“Roll him back over. Suction his airway. I will grab atropine,” I said as I began to unbox the vital medication. My heart beat faster and louder while the beats from John’s cardiac monitor were fewer and further between; 49 … 45 … 37. Then I watched as his heart rate began to climb in response to the atropine that I pushed into his vein. Other coworkers ran and stood outside of John’s room as they made the sensitive decision of whether they needed to don personal protective equipment and enter the room or patiently observe from outside of the glass doors. I felt my heart pound in my chest as the room fell silent. We focused our attention between John and his cardiac monitor. When his heart rate finally settled, I glanced at my coworker, the other critical care nurse in the room, and we exchanged hesitant smiles before continuing to carefully reposition John.
I had been working with John for a few nights now. He was admitted to our critical care unit about two weeks prior with a diagnosis of COVID-19 pneumonia and acute respiratory distress syndrome. Unfortunately, he had recently entered multi-organ dysfunction syndrome and the latest organ in immediate concern was his heart. His physicians deemed him too critical to warrant normal cardiac diagnostic measures, but as of now, the clinical suspicion was sick sinus syndrome. John held the title of the sickest patient in our unit: he was on multiple intravenous titrated medications and mechanically ventilated with every setting maxed out. If John began coughing, his oxygen saturation and heart rate would plummet. If his neck fell forward without timely and purposeful repositioning, his oxygen saturation and heart rate would plummet. If he was not sedated and paralyzed adequately and made any movements that increased his work of breathing, his oxygen saturation and heart rate would plummet. Each minute dragged on throughout the night. Caring for John began to feel more like a fight for his existence. That had become my goal, my mantra, to cope with the sheer amount of death to which I was exposed. Instead of mulling over the very real possibility of this being yet another patient who died in my care, I became hyper-focused on the details, the pieces within my locus of control. Of particular importance were the details surrounding how to equip his room and environment to protect him at all costs, including the atropine that I had ensured was in his room days before.
I was tired. I had been averaging 60-70 hours of work per week. The hospital had been experiencing cyclical financial difficulties and was on the verge of closing down, but the COVID-19 crisis, ironically, is what kept our doors open. I was an outsider — this was not my home hospital — but I did everything I could to help because the hospital desperately needed it. Resources were minimal and staffing across departments was perilously low. The dire reality of what we faced every day during the pandemic highlighted the importance of camaraderie and brought our interdisciplinary healthcare team together. Despite being new to the hospital, I rapidly felt kinship with my coworkers and a responsibility for our patients. I worked tirelessly and learned as much as I could to be the best critical care nurse in emergent patient situations.
Each intensive care unit (ICU) admission seemed to have parallels that predicted death. It was almost as if certain phrases in the patient’s history of present illness had some way of placing a toe tag on them as they entered our ICU. I wondered at what point we could return to normal; although “normal” did not seem to begin to capture what I had in mind. I longed for the times when we did not have shortages of ventilators. I longed for the times when patients could die with their loved ones at their bedside. I longed for the times when I did not have to bear daily witness to fearful, anxious patients who were breathless but still alert enough to understand that their condition was likely to quickly worsen.
I want to be able to do more than I am physically capable of doing. The inevitable is inescapable; I watch as patients who were previously able to engage in conversation now lay tethered to machines with lines and drains arranged strategically in place. What I can control is how I manage the patient room and my keen sense to detail so that I am prepared for any circumstance. Although I was constantly in action in times of medical emergencies, I could not escape these thoughts, watching as my patients lay dying, longing for a shift in which I did not have to place any of my patients in body bags.
During my time working nights, I saw and experienced things “normal” humans should not. I held the hands of those who needed a human touch. No one should die alone, to have to feel what it is like to leave the grasp of this Earth and onto the next without anyone in sight. But the human touch can say more than words — at the very least, touch helps alleviate the anxiety that may come with dying. I became a physical extension of families who could not enter patient rooms. In one hand, I grasped my patients’ fingers and in the other, I held my phone sealed in a ziplock bag as I did my best to give my patients’ families a glimpse of their loved ones. Although I was the one receiving thanks and blessings from family members after a patient passed away, I felt I should be the one thanking and blessing them. The opportunity to be there for my patients and their families in these moments was a privilege and a responsibility that, while wrenching, sustained my sense of purpose during the pandemic.
To the world, we were called heroes. But how could I be a hero when so many lives were lost and still continue to be lost to this ongoing battle? I, like many of my coworkers, am resilient. We place ourselves in immediate danger to promote healing and reduce suffering. My only hope is that we gain and remain in control of this virus. For the sake of the patients, their loved ones and every healthcare worker in this country, we must. Too many bodies were placed in body bags between 2020 and 2021 and I pray that someday we can collectively decide that enough is enough.
As I now continue my healthcare education as a medical student in 2022, I reflect on my journey while working as a critical care nurse and experiencing a disproportionate amount of patient death between 2020-2021 than I did prior to the pandemic. Although the burden of patient death was devastating, there were many moments in which I found the motivation to expand how I was able to care for my patients by pursuing a career in medicine. Several hours spent at the bedside as an ICU nurse are now traded with hours spent studying to become a prepared physician in the face of another virus that may bring about great anguish like the COVID-19 pandemic. Although, it is my hope that with the lessons we have learned from COVID-19 that we will be ready should that time come. As I respond to the call to medicine, these experiences have emphasized the importance of being a comforting presence for those in need. There are times when death is imminent, but that does not preclude us from showing empathy. I am grateful for the lives I have been able to touch and for the opportunity to lend a healing hand for those in their last moments on Earth. As I start the next chapter in my career, I will continue to hold this awareness and understanding of the human condition dear in my heart.
Disclaimer: The actual name of the patient was changed to protect patient privacy.