A coronavirus ICU nurse on ‘dying alone behind sliding glass doors’
The Daily Beast
April 16, 2020
A nurse at a leading New York hospital’s ICU tells Tim Teeman about the challenge, fear, trauma, and total commitment he feels while treating critically ill coronavirus patients.
The first thing the nurse noticed upon arriving at the ICU unit within the major New York City hospital was how “crowded” the room felt.
“It has 12 beds. Every bed is used. Every bed is used by COVID-19 patients. Every bed is kind of maxed out, with ventilators and tubing. I am super used to patients who are intubated and sedated. I am super used to critically ill patients, with maybe a GI [gastrointestinal] bleed, cancer, or who have suffered a heart attack. But for everyone in the unit to have the same diagnosis is shocking.”
The nurse—who requested anonymity, and to not name the institution, to speak freely—was talking to The Daily Beast as New York City’s Health Department placed the number of “confirmed” deaths at 6,840 and “probable” COVID-related fatalities at 4,059—10,899 in total. At the time of writing, 868 patients are being treated in New York City hospitals’ intensive care units.
In the ICU where the nurse is working one patient is in their 80s. The others are in their 50s and 60s.
“Every one of the COVID patients is suffering from respiratory failure,” the nurse told The Daily Beast. “That’s the bottom line. Everyone looks the same. They are not awake. They are on paralytics [muscle relaxants] and two or three pain medications. They are on ‘pressors’ to raise low blood pressure and medications to help their kidneys. Many are going into renal failure, so they are getting peritoneal dialysis. It’s full on. It doesn’t stop.”
The nurse’s voice choked with emotion.
“It’s like a recurring nightmare. I lived through the AIDS epidemic. At first I was angry at the huge response to COVID-19 because when HIV and AIDS first emerged President Reagan and the U.S. government did nothing. Now the response has been enormous, and appropriately so. I find myself thinking, ‘Where was this in the 1980s?’ Back then, we in ACT UP fought to draw attention to HIV and AIDS. I looked after young hospice patients, beautiful young people dying so graphically and horribly. There was so much alienation.
“COVID has taken me back to that bleak time. I look at the patients in the ICU and think, ‘How does this happen?’ I know the body is an incredible, functioning machine. Yet somehow it can be taken down so easily by this little microscopic engine that knows how to beat up our bodies. It survives and we die.”
The medical staff do all they can for the patients, but the danger of possible transmission of the virus prevents the nurse from doing something he considers key to his profession—touching the patient, being with them, a prohibition made even more terrible by family members also not able to be present.
“It’s so horrible to me,” the nurse said. “You are basically surrounded by people, but they are dying alone behind sliding glass doors. The staff are frightened, terrified to go in, so you have as little contact as possible. They are so critically ill that many of them cannot be moved, or be turned from side to side, because their bodies can’t tolerate the movement.”
The nurse’s voice broke again. “That loss of human contact is awful. You want to be with someone when they’re dying. That’s a very emotional and powerful experience to have with someone. I’ve been with a lot of people dying. To guide them through that, to hold their hand, that is what’s missing here, and that’s very difficult for me. Or not having family and loved ones there. And the medical staff—the nurses, respiratory therapists, the doctors—who have made a connection with the patient can’t be there. We are behind glass to protect ourselves and society.”
The nurse paused, and sighed. “As they say in hospice care, ‘There’s a good death,’ and to me, that’s not happening with COVID-19. It’s really excruciating not to be able to provide it. It leaves a horrible void deep within your soul. It’s painful.”
“It’s hot. That mask stinks after a couple of hours. There is a lot of fear”
In his 25-year career, the nurse has worked in San Francisco, Sydney, and other hospitals in New York City, employed variously in other ICUs, a bone marrow unit, and an oncology and chemotherapy out-patients unit. He also did AIDS-related voluntary work in Africa. For the last eight years, before the COVID-19 crisis, the nurse has provided home-based care to veterans who served in World War II, Korea, and Vietnam.
Four weeks ago, three of the nurse’s 10 colleagues tested positive for COVID-19. There then followed a two-week self-quarantine, during which “the crisis ramped up,” as the nurse put it. “I saw my veteran clients virtually, which was good, important work. I love to hear their voices. But I felt I was not where I should be. I kept hearing how much the hospitals needed people, that health care staff were coming to New York from all over the country. I thought, ‘I’m right here. I should be on the frontline and go back to the ICU. I have to do this. I have to be there.’”
“President Trump has got blood on his hands,” the nurse said quietly. “The way the federal government has handled this is horrendous. It’s just unconscionable.” While at the nurse’s ICU there was no lack of personal protective equipment and other necessities, the authorities were “completely unprepared” for the medical emergency that has enveloped the world, said the nurse. “But we, the medical staff, are here. We are doing all we can.”
The nurse has been working in the ICU since his quarantine ended two weeks ago. Every shift is 12 and a half hours long. “I have two masks on, a face shield, a head covering, my scrubs, two pairs of gloves, and a gown. Breathing is a challenge. It’s hot. That mask stinks after a couple of hours. There is a lot of fear. All the nurses, doctors, and respiratory therapists are gowned to the same degree. On my first day, I was next to another nurse for two hours and didn’t realize I knew him. I couldn’t tell who he was.”
A typical shift begins with getting “completely gowned up. Think about that. Trying to go to the bathroom is a big deal. Taking a sip of water is nearly impossible, because you need to take everything off and put it on again. You try not to drink too much water and coffee, so you don’t have to go to the bathroom. You try not to touch your face.”
The nurse then reads the patients’ reports from the preceding shift, to check medications and the proper doses of “maintenance fluids,” and pain and body stress-alleviating drugs like fentanyl, propofol, ketamine, Librofed, dopamine, and Dobutamine.
Most of the patients are also connected to a machine that removes the carbon dioxide from their blood, replacing it with oxygen. “It is shocking to see a machine lying on their bed, taking their blood out,” said the nurse. The patients also have a feeding tube or nasal gastric tube to help feed them, and an insulin drip. The nurse draws blood to measure their arterial blood gases. If a patient is uncomfortable or wakes, the nurse will administer drugs like Ativan to calm them, “so that they are able to tolerate the machinery breathing for them, because without that they will not live.”
Typically, such things are done at the patient’s bedside. But in the solely-COVID ICU, said the nurse, each patient has long extension tubing snaking from their beds 10 to 12 feet to an area away from them, where their individual IV prompts are controlled from. “One of the most shocking sights is to see patients flipped on their fronts,” said the nurse. “It looks terrible, but it actually gives their lungs more capacity to breathe.”
The nurse thinks more people die on the hospital’s wards, or at home, than in the ICU. Although only one COVID patient at the ICU the nurse works in has left the hospital alive, the ICU population is mainly made up of the same people who were there when he arrived—all being kept alive on ventilators. Respiratory therapists, “who you don’t hear much about,” said the nurse, “are literally in the frontline, giving breathing treatments to patients, and probably at the greatest risk of exposure.”
“I do not know how loved ones can process this away from the bedside”
The most frustrating, professionally discombobulating limitation is around touch. “We are asked to keep apart from the patients and try to limit contact as much as possible,” the nurse said. “If I have to go into their room, I can only have a quick talk. I tell them that I am there, and that I hope they are comfortable. If they are not comfortable I give them more sedation and anxiety medications, and ketamine, which always blows my mind”—he laughed softly—“because a long time ago as a party drug I had the best experiences of my life using it. Now that it’s a drug for patients is a mind-fuck for me!”
“I’m a very hands-on, nurturing, caring nurse,” the nurse continued. “The whole thing for me is being present for someone. In Swaziland, I didn’t speak the language. I was a middle-aged white guy. But I was able to connect with the patients by being present, by holding their hands, looking in their eyes, and comforting them, parents or children.”
The nurse’s father died at the end of November. “If I couldn’t have been there…” the nurse began, then choked up again. “It would have been unbearable. The pain is being magnified for both COVID patients and their loved ones, by those loved ones not being able to be there. One veteran I know is 97. His wife is 93. She got COVID and is dying in hospital. He’ll never see her again. That’s it. After 68 years of marriage.”
Typically, the nurse said, when taking care of a patient, “the ritual of bathing them is very important. Before this, I always made sure my patients were well-shaved and super clean, and that the bed was perfect and the room was perfectly organized and spotless, so when the family visited they could get a visual of ‘Someone is in control here.’ That’s my priority at someone’s bedside. With COVID, that’s an intricate and integral part of nursing that is missing. COVID patients are missing that human touch—their backs being rubbed when I am bathing them. That kind of stuff.”
Before COVID-19, the nurse said, before a family visit if the patient was intubated and sedated, he could at least make them “look nice” for their loved ones. “And as nurses, we talk to those loved ones about ‘How did you both meet?’ ‘Did you have kids?’ ‘How many?’ Or to the kids, ‘Who do they take after?’ You learn about the patient and the family. It can be a difficult and upsetting situation, but it can be cathartic and the family can process it. With this, I do not know how loved ones can process this away from the bedside.”
The nurse had just spoken to his sister, wondering aloud about how “excruciating it would have been and horrible for all of us” if their father had died in similar circumstances. He held court in his hospital bed for the last four weeks of his life, with his children, grandchildren, great-grandchildren, and great-great-grandchildren.
The COVID-19 situation could not be more different. But the nurse says, “I have to be there. I have to bear witness to this time, for the patients and for myself.”
However, the nurse added, “I hate to admit it, but I am worried about becoming infected.” He has already endured “a huge amount of loss” in his life—both parents, two siblings, and friends and loved ones to HIV and AIDS. Medical professionals have reassured him “you’ll be fine” given his own good health, “but it’s always at the back of my mind that I might not be. I think, ‘Have I made the worst decision of my life?’ I would be gone. How would it affect my family and loved ones? It is stressful, to say the least. But if I got sick, I would want the person that provides the type of care I provide to do that for me. I need to be here to do that for the patients, so it is a risk worth taking.”
“This is a fucking nightmare, crazy shit is happening, but the world is going on”
The pandemic’s social and cultural implications seem clear to the nurse. “COVID has reinforced how our social and economic place in life has a huge influence on our life expectancy. Black and brown people are dying more than white people. We can talk about various health factors, but above all of that this disease has shown, again, what inequality of opportunity there is in this country.”
One of the nurse’s colleagues, in his early 60s, died on Sunday. “I guess the very elderly who have it don’t even make it to the hospital. Four of my home-care patients have also died. It’s just horrific.”
One at-home patient of the nurse’s, aged around 85, “coded,” as the nurse put it (went into cardiac arrest). The patient’s home health aide called 911. “The emergency responders got there and said there was nothing they could do. He died then and there. The EMTs couldn’t take him. Then the medical examiner called and asked the poor home health care aide if the patient had air conditioning in his apartment. She told them that he did. They told her, ‘Turn it to the lowest setting and close the door. We won’t be there for two days.”
The nurse choked up again. He is proud to work with veterans and in awe when they tell him stories like lying about their age—at 16 or 17, claiming to be older—to join the military in the first place. One African American client recalled only being given a weapon to use in World War II after Pearl Harbor, “when his military bosses were like, ‘Now we really need you.’”
On Mondays and Fridays, he still checks in virtually with his home-care patients, both parties delighted to hear each other’s voices. Just going outside for a quick break during a shift is important. “I’m able to take off my mask and breathe for a minute. I know this will sound corny, but just looking at the blossoms on a tree reminds me life does go on. This is a fucking nightmare, crazy shit is happening, but the world is going on.”
Working on the ICU ward is “emotionally all-encompassing,” the nurse said. “I wake up at 4 in the morning in a cold sweat thinking, ‘Am I going to get infected, or worse bring it home to my partner? I don’t want to do that, but he doesn’t want us to be separated either.”
The couple, who have been together for 14 years, are fortunate to have an apartment in the city, where the nurse stays while working his shifts, and a home upstate where his partner lives and where he goes on days off. They have space to walk and relax.
“But when we are together, we are not sleeping in the same bed anymore, or touching each other. He sleeps in one bedroom, I sleep in another. We socially distance properly. I’m missing that intimacy. It’s pretty shocking not to have that nurturing, tactile situation that’s such a big part of a relationship. That’s a huge loss. But I don’t want to run the risk of infecting him.”
The experience has “reinforced what we had all along,” said the nurse. “We have a lot of respect for each other and we are there for each other. It has made me realize how grateful I am, and we are, to have each other. He said to me, ‘You take care of me always,’ and I said, ‘Well, now you’re taking care of me.’”
This love and care is so important as the nurse ventures day in, day out into his raw professional world. Approaching the hospital, he is struck by New York’s surreally empty, silent streets. “Then I go into the hospital and everyone is wearing masks, the whole place: people cleaning, transporting patients, everyone. Visually, I can’t get my head around it.” A car rental company wouldn’t rent a vehicle to the nurse upon learning he was exposed to COVID patients all day. “I was flabbergasted.”
The nurse said he was also suffering from “compound grief,” which happens, he said, “when you have experienced a lot of grief in your life, and then something happens—in this case COVID-19—which brings up the memory of those other losses. It makes my head numb, my face tingle, and my hands shake.” But, he said, he has a supportive partner and family. “I’m in good hands.”
The camaraderie of the hospital staff has also been vitally sustaining, said the nurse. Gifts of donated food have been gratefully received, although the nurse says more than once he does not feel like a “hero.”
Why was it so important for the nurse to be on the frontline, treating the COVID-19 patients in the ICU, this reporter asked.
“I guess being a nurse is a vocation. I am a caregiver, that gives me purpose, and it’s super-rewarding,” the nurse said. “I hope that even under these difficult circumstances I am being present for those families that cannot be there for their loved ones. I am doing my best to somehow provide the best possible care given the extreme limitations we’re under.”
The nurse paused. “I hope that if someday I meet someone from a family who has lost a loved one to COVID, that I would be able to say that their loved one really wasn’t alone, that we were there, that I’m sorry that they could not be there, but that somebody was there.”