Covid Through The Eyes Of An ICU Nurse

Subject: Covid Through The Eyes Of An ICU Nurse
From: An Exhausted Covid ICU Nurse
Date: 17 Aug 2021

August 16, 2021

To Whom It May Concern:

One of the most difficult parts of my job is trying to explain to a spouse or parent what it will be like to watch their loved one pass away. I feel the need to try and warn them about what they may see and hear as they hold onto their family members hand during the final moments of life, as dying is not always a peaceful and quiet process. This is especially true when the person who is dying is suffering from pneumonia or any other severe lung ailment. These patients can become severely “air hungry”, as they are unable to satisfy their need for oxygen. Healthcare workers do everything in their power to make dying people comfortable but sometimes it is just not possible and we fail. One will witness many different types of breathing when a person is dying but they all have one thing in common; they are all difficult to watch and to listen to.
The past eighteen months have been incredibly challenging for so many people around the world. For some it has been an era filled with anxiety, fear, and tension. For others, it has been a time of unfathomable loss and pain. An astounding number of people have had to watch and their loved ones die because of COVID-19. Some were fortunate and were able to be at the bedside of their loved one as they passed away but many others were forced to witness their family member’s last breath via an iPad or an iPhone. These deaths were the hardest to be a part of. I would often hold the patient’s hand with one of my own and gently place my other hand on the back of their neck or the lower part of their head after I found a way to prop up the iPad on a pile of pillows and blankets. I have personally witnessed hundreds of people die throughout my career and it is never easy.
Prior to COVID-19, I worked as trauma ICU (intensive care unit) nurse in a very large urban hospital in Tulsa, Oklahoma. During that time I witnessed countless horrors that most people would only ever see on a big screen, death was a very normal part of my job. It was challenging but people were always very appreciative of the work and everyone I worked with felt as though they were making a difference. I was proud to help my community and always felt I was making a positive impact. I have lived in Tulsa for a little over thirty years. I went to elementary school, middle school and high school in the Tulsa area and then went to college in Stillwater, OK. After working as an educator for seven years, I decided to switch careers and received my BSN from OU in Tulsa. I have always wanted to help people in my community and have been fortunate to be able to do so throughout my career as a teacher, and now a nurse.
One of the really challenging things about being a teacher was that I never felt like the general public was “on my side.” I never really felt supported by my community or the local government in Oklahoma. Most Oklahoma politicians will vote against funding education every chance they get and many were not shy in their support of favoring private charter schools. Also, there were a lot of people in the community who would do nothing but talk negatively about our public schools and often used teachers as scapegoats for a lot of the problems that children face. It was very hard to come to work each day when you felt as though no one really supported you or even wanted you to succeed. Thankfully, I never felt this way about my nursing career until this COVID-19 pandemic began.
I have worked almost exclusively in “COVID ICUs” since the beginning of this pandemic. I have always wanted to work with the most critical patients and the people who most needed my help. I always took great pride in the way I cared for patients in the most critical state, on the brink of death. These are patients being kept alive on a ventilator with eight different drugs constantly dripping into their veins via their central line. It was my responsibility to constantly monitor their vital signs and make adjustments to the lifesaving drugs when needed. I was responsible for ensuring that the machines filling in for the patient’s lungs, heart contractions, and kidneys were working properly. I had to be ready to rush in the room at any moment and quickly fix any of these life-sustaining machines. None of this makes me unique or special and I am not trying to imply that it does. There are thousands of highly skilled ICU nurses keeping thousands of patients from taking their last breath every day. A strong ICU nurse can be worth their weight in gold and could not do their job without the help of countless others working in the hospital.
COVID ICUs pose their own set of challenges. At the peak of the pandemic early this year, my hospital had to turn five entire floors of the hospital into COVID units and there were additional COVID patients sprinkled throughout other areas. My home floor was the ICU for COVID patients and consisted of 30 beds that were full constantly. Nearly every person on the floor was intubated, about half of the floor was requiring proning (the process of flipping a patient over onto their stomach in the bed to help with oxygenation) and almost a third of the floor had gone into renal failure and required SLED (a type of dialysis that is done by the bedside nurse over a long period of time). Almost everyone who was intubated was in severe acute respiratory distress syndrome (ARDS) and requiring near maximum support from the ventilator. Pre-pandemic, a patient in severe ARDS, requiring multiple continuously infusing medications to bring up their blood pressure and in need of SLED treatments was rare. The charge nurse would assign their strongest nurses to those patients with the goal of the patient just surviving the twelve-hour shift. These extremely acute patients became the norm during the worst of COVID. I had never seen anything quite like it. It was extremely challenging and emotionally draining. The hospital was chronically understaffed, inundated with extremely sick patients, the staff worried about their own safety, and we would loose two or three patients every single day. It was an extremely trying time but we made it through and things seemed to be getting back to a new normal as the winter came to an end.
Now, we are doing it all over again with the Delta variant. Hospitals all over Tulsa are being overrun with COVID again and this time it feels worse. The patients are much younger and we are filling up at an alarming rate. I’m not sure how much longer the hospitals can sustain this influx, as it feels like we are already hanging onto an orange life preserver. We are experiencing a mass-casualty incident in slow motion. It is absolutely devastating. It is also significantly harder for me to deal with because this time it is mostly preventable.
It is not my intention to scare anyone. I do not want anyone to live in fear of this horrible virus. However, it would be nice if we all adopted a healthy respect for COVID. For those who constantly downplay the virus and go out of their way to show that they do not care about contracting COVID or spreading it to others:

-Please stop calling this pandemic a “plandemic,” as many of our own political leaders have. Spreading misinformation minimizes the severity of this situation and may cause others to not develop a real understanding of the virus. I can assure you that this virus is unquestionably real. I have seen too many people die from it with my own two eyes.
-Please talk to your healthcare provider about getting vaccinated and please do not get your vaccine information from social media, a political candidate or cable news outlets. The vaccines are working. As of today, 90% of hospitalized COVID patients are unvaccinated at my facility. That should be all the proof you need of their efficacy. In addition, if you think you may have contracted COVID, talk to your doctor early, as there are treatments available now that could prevent severe illness and/or hospitalization.
-Please wear a mask while in public and if you are a high-risk individual you consider using an n95 mask. Please stop saying that masks do not work. They do work and if they did not work a lot more frontline healthcare workers would have passed away, as that is all we wear at work. Maybe you could say, “an n95 mask is very effective at preventing the spread but I don’t trust a cloth mask” instead of just saying masks do not work (or worse).
-Please just be careful and avoid unnecessary risks for a little while longer. Trust me, you do not want to have to go to the hospital right now. We should all be avoiding large indoor crowds at this time.
-Please know that your words matter, especially if you are a public figure. If you are a politician or an aspiring politician and you have devoted your voice to being simply anti-mask and anti-lockdown then you are a part of the problem. You can promote mask wearing without being in favor of a mask mandate. You can encourage social-distancing without being in favor of lockdowns. You can support personal freedom while also promoting a healthy respect for this virus.

It truly breaks my heart that such a large percentage of my community is actively spreading misinformation about COVID and working so incredibly hard to do the exact opposite of what the medical community is advising. If you were diagnosed with cancer would you seek treatment advice from Facebook? If you got into a horrible car accident would you not go to the hospital and do what the doctors and nurses told you to do in order to recover? If you caught community-acquired pneumonia and ended up on a ventilator would you want your family members to take advice from a doctor or someone running for the United States Senate? Oklahoma, we are better than this and we can get through this if we all work together. You can still be actively engaged in preserving your personal freedoms without downplaying this virus, spreading misinformation and actively going against the medical advice of educated and experienced scientists and medical professionals. I do not want to see one more person on life support because they thought it would not happen to them or because they did not want to be a “sheep.”
Honestly, I (like many of my colleagues) am questioning my future in healthcare. I just don’t know if I can go through this again. It is too tragic. I have suffered depression and PTSD from what I’ve witnessed over the last 18 months. I don’t know if I can continue to work in a career where a good percentage of the public is actively working against me. Why should I? Why should I continue to risk my own mental and physical health to care for people who do not believe that COVID is real? When I became a nurse I signed up to help those in my community who needed it most. I can understand addiction, I feel for people who make a momentary horrific mistake and severely injure themselves or others. I understand that maintaining a healthy lifestyle for one’s entire existence is difficult and I understand that aging comes with a plethora of medical issues for most. I have always been filled with empathy for those patients. I have cried with them and lost sleep over them. However, I have completely run out of empathy. I have nothing left to give, especially when it all could have been avoided with a free and readily available vaccine. I have nothing left for those who mock people wearing masks and call it a “plandemic.” I am having a hard time caring for people who attend political rallies about personal freedom while openly joking about the threat of COVID.
Please talk with your doctor about getting vaccinated. Yes, you are correct, you could still get COVID. However, if you get vaccinated you will most likely avoid having to hold onto my hand as you gasp for air with your spouse, partner and/or family watching you pass away on an iPad screen.

An Exhausted Covid ICU Nurse