COVID-19 and switching gears

March 26, 2020

My emotions are very similar to my original blog post. I have so many of them about so many issues related to this global pandemic but I will avoid politics and my economic fears (which could be an entirely different blog of equal or greater length), so I can focus on my personal experience, fears and feelings. As you have read in the original post, the cardiac cath lab is essentially closed with the exception of emergent “life or death” cases, and we are allocating staff to other parts of the hospital to assist where additional staff is needed (essentially everywhere).

My last shift I was working in the overflow MICU/CCU area that was set up in a monitoring area of the hospital for patients that have just come out of major surgery to recover before stabilizing and going to a hospital floor. I will not get into details to protect the confidentiality of the patients and to not dive into the specific issues about the hospital I work at (for the hospitals protection and my own). To sum it up, it was what you would expect from a hospital that is scrambling staff to take care of patients in an environment nobody has ever been in. To make the matters even more stressful, I was using a documentation system that I haven’t used before and with a patient population I have never cared for. When my shift was over and I was ready to go home and cry the oncoming shift was also hesitant to come on shift due to the issues with taking patients they were not comfortable taking which was just adding to the extra time spent there once my shift was over.

I am currently working 13 week contracts with an agency that is able to staff me around New York City in various hospitals to ensure each facility is able to meet their fluctuating staffing needs. I have 4 weeks left on my current contract before I will be switching to another assignment, or renew with my current hospital in Manhattan. As you also read in my original post, you will know that I was originally trained as an emergency department nurse before making my switch to cardiac cath lab. So moving forward in my contract I will be transferring to the emergency department at my current hospital to assist them with their staffing needs and to assist with the COVID-19 outbreak surge of patients. While this is not ideal for my choice of position since I am a cath lab nurse at heart, the reality is that I am an emergency nurse in my blood. While in the cath lab I work very well with former ICU nurses because we provide different strengths and naturally cover each others weaknesses. I have attached a link to a site that explains the difference between us very well. If you do not work in the hospital or nursing field I highly suggest you check it out if you want to understand how different we are, or if you are one of my hospital friends you will get a laugh out of the page. https://nurse.org/articles/differences-between-icu-er-nurses/

I am here living in New York City which is currently the United States epicenter of COVID-19 and potentially the epicenter of world at this moment, I am young, healthy, and ready to help in anyway possible. But for me to provide care for my patients I need to be in an environment where I can provide the most bang for my buck, and if it isn’t the cath lab, it is for sure the emergency department.

I have been off of work the past two days unwinding as best as I can but the truth is that I am emotionally in a position I have never been in my nursing career or quite honestly my entire life. If you know me personally, you will probably agree that I am an upbeat and positive person. I know that my biggest strength in nursing is to keep moving through my shift with an bright attitude, a warm smile with a calming presence for my patients that are going through an acute crisis, and an excellent communicator for my patients families to feel as though they are not ignored like it is easy to feel in a busy emergency department. But right now I am struggling. I am struggling with panic attacks and uncontrollable crying. I haven’t taken a shower in the last week where I haven’t stood there and cried until I couldn’t anymore before getting out of the shower and collecting myself before continuing my day. I am unable to remove my thoughts from the topics I will discuss later in this post.

The reality of New York City hospitals is sobering right now. Many people who are staying home and experiencing their own personal struggles or anxiety with the COVID crisis, unemployment, and isolation may not know the details of the crisis here.

To start off I will say that multiple NYC hospitals and many more to follow have refrigerated trailers outside of the hospitals waiting to be loaded up with bodies of COVID patients who passed away because we are out of space to put bodies waiting for burials and cremation. This past night, NYC emergency departments had 19 people die from COVID complications alone. These patients never saw the inside of the inpatient hospital whether it was due to acute progression of their symptoms while in the emergency department or they were waiting for a bed to open on a  COVID positive floor for them to start receiving care at an ICU level.

The next sobering reality is that an assistant nurse manager named Kious Kelly passed away overnight due to progression of his symptoms that were unable to be managed. Kious worked for a hospital that was unable to provide the appropriate PPE (Personal Protective Equipment) to care for the patients with COVID-19 on his floor. Go ahead and search his name online. You will find that they were so low on supplies that the staff was wearing garbage bags in order to prevent the contact spread of this virus. You read that correctly, IN 2020 A HOSPITAL IN MANHATTAN WAS UNABLE TO PROVIDE BASIC EQUIPMENT TO NURSING STAFF DURING A GLOBAL PANDEMIC! Read that over as many times as you need, and let it sink in that we are not immune to these horror stories here in the United States.

A third sobering thought that we have in our brains right now, is that COVID-19 patients here in the city could potentially be forced DNR (Do Not Resuscitate). This means that if a patient who is COVID-19 positive, intubated, in an intensive care unit goes into cardiac arrest, no matter the age, will not receive CPR and potentially left to die. This is because of the potential exposure risk that every staff member involved in a fully run code is put at and the potentially wasted resources that we are already trying to extend the supply of. Right now the hospitals need as many nurses, doctors, and other just as important health care staff as possible and by losing more team members would increase a further strain on the system and more patients to not be seen and potentially die. This DNR policy is not official, but as we see an exponential increase in our patient volume, a supply chain that is unable to keep up with the demand, and a health care staff that is already short on workers, we cannot afford to spend any resources on a patient that will have a poor outcome, resulting in our system putting other patients who could be saved at a higher risk of mortality. This is one of the many moral decisions that I never thought we as a health care system in the United States were ever going to need to make.

To add icing to the depression cake, every hospital here in the city and possibly most in the country have a strict no visitors policy (husband and wife included). If you were in the hospital or emergency department in New York City right now, you would not be able to have your husband or wife at your bedside. To change the perspective, if your mother or father was a patient in the hospital in New York City right now (COVID positive or not), you would not be able to be there to comfort them in the time that they are most vulnerable, scared and in need of family love while they take their last breath. If your mother or father is in the intensive care unit, on a ventilator, multiple medication drips and is guaranteed to pass away within the hour, they will be doing so alone with nobody at their bedside besides their already busy nurse and or already busy doctor. The nurse’s day doesn’t end there. The bed, equipment, and room will be cleaned, followed by the crowded emergency department sending up another alone patient in desperate need for intensive care that could possibly not help the patient survive even 24 hours later. The nurses who are taking care of these patients will be the one at their bedside as they are grasping for their last breath and moving onto an afterlife that is unknown to everyone on earth.

Everything that I have written in this post is what is currently happening in New York City. But this is just the beginning. The hospitals have just started to see the real power of exponential gains (in this case symptomatic patients). Experts whose forecasts have been right on their predictions to date, expect this to exponentially increase over the next 5 to 6 weeks before we start to see a decrease in patient volume.

Tomorrow night I will be suiting back up in scrubs and putting on a mask that I haven’t worn in a few years, the emergency department nurse mask. I am sad, I am anxious, I am worried about New York City, and I am very scared. I will be thinking about my original emergency department family and everything that the experienced nurses there have taught me about ER nursing, about holding yourself together, and how to manage the sheer volume of patients during your shift.

10 months ago, I told everyone in my life that I was moving to New York City to pursue opportunities that I could not even see at the time, but this is not what I had in mind during the move. New York City is where dreams come true, but in this case today on March 26^th 2020 we are living a nightmare.

                                                                                           -MacDonald Dailey, RN