Editor’s Note: This report is based on conversations with Nurse T., who works in an ICU in a New York hospital that serves an impoverished Black and Hispanic community.
New York, NY – Nurse T. is shaky. It is nine hours into her twelve-hour shift and she hasn’t had lunch or even a coffee break. Her legs are wobbly. Finally, she gets fifteen minutes in the nurse’s lounge, where Nurse M., a co-worker, is wolfing down pizza donated by a local business. Nurse T. wipes down the chair and the table surface, settles in and grabs a slice thick with roasted vegetables and jerk chicken.
“You know what I miss?” Nurse T. asks.
“A real lunchbreak?” Nurse M. replies.
“That, too, sure, but I miss the families. I miss hearing about my patient from them, when he’s sedated and can’t tell me himself.”
“Mmm, yeah, I miss that, too. There’s no time to even talk on the phone to them, we’re running around like machines.”
“Robots,” Nurse T. says. “We’ve become robots.”
The ICU nurses are used to encountering death, but not so many dying in a day. Not so many unstable, septic patients. And not so many patients attacked by a disease they don’t understand. Even when a patient’s breathing tube is removed, they have no time to sit and answer questions; no time to comfort and reassure. The traditional connection between nurse and patient and nurse and family are severed. It is a central part of the nurse’s role and is critical for the patients and family as well.
Finishing her slice, Nurse T. gets ready to go. “I hope Mr. W., makes it,” she says. “He reminds me of a big teddy bear.”
“A 350-pound teddy bear,” says Nurse M.
Mr. W. has been in the ICU and sedated for 18 days. He has a psych history. Nurse T. suspects he had a developmental disability as a child, but the history is unclear.
On his third day in the ICU, he pulled out his endotracheal (breathing) tube when the sedation wore off, the pharmacy had run out of the drugs needed to keep the patient unconscious. He coded and was revived. Today, his oxygen levels have improved to the point where the Critical Care Attending is hoping to extubate him.
The Attending nods to the Fellow, who gestures to the respiratory therapist. Nurse T. follows them into the isolation room. She has been reducing the patient’s IV sedation gradually over several hours. He is now awake enough to trigger the ventilator. He half-opens his eyes and looks into Nurse T.’s face.
“Mr. W. We’re going to take the tube out of your throat now, okay? Just lie still, it will be all right.”
As Nurse T. loosens the tape that secures the tube, the Anesthesiologist deflates the pilot balloon that helps anchor it in the airway. He pushes the closed-suction catheter down to catch any loose secretions, gently pulls out the tube and drops it in the waste basket.
Nurse T. quickly switches the patient to a mask and turns up the flow of oxygen. She elevates the head of the bed to help Mr. W. expand his chest, then she releases the restraints that had held his arms down.
“Please don’t pull on any of your tubes, okay?” she says, gently placing her hand on his shoulder. “You could hurt yourself if you do.”
Mr. W. looks around the room. Looks at the caregivers putting away their instruments and stepping out of the isolation room. His face betrays his confusion: he does not know where he is or who the people in the masks and strange outfits are.
Just as the doctors leave the room, Mr. W. begins to yell and scream. He kicks his legs out from under the top sheet and shifts them over the edge. He pushes down into the mattress, trying to pivot his great body so he can sit on the edge and get to his feet. As Nurse M. rushes into the room, Nurse T. grabs Mr. W. by the shoulders. She knows he is too big for her to lift him if he collapses onto the floor
“No, no, Mr. W.! You can’t get out of bed yet, you’re not strong enough. Please, sit back!”
A fresh look of fear on his face, he reaches to the oxygen mask and tries to lift it away from his face. “Where am I?”
Nurse T. gently presses his hand down onto the bed. “You were on the breathing machine for 18 days! We had to sedate you, you had a Covid infection!”
“I had the virus?” The situation slowly dawns on him. The confusion in his eyes begins to clear. “Wow. I had the virus…”
“Yes, but you’re strong, you’re getting better. That’s why you have to stay in bed. If you fall down you’ll be in the hospital a whole lot longer, and we’re just nurses, we couldn’t pick you up if you fell. Okay?”
“Okay, yeah, okay.’ He settles back into the bed and closes his eyes. His face is calm, his breathing, regular. Nurse T. looks up at the monitor and sees his oxygen level is 90 – a good sign.
Nurse M. says, “Your brother Raymond called, I told him you were doing much better. He sends his love.”
Mr. W. nods his head and smiles a little piece of happiness. “Okay, now I know where I am.”
As the nurses straighten out the sheets and tuck them in at the foot, Mr. W. asks if he can hear a song. There is no TV or radio in his room. Nurse M. hums a little tune. Mr. W. says, “No not that, something with rhythm. Bob Marley.”
Nurse M. begins to sing “Don’t worry about a thing…” Nurse T. and Mr. W. join in, all swaying to the song.
When her co-worker goes out, Nurse T. asks, “How about a nice back rub?” He smiles. She works the controls on the bed and it begins to massage his back, the bed has a series of motors that rhythmically press against the mattress. The treatment also helps loosen secretions in the lungs. As the massage calms the patient, he relaxes into the bed.
Nurse T. tiptoes out of the room as if leaving a sleepy child at nap time. Removing her outer PPE, she softly sings, “’cause every little thing is gonna be alright.”
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.