Content Warning: the following article contains some descriptions of patients diagnosed with COVID-19 that might be upsetting for some readers.
In an effort to better understand the roles and work of healthcare professionals on the frontline during the COVID-19 pandemic, we asked two healthcare workers — Ryann, a registered nurse working in the Critical Care Unit in a Nashville hospital, and Kelsey, a resident in a DC hospital — to answer some questions that highlight the immense struggle facing healthcare workers fighting COVID-19, the disease caused by the novel coronavirus.
Q: How has your job changed since the start of the COVID-19 pandemic?
Kelsey: The roles in our residency program have been restructured to ensure that we have plenty of residents to help staff the emergency department, ICU and general inpatient units. We also have built in time for rest/recovery between rotations. I’m happy with my new schedule and thankful to have some time built in to rest. I’m also grateful to still be employed during this difficult time.
Ryann: Day in and day out, my job as a registered nurse in critical care is stressful, but lately it has been unprecedented. I work in a 30 bed medical ICU, and our usual patient population is very diverse. I have taken care of patients with critical illnesses of all organ systems, all requiring some type of close monitoring. I have worked there for five years, first as a lab technician, then as a CCU tech, and I have spent the last year and a half there as a RN.
Since the start of the COVID-19 pandemic, I have taken care of some of the sickest patients I have ever seen in my nursing career. Our unit has several negative pressure rooms so we have been taking care of COVID rule outs, and COVID positive patients frequently. These specific rooms have not been empty since the end of March. One of the hardest changes has been adapting to the “no visitor” policy. I have always loved having patient family at the bedside. They are typically helpful and provide the healthcare team with valuable information about the patient’s baseline health. Now, seeing these critically ill patients, incredibly vulnerable and isolated from their loved ones, has been one of the most difficult parts for me.
Each night, family members call to get an update on their loved ones, and I try my best to explain the patient’s condition to someone with no prior medical knowledge and no way to truly “see” their loved one. This disconnect has made caring for my patients more difficult. I wonder if patient families would want to continue such aggressive treatments if they were able to see how tired their loved one looks or how uncomfortable it is the be tied down to the bed with a tube down their throat breathing for them and little hope of improvement. I know this all sounds callous, but these are the realities of COVID-19 patients.
The second reality is that our hospitals want us to minimize our exposure to these patients since it requires so much PPE (Personal Protective Equipment) and increases our risk of contracting the virus. This means often I and one respiratory therapist are the only people to enter a patient’s room for 12 hours. On a day to day basis, I am used to entering my patient’s rooms more than once an hour to assess them. With COVID patients I am limited to clustering care and entering sometimes only three times a shift.
If my patient’s heart stops, I must don my PPE correctly before entering the patient’s room. This takes two to three minutes and requires the help of ancillary staff. By the time I am able to initiate CPR, my patient has been without blood flow for up to three minutes. Without adequate blood flow from the heart, brain death begins in 6 minutes. I have 6 minutes to recognize my patient is in cardiac arrest, find someone to help me don my PPE, correctly don my PPE and rush in the room to begin this life saving measure. In the meantime, I am the only provider present until support staff arrives and dons their PPE to provide medications to treat the initial reason for cardiac arrest. It feels as though bedside nurses and RTs (Respiratory Therapists) are truly the LAST line of defense a patient has.
Q: What worries you most about what you are seeing right now?
Kelsey: Prior to starting my current rotation, I had read about racial disparities in COVID-19 patients, but actually seeing it is unsettling. Today, I provided care for five black patients and one hispanic patient, all of whom have COVID-19 and are in the ICU. These disparities highlight problems with healthcare access, systemic racism, as well as medical and healthcare mistrust. I hope that our country uses this knowledge to provide better care to people of color and work toward resolving inequities in our healthcare system.
Ryann: I do hope many good things result from this pandemic such as a living wage, worker’s rights, better wealth distribution, and healthcare for all. I know a greater appreciation for human connection and simplicity will emerge from this pandemic. I am most worried about the lasting mental health effects this pandemic will have. I often feel traumatized and isolated, and I know many of my colleagues feel the same. I worry once the pandemic is over, us front-line healthcare workers will be faced with a lifetime of flashbacks to these traumatizing situations. I worry for my patients who will physically recover and if they will have lifelong deficits or if they will, like me, be subject to a lifetime reliving our darkest moments.
Q: Are you being given everything you need to get through this time? How can others support you during this?
Kelsey: I feel well supported by my hospital system and my residency program. I am very fortunate to be in a hospital that has adequate PPE and adequate staffing. The residency program leadership has been transparent in their communication with us, which has helped me feel confident that they have my best interests in mind.
Ryann: I feel most supported by my family and friends when they reach out to me. The simple text messages saying, “We love you” or “You are an amazing nurse” are what mean the most to me. Lately, I haven’t been feeling confident in my nursing skills as we fight an unknown enemy, and encouragement from those who know me best reminds me nursing is much more than textbook knowledge about viruses and diseases.
When someone acknowledges that this grief, confusion, anger and sadness I feel are valid emotions and I have every right to feel them, I feel supported. I know our community has also been donating food to the hospital, and it is so nice to not have to worry about being hungry at work. When I already have 100 anxieties racing through my mind as I prepare for my shift, it is nice to not have to think about what I will eat for dinner. I have also appreciated the donations of PPE to the hospital. I have friends who have made me face shields with their 3D printers and headbands to hold up my mask so it doesn’t pull on my ears for twelve hours. I have also had friends donate masks, gloves and Clorox wipes. These mean a lot to me and are tangible ways the public can help us feel supported.
Q: If you could tell people one thing about this pandemic, what would it be?
Kelsey: I think like most people, I have more questions than answers. I’m hopeful that we can make our healthcare system better as a result of this pandemic with regard to access and how we deliver care.
Ryann: I would tell people that no one is safe. We have seen otherwise healthy, young people, be brought to the edge of death in matter of hours. Do not feel a false sense of security because you are young and healthy. I would also remind the public that there is no cure for this. There is no magic fix. If this virus attacks your immune system and your organs shut down, there is not a single therapy that can erase the virus.
We can keep you alive until your body fights off the virus, but we can only do that for so long. We just bide you time. I say these things because I see it. I take care of these patients and pray the virus doesn’t start shutting down their organs one by one until their heart stops because we have no way to stop the virus. I watch these patients sit in a medical purgatory, breathing easy one minute and gasping for air the next. Please stay home. Please wash your hands. We will come out of this pandemic stronger and with a deep reverence for our common humanity, but we need to minimize the suffering while we still can.
Do not live in fear, but walk in courage. Do not be naïve by thinking yourself immune to the ramifications of this pandemic. Know that by staying home you are not only protecting yourself, but you are clearly saying to every nurse, doctor, respiratory therapist and healthcare worker that you deeply respect the work we do and want to protect us from unnecessary suffering as well. If you cannot find the courage to stay home for yourself, please do so for me.
Q: How are you managing your mental/physical/emotional health outside of work?
Kelsey: Getting adequate sleep is important. Also taking time to destress when I get home; whether it is making a meal, spending time with my roommates or watching a TV show.
Ryann: I am still figuring out how to manage my mental and emotional health at home. I facetime my family and friends a lot. I reach out to people who love me and value me exactly as I am. I have started journaling. I walk my dog. I find myself recharging by learning new things, that don’t have to do with saving people’s lives. I take social media breaks. I limit my media consumption to only watching “A Closer Look” and “Last Week Tonight”.
I stopped trying to “be productive” and started doing things that make me feel good. I also binge watch Tiger King like everyone else. I let myself feel how I feel and don’t try to justify it or find meaning in it. Sometimes, I am just sad. Sometimes I feel like crawling in a hole and not coming out for a year or two. Sometimes I cry for my patients, and that’s okay. Sometimes I cry when my boyfriend forgets to buy bread at the grocery store, and that’s okay, too. But mostly, I am allowing myself to feel what I feel without trying to “decipher it” or “find deeper meaning.” The only way out is through.
To learn more about the current COVID-19 pandemic, visit www.cdc.gov. To help provide support to frontline healthcare workers like Kelsey and Ryann who are fighting COVID-19, consider making a donation to your local hospital or supporting an organization providing food and supplies to healthcare workers. Most importantly, we urge our community to stay home if you’re able, wash your hands frequently and adhere to social distancing guidelines.
To hear more from Kelsey, you can find her SHEs In STEM post here.