COVID and Locusts and Protests and Love–A Community Nursing Perspective

 

My last patient had screened negative for all COVID symptoms in the waiting room, and his temperature was 97F, like everyones. We could set ourselves on fire and the touchless thermometers would still read 97.2, 96.4. Before entering the exam room, I looked at the stack of PPE, which we counted each morning. I knew the patient’s risk factors – no social distancing, polysubstance use, in and out of group homes--but better to save the N95s, I thought. They were already talking about shortages and reusing masks. I donned a face shield, which in the initial months felt like wearing a Star Wars costume.  

This man had a history of cellulitis, bacteremia, Hepatitis C, endocarditis. A fungal peony bloomed on his mitral valve. That day, though, he said he felt good. As I leaned in to listen to his heart, he added, But my wife has diarrhea and she says it’s hard to breathe, looking away. I straightened. Do you think she has COVID? He shrugged. Maybe. I’m thinking yes. Her son is staying with us, and he’s always showing up with five or six people so I think we’ll get it. But maybe it’s withdrawal. Then he brightened. Or maybe it’s just HIV. There’s treatment for that, right?

Sometimes wind shifts a certain way-- smacks your face, grabs your breath. I considered the years I’d spent working in infectious diseases, and how HIV had usually been the dreaded possibility. I told Thomas I wanted to get him tested for COVID, and that his wife should be tested, too. He looked at me, something caught and shifting. I thought of the almost-sound before a sail billows, the rattle before the first window shatters in a storm. It was April 2020. 

~

In the first weeks of COVID, I often wondered, Is this the way I will get the virus, and will it kill me? It wasn’t an ambush of panic, but a slow recurring thought, like fireflies drifting and flickering around the exam room. Our security guard’s job had shifted to cleaning chairs and door handles and spraying the waiting room. Patients who worked in factories were coming in for tests, reporting that everyone around them was sick, that coworkers had died. My biggest concern was getting someone else sick. 

I’m a nurse practitioner on the west side of Chicago, in a zip code with amazing art, architecture, and food. The neighborhood is home to a sprawling public park and the city’s highest rate of heroin overdose deaths. Our clinic remained open through 2020, and the people who needed our help were often those with the fewest resources. We saw conditions that typically would (and should) be treated in the ER, but people were too afraid to go to hospitals. I treated an infected human bite, large abscesses that required incision and drainage, and pancreatitis. In the winter, a car deposited an unresponsive man in a snowbank at our front door, then sped away. We grabbed the Narcan and raced into the cold. The number of people coming in for treatment for opioid use disorders increased each month. The ER down the street was receiving more than 30 overdoses per day. There’s no shortage of heroin out there, said one young man, who was squatting in a nearby abandoned building. 

During COVID, people without a place to stay were afraid to go to shelters. One man said he was getting nervous to stay in the tent he’d had for years, under the expressway. A lot of his neighbors had disappeared, and he wondered if they’d gotten sick. But he was more scared by the thought of being in a shelter, stuck and waiting for it. Many of those who did have a home were afraid of losing it because they could no longer afford rent. 

Among the people we serve are previously incarcerated men who reside at adult transition centers. They too felt stuck, and terrified, waiting for COVID to infiltrate their group setting. At the beginning of the pandemic, when isolation was more difficult due to higher occupancy rates, infected individuals were sent back to prison to recuperate in solitary confinement. 

I served as a clinical liaison for a nearby family homeless shelter that occupies the fourth floor of an old YMCA building. Even at reduced capacity, the isolation of infected individuals was almost impossible. In the summer, it was sweltering, especially in PPE, which many of the staff and residents refused to wear. Tiny rooms sometimes housed families of four. The handwritten NO SMOKING signs that lined the halls were studded with cigarette burns. The staff did their best to make the facility home, but the neighborhood is known for high rates of street violence, and everyone arrived with a heavy load of trauma. A teen was shot while playing basketball in the shelter’s parking lot. When I told one resident that she had tested positive for the virus and would be moved to a private room in one of the city’s COVID hotels, her immediate response was, I won’t let anyone take my children from me, and I won’t let you experiment on me for some vaccine. Everyone was scared. Everyone had a different version of the truth. 

~

During the day, I stayed busy at work. I typed anosmia and ageusia more than I ever imagined necessary. We called our patients with COVID to assess their breathing. Some days, we tested almost everyone for the virus, and for a stretch of weeks, nearly every test was positive. One afternoon, we called an ambulance for a patient who became increasingly short of breath mid-sentence and said he felt like he was going to pass out. He tested positive in the ER and was sent home because there were no beds available. 

The hospitals had gone from forbidding masks in the early weeks of the pandemic to universal mask mandates. The COVID clinics were well stocked with PPE, and my three friends who’d volunteered to work in them felt safe, noting that they weren’t having to choose when to wear full PPE. I’m covered head to toe all day, Mo said. It’s easier that way. We were grateful for the PPE, and we hated it. I couldn’t imagine the people working in the ICU, wearing an N95 for twelve or more hours while providing bedside care. I hate the mask’s odor and imprint. They make us thirsty and give us headaches. They make me crave air. In a poem, I complained:

                                I want
          a breeze, no airtight press of dread.
          Peroxide vapor in my throat,
          an arid ghost. My face before
          a fan, a flock

Our patients arrived at the clinic in increasingly bizarre outfits. They kept their sunglasses on the inside, and triple-covered their faces with bandanas and scarves. They wore hats and two pairs of gloves in warm weather. Some were afraid to be examined and wanted the door left open. One patient noted that her skin was dry because she put bleach in her bath water in hopes of killing the virus. Another had begun bathing her cats every day. 

In-home case management and ride services for individuals with serious mental illness had been suspended. Patients in need of their long-acting injectable anti-psychotics were having to take public transportation, which felt perilous or forego their medication, which could result in decompensation. Older people and those with limited physical abilities either weren’t able to keep their home care aides or were afraid to let them inside. One patient with diabetes was eating only food that he could obtain from the gas station across the street. Our behavioral health team worked long hours, and our nutritionists expanded their scope to include food insecurity, partnering with agencies around the city to have food delivered to homebound seniors. 

People looked after us, too. Friends sent an enormous basket filled with coffee and treats to the clinic. They attached a note thanking us. A patient who had been homeless and who had moved into her own apartment just months before the pandemic stopped by with a bouquet. She knocked on the window, passed the wilting flowers through the mail slot, and held up a sign: Thank you for not forgetting me. A friend on the east coast called to tell me how a nurse had explained what would happen when her mother was extubated, which made her death less horrifying. Nurses change our lives in the moments when it matters most, she said. 

Not everyone felt happy about crossing paths with a healthcare worker. I had switched to wearing scrubs to work. When I arrived home, before doing anything else, I would strip at the back door, place the scrubs in the washer, and shower. Before work, I would walk the dog wearing a new set of clean scrubs. Early one morning, the woman two houses down watched me from her porch and called out that I should be covering my face. You should know better! she reprimanded behind her bandana. That night, she left a bottle of wine at the front door with a note explaining that she has a health condition and had panicked. I haven’t left my home in months, she wrote, but I realize you weren’t close enough to make me sick. Another morning, I stopped at a UPS store, again in clean scrubs. A woman waiting about ten feet away looked me up and down. Everyone in the store was masked, including me. She backed toward the other side of the store and left, clutching her package. Lots of people want to thank us, but no one wants to see us, one colleague observed. I couldn’t blame them. 

~

At home, the drawbridge was up. It was me and the dog. My stepchildren are in their early twenties, and their stepdad was dying of cancer during COVID. They maintained strict social distancing and couldn’t be anywhere near me because if I infected one of them and they went home to him, that would be it. He was completely immunocompromised. My stepson suggested I could leave healthcare. I reminded myself, and my family, that I no longer worked in the ER, or Infectious Diseases. My risk was relatively low. Then I felt guilty that I no longer worked in the ER or Infectious Diseases.

My husband was working from home, but not our home. I worried about getting him sick and didn’t want to prevent him from seeing the kids, so he stayed elsewhere. I book-ended my day with calls to him, and he always made me calm, and helped me laugh. My brother was also staying away from everyone. He is an international pilot. He called with stories of how pilots had been taken to quarantine facilities after landing in Asia, tested repeatedly, and sprayed with a disinfectant that made him cough. Yet when he returned to the US, he was waved through customs without even a temperature check for the first half of 2020. 

Everyone was keeping their distance from our mom, who is 89 years old, lives alone, and loves nothing more than the chance to socialize. Although I visited her every weekend, I didn’t go inside for the first several months of the pandemic.  She would sit in a chair by the front door and say how fortunate she was to be in her own residence. All her friends in nursing homes were just trapped there, alone, waiting for a lunch tray and wondering if this damn virus will kill them. 

My coworker and I agreed that if one of us got COVID, we’d move in together so she wouldn’t get her kids sick. We’d take care of one another. There were times when the solitude was peaceful. Or at least dependable. There was a relief in loving from a distance, in believing I could do something to keep my family safe, even it meant staying away. It was a lovely illusion, believing I could titrate risk. 

~

The same morning that my cousin posted something on Instagram about COVID being made-up by Democrats as a way to impede economic growth, I learned that a former co-worker and her husband had COVID, and were both intubated at the hospital where I used to work. Patients and colleagues were losing family members to the virus. They mourned their loved ones and mourned the chance to comfort one another. A patient described his mother’s death, how she suffered alone in the hospital, then was moved to the morgue. It was horrific, the way she was put away, without us. Another young man cried in the clinic, describing how both his parents had died within hours of one another. He and his sister had also tested positive for COVID. I just assumed we would all die, he said. And now that we haven’t, we’re not sure what to do. 

In the evenings, I often continued to work, closing notes, and trying to keep up with the changing clinical protocols. I took a poetry class that met via Zoom. I rearranged the furniture. I couldn’t bear listening to the news, but read headlines online. A locust cloud three times the size of New York City was descending on Africa. I clicked on the story. An estimated 25 million people could starve as a result of the insects’ destruction. A goat herder in Kenya described being swarmed and said it felt like the end of the world. I returned to poetry. 

I cleaned, then cleaned again. I considered reupholstering everything. Burlap vs linen vs kilim. I walked the dog farther. I made my showers hotter. I was physically tired. Still, before sleep, worry revved up. Why hadn’t I bought an oximeter for the house when I’d had the chance? Why are all our thermometers broken? Will my husband tell me if he doesn’t feel well? What will I do about the dog if I get sick? How is my mom bathing herself? Then I would dream that I was in motion – driving or skating, slipping through narrow tracks, or icy ruts. I couldn’t get traction. My dream weather was always windy and hectic. Sometimes, someone driving past me would shout and hold out a cap, as if wanting me to place something in it. I’d wake disoriented, certain I’d forgotten to do something essential that would result in someone else being harmed. 

~

In May, police murdered George Floyd and the world erupted. Helicopters were constantly overhead, storefronts were boarded, and all the pharmacies around the clinic were closed. No one could get medication. We received a call from a woman who said They are burning our grocery store. We began talking about race and racism with our patients, acknowledging the brutality, and asking more specific questions about trauma. One African-American father told me that as a black man, he’d never felt safe in this country. Maybe it’s time for everything to fall apart, he said, but I’ve never felt as unsafe as I do now. One local pharmacy stayed open and kept delivering medications to the most medically fragile patients—those in need of insulin, blood pressure medication, and Suboxone. On a Tuesday afternoon, the owner of the pharmacy called to tell me they had to stop services for the day because their driver, a young Indian man, had been pelted with rocks while making deliveries.

The clinic’s security guard arrived hours late because so many public transportation lines went down. Blocks away, a woman sat on the hood of an SUV parked along the entrance of her hair salon. A man with a gun stood on the roof. They had propped a sign that read NOT THIS STORE. OUR FAMILY-OWNED BUSINESS IS NOT YOUR ENEMY. As the National Guard lined up around Chicago’s Loop, a childhood friend posted birthday photos of smiling, maskless faces gathered around a cake. I received an email from my former boss who’d just lost his home in the California wildfires. Do you have a weapon of some sort? It looks pretty rough in your city. The world is facing some kind of reckoning. 

~

In July, I drove to see my husband and stepdaughter, who were staying in a house in a wooded area a couple of hours outside the city. By then, bicycles and puppies were impossible to come by. Everyone was limited to one package of toilet paper at the grocery store. But life in that little rural area was quiet – mercifully but also strangely unaffected by the world’s chaos. The forest heaved with humidity and, despite the fact that I stayed on the screened-in porch, I kept my mask on. The dog panted. Sweat rolled down my face and back. 

There were industrious, noisy birds and kids yelling down the lane. I saw that my family had routines unknown to me. Each day they walked down a gravel road, past the railroad tracks, then back. My husband had perfected a subtle, expected side wave at passing cars—part cowboy, part small-town friendly. I napped on the porch while he cooked. I had nothing to talk about other than the clinic and COVID. If I avoided those topics, I almost didn’t know what to say to the people I love most in the world. 

One morning as my stepdaughter tossed a ball around for the dog, she skidded on a mossy stone and landed on her side. I ran to her, then stopped short. How close should I get? She’d had the wind knocked out of her, and her elbow was bleeding. I stayed back, and called to my husband, feeling like a useless liability. She looked up at me, confused that I’d not come to her aid. Oh, that’s right, she said. You’re not supposed to breathe on us. 

~

A few weeks later, just after I’d returned from work, I received a call from a policewoman that my mom had pushed her Life Alert button. The paramedics were on the way. I got back in the car and called my mom as I drove. No answer. When I arrived, the paramedics were leaving. They offered a quick report – she’d fallen on the carpet. No head injury, ambulating okay, good vital signs. I decided to go inside, and I found her in the living room. She was delighted to see me, as if I were a guest who’d declined an invitation to a cocktail party, then surprised everyone in the last hour. She cheerfully explained how she’d tripped, and just needed help getting up. The paramedics, she explained, were very handsome, and didn’t think anything was fractured, so she’d given each of them a store-bought Rice Krispie Treat and sent them on their way. She was ecstatic to have had visitors. 

I hadn’t been in her house in months. A lightbulb in the room where she spends most of her time was burned out, so she’d been using a flashlight. There was a pile of clean laundry in the kitchen. Using her walker, she was ferrying it in small stacks to the bedroom. I considered the risks of me giving her COVID versus her becoming deeply depressed from isolation. That night, we decided that I would start entering her home again. I explained that if I gave her COVID, it could kill her. I know, she said calmly. But it’s worth it.  We discussed it with my brother, and he agreed. I would remain masked, and keep my distance, but she needed companionship. I helped her onto the patio, and as I put together a dinner, she sat outside for the first time since winter. 

As I left her house that night, the neighbor was walking past with her dog. She stopped to let me know that her father-in-law had just died of COVID. He hadn’t gone anywhere, she explained, her voice shaking. They think he got it from the food delivered to his room at the assisted living facility. She looked toward my mom’s front door, and asked, As a nurse, are you sure it’s a good idea to go inside your mom’s house? I thought of the goat herder covered in locusts, ICU beds full of people struggling to breathe, a man suffocated beneath another man’s knee, a man shot while jogging, and fires roaring through bedrooms. Protestors, healthcare workers, garbage collectors. The sixteen-year-old bagging groceries, our kids’ stepdad prepping for the transplant that he knew was a long shot. So many lives, some in the hand of choice, most in free fall. I smiled at the neighbor. Thank you, I said. No, I’m not sure it’s a good idea. And I’m sorry for your loss. 

I’d watched my mom through the window that night as she tilted her face to the sky, then lifted her arms in the breeze. She’d touched the shrubs with her fingertips, then put her hands to her face, and sobbed for a moment. It seemed she was saying goodbye to the world, or I love this world despite all, or both. Maybe it’s the same thing.