Exhaustion, sadness, stress and anger. That is how one Arizona nurse describes working inside one of the busiest COVID-19 units in the state right now.
Charge Nurse Debra, who requested we not use her last name or the name of the hospital in which she works, said she wanted to share "her truth" with a community that seemed divided over wearing masks and social distancing.
"I never ever want to get this virus, and I don't wish this on anybody," said Debra.
After almost 20 years of working in an intensive care unit, nurses like Debra are used to seeing pain and suffering, but Debra said what she is seeing with COVID-19 is on another level.
"It's intense, very stressful, very, very challenging. I never would have guessed that this would have happened in my career," said Debra.
In March, Debra and her team were informed their unit would be turning into a COVID-19 unit.
"At that time, I think we had about eight patients. Now we're full, we're overflowing into other units. It's difficult. It's challenging," said Debra.
Debra began posting about what it was like inside her hospital. In one social media post, she said:
"On the very first night there, we only had about 8 patients and by looking at how sick each of them were, I got teary/emotional and thought to myself, I can’t do this!!!! The amount of tubes, machines and continuous IV meds attached to these patients was barbaric!!!
As each bed opened, or became available due to a patient’s untimely demise, I have witnessed an amazing team of healthcare providers work relentlessly for each patient. But in a lot of cases, it was never enough. I have watched us try every concoction of ventilator settings and continuous IV infusions to help a patient let the ventilator do its work for them, but in many cases, it still didn’t work.
We try everything we can if the patient tolerates it. Five team members will go into rooms and sort out a vast array of tubes, IV lines, cables, equipment and wires, so we can flip a patient onto their stomach. This will sometimes help patients through the extremely severe inflammatory process that COVID causes.
Most people are not in perfect shape – we have to position pillows and foam pieces underneath their body just right to avoid pressure sores, to avoid their belly from pushing against the mattress which can also prevent the ventilator from working adequately and to prevent the lines, tubes and cables from becoming detached. This process can take an hour depending on the situation."
Debra also admitted she, along with experienced team members, had moments where they broke down and cried during their shifts.
"We all understand and are just there to help each other through it," said Debra.
Their supervisors often asked them if they needed a break or some time off, but Debra said for her, that was not an option. She knew her team members and her patients needed her.
For Debra, it is hard to describe the suffering she witnessed.
"Some patients, they cannot breathe. They're struggling to get comfortable. I don't know if you've ever felt you cannot get your breath, you cannot catch that breath, the anxiety that goes with it," said Debra.
There is also a fine line when giving patients medication to calm down. There is a risk the medication could slow down or stop a patient’s breathing.
Debra says she is sharing her experience with the community because she knows that numbers, charts and graphs shown by the state's health officials may be difficult for people to understand. Numbers can also be interpreted differently, based on how you looked at them. So, her clear message to people: what is happening inside our hospitals’ COVID-units today is very real.
"The last night that I worked, we had one COVID bed available. There are other intensive care unit beds, but people are still having car accidents, heart attacks, strokes, things like that. We need to keep those open for them," said Debra.
In her social media post, Debra stated medical professionals were doing everything they possibly could to save patients’ lives, but they desperately needed more medical professionals. She also further described how they must flip patients several times during a shift and how complicated that process can be:
"Placing a patient on their stomach is called proning. There are some shifts I work where we may flip patients 16 times (total flips for all patients). If anything emergent happens, we have to flip them back. This can happen to multiple patients at once and we only have so many staff members. A respiratory therapist has to be in the rooms when we flip as well. If they are in another room or we don’t have enough hands on deck to help, the patient in need just waits while their body suffers the lack of oxygen. Kidneys are being damaged and many patients have to go on dialysis.
Some may be from the lack of oxygen, some are from the problems caused in the blood by COVID and others because of the septic shock and lack of adequate vital signs to ensure the kidneys actually receive enough blood flow. If a patient can not tolerate regular dialysis due to how badly their body is in shock, they are placed on a continuous type of dialysis. This requires one nurse to provide dedicated care to that patient. This nurse cannot take care of other patients.
(Side note, we do not have enough nurses so every patient can have one for themselves) When everything we do is no longer enough, some patients may qualify for a treatment called ECMO. Very large tubes are placed into the patient. Blood flows out of the patient through this tube, goes through a machine that works like lungs should and puts oxygen into the blood, then the blood is returned to the body so it can deliver oxygen to the body."
Nurses like Debra are also doing what they can to comfort patients in the last moments of their lives. The hospitals have chaplains, but sometimes it is too late by the time the chaplain arrives. Debra says some hospitals are allowing family members in to say their last goodbyes, but often, a nurse is the only one holding the patient's hand as they pass away.
"We never let them pass alone. One of us is always in the room when they do pass away, but I've definitely prayed over patients," said Debra.
In her letter to the community, Debra went on to say:
"As our hospital has been told to go into emergency mode, we are preparing for things to get worse. We are barely afloat now. My words here cannot do the gravity of the situation enough justice but I hope they leave you considering a few things. Imagine not being able to breathe, struggling for air and no help comes. Imagine the same for your parents, siblings, children and no help comes.
People are tired of being advised to stay home, people disagree with what the numbers say, people don’t grasp exactly what it takes to make and staff an ICU room. People don’t understand the supplies and equipment needed and just how far that stuff goes.
What can you do? Be a little more cautious and considerate. Be more mindful of how you interact and whether things can wait a bit longer. Be safe! Be smart! It is so much easier than being a patient right now."
