My MVPs of 2020 & a mini rant

MVP MVP MVP

Ok, so the ERs are overwhelmed, right? You’d have to live under a rock to not see images of ambulances waiting to unload and patients in hallways and hear about record wait times and how people are being sent home on oxygen because in some areas there are no rooms, right?  

Yeah. It’s real. Everything sucks right now. November/December was really fucking awful in the Midwest—January has not been as awful, though we are still at 90%+ capacity in most facilities and ICU beds are pretty hard to come by. It’s the “new normal”, a phrase I first encountered after my son passed away, and this is the second time I keep hearing it used regularly. I can interpret that as this is just how it is, it’s gonna suck forever, so get used to it.  

A few days ago one of my coworkers said “remember how pissed we used to get when we came in if there were ANY inpatient holds and now you’re just like “YAY THERE ARE ONLY TWENTY” and I was like YES THOSE DAYS WERE THE BEST. The BEST. I wanna go back.  

COVID this month, based on my personal experience—still here. Still deadly. Numbers I’m seeing are not going down, but not going up either. Lost a patient this week, sent others to be admitted that likely won’t make it, sent others home with strict instructions to return if they grow worse.  

Which brings me to this—as hard as it is to work in the ER right now—it is not the worst. 

My MVPs for COVID are the ICU nurses at the facilities that are dedicated to the COVID unit. There is a good friend of mine that works at such a unit. Every single shift she’s worked since the pandemic began has been in the COVID ICU with 2-4 COVID patients. Their ratio should always be 1:2, but turnover, illness, and burnout has decimated their team. She has seen a lot of people die. She doesn’t know how many. She can hardly remember last week. In the beginning we talked a lot about COVID and  treatments. Pronate early! Airvo over BIPAP! Remdesivir! Dexamethasone! Keep em off the vent!  

I think we all had hope that we would find some treatment that WORKED. Not that those don’t have their benefits—they do, but there’s one thing I’ve learned about COVID—COVID doesn’t give a shit.  

I’ve had 80 and 90 year olds go home fine. I’ve sent young patients to be admitted and heard back they died. What we do is important, but it’s nowhere near as effective as treatments for things like GI bleeds or regular pneumonia or strokes. Sometimes none of our treatments are going to work. Sometimes you look at the patient coming in and you know in your heart—they’re probably not going to make it. You know that no matter what you do, they’re going to end up on Airvo, then they’re going to buy the vent. Once they’re on the vent, they’re going to require so much pressure support and PEEP as well as near pure oxygen, that their lungs will actually suffer from injury from the necessary treatments to keep their blood oxygenated enough to keep their vital organs alive. Their lungs will fail, their heart will fail, their kidneys will fail.  

As the months have gone, as COVID has run rampant, she sounds more tired and depressed each week. She’s written down something about her patients in a small notebook, to remember them by. It’s the least she can do. The other nurses are wearing out too—turnover is insane. They have lost some of their own as well. One of the residents told her, struggling and maxed on Airvo, just before he was intubated, “I know I’m going to have to get tubed. I know I might not make it. It’s ok. I know you guys have done everything you can.” He did make it, but it was a rough road, and his recovery will be long and arduous.  

I took care of one of my own a while back. She fought hard and we ended up avoiding intubation but I was as scared as I’ve ever been at work. If she had said that to me I’m pretty sure I would’ve lost it and started bawling. She’s still out, months later, with limited function due to lung scarring and continued shortness of breath with any activity.  

This is life right now. My job is hard, yes, and at times we see death on a similar scale—multiple casualties from a bad accident or whatnot, but not every day.  

There’s little talk in our conversations now about treatments—they’re already pretty much established. There was a cool little burst of hope when we both got vaccinated, but we know we still have a long road to haul. Mine is a little easier—I have non Covid patients too, and our time with these COVID patients is limited—they move to an inpatient unit eventually.  

Some of these patients fight for weeks only to pass away. I used to work ICU. I know what’s it’s like to care for someone for weeks only to lose them. It’s awful. They are experiencing this routinely. And then they clock out and step into a world where some people aren’t wearing masks and spreading anti-vax bullshit and it feels like being a stranger, walking out into this world where everything just....keeps moving like this isn’t happening.  

She’s my MVP. They’re all my MVPs because honestly, I don’t know if I could do it. I’m having a hard enough time in my own world, with my own new normal.  

Which brings me to an experience I had. I saw a video of a long term care nurse the other day. They had a COVID outbreak last month. They lost most of an entire wing of elderly patients. People she knew for years, had attended to since they arrived there. And she was just sobbing. They’re all gone, she said. Please wear a mask. Please. Stay home. Please. 

This things are happening, and we’ve come to accept them, the way we accepted all the other shit that has happened over the last few years.  

We’re not asking that much. Just to wear a goddamn piece of fabric over your fucking face in public. My kid does it, she doesn’t ever complain since the second week. Don’t gather in large groups. Avoid holidays this year so Grandma and Grandpa are still around next year. It’s not that fucking hard. I can’t fathom why people still refuse to do so. I’d like to know how many of them have zipped more than one body bag in a day. How many know postmortem care, to rinse the eyes with saline and tape them shut, elevate their head and cross their hands on their chest to prevent blood pooling and discoloration. How many times they have had to say “I’m so sorry but we did everything we could.” How many times they’ve said, “time of death; 1:17 am.” How many times they’ve brought meds from a second crash cart in, then a third.  

I don’t tell electricians how to prevent wiring fires, so if you don’t know what PC 24-650-10-100% means, or what a base deficit is, you can get the fuck out of my face with your anti-mask, anti-vax, anti-social distancing bullshit.  

We owe the teams working in COVID ICU’s—doctors, nurses, respiratory therapists, techs, mid level providers, all of them, an enormous amount of gratitude, and we also owe them the acknowledgement of the pain and injury they are suffering through.  

— the Midwestern One