An open letter to my patient
….from an ICU nurse.
I’m sitting here in my car this morning, too exhausted to even start driving. I can’t get your face out of my head. These community hospital shifts are brutal. I remember taking care of you 4 weeks ago. You had gone to urgent care the beginning of august. Just barely in your 50’s. A few years older than me. No medical or surgical history. No vaccine. Diagnosed with Covid, sent home with meds. 2 days later EMS brought you in, hypoxic, in horrible condition. We quickly intubated you. You looked so bad. You suffered through proning. Acute kidney injury. Dialysis. 4 weeks ago we were hopeful. You were going for a peg and trach. We couldn’t get you off sedation or you would panic and decompensate. I don’t remember now what problem you were having that was making it so hard to get the trach done, I just remember it kept getting cancelled. Fast forward 5 weeks later. I’m back at this hospital after my own bout of Covid. I’m back to work already. But I was vaccinated. you are my patient again. You are not doing well. They thought after the trach you would do better. You did for a couple of days. Then the first lung collapsed needing a chest tube. Then the second. Then more pneumonia. More dialysis. You are a DNR now. Your wife is exhausted. We were supposed to make you comfort care tomorrow. You have 3 daughters. The youngest is just 14. We are waiting for her to come in.
You can’t wait for tomorrow. I get report to find out you tanked. They pushed atropine at 6pm to get your heart rate up, went up on the pressors. Your wife has been told, she had just finally gotten to the laundry mat and put the clothes in. We tell her you won’t make the night. She’s hurrying as fast as she can.
I go in to see you. You are a shell. You don’t respond to anything anymore. You lay there, pale and gray, mouth hanging open. I wave a fly away from out of your mouth, it can’t seem to wait for you to pass. your wife and kids come in. They are barely holding it together. My eyes go to your youngest. She looks terrified and lost. I can’t imagine what this is like for her. I just want to hug her. I try to smile with my eyes from behind the mask, doing everything I can to give comfort. In an ideal world you would be my only patient- but we have only half the nurses we should. We are all running. Transferring patients to get more in. I have to go see my other unvaccinated Intubated Covid patient, also your age. I squeeze your wife’s arm supportively and hurry to put on all my gear. You seem “stable” so I hurry to do what I need in my other room. Im not in there 5 minutes and your heart rate and blood pressure drop again. The doctor sticks her head in to let me know. There’s nobody to go attend you, we are all drowning. I hurry. I come out and the doc asks me if we are waiting for any other family members to arrive- judging if we will make you “comfort” or keep trying to keep you alive.
I try to find a way to gently bring this up with your wife. She says at first no, nobody else is coming. Yes comfort measures are good. No more interventions. You are air hungry, breathing too fast and alarming your vent. Doc gives me pain med orders to keep you comfortable, I go up on sedation and push meds. Your 14 year old is holding your hand. She can’t watch me do it, she is terrified of needles and afraid I’m poking you. I show her I’m not, it’s just a syringe in your IV. Tears are in her eyes and she just can’t watch. Doc tells me to turn of your pressors. Your wife comes out and says wait- let me call his mom. Your mom was planning on coming tomorrow morning. I go up on your pressors and we wait for her. This tiny frail woman comes in. She worries me. I’m a mom myself. I can’t imagine seeing my child like this, let alone watching him die. I give everyone some time, then when they are ready I turn off the blood pressure meds. Your heart rate is already in the 40’s. It doesn’t take very long, about an hour. Your heart rate gets slower and slower as your oxygen level reads less and less, until there is no more blood pressure reading or oxygen. I watch your rhythm change, I know it will be moments. I want to be in there with you and your family, but we don’t have enough staff. I sit on the monitor so I can keep silencing the maddening alarms. Your family watches as you flatline. A wail goes up that pierces my soul. It’s your girls. Your wife is trying to be strong for them. I keep silencing the alarm, trying to find help to get the monitor turned off. I print your last EKG strip showing asystole. I call the doctor as I frantically mash buttons. Finally I get some help to turn it off once the doctor has come to pronounce you and take you off the ventilator. Time of death, 3 hours into my shift. Even flatlined and off the vent, you give one little sigh and belly rise after the doctor pronounces. I pray your kids didn’t see it, I don’t want them any more traumatized. Your family stays a while. I make my mandated call to the organ and tissue donor line. We go through the rote questions, even though we both know Covid will keep you from being a donor. The lady on the other end asks me the cause of death. I give a dark laugh, Covid of course. I ask her is there any other kind right now? She sighs and says no. I hang up and check on your family. I go through all my tough questions and paperwork. Do you have a funeral home picked out? No? That’s ok you can call us with that information. They ask what happens next. I tell them to take whatever time they need. Your wife asks me if we need the room. I lie and tell her no. Where will you go, they ask. I let them know you will be transported to the morgue, pending funeral home pick up. Your daughter gives a hitching sob. I ask if there are any belongings. Your mom wants your ring. Your wife has your regular wedding ring at home. It’s just silicone on your finger now, but I give it to your mom. The only thing else here is the shorts you came in the ambulance wearing. Your wife doesn’t want them, she can’t bear to look at it. She tells me to just throw them away.
Your family is ready to go. They mill about outside your room, all but your oldest. She can’t bear to leave you. She sits by your bed, crying. Your youngest is shriveled in on herself, holding her stomach like somehow she can contain her grief that way. I give my condolences to your family; it sounds hollow even to myself. What can I say? I tell your wife that your daughter can stay as long as she needs, they can go on home if they want. This is where your wife loses it, her voice breaking and tears spilling out. “I don’t want her driving by herself. I need to know she’s ok and not alone”. I nod in understanding. I have a kid her age. I have to go check on my other patient, I hear IV’s beeping and alarms going off. They never stop. When I come back out, you are all that’s left in the room. I do your post mortem care. All of the lines and tubes and invasive things have to come out. I remove your chest tubes, your dialysis catheter, your central line, your internal fecal bag. Your trach we worked so hard to put in. I try my best to clean up all the foul fluids and place bandages on you so you stop leaking so badly. I wash you and attach the tag to your toe. I get help and zip you into the body bag, naked but for that toe tag. Security comes and you finally leave this ICU, after entering it 7 weeks ago.
Housekeeping comes and does a stat clean- there are more patients waiting for your bed. Another nurse tells me your wife is so upset because one of your daughters has still been refusing the vaccine. She says how can you risk putting me through this again? I wonder if it’s the one who couldn’t leave. I hope for her & your wife’s sake this changes her mind. I sigh, try to shake it off and go admit the next patient who can’t breath.
TL
R- all of this is a real account. None of it is exaggerated or made up. If anything I held back, for fear of revealing too much patient information. This doesn’t even talk about what it’s like when all these patients keep coming, all having the same outcomes. My next admit from the floor is 74- both him and his wife caught Covid. His admit note says he was vaccinated but the doctor tells me no- they asked their kids and their kids told them not to get it. He’s dying and all I can notice is the sassy earring he sports. He is confused and won’t keep his bipap on, rips it off and fights and screams for me to help him. For all of you lurking who are vaccine hesitant or anti-vax- please read this. Think about your kids, your family. Think about their grief and exhaustion. My patient was fit, healthy, working. He was a skeleton in that body bag. For those of you posting in here, I’m glad for the support you give us, and for the positive reinforcement you give those that decide to get vaccinated. I also hope this gives you some insight as to why it’s not so easy to just say “too bad so sad you didn’t get vaccinated”. I don’t know if my patient was anti-vax, ignorant, or thought he wouldn’t be affected. I don’t actually care. What I care about is that poor 14 year old girl who will be traumatized for the rest of her life. Please get vaccinated. This is all so unnecessary. Thanks for coming to my TED talk. Sincerely, your friendly neighborhood ICU nurse.
