I'm an ICU Nurse Working in a COVID Ward: I'm Exhausted
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I'm an ICU Nurse Working in a COVID Ward: I'm Exhausted
This is what it's like caring for patients on ventilators before they take their last breath.
I never had a chance. No one did. Every nurse around me had about as much of a chance at a good day as their patient did of surviving.
I walk into the COVID floor of our hospital. It’s 7 a.m., and despite the fluorescent lights above, there’s a gloom seeping into the ICU. Ventilators and monitors beep with a tone that is embedded in my nerves like an early morning alarm clock. I’m caught between the droning monitors in a tug of war between doing everything I can and the bare minimum. Someone’s oxygen is dangerously low. They’re already on maximum support—the only thing left is to “throw the kitchen sink at them,” as they say, and hope something sticks. It’s all we have left when the machines can’t pull the patient back.
Ten minutes past seven and I am hearing the plethora of struggles the night nurse was up against. Another unvaccinated COVID patient. The same story—they can't breathe on their own. She’s inundated with medications, ventilators and other life-saving devices, but it isn’t enough. Her lungs are scarred; fibrosis has set in; and she has enough sedation and paralytics on board to take down a whale. Healthcare’s a 24-hour job, but it’s still hard knowing someone will die during your shift.
I wish this wasn’t so routine. If it has to be so routine, then I wish it didn’t feel like such a rut. I try to focus on my rounds to avoid thinking about the odds of my two surviving patients. I try not to think about what caring for one means for the other. I want to stay dedicated to my routine, to stay present for the sake of my patients and ward off the doubt.
They’re dead though. Even if they’re just technically dying, they’re dead. The machines replaced their diaphragm and preserve what is left of their brain. They aren’t there. Maybe I should use more tact. Maybe I shouldn’t let myself feel this way. How can’t I when all I’m ever doing is prolonging the inevitable? I think I should care more. Am I truly doing enough? At this point, though, caring any more than I already do would be the death of me.
I've Gotten Used to People Taking Their Final Breaths Around Me
I'm an ICU nurse in my second consecutive year working on the COVID floor. It's September of 2021 and the Delta variant is causing a spike of infections as the world's apathy toward the virus is ramping up. I can feel myself burning out. I can see the fire fizzling out of my colleagues' eyes as we all go numb, losing patient after patient each week. That's when I really start to wonder: How can I say I care when I've gone numb?
I can’t stop thinking about the odds that the patients and their families are up against. None of this seems fair. I’m sawing my mind in half just to make my two patients comfortable. I’m juggling two patients teetering on the brink of death. This fear never leaves; it just pulls tighter, no matter how much I try to remain present. As I advocate for one patient, I wonder if I'm doing enough for the other. Nothing I do feels good enough. Her eyes are glossy. Her worn-out body looks ready to slide away, only for monitors to pull her back to us.
She’s comfortable, though, my patient. She doesn't track the doctor or me as we approach her bedside. At times, I think she drifts away toward a bright light at the end of a dark tunnel, only to have a machine pull her back to the routine beep of a monitor. She’s fading. I’m listening to the absence of life creep in between her heartbeats. The machines are losing their grip.
Stop. Don’t think about that now. I’m making my way to my second patient, across the ICU floor that feels more like a tightrope. I’m preparing to enter his room, and I can hear his heart rate dipping. His pulse keeps dropping one beat every second to one every other. I pump him full of what I can only describe as jet fuel to get him going. Only he’s so acidic that his body won’t budge. I have to balance out his acid levels, and we mix the jet fuel with more chemicals. With any amount of luck, this may allow the medicine to work. We’ll consider the chemical aftermath if he survives.
I listen to him breathe. Each breath is like gentle waves tugging a boat against a gravel shore, shallow and difficult. I’ve gotten so used to the sound of ventilators that having a patient breathe on their own feels like a win. From the door, though, it doesn’t look like one. The man’s body is just as beaten down as my other patient. I’m checking his vitals when his heart lulls between a beat. Even while breathing on his own, his pulse has continued to lag. His blood isn’t moving, and his brain has begun to starve. His mind’s malfunctioning, each brain cell short-circuiting. I picture the air leave his body as his organs deflate. Soon, he reaches the depths of multisystem organ failure.
Yet, this is as stable as his condition will allow him to be. The routine has become demoralizing, and the best I can do is skate by, waiting for the slack I’ve been given to be pulled tight. I have to leave his room and go back to my first patient. I can hear his breathing while stepping out of the room. The boats are still scraping against the shore, and all I can hope for is that they will still be there when I return. There’s a gnawing sense pressurizing me into second-guessing myself. I'm afraid that even if I’m doing everything I can, Mother Nature will undo everything in one climactic moment.
Trying to Explain Science to Family Members Is Often a Lost Cause
I’m preparing to enter my first patient’s room, half-listening to the monitors in her room and half-listening to the doctor talking to the patient's family. He's telling them what my patient is up against, explaining her low chances of survival. The patient’s daughter doesn’t want to hear it. She doesn’t want to believe there’s nothing more to do. She’s getting angry; her voice is croaking; and her head is shaking. Her chin is twisting, trying to remain in control. I don’t blame her, and I won’t blame her if she loses control.
No one wants to listen to a doctor foreshadow their loved one’s death. No one wants to hear how much of healthcare is just straining out into the dark and hoping you catch light. Both the patients and their families want to believe that medicine is made up of hard and fast rules, but it's almost never like that. Especially when we’re up against an unknown virus like COVID, everything is troubleshooting. There are more solid answers to an engine knocking than to a human heart failing.
Between my training and the doctor’s degree, families expect us to have those answers. But we don’t, and I want them more than I can explain. I know some answer feels better than no answer. This is also part of the routine that sends family members spiraling down healthcare rabbit holes looking for YouTube therapies and solutions. I don’t blame them. If I truly thought the answers were there, I'd also scroll endlessly for some sort of resolution. We all want answers. We all want someone, somewhere, to shed light on this pandemic, to be the beacon we all need. In the meantime, we keep pumping drugs into them, hoping something will spark in the middle of the night. But after almost two years of the pandemic, it’s starting to feel like there is no light.
As I check her vitals, I can still hear the doctor’s muffled conversation through the window. The family is spitballing Google hypotheses. They’re grasping for something concrete in a world obscured by the internet. That’s what makes this hard. Especially when the doctor can’t sugarcoat it. “It’s the variant," he says. "It destroys the lungs and cuts off oxygen to the rest of the body. Eventually, her organs will fail.”
That’s not what they want to hear. The family members duck their heads back into their phones. But there are only so many ways the doctor can say it. There are only so many ways you can tell a family their loved one never had a chance. I move to the woman’s other side to see the doctor’s eyes focused on the daughters. His head is shaking back like he doesn’t want to say it out loud, but he does.
“The only chance she had was to be vaccinated," he says. "Maybe then, it could’ve lessened the severity.”
Anger floods the daughter’s eyes as she paces frantically. She won’t have it. Her skin flushes, marked by tears running along a confused face. It’s the most frustrating part of the routine. The daughter’s voice is cracking as she hurls a whirlwind of compartmentalization toward the doctor. The daughter explains what her mother was really up against. In her mind, her mother isn’t up against an unknown virus. She’s being martyred by the globalist elite because her family won’t comply with protection from a Fauci-funded virus. Her mother is dying for refusing to be tracked by Bill Gates’ vaccine.
That’s why we can’t save her—because we aren’t trying. They all swear that we’re propagating lies and inciting fear.
That’s when I stop listening.
I'm Responsible for Ending My Patient's Life
A mother is dying, and her daughters don't believe we’re doing everything we can to save her. How could they with so many conspiracies in their head? When they can confirm their paranoia with generalizations and betrayals? There’s a foundation of distrust beneath everything they’re saying. I know it must look like we’re not doing anything. I know it feels like a cop-out by explaining the vaccine’s saving power. I know it must feel like betrayal, but I swear I’m trying. I don’t want anyone to die. I just don’t know how to convince them that I’m trying. I don’t think anyone does, and it all just keeps making the light at the end of the tunnel that much harder to see.
We give the family 15 minutes to watch their mother through the windowpane, just as she begins to crash. I look to the doctor for a solution, but I know he can’t get prepped and be in the patient’s room in time to do anything. There’s nothing anyone can do. No one has the answers. The woman’s failing, and she’s so infectious that no one besides me can be next to her. I’m alone with a woman’s body that has all but given up. I know what I have to do. It’s what I knew would be coming when I started my shift.
I push a large dose of fentanyl through her IV. Its clear liquid slides down the tubes, stopping abruptly at her arm before sinking into her bloodstream. I’m killing her. I don’t want to believe that, but I know it’s true. I don’t know how other nurses feel about this. I don’t know how I feel, and I’m too afraid to ask. I’m sure some nurses believe they’re just doing their job and making the patient comfortable. I don’t know if I feel the same way. I don’t think I feel the same way. I don’t want to believe I’m killing someone. I want to believe I’m doing my best. I don’t want to believe I’m just making them comfortable. I don’t know what to believe because everything feels like a failure.
The machines grow quiet as my patient slides into a fentanyl-induced abyss. Her glossy eyes dilate and her eyelids get heavy until they gently flutter to a rest, as if she’s just settled beneath the surface of a warm bath. Her heart begins a rhythm only I and the doctor know are not compatible with life before she flatlines. The ventilator is shut off, and her shallow breaths no longer raise her white sheets. I hold my breath until her body eases. I notice the muffled cries from behind the windowpane. She’s gone. I phone the transplant center, hoping some good can come from this, but her organs have been eviscerated by COVID. There’s nothing left to transplant. I hang up the phone and watch the doctor enter data into the patient’s chart. I can’t stop thinking about her cause of death.
I'm Not Sure How I Can Continue Watching Unvaccinated Patients Die
Being unvaccinated and a lifetime smoker had left the virus unchecked to wage a one-sided war against her body from the inside out. Her lungs were doomed to fail. She never had a chance, or at least that’s what I keep telling myself. That’s the truth though. The only way I know how to see it. She never had a chance. She was always going to die. Always. And I was always going to be the one there beside her to make her comfortable. I was always going to be the one beside her as her family watched her go. There weren’t any other options. This was the way it was always going to be.
What am I supposed to do? How am I supposed to feel? No one understands anything. We don’t understand this virus. The family doesn’t understand that we’re doing everything we’re capable of. No one understands how demoralizing this routine is. No one understands how this keeps happening and how it keeps withering everyone so far down that everything we do feels like a rut. More than that, it all feels wrong. It feels whiny. How can I complain about how I feel when someone else has just lost their loved one? It’s selfish to complain when someone else has just lost their world.
But they’re angry at me. They can’t understand how a politicized disease killed their family member. They can’t understand the contradictions in what they believe is happening around them. And I can’t understand why they wouldn’t just get two fucking shots. That’s it, and it pisses me off to no end because if they had just done that—if they had just been vaccinated—then maybe I would have a chance to save them. But even with their loved one gone, they won’t. The rumors, lies and misinformation have scared them away from doing the one thing that would have given me the chance to save their life. What other fucking options do I have besides making them comfortable?
I’m sick of leaving a dead patient to care for a dying one. I keep trying to flip the switch. I try to find the light in the darkness. I don’t want to think about the old woman and her family. I want my other patient with the dipping heart rate to have every bit of my attention. At least now, I can give him that. I’m going to check his vitals, and if everything is going well, then maybe I can eat lunch, but I still won’t be able to turn it off. The whole time, I’ll wonder if I’ll lose him or if I could have done anything more for him. I step into his room, and the monitor's alarms are blaring. His heart rate is plummeting. His lungs are failing, and just like that, I’m back to where I started.