Your call to duty as a COVID-19 ICU nurse
Pick a spot on the floor and stare.
As a COVID ICU nurse, you hold back your tears.
You think, “Respect the family’s grief. You didn’t know them, so you don’t have the right to mourn them. Lord, provide your strength.”
Pick a spot on the floor and stare. Swallow the pain. You just spent 12 hours trying to save them, or 36 hours, or two weeks, or two months. You’ve been fighting this since the beginning, since March 2020. You held their hand when they were admitted. Behind your N95 mask, underneath the shield, the gown and the gloves, you spoke to them trying to calm them and give them peace.
You saw the menacing white spots on their chest X-ray. You gave them oxygen, then more oxygen, then more, then more until they were completely maxed out. You don’t put them on the ventilator just yet. You have seen countless others already die on the ventilator, so now we try to wait. The monitors start to alarm as their oxygen levels plummet. You try to teach them what proning means; try to explain that lying on their stomachs will bring their oxygen level back up — for now. Proning only buys them time. You try to give hope to their family members while being realistic. You know the odds of them recovering at this stage.
After a while, they can only breathe while on their stomach. While struggling for air, they ask you to stay in the room for a little bit because they are so lonely. You hold their hand and stroke their forehead. You try to send healing through your fingertips.
They can no longer eat, and they can no longer speak without losing their breath. Eventually, they are not able to lift their heads. Only then do we intubate. Their body starts to fail, the pneumonia gets worse, the sepsis comes alive, their kidneys cease to function, and their blood pressure tanks. And you do what you were trained to do.
You fight for them. You fight for those who cannot fight for themselves. After seven-plus years of working in the ICU, you know that sometimes the hard work pays off and sometimes it doesn’t, but that was before COVID-19. Now, your hard work hardly ever pays off.
After starting continuous dialysis, starting multiple continuous vasopressors — which keep the blood pressure high enough to get blood to the brain — after placing tubes that penetrate the lungs for fluid to have an escape, they finally start to break down. Their skin starts to fall apart. They swell until they are unrecognizable. To keep them alive, you must keep them proned. While they are face down, their cheeks split open. They now have two large black ulcers all along both cheekbones. They don’t look human anymore. But they are.
This was the man whose hands you held. This was the man who you tried to comfort with words of encouragement and peace. This is the woman whose husband calls every single night asking you to walk in the room and tell his unresponsive wife that he loves her. They cannot come see their family members dying. You are their eyes and mouths now. You must see for them and speak for them. Lord, provide strength.
You know the signs; the steadily decreasing heart rate, and the drop in blood pressure when you reposition them. You know death is coming. “Ma’am, I don’t think he’ll make it through the night.” You’ve said that countless times.
Pick a spot on the floor and stare.
“Sir, you need to go ahead and come up here.” Will they make it in time to see their loved one die through the glass window? They beg you, “Please, please, can I go in and hold my mom’s hand? I just want her to hear me and feel me?”
Pick a spot on the floor and stare.
Through your own tears, you must tell them no. Your mother wouldn’t want you risking it. You need to stay safe, so you don’t get this disease.
You tell yourself you didn’t know them, and you don’t have the right to mourn them, but you did. You were there at the end of their life. Their family couldn’t hold their hand, so you did. Even the doctors don’t go in unless absolutely necessary. This was your patient, and a bond like that can never be broken. You skip your lunch break because they are too unstable. If you leave the unit, even for a second, no one knows this patient like you do. If they crash, you need to be there, and they do crash, they do die, time after time after time. You hear the sobs. You pick the families up off of the floor when they break down in sorrow. But you still have the paperwork to do. You ask about funeral homes, you have them sign the papers. You now have to go in and clean the body. In respectful silence, you wash your patient. That unbreakable bond between nurse and patient is still there. Lord, provide strength.
You place another body in another body bag. You hope the morgue isn’t full. You hope you don’t have to stack the bodies like you had to last week.
Pick a spot on the floor and stare.
The walk to the morgue is a long one. Other staff pass you in the hallway with knowing eyes. A single sheet over a flat stretcher can only mean one thing. As you roll the patient into the cold, dark morgue, you say your goodbyes. But, you better hurry, because you are getting another admission, and it’s time to start over.
This has changed my life. I have learned to focus on my mental health and to accept help when it’s offered. For many, COVID-19 has taken something from us. It may have taken job security, a social life or perhaps a loved one. Just know, your grief is shared. I will always have my patients’ faces etched in my memory. Just as you remember your loved one, so do I. You are not alone.