Nurse T is the pseudonym for a loving, dedicated nurse who worked all through the dark years of the Covid-19 pandemic. Day after day, she and her colleagues braved the deadly virus to provide whatever care they could offer, given there was no effective treatment or vaccine.

In 2020-2021, Nurse T and I (editor) met OUTDOORS for lunch. There, she would tell me stories about what she and her colleagues and patients were enduring.

I would type up her story, then email it to her with writing prompts. Over many months she sharpened her storytelling skills and finished her powerful account of working in an ICU during Covid.

IN THE ICU

March 25, 2020

When I walk through the automatic doors into the ICU at 7 AM, I step into a war zone. There are overflowing trash buckets and debris scattered all over the unit. Four red crash carts sit outside the rooms, their drawers open and largely empty, witnesses to the chaotic night. One of the patients who coded survived, the three others died. One body in a white plastic shroud is still in a room on the bed waiting for a stretcher.

I ask, “Why is the body still here?”

A weary night nurse tells me there are no stretchers to be had, all of them are in use hold- ing bodies waiting for the trip to the temporary morgue – two refrigerated tents out in the hos- pital parking lot.

In normal times we might see 2-3 codes in our ICU in a month; now we see 4 or more in a day. Sometimes, two at the same time. Truly battlefield conditions.

IN THE ICU

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A PANDEMIC NURSE’S DIARY

I hear one of the night nurses yelling from inside a patient room at a young, baby-faced intern to come help, her patient is crashing and about to code. But the intern is afraid to leave his safe island in the doctor’s report room, he knows that the Covid-19 virus is everywhere. Death’s wings have scattered the virus like fine snowflakes over every computer keyboard and phone and countertop and chair in the unit.

As the ICU Attending and the Fellow join the nurse, the intern slowly follows them in, look- ing scared to death.

While the night nurse and the doctors are trying to save the patient who is crashing, I go into a small room that is cluttered with equip- ment. I cover my cotton scrubs with paper pants and a paper shirt, then I pull on a thick, long- sleeved cloth procedure gown and tie it snugly. I will wear the gown all day, hoping...praying it will keep me safe, and keep my family safe, when I return home.

I don an N95 “TB” mask, the only mask I will have to use for the twelve-hour shift, and follow it with goggles, a paper hat to cover my hair (already tied in a bun), and paper booties.

Standing outside the room of my first patient, the only survivor of the four night time codes, I

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put on a disposable isolation gown. It is a gown I will have to reuse for the whole 12-hour shift.

Outside the patient’s room I take a deep breath...pause...open the door and step into a pool of bloody fluid. During the night the patient had pulled out his endotracheal (breath- ing) tube because they did not have enough of the sedating and anesthetic drugs to keep him asleep. There is no more Propofol or Versed, so we must go in the room every four hours or more and inject a dose of a 2nd or 3rd line seda- tive, hoping to keep the patient asleep. We will have to go back to Valium and Scopolamine if the shortage persists.

The patient came to the ER the day before with pneumonia in two of his lower lobes (bilat- eral basilar pneumonia). It is a classic Covid-19 presentation. Within twelve hours the pneu- monia consumed all the lobes, whiting out the entire lung. He felt as if he was being held underwater drowning because he was drown- ing on his own pulmonary secretions and blood. So, he pulled out the endo tube hoping to take in one full breath of pure air. That was when he coded...and somehow survived.

After hanging new intravenous solutions and manually taking his temperature (the dis- posable automatic temperature probe that

NURSE T

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A PANDEMIC NURSE’S DIARY

would normally display his temp on the heart monitor is out of stock), I ask our nurse’s aide Lily to bring bags of ice. She hands them to me and I pack the bags of ice around his body to bring down the 104-degree fever. Satisfied, I remove the isolation gown, turn it inside out and stuff it into a plastic bag outside the room, ready to don it again with the next visit. By the afternoon when I put the gown back on for the umpteenth time, I will feel my own sweat cling- ing to the gown.

It is a sickening feeling.

Finally, the last dead body from the night is taken away. A housekeeper in a full hazmat suit comes in to clean the room. I can smell the bleach all the way to the nursing station. I say to my friend, Nurse O, “I wish the entire unit could be bathed continuously in the bleach solution.”

Nurse O says, “Don’t get me started on my wish list!” I can hear the exhaustion in her voice and see it in her eyes. Nurse O was born in Puerto Rico and grew up in New York. She gets tired when people ask, is she going to apply for US citizenship, she is a citizen by birth.

Nurse O is quiet and soft-spoken and has a lovely face, all the young doctors hit on her when they rotate through the ICU. Some of the

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Attendings do, too, but she will be married in June...if the pandemic even allows for a ceremony. At the head of our wish list, we want the hospital engineers to put fans in all the patient windows to blow the Covid-19 virus out into the wind where it will harmlessly dissipate, instead of letting it waft out into the ICU every time the door is opened. But the hospital has not

approved the fans, we don’t understand why. We ask a Supervisor why they won’t install the fans, other hospitals in New York have done it in all of their ICU rooms. She just shrugs. She

doesn’t know.
Providing enough PPEs so we didn’t have to

reuse ours over and over again would be nice. We’re told not to expect more supplies any time soon, every hospital in the country is ordering them, the suppliers are out of stock. And to have enough first-line sedation and anesthetic drugs so our patients don’t wake up and pull our their breathing tubes – that would be Heaven-sent. The Pharmacy doesn’t know when the manu- facturers will fill their orders. It may be days... or weeks...or months?

The ER nurse calls and yells in my ear. “Why is it taking so long to send my patient upstairs?

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A PANDEMIC NURSE’S DIARY

It’s a madhouse down here, we have patients wall to wall and lined up in the street!”

I don’t bother to defend myself, we are all working in the same hellscape – a scene a movie director could hardly imagine for the scariest horror movie ever.

A half-hour later Mr. G, the new patient, arrives. He is 45 years old. His skin is mortu- ary cold, his fingernails are gray instead of a healthy pink, and his blood sugar is 1800. I ask the ICU Attending, “Have you ever seen a blood sugar this high?”

Our Attending for the month is Dr. V. She is a veteran Pulmonary Care Physician who has seen it all. I always feel good when she’s cover- ing the unit. Dr. V tells me she has never treated a patient with a blood sugar that high before. She tells us they are learning that the Covid-19 virus wreaks havoc on diabetics. The current theory is that either the virus itself or the body’s hyper-immune response makes the organs in the body resistant to insulin. Without insulin doing its transport job, glucose can’t enter the cells, so it just builds up and up in the blood stream while the cells starve for nutrients.

With our fearless Nurse’s Aide Lily help- ing, I settle the patient into the bed, adjust the

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intravenous infusions and tie his wrists to the bed frame to keep him from pulling out his breathing tube. Finally, I look for the first time into the man’s face. It is a handsome face. It is a face that once laughed and smiled and winked at his children.

I know he will laugh no more, the cold ones always code, and they always die. I know that soon, probably during my twelve-hour shift, after another fruitless code I will have to drag the young intern out of his safe harbor to come pronounce the man ‘dead.’

The hour waiting for a stretcher to remove the body will be when I get to eat my lunch.

In the nursing lounge at the end of the ICU I finally get a fifteen-minute lunch break – at 3 PM. I hurriedly gobble the last of my sandwich and gulp down a cup of lukewarm coffee. The thought keeps coming back to me: how did we end up in such a mess? How come we weren’t better prepared for the avalanche of patients that is crushing us?

What went so very, very wrong?

YouTube Link: https://www.youtube.com/watch?v=JjSo6R8llVU