There was no other option. To say that healthcare workers—in particular, nurses—went above and beyond this year would be to underscore their life-saving work. Nurses were championed by the mainstream media as warriors, valorized for their ability to treat in the midst of a pandemic, in conditions referred to with wartime jargon: they traveled to field hospitals, working in triage. But being a nurse shouldn’t be likened to military obligation—“hero” narratives help to make sense of memorializations, to associate working in an ICU with “the ultimate sacrifice.” These were women who risked their lives not for gallantry, but because they were doing their jobs, and their jobs became life-threatening. They protested untenable working conditions, and fought for better protections while battling covid-19, battling labor injustices while masking up for those most vulnerable.
Nurses are vital to our health every year, and this year, they’ve reminded us just how critical their services are to our survival. There is a reason the first Pfizer covid-19 vaccine was given to Sandra Lindsay, RN, a critical care nurse in New York City, the U.S. location hit hardest during the first wave—the city and the country know the power of her profession, and the weight of televising her treatment. Sure, it’s political, but only because it is effective; there is universal reverence for nurses now, as I hope there will continue to be.
And so, instead of waxing poetic about the essential work nurses have done in 2020, I decided to ask four RNs about their experiences, straight from the ICU, in the hopes of gleaning insight from their time treating covid-19 patients. What they had to say was often hard to swallow—battling viral disease at work and rampant misinformation elsewhere—but at the heart of these conversations was their outstanding empathy, the idea that we will get through this devoid of the shallow consumerism of a covid-19-themed commercial. Read on.
Interviews have been edited and condensed for clarity.
I’ve been an ICU nurse for 11 years and the past nine months has been the toughest time in my nursing career. My unit became the designated ICU covid unit in March, and we’ve been taking care of covid-19 patients since then. Not only has it been physically hard, but mentally and emotionally as well. I work in a very busy MICU unit in Houston, TX. Back in July, Texas was a hotspot, in terms of an increased amount of positive, hospitalized covid-19 patients. It got better for a couple months but now covid-19 hospitalizations are on the spike again. We are all exhausted.
When I learned that my unit was going to take care of covid positive patients back in March, I was scared. I think all of use were. It was very new. Something that we didn’t really know much about. We are now more familiarized with it and the treatments are evolving day by day. It’s been a very tough year for so many people. But I’m very hopeful about the upcoming covid vaccine. For the first time since covid started, I’m starting to see the end of this dark tunnel.
I would like to let everyone know that covid is real. It’s still here and it’s probably not going away anytime soon. We all need to work together and follow guidelines such as washing your hands, wearing a mask, and to not gather in big groups in order for the virus to be contained. I’ve learned that we are resilient despite the challenges we face. It’s also very important to take care of our mental health and well being. Take the time to enjoy activities such as going for a walk, reading a book, or learning to cook a new meal. We all need to find ways to de stress during this difficult time.
This year has been the toughest of my entire life. I’m a single mom of a six-year-old girl, who finished the second half of her kindergarten year doing virtual classwork. Most of her questions regarding the pandemic have started with the phrase “Mom, when covid is over can we ‘insert a question about bowling, laser tag, or Disney World here.’” I don’t have the heart to tell her the truth; covid might not be “over” for a very long time.
I graduated from nursing school in December 2019, and started the critical care residency at Munson Medical Center on February 10, 2020. It was just over a month later that the first lockdown was initiated in Michigan. I not only had to navigate being a brand new critical care nurse, but a nurse during the beginning stages of a pandemic. My unit was chosen to be transformed into what we affectionately call ‘Critical Covidland.’ They’ve combined all of the critical care floors’ nurses into a massive pool to staff this unit, with the ‘med-surg covid’ unit being staffed with step-down and med-surg nurses.
We care for patients experiencing a variety of oxygenation support, from simple nasal cannula to being dependent on a ventilator. While yes, most of the patients we are caring for do recover and go home, there is still a high number that don’t leave unless in a body bag. I understand this is morbid, but being a nurse in a pandemic is just that: morbid. The number of covid patients who have been extubated (taken off of a ventilator because they’ve recovered enough to breathe on their own) in the last nine months at my place of work can be counted on two hands. Patients are having to rely not only on oxygenation support, but continuous dialysis when their kidneys have shut down, vasopressors to maintain adequate blood pressure, and often times an insulin drip when their bodies can no longer effectively control their own blood sugar.
Whenever people have asked me what I want people to know most about covid-19, it’s that the patients who are passing away are not only the elderly. They’re not only people with severe co-morbidities. They’re not only diabetics, asthmatics, etc. I’ve watched patients of all ages die. I’ve watched patients with all varieties of health risks die. I’ve watched too many people die. I beg on a daily basis on social media for everyone to wear their mask. I continue to see people commenting with statements like “It’s a hoax,” and “Masks don’t work,” and “They’re taking away our rights!” My only response is this: The only things being taken from us are the lives of our loved ones.
As a newer ICU nurse (less than two years of experience) I would’ve never thought I would be working in the middle of a pandemic. I am now a travel nurse, going to different hospitals that are experiencing a covid crisis. I have had a major learning experience. As a travel nurse, you are expected to be very independent and sharp with your skills. On the other hand, I have seen so much death. Currently, many of our covid patients are in critical condition and we are expecting it to get worse as the holiday [brings new] waves of covid patients. It’s going to be a struggle [because] most of the time, we have no open ICU beds. That means many non-covid patients or even covid patients who need ICU care aren’t able to receive it, simply because we don’t have any beds available.
I’m scared of the unknown. We are still learning new things everyday about covid. I was never expecting this to last this long, or even be this bad. I do believe that there were so many things that could’ve been done to better protect our country and each other. Everyday I see people improperly wearing a mask or [going] without one at all. This has been a strange year for everyone, and I truly wish people would do their part to beat this virus versus finding ways to adjust to it.
But wearing a mask isn’t enough. We need everyone to stay home. Protect others by staying home. Hospitals are seriously running out of beds, RELIABLE ventilators (not these new ones that are being mass made), and nursing staff to care for patients. The only way to protect people at this point is to stay home. I hate [seeing] older people with covid, when clearly they got it from a family member who was asymptotic. It breaks my heart each and every time.
I have learned a lot about myself and the human mind/body this past year. There’s only so much sadness or death that the human mind can take. There have been many times where I had to be beside my patient and hold their hand while they died. There was no family allowed because it puts them at risk. I’ve cried so many times because it never ever gets easier being by someone’s side as they die—having to tell family that they cannot be by their loved one as they are dying. Many nurses are beaten mentally and are physically fatigued from the long hours and excessive work days. We offer extra help because we don’t want our hospital or our coworkers to struggle alone. Many nurses have been exposed to the virus as well, [trying] to save a patient’s life. I truly hope that our experiences with covid allows everyone to have a softer heart. I hope this experiences allows us to be kinder to one another.
I remember when it sunk in. It was March 12th. I was working in the ICU overflow area and one of my patients had the news on, a segment about the pandemic hitting Italy. I thought, “This could never happen here.” Later that day, I received word someone tested positive in the city I work in, and that two patients with suspected coronavirus were being admitted to my hospital. The next day, visitors were banned.
The maintenance crews worked diligently to convert every ICU room into negative pressure rooms so they could be used for airborne isolation [and] converting the rehab gyms into makeshift ICUs. Then there was a rapid response called overhead—a rapid response is initiated when a non-ICU patient is showing signs that they are deteriorating so that we can intervene. And then another one was called. And then another one. They were all patients with suspected covid-19, and they were all going very bad, very fast. Next thing I knew we had three in ICU; by the end of the day we had six. Every day, that number doubled. Our first covid code was a person in their 20s, healthy and athletic. I remember looking at the horrified faces of the nurses around me, some of them had been working in critical care for 40 years.
PPE started out scarce and only got worse. We were issued a single-use n95 mask that needed to last for weeks. Nurses on my unit pooled their resources to supply our own PPE since the hospital didn’t have enough. In the beginning, testing was terrible and it would sometimes take seven to ten days for results. This caused delays in treatment as drugs like Remdesivir needed a positive diagnosis to be issued since it was not yet FDA approved.
We had to increase our ICU capacity from 49 beds to over 100 beds and it became an all-hands-on-deck situation. The operating rooms were closed to elective procedures, so the anesthesiologists became part of an intubation team to free up the critical care doctors that were drowning in critically ill covid patients. The operating room nurses and the physical/occupational therapists were reassigned to a “prone team” that rounded in critical care to turn patients onto their stomachs to try and improve oxygenation. This process took 6-7 people for one patient. The hospital was quiet without visitors, but overhead there were constant pages for “intubation team needed” to various units. I believe we had 85 patients on ventilators at one time.
It seemed like everyone died. The freezer trucks behind the hospital to stack the bodies in were full. We had about 25 people dying per day. It seemed like the spirit of every nurse and doctor working in my hospital died as well. You could see the stress on their faces. You could see the anguish in their eyes. There was no relief.
I personally fell ill with the coronavirus at the end of March. I had a fever for six weeks and spent five days in the ICU. I have lingering nerve damage in my trigeminal nerve from it and continue to have long lasting fatigue. Now we are standing on the door step of the next surge and it’s frustrating and upsetting that we are here as a nation. It feels like a slap in the face.
What I learned during all of this? Well, I think the pandemic exposed major flaws with the corporate health care system. It exposed major flaws in our government and the importance of leadership. I learned that people tend to follow politicians blindly to their own demise. But I also learned that the majority of people will always come together to help one another.
I could scream into the void about social distancing, mask use, hand hygiene, etc., so instead of imparting knowledge, I would grant everyone the ability to feel empathy. The lack of empathy so many people have for others is driving the continued surge of the virus. People know what they are supposed to do, they just don’t care because they haven’t been personally touched by the virus. They don’t see the things I can’t unsee. Until it kills their Meemaw or Uncle Jimmy, they will continue to see it as a big joke. They’ll still chant “99% survival rate!” as if one percent of the United States isn’t 3.25 million people. I still believe that people are generally good, that they generally try to do the right thing... but it’s always that small percentage that ruins it for the rest of us.
As for what I’ve learned about myself, well, I have always been a helper. I will always remain a helper. It’s one of the reasons I became a nurse. But the PTSD is real and scary and is like being wrapped in a big, suffocating blanket. I feel like I will never be able to sleep soundly again. I feel burnt out, depressed, fatigued, and downright jaded. I have found myself questioning every decision I have ever made in my life. I find that I’m more frustrated with people that refuse to believe that this is real life. But I know in my heart I will still always want to help others. And I know when I have a patient that was an anti-masker, I will still hold their hand so they don’t die alone.