Devon E. Jones, RN BSN
I was working on 10CD, a medical-surgical unit at Overlook Medical Center in Summit, New Jersey when the first wave of the COVID-19 Pandemic hit in 2020. We were one of the hardest-hit hospitals in the state – being on a major hub of the train line going into New York City. We didn’t know how this virus spread or what it was capable of. The whole world was terrified. We were terrified we would get sick, that we would bring it home to our families. We wore hospital-issued scrubs that never left the hospital. I would change the clothes I wore to and from the hospital before I came in the house then go naked to the shower.
The unit I worked on specialized in respiratory and infectious diseases, and we were vent certified. We were the best trained for this disease outside of the ICU – some of us even volunteered to take a crash ICU class to go down to the ICU to help out. All three of our ICU units were double stacked with patients. 10CD became a step-down unit.
What we experienced
My coworkers and I saw terrible things. We cried on our way to work, we’d stare into space in the break room, then we’d cry on our way home, and in the shower. I woke up one morning and could not stop crying. It was the morning after I found out that a man I worked with had died, 2 of my eight patients on my last shift had been vented, one had died, and our hospital would no longer be performing CPR on COVID patients – because it wasn’t working. I had begged my patient who had died to stay in bed. He kept wanting to get up to go to the bathroom. I remember his face, he didn’t believe me that I would rather clean him than have him walk to the bathroom and lose his breath.
Our Patient’s Isolation
Our patients were isolated in loud scrubber rooms. They couldn’t breathe. They couldn’t see their loved ones. It was too loud to talk on the phone and many didn’t have the strength to talk anyway. We could see the fear in their eyes as they suffocated, felt there was nothing we could do but be present, and begged them to rest, not to move. If they lost their breath some couldn’t catch it again and we would have to vent them. We would find out on our next shift that they had died.
Most of my patients were discharged. Many were intubated. I lost young people, the youngest being 31 yrs. I had a young woman be intubated and then come back to us from the ICU completely decompensated physically. When she woke up she learned she had lost family to COVID. These people were the hardest to care for because of their depression. They had come to the hospital in the prime of their lives and were now practically quadriplegics. They had been intubated for weeks under medically induced comas, unable to breathe for themselves. I explained to one family that it was like going into space, if people don’t use their muscles they atrophy. When they woke up we did not have the resources to help them (physical therapy, psychiatry, social work).
We limited our exposure and saved PPE with cluster care – entering each room in teams for longer periods at much less frequent intervals. The aim was 2 entries into each room a shift. Except for emergencies, this was all our patients saw us.
Reflections on the first wave
We would later learn that the longer we held out intubating patients, the better outcomes they would have. This would have been negligent practice before this first wave hit. In the before times, if a patient required 100% on a non-rebreather they would require BiPAP and would be sent to the ICU. Now we were putting patients on 100% non-rebreather, 15L nasal cannulas or high flow if available, and proning them before the BiPAP. Once on BiPAP, we would hold them as long as possible before sending them to the ICU for intubation. We also learned that we were over hydrating them with IV fluids – another intervention that would have been negligent if we had withheld before this. It was incredible and horrifying.
My part- Choosing to stay
I didn’t know I was pregnant when the first wave hit, but found out shortly after. My husband and I discussed leaving the unit, but I couldn’t. We decided I would stay because it was the right thing to do. Many nurses didn’t – many left because they were afraid. The rest of us showed up for work. We didn’t call out. We picked up extra shifts to cover nurses that were sick or had left.
Our patient load eased up in the summer. I transferred units. I had already been looking for a new position before the first wave of the pandemic hit but waited until the census lowered before I acted on it.
My son was born healthy that December.
Reflections: I wrote this in January 2021 knowing the first wave wasn’t the only wave but not knowing how politicized COVID would become. I truly thought it was ‘over.’