I’m not a writer, I blog mostly for myself, so no editorializing here please.
Don’t call me a hero. I’m not one. Heroes are those crazy folks who rush into burning buildings, not concerned for their own safety. Trust me, I’m concerned. I’m SCARED for my safety. I’m not a hero. I’m just a nurse.
So now we are over 44,000 Covid-19 deaths in the U.S., even as some states are considering loosening up restrictions. And I understand how frustrating and boring it is to be staying at home all day, every day, and how shitty our economy is right now. But, I doubt that a bunch more dead folks will help the economy.
For those who still say that C19 is no worse than the flu, go for it, keep your delusions. True, the CDC numbers on the flu this year are undetermined, but that somewhere between 29,000-59,000 will have died from the annual flu. That’s a big range. That’s also over a 6 month period. We have 44,000 dead from Covid in less than 2 months. And some of those flu deaths could have been prevented, because we have you know, a VACCINE for that virus. Nothing for this one. Nothing on the horizon either, since the CDC themselves say an optimistic estimate of about 2 years for an effective vaccine.
So what happens to a Covid-19 patient? So glad you asked. First of all, I go into the room wearing a gown, double-gloves, and this crappy, loud-ass thing called a PAPR (pressurized air purification respirator). I look ridiculous, like some extra out of Star Wars, and I can’t hear you and you can’t hear me over the sounds of the PAPR. The doc may ask me how the patient’s lung sounds are, and I say “I’ll be damned if I know”; when said doc shrugs and says “fair enough”, you know that this thing is loud. So here I come into your room looking like this:
Yeah, seriously, the PAPR is not a good look for anyone.
Covid-19 causes shortness of breath and severe hypoxia. Trust me, we’ll try to oxygenate you, using all of our abilities, and try NOT to intubate you. Because the odds are if you are intubated, you’ll die. Somewhere around 70% of folks who get onto a ventilator will not get off of it alive with this virus. It goes against the grain of the pulmonary doctors, to watch a patient struggle for breath and to try to NOT intubate them. But there you go, this thing is a vicious piece of shit.
You fail. No, not you personally, but you go into respiratory failure, and we end up intubating you. Then what? Well, imagine breathing through a straw; and imagine another loud machine forcing you to take a breath when you aren’t ready for it. Imagine the discomfort of struggling to breathe even though you are on life support. A lot of these intubated Covid-19 patients will struggle against the ventilator, overbreathing the machine or ineffectively breathing against the machine. There are times when the sedation we put you on to help you tolerate the ventilator is not enough. There are times when we have to actually chemically paralyze you to help your body work with the ventilator. So imagine you are not able to move or even blink, but may still be awake enough to be aware of this. To make sure we are sedating you appropriately to not be just freaking torturing you, we add another piece of equipment to the mix, a sedation monitor. That gives us a constant reading of your brain activity, to tell us if you are adequately sedated to be on the paralytic.
Keep in mind, we’ve also put a catheter into your bladder at this point, because Covid-19 will also cause your kidneys to shut down, and we need to be able to monitor your renal function and urinary output. So that is another tube shoved into you in an unpleasant area. It is not uncommon for people to end up needing at least temporary dialysis while being treated for Covid-19; add another tube, a dialysis catheter, usually a neck or chest vein. Additionally, at this point you have multiple IV sites, in arms, and possibly neck or chest as well.
Oh wait, I’m not done yet. Do you know what else Covid-19 and its treatment does to you? It gives you the shits. Yep, diarrhea galore. So to protect your skin, since it frequently is continuous poo, we’ll sometimes also put in a rectal tube to keep the poo away from you. How dignified is this sounding at this point?
Your family is frantically calling, multiple family members, multiple times a shift. I can’t remember who I have already talked to, and we try to establish one person to be the family point of contact. But that doesn’t always work. Your family is terrified, crying on the phone, and unable to come in to see you. We try to set up Facetime, so they can at least see you, even though you are not at your best.
Our pulmonary docs are frustrated and at some points near tears with their inability to ventilate you; you get to the point where you can’t be oxygenated, even on the ventilator, even on the highest of ventilatory settings. To quote one of our docs one night “I can’t even oxygenate someone on a ventilator, what the hell did I go to school for?”
You’re dying. Sorry to say this, but it’s true. There is only SO much that we can do, and only SO much that our treatments can do for you at this point. If you are over 50 (although we’ve lost patients in their 30s and 40s). If you have an underlying medical condition. If you are male (it seems more disproportionately that the men are dying). If you have darker skin, either Hispanic or African-American. You are more likely to die.
Your family cannot be with you as you are dying. We desperately contact your family with your condition, attempting to get the “DNR” or “comfort care” order so that we do not have to pound on your chest, fill you with chemicals and shock you repeatedly to try to get you back as you drift away. But even if we get those orders and are able to let you quietly go, there is drama. Because you are ALONE. No family can be in with you. Yes, I as your nurse will try to be in your room with a phone, letting your wife and children tell you goodbye. I believe that no one should die alone, and I try to stay with you. I even hold your hand. And you can’t even feel it, you have no physical human connection as you are dying, because I am in there wearing a PAPR, and two pairs of gloves.
Even as you are dead, even as we treat your body with respect as we clean you and remove the tubes and lines, we are gowned, and gloved, and PAPR-ed. You don’t even get that little human connection as we are preparing your body, putting you in a double body bag, and taking you down to the morgue.
Covid-19 takes lives. It takes away humanity and human connection. It takes away individuality. It leaves pain, heartbreak, frustration, loneliness. It is powerful, and it is brutal.
We have no vaccine for this virus yet. We have limited treatments that “seem” to work on some or even most people. We don’t even have sufficient testing yet, for the virus or antibodies (yes, some areas have more test kits than others, but we are still not testing frontliners at this point). This is an invisible opponent that we as nurses (and other front-liners and first responders) are desperately trying to fight. Because our job is to save you, and it is SO FUCKING MISERABLE when we can’t. And when we can’t for young people, and multitudes of those people. We have lost some of our own front-line staff. Our front-line staff has lost some of their own family.
But tell me again how inconvenient it is for you to not be able to get your hair done, or to not have your children in school, or to not be able to go out to dinner?
Yes, I get that the economy is in the shitter right now. I repeat, a bunch more dead people are not going to change that situation.
Don’t call me a hero.