Editor’s Note: This report is based on conversations with Nurse T., who works in a New York hospital ICU that serves a a largely impoverished black and Hispanic community.
New York, NY – Nurse T. started her shift on Good Friday with the hope that the day would be different. “This is going to be a better day,” she told herself. She had prayed for relief, not so much for herself, but for her patients. The mortality rate for intubated patients in the ICU stood at 50% – “as deadly as the Bubonic Plague was in the Middle Ages.”
The day prior, a Covid-19 patient on the medical ward became acutely short of breath, with an oxygen saturation in the low 80’s. She had a nonproductive (dry) cough, chills and fever. The physician tried to support her breathing with an external positive-pressure mask (Bipap). It is much like the mask that people suffering from sleep apnea wear during the night. But the Bipap failed to raise the patient’s blood oxygen level. At noon, she was transferred to the ICU for sedation and intubation.
Nurse T.’s heart sank when she took report on the patient. Miss O. is one of the floor nurses, a shy, quiet woman who has given or taken report from Nurse T. countless times over the years. The ICU nurse silently vowed to fight her hardest for one of her own. She knows it could easily have been herself or one of her co-workers admitted to the ICU fighting for breath.
The intubation in the ICU went smoothly. Nurse T. pushed a sedating drug through the IV tubing, immediately giving Miss O. the gift of sleep. The anesthesiologist, a Russian gentleman with a three-day beard and a calm manner, made the procedure look easy. The patient’s oxygen level slowly rose as the ventilator pushed against the resistance of “stiff lungs” – airways inflamed by the invading virus.
Because Miss O. requires only light sedation, Nurse T. is able to talk to her. She encourages her fellow nurse, telling her, “Concentrate on breathing slow and deep, and stay strong, we are here for you, you’re going to make it!” Miss O. nodded her head, trying to believe her nurse’s words.
Nurse T. adjusts the light sedation and steps out of the room. The nurses have loudly and bitterly complained for weeks that they have not received extra-long IV extension tubing. Using the old tubing, they must go into the isolation room whenever they have to adjust the intravenous solution’s rate of flow, replace an IV bag or hang a new medication. Often, they must access the IV line and push a sedative or narcotic directly into the blood stream to rapidly suppress delirium and agitation.
On this Friday morning, Nurse T. is surprised and relieved to discover the extended IV tubing arrived late on Thursday night. The IV pumps are now positioned outside the room, so she is able to adjust them or inject IV meds without entering the room, minimizing her exposure.
That one simple improvement lifted her spirits. She now felt like a Super Nurse. “I will save all my patients! I will defeat the Grim Reaper!” she declared. Even the rate of admissions has dropped, the ER sending only one patient that morning. Miracle of miracles!
The night nurse gives Nurse T. the best news of all: she was able to wean Miss O. off her sedation. The patient’s oxygen level is stable, she is awake and calm and waiting to be extubated. She is the first patient to be purposely extubated that Nurse T. has cared for over the last two weeks.
Nurse T. suits up with her four layers of PPE. She dons her face mask and goggles and lowers the face shield over her head, a generous gift from the UAW (United Auto Workers Union), which had donated 6,000 priceless shields. She opens the door and slips into the room.
When Miss O. sees her nurse, she wiggles her fingers, motioning the nurse to come close. Both her wrist are restrained for her safety, because too many patients are pulling out their breathing tube out of desperation to just breathe. Hesitating at first but looking at Miss O’s bright eyes, Nurse T. leaned closer and told her, “We are getting that tube out today, and I’m going to help you keep it out!”
A few minutes later the ICU Fellow and a Respiratory Therapist entered the room. They removed the tube safely and switched her to a high flow nasal cannula. Miss O’s first words were, “Thank you!” Tears of joy ran down her face. Nurse T. could not hold back her tears, as well.
A truly Good Friday. “Thank you, Jesus,” Nurse T. said to herself as she exited the room. She removed her outer, fourth layer suit and gloves and mask and went to wash her hands. She knew not to touch her eyes to wipe away her tears.
Timothy Sheard, RN (retired), worked in hospitals for over 40 years. He is an author of nine medical mystery novels and founder of Hard Ball Press, a social justice imprint.