It’s a big process to intubate someone—an anesthesiologist arrives and dons a white tyvek suit with a hood and built-in respirator. The patient is knocked out with intravenous propafol and a respiratory therapist assists in placing the tube down the patient's throat.The patient is then attached to the ventilator.
Paul: What are a few things that have changed at your hospital since the start of the pandemic and what are some of the new challenges you are dealing with while providing care?
Lisa: What has changed is how much time it takes to put on all the PPE (Personal Protective Gear) before entering the room, and more importantly the time it takes to remove the PPE with hopefully enough care you don’t send droplets of the virus flying into your eyes, nose and mouth before leaving the room. The hospital has removed one pane of window glass from each room and installed a plywood board with a hole cut out for a large duct sucking out the air from the room to the outside. This supposedly makes it a “negative pressure room”. Our PPE consists of a plastic gown that is tied in the back, leaving our clothing exposed in back, double gloves, goggles, a hair net, an N95 mask with a surgical mask on top of it. The television pictures of nurses in China and Italy wearing white hazmat suits with full head and face protection is definitely not what we are provided. What we have feels inadequate. Both my nursing unit manager and her second-in-command are now out and on isolation. As of last Monday, three daytime nurses are out pending COVID-19 test results, as well as two nursing assistants. That is just on my nursing unit alone. Dozens more nurses are out from all the other units in the hospital. There also several doctors out sick, one of them is in our ICU, and one who has died. These numbers will have gone up by publication of this. Two nights ago I was “floated” (borrowed from my regular unit) to work in our ER where they have set up an “auxiliary ICU” for COVID patients on ventilators. This area in the ER was sealed off by some flimsy plastic sheets, hardly air-tight. Even so, those of us working inside that area felt as if we’d spent 12 hours in a COVID stew. I told my husband if I get sick, it will likely be from that experience. It was an eerie scene from a disaster movie—every COVID patient was on multiple intravenous drips, including drugs which paralyze them so they don’t fight against the ventilator. They were all deathly silent. There is not much hope for most of the patients who end up on ventilators, unfortunately. At least when they finally pass, they will be oblivious to it.
Paul: What is the most shocking thing about COVID-19 and how it affects people?
Lisa: The shocking thing about COVID-19 is how quickly it can attack the lungs and render someone unable to breathe on their own. In the past two weeks, I’ve seen dozens of people progress from not needing any supplemental oxygen in the morning to needing a nasal cannula with a little supplemental oxygen by the afternoon, a 100 percent non-rebreather the second day, high-flow oxygen the third day, and then intubation for a ventilator the fourth day. As of the time this article is being written only one of those people intubated two weeks ago has come off the ventilator. The doctors have grown more and more hesitant to intubate patients, as once a COVID patient goes onto a ventilator, they don’t seem to come off. The other shocking thing about COVID is how difficult it is to predict who ends up with the worst outcomes. The first two patients to die on the ventilators were 29 and 44 years old. One was a hospital employee who worked in our cafeteria and as far as anyone knew, had no underlying conditions. My very first COVID patient was a 49-year-old with no underlying conditions, just a few pounds over-weight like a lot of us middle-agers. I had monitored his declining oxygen levels overnight and woken him up so many times through the night that by 6 am he called me in to request “an experiment.” “Could you please stop coming in so much and let me sleep for an hour and see how I do? Maybe some solid sleep will fix the problem.” By later that morning he was intubated and has been on a ventilator ever since.
Paul: What changes to your routine outside of work have become a normal part of life since your hospital has become an epicenter of the NJ outbreak?
Lisa: My days off are filled with anxiety and dread, I’m frequently tearful and feel sad that I may not live to enjoy all the plans I’ve made for retirement. Watching endless hours of news coverage makes it worse, learning how many nurses and doctors have already died around the world. I’m superstitious about planning ahead, bargaining with myself that if I don’t make plans, maybe I will survive this. My husband started telling me about plans for our thirtieth wedding anniversary on May 12, but I just shut him down. What if I don’t even make it through April? My new rule is to talk only of plans for the next 24 hours, not plans even a month from now.