New York, NY – When she walks through the automatic doors at 7 AM into the ICU, Nurse T. steps into a war zone. There are overflowing trash buckets and debris scattered all over the unit. Three red crash carts sit outside three rooms, their drawers open and largely empty, witnesses to the four codes from the preceding night. All but one of them died.
One body is still in a room waiting for a stretcher, but Nurse T. learns there are no stretchers to be had, all of them are in use holding bodies waiting for the trip to the temporary morgue: refrigerated tents erected just outside the hospital.
In a normal month, nurses might see two to three codes in this ICU. Now, at the height of the coronavirus crisis in NYC, they see six or more a day.
One of the night nurses is yelling at a young baby-faced intern to come help — her patient is crashing and about to code. But the intern is afraid to leave his safe island in the doctor’s report room, he knows that the Covid-19 virus is everywhere. Death’s wings have scattered the virus like fine snowflakes over every computer keyboard and phone and countertop and chair. The Attending and the Fellow join the nurse, the intern slowly following them in.
Nurse T. goes into a small room that is cluttered with equipment. She covers her cotton scrubs with paper pants and a paper shirt. Then she pulls on a thick, long-sleeved cloth procedure gown and ties it snugly. She will wear the gown all day, hoping…praying it will keep her safe, and keep her family safe when she returns home. She dons an N95 “TB” mask, the only mask she will have to use for the twelve-hour shift, and follows it with goggles, a paper hat to cover her hair (already tied in a bun), and paper booties.
Outside the room of her first patient, the only survivor of the four night time codes, she puts on a disposable isolation gown. She will have to reuse it all shift.
Nurse T. opens the door to visit her first patient, stepping into a pool of bloody fluid. The patient had pulled out his endotracheal (breathing) tube during the night — there’re not enough sedating and anesthetic drugs to keep him asleep. There is no more Propofol or Versed, so nurses must go in the room every four hours or more and inject a dose of a second- or third-line sedative, hoping to keep the patient asleep. They will have to go back to Valium soon if the shortage persists.
The patient had come to the ER the day before with bilateral basilar pneumonia. Within 12 hours, the pneumonia had consumed all the lobes, whiting out the entire lung, making the patient feel as if he were being held underwater because he was drowning on his own pulmonary secretions and blood. He pulled out the endo tube hoping to take in one full breath of pure air. That’s when he coded.
After hanging new intravenous solutions and manually taking the patient’s temperature — the disposable automatic temperature probe that would normally display his temperature on the heart monitor is out of stock — Nurse T. packs bags of ice around his body to bring down his 104-degree fever. Satisfied, she removes the isolation gown, turns it inside out and stuffs it into a plastic bag outside the room, ready for her to don again with the next visit. By the afternoon when she puts it back on for the umpteenth time, she will feel her own sweat clinging to the gown.
Finally, the last dead body from the night is taken away. A housekeeper in a full hazmat suit comes in to clean the room. Nurse T. can smell the bleach all the way to the nursing station. She wishes the entire unit could be washed continuously in the bleach solution. And she wishes the hospital engineers would put fans in the patient windows to blow the Covid-19 virus out into the wind, instead of letting it waft out into the ICU every time the door is opened. But the hospital has not approved the fans, she does not understand why.
The ER nurse calls and yells at her. Why is it taking so long to send her patient upstairs? Nurse T. doesn’t bother to defend herself, they are all working in the same hellscape; a scene a movie director could hardly imagine for a horror movie.
A half-hour later, a new patient arrives. He is 45-years-old. His skin is mortuary cold, his fingernails are gray instead of a healthy pink, and his blood sugar is 1800. Nobody in the ICU has treated a patient with a blood sugar that high before, not even the attending, and he’s a veteran trauma surgeon. They are learning that the Covid-19 virus wreaks havoc on diabetics. The attending theorizes that either the virus itself or the body’s hyper-immune response makes the organs resistant to insulin.
Nurse T. settles the patient into the bed, adjusts the intravenous infusions, ties his wrists to the bed frame to keep him from pulling out his breathing tube, and finally looks for the first time into the man’s face. It is a handsome face. It is a face that once laughed and loved and winked at his children.
She knows he will laugh no more, the cold ones always code, and they always die. She knows she will have to drag the young intern out of his safe harbor to pronounce the man ‘dead.’ The hours waiting for a stretcher to remove the body will be when she eats her lunch.
This report is based on conversations with Nurse T., who works in an ICU in a New York teaching hospital.
Timothy Sheard, a retired RN, worked in hospitals for over 40 years. He is an author of medical mystery novels and founder of Hard Ball Press, a social justice imprint.