The First Wave: A Nursing Story
Stories of frontline health care workers during COVID-19's first wave
Sometime before dawn, Andrea was given an impossible task. Even though she had been a nurse for 20 years, this was the one duty she simply couldn’t imagine carrying out. But the hospital where she worked had one ventilator left, and her patient––nearly 90 years old with oxygen stats in the 70s––had little chance of surviving on the vent. The other patient––40 years old with oxygen stats in the mid-80s––might just make it, but his need for the vent was urgent. She understood all of this, understood the logic behind the decision to let her favorite patient die, but that didn’t make the task any easier or any less painful. In the younger patient’s room, as she reached around the tangled strands of wires and tubes toward the machine, she felt hot tears drip down her face. “I’m sorry,” she whispered to the dying man across the hall. Then she plugged in the vent.
On December 13, 2021, billionaire Elon Musk was named TIME Magazine’s person of the year. While this announcement was surprising to many, including those who have fought on the frontlines of the global COVID-19 pandemic, it should not have been. In the United States and elsewhere, the story of the last two years has become a story not about a global public health system in disrepair, but a story about those who control it and who are responsible for its failure. It has become, in other words, a story about the powerful––about the raw ambition of their celestial plans, or about their failure to realize the plans they made, or about the paths they’ve taken (including to outer space) that distance them from the pandemic and from the too-harsh reality that they have not done enough to help.
I want to tell a different story about the last two and a half years. This pandemic story is a nursing story: For it was the nurses, not the politicians, nor the billionaires, who cared for people when they struggled to breathe. Nurses took off their gloves and held patients’ hands so they would feel comforted, they drew silly doodles on their masks so patients could see something human in their last moments, they sang songs so others would know that they were never, truly, alone. They gave everyone all they had, and society owes them its gratitude. The least Americans can do now is try to care for nurses in the same way, and with the same fervor, with which they cared for us.
Lauren hated seeing him like this. Nick was one of her favorite patients, a 40-something-year-old man with two grown kids and no wife and plenty of will to live. But today, when she walked in to check his vitals, he looked depressed. When she asked him why, he explained, “I haven’t seen anyone but you, no offense, in nearly a month.” And it was true. Because of his illness and the hospital’s protocol, Nick wasn’t allowed to have any visitors. Just me, Lauren thought. The idea unnerved her. Clad in pounds of PPE, she thought she must look like an alien or a robot, but certainly not a friendly visitor. Then, the thought dawned on her. As she reached for Nick’s wrist to take his pulse, she craned her other arm behind her head, reaching under her hazmat suit, and tore off her ponytail. As her wavy brown hair tumbled down below her shoulders, she saw Nick smile. “Finally,” he breathed. “Something human.” Then he bent over, still smiling, and kissed her gloved hand.
When I asked health care workers about the most difficult part of treating COVID patients at the end of those patients’ lives, no one spoke about technical procedures, like vent programming or other typical end-of-life care practices. Everyone described the COVID end-of-life process in terms of the emotional difficulties it presented, both for nurses and for patients and their families. The word “isolation” appeared frequently in the 22 interviews I conducted with health care workers, most of them nurses. They often told me that the main difference between COVID end-of-life care and the care given to other types of terminal patients (those in hospice, oncology, etc.) is the isolation––the too common occurrence of patients dying alone.
Watching patients die alone posed several problems for nurses, beyond the trauma they experienced as the sole witnesses to so many isolated COVID deaths. The biggest problem nurses faced was related to the fact that patients’ families were not allowed to see their loved ones, and therefore didn’t know how sick they really were. That families were largely in the dark about their loved ones’ condition meant that it was difficult for nurses to convince them to take appropriate end-of-life measures, like signing DNRs or designating a health care proxy. Nurses spent a lot of time and effort trying to convince patients’ families that their loved one was dying, and that being on a ventilator would not save them but would instead prolong their suffering, but many families were unwilling to let go. They simply couldn’t believe that their loved one––who, in many cases, was young and had little or no medical history––was dying. In these cases, nurses describe having to watch passively while COVID patients suffered the “torturous” process of being ventilated for months, with no chance of survival or, at the very least, of any kind of quality life post-COVID.
Even while nurses described feeling helpless in the face of this suffering, they also described taking extra care to try to connect family members to their loved ones. While some hospitals had tablets in every room that nurses could use to FaceTime patients’ family members, others had fewer resources to contact their patients’ loved ones. When it became clear that a patient was dying alone, many nurses told me, they would reach into their scrubs, pull out their personal phones, and call the patients’ families themselves––an act that violated hospital protocol. Yet even so, and even though ventilated patients could not speak to their families directly, nurses held their phones to their patients’ ears for many minutes at a time. They listened while family members cried, while they remembered, while they begged their loved ones to survive. In the words of one of my interviewees, nurses became, especially during the first wave, their patients’ “angels”––the last and sometimes only person to see and touch them before they died.
Sabrine woke up suddenly, before dawn. She was sweating profusely and her mouth was dry. Truth be told, she hadn’t slept well for months, not since the first wave began. The virus tearing apart her workplace followed her home at night. And the thoughts, the thoughts she couldn’t shake. The chaos that swept through the hospital burned so quickly through her nurse friends. Many couldn’t take it. They quit. Sabrine didn’t blame them. After all, she thought, they must have felt guilty. She certainly did. With so many critically ill patients, she just couldn’t care for all of them the way she wanted to. And sometimes, when one patient decompensated (when their condition deteriorated rapidly), and when she rushed to the room to administer CPR, the patient she left to be there dropped dead. Those deaths were preventable. Was it my fault? This was the question she constantly asked herself. Was it because of me and my neglect that they died? The thought haunted her dreams. Maybe what she needed was to say it––say it out loud. She opened her mouth. “It wasn’t COVID that killed them,” she whispered. “It was us.”
Although healthcare workers have been hailed as heroes in the COVID-19 pandemic, the nurses I spoke with often mentioned that this idea makes them uncomfortable. What they experienced treating COVID patients was not heroism so much as grief, trauma, and above all, guilt. Guilt for not knowing more about the virus wrecking its way through the country and world, guilt for not being equipped––with knowledge or resources––to adequately treat every patient who walked through the door, and guilt for watching, watching and waiting, while so many of their previously healthy patients were placed on oxygen, then high-flow, then intubated, ventilated, and trached. The guilt that comes with caring for COVID patients has led some of the nurses I spoke with to step away from the COVID ICU, transfer to outpatient services, quit their jobs, or leave the profession entirely. Many more, however, have stayed. And they continue to treat COVID patients every day.
Even when their days were marked by chaos, fear, and panic, nurses went to work. Even when they found, about a month after the first wave began, that there were not enough masks and other kinds of PPE to go around, they signed on for one N95 per week. And even when their masks were practically disintegrating, they carefully placed them in brown paper bags inside their lockers, ready for the next shift. During the first wave, many hospitals took steps to minimize the number of staff going in and out of COVID rooms, so it was the nurses who took over food services, cleaning duties, and even some of the more complicated functions that typically belong to respiratory therapists, like setting up vents and high-flow oxygen. Nurses also described having to care for more, and sicker, patients than normal. The typical number of patients assigned to a nurse per shift was five, and these patients were all critically ill, ICU-level patients, which meant that nurses’ demands increased, and the time they had to spend with each patient drastically decreased.
Ghastly sights and sounds became a standard part of nurses’ work environment during the first wave: the sight of new patients passing out in the ER, the sound of worried families crying over video calls or on the phone, the sight of patients literally blue in the face with oxygen stats in the 70s, and, above all else, the sound of the vents, which whirred constantly in nearly every hospital unit. And frequently, the alarms that went off when a patient started to decompensate. So many nurses described the sound of COVID as a ghastly combination of the very human fight to stay alive (death rattles, choking, crying) and the unrelenting machines that roared “with the sound of a mighty rushing wind” and rang so loud that nurses could hardly hear themselves think––let alone hear their patients or each other. One nurse described the sound of the vents in one area of her unit as marking “death row.” That unit contained a large room where patients who were seriously ill (all intubated and on vents) were brought. This room was a place from which few patients returned. A place where the sound of the machines was so loud that they rendered family FaceTime calls useless. Nurses who were sent to work on “death row” felt like they were being punished. What if they got sick? What if they brought the virus home to their families? The answers to these questions scared them. But it didn’t matter. They went there anyway, weeping as they walked.
Photo by Mulyadi on Unsplash