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Temporary Tears of Joy Inside the COVID-19 ICU

May 11, 2020

By Tim Sheard

Editor’s Note: This report is based on conversations with Nurse T., who works in a New York hospital ICU that serves an impoverished Black and Hispanic community.

Despite talk of reopening the economy, the coronavirus crisis continues to hit New York City hospital staffers hard.

New York, NY – Nurse T. is driving to work, her co-worker Nurse M. is in the seat beside her. It’s a cloudy, gray day; spring seems late and there’s been a lot of rain.

“Much weeping in the heavens,” Nurse M. says.

As soon as they spy the roof of the hospital, Nurse M. breaks into tears. Nurse T. parks the car and sits silently, waiting for her friend to finish.

“Ready?” she finally says. 

Nurse M. dabs her eyes with a tissue and nods her head. She exits the car and walks toward the hospital as if going to a hanging.

When they enter the ER, they spot Nurse A., a sprightly young nurse from Israel. Nurse A. is rotating through the ICU during her orientation. Everyone likes her and wishes she will work with them.

“How is Mr. W.?” the ER nurse asks. “I admitted him a week ago. Such a lovely man. So big and healthy looking.” Mr. W. is six-foot, two-inches tall and built like a linebacker. He has no chronic health conditions.

Nurse M. tells her the doctors don’t expect him to survive. Nurse A. recalls how the man came to the ER twelve days ago with mild, flu-like symptoms. The physician saw that the man did not have a high fever and was not short of breath, so he sent the patient home, saying, “Come back if you feel worse.”

Four days later, Mr. W. became weak and extremely short of breath. His wife called 911. As the paramedics wheeled him up the ramp to the ER., he waved to his wife and son, who were not allowed into the hospital. 

The ER nurse asks Nurse T. to send her warmest wishes to him.

Arriving in the ICU, the nurses don their three layers of protective clothing — respirator masks, face shields, gloves — and step into the unit. In morning report, Nurse T. learns that Mr. W. has become unresponsive. He exhibits no gag reflex when the suction catheter is pushed down his airway. He was weaned off his sedation…with no effect.

In normal times, the nurses lighten the ventilated patient’s sedation once a day to assess the brain function. Can the patient move all limbs, nod or shake their head to a question, understand where they are? With the frequent shortages of sedation and anesthetics, patients have been waking up without warning. Panic drives them to reach for their breathing tube. Lately, the medication supplies have been adequate.

Dr. B., the resident on call during the night, is reporting to the Critical Care team. He is a British gentleman with a dry wit. Although, there’s been no place for his humor.

“I put in a consult for Palliative Care,” Dr. B. tells the attending physician. “Be here mid-morning.” He reports that the dialysis catheter in the patient’s groin clotted. Again. He replaced it.

Nurse T. asks why the anticoagulants they have been infusing to stop the blood from clotting isn’t working. The resident replies that they still have no idea which of the clotting mechanisms the COVID-19 coronavirus is triggering, so they’re not sure what therapy would be best.

“We’re shooting in the bloody dark,” Dr. B. say bitterly, without apologizing for the pun.

As the physicians begin their rounds, the housekeeper, Mrs. C., asks them to not step on the wet floor she just mopped. The smell of bleach tingles their noses. It is a welcome smell, the bleach is killing the virus on hard surfaces. As she dons a 4th layer of protective clothing, Nurse T. greets her. Mrs. C. silently nods in reply and continues mopping.

Nurse T. goes in to assess her first patient, Mrs. O., a woman in her late 50’s. She works as a ward clerk on the OB-GYN floor. She is stable on high doses of intravenous epinephrine (adrenalin), given to support the blood pressure. The blood gas, though, is horribly low, even with the ventilator sending 100% oxygen to the lungs. The respiratory therapist, a short woman with gray dreadlocks and a lovely face beneath her mask and face shield, increases the positive pressure on the ventilator. Nurse T. prays the pressure will not rupture the lungs.

Finished with Mrs. O., Nurse T. goes to Mr. W.’s room. She checks her intravenous drips, which are outside the room, delivering fluids and medications through long extension tubing. Somebody has stuck a sticker with a smiley face emoji on the bag of the dextrose and sodium.  Someone in Stores, maybe. It brings a faint smile to Nurse T.’s lips.

She prepares to enter Mr. W’s room just as Dr. P., the palliative care doctor, arrives. He is a tall, lean, soft spoken man with thinning hair and the gentlest of manners. Nurse T. has heard he studied to be a priest before choosing medicine. She would be glad to give him her confession.

In Mr. W.’s little room, the palliative care doctor tests Mr. W. for reflexes. The pupils are fixed and dilated, as they are on a corpse. There is no blink response to a sterile gauze pad rubbed across the opened eyes. A jab to the chest with the sharp end of a broken wooden Q-tip elicits no pain response.

Leaving the room, the doctor makes a note in the electronic chart. He recommends asking the family for permission to turn off the ventilator. 

After checking with the Critical Care team, Nurse T. calls the family and asks someone to come to the ICU. This is a change in policy. Up until now, family members were not allowed into the hospital. But too many patients have died without a loved one at their side, so the policy was amended: one family member may visit the dead or dying.

An hour later, Mr. W.’s son arrives. The palliative care physician is paged and arrives promptly. The doctor explains how the patient failed the brain death protocol and is legally dead. The son, a man in his early twenties who resembles his dad, says he understands. Nurse T. knows he is putting on a brave face. 

She leads the son into the room. He is wearing a mask, gown and gloves. He bends down to kiss his dad on the forehead through the mask. Nurse T. and Dr. P. wait silently by the door.

“Can you do one thing for me?” the son asks.

Dr. P steps closer to listen.

“I understand, you’re going to take him off the breathing machine. If…if he does take a breath, I want you to put him back on the machine. Okay?”

“Of course.”

Nurse P. disconnects the ventilator tubing and turns off the machine. She also cancels the alarm. As they stand and watch, they hear a ventilator alarm going off. Nurse T. is puzzled.

Nurse M. sticks her head into the room. “Your other patient is coding. We have another code in room one, can you come?”

Seeing that Dr. P. is staying with the son, Nurse T. hurriedly sheds her outer layer and pulls on a second isolation gown, stored in a trash bag outside the room.

Mrs. O. survives the code, but she, too, is without reflexes.

After Mr. W.’s body, cleaned and wrapped in a body bag, is sent to the temporary morgue out in the parking lot, a special cleaner comes in and sprays the entire room with a powerful disinfectant. Once it has had time to penetrate the virus that covers everything, Nurse T. asks the housekeeper to clean the room.

The housekeeper dons her gown and pushes her rolling bucket into the room. She sees that the mattress is still deformed where Mr. W. had lain unmoving for eight days. At the sight of the empty bed, she breaks into tears and steps out of the room.

“It is too much,” she says. “It is too much, the dying.” Her speech has the soft accent of her native Peru. Mrs. O. came to the U.S. with a degree, a child and a husband. Since her degree was not recognized, she took the housekeeping work and is taking college classes.

The housekeeper looks around the ICU and sees all the nurses are looking into large, black plastic bags. “What is that?” she asks Nurse T., who is standing at the nursing station holding her black bag.

“It’s from the Red Cross. They sent gifts for all of us. We got cologne and powder, hand sanitizer and a whole lot of stuff.”

About to return to the empty room to clean it, Mrs. O. spots her supervisor walking toward her carrying one of the big, black plastic bags. She offers it to Mrs. O.

“For me?” the housekeeper asks

“For you.”

Nurse T. approaches them. “Come on, let’s go see what we got.” She and Mrs. O. walk to the nursing lounge, where Nurse M. is already looking over her bounty.

Mrs. O sits down and opens her bag. She begins to cry once more. “I am so grateful, they thought of me. They brought a gift for me.”

Nurse T. looks over at her colleague, who is not crying. They open their bottles of cologne and spray themselves.

Although the cologne will not kill the virus, it does transform tears of sorrow to temporary tears of joy.

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.

May 11, 2020

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