Beeep. Beeep. Beeep.
The alarm on the alaris pump is going off.
Line occlusion.
Bingg. Bingg. Bingg.
The cardiac monitor is alarming.
Low saturations.
Bop. Bop. Bop.
The ventilator is alarming.
High circuit pressure.
The doctor is bellowing out orders: "I want an x-ray, art line, and central line. And add in covid serology, ICU bloodwork, and an ultrasound. This woman is pregnant."
The nurses are pushing drugs and yelling out to the transcriber: "Roc. 50mg. Versed. 2.5mg. I got the propofol line hung. It's infusing. 30mcg/kg/min."
The RT has one eye on the monitor and the other on the vent, acutely aware that the patient's stats are only in the 80's, despite being maxed out on vent settings.
There's a flurry of activity outside the room as the nurses attempt to process orders, run for supplies, and communicate with the staff inside the room about what's going on. The docs are all talking about what's been done already, and what needs to be done next.
And here I am. Standing outside the room, wishing I knew what to do. I'm not a ICU nurse. Not even close to it. But that doesn't matter now. It doesn't matter that I have no experience in critical care, or that I haven't been on a medical unit since nursing school. It doesn't matter that I don't know how to start an IV, or that I don't remember how to give IV medications. All that matters is that I'm a nurse. From somewhere.
This unit is bursting at the seams, in desperate need of more bodies to help out the nurses that are already burned out, having been pushed way beyond their limits. So here I am, one of the many nurses that have been pulled from our home units, from the places we've trained to work in, and redeployed to work in the ICU. And it wasn't by choice. It's not like we stuck up our hands and said "Pick me! pick me! I'll do it! I'd love to go back to working shift work and throw my whole schedule and routine out the window! Pick me!" We were told we were going, and that was that. Final answer.
But with good reason.
In the ICU it's 1:1 nurse to patient care. The patients in the ICU are so sick that they require the constant care and attention of a highly trained critical care nurse. Amazing nurses. True inspirations. But Covid has thrown that out the window. This is normally a 25 bed unit, but with patient numbers upwards of 40 on the unit, doubling up, or even tripling up has to happen. Nurses that have worked more overtime over the last 18 months than they care to admit, are now sometimes required to care for 2 or 3 patients at a time. It's not a good situation. Nor are the state of the patients coming in. Covid is not a pretty sight. But I'm not sure many people really understand what it means to be in the ICU for Covid.
So let me paint you a picture.
First of all, you're very likely intubated (if not at first, then within the first couple of days). This means you have a hard plastic tube through your mouth into your throat, which is secured with a very sticky and tight tube holder that's attached to your cheeks and around the back of your neck. This tube is connected to a ventilator, which is essentially a fancy machine on wheels that's breathing for you. It's generally not tolerated all that well, so they'll put you on a continuous IV infusion to sedate you. You'll need meds and nutrition during your stay, and these things need a way to get to your stomach since you're asleep and not able to swallow. So, you'll have an OG (orogastric) or NG (nasogastric) tube through either your mouth or nose, respectively, which goes directly down into your stomach. And speaking of nutrients, your food is now tube feed. A delicious custard-yellow liquid that hangs in a bag from an IV pole and connects directly to your OG or NG. A continuous supply of nutrients 24/7, sans any taste. You'll also need other medications, most of which are given intravenously. So not only will you have a couple of peripheral IVs to your hands/forearms/feet, but you'll likely have a central line - an IV into the jugular vein in your neck. We also need to closely and accurately monitor your blood pressure and the various elements of your blood, so a special catheter will be placed into one of your arteries (generally in your wrist) and sutured into place. This is called an arterial line, and it's definitely not something you want to accidentally pull out. And to add another couple tubes into the mix, you'll have a foley catheter to catch the pee, and after a few days of tube feed, perhaps a Zazi to catch the liquid poop (essentially a tube up your rectum that flows into a collection bag attached to the side of your bed). That's a lot of lines and tubes. All critical to your care. All of which need to stay in. So as an assurance that you won't accidentally pull one of these out, your arms will be in restraints, tied to the bed. Every two hours someone will come and turn you, putting pillows under one side of your body, then the next. If you happen to have had a bowel movement, you'll be rolled from side to side to have everything cleaned up. Your bed baths will be once per day. You'll also get water swabs to moisten your mouth, and drops in your eyes to protect your peepers. Everything will be hunky-dorey.
Until you're oxygen levels begin to drop...
Then the discussion will occur. If your very sick lungs are just not happy, and your oxygen saturations don't want to hold at a life-sustaining level, then we'll need to try proning you. You'll be flipped over on your stomach, tubes and all, and there you'll be, in all your glory, with a gown lightly draped over your backside. Then sometime later you'll be flipped back over on to your back. And the cycle will continue, until your lungs start to heal.
With any luck you'll be in a private room, which rooms in the ICU are supposed to be. But, as it was, at the height of wave 4 when I was redeployed to the ICU, this was just not the case. There were literally SO MANY patients with Covid that the ICU completely took over 2 OR recovery rooms. That's right. Completely. It was like a field hospital, within a hospital. Bed after bed, side by side, separated by ventilators and bedside tables. Just a big room with row after row of covid patients.
_____________________
As I said, this was at the height of wave 4. I was redeployed to the ICU in the middle of September. Working in the OR we just didn't have a good grasp on how bad things really were out there. We heard the stories, but we didn't see it. We knew it must have been bad because surgeries were being cancelled left, right, and centre. There just weren't any beds for these patients to go to after. The beds and staff were needed elsewhere. But when I first got up there (to the ICU), what an eye opener. It was no joke. Covid is no joke. All the things you were hearing on the news were true, and worse. The doctors and nurses up there really were struggling to stay above water.
It was so hard to be there. In part because of the stories you heard, and the things you saw, and the reality of death looking you straight in the face. But it was also hard because I had no idea what I was doing. I'd never cared for a patient on a ventilator before. In the OR all of our patients are intubated, but there's an anesthesiologist there at all times to deal with that side of things. I had no idea how to deep suction a patient through a breathing tube. I had no idea how to start a new IV medication. I had no idea how to properly clean up a patient who had had a bowel movement (trust me, these nurses have even that down to a science). I had no idea what it meant to "send these blood cultures". I had no idea how to draw blood from an arterial line. I didn't know where anything was. I didn't know the routine. I didn't even know where the bathroom was. Add to that the stress of having to go back to working shift work - days, evenings, nights. Back to working six days in a row. Back to working weekends. It was extremely hard.
But, was it all bad? No. Difficult, yes. However, I was more than happy to help. I am more than happy to be there supporting the nurses. They're all amazing. They're friendly, nice, and truly care about their patients. There was never an expectation that I would have to "take a patient". All I was there to do was help. Help in whatever way I could. At first, that was mostly just fumbling around trying to find supplies. But slowly I got the hang of things. I learned where things were. I learned how to use an inline suction catheter to suction out the deep secretions from an intubated patient. I learned how to draw blood and blood gases. I learned how to use the alaris pumps so I could hang IV meds. I learned how to be a bit more helpful than I was during those first few weeks.
The height of wave 4 was rough. There's no denying that. When you'd ask the ICU nurses how they were coping through everything, they'd simply say: "we're not." They still say that, even though the numbers have now come way down. But that's not to say there aren't Covid patients on the unit anymore, because there are. There are still new admissions happening all the time. There are still deaths. I know this first hand. I've heard the stories. I've seen the fight to keep people alive. And tonight I stood beside one of these patients, holding her hand, and gently stroking her hair. I reassured her. I kept telling her that her family was on their way. I sang to her. I prayed for her. And then I watched as the monitor showed her heart rate go from 50 beats/minute to 0. I was with her as her time on this Earth came to an end. Because of Covid. There was nothing else we could have done. So I did the only thing I could do at that time. I held her hand and prayed.
This was the first time I've been in that situation. Yet for these ICU nurses, this is nothing new. Covid has taken so many lives from this Earth. They've been in that exact situation countless times already. They've fought like hell to keep these people from succumbing to this ravenous virus. But all too often the outcome is not the one anyone wants. I don't know how these nurses can carry on. I don't know how they can wake up each day and know that they're coming face to face with this ugly virus, yet again. But they do. They keep going, because what else can you do?
I truly hope it will all end. We all want to get back to the life we had before. But still, it continues. More patients. More life-saving measures. And more death.
On,
and on,
and on.
Beeep. Beeep. Beeep.
Bingg. Bingg. Bingg.
Bop. Bop. Bop.
These are the sounds of the ICU.
And it looks like I'm here to stay.
** Please note, I'm in no way trying to be insensitive to those people and families that have had their loved ones in the ICU. I'm just being honest about the reality of all that goes on behind those double doors and sharing the struggles that occur. Please know that all the doctors and nurses truly care, and ensuring a patient's humanity and dignity are always upheld and are at the forefront of everyone's mind at all times. Everyone is always cared for in the most humane, loving way possible. These healthcare providers really are healthcare heros. They do their absolute best every minute of the day and I'd without a doubt trust them with my life. My thoughts and prayers to all those who are struggling with the dark effects of covid, and those who have lost their lives, or have had loved ones pass on from this horrible virus. May you find peace in all this darkness.
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