Battle Fatigue on the Frontlines of COVID

I grew up in a town with a population of 900. We knew everyone; they us. I grew up knowing who died, who became a parent, who divorced, whose barn burned and the date we’d all meet to rebuild. I lived on a lonely country road ten miles from my high school whose last stretch was a mile of gravel. We depended on and showed up for our neighbors; they always did for us. Politics, religion, varying points of view were irrelevant. We were a community that depended on each other.

I thought of this as I tended to Mark who has been dependent on a ventilator for his every breath and a nurse’s capable hands to keep him safe for 7 weeks. He is from a small town in the periphery of the state; 3 hours from home. His family couldn’t be at his bedside for the first two weeks due to COVID precautions. Out of isolation for the past 5 weeks, his wife, with rotating adult children, hold vigil at his bedside. I am grateful for them. I couldn’t know who he is otherwise. As I tended to necessary tasks, treatments, and ancillary staff who step in to direct care, I get to know him.

ICU nurses must know whom we are treating. What matters most to them? What outcome is acceptable to them? What drives them? What are their greatest accomplishments? The answers to these questions guide my care. Without his family as a conduit to knowing him, I will give him my best in care, but there are vital pieces missing. Mark’s family couldn’t love him more. They laugh, cry, and proudly tell his story. His life has been one well-lived. He lived without a thought it would end until COVID struck him two months ago. His decision to decline the COVID vaccine will be a fatal one.

In 15 minutes, I knew this man. He was my father. In telling his story, my mind settled on my strong, hardworking father; my upbringing; my history; the history of my family. His roots are the same that grew me. 

I gaze in his eyes, assess for signs of him, and scan for light. As his family speaks of him, he comes to life through them. The realization that I’ll never fully understand any situation or human, is highlighted in these situations. A life is too complicated to piece together from the outside.

As I get shift report from the night nurse, I think, “why can’t they let go?” His body is trying to say goodbye, but they’re not ready. In knowing him through them, I begin understand. He comes from cowboy stock. He’s been mentally and physically strong for 7.5 decades. His top values have always been hard work, family, fatherhood, church, and community above all else. He’s the ballast in the family whose absence they can’t fathom.

So goes COVID. Every nurse on the front-lines of this never ending battle can tell countless stories that torment sleep, and haunt in the light of day. Since delta stormed our shores, and filled our hospitals to the breaking point, the battle seems endless and unwinnable. It’s still not real enough for many to take seriously. Americans don’t tend to the death of their family at home like 1918’s Spanish Flu. Because they can’t see the body of a loved-one face down, sedated and chemically paralyzed on a ventilator with active COVID, it isn’t real. At home, they only envision the love they know, and it is not what I see. 

I’ll paint the picture. This description is not of a single patient, but a conglomeration of too many. 

We flipped him on his belly again with the help of four staff. Being face down has been shown to best oxygenate fluid-overloaded, stiff lungs. His are too damaged to make any difference.

He has been with us for four weeks, in steady decline. Her dialysis machine hums on one side of her body, the ventilator on the other.

She is heavily sedated, unresponsive. Five-foot nine, 275 pounds, stage 3 kidney disease, poorly controlled diabetes; he’s among the highest risk patients who have declined the COVID-19 vaccine. 

Now, he’s fighting for his life, but not on his own. I am the one fighting for what he cannot.

I don and doff PPE as I move in and out of his room from 7:00 a.m. to 7:30 p.m. in a futile race to save his life, a life that he could have saved on his own.

The vaccine—proven safer than the high doses of over-the-counter ibuprofen he’s taken for so long it damaged his kidneys—could have prevented all of this.  Any wrong move by me, any lapse in judgment, could tip his delicate balance to death. 

I wish he had trusted any healthcare provider to help him understand how he could have avoided this horror. 

Now his family cannot see him, except through an iPad call.

But they don’t call. Instead, this morning, they had a virtual meeting with our palliative team. Over the course of two hours, the family decided that he is a “fighter,” and decided to keep up this dance just a bit longer. 

His death is believed a foregone conclusion by the medical team. We can’t make the family understand.

The time on his belly causes his eyes to swell shut. We must turn his head every two hours to prevent pressure wounds to his face. Three members of the National Guard, me, and a respiratory therapist work in tandem to lift his body and turn his head against a very stiff neck. 

He has a large-bore venous line in each side of his neck; one to deliver medication; one for continuous dialysis. An arterial line in his right groin gives me his blood pressure in real time. A breathing tube in his throat delivers his every breath. A dislodgment of any of these would result in his immediate and sure death. 

His belly is large and is forced to one side as we turn his body. I infuse escalating doses of medication to maintain a blood pressure that perfuses his brain, heart, limbs. Still, his fingers and toes are cold and blue. 

He can’t maintain his own body temperature, so a forced-air hot blanket and the dialysis machine are set to maximum temperature around the clock to do that for his.

I can’t communicate much of this to his family. I don’t have the time, and they don’t have the medical literacy to understand. I’m angry that politics has put me, and my colleagues, in this untenable position. 

And there is no end in sight. 

A vaccine could end most of this madness in a month, but my suffering and/or dying patients have taken in misinformation—fueled by tribal politics—that will end their lives. It’s only a matter of time. 

I feel every minute of that ticking clock. Every step and breath I take determines his very existence.

It’s too heavy a load: I find myself just going through the motions. I carry the horror home, and it torments me in my dreams. I’m afraid: is this injuring my soul in ways I can’t even imagine?

It’s a nurse’s reality: I have no choice but to gather my wits and go in to work another shift in a never-ending game.

I am asking myself—as are my colleagues—“Should I continue?” Is it time to throw my stethoscope on a pile of patient stories?

Has my country turned against me, and left me in the rubble of a battle that so many fail to see? 

If only I could breathe.