It was an emotional night at a nurse’s home in Southern California in early April. The nurse, in her 20s, lives with her parents and she made the difficult decision to leave home for their safety as she works closely with COVID-19 patients.
She cried as she packed her bags that night. “Not knowing when I can come back is a little bit rough,” she said.
The nurse, who prefers not to be named, was assigned to care for COVID-19 patients in late March. She could provide them with some care they needed, but she didn’t have the training to work with intubated patients on ventilators.
When she was told recently she would receive that training, “it really put into perspective what the next few weeks might hold,” she said.
Others at her hospital have also decided to quarantine themselves, and being in the same boat helps them support each other.
“I’ve talked to a lot of doctors and nurses who are in the same situation,” she said. “One doctor stays in his room the entire time he is at home. His wife takes food to him and leaves it outside the door.”
She often stays late after work to talk to other nurses about their experiences on the job.
“We let each other vent,” she said. “Sometimes having someone who can truly relate and understand is the best medicine.”
Although she will miss her family, the kinship with other nurses is a blessing, she said. “It brings us closer, because it’s hard to be so isolated from the world right now.”
Calm Before the Storm?
The hospital where she works is eerily quiet.
It has far fewer patients than normal, about 30 percent of capacity. Normally, the occupancy rate is about 90 percent, she said. Almost all elective surgeries have been postponed, and visiting hours have been cancelled.
“Are people just taking better care of themselves, right now? Like, these stroke patients, where did they go? Are people not having strokes anymore? It’s just a little weird,” she said. “Like, what is going on here?”
Recently adjusted predictive models used to track the COVID-19 pandemic are showing the curve may be flattening, and the pandemic may not be as catastrophic as originally thought. California has fared much better than New York and countries such as Italy, where the health care system was overwhelmed by a sudden surge in patients.
“There’s still the reality that could happen,” she said. So, she hopes for the best, but her job is to prepare for worst-case scenarios.
So far, she hasn’t been asked to care for a seriously ill COVID-19 patient in an Intensive Care Unit (ICU) setting, but she has seen what some of her more senior coworkers have experienced.
“When I’ve gone to those floors, I see a lot of the things my co-workers struggle with—just a lot of heart-breaking things,” the nurse said.
Often patients come to the hospital with no need for supplemental oxygen, and within eight hours they end up on ventilators, she said. “They just deteriorate that quick. That’s definitely very scary. And, there’s no standard of what kind of medication to give them.”
But, she is encouraged as international medical research teams race against time to develop new medications, treatments, and vaccines.
One of those treatments is convalescent plasma—the liquid component of blood containing antibodies taken from someone who has recovered from COVID-19.
Since March 28, some critically ill COVID-19 patients at hospitals in New York City and Houston have received experimental plasma treatment, which the U.S. Food and Drug Administration (FDA) has now authorized for emergency use.
“Right now, they’ve kind of gotten a lead on things that have really helped,” said the nurse.
President Donald Trump and the White House Coronavirus Task Force have frequently mentioned hydroxycloroquine in daily press briefings. They say this anti-malaria drug has had some early success in treating symptoms. As in the case of the plasma treatment, the FDA has approved the drug for emergency use only.
She worries about the ethical dilemmas nurses and doctors could face if there aren’t enough beds, or ventilators, to go around if the pandemic continues to spread rapidly.
“Then we’re going to have to make a lot of tough decisions like that,” she said.
She has heard and read about doctors having to choose who lives and who dies, and that terrifies her.
“In places that are hit by COVID-19, ICU doctors are forced to make difficult ethical decisions based on their knowledge of the progression of the disease. They have to choose which patients they’re going to intubate and which ones they’re not,” the nurse said.
Patients with severe symptoms may need to be hooked up to ventilators for more than two weeks, which may eventually cause a shortage of ventilators. Doctors are sometimes forced to choose which patients have the best chance of recovery as opposed to assigning ventilators to all patients, the nurse said.
“We’ve seen a little bit of that already—doctors being hesitant because they think that an older patient that is over the age of 80 might not have the best outcome, even if they are intubated. So, they just don’t want to go through with it,” she said. “It’s really heartbreaking, because you never want to be the nurse who has to have that conversation with a family when you’re advocating for that patient.”
Even in ordinary circumstances, she said, there’s often a dialogue between nurses and doctors about the best treatment, with nurses more emotionally attached to the patients and acting as strong advocates for them.
Because nurses spend more time with patients, they often get to know their patients better as people and become more attached. “We can see a patient more holistically than just a patient on paper,” she said.
“A lot of times nurses kind of fight with doctors about the best treatment moving forward, because I think we can see things in a different light—not that we’re any smarter than the doctors but we both have different types of knowledge.”
Fortunately, for now, it appears California has enough beds and ventilators, she said.
Dealing With Panic
When patients and their families fear the worst, it’s a nurse’s job to calm their fears, but that is not always possible.
“For even the most experienced nurses, there have been situations sometimes our words just fall flat. And, all we can do really is just be present in the room, and be someone who can hold their hand, try to get them on Facetime with their families, call their families to give them updates, and just try to be involved without actually knowing how to address their feelings,” the nurse said.
“I feel I’m trying to meet a need, calming a person down and giving them a sense of hope when you don’t really have the right words to say,” she said. “I can’t imagine what goes on in these patients’ hearts and in their families’ hearts.
“It does push you to go above and beyond to be the best nurse you can be.”
California Gov. Gavin Newsom and the Trump Administration have promised health care workers that more Personal Protective Equipment (PPE) is on the way, including tens of millions of masks which are in short supply nationally.
The nurse said she has been offered and given much of the PPE she needs, but masks are still in short supply for a full-blown outbreak.
“We are asked to re-use masks. We use the same mask essentially the whole day, and only take it off if it’s visibly soiled or if we feel like it needs to changed. But, we’re still trying to ration the masks because of the shortage,” she said.
For now, nurses are wearing simple surgical masks, and the hospital has set up times for nurses who want to volunteer to make face shields, she said.
On the COVID-19 floor, nurses wear different masks than they do in the rest of the hospital.
“The nurses have plastic bags with their names on them, where they store their masks for that area of the hospital,” she said. “If you enter the room then you put on the mask just for that room.”
They are wearing two pairs of gloves, and covering every inch of their face and bodies, she said.
Recently, there has been some debate in the medical community as to how contagious COVID-19 really is. “They don’t think the virus is airborne. They think it is [spread through] droplets,” she said.
Theories about how the disease is spread and directives on PPE requirements constantly change, and it’s unnerving for nurses who want to ensure they’re fully protected on the front lines in the battle to save lives, the nurse said.
“They are kind of going back and forth on what we should wear, right now. That’s one of the most frustrating things.”
People from all over the community have really stepped up to show their gratitude for health care workers, she said. Recently, a bakery donated hundreds of cookies to the hospital staff, and they have received boxes full of homemade masks.
“Those are really amazing things people have been doing.”
What Gives Her Hope
“I have a lot of anxiety moving forward with all of this, and I think for me, personally, [it’s about] … trusting in my faith, and trusting in God that there is light at the end of this, and during it too,” she said. “One of things that gives me hope is how people have come together and really stepped up.
“For me, it’s holding on to my faith. This is all going to end, and we’ll come out stronger.”