This piece is by Brenda Cyr.
Damn, I did it again!
Melissa pulled off the latex-free glove that she had just poked her left index finger through. Everyone else made putting on personal protective equipment look so easy. For Melissa, it felt like struggling to put on a wet suit that was two sizes too small.
She tried to look confident; after all, she graduated at the top of her class and was one of two new grads accepted into the ICU. Fresh off orientation, she had begun to realize that there was more to being a nurse than what they taught in textbooks. All the senior nurses appeared to flow through the hourly checks and rechecks as easily as water flowing downstream. Melissa felt stuck in the rapids, with a waterfall ahead.
After successfully pulling on two pairs of gloves over sweaty palms, she made sure that her personal protective equipment, or PPE, was secure. There was a large sign on her patient’s door, ISOLATION- DO NOT ENTER without AUTHORIZATION and PPE, that partially blocked the window. The door creaked as it opened and clicked when it closed behind her.
“Good morning Mr. Rodrigues! My name is Melissa, and I will be your nurse today! It’s bright and sunny outside, and no rain is forecasted for the next couple of days.”
Softly touching his pale, cool hand, she tried to remember everything her preceptor had told her. She had carefully written down everything, but she couldn’t bring in her notes with her, due to Corona.
I haven’t even sorted out how things are supposed to work, and now this crazy Coronavirus strikes, and nobody knows what to do about it. Corona is a good time beer that we had after class, not some sneaky killer that nobody understands.
The regular swoosh swoosh of the ventilator and rhythmic beep of the heart monitor assured her that, for now, everything was okay.
Well, as okay as you could be when you have a mystery illness in the ICU.
Adjusting her seat lower, she attempted to log into the computer. What was the stupid password they gave me? Shoot, I can’t remember.
Two attempts later, it came to her. Hick0RYsTiCKs7. How the hell was anyone supposed to remember something like that?
The screen flashed warnings about the Covid virus, demanding anyone suspected of having it report immediately to the employee health nurse and self-isolate.
The next screen was almost blinding with a display saying, “THANK YOU FOR BEING A HERO.”
I like the sound of that. I want to be a hero.
Clicking out of that screen, she brought up the previous shift report. She slumped in her chair as she read it.
“Mr.Rodrigues, 40 years old, married to Julie, two children, 10 and 7years old. 6’ tall,275 lbs., no preexisting conditions. Patient came to the ER at approximately 2200 hours. Patient stated he had flu-like symptoms, fever, and body aches x 3 days. Patient stated he had poor appetite and a dry cough. Patient stated his temperature rose to 103F earlier this evening, and his wife insisted he come to the ER. On arrival, BP 160/80, HR 115, Resps 20, Temp 102.8 oral,O2 Sat 75%. Patient sent for CXR, admitted to ICU, suspected Covid 19. Wife sent home to self-isolate with family x 14 days and told to return if any symptoms occur.”
Ten hours before, this man walked into the ER, and now machines and medications were keeping him alive.
And the poor guy is stuck with a new nurse that barely finished orientation. If I miss one thing, this poor man will be gone, and it’s all on me, she thought to herself.
The soothing swoosh, swoosh, and rhythmic beep comforted Melissa as she began her first round of checks and rechecks of everything that was keeping her patient alive.
CODE BLUE Room 12 blasted over the intercom.
Her training taught her to remove all the PPE and sanitize herself before putting on a fresh set of protective gear to enter the other room to help.
What if something changed, and Mr. Rodrigues needed help while she was in the next room. Nobody would know, and nobody would be there to help him. But someone was dying in Room 12, and they need help.
Melissa’s heart pounded, and her face shield began to fog up as panic set in. She started to pace back and forth.She realized there is no right answer.
Outside the window, she could see everyone rushing by, various pieces of equipment in hand.
I should go.
Just then, Cheryl, her mentor, waved at her to stay where she was and gave her the thumbs up- they had it under control. Melissa sank into her chair with relief. Several minutes later, her hands stopped shaking, and she could see through the fog on her face mask again.
Swoosh, bleep, bleep, bleep. The bleeps were getting louder, and something was wrong with the ventilator. Mr. Rodriquez’s heart rate was increasing, and the oxygen saturation was dropping fast.
“No, no…don’t do this. Mr. Rodrigues, if you can hear me, just hang on!”
The IV pump began beeping, solving the mystery. Fentanyl, the pain medication, had run out, and Mr. Rodrigues was reacting to the pain. She quickly refilled the supply, and within minutes, the comforting swoosh, swoosh of the ventilator, and rhythmic beep of the heart monitor resumed.
It took Melissa over half an hour to fill in her charting exactly how they had shown her to do in orientation. She double checked everything she entered and was sure it was all correct. School drilled about the importance of accurate charting but failed to teach how to deal with the panic and responsibility involved in this work.
Rolling her chair to the bedside, she took Mr. Rodrigues’s hand between her double gloved hands.
“I know your family wants to be here with you. I know you want them here too. But for now, you will have to settle for me. When I go out for my break, I will see if I can find a book I can read to you. I know it’s not much, but it’s all I’ve got right now.”
Melissa started thinking about her own family. Her Dad wasn’t that much older than Mr. Rodrigues, and her kid brother was just a bit older than his kids. What would she do if her Dad suddenly got sick and ended up here? What if her Dad was dying? She cringed at the thought. Sure, over the years they had some significant disagreements, but he was her best friend. And he was bursting with pride when she graduated.
I can’t imagine life without him.
She tried to imagine what his family was feeling, having to stay at home in isolation, not able to see him or touch him—only permitted to call once a day.
My God…what if one of them has it too? What if the whole family ends up here in the ICU? Could that even happen?
As she finished her thought, a piercing blare erupted from the heart monitor. The rhythm was 190, and Melissa had never seen anything like what she was now seeing on the monitor. She knew the alarm was also sounding at the nurses’ station; her stomach was rolling as she ran to the window, desperate for help.
She could see Dr. Lovett on the phone. He hunched over the desk, looking old and worn as he broke the news to the family of Room 12.
She could see the charge nurse, the respiratory therapist, and the intensive care resident putting on their protective equipment outside her door. The ventilator had started squealing as well, red alarm, Mr. Rodrigues wasn’t getting any oxygen. With help only feet away, but unable to enter, Melissa knew she had to do something- but what? That heart rhythm looked insane. The ventilator…she could take him off the vent and manually give him oxygen. She remembered that much. She stumbled over her chair on the way to the bedside, sending it crashing into the IV pumps. Struggling to disconnect the ventilator from Mr. Rodrigues, she was finally successful. She began to pump the Ambu bag to deliver oxygen slowly. Just then, everyone burst through the door. They didn’t ask any questions. They went to work. Melissa stood back, feeling helpless as each member took their position and started a task, like a well-choreographed dance group.
What have I done? she thought, and then whispered, “How could I have let this happen?”
Dr. Lovett finally arrived, looked at the heart monitor, which displayed a slowing heart rate, 50, 40, 30.
“Stop all treatment; he is gone—the time of death 1800 hours. I saw the rhythm on the monitor. He developed a massive blood clot that stopped the blood from leaving his heart; there was nothing anyone could have done for him.”
“This is all my fault,” said Melissa,” I let the fentanyl run out for almost a minute…” tears were pouring from her eyes, absorbed by the mask around her mouth. She hung her head, dropping her chin to her chest.
“That makes no difference- this would have happened to him anyway. It’s just another horrible way this virus kills,” said Dr. Lovett, looking even older and more worn than he had just a few moments before.
Everyone stepped back from the bed and bowed their heads, as they had so many times already this week. Each had a personal prayer to offer, in silence. After a few moments, the routines resumed. The doctor went out to notify yet another family of their loss. The respiratory therapist began dismantling the equipment to be cleaned and sanitized for the next patient. The charge nurse helped Melissa prepare the body for the morgue.
She was apprehensive about the task at hand. Her chin trembled, and her hands shook as she slowly started removing equipment from the lifeless body.
Ellen, the charge nurse, tilted her head to one side and looked directly at Melissa.
“I remember the first time I lost a patient. I was devastated. I sat in the corner of the room and bawled. You were fabulous today, Melissa. You stayed with us right till the end, and you are still here. I am proud of you.”
Melissa chewed on her lip and offered no reply. She continued disconnecting the equipment.
“ Don’t worry honey, you heard the doctor, nothing could have been done. Any one of us could have been in this room, and nothing different would have happened.”
“But what about his wife, his kids, what will they think of me. They will think I was the nurse that killed their Dad. I know that’s what I would think if it were my Dad. How come you didn’t do more, how come you let him die? Why didn’t you call us?”
She was imagining that it was her Dad lying there, and that just made things worse. Tears began to pour again, and Ellen stepped over to stand beside her.
“I wish I could hug you like I do with all my new nurses, but with this crazy virus, a hug might just kill you- so let me bump elbows with you. I promise, once we get through all this isolation business, I will have you over to my home, cook you a fabulous dinner. I will even let you play with my dog, Ethel. You have to be really special for me to allow that!”
Melissa looked up with a hint of a smile in her eyes, placing her hand over her heart. She said, “Thanks, Ellen.”
They silently completed their work, removed all the contaminated equipment, and joined the others at the desk. Someone had turned down the lights, and the glow of the computers cast an eerie green glow over the desks.
Melissa heard the end of Dr. Lovett’s call with Mr. Rodrigues’ wife.” I am so sorry; we all feel your loss. I can assure you that our nurses did everything possible for him, and to ensure he didn’t suffer.” After a brief pause, he continued, “Sure, his nurse’s name was Melissa, she is a great nurse. I’d want her to take care of me if I ever ended up in here. We are all praying for you and your family.”
Melissa bit her lip and gazed down at her shoes. Melissa didn’t know Dr. Lovett very well, but she was sure he gave the family her name so they could report her. She would probably lose her license for killing her first patient. Four years of school, all the hours studying, refusing to date, or hang out with her friends on the weekends so she could concentrate on everything she had to learn, and poof- gone in her first twelve-hour shift. How would she ever explain that to her father? He will be so disappointed. And her Mom, oh, Mom, she will be beside herself. Maybe Ellen will let her stay with Ethel, so she doesn’t have to see the sadness in her Mom’s eyes.
“Hey Melissa.” I guess Dr. Lovett is going to break the news to me.
“Mr. Rodrigues’ family asked me to tell you God Bless You and offer their deepest gratitude for everything you did.”
“His wife wasn’t mad?”
“Mad? No, why would you think that? She knew he had the Coronavirus, and the ER doctors told her to expect the worst. She and her family have been home praying for both him and everybody caring for him. She was grateful that he didn’t suffer.”
Melissa looked at him, wide eyes. That was not what she was expecting.
“I know you are new here,” he continued, ” but I meant what I said. You showed us today what you are made of, and I am glad you are one of our team members. Do you know if there is fresh coffee anywhere?”
Melissa looked around to see if anyone had heard their conversation. Everyone was standing and started to clap.
“Welcome to the team Melissa,” they said, almost in unison. “We heard that Ellen invited you over to meet Ethel, you must be pretty special. Most of us haven’t even seen a picture of her prized pooch.”
Just then, the manager arrived, holding a massive tray of tacos, burritos, and other Mexican treats.
“ I am not sure what you guys have been up to, but the Rodrigues family must have thought you worked up an appetite. It looks like there is enough food here to feed the whole hospital!”
Ellen grabbed the tray and said, “ Well, I don’t know about anyone else, but I am famished! And I know we all worked up an appetite- especially for Mexican food!”
She winked at Melissa as she took the tray into the breakroom, everyone following the heavenly scent.
She heard the next shift arrive and realized her day was over. She looked up at Louise, the other new graduate. She watched as she put on her PPE and frowned as she put her finger through her latex-free glove.