On July 27, 2020, I saw my name followed by “RN” for the first time. The next day, my mentor or mentor and I were assigned to the COVID intensive care unit of our hospital in Nashville, Tennessee. I read the worksheet with a strange knot on my chest. This is not fear or fear rising into my throat, but something more difficult to name.
For months, as an intern nurse, I have been watching exhausted nurses coming out of the COVID ward, taking off their personal protective equipment like soldiers taking off their armor, their faces wrinkled from the pressure of the respirator Baba. At that time, I couldn’t fully understand something on their faces, something deeper than sadness, a terrible weight that comes from caring for these patients. Now it’s my turn to enter the fields of nursing and medicine. I learned how to keep beeping and hissing from the ventilator and the nurse behind the ventilator and yellow robe, which cannot support the failing lungs. I learned how to be a nurse, and the moment of death followed.
Because I’m so new, I don’t have a benchmark for what normal care looks like; I just have a vague feeling that it can’t look like this. The army was in depression, everything we did felt futile, and I realized that at some point, I felt more like a dying ferryman than anything else. Some people are still alive-if they have never reached the point where they need to continue BiPAP, BiPAP is a mask that constantly pushes air into the lungs. Most of them are not alive. When they came to us, they were so sick that we could no longer cure them. They are kidney failure, respiratory failure, liver failure, and heart failure. An organ system will fall, it will fall down like a domino, and then the next one. This is a terrible cascade that we can predict but cannot stop.
I watched one patient after another go through the various stages of the disease. I felt helpless. Everyone needed a higher level of oxygen support: from nasal cannula to Vapotherm to BiPAP. Then, when their chests began to rise and fall, even though the BiPAP mask forced the highest possible oxygen concentration into their lungs, they began to sweat, I was very afraid that they would be intubated soon. I remember every time I called the doctor to tell her it was time. Then there was the quiet acquiescence at the end of the line and the busyness when we prepared the ventilators and kept them comfortable afterwards. I remember calling my family at 2 am every day so that they can hear their loved ones at least once again.
“She will be fine, will she?” they would ask. I try not to lie or give false hope. I heard too many voices on the other end of the phone, and the family was troubled by helplessness and grief. “We will do our best,” I will say.
We cannot call you back in some places-we cannot track where you go. This is one of them. ICU feels like purgatory, like a punishment, just like we are torturing these physically overwhelmed people. I can’t get rid of the feeling that we have let them down. The feeling of error is so common that it follows me home, and it will suffocate me if I let it go. So I didn’t let it. I am used to death. I surrounded it, pushed it down, and completed my work. I advocate death with dignity, treat and comfort as much as possible, and I accepted the fact that we cannot save everyone early on.
Every time I try to describe the COVID unit with anything other than metaphors and allusions, I hesitate. I can tell you that for a while, walking into work was like Dante following Virgil through the gate and the warning engraved there. I can talk about Charon and Styx, and how nurses travel between the world, crossing the river of death every time we enter the COVID ward. What I said was dramatic and pretentious, but the language failed here. I think there is no text to describe what this is. The COVID unit is mottled limbs and burning skin; one by one enters the bloody secretions of patients with abnormal heart rhythms and constant alarms;. This is the beeping sound of Prismaflex, which provides continuous renal replacement therapy because the patient’s blood The circuit that was pulled out of the body to filter, as the failing kidney should do, condense again. There are 1,000 reasons why the ventilator sounds an alarm from the inside of the room. Some of them can be repaired, and some are not. Patients in room after room are staying alive, except for the relentless bells and beeps reminding us that they are dying and we are failing. When I got home, those alarms sounded in my mind, reminding me of the various ways in which they could not be saved. We are now plagued by failures, starting with the failure of the policy of allowing human lives to be sacrificed on the altar of the economy, to telling our family that there is nothing we can do. COVID has made all of us martyrs.
The past December to February was the worst-until now. For several months, the ICU has taken over part of the post-anaesthesia recovery room because the ICU beds are so occupied by COVID patients that people with heart attacks, strokes or major operations have nowhere to go. The unit has been transferring and will not accept new patients. When we left it even an hour, we received six or seven admission notices. Even during the transfer, patients continue to flock in-people from the emergency room or internal medical operating room, who quickly decompensate and cause respiratory failure, and the burden of one nurse after another is three times the burden of normal patients in the intensive care unit. If necessary, the normal ICU ratio of one or two patients per nurse was abandoned. Every shift, we drowned. The attack was cruel, relentless and unsustainable.
Spring is here, and the numbers begin to fall. The three COVID intensive care units became two, then one, and then we had fewer than six COVID ICU patients. After becoming a nurse, I can breathe for the first time. I began to understand what it was like to be a nurse in the pre-COVID era, and realized how many people usually survive the ICU. What I do is important; my actions actually save lives; death is no longer my constant, silent partner. The more time I leave the COVID department, the more I realize how bad it really is; all the vents, CRRT (blood purification), we can postpone the ruthless march to death for a while but never stop. Walking through the much smaller COVID ICU feels like walking through a cemetery, haunted and weird with souls who just want to rest.
I began to think, soon, we will be free. I’m wrong. Like many people, I relaxed my vigilance. I was careful not to wear a mask when the grocery store was not packaged, and even went on vacation with my boyfriend. I began to see a future where there are no dark clouds over the horizon, a future where my family is safe and my patients will not die from these slow and painful deaths. But we all know what happened next.
This time it was a lot worse. We can all give much less. We still bear the fresh and heavy grief of the past year, and we are trying to find a place to vent all this anger. But the patient will not stop coming. And the anger will not stop. Under that anger, I felt defeated. What we do is not important. When we fight to save the coming wave with fewer employees, fewer resources, and a heavier heart, the world is spinning, ignoring and warlike. The number is now higher than ever, the patients are getting younger and younger, and the condition is getting worse. Death fell on my shoulders again, as silent as he was mercilessly.
I don’t know what to say so that people can listen to us and take some basic steps, such as masks and vaccinations. This may be our way out of this nightmare. I hope I can pull so many people out of the selfish coma, but I can’t do it, so I can only watch people study hard. Imagine you have a tube in your throat-and the sentence “Blue code, blue code!” External compression of the sternum caused the sternum to rupture. I called your family at 3 in the morning, my hands were still trembling from CPR, my voice was trembling, and I knew I was about to crush someone’s world. In a little over a year, I have become very good at telling people that their loved ones are about to die.
You are learning very hard, I see it through. I bear your choices and the pain they cause.
It doesn’t have to be like this. In this terrible, sunken story, we could change direction at any time; we could have made the decision to do the right thing. Epidemics hit our hearts because they reveal intricate and ruthless networks of human relationships, which are becoming more and more overlooked. Americans have always been individualistic and sometimes wrong, and I saw this more clearly than ever during the pandemic. We have forgotten that we are all connected, a huge golden network with rays of light among friends, parents, children, brothers and sisters. This network spans the globe and connects us to each other. One person’s actions affect the lives of many people, and the epidemic illustrates this in the cruelest way. A person with a sore throat entered Kroger and infected eight people, each infected another eight people, and then another eight people. No one is an island, all our actions will have an impact on the world and communities around us. There is a truth behind this, which is deeper than political parties, vaccines and even science itself: nothing in this world is more important than being kind to each other. Nothing is more important than heritage.
This is an opinion and analysis article, and the views expressed by the author or author are not necessarily those of the author Scientific American.