It's hard for me to fully understand what I've gone through as a critical care nurse during the COVID-19 pandemic. For many health care providers, I think this is a protective mechanism meant to shield us from experiences too difficult to absorb. Every day is a variation on the last, a repeating pattern I can't quite figure out: a loving husband unknowingly gives COVID to his immunocompromised wife, a family is forced to say goodbye to their grandfather over FaceTime, a healthy young person ends up on ECMO for reasons no one can explain.
Memories come unannounced. I see a patient on high-flow oxygen through the door of her room, across from where I'm charting. She looks sad, in disbelief. I can't believe this is happening, I imagine her thinking. I see the dressing I just placed on a new central line, initials and date written in black Sharpie. Bright red blood appears in the tiny lumens as I draw back, then flush with saline. And I can't get the larger-than-life studio portraits of newborn babies out of my head. During the height of the pandemic, our "emergent ICU," colloquially known as COVID Island, found its home in the neonatal ICU. Those photos were often the easiest things to look at.
Though the pandemic feels endless, I can easily recall the fear from those early days. Anyone requiring oxygen was placed in isolation, and patients from nursing homes were assumed positive until proven otherwise. Test results took days to come back, and the process of getting into our personal protective equipment was a two-person job. One nurse would read the protocol while the second geared up. Those minutes felt like an eternity when the stakes were so high. I remember how the thick plastic on a respirator helmet bruised my head during CPR on an elderly man. The sounds of those around me were muffled into a muteness that left me alone, remembering only the basics: don't stop until the next pulse check. We changed into and out of scrubs at work, showered in empty patient rooms, and developed contingency plans for our personal and professional lives.
It's hard to remember my job before all this began. I've been a nurse for three years, so I've known COVID for most of my career. I started in critical care, and I've grown up on my unit. And during this time, our unit has grown up too. We became used to working with less and set new bars for delivering critical care. We are better listeners, teammates, and friends. We learned to lean on each other, especially across the hierarchy of titles that so often divides us. I remember hearing one of our pulmonologists break down during a debrief for a patient who passed away on life support. At some point, we began allowing ourselves the freedom of emotion, and let that emotion drive us closer together. It is these shared experiences that help us maintain our resiliency.
Now the time between these experiences is lengthening. COVID is still present on our unit, but the emergent ICU is long gone. Every time I pass through the corrugated plastic doors to our COVID area, I'm reminded of how temporary a solution this partition was meant to be. Its designation as an island is still accurate. Nurses and other health care providers assigned to this area are rarely seen beyond its doors for the entirety of a 12-hour shift. Often these patients are singled (staffed one patient to one nurse) owing to the severity of their illness. The resources available to our entire unit had to be duplicated on this small, self-sufficient island.
Recently, a patient's wife and their three adult children were approved to come in and say their goodbyes. Although the patient was only in his 50s, his illness progressed faster than I had ever seen. Mechanical ventilation, proning, and continuous dialysis were not helping, and we couldn't find the source of a secondary infection ravaging his body. With the end clearly in sight, we brought his family through those plastic doors, onto the island we'd spent so long protecting. The experience was sobering. I couldn't bear to think how it must have felt being in a place like this for the first time. His daughter wept quietly as I tied the back of her gown, shaped the wire of an N95 to her nose, and pulled her hair through the elastic of a face shield.
I often wonder who I would be without everything this pandemic has taught me, and I know my colleagues think about this too. I take solace in having never felt alone, no matter how physically and emotionally isolating this island has been. I think of those we've lost, and what I'll never forget. I think of who I've become and how proud I am of our work. And then I think that, maybe, the island I've been living on has a tide that's now receding, revealing the numerous sandbars that connect it to the mainland.