Thoughts on COVID19

I work in a 14 bed ICU in a 280 bed hospital about 30 miles south of metro Atlanta. We get a lot of post heart attack, post stroke, and many patients with cancer or chronic illnesses who are nearing the end of their life. On my first day here last summer, two patients died within the first 4 hours of my shift. This ICU is no stranger to death or tragedy but the events of the last few weeks have been absolutely devastating.

In early March, we had heard about this coronavirus in China and that it was starting the spread, possibly in the United States; but it still felt distant and like it would never affect us. I remember when a patient or staff member would cough, we would even joke "Watch out! They might have the corona!" I remember staff members talking, saying that people and the media were probably over-reacting and that it would probably just be another swine flu.

The second week of March, our first patient tested positive for COVID-19. The week following, we increased from one patient with COVID to 10. The next week we were forced to a larger 30-bed floor as our 14 bed ICU could no longer hold the influx of patients. As of this week (March 29), we are expanding to 50 beds.

Unsurprisingly, as an ICU nurse, I have seen death many times. It is my job to care for those at "death's door." However, my patients usually had a long battle with cancer, a chronic history of COPD, or other comorbidities that lead to the end of their journey here. People who die in the ICU are usually in their 60s, 70s, and 80s.

With COVID-19, over and over, we have seen people come in who are in their 30s, 40s and 50s, with a limited medical history of hypertension or diabetes. They come into the emergency room after a couple days of flu-like symptoms which have developed into a fever they can't control or shortness of breath that is scaring them. These patients usually have no travel history or any idea where they may have been exposed to the virus. They are placed on supplemental oxygen, tested for COVID, and admitted to the hospital. Usually within a few days, if they aren't already to this point in the emergency room, they cannot breathe on their own, so we intubate them with a breathing tube and place them on a ventilator. Often I have seen these patients unable to recover. Two weeks later they are still on life-supporting ventilation, and we have no sign of improvement. That being the case, we try sedating them and medically paralyzing them. Because their lungs are so stiff, making them unable to move anything is the only way to adequately oxygenate them. And if that still does not adequately oxygenate them - we turn them onto their stomach to try and find some lung space in the back of their lungs that has enough flexibility to oxygenate them. And when all of this is making no difference and their oxygen levels are still dangerously low, we stand there with a bag resuscitation mask, physically pumping oxygen into their breathing tube, praying that they don't code and we have to resuscitate them. At that point we know the chances of getting them back are low - not to mention that resuscitating a patient places all the healthcare providers at higher risk of exposure.

Because of the highly contagious nature of this virus, no family members are allowed inside the hospital. Thus, the doctors are calling the families, trying to explain that we are doing everything we can for their spouse, parent, or child. The doctors ask them to start thinking about end of life decisions. As ICU nurses, we call the families every shift, trying to convey to them the condition their family member is in. Sometimes they understand, sometimes they don't.

If the family does decide to withdraw life support and allow their family member to pass, ICU nurses are the only people at the bedside. There is no family surrounding them, holding their hand, singing their favorite hymns, whispering that they love them, telling them it is okay to go. It is just us, trying to find some words to say to this stranger as they breath their last. Watching this over and over has been the most devastating part of this whole virus. People should never have to die alone. Without their family. And this is happening multiple times each week.

Before witnessing all of this, I doubted the severity of the coronavirus. I wondered if the media was over-exaggerating. I wasn't concerned with contracting it myself or for the impact it would have on those I love. But I am now.

I have seen too many people who previously lived a "normal" life die just days to weeks after contracting COVID-19. I have seen a middle aged strong man get this disease, fight for weeks on a ventilator, and become one of our miracle stories who was actually discharged. Yet, he went home leaning on a walker and wheeling an oxygen tank behind him. Perhaps many of those who "get better" will never be what they once were.

So now I take this seriously. I stay home when I'm not at work in the hospital. I meet with those I love virtually. I pray for others on the front lines.
I believe we will all be accountable both as individuals and as a society for the choices we make.
Protect yourself, protect your family, protect your neighbors and thereby show them love.