile and walk into the next patient’s room who needed care too.

 Why?  Why was this happening? How could a 40-year old die of COVID, a strong 53, 54, 55 year old with at least a third of their lives still in front of them? A woman with young kids at home?  A father whose 9-year old son clung to the window and begged his dad to pull through?  Could I do anything differently to make this any better, whether for the patient or their families?  And so I dug out my ‘Nursing Pledge” because I needed to reorient myself. Remind myself of why I was doing this service and what the expectations were, because it seemed that when it came to COVID-19, the lines between what we knew and what was were blurred. 

My Nursing Pledge said, amongst other things, “In the full knowledge of the responsibility I am undertaking, I promise to care for my patients with all the knowledge, skill, and understanding I possess,…,sparing no effort to conserve life, to alleviate suffering , and to promote health…With full awareness of my qualification and limitations, I will do my utmost to maximize the potential of the nursing profession and to uphold and advance its standards.”

In other words, at all times, I had to be my patient’s advocate. Within my limitations was a reminder that I was not the patient’s physician and did not make the orders, but I was part of his/her care team and my patient’s number one advocate and care giver. If the patient entrusted health care decision-making to a member of the family, was I allowing the family enough time to process?  When the patient/patient’s family signed a DNR/DNI down the road, did that result in a subtle change in my level of care? Was I making a conscientious effort not to write any patient off?   Did I give the family hope by answering their questions with the positives that day or “prepare them” by sharing the ominous signs?  Did I understand that some days my patient was just scared and tired, in despair, or frustrated, and in those days/hours needed my encouragement and emotional support the most, or was I being hasty to interpret it as a sign of giving up?  With family not able to be by the patient’s side, was I doing everything I could to make the patient not feel so alone?  With this being such an unprecedented disease, when did we think more treatment was futile and instead just prolonged the patient’s suffering?

Often, when I felt tired or weary, I would look at a patient and imagine him/her to be my son, or my mother, my grandmother, or my father, and that usually gave me the strength to make that one more above-and-beyond action that made the patient feel special. My coping mechanism – if I can even call it that – was comfort in the knowledge that I’d given this person the same standard of care I’d have given my own family.

And even as I write this, I feel that this is probably the most inadequate piece of writing I’ve ever done because it fails to effectively capture what I need to express. But I needed to try. Because when people tell us nurses: Thank you for your service; thank you for what you do for our families; you want to feel that that trust is deserved, that the gratitude is earned. Sometimes I feel so helpless, I simply pray for my patients. I say, God, let Your Will be done. And even then, as I stare into the helpless faces of family clustered at the large clear window, the closest they can come to getting some closure of how their loved one died, as I read the cards to the patient, willing them in their sedated state to hear the family begging them to hang in there, as I hold up the phone to their ears and play the recordings or live calls and see their vital signs quicken, I still wonder, what else can I do?  I still feel helpless. 

This is what COVID has done – left us helpless and frustrated. Even as we feel a ray of hope and see a light at the end of this dark tunnel with the advent of the corona vaccine, the surge remains. The deaths continue. The gloom. I came to the ICU at a strange time, when most critical cases are COVID-related, but it has taught me a lot.  They say: the more we’re tried as human beings, the better we become. “The more you cut the branches of a tree, the higher and stronger it grows.” These challenges ground us. But oh boy, do I join the choir when I say; happy riddance to 2020.  I look forward to a better year ahead…for all of us. And I pray that these experiences will help me and others in my profession emerge more worthy caregivers in the months and years ahead.