By Robin Postell
Blair, 29, is an ICU nurse at a large South Georgia hospital that serves the population of numerous surrounding counties. An RN, Blair has two more years before she gets her BSN. Throughout the COVID pandemic, she has been working on the ICU floor.
This is her story.
“How are you holding up?” I text her while she is working.
“The answer I give everyone is, ‘I’m holding up ok.’ But I think a more honest answer is, ‘I’m surviving.’ I do not think I could give you a simple answer to that though. The amount of death I’ve seen in this past year and a half is the most heartbreaking and heart-wrenching thing I’ve ever had to deal with in my life.”
Asking these frontline COVID workers which “wave” of the pandemic they are dealing with is another hard-to-answer question.
“I’ve honestly lost count of which ‘wave’ of COVID we’re supposed to be on now, but whatever wave it is, it is now killing younger and younger people,” she writes back. “As absolutely morbid as this sounds, when the elderly were the main patients dying, I at least had some peace knowing the majority of them had lived long, healthy, full lives, but now we’re seeing kids my age and younger die on the ventilators.”
The nightly news might be providing statistics and projections, but the nurses featured in this series do not know or care about them. They refer solely on their personal experiences in their professional capacity. Personal and professional get interwoven in odd ways for healthcare pros dealing with COVID daily.
“I cannot describe the actual feeling a person experiences as you put a 27-year-old kid in a body bag and zipping the zipper closed,” she says grimly. “He had no co-morbidities. He was a little overweight but that was all – and he got COVID and died. What is causing some people to get it and die, and others to be fine?”
This is the newest question on healthcare workers’ minds because the type of patient has changed so much since early 2020. Some get it, some don’t, but it doesn’t seem to have anything to do anymore with age and co-morbidities anymore.
Recently, in 2021, Blair lost her first patient who had been in her charge. What made it worse was that it was a good friend’s stepfather.
“I cannot tell you how many times I’ve laid down at night and think about the last words my 40-year-old patient said to me before he went on the vent, only to die literally 3.5 weeks later. ‘Please don’t let me die.’ Walking families over and over down the ICU hallway to see their dead loved one feels almost like a dream sometimes. Maybe more of a nightmare. It’s like those movies where the hallway gets longer and farther away.”
Blair says she feels fine physically but is in emotional turmoil.
“I feel like I give my all every day to my patients to make sure they have the absolute best shot for the best possible outcome I can offer them,” she says with frustration. “But sometimes that means using all my emotional energy at work. Sometimes I forget how to continue to care about the ‘unimportant’ daily tasks at home and it is really taking a toll.”
Blair and her co-workers, she says, have all been discussing how important it is for the public to hear what they have to say. She’s grateful other healthcare professionals are coming forward, too.
“As I text this, I’m pushing the morgue cart up to take yet another body downstairs. It has just been absolutely crazy,” she says in a message.
On Tuesday, September 14, 2021, Blair wrote, “Today has already been crazy. I picked up an extra day because we are so short-staffed and they’re offering extra money.”
All 20 of the ICU beds are taken by COVID patients on ventilators.
“Now, instead of being a resource nurse for ICU I had to run to an emergency intubation, and now I have a vent patient on the floor because I’m an extra ICU nurse and only ICU can take vents,” she explains.
Referring to a 61-year-old patient who they had been keeping alive in ICU for the family to arrive, she tenses. Afterwards that ventilator will go back to the unit to use on another COVID patient. Keeping the patients alive for long periods of time is not uncommon. The patient’s family must make the decision to take their loved one off the vent. For the nurses and techs this is one of the most disturbing aspects of their work.
“People think death is the hardest part of my job, but it’s actually being forced to keep someone’s body alive far past the possibility for any meaningful recovery,” she says, her voice breaking. “There are worse fates than death.”
Once he had passed, Blair had two techs clean the room up and the patient, “So he’d look like a resting angel.”
Swollen, with mouth sores from the vent, and overgrown hair, Blair and her colleagues shaved some of his beard off in an attempt to make him look more like himself.
“I went to get the family, which was my friend’s mother and brother,” she remembers. “I just hugged her. She was pregnant. We both cried for a minute. I said, ‘Let me take you to him.’”
Walking down that seemingly endless hallway, Blair didn’t know what to say. “What could I say?” she asked. “They trusted me with their loved one and now he’s dead…Once we got to him, I let them stay in there with him for two hours.”
Blair begins to cry, saying she’s sorry, pausing the interview to gather herself.
“Out of the 21 vents in the hospital now, there are 19 patients positive for COVID. The youngest is 32-years-old and the oldest is 68,” Blair reports. “A family just got here in tears listening to our patient’s mother tell her goodbye over the phone because she can’t come up here.”
Before intubation, patients are usually awake and talking.
“Then we sedate them – and paralyze after sedation. We have to do it in that order,” she shares. “It is terrifying for them. No one usually refuses unless they’re very, very old and they’d rather die at home. That’s usually when people say, ‘Please don’t let me die.’ I’ve seen three people record video messages for each individual person of their family because they know once they get on that vent they are likely not coming off. I’ve personally recorded one of those patients for their family. It was unbelievably sad.”
People need to know, Blair says. She hopes that by sharing the cold, hard truth happening in their community hospitals it might change how they live their lives.
Blair thinks that the public would be surprised about how family members accuse them of giving their loved one a COVID vaccine, or how uncaring some patients are when multiple fellow patients are dying.
“They are not understanding at all that the reason we can’t get warm blankets to them on time is because we’re coding people literally to the right and left of their room,” she says incredulously.
Blair explains that many nurses are experiencing “compassion fatigue” from taking care of people dying constantly.
“But I truly think the kind of compassion fatigue they’re experiencing is that they are tired of taking care of people who aren’t caring about the other more critically ill patients,” Blair surmises.
On Wednesday, September 15, at 2:22 p.m., Blair had just gotten off Facetime with the family of an early 20’s COVID patient. The patient’s two-year-old daughter kept asking, “What’s wrong with Daddy?” and “Why is he sick?” and “What does he have on him?”
“We are literally losing nurses left and right,” Blair refers to the understaffing issue. “And the ones that haven’t left have developed the absolute worst anxiety and depression. Experienced, good nurses don’t want to do this anymore because at least before COVID they had patients survive.”
Blair and her co-workers cry often at work. She impresses the fact that they are with the patients the most and develop relationships with them and their families. “We probably know more about their family dynamic than the patients themselves do,” she injects.
After weeks of developing that relationship, they die, and Blair tries holding it together for the family members when they get to the hospital to say their goodbyes.
As soon as that happens and the patient is taken down to the morgue, another patient is put in the same bed who are just as sick and need our help just as bad. “We all know the pattern now,” Blair says. We watch the slow progression of oxygen devices – nasal cannula, to non-rebreather, to high flow, to BiPAP, to ventilator.
A week into a patient’s ventilation, which Blair refers to as “COVID limbo” – the vents provide an oxygen amount that can be turned down and they could do well, but more typically, the settings go up and they do poorly.
“These patients usually have tubes and lines and wires all around them and in them and the family that DOES get to visit doesn’t even want to touch them because they just look so fragile,” Blair recounts. “They get sores from the equipment, or the bed, and they start to not look like themselves anymore. Nurses are exhausted and are leaving the bedside to do things completely different than nursing, or they switch to travel nursing. A travel nurse with the same credentials and experience as a veteran nurse, in the same hospital doing the same job, makes about two times the money than the veteran nurse.”
Nurses have never done it for the money, she adds.
If they did, nurses wouldn’t be nurses. They do it because helping people get better is their passion.
“But when we can now rarely help people get better, and all you see is death and families torn apart, it takes a toll on you,” she sighs. “I think I said this before, but I cannot describe the absolute horrible feeling of zipping a human up in a body bag. And to do it over and over and over is unreal.”
In spite of it all, Blair picked up some extra shifts this week. Four weeks ago, it went from a nursing shortage to a nursing shortage crisis.
“They were giving us an extra $20/hour but that didn’t last long,” she says. “They bumped it up to $50 on your fourth pick up day. Compared to my regular salary it’s great, although honestly I don’t think any amount of money waved in front of our faces would make any of this okay.”
“What’s terrible is the nurses who are doing everything are not being compensated for everything they are doing,” she says. “At Hobby Lobby you start out at $17.50 an hour and us new nurses start out at $24.50. I could be doing something way less stressful, less sad – I love arts and crafts, I could do that happily. But I love taking care of people. If it were about the money, I wouldn’t be a nurse. But doctors don’t even go see their patients and they get paid so much.”
One nurse Blair works with has been a mentor for her since she started working at the hospital. Blair would ask her questions as she accumulated on-the-job experience. “She put in her notice to go part-time and was thinking about quitting altogether,” Blair says. “The only reason she doesn’t quit is because of the people she works with need all the help they can get.”
Another nurse Blair works with and who she has been inspired by due to how deeply she cares about patients breaks down crying every day now. “She kept saying how overwhelmed she was and that before COVID it wasn’t this crazy,” Blair recalls. “She tried to convince me that before COVID people didn’t always just die on you.”
Dealing with family members and friends who continue to toss around the myriad conspiracy theories muddying the entire world’s perception towards COVID has been challenging for Blair.
“I kept telling them I wish this was a conspiracy theory,” she reflects. “I wish I didn’t have to see this. I don’t want to watch a 27-year-old die. I wish I was making all of this up and that these terrible stories weren’t true, but they are. One day a few weeks ago there were two codes at the same time right next to each other. The intensivist was trying to run two codes at the same time. They were screaming down the hall that there was another code. There was no way she could run two codes by herself. The family for the COVID patient I was with accused the nurse of giving her the COVID shot and that’s why she was that bad. We said, ‘Sir, she’s coded twice this morning. Even if we had given her the COVID shot, which we didn’t, it was already too late.’ Another woman was vented and had a catheter and wound up getting a UTI. The family asked what was wrong with her. We explained she had bacteria in her lungs and bladder. They asked if I had tried cranberry juice.”
Blair was inwardly aghast. If only cranberry juice could solve all the problems on her ICU floor.
“We flip patients on their stomach so they can get more air to their lungs, which is called ‘proning.’ This makes their face swell up bad,” she says. “I don’t know whether it’s proning or something about COVID that causes them to bloat so badly. After this woman died, we were attempting to put her in a body bag when I picked up her arm and her skin peeled back because she was so swollen. I’ve never seen anything like it, and I hope I never do again. It was horrible. When we were pulling out the vent she bit down hard – a post-mortem reflex – and clamped on her tongue, which started bleeding.“
Looking back over the relatively short time COVID has taken over hospitals, she thinks if it hadn’t become a political issue there would have been far fewer deaths because people would have taken it more seriously.
Blair, whose father is a doctor, has 19 COVID patients presently and most are vaccinated. “We are seeing breakthrough cases,” she says. Her father had a patient die this week who had been vaccinated.
“The hospital where I am doesn’t have the ability to test for the Delta variant, but there has to be something different about it because younger and younger people are coming in,” she expounds. “It’s almost like it killed all the older people off and now it’s coming for the younger. Now it’s coming back with a vengeance saying you didn’t want to stay indoors before well now I’m going to show you.”
The number one topic that baffles Blair the most is when COVID comes up in conversations, many people figure out some way to include President Biden or former President Trump. “I’m thinking, what are you talking about? These are real people, not just numbers walking across the screen,” she says with frustration. “It’s like the community has stopped caring about everyone else. As long as they’re fine they don’t care about anybody else. Right now, the hospital is full, maxed out, we don’t have room for a rat in the corner. You want to go out and infect people? My friend has been terrified since this started and did everything by the book but two weeks ago, she got COVID. She said she hadn’t done anything different, had even gotten vaccinated and still got it. She had to have gotten it from someone who wasn’t taking precautions.”
Regardless of these hot and aggravating topics, she firmly disagrees with some of the back chatter going around on Facebook about how unvaccinated people shouldn’t be allowed to get an ICU bed. “I understand triaging patients based on who you think will survive but at the same time, how are you going to turn away a 27-year-old who didn’t get the shot which at the time wasn’t FDA approved,” she reasons. “How can you look that patient’s parents in the eyes and tell them that?”
On both sides no one cares about anyone, Blair has concluded. She doesn’t care who you are, what you look like, if you come to the hospital and need help, she says she is going to take care of you.
“I’ve taken care of a prisoner, drug dealers, drug addicts, a doctor, a nurse from the ER, stay-at-home moms, a lawyer, all walks of life of people,” she says. “Not one time I didn’t say or think, oh you’re from this party or that and think I’m not going to give them the same quality care. Basically, no one in the healthcare system wants anyone who isn’t involved to weigh in. Don’t put your two cents in. It’s worse than children having petty fights.”