Our Sunday Long Read this week comes to us from Scientific American, where an ICU nurse, Kathryn Ivey, describes her experiences in the ICU as a rookie.
I saw my name followed by “RN” for the first time on July 27, 2020. The next day, my instructor, or preceptor, and I were assigned to the COVID intensive care unit at our hospital in Nashville, Tenn. I read the assignment sheet with a strange knot in my chest. It wasn’t fear or dread rising into my throat but something much harder to name.
For months, as a nurse intern, I’d watched the battle-weary nurses emerge from COVID rooms, taking off their PPE like warriors stripping off armor, their faces lined from the pressure of the respirators. There was something etched in their faces I couldn’t fully understand at the time, something that ran deeper than sadness, some terrible weight that came from caring for these patients. Now it was my turn for what became a grim initiation into the world of nursing and medicine. I learned how to be a nurse behind a respirator and a yellow gown amid the constant beeping and hissing of ventilators that couldn’t support failing lungs. I learned how to be a nurse with death constantly at my heels.
Because I was so new, I had no baseline for what normal nursing looked like; I just had a vague sense that it couldn’t look like this. The unit was bleak, and everything we did felt futile, and I realized at some point I felt more like a ferryman to death than anything else. Some people lived—if they never got to the point they needed continuous BiPAP, a type of face mask that constantly pushes air into the lungs. Most didn’t live. By the time they came to us, they were too sick and were beyond the power we had to heal. They were in renal failure, respiratory failure, liver failure, cardiac failure. One organ system would fall, and it brought down the next and then the next like dominos, a horrible cascade that we could predict but not stop.
I watched, feeling helpless, as patient after patient progressed through the stages of the disease, each requiring a higher level of oxygen support: nasal cannula to Vapotherm to BiPAP. Then, when their chests started heaving and they started sweating despite the BiPAP mask forcing the strongest possible concentration of oxygen into their lungs, I knew with heavy dread that soon they would be intubated. I remember every single time I made the call to the doctor to tell her that it was time. Then came the quiet acquiescence on the end of the line and the flurry of activity as we prepared the ventilator and the medications that would keep them comfortable after. I remember every single 2 A.M. phone call to family members so they could hear the voice of the person they loved at least one more time.
“Is she going to be okay?” they would ask. I tried not to lie, not to give false hope. I heard too many voices cracking on the other end of the line, the family beset with helplessness and with grief. “We’re going to do everything we can,” I would say.
There are places we can’t call you back from—places you go where we can’t follow. And this is one of them. The ICU felt like purgatory, like a punishment, like we were torturing these people whose bodies were wrecked beyond hope. And I couldn’t shake the feeling that we were failing them. The feeling of wrongness was so pervasive that it followed me home and would have choked me if I let it. So I didn’t let it. I got used to the death. I walled it off, pushed it down and did my job. I advocated for death with dignity, with as much kindness and comfort as we can muster, and I accepted very early on that we can't save everyone.
Every time I try to describe the COVID unit in anything more than metaphor and allusion, I falter. I can tell you that for a while, walking into work felt like Dante following Virgil past the gates and the warning inscribed there. I can talk about Charon and the river Styx and how the nurses flitted between worlds, crossing that river of death every time we entered a COVID room. What I’m saying is dramatic and probably pretentious, but language fails here. I don’t think there are words for what this is. The COVID unit is mottled limbs and scorching skin; bloody secretions and constant alarms from one patient after another going into abnormal heart rhythm;. It is the beeping of the Prismaflex delivering continuous renal replacement therapy because the circuit pulling the patient’s blood outside of their body to filter it, as the failing kidneys should do, has clotted yet again. The ventilators sound the alarm from inside the rooms for 1,000 reasons, some of them fixable, some not. Room after room of patients are on life support, silent except for the relentless chiming and beeping that remind us that they are dying, we are failing. Those alarms ring in my head when I get home, reminding me of every way I couldn’t save them. We are haunted by failures now, starting with the failures of policy that allowed human lives to be sacrificed on the altar of the economy and ending with us telling a family that we can do no more. COVID has made martyrs of us all.
Zandarmom is a retired nurse, and I just scream when I read accounts like this and think of the absolute, infantile selfishness of the anti-vaccine fools. I don't want to bring them into the fold, I want to wring their damn necks.
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