COVID-19 New York City.

I have so much to say, yet I am unsure where to start. This journal/blog is meant to bring everyone in my life from my high school friends, to my friends from my nursing career, and my family members that wonder how I am doing here in New York City as a nurse during this crisis. I am hoping that this with help explain the severity of our immediate situation in the hospital to everyone reading. I will not have the time in the upcoming months to message and contact everyone that wants updates, so I am hoping this will serve as a central place where people can find out. The past 72 hours have been me updating my friends, close family, and my concerned nurse family that mean the absolute world to me, and I need some time to unwind and separate myself from the hospital situation on my time off.

To give some background I’ve been a RN for 4.5 years now. I started in a busy and crowded emergency dept before I made the switch to interventional cardiology. For those who do not know what interventional  cardiology is or “Cath Lab” as we call it, it is a department where patients come to get stents placed in coronary arteries, to have heart valves placed through a complex system without open heart surgery, or to measure pressures in different areas of their heart or pulmonary system to diagnose disease. Some patients will walk into the department to get a stent and leave later that day, while patients are current Intensive Care Unit patients that emergently come to us for live saving procedures that we will transport back to the Intensive Care Unit when we are done.

About 9 months ago I decided to move back to the place I would easily visit 3 times a year and with a plan to continue my career in interventional cardiology as this has become something I am truly passionate about and feel I make an immediate difference in my patients and their families lives. Since the move, I’ve been living in Brooklyn and commuting into Manhattan 3 days a week to work 12 hour shifts during the day. Life has been amazing, my work schedule and department is ideal being 3 long workdays with 4 days off, and my days off are like a vacation in my favorite place in the United States (Berlin, Germany beats NYC by a long shot. You should check it out).

As we all know by now what has been happening with COVID-19 and the emergency our health systems are facing this reality has been turned upside down. The Cath Lab is an extremely profitable department that treats and saves patients from having to get coronary bypass surgery and open heart valve replacement surgery, thus providing great outcomes for patients health and their bank accounts.

Currently many interventional departments are going to be closed, with exceptions to be made for emergent and necessary cases that are needed for patients immediate health. The areas where patients would be monitored waiting for their procedures and the areas where they would go to recover and be monitored after their procedure are being turned into overflow units for the Coronary Care Unit and Medical Intensive Care Unit. These patients could potentially become or currently be the sickest patients in the hospital. While this is true for my current situation in NYC, it is quickly becoming a reality for other metropolitan areas in this country (and the world). It isn’t everyday that a hospital closes a highly profitable department to grasp at straws to attempt to keep patients alive with whatever resources they have left over.

As we have all heard we have a nursing shortage in the United States, so creating new departments will need to be staffed with anyone who is able to fill in, especially by the staff whose departments are being transformed into emergent pop up units for the sickest of patients. Essentially overnight, a lot of our medical staff around the country is going from working day shifts in their current specialties to being an overnight Stepdown and/or ICU nurse with more overtime that needs to get picked up than just an extra shift. Day time holding areas for stable patients are quickly becoming 24/7 operations to care for unstable patients with a nursing staff that is unfamiliar with a lot of equipment and unfamiliar with the work flows of managing an ICU patient assignment.

While this is the immediate reality for nurses here in New York City and soon to be the whole country, we must keep our perspectives open and appreciate what we as health care providers and patient care workers have right now. Saying that I am grateful for my personal situation during this whole crisis on our health system is an understatement.

To just graze the surface of what I am reminding myself during this pandemic and attack on the integrity of our health system is that I currently I am 30 years old and healthy, my parents are able to pay their bills and have the ability to stay isolated, my brother is healthy and in a position where he is able to work from home, and I have nobody who is dependent on me for their livelihood with the exception of a cat who cries over a half full bowl of food. But MOST IMPORTANTLY is that millions of Americans right now have absolutely no control over the future of their job, they have no control as to when their next paycheck will arrive and are unsure as to how their April and May bills are going to get paid. Millions of people are anxious about what their situation will be once this settles down. Are they going to get back to their same job? Will their job still exist once we start to rebuild? During this time how will their bills get paid? Their month to month financial routine has come to halt, despite still needing these basic necessities they need to pay for.  As nurses and health care professionals, we are in a position where this is not our financial situation or career situation. The demand for skilled nurses is at an all-time high and supply of nurses is slowly dwindling down. During this crisis and worldwide emergency, we must remind ourselves that while on the frontline, we are not in the same situation as these millions of Americans.

As a young, healthy, skilled nurse, with minimal life obligations outside of my patients care I am planning on switching my lifestyle to all night shifts in this overflow unit that was once my comfortable department. I’ll most likely be working four 12 hour shifts a week, with majority of my hours over the weekend. If you are a nurse who does not have kids or dependent family members and you are nurse in my situation I hope you will put yourself forward and offer to be the essential staff during these time slots since we do not have many out of work obligations that will become complicated by working a night shift, weekend, overtime schedule.

Many of us in the health care system are taking everything one day at a time, as everyone in this country is with their individual unique stuggles, situations, and anxiety. We are not doing “ok”. We are stressed more than we've thought possible, and many of us are panicked by the situations on our current units/departments. Sending a text, email, or private facebook message just saying a simple “I Love You, be safe” is very encouraging, and we are all grasping for reassurance while doing whatever we can to care for a different population of patients. Anybody who has worked with me in the hospital, whether it was a slow day shift in the cath lab, or a rapidly evolving minimally staffed code blue at 3 am, you will know that I am pretty optimistic and put a conscious effort into smiling and building morale while supporting other nurses with this positive attitude.

But right now I am scared. I am scared for our patients outcomes, I am scared at the choices that will need to be made on these units when mechanical support is not longer available, and I am scared for the well being of all of us in this country. The numbers are speaking for themselves, and our patient volume severely out weighs our human resources of nurses, doctors, other hospital staff, and mechanical support resources such as the ventilators we've all heard about in the news this past week.

Anybody that has been a patient in the waiting room of a busy emergency department has seen what it looks like to not have enough space and staff for the patients. Fortunately in emergency departments, many of the patients are stable but still need to see a doctor eventually. A patient that has a sprained ankle might be in pain and frustrated that they are not being seen or being taken to get an x-ray. But the reality is that if they were to wait another 24 hours in the waiting room before being seen is that their outcomes would still be the same, and this is not true for actual emergent patients in a life or death emergency. Some patients come to the emergency department and must be seen by doctors immediately and also receive care, interventions and medications from nurses or else their outcomes could have a life long effect or the patient could even die.

I have a vivid memory of working the emergency department during flu season where a patient who had waited almost 10 hours (after being evaluated by a triage nurse) to get back to a room that was in my nursing assignment. I went in to evaluate the patient and start my initial assessment when they said, “You guys are lucky I wasn’t actually dying or it would be too late!”. This is why we have triage and this is why true emergencies go first in the department. Yet, what we are currently about to experience with this fast growing pandemic is exactly that, but with the patients that are unable to wait. Our hospitals have a limited amount of nurses and doctors, a limited amount of life saving mechanical equipment, and limited amount of beds we can fit into the hospital, but with rapidly accelerating volume of patients that will to need that truly live sustaining equipment and we just do not have enough. It doesn’t take Elon Musk to do the math and understand that as a health system, we are going to need to make dire choices to decide who gets what resource and why we chose those patients. I don't think we are ready as a system to make these choices and bear that weight moving forward.

People at home are wondering what they can do to assist this problem. I know it sounds ridiculous but the truth is to stay at home by any means necessary. We suspect that majority of the population is going to end up contracting this virus at some point in time. But the longer we can extend the time frame of people contracting the virus, is the less busy hospitals will be at one time, the less overwhelmed our medical staff will be, it will increase the odds that life saving equipment will be available when your love one needs it to get them through the worst of the symptoms, and more lives will be saved due to a lower patient volume at one point in time. Deciding to go out into a crowded public space is not brave, it is selfish.

The nursing profession prides itself on being caring, hardworking, great listeners and overall extremely empathetic of another person’s situation. If now more than ever we need to highlight those traits, appreciate that we are in a stable career and financial situation, provide understanding and support for our patients and the Americans who are unsure about how they’ll pay their bills. The nurses like me who do not have the out of work responsibilities of dependent family members, hopefully will step up and put themselves forward in being available for the hospital when they are needed. We have been rated the most trusted profession for over 20 years in a row. Right now is the time for us to step up for what is necessary for our society to get through this emergency, for what is right for the best outcomes for our patients, and to show why we are the most trusted profession in the United States.

                                                                                            -MacDonald Dailey, RN