A nurses life in the age of coronavirus

Updated: Jul 8, 2020

Today is my husband's 64th birthday. We celebrated with friends with a zoom happy hour. This zoom happy hour was a bit different. We are practicing social distancing - even from one another for the next two weeks. It may be extreme on our part, but life is precious, and good health even more so. We were each in our separate spaces communicating with each other and our friends via technology.

I've been a nurse for 37 years. The first 30 years primarily in critical care and emergency/trauma. In those days, I did not give a second thought to my own personal safety.

Early in my career I worked 3-11 shift at a hospital uptown New Orleans. Often, my coworkers and I would have a drink at the bar across the street after work. The night the hospital caught fire, we left our drinks and rushed in to help evacuate our patients to safety. A few years later the HIV epidemic hit. By that time I was working in a medial intensive care unit. I recall a patient with HIV related pneumonia, complicated by a bleeding disorder, on a ventilator and coughing up blood. I jumped right in. Followed protocol and did not give it a second thought. A decade or so later, I was heading to a travel assignment in Espanola, New Mexico when the Cerro Grande Fire was blazing. I did not let the smoke coming from the direction of the hospital deter me. I don't know if it is age or wisdom, but this current coronovirus epidemic has definitely disturbed that sense of invulnerability.

Recently I have been counting my blessings. As I read the stories of health care professionals in the hardest hit areas I felt so very grateful that I no longer work in critical care or emergency. I work PCU in a specialty hospital which is a part of a large healthcare system in a metropolitan area. My hospital was not designated part of the COVID hub. We do rapid testing in the ER and transfer any COVID patients for specialty care at the appropriate facility. I thought I was home free. But I was wrong.

Yesterday morning we transferred a patient in my care to a COVID Hub ICU.

I had minimal contact with him on Monday night. Clinical picture:  COVID19, Flu type A and B, as well as all other assays and PCRs resulted negative. CXR showed RLL pneumonia, sputum gram stain showed gram negative bacilli. It seems probable that it was pneumonia that would respond to antibiotics.

On Tuesday he was to be discharged but temperature spiked and O2 requirement went from 2L to 4L per minute. 2nd COVID test was negative. WBC normal. Lactic Acid 1.6 Chest CT was negative for PE but showed diffuse bilateral infiltrates. 

I took care of him last night. In the beginning of the shift I gave him Tylenol for chest discomfort, headache and low grade fever, O2 sat 94-95% Heart rate was 90 and went up to 110 with minimal activity. I used droplet precautions even though per policy - flu & covid negative  it was not indicated. Patient and I wore simple masks. He seemed okay.

At 2am O2 sat crashed to 78%. He was alert and oriented, sinus tachycardia 110 to 120, some nasal flaring, uncomfortable. Breath sounds continuing to worsen. With albuterol neb, O2 at 10 L high flow cannula, and Tylenol, his O2 sat came up to 95% But...on ABGs pO2 was 57. Ferritin level > 1800.

It seemed textbook - well no, this is not in the textbooks yet. It seemed to fit the picture for COVID19.

Even though his tests are negative, and according to all standards and guidelines I have no documented exposure, my gut tells me that this is a tricky little virus. The best and brightest doctors and scientists do not have a clear understanding. I have read more that one anecdotal account of people becoming fatally ill after multiple negative tests. Doctors and nurses are dying after caring for these patients. I am not fear mongering. I am telling the truth of my experience.

I respect science and understand its limitation. I trust my gut. In my experience, ignoring intuitive guidance proved to be an expensive mistake. There was that yoga retreat in Costa Rica that fell through and cost us $1500. Then the agreement to help a "friend" start a yoga studio - that was a $25,000 mistake. I cannot risk - in the event that the sneaky little virus has taken up residency in my respiratory system - passing this along to anyone, most of all my husband.

So for the next two weeks, it will be a different life. More solitary. But I'm an introvert anyway. I can still go for long bike rides, practice yoga and meditation, work in the garden. I'm practicing excellent hand hygiene and wearing a mask when I am in a shored space with my husband. It feels like an experiment in intentionality. And, I have finally started this blog.

Be safe and stay well my friends.

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