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Our 23 bed ICU has been converted to Covid-19 patients.
All of them.
I want to tell myself this is science fiction, but it’s not. It’s real. And we are scared.
As I enter the unit to start my night shift, we have a huddle of the off-going and oncoming nurses.
We are committed to fight this invisible monster.
After a brief update of all of our patients, we bow our heads and say a prayer. A prayer to protect all healthcare and essential workers across our nation. And our Universe. A prayer for safety and strength. A prayer for the patients stricken with this potentially lethal virus. A prayer for the families that are not allowed in to see their loved ones. Not allowed in to say hello, or to say I love you or to say their goodbyes.
ICU has always been my favorite job. The dynamic and strong work here. Fearless and endless, we never stop.
But this is different.
We receive our assignments. If we are lucky, we only receive 2 patients. Both on ventilators. We have a clean nurse to assist with adding our PPE’s. We also pray that we have the right protective equipment. N-95 masks, isolation gown, gloves, foot covers, and face shield. I am the “dirty nurse”.
I have to be prepared to have everything ready to go into that patient’s room.
IV antibiotics, IV drips like vasopressin and Levophed for those dangerously low blood pressures. Lab vials for the continuous need of lab work taken from the patients arterial line. Tube feedings for their nutrition. Morphine IV drips for their pain and discomfort, propofol for sedation.
Beyond all of the technical and mandatory medical needs of this patient, I have to remember there is a person on that ventilator. A person who is all alone. There is no family member with them. It’s me and the patient. And that steady beep of the EKG monitor and the pumping of the ventilator. The noises that provide no comfort.
This virus does not discriminate.
I have 30 year old male who was perfectly healthy and I have 64 year old lady. This virus is an equal opportunity employer.
In my 30 plus years as an ICU nurse, never have I seen this incredible death threat.
I check the ventilator along with the respiratory therapists at my side. Check the settings, suction the patient. Though the patient is in a semi-chemical daze from the pain meds and sedation medications, I squeeze this young man’s hand, I let him know we are here for him. That we are going to do everything possible to make him strong again. To let him walk out of this place and see his wife again and hug his little kids again. And pet his dog again. I tell him to hang in there. That we are doing everything possible to fight this monster.
His breathing is shallow. His lungs have taken a beaten. But I can see his pulse and I can feel his pulse.
I hold his hand. And tell him to be strong. I say a pray for him. For us.
I want to shatter inside myself but I know I can’t . We must stay strong.
He turns his head towards me.
And squeezes my hand back.
Hope.
This is dedicated to all of the nurses, physicians, respiratory therapists who dedicate their lives every day in the face of danger. Thank you for all that you do.
Do Not Resuscitate 
As an experienced geezer (6 years since age 65), I’m sidelined (from direct patient contact) at the academic institution where I’m on faculty.
I also had a private practice in endocrinology for some 37 years, and while I resigned from the local hospital staff several years before retirement, my friends there tell me about the incredible pressure from administration for independent docs to “volunteer” their services, with inadequate PPEs and no insurance riders to cover provision of “out of specialty” services.
I’ve come up with a sample “Policies and Procedures” manual which could very well find applicability in the local hospital system:
New COVID-19 Policies & Procedures
1. Ultrasound the wallet before triage! All patients without insurance are to be enrolled in the outpatient PTBT (President Trump Bleach Trial) program.
2. Physicians not employed by (Hospital) must do mouth-to-mouth ventilatory support on any patient in respiratory distress. This saves money on ambu bags, which sometimes need to be cleaned between patients.
3. Conversion of all ventilators to coin-operated pay-per-breath (COPPB) will be complete by next Tuesday
4. Re-use gloves, especially after rectal exams, by turning them inside-out and re-applying
5. If you find a discarded mask on the floor, do your part! Re-use! If overtly dirty, maybe spray with some lysol (if available) first.
If lysol is not available, hold the mask in full sunlight 15 seconds for the UV; we believe that should make it safe enough, for you.
6 . The 15 minute super-crash course in BLS/ACLS for the janitorial staff is in place; they will step in when there are no longer any other trained medical personnel.
7. A plumber has been designated to intubate patients when necessary if no other trained staff is available.
8. Due to the shortage of N95 masks, they will be allocated according to the following priorities:
Senior administrators in the same zip code as a hospital
Senior administrators working from home
Mid-level administrators
Junior administrators
Billing personnel
Any masks left over will be tossed in a heap in the ER for clinical personnel to fight over
9. Physicians and other personnel who acquire COVID-19 infection as a result of their services to GHA will automatically be enrolled in the CVIRS (CoronaVirus Increased Revenue Stream) program.
10. Remember, volunteer physician participation (without pay or out-of-specialty malpractice insurance coverage) will allow us to re-allocate funds to end-of-year executive bonuses, funds that would otherwise be squandered on paying our employees overtime. Post-pandemic, appropriate sanctions will be applied to physicians who do not “volunteer.”
Remember: Our administrators care!* – just not about you.
*CPT code: G0181 – Care, NOS
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Behind your humor is the sad truth. Nurses and physicians on the frontline are dying because of lack of PPE’s. Apparently we’ve become “the sacrificial lamb”…. not by choice though. I condemn the management that pocket their bonus checks while we are being shunned and ignored by not providing mandatory PPE’s. I condemn trump and the White House and all of the states opening up as the corona virus keeps killing us. The poor morons and illiterates that think this virus will just disappear… because they believe trumps world and his work which is only about himself and his money…. no matter how many of us die on the lot.
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