To the Families of My COVID-19 ICU Patients,
My heart always gives a little jolt when I see someone younger than I am lying in the bed. “Oh no—Death isn’t stopping for this one,” “That’s not happening on my shift.” In fact, Death, I’m going to scratch and claw your eyes out. You have been warned. No one is “kindly” stopping for anyone, not if I can help it.
But the truth is, often I cannot stop people from dying. The novel coronavirus sweeping over our communities is deceitful, baffling, and seemingly all-powerful. There are no real clues why young, healthy people are suddenly in my care, fighting for their lives.
I am usually an OR nurse, but I’ve been thrust back into the “hot zone” at a New York City-area hospital because I worked in critical care two decades ago. I’m a little upset at being abruptly transferred into the ICU with little warning and no refresher training. The most seasoned intensive care unit nurses have difficulty coping in a situation like this, not that we’ve faced one in recent memory. But this virus isn’t giving us a choice.
Normally in an ICU, we’d have four or five nurses staffing 10 or 11 patients. Now, it’s just two of us. I must start giving all my patients their medications three hours before they are due to be administered because I know by the time I reach the last patient in my care, their meds will be an hour past due. As quickly as I am moving, I scan all the patients’ faces, looking for telltale signs of pain or discomfort; these tell me to increase the sedatives they're getting so they can stay comfortable.
I cringe when I see the media portray us as heroes. If anything, I’m the anti-hero. I bitch and complain about the unfairness of my having to take a full patient load because I often feel inadequate and completely out of my depth. I unleash my full outrage on the next shift of nurses to arrive, who, just as busy as I am, keep me waiting 40 minutes to give my report. I just worked 12 hours without urinating—I want to be out of there! I am appreciative of all the food people in our community are donating, but the last thing my size 14/16 hips need is another roast beef sandwich! I’d sleep easier at night if it was going to a food pantry instead.
The bottom line is that I’m not some angelic martyr. I am a deeply flawed human being grumbling about the injustices of the universe. I prefer dogs to people any day of the week— I practiced self-quarantining before it became a thing! I often feel a sting of shame when I talk on the phone with my patients’ family members, because I know I would never be as controlled and gracious as they are if the situation were reversed. I encouraged my sweet husband, an electronic technician, to work in the pits of the World Trade Center on 9/11, 19 years ago. He subsequently developed cancer. Must I now be in the thick of things, bring home this virus, and finish him off?
But for all my outraged bravado, there is one undeniable truth:
I’m as scared as you are.
I’m scared I will make a mistake, that I will miss a subtle sign that could have given a patient another day. I’m scared someone has a pain I can’t see to help alleviate it. I’m scared that I won’t know how to support a terrified wife or daughter in the way she needs to be comforted, that I will let my own indignation about being overworked and afraid stand in the way of kindness.
But my biggest fear is that I will have to let someone you love die alone. So far, I haven’t had that happen, but it is the last thought in my head as I struggle to sleep every night.
When I hear of the applause that rings out nightly in support of healthcare workers, I do an inventory of all my frustrations and my shortcomings. I think, “I don’t deserve this.” But I guess that’s beside the point. The point is the people in my care.
So here’s what I can do, and what I do every single night: I try to humanize every person in the ICU. I talk to them when I suction their endotracheal tube, or when I turn them to prevent their skin from breaking down from lying in bed for so long. I bathe them, and as I do, I imagine their limbs springing back to life after all this is over. I move their arms and legs in quick passive exercises, so that the ordeal of lying motionless doesn’t leave them with muscle contractions or limited mobility if they do recover.
As out of my depth and as flawed as I am, I can promise you one thing: I’ll try my best. I’ll continue to sneak in a foot rub for the person you love and wash their face and stroke their hair. I won’t let my fear, anger and anxiety overtake me. I’ll try to communicate wordlessly to your loved one that they are loved, valued and appreciated.
I can’t tell when this madness will end, but I can tell you that we are all trying the hardest we ever have. That’s something you can count on.
Margaret Bravo, RN
