Come tell me to my face that "fear is worse than the virus!"
Running out of Outlets
Tuesday
Apr 2020
Posted by kristenfmartins in New Jersey 2020
Wake up. Eat breakfast. Put my mask on and walk to work in the brisk, early morning sunlight of New Jersey. My shift starts at 07:00. As I walk into the hospital, like every day, I am stopped for a forehead temperature scan and asked if I have any flu-like symptoms before proceeding to the ICU. I gather my one N95 mask for the day, a single hair net, shoe covers if available, a plastic gown and a pair of hospital issued scrubs. I reuse my face shield everyday.
I head down two floors to the makeshift ICU. The entrance is blocked off with heavy-duty construction plastic as an attempt to make the OR and PACU ‘negative-pressure’. [COVID can stay airborne for several hours with aerosolization and the negative pressure means particles will flow into the COVID area, not into other surrounding hallways]. This area is filled people, each crammed side-by-side, with just enough room for a ventilator and few IV poles between patients.
Report is quick and straight to the point. Keep them alive. This place is incredibly noisy. A place of excessive audio and visual stimulation. Constant dinging vents, monitors, IV pumps. Lights flashing on the monitors for low oxygen saturations, low blood pressures, dysrhythmias. Lights flashing on vents for high peak pressures, low minute volumes, low tidal volumes. You have to literally yell to the person next to you because of all of the noise, coupled with the muffling that occurs when wearing a respirator and face shield. It is hot. Stressful. And I am rebreathing my own exhaled CO2 for the next 13hrs in these masks. They’re are so tight that I have bruises behind my ears and wear a bandaid on my nose to protect myself from a pressure ulcer.
Supplies in this area are sparse. I run around asking people just to find saline flushes. Alcohol pads. Linen. We are running out of syringes. Running out of IV fluids. Running out of places to plug in all of the electronics that are keeping my patients alive. Needing to prioritize which patient is the Most sick to see first. Stabilize as much as possible and move on to the next. There are between 4-6 critically ill patients per nurse. Each patient with a minimum of three titratable drips and fluids means managing a minimum of 12-18 IV pumps, and that is being conservative. We have anesthesiologists and specialized physicians working as attendings. Nurse anesthetists working as attendings. People doing jobs they have never done before this pandemic. We must work as a team to keep the patients viable and each other sane. Or mostly sane at least.
I auscultate my patients lungs. I hear fluid/mucous. They need to be suctioned. We have run out of in-line ETT suction catheters. The only option is sterile suctioning, which would require unhooking the patient from the vent [aka aerosolizing] and putting COVID airborne. But the patients O2 sats are dropping, their heart rate is increasing, they are visibly in distress. Intervene immediately or likely respiratory arrest followed by cardiac arrest. Benefit outweighs the risk. Exposed.
I do not beat myself up for not being able to give personal care to any of my patients because keeping them alive is more important. I run my ass off all day and literally have no time to even go to the bathroom myself. I happen to have a few helpers with me this particular day which means my patients can get some much overdue cleaning up. They are with the patient right behind me, giving him a quick turn, wash down, and clean sheets. I hear the alarms start ringing. O2 sats in the 80s. I give him 100% oxygen and suction down is ETT and in his mouth. They turn him to his left. Flat line. I check the carotid. Nothing. I lower the side rails and get onto the bed, hands on his chest, while simultaneously yelling if anyone else feels a pulse?! No pulse. I immediately start CPR. “I NEED HELP!” GET THE AED!” I feel his ribs cracking under my palms with each compression. Getting adequate CO2 capnography, meaning compressions are good, at this point. His chest recoil is shit. Doctors are at the bedside. Quickly discussing how long to attempt resuscitation. Epi is given. No pulse. No rhythm. No shock. CPR. Bicarb given. He starts profusely bleeding, spraying bright red blood from his mouth, around the ETT tube, and nose. Code lasts under seven minutes. My first death. This is only 09:20.
This man, who had no past medical history, had become so sick he was requiring daily dialysis. I have said in the past, getting a breathing tube is a death sentence. More accurately, I would say if a patient gets to the point of needing a dialysis catheter, it is just prolonging ‘life’. That being said, there has only been one person who wasn’t taken to the body trailers after their breathing tube was removed. One.
As soon as one body goes out to the trailers, a new person is being admitted from the emergency department or someone is transferred from the floor who needs ICU care. I admitted three more patients by the end of the shift, giving me the opportunity to care for six patients. One of my admits coded as soon as she got to me. Two codes and two deaths in six hours. I needed to dust myself off and get back at it. I had four others people who needed my best. No time to grieve. Crying is for my days off. When I am alone. When I can process and decompress. My husband and my big sister are my people. I can vent, cuss, cry, yell, scream, feel all of the emotions and they will be there to hold me up, even if it is virtually from 1,200 miles away.
19:30 Night shift shows up. Fresh faces as compared to my sweaty, worn out face. I feel as if I have been hit by a train. Again, the report/handoff is quick and talking about only what is essential. Is anyone teetering on life and death? Is anyone actively trying to die? I wish them luck and leave the unit. I doff my PPE that I put on thirteen hours earlier. I wipe down my face shield for use on my next shift. Noticing I have been wearing specks of my patient’s blood all day that I was sprayed with during CPR. I recognize my shoulders and chest ache from performing those chest compressions as my mind replays the whole scenario. The pain I experience when removing my mask is a deep ache radiating on all bony prominences of my face and head. I scrub my hands, my arms, my face with soap and water. I put on a simple mask to return to the ICU to change and gather my belongings before walking home.
It is now 20:45. I am walking down the streets, alone. I hear the alarms in my head. They sound like a chorus of emergency vehicles sirens all going off simultaneously. An occasional car will drive by, but it is otherwise silent. It is dark. I again feel the brisk cool wind on my face. I slide my mask down and take a deep, cleansing breath of fresh air. I look up at the stars. My eyes well with tears for those I lost today. As much as I need the rest and sleep, I know I am needed in that place and am anxious to go back. I am honored to be able to be a part of something historic and to help save lives each day.
My message to those protesting the stay-at-home orders in Minnesota, Tennessee, Washington, Colorado, Florida, Illinois, California, Arizona, Montana, and any other state & to Trump:
Come take a step into my daily hell.
Come tell me to my face that “fear is worse than the virus!”
Come walk into the trailer full of dead, rotting humans, and I will pick out a spot for your body, since it is “your body, your right”.
If “Jesus is your vaccine”, tell me why I am taking the rosary off my patient’s lifeless body?
Anyone protesting should forfeit their rights to receive any medical care. NONE. You are putting the lives of anyone you come into contact with because of your boredom and selfishness. You are putting every single healthcare worker’s life not only at an increased risk, but your disrespect for humankind because of your ignorance and stupidity is beyond appalling. You are a disgrace.
from here:
https://kristenfmartins.wordpress.com/2020/04/21/running-out-of-outlets/
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