Perspectives From an ICU Nurse: Sometimes I am Not Okay

This blog was originally published in December 2020, during the height of the COVID-19 pandemic.

Each time a friend or family member asks how I am, I tend to tell them I am okay, hanging in there, doing my best. While these are all true, I don’t often tell them that some days I am simply not okay. How about you? Can you relate? People want to truly hear how it is going for me as I work in the Intensive Care Unit caring for really sick Covid patients. I don’t believe people can completely understand unless you are there yourself.

No one is allowed in the ICU unless they absolutely have to be there, including the patients. No family members, no physical therapists, no pharmacists; only the bare minimum of staff. It’s like a ghost town. Dutifully committed nursing, medical and respiratory professionals are there 24/7 in their personal protective equipment (PPE) caring for the patients.

I enter the hospital through the one and only open entrance, have my temperature checked, change into scrubs and meet the night shift team to hear about the patients. After dividing them between our team, I look up lab work, chest x-rays and other medical information then head to the prep room to “don” my protective gear; shoe covers, head covering, PAPR and then I go into the unit. A PAPR is like a space helmet hoodie with a hole in the back for a hose that connects to battery powered device I strap around my waist. When turned on, the PAPR blows filtered air through the helmet. Then before I go in the patient’s room, I put on clean gloves, then a protective gown, and then a second set of gloves.

«The tough calls are notifying the family that their loved one is not doing well or may not survive. I wish we could do more.»

Most Covid patients are sedated with medications and supported by a ventilator for acute respiratory distress syndrome (ARDS). I check in with the nurse to see if they need anything for the patient, review medications, treatment plans and make sure we are providing nutrition through a feeding tube. When I am ready to step out, I must “doff” (take off) my equipment in reverse, careful not to touch anything that is clean with a dirty part of my equipment.

Then I chart notes, discuss plans on rounds and admit new patients or transfer patients out if they no longer require ICU care. We call the families in the afternoon to give them daily updates. Families are rightfully very concerned, wanting to know about any new progress that has been made or attempts at weaning off the machines. The tough calls are notifying the family that their loved one is not doing well or may not survive. I wish we could do more.

«Unfortunately, in a matter of minutes, a patient can go from being awake and talking to becoming critically ill requiring the ventilator and multiple blood pressure medications to keep them alive.»

The patients’ age range is 30s to 80s. Many in their 50s and 60s. And many have not survived. I think about the conversations I’ve had with my patients before they had the breathing tube placed and go on the ventilator. It’s difficult when I know something special about a person and then I hear a few days later that they didn’t survive. Unfortunately, in a matter of minutes, a patient can go from being awake and talking to becoming critically ill requiring the ventilator and multiple blood pressure medications to keep them alive.

After giving sign out to the night shift, every staff member takes a shower before going home, leaving our scrubs and our day behind. But I am willing to bet the days’ events are with us on the ride home and possibly even after we get home.

I’m grateful for the people in my life that check in on me to see if I am okay and send prayers. I’m grateful for the multiple donations of food and snacks that come to the hospital. I am grateful for the gallons of hand sanitizer, bleach wipes and the PPE that we have received, there are a lot of us in small spaces and we need to keep safe for those around us. I’m grateful for the tremendously talented and committed coworkers that have each other’s backs day in and day out as we truly work together as a team. I know we will get through because we are resilient. And I am grateful I have learned to ask for support from some very special people in my life.

How about you? How are you doing and is there anything I can post here to support you? Please email me with your thoughts and suggestions. And remember to stay home, take care and be kind to yourself.

“When we learn how to become resilient, we learn how to embrace the beautifully broad spectrum of the human experience.” – Jaeda Dewalt