BEFORE THE STORM
BEFORE THE STORM…
There was stillness in the air and it was welcome. The halls were empty, the beds unoccupied, the lobby without people waiting for someone to remedy their real or imagined emergencies. The stillness was short-lived though, because an awareness replaced it with a knowing of the chaos to come. And there’s a rule, a myth, a superstition of sorts - you never acknowledge the calm; you never look it in the face and say, “Quiet, I’m glad you’re here.” The force frowns on being recognized; its a blessing granted only for a short time and saying its name hurries it away.
It’s been a long time since the stillness visited us. In its place has come “perpetua sedes”. Perpetual habitation of beds, lobbies, halls; it’s the foremost topic of conference rooms, the bane of EMS crews, a thief of life. Chaos, thy nickname is Covid. “The Virus, The ‘Rona, or That Shit” as named by many has turned our lives around and off into a direction that none of us ever wanted to go. There was a time when the thing we, as ER staff, worried about bringing home to our families was bedbugs, nasty little hitchhikers from an infested place none of us want to think about. I met my first bedbug on a patient brought in by ambulance, on whom the initial thing i noticed was fecal mud - a combo produced by the process of mixing of feces in urine as the patient fell in it repeatedly in an effort to stand. The man was covered in this noxious paste from waist to foot. At the time, I thought this concoction was the worst problem I would have to encounter with this patient; then I started the cleanup process and met The Bedbug. As I removed the stench-laden coat, several fat little black bugs ran for cover, never to be seen again. Fast forward through the quagmire of filth and grime on to the part where the patient is cleaned, treated and stabilized and then to the aftermath of cleanup. Fortunately my friends at the Fire Department helped by bringing me a fire brush truck and enough liquid firepower to blast the buggers into oblivion. “You brought this situation to me, now please help me clean it up!” or something similar is what I said. From there, the decontamination and extermination process ensued. A call to Elderly Protective Services was necessary as well. Note to the wise here…if you have a debilitated friend or loved one, make sure to drop by frequently and unannounced, whether they live in an assisted care facility, nursing home, or in a private residence. An extra pair of watchful eyes can make the difference in care and outcomes. The elderly Bed Bug gentlemen spoken of earlier had a 20-something year old niece at home, “caring for him”. According to EMS, the entire house was infested and covered in filth; they had to kick a path for the stretcher to roll through to load the patient up for transport. I digress, now back to Covid, the next source of dread in the ER.
The Coronavirus swooped in like a least favorite relative for a much-too-long visit whose departure we await still. Covid’s penchant for snatching lives and devastating families escapes some and leaves them oblivious to its presence, doubtful of its malevolence. This was obviously the case of the girl who told me during triage, “I went to New York during the pandemic because the airfares were low; so now I want to be checked for The Virus.” ER nurses see this sort of blatant indifference in some while other people lose one family member after the other, disbelieving all the while. “Please put your mask on” and “Your mask has to cover your nose too” have become mantras for us.
In the effort of decreasing the spread of this insidious illness, most hospitals don’t allow any family members or visitors to Covid patient rooms. Imagine how this comes into play when an elderly couple presents to ER seemingly for headache, nausea and vomiting, then not only is told that the patient has Covid, but that they must leave their loved one alone, having quite possibly seen them for the last time. I witnessed the reality of this as a man was about to be transferred to the Intensive Care Unit; he said, “Well, I’ll see you later.” Then wide-eyed as the solemnity of the moment fell upon him, “I HOPE I’ll see you later.” ICU nurses have had the task of facilitating FaceTime phone calls between a patient and their family members in the last moments before the patient is intubated. All too frequently these were to be the patient’s last waking moments and final words to loved ones.
ER and ICU nurses are grouped into the segment of the workforce known as Frontliners. We work long strenuous hours, extra shifts, and manage tasks we have little training for with a nurse to patient ratio that’s hard to manage at times, partly because of this new Viral enemy. We receive and act on information handed down to us about Personal Protective Equipment and follow mandates about how best to protect ourselves from a potential killer. We’ve been jostled to and fro with schizophrenic directives from the CDC - no mask, wear a mask, mask must be N-95, save the N-95 for direct contact, you can only wear OUR 95, take your mask off in the hall, wear a mask everywhere, wear a face shield, no face shield; the changes are dizzying and frankly scary. We’re spending extended periods of time at contaminated bedsides, then hurrying off to care for those uninfected. The pace is frenzied, unrelenting and rarely good enough for patients, “I’ve been here an hour and no one has brought me a blanket or something to drink.” Think I’m kidding about this? Last week a mother whose child was in ER with a serious illness was distraught, pacing and worrying over the fact that she’d forgotten her phone charger. Of course her phone was in a state of discharge since it had never left her ear since her arrival. “Does someone have an Android charger?” I knew for sure that our crew was solid iPhone and told her such. “Well, you need to go walk around the hospital and find someone with one.” She was appalled when I told her that wasn’t possible and said, “Well, that’s what you do, isn’t it?” Not sure how I replied to her as I walked away. Another woman known to be Covid positive was walking about in our ER lobby, refusing to wear a mask. As Charge Nurse, I explained that to remain in ER and be treated she must wear a mask. She later lamented to the Triage Nurse that she didn’t understand why I was so mean to her. So much gratitude has been expressed by the world outside the ER for the work we caregivers do - food treats, signs expressing appreciation, homemade masks and scrub caps donated to us; the kindness from outside is overwhelming. From within the ER comes impatience, entitlement, and often hostility. A woman threatened to crush my throat for asking if her vaginal itch was the only thing that prompted her to call 911 for an ambulance to take her to ER. As it turns out, her car had been borrowed and a Taxi wasn’t cost effective. The antipathy and disrespect are disheartening at times. Fortunately, gratification from a job worth doing keeps us pulling on our scrubs.
Nurses are always leery of spreading disease and pestilence - whether entomological or biological and do our best to keep the latest bug at bay; bringing infection home to those we love is always one thought away. So today nurses disinfect and protect to the point of raw skin and pressure sores, then practice their own rituals of disrobing privately or semi-privately before running into the house and straight to the steamy hot shower. Our newest dread has replaced the BED BUG; its name is Corona.
Whether the monster staring us in the face is Swine Flu, Ebola, Bird Flu, or Corona, nurses will always do the right thing. The question is whether adequate support, reliable information, and fair compensation will be there for us. Who will step up for us?
“You can’t force someone to respect you, but you can refuse to be disrespected.”