I am going to wrap up this section of my nursing experiences in my memoirs with a discussion on the COVID-19 pandemic. While there has been an endless barrage of information on this subject, I don’t feel that there has been that much from the perspective of someone who has actually been in the frontlines this whole time, that of an ICU nurse. Most books written are by doctors who only spend a few minutes with their patients and make it sound like they are the ones who actually are taking care of them. When in actuality, it is the much maligned nurses who do the vast majority of the thankless work surrounding patient care and only get a fraction of the compensation. While it is true that CNAs are involved in patient care as well, they are not part of the care with ICU patients which is where most of the serious action has taken place with the COVID-19 patients in this pandemic. If an infected patient is fortunate enough not to require a transfer to the ICU, they usually have full recoveries. It is those patients unfortunate enough to reach the ICU, whom don’t do so well. For even if they survive, many suffer from long term symptoms of the infection. Which is something that is just being discovered by the medical profession but has been observed by nurses for quite some time. It may sound like I am a little bitter, well, I am. I have seen more people die in the last 20 odd months than I have in the rest of my career. Thanks to politics and infighting with the corporate elite those numbers are not radically changing. I am sure that you have heard about all these percentages on how many people survive COVID, over 98% do, well, that is no consolation for the ICU nurse when our survival rate is less than 10% for those patients. While I don’t have the actual numbers, I fear that it is way less than that. During the peak time of the pandemic, I have seen as many as five people die in one night. To give you a better perspective of this, my unit had less than 30 patients in it at the time.
I am sure that you hear about all the drugs and treatment modalities that are out there, well, it doesn’t do the patient any good if they are not being utilized or started soon enough. What I am seeing is the same old pattern of treatments for these patients while their symptoms gradually progress until they just up and die. I am sure it is also very frustrating for the doctors as well. I know that their hands are being tied. This is where I need to be careful because I have a license to protect and my livelihood as well. Since I am not a doctor, I am not privy to information or the discussions that take place with them. I am not sure if they have certain guidelines they have to follow or not. If they do, they need to change them, The current crop of treatment plans involves drying out the patient to such an extent that the patient’s blood pressure suffers and eventually so does their kidneys. Many eventually have to be put on continuous dialysis treatments or CRRT. This loyalty to this treatment modality causes the patient’s condition to take an up and down path, I feel unnecessarily so. But who am I? I just spend 12 hours a day taking care of these patients. I am just a lowly nurse who also happens to use a stethoscope. Well, enough of the self pity, it is just frustration because we did not go into nursing to see people die.
I am sure that you have heard a lot of nonsense going around about the vaccine. Well, I am a pro vaccine person. That is it should only be given under certain circumstances. I believe that it should never be mandated. If we as citizens were kept in the loop and were given information that we could truly trust, I think that things would be a lot better. I am highly trained nurse with over 11 years of critical care experience alone and I feel like I can’t trust the information out there. I also am a blogger of sorts who has devoted an inordinate amount time researching and writing about the pandemic and I am having a really hard time finding accurate information. It has come down to power and money and nothing else. I have researched Dr. Fauci and Dr. Birx extensively. I feel that they are at the bottom of this misinformation campaign. If you go back and look at their history you will find out that they were at the core of all the HIV/AIDS panic back in the 1980s. If you want more information simply go to my blog, common-sense-in-america.com and look up two categories, COVID-19 and Healthcare and Dr. Fauci. You will find countless articles covering this subject. Dr. Fauci is a power hungry little troll who is responsible for hundreds of thousands of people’s deaths worldwide. I firmly believe it is his arrogance and his godlike complex that are at the core of our current pandemic. But irregardless of all the propaganda and misinformation out there, the vast majority of the patients that progress to the ICU are those that are not vaccinated. So despite what all the media is saying on either side, this is the unvarnished truth. You can do with it what you will. One more thing, with the Delta variant the age of our ICU COVID patients is getting younger and younger, people in their 50s and even 40s are getting deathly sick. No longer do they even need a slew of comorbidities to earn them an ICU bed.
I have seen a rate of nurse burnout that I have never experienced before. I actually think that we are experiencing PTSD or Post Traumatic Distress Disorder. I have recently joined this number. I just recently tendered my resignation in an effort to keep my sanity and to also prevent any safety issue with my patients. My patient’s safety is of the utmost importance to me and I could not live with myself if I did something to jeopardize their safety or health. So I am taking the next couple of months off so that I can get some much needed rest and re-think my career options. Nursing has become a job for young people. The 12-hour shifts are becoming more and more difficult to manage. I used to work four and five days a week but ever since the pandemic entered the picture, I have been barely tolerating my three 12 hour shifts a week. I feel that I have aged 10 years in the last 20 months.
I have decided to keep this chapter short and to not provide specific examples like I have in previous chapters. I will, however, discuss what a generic and typical patient goes through right up to their death. First of all, once the patient is found to be positive, their whole life changes. They are now isolated from their family. The family can’t even see them through windows in the door of their room. I think that this is carrying things a little too far. However, we do allow phone calls and we can set up zoom calls with them if they are unable to do so themselves. When I went into nursing school, I was told during a class on end of life, that the hearing is the last sense to go even after the sense of smell. So we were told that is very important that we watch what we say around our patients because they may actually be able to hear us talking. So even if they are intubated and sedated, we allow the zoom calls in the hopes that the voices of their loved ones give them some solace. The patient is also isolated in the kind of care they are now receiving. They now only see people in protective gear with masks, respirators and face shields. Their care by necessity has become highly impersonal and lacks the humanity of the human touch. Touch that is not through protective gear but with skin on skin contact. People are a social creatures and need this contact, why else do we use solitary confinement in our prisons as a form of punishment?
I have listed below some of the symptoms that a positive patient can experience.
Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19:
-Fever or chills
-Cough
-Shortness of breath or difficulty breathing
-Fatigue
-Muscle or body aches
-Headache
-New loss of taste or smell
-Sore throat
-Congestion or runny nose
-Nausea or vomiting
-Diarrhea
Look for emergency warning signs for COVID-19. If someone is showing any of these signs, seek emergency medical care immediately:
-Trouble breathing
-Persistent pain or pressure in the chest
-New confusion
-Inability to wake or stay awake
-Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone
The main symptom that causes the nurse concern in our patients is their breathing difficulties. This is obviously the most critical symptom that we have to control. Patients will experience progressively greater and greater shortness of breath. They will get to a point where the act of eating is too much for them. During this time they are already receiving the various treatments that are allowed in their respective states. We start them on a simple nasal cannula and we gradually increase their flow rate till it reaches 6 liters. Then we have to switch to usually a non-rebreather mask, then by this time they have been usually transferred to the IMC. Soon the mask is no longer sufficient and they require a Hi-Flo nasal cannula which provides more aggressive support with a much greater flow of oxygen. Sometimes they require both a mask and the Hi-Flo cannula. If the patient can tolerate it we place them on continuous CPAP or Continuous Positive Airway Pressure. By this time, the patient requires assistance to do the simplest tasks even taking sips of water. Eating solid foods has long since become but a memory. If they are lucky they may be able to tolerate a protein drink but the increased work of sucking the viscous fluid through the straw may be too much work for them. It is typically at this stage that they get upgraded to the ICU.
Once they are at the ICU which is the vast majority of them, it is their final destination. After a few days, some may take a little longer but they eventually all succumb to the call of the ventilator and the endless flow of aggressive IV therapy that this entails. Each new drip (gtt) we add brings with it additional issues that we have to monitor for. The patient on the artificial breathing machine needs sedation to keep them calm enough so that they can tolerate it. They are no longer aware of their surroundings which is usually for the best. Because now they have tubes in most of their orifices, one to feed them, one to collect their urine and another one to collect the all too frequent diarrhea that arises due to the tube feeding that they will soon start receiving.
If they survive the next two weeks on the ventilator, the family will find themselves at a crossroads either they will have to decide to withdraw life care or allow a surgeon to put a tracheostomy and a peg tube in their loved ones. During this time their organs are becoming more and more damaged by the ravages of the virus. Micro blood clots continue to form despite anti-coagulation therapy and block off the microvasculature of the body which is in the brain, lungs, kidneys, and the liver. If the patient is lucky enough to get off the ventilator, the damage done to these organs is irreversible and leads to all the symptoms that an increasing number of patients are experiencing.
However, if they are not so lucky eventually the lungs start to collapse and require chest tubes to keep them inflated. During this time we are having to get more and more aggressive with the ventilator settings. Eventually the lungs become so damaged that nothing works any longer and they go into respiratory arrest and after 30 or so minutes of CPR their life ends. Remember that this is happening to younger and younger people. What an ignoble way to die!
Have I painted a vivid enough of a picture for you? So now you know what your loved one will experience and what your nursing relatives have been suffering through the last 20 odd months.
After thinking about this matter for the better part of the day, I decided to include one actual case after all because this was in fact a truly unique one for me. As a matter of fact, this may have been the case that finally pushed me a little too far. Maybe I had just lost too many patients and I could no longer just go on like it was just another day in the office. This was just one of those tragedies that may possibly have been avoided if our country was still the country of fair play and hope where anything is possible as long as you persevere. In most of the cases I have taken care of, I see them for a three to four day run and that is all, I don’t actually care for them throughout their whole COVID-19 progression. With this patient it was different, thankfully, I was spared watching him leave this world because it happened on my day off. But the impact and sense of loss was still there.
I started caring for him when he first was transferred to the ICU. He had progressed to the point where he needed the Hi-Flo nasal cannula and occasionally the non-rebreather mask as well. You may recall this from my generic patient monologue. There are several reasons why he became so special to me. He was just a few years younger than me for one, so we had a lot in common, he was also a public servant as well. He was much loved by his co-workers and they provided a 24-7 vigil outside the hospital the entire time he was a patient there. Even though it is ill-advised we became fast friends. I know this never should happen, especially in the era of COVID but it did. I am only human after all and not a heartless robot. That is why I became a nurse to help the less fortunate. The thing that set him off from all the patients I cared for was the number of days I actually cared for him. I cared for him for a total of 12 days which spread out over five weeks, I was even off work for a seven-day stretch and when I came back he was given back to me. This trend continued every week, I would be off my three to four days and like clockwork when I came back, he was my patient again… that is until he was no more.
It was during my period of seven days off that he was intubated and now I was no longer able to converse with him. It was amazing how far he had slid down the COVID rabbit hole in those seven days. It truly was heartbreaking when I came to the realization that he was going eventually become just another pandemic statistic. Maybe this is what I am doing with this addendum of sorts, I am trying to give this amazing individual a little bit of immortality. He gave so much to his community. He worked three jobs all involving public service in one form or another. He was also the father of eight children and husband of a loving and faithful wife, an individual who I got to know even better than her husband. Every night that I cared for him, I conversed with her on the phone not just talking about his condition but discussing their lives together and all their wonderful children. While at first it was a chore but after a while I actually looked forward to talking to her. Because I knew that I was the only one who had developed this relationship with not only her but her husband as well. Somehow from the very beginning I felt in my heart his was going to be a very special case for me, one that I would not soon forget.
As each night progressed, he became weaker and sicker, he too eventually required a chest tube to keep his lungs inflated. Unfortunately, his chest tube gave us plenty of trouble, a couple of times I thought we had lost him when his chest tube clotted off. However, once the obstruction was cleared he would bounce back a little. Every night that I talked to his wife I would tell her of his little victories, not to give her false hope but to let her know that he was still fighting. I always tried to be not only honest but positive as well. Over the years I have seen many miracles. I have seen patients survive when I thought all had been lost, and it was only by the love provided by their family that they persevered and survived. They just never gave up on their loved ones. One day, one of these patients came back to visit our floor to show her appreciation. It was moments like this that made all the struggle and heartache worthwhile. That is why I have such a hard time giving up on my patients because I have seen these miracles. So I try to impart this to the families, that no matter how bad things get, you have to believe in them. Because after all who else does the patient have to love and care for them?
My patient finally breathed his last breath mainly due to an unforeseen complication. Thankfully, his wife had previously out of love and selflessness made him a DNR, so his final moments were not torture. He simply passed away, his body no longer able to keep up the fight. It is out of necessity that I keep his identity private, I have no easy way to reach his wife, and I think it would be in poor taste if I did so because I would only re-open the all too recent wounds his loss has created. So I will pay homage to him in my own humble way. I hope with time, the family will heal and be able to move on. They still have three children left at home, so I am sure that it will be a difficult process but I know that she will not be alone in her struggle. In his life, he made a lot of friends, people that will be there for her. I wish her the best.
I write this final section for a somewhat selfish reason, I am hoping that it will be a bit of a catharsis for me. I just finished doing a self evaluation for PTSD and I have over three quarter of the symptoms listed, so I guess, I have some healing to do as well. You never know what life will bring you, I guess all we can do is to keep on fighting.