Nothing prepared them for the onslaught of ever-climbing numbers of patients succumbing to COVID-19’s cruel, suffocating ravages. And December 10, 2020 was no different. Towards the end of the night shift, a patient died from COVID-19. Shortly after the day shift took over patient care at 7 am, another patient would die in the 25-bed unit.
In a world of masks, eyes tell all: tiredness, exhaustion, and the same question day after day—will this ever end?
That Thursday morning, nearly all the patient rooms had red signs hanging above their doors, declaring the virus’ presence.
The central monitor at the nurse’s station offered a constant snapshot of the medical story of the unit’s patients, their heart rate, respiratory rate, blood pressure, and oxygen level. When a patient’s situation took a turn for the worse, a nurse crouched in front of the monitor, hand on the mouse, closely analyzing the data before running to the patient’s room.
The nurse’s station is where a frontline worker can catch their breath for a moment—powered air purifying respirator (PAPR) still over their shoulder—and try to process yet another startling, COVID-19 related event that has just taken place in a patient’s room. “Guys, guess what just happened."
This is what the unit calls the family table. It’s where staff gather, when patient care permits, to catch up, touch base, shoot the breeze.
It’s where the night or day shift can take stock for a few minutes as they wind down until the next shift comes on, grateful to have made it through another 12-hour stint.
When COVID-19 patients’ breathing
deteriorates to the point they have to be put on a ventilator, one concern is to try to get oxygen to all areas of the lungs. That requires proning, a physically and mentally demanding, time-consuming process for nurses. That's because they have to work together in a series of synchronized movements to turn a patient onto their stomach, so oxygen can reach the back of their lungs. Sixteen hours later, they turn the patient back over. Eight hours more and they flip them over again on their stomach. And on it goes.
Proning means all hands on deck, twice a day. It’s exhausting work.
So much can potentially go wrong—a breathing tube becoming dislodged, a patient’s blood pressure collapsing, cardiac arrest. As the number of COVID-19 patients in the unit during the winter weeks and months grew, so inevitably did the number of patients needing proning.
COVID-19 patients have a very hard time breathing. It’s not only the virus’ impact on their lungs. They can experience anxiety to the point of not remembering to breathe due to a variety of factors: knowing they are COVID-19 positive and the implications of that diagnosis; being in such a foreign environment as an ICU, isolated from loved ones with only providers in space suits for company. Then there’s the machinery they are hooked up to. While a C-PAP machine can help them breathe, it’s tightly affixed to their face. Not only is it humid, it’s also claustrophobic.
It’s just a hand on a shoulder and a few soothing, gentle words, as a respiratory therapist urges the patient to do something that ultimately their life depends on.