The Things We Carry in Munson’s COVID Ward
November 13, 2020
There are gowns and face shields and masks. The new air purifier helmets are lighter and quieter and more comfortable than our old ones, but after three or four or 12 hours nonstop in one, they’re heavy on the neck, and they dig into your scalp.
Wearing one lets a patient see your face, but it’s hard to hear over the fan next to your ear. An N95 mask and face shield is okay too, but in order to be effective, the mask has to be painfully tight and the face shields flop around at inconvenient times. Overall, the helmet and hood are a better choice; we can move fast in them when we need to.
On a weekend in late September, I had to move fast. I was assigned to sit with a COVID patient who wasn’t getting nearly enough oxygen, so as the day progressed, he became more and more agitated and confused. My job was to keep him safe and calm, to stop him from pulling the oxygen tubing from his nose, to help him lie on his side or belly to help his lungs work.
By the end of my shift, he’d broken his oxygen tubing and needed two people to hold his arms down while we got everything reassembled. In the bare few minutes it took to get him set back up, his blood oxygen level went from 88%—which is low, but tolerable; normal is above 95%—to 50%. A pulse oxygen reading of 75% generally leads to loss of consciousness. Fifty percent doesn’t bode well for continued survival.
When we got him calmed down and settled, I let myself cry for the first time since the pandemic started.
I have seen some truly painful things while working at Munson’s COVID ward during the coronavirus pandemic. One of my nurses spent 45 minutes trying to set up a FaceTime chat, a Zoom call, anything that he and the patient’s family could think of so that they could see and talk to him. They never got it figured out that day. I hope they managed to before he died the following afternoon.
Patients have lost limbs to blood clots, gone through amputations and died anyway. Families are being forced to have conversations about death and dying and treatment and care that they aren’t ready for. Let me tell you: have the conversations now, before you need to. Make sure your people know where to draw the line, what your priorities are for life, so that if you’re the one on a ventilator, on life support, with dialysis running continually to support failing kidneys and nutrition going through a tube, they know whether that’s actually what you want.
There have been beautiful moments, too: nurses singing hymns to their patients through masks and shields, staff forming bonds like in trench warfare, conquering steep learning curves and ever-evolving standards for everything from what mask to wear, and when, to how to wipe off your helmet, to who’s even allowed in COVID patient rooms. One week, I got three different trainings on how to remove the same piece of PPE (personal protective equipment).
It’s okay; we’re all learning as we go and tweaking things as we learn. That goes for your governor, as well as your hospital staff.
We play music for vented patients and hold their hands, we try our best to save their dignity. We’ve had babies born on our unit for the first time, to new parents who test positive for the virus, and we’ve learned how to support each other when things get really scary or tough.
Signs started going up on the unit in April, a couple of weeks after we moved all the open-heart and other cardiothoracic surgery patients into a different floor and set up isolation equipment stations outside all of our rooms. Instructions in bold green letters, hand-written, on how to bridge sedatives if we ran out of a
NMC nursing student Elitza Nicolaou currently works in Munson’s COVID unit.
specific medication; what precautions to take for patients who were just waiting on test results, or who were confirmed positive, or who were on mechanical ventilation; how and where to get fitted for an N95 mask.
When we got rapid testing and didn’t get so many triage patients, the COVID-positive patients and their signage moved into the side of the unit we kept reserved for isolation. There used to be a cheerful, hand-lettered board of success stories (“Today we took ONE patient off the ventilator!”) but the one we see every day, still, is “Morgue process at charge desk.”
I thought it would stop getting to me after a little while, but it hasn’t. Every time I have the aide assignment in COVIDLand, I stare at it over and over. Morgue process at charge desk. We have to treat our COVID dead a little differently.
We have to treat our COVID living a little differently, too. It’s hard to develop a relationship with a patient when you’re wrapped in PPE and trying to protect yourself; the barriers are physical and psychological on both sides of the equation. We spend enough time and energy donning and doffing our protective gear that a normal patient interaction —getting a glass of water, or a hairbrush, or changing the sheets—is a long, often-exhausting process. We give the best care that we can, but it’s draining.
I don’t know when this pandemic is going to end, or if things will ever get back to what we thought was normal a year ago. I know that I’ve had to learn too much this year, that we’ve all had terribly abrupt lessons in what it means to live in a society. We’re all in this fight together, even if we don’t all have the exact same fight, and our actions can deeply affect other people: we can choose to try to keep others safe, or we can not.
When I see people without masks, I wonder if they have any idea how much that feels like an insult to the memory of more than 240,000 people in this country lost to COVID, and how much it feels like they’re thumbing their noses at those of us working on the units. I wish, sometimes, that they could see what we’ve all seen on the unit, whether it would help them take it seriously.
There’s a good article on the scientific journal portal SpringerLink that wearing masks doesn’t just slow droplet spread, but actually reduces the severity of infections: the fewer virions we inhale, the longer our bodies have to mount a good immune response before becoming overwhelmed by the virus. I’d hate to defeat this pandemic by appealing to selfishness rather than empathy, but at this point, I’ll take what I can get.
Elitza Nicolaou is an NMC Nursing student currently working in the COVID unit of Munson Medical Center. This story first ran in the Glen Arbor Sun on Oct.11.