2020 was supposed to be a great year, 20/20 vision for the New Year. A year of hope and a new beginning as we entered into a new decade. Until March, the unknown disease spread from country to country and entered the United States. It wasn’t long until nobody could find toilet paper, and cleaning supplies on the store shelves. States closed, offices closed, and communities indeed found which job positions were considered essential. Employees in many career positions found themselves temporarily and permanently out of work for months at a time.
Nurses went to work. We were proclaimed heroes and somehow liars, by different groups. The rooms filled with people of all ethnicities, ages, sexes, and backgrounds. They came in with shortness of breath, loss of taste and smell. Every so often, shortness of breath met with gastrointestinal issues. Some people recovered and went home. The argument to open states and cities and the mask mandates enraged some people. Their argument rang out, the mortality rate was only 1%. But nurses dealt with those patients. That 1% of people only a statistic to most public, but a person to Nurses who watched them succumb to the disease.
My unit, a Medical-Telemetry unit, became the Respiratory floor, known to the rest of the hospital as the Covid Unit, or Covid World.
#1 Lack of PPE
Early on, in the Pandemic, we ran out of PPE. We were given one N95 and expected to reuse it until it became soiled. For those who don’t remember or don’t know, an N95 is only a don’t time-use item. For example, a patient with Tuberculosis needs droplet precautions, requiring an N95. Before going into the room, nurses don gowns, gloves, and mask. They enter the room, do whatever clustered care is needed then doff and throw out the mask after leaving the room. I had one mask for two months, and I wore it for 3 to 4 shifts a week, 12-hour straight. By the end of the two months, it had collected skin cells and oil, and I threw it out because it smelled rancid. Our gowns changed from plastic disposable to heavy reusable aprons to reusable light gowns. Our hallways were covered in reusable gowns as they hung from hooks outside of the rooms.
#2 Argument about the Pandemic
Several patients came into the hospital with shortness of breath no taste or smell. They complain about how sick they feel. The patient was placed on supplemental oxygen when their baseline at home was room air. Even with all the symptoms, several patients continued to tell the staff that the disease and Pandemic didn’t exist. Everything was a hoax. Covid damaged multiple organs, lungs, heart, liver, kidneys, and vascular. Patients who were moments away from intubation continued to argue as they struggle to breathe. We’ve heard it all. It’s the 5G satellites, only wrong or absolute denial of the severity of their diagnosis and prognosis. One particular patient in their late 30s refused to come to grips with their symptoms or the diagnosis. They tried to leave the hospital but could barely walk down to the end of the hallway. The patient refused to keep their oxygen on, which eventually led to a rapid that ended with intubation and expiration within 24 hours. Regardless of anything they experience, the patients did not understand how sick they were, and arguing with these people is a waste of time for the healthcare staff. Still, education is key to the daily care of the patient.
#3 Death and Waves
Each wave of the disease contained a build-up, a peak, decline, that allowed with a lull. Each wave lasted about two to three months from the build-up to lull in my observation. Each recess of the Pandemic left people in false security. Society began to open, mask mandates loosen up or disappeared altogether, allowing the disease to move with more ease from person to person. People who thought they only had a cold continued to go to family functions and friendly picnics. When transferred to someone with comorbidities such as obesity, asthma, emphysema, COPD, and diabetes, their mild symptoms sent their friend or family member to a lengthy hospital stay or death.
First Wave, Spring 2020, the area’s population density is low where I live. The entire state of Nevada has half the population of New York City. The first wave, not as severe, hit the elderly and those over 60. At this point, I have never seen or dealt with high-flow nasal cannulas. This medical device quickly became an everyday staple on our floor. In the second wave, the Summer of 2020, the ages primarily affected and hospitalized those in their 50s and older. Many of the younger patients in that group were either obese, had asthma or diabetes, and didn’t know they had diabetes. Typically due to a health mentality of if it doesn’t hurt, I don’t need to see a doctor, whether due to insurance status or noncompliant with health recommendation. During the first and second waves, the deaths were to the eldest or those with the most comorbidities.
In the third wave, November and December of 2020, there was death everywhere. Every shift, we were running rapid responses and codes. Our Med-Tele unit kept two intubation kits, and it was a regular occurrence to have ICU about to perform bedside intubation. Some bedside intubations led to the patient’s hurried to the ICU or the morgue. The ICU filled with intubated patients, where only a few patients came off intubation and went home. At this time, doctors became prudent to intubation. Whether to intubate or not, these decisions left nurses and patients in a grey area. Not being intubated gave patients a better chance if they could recover. Still, if they needed intubation, the patient was usually more ill than an average intubated patient would be before the Pandemic. I had multiple patients pass away each week. Everyone was on High-Flow Nasal Cannula, and a Non-rebreather completely maxed without Bi-Pap or intubation. Before Covid, these patients were considered ICU patients, now left on our floor, with our matrix of four to five patients with one nurse.
During the 2020 year, the need for nurses increased as hospital beds filled, nurses left the field, or went into traveling with the mentality if they were going to work in these environments might as well make money. Contracts reach 10k a week working four to five days a week, or a 28-day contract, where someone works for 28 days straight to earn something around 60k. Between the building of temporary care sites, crisis nurses, and the overabundance of patients, hospitals across the nation and the world ran out of money as the third wave turned into the lull for the beginning of 2021, hospitals laid-off offices, kitchen, and janitorial staff. The hospitals were left severely understaffed and near broke. Covid numbers decreased, the public naively thought the Pandemic was coming to an end, with the availability of the vaccine in early 2021
As the school year began in 2021 in the late Summer, so did the Fourth Wave. This wave was different from all the others. The patients are now categorized as Vaccinated and Unvaccinated. Those who were over 65 years old and vaccinated came in needing supplemental oxygen, and a one to three-night stay and would discharge home. Then the unvaccinated, decades younger than what we have seen earlier, the patients in their 30s and 40s. These younger patients severely ill filled the rooms, they pleaded with their shortened life, they struggle to breathe, the patient gets to a certain point when you know deep down that’s it’s only a matter of time until their body gives up, either the lungs or the heart, they throw a clot and die.
Believe me or not, this is what I have seen first hand and performing postmortem care on a 43-year-old with children and a husband at home, or making the phone call to the family as the patient is receiving CPR performed on them as the outlook turned futile. A 64-years-old, struggled to take each breath, their heart rate increased to the 160s, as their body compensates, but their oxygen sits at 68% and not recovering. The patient adjusted themselves in bed. The slight adjustment was enough to over-exert the person, and their lungs exhausted, the oxygen decreased. Each death had a face, a family, and a story. I began therapy, my mental health decreased with each additional shift. With the addition of understaffing and no budget, the shift to shift deaths stays with the nurse as they go home. It’s hard to separate work and home when it sits on your shoulders. There was nothing else that could be done, you advocate from your patient, you prone them, but it’s not enough. I know that healthcare workers have seen the worse of it. We don’t see those who have gotten the disease and didn’t need hospitalization except for our co-worker that came down with the illness and stayed home until they could return to work. We are biased because we have seen the worse or worse.