Editor’s Note: This report is based on conversations with Nurse T., who works in a New York hospital intensive care unit serving an impoverished Black and Hispanic community.
It’s midweek in the COVID-19 ICU. But weekdays or weekends — it doesn’t matter. It’s all the same. Every day there are shortages of staff, equipment and medications.
A few traveling nurses have been brought in to supplement the staff. They are excellent, highly professional and experienced. The regular staff is grateful to have them.
When Nurse T. asks the night nurse, a traveling nurse from Wisconsin, about her evening, the newcomer reports she had an empty bed for the last four hours of her shift.
“Four hours? Empty? Aren’t you the lucky one!”
The hospital census has dropped from its peak of over 400 to 74 — but in the ICU, no bed stays empty for long.
After seven to ten days on the ward, several of the Covid-19 patients develop a heart attack or stroke, or sink into septic shock and multi-organ failure. Too many might be making this ICU their final port of call.
As if the ravages that the virus inflicts on the body aren’t bad enough — patients are now suffering the effects of their treatments as well. Some are prescribed by a physician — but others are home remedies.
A number of the Emergency Room doctors are still treating Covid-19 patients with the antibiotic Zithromax and the anti-malaria drug touted by right-wing media, Chloroquine. Mr. G. transferred to the ICU during the night with an abnormal EKG and slow heart rate caused by the latter. He has a temporary pacemaker that is threaded through a catheter in his neck.
Before Nurse T. has time to complete her first patient assessment, Mr. G.’s heart rate drops dangerously low. She alerts the ICU team and pages the Cardiology Service — STAT. The two teams are soon poring over the EKG and puzzling over the slow pulse (bradycardia), which the pacemaker is supposed to prevent.
“Maybe the wire is coiled in the heart,” Nurse T. suggests as she adjusts the intravenous pump.
The senior cardiologist is surprised. “I didn’t think the ICU nurses knew so much about pacemakers,” he says.
“Bed two, three and seven are all cardiac patients,” Nurse T. explains. “We get so many heart patients because of the fricking chloroquinolone — it’s like working in a CCU [Cardiac Care Unit] around here.”
The ICU attending orders a STAT portable chest x-ray. Sure enough, the wire is coiled in the heart chamber, preventing it from establishing a good interface with the muscle. As both teams watch the heart monitor above the bed, the cardiologist pulls the wire back and gently advances it, fishing for a “bite.” Finally, the tip of the catheter establishes a good contact and the heart rate comes up to 72, the rate set on the pacemaker.
As the heart doctors leave the unit, the ICU fellow winks at Nurse T. He knows a good nurse when he finds one.
Minutes later, the ward clerk calls out. “ER on the line — we have an admission!”
With a weary sigh, Nurse T. washes her hands, dries them and picks up the phone to take the report. Even with two months in the Covid-19 trenches, she is still shocked by what she hears.
Mr. L. arrived at the ER unconscious. The EMT told the physician that the man’s roommate reported the patient had been depressed and had swallowed a bottle of household cleaning solution to fight off the virus. The EMT brought the bottle with him so the doctors could assess the damage. The fluid contained bleach, a powerful corrosive.
In the ER, the GI consultant examined the patient’s esophagus with a flexible fiberoptic scope. The lining was red and eroded. The man will not be able to swallow liquids for a very long time. He might even need a long section of his esophagus surgically removed. A perforation of the eroded esophagus could leak bacteria and fungi into the chest — a catastrophic event for any patient, let alone a Covid-19 one.
Hanging up the phone, Nurse T. wants to go out into the street and yell and scream at the right-wing pundits who have pushed dangerous, even lethal home remedies, like swallowing cleaning fluid.
When the patient arrives in the ICU, Nurse T. settles him into the bed while the respiratory therapist adjusts the ventilator. The patient is a 30-year old construction worker. He is stocky and muscular and has strong, calloused hands and a baby face.
The ICU team look at the photos of the damaged esophagus attached to the chart. They are shocked and appalled. Nurse T is relieved that the patient is unconscious, she is sure the pain would have been unbearable were he awake.
“What are you going to order for Mr. L.’s Covid?” she asks. The ICU attending is not sure, no one has found an effective treatment. “I guess, Zithro and Chlorquinolone. And convalescent antibodies.”
“But all our patients in the unit are dying!”
Nurse T. is upset, the ER physician and the medical doctors on the wards are not trying new treatments. She has downloaded Covid treatment protocols from hospitals in Dubai, in Boston, in China. A year ago, she mentored a nursing student who was born in Wuhan. The nurse returned to China at the first news of the coronavirus outbreak. She has kept Nurse T. informed of their failures and successes there.
“What about Interferon?” Nurse T. asks the ICU attending. “What about the HIV cocktail? What about…?”
The attending promises to talk to the Infectious Disease fellow and consider their options. Although Mr. L. is not expected to survive, given his horrific injuries from the cleaning solution — nobody is giving up on him.
During a late lunch, Nurse T. tries to reach a family member by phone. She needs to determine who is the next of kin with the power to make decisions. The family is scattered all over the U.S. Reaching a brother in Los Angeles, she sends him a photograph of the man via text messaging. He confirms it is his brother in the ICU.
“Please, please help him,” the brother says, crying. “He is a good man. He never hurt anyone. Please help him.”
Nurse T. cannot in good conscience give the brother false expectations. At the same time, she does not want to take away all hope.
“The virus causes a very bad infection, you know that, right?” she asks. “We are doing everything we can, the doctors are doing their best. I just want you to know, your brother is in critical condition. He is very sick.”
The brother understands. “Pray for L., won’t you nurse? I know you have many patients, but say a prayer for him.”
Nurse T. promises, even though she no longer believes in miracles. She says goodbye and hangs up.
With all of the drugs and ventilators and pacemakers in the world, Nurse T. knows with infinite sadness that they are no match for the right-wing mouthpieces, including and White House administration, who push dangerous, ineffective treatments — like swallowing cleaning fluid. They never see the consequences of their ignorant home remedies. Only the pathologist in the morgue and the hospital staff see it and have to explain the end results to the family.
Nurse T. thinks those who hawk snake oil cures are a plague on the world. She wants to know why no one has come up with a treatment protocol that silences them — so her patients, at least have a chance to survive.
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.