I’m looking at this computer screen, and I don’t even know where to begin. I’ve probably written and re-written parts of this blog over and over again. I’m looking at the corner of my computer screen, and I see five drafts for this one blog post. I don’t think there will ever be a perfect way to write this out, so bear with me. I debated even writing it to begin with because people are probably so tired of hearing the word “Coronavirus.” I thought to myself “who would actually read this or even care at this point?” I’m not much of a writer to begin with, so I don’t even know what direction to take this… However, with Coronavirus cases spiking up again in many parts of the United States, including my own home state, I feel that it is important to share my story of when I worked in the East Coast so maybe people will have a better understanding of how serious this is.
So, here’s my story.
In the middle of April I found myself on a plane looking down at the massive skyscrapers of New York City. The airport was empty when I arrived, and the overall feeling of my new home for the next few months was nothing short of ominous. I crossed the George Washington Bridge to New Jersey just across the Hudson from NYC. Coronavirus cases flooded this area and hospitals were begging for help. Travel nurses, doctors, and respiratory therapists had been flying across the country for weeks to help in any way. As I arrived at my apartment, my travel nurse friend who had been working in New Jersey for a few weeks greeted me outside. I could see the exhaustion in her eyes. At dinner that night, she and the other travel nurse roommate began to prepare me for the chaos I was about to walk into, giving me advice on how to treat the patients and catch the signs of deterioration quickly.
A few days later I found myself walking to the hospital I was assigned to for an abbreviated orientation. Three hours of computer training and then seven hours shadowing a nurse on the floor. That was the only orientation there was. These were desperate times and they needed us travelers on the floor helping as soon as possible. During my orientation shift, I donned my surgical scrubs, face shield, N-95 mask with a surgical mask on top, hair bouffants, and gowns. The nurse I shadowed looked at me with desperate eyes and states “Get ready for codes, rapid responses, and intubations to be a regular part of your shifts. We have even walked into rooms and found dead bodies.” I was shaking on the inside. That shift we called a rapid response on a patient who was declining quickly. My preceptor nurse taught me how to prep for a patient to be intubuated and ventilated. The ICUs are so over-loaded that ventilated patients will often stay on med/surg floors for extended periods of time.
A few days later as I walked to work in the evening for my first shift on my own, I was terrified. I questioned a million times if I could do it. I mentally prepared myself to see a lot of death, to do whatever I could to save people and just keep them alive. The words that nurse told me played back in my head like a horrific broken record “…we have even walked into rooms and found dead bodies…”
As a traveler, I floated to all of the units in the hospital. The first week I was on the Progressive Care Unit, which is a step-down from the ICU. All of the patients were very critical. The entire hospital was filled with Coronavirus patients. I took six patients on a step-down unit. Each room was turned into a double room to cohort two Covid patients each because there was such an extreme need for beds with the hospital being flooded with Coronavirus. I felt like I couldn’t keep my head on straight. We were told to bundle care and limit our exposure, to stay out of the patient’s rooms as much as possible. Most of the patients were so critical that they couldn’t get out of bed and move or their oxygen saturation would drop alarmingly low (when it should be greater than 90%).
Many patients became delirious from lack of oxygenation. Patients would be on high flow nasal cannula maxed out on oxygen with a non-rebreather mask on top and the oxygen saturation would still be dropping and you would see them breathing fast and struggling. Doctors and residents were reluctant to intubate many of the older patients because they knew these patients would never come off the ventilator. Even worse, no visitors or family members were allowed in the hospital in order to prevent the spread of the virus, so patients had to go through this without their loved ones. Many died only with the nurses and doctors by their side.
Families didn’t understand the impact this virus was having on their loved ones. I recall many phone calls with family members asking me questions like “Are they getting better? I’m so worried.” I remember crying with a patient’s daughter over the phone. I had to explain to families over the phone all the time “Well, your loved one is requiring more oxygen and is still having a hard time. We are doing everything we can to take care of them and get them better but there’s no way of knowing what will happen.” I imagined if it were me sitting on the other side of the phone hearing that. I would think “what kind of answer is that? I need to know if my loved one is okay!” But this was all so new… I remember looking at the faces of experienced doctors and seeing the uncertainty and fear in their eyes. Those are the people who we count on to have the answers, but truth be told they were figuring things out day by day, little by little, and to this day not everything is known and there still is no definite treatment plan that will work for everyone.
I treated patients with the hydroxychloriquine, Remdesivir, and antibody plasma infusions. Can I truly say what worked best? No. Everyone reacted differently to treatments. Some patients improved while others did not. Patients were given a plethora of vitamins, melatonin, zinc, steroids, antibiotics since Covid caused pneumonia. Coronavirus is insidious. It caused people to have blood clots in their bodies which could be in the lungs or brain causing strokes or pulmonary emboli. Every Covid patient was on blood thinners, usually through injections or drips.
I remember talking to doctors and residents, looking at their exhausted faces, and seeing the uncertainty in their eyes. This was a disease process the world had never seen before. It seemed like each day we were learning more, but each day brought more uncertainty. Covid was spreading like wildfire, and so many people were dying. I remember there were nights I would see up to five body bags rolling down the hall to the body trucks. I remember nights where I would hear rapid responses and codes called overhead constantly. I never performed more CPR than in those few months. The body trucks were a real thing. One night after one of my patients coded and did not survive, I had to help the transporter take the body down to the body truck. It is an image forever ingrained in my mind of bodies in white body bags stacked on shelves. I wish would have never seen it. You hear about these things, but when you actually see them, it scars you in a different way.
Recalling all of these memories brings me to tears as I type these words. It’s something I’ve left behind me in the last month since I’ve been on vacation, but I’m digging these memories up in a deep place within me because I know this is important for people to read even if it is morbid and a bit horrifying to think about. I remember walking home from work after horrible shifts feeling blank. I would walk inside the apartment, wipe everything down with bleach wipes, take a shower, look at myself in the mirror and see the pure exhaustion on my face. I didn’t even recognize the person on the other side of the mirror. I was completely detached sometimes. I didn’t even know how to talk to anyone about it. I would try and talk to my friends, but I felt like it was just too terrible and traumatizing. I didn’t want to burden the people I love, and I just felt no one would truly understand. My travel nurse friend that I stayed with was my biggest support because I knew she could relate since she was working in it as well. There were times I would cry to her, but most of the time we were too exhausted to bring it up and talk about it.
I felt so guilty that I couldn’t be there more for the patients. It was just so overwhelming and there were so many patients. I felt so horrible that these patients were scared and alone and behind closed doors. I felt bad when I couldn’t tend to their every need. I felt bad that I didn’t have the time or capability to be a better nurse. There were so many patients and so much to deal with that the main focus became life or death matters. We had to keep them alive. But I cared so much about each and every one of them, I felt their fear, and my heart ached for everything they were going through… and to be alone, without family and friends. I cried in the bathroom, I cried on my walks home, I would sometimes wake up on my days off crying. There were parts of me that wished I could turn off my emotions and feel nothing because it would have been so much easier. But I never lost my compassion. I couldn’t imagine not caring for these poor people.
When dealing with these emotions, days off were important. I worked 50+ hours a week on graveyard shift. 13-14 hour shifts were the normal. Keep in mind we wore the N-95 masks with all of the surgical masks on top, gowns, gloves, etc. for that long as well. I didn’t have a car, so I walked to and from work. Days off were spent in the apartment. The occasional trip to the grocery store was the most excitement there was. I was too afraid that I could be infected and infect other people. In New York and New Jersey masks were required to be worn by everyone in public places, and you would be kicked out of a store if you came without a mask. I did end up renting a bike and riding through New York City one day which was a good adventure and helped me get out of my shell for a bit. What an experience to ride through the city with no traffic. I would also go on runs along the Hudson and do home workouts in the living room to blow off some steam. I would listen to my meditative music, and pray to the universe and the higher power that is out there. I would do anything I could to find strength within myself.
I made sure to take care of myself in any way I could. Of course I was scared to get sick. I was across the country, away from my family. Even though I am young and healthy, I didn’t want to risk infecting my roommates either. I took lots of vitamins and made sure to eat healthy and most importantly get enough sleep. I think that really prevented me from getting sick in the long run.
I know this post has been pretty negative and morbid so far, but it has been entirely realistic. People ask me all the time about the age group of patients I saw most. Most people assume the elderly. I actually saw a lot of people in their 40’s and 50’s. I even treated people in their 30’s and a few in their 20’s. Most people would assume Coronavirus is a respiratory illness since so many end up on a ventilator, but it really isn’t. People who are infected with minor Coronavirus really don’t experience too many respiratory symptoms at all. Fever, fatigue, loss of taste, maybe dry cough and shortness of breath are common in minor cases. However, in the major cases, people’s immune systems either go into overdrive or cannot compensate. This leads to a secondary infection like pneumonia which leads to septic shock, multi-organ failure (kidneys, liver, lungs, etc). The way the disease process progresses is different for each patient. Obviously the elderly or people with compromised immune systems are more at risk. But I did see a lot of people with no previous known medical history come in with severe cases and even end up ventilated.
I ended up working in the ICU quite a bit since there was such a shortage of ICU nurses. Essentially, they would send travelers and other med/surg nurses into the ICU to help the ICU nurses. This is where I learned to care for ventilated patients. I remember seeing patients on ventilators for weeks at a time, some even going into surgery to have a tracheostomy tube placed since they would never be able to breathe on their own again. They would get permanent feeding tubes surgically placed as well. Coronavirus causes permanent damage to the lungs in many cases. I was always happy to see when patients were preparing to be extubated (taken off the ventilator to breathe on their own again.) I remember one case in particular where the patient was a male in his 40’s and had been on a ventilator for a few weeks. He was improving, was off sedative medication, and they were going to extubate him the following morning. He was fully aware of what was going on. Although he couldn’t talk with the breathing tube down his throat, he communicated with me by nodding and shaking his head. I could tell he was anxious. Who wouldn’t be in a situation like that? I had the opportunity to stay with him most of the night and keep him calm. I reassured him that he was doing well, he would soon be off the ventilator and breathing on his own, and the road to recovery would begin. My triple-gloved hand held his. I found out that he loved The Beatles, so I sang some of my favorite Beatles songs to him throughout the night. I’ll never forget that night because it was the first time I saw some light in the darkness and hope that people could get better.
I saw a 92 year old intubated and then extubated a few days later. He ended up being discharged a few days after that. I saw people in the hospital for weeks, some who I thought wouldn’t get better suddenly turn the corner and rapidly improve. A lot of patients were discharged home with oxygen tanks, but I saw a lot of people make a full recovery. Each time a patient was discharged, the hospital would play “Here Comes the Sun” by The Beatles overhead. The hospital stays for these patients were a few weeks on average which is much longer than what is typical.
Towards the end of my assignment, things were a lot better. The hospital was starting to switch back to normal. I saw the makeshift ICUs shut down until the hospital was back to one ICU. The post-op floor was completely cleaned and sanitized for a week and opened back up to welcome non-Covid patients. Each patient was tested before admission. It was crazy to see the transition from all Covid back to a semi-normal operation. We finally saw the light at the end of the tunnel. I was ready to come back home to the west coast. I couldn’t remember what life was like. I ended up getting the swab test and the antibody test upon my return, and both were negative.
I think there were definitely a few factors that were important in considering why parts of the East Coast like New York and New Jersey were hit so hard. Firstly, there is a very large population of people out there. New York City is a major travel destination. There are a lot of people living in a very condensed space. Secondly, the East Coast is very ethnically diverse. A lot of cultures are more family oriented, so multi-generational households are common. Lastly, rent is expensive out there, so there may be a lot of people living in one household. I saw a lot of cases where one person in a household got infected at work and would bring it home to the entire house, and so a parent or grandparents got infected and ended up in the hospital. With so many people becoming deathly ill from this, the healthcare system was flooded. This could easily happen anywhere. I know for a fact our healthcare system cannot handle so many people getting seriously ill from this. How could you prepare for such a disaster? No one saw this coming.
I want to take a moment to thank all of the staff at the hospital I worked at for welcoming us travelers and being so remarkable. I just want to bring to everyone’s attention the fact that these nurses, doctors, CNAs, RTs, etc. who work at these hospitals in the East Coast are the true heroes. They worked this crisis from the very beginning before anyone knew what it was, before we knew what kind of PPE to wear, before there was any help from the travelers. I know that more than half of the staff at the hospital I worked at ended up sick, and a few even lost their lives. My hat truly goes off to these wonderful people. They were the hardest working and most compassionate people I every worked with, and we all came together in such dark times. I had a choice to go out there as a traveler and help out, and that makes me fortunate. I am forever humbled and absolutely changed because of this experience. I’ve become a better nurse and person overall, and I hope to never take my health for granted. I am so grateful that my family and friends all remained healthy, and I am very thankful for all of the support from my loved ones. Thank you for the kind and loving phone calls, texts, and care packages sent out with N-95 masks, food, etc.
As dark as a time as it was, I know that I was meant to be there. It was hard to leave my dog and my entire life at home, pack two suitcases, and fly into the middle of a disaster. However, I am a nurse. This is my job. I feel so honored that I was in a position to be able to help in any way I could. A big thank you to my wonderful parents for taking good care of my pup Athena while was gone.
This blog post has been pretty long so far. I do plan to write another blog post on the aftermath of working the crisis and some of the things I’ve experienced since being home. I don’t want to get political or too opinionated. For those of you who are reading this who may have thought this was a hoax or wasn’t real, I hope this gives you some perspective. I try to remain compassionate at all times, even when I receive backlash from people or when people want to argue with me about this. I don’t really even engage in arguments because I can’t waste my energy. Everything I have written in this post is 100% true. It is hard to understand when you haven’t been through it or when you haven’t lost someone close to you. Or perhaps you live in a place where it really hasn’t gotten bad, much like my hometown. How could you quite grasp the severity when you haven’t been there? I know before I arrived in the East Coast, I didn’t quite understand either.
But let me leave you with this: Just because you haven’t seen something or haven’t been through it, does not mean it isn’t real. Coronavirus is here and it is here to stay. A vaccine is on the way and hopefully one day we will have definitive treatment and life can go on. But right now, this is the situation. Protect your neighbor, think of other people, and take this chance to reflect on how you can be part of the solution. Simple things such a washing your hands, wearing your mask in public, avoiding crowds as much as possible, etc. I do believe life must go on. I don’t think shutting everything down and destroying the economy is the answer. I think that each of us doing the above things I mentioned can go a long way.
Although this summer has been a lot different, I hope everyone is taking time to themselves, disconnecting every once in a while, and doing things that you enjoy in a safe manner. The world is crazy right now, but don’t forget that there is still a lot of good. Life continues to go on. Take care of yourself physically and spiritually. We are a part of history right now. And I have seen so many good things in humanity throughout all of this. That is what I focus on.
Thank you for taking the time to read. Stay safe and healthy. Many blessings.
Travel Nurse Courtney 