VISITOR RESTRICTIONS IN PLACE. Visit link for details and more updates.
VISITOR RESTRICTIONS IN PLACE. Visit link for details and more updates.
By Caitlin Kretschmar, BSN, RN, RN-BC
In March 2020, shortly after the World Health Organization declared COVID-19 a pandemic, it was decided that the unit I work on would be the designated COVID unit.
In the very beginning it was petrifying - the complete unknown of this horrifying new disease. Policies were changing by the minute. What was the most appropriate PPE? Did we have enough? What does this disease do and how do we treat it?
We were scared to come into work, scared to be around our families, and scared of what would come. We were told to spend the least amount of time possible in each patient’s room and monitor ourselves for symptoms. Yet we continued to provide that innate compassionate care to our patients, despite putting ourselves at risk. Everyone was rallying behind frontline workers, calling us healthcare heroes.
I remember my first COVID patient that had to be intubated. It was April 2020. She was a young mother who, in the midst of not being able to breathe, gave me her phone to text her daughter for her. Her 18-year-old was going to college to be a nurse. She asked me to say in between gasps. “They are going to put a tube down my throat, I don’t think I am going to make it,” she said. “I love you so much, take care of your father for me.” Little did I know, this was only a precursor of what was to come.
It feels like a lifetime ago. I mean it has been a grueling almost two years of this, but it’s different now. Initially, we did not have the surge that we had planned so immensely for. We had some COVID patients, but nothing like the surge we are currently experiencing. And there was no vaccine - or end in sight.
Fast forward to a year ago - December 16, 2020. We got that email asking who would want to be in the first round of vaccines. I remember crying when I saw it. Immediately, without a moment of hesitation, I responded. I, and I am sure many others, thought this is it. We have a vaccine. By this time next year, we are going to be out of the woods, and everything will be back to normal.
We had no idea that a year later (to the day) we would be overwhelmed with COVID patients, the sickest COVID patients we have ever seen, and in the middle of a crisis. A COVID crisis that could easily have been prevented with a very accessible vaccine.
Around September/October, it was easy to be angry at the people who were not getting vaccinated. We had a fair amount of COVID patients, and right outside these patients’ windows were demonstrators, protesting against the vaccine. It was hard to not be angry. To have gone from being a healthcare hero, to having people not believe us, or believe in science, or think this is all fake, has been infuriating.
Now that we are in the thick of it, that anger is still there, but it is different. The anger is shaded by devastation and sadness. There is a new anger. An anger from feeling like we can’t do anything to help these people, and that we are just watching them die.
Speaking on behalf of the experiences on our unit, that anger quickly faded to the background. We ask new COVID patients if they are vaccinated, but that’s it. We don’t think about it at all when providing their care. These patients are someone’s mother, father, brother, sister, wife, or husband. Yes, they decided not to get vaccinated. But being angry about it, when they can’t breathe and are terrified, is nearly impossible. When someone comes into the hospital having drank themselves into liver failure, and are dying, or some other preventable ailment - we don’t treat them any differently. We don’t look at them and think “well you shouldn’t have drank.” No, we take care of them. We put that anger aside. We offer them support and do our best to provide them with the best care possible. We are not thinking about a patient’s vaccine status when they are looking into our eyes, unable to breathe, asking if they are going to die, and begging for help.
These past few weeks have been the worst yet. Every day it feels like the patient you had yesterday - the one you really got to know, the one with three kids, the army veteran, the one whose wife calls 15 times a day - has been sent to the CCU to be intubated. Or worse - passed away.
Our unit cares for these patients as a team. When a patient isn’t doing well, it requires multiple staff to take care of them, to help prone them, to answer the alarms that their oxygen saturations are in the 50s. We all get to know these patients. When a patient dies, or gets intubated, it affects all of us. And we take that sadness home. We carry it with us.
For example, we had a husband and wife on our unit. The husband was doing okay, but the wife was on a high flow oxygen nasal cannula, offering her the maximum amount of oxygen. The wife had been there for a while. We all knew her. She was lovely, but scared. Still, she was more worried about her husband than herself. The husband was being discharged, and before he left, I wanted to bring him in to see his wife. But I was too busy with my other three COVID patients. I didn’t get to bring him in before he left. A couple of days later, his wife was intubated. And she didn’t make it. I was too busy to bring this husband in to see his wife for the last time without a tube down her throat. Too busy. Was she vaccinated? No. But I don’t carry that anger with me. I carry a feeling of guilt, instead.
We have learned from instances like this. Recently, we had a father and son on our unit. I told a fellow nurse about the guilt I was struggling with. When the father was discharged, she made sure he got to see his son before he left. His son is now intubated. But he was able to see him one last time.
We try so hard to get families in before they have to go to the CCU, but it isn’t easy. We have learned when to call families to ensure they can see their loved one before they may never see them again without a tube down their throats. I’ve watched daughters climb into their mother’s hospital beds, to lay with them as they can’t breathe and are dying, even though they are scared of getting COVID themselves. I’ve watched wives not be able to kiss their husbands of 50 years, after they’ve died, because they can’t wear a powered air-purifying respirator. I’ve watched my coworkers advocate for patients like it was their own family member, and the devastation in their eyes when they don’t make it. I’ve Facetimed a patient’s family from my own phone, just to be able to allow them to say goodbye. Those intimate moments - when a husband looks at his dying wife crying, and his wife in between gasps is telling him that she wished she had listened to him and gotten the vaccine, and the husband just looks at her and says I love you – are unforgettable.
During these moments, we aren’t thinking ‘well you should’ve gotten vaccinated’. We are feeling the heartache of the husband who has to take off his PPE and leave the hospital without his wife. When a patient with COVID passes, it’s not just another COVID death. It’s a wife, a son, a daughter. It is someone’s person. Vaccinated or unvaccinated, it is someone who would not have died if they didn’t get COVID. And we carry that guilt and sadness with us.
We spend our days donning and doffing for a box of tissues, donning and doffing to rush someone to the unit, doffing to cry in the med room, donning to see that patient who is angry because their meds are late after you just coded someone, donning family members to say their last goodbye, and doffing them after as they are crying. After donning and doffing all day, the best thing we can do is be there for each other.
And we will always provide our patients, and their families, with committed, compassionate care. No matter what.
Caitlin grew up on the Seacoast and received her Bachelor of Science in Nursing degree from the University of New Hampshire. After graduating in 2015, she started at Wentworth-Douglass as a new grad and has been working on the cardiac/ telemetry (now COVID unit).
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