Tuesday, April 28, 2020

The Hands and Feet of Jesus - Covid 19 Warrior

Week four

Week four brought some changes. My walk to and from work buddy got moved from my hotel to a different hotel. We have been walking the 20 minutes to and from work on the days we both work. We made a routine of stopping to pray before we get to the hospital to begin our shift. On the bright side, I got some buttons in a package from my mom and was able to sew them onto the headband to protect my ears. I also ordered a scrub hat from Amazon (and it came surprisingly quickly) along with the 2 scrub hats I received from my friend's donations (one was pictured in a previous post) and I was able to sew buttons onto those hats as well to keep pressure off my ears.

I had a talk with a friend last night, and she shared how my story has affected her. She said to me "Laura you are literally being the hands and feet of Jesus." This really stopped me in my tracks as I reflected on this and our conversation. I hope that the nurses and patients I come into contact with are uplifted by my reflection of Christ. In rooms with patients who have no family at their side while they are scared and sick, I can be there and love and encourage them.

I had to walk to the pharmacy today as I haven't been inside a store for a few weeks and haven't been to a pharmacy since getting to New York. Below is a photo of the pharmacy as I walked up. There was a line outside the store for people who needed to go to the pharmacy and then another line for people who just wanted to shop at CVS. They have the whole pharmacy area completely taped off and wipe down everything including the credit card machine after each person. 

Some other good news from the front lines....the last few days I have worked there have been open beds on some units! I'm not saying its all better here, but the last few days the ER has been overstaffed with nurses! It is the small things, I will take it! 

Also, a giant care package came from Washington (the hometown of the nurse shown above). It had 250 mini bottles of hand sanitizer, clorox wipes, pens, safety pins, ear savers, cloth masks, and best of all cookies!

Wednesday, April 22, 2020

Overwhelmed beyond words - week 3

After a rough end to last week, I was blown away by week 3. So many people giving all at once, I have no words to even describe the feelings. I will show pictures and allow you to imagine the feelings after the situation described in my last post. This was me trying to be resilient and get out of bed. I went for a walk to get some fresh air and clear my head on my day off. Who says you can't color coordinate during a pandemic? 😀

A local restaurant has been providing to go meals to first responders. It was delicious and made my day! Although I probably ate it in about 5 minutes (my grandma always scolds me for eating so fast, my only defense, I'm a nurse, I have to)

My new travel nurse friend received mailed care packages from her hometown and shared a srcrub hat with me! The green fabric says "hugs for heroes." We have been wearing disposable hair covers all day long, so now I can wear this under the disposable one for another layer of protection.

Someone came around the floor passing out face wash and compression socks to staff. Same day, all staff was given a ticket to go redeem for a bag from Red Cross. This bag was loaded with supplies including toothpaste, deodorant, food, coffee, toilet paper, and energy drinks.

A family member reached out to me and thanked me for coming to NYC. She insisted on buying my dinner of my choice and having it delivered to my hotel when I got home from work Monday night. She even ordered more than what I requested because she thought I might like it and should have choices. Also she sent all the drinks because I told her drinks are hard to find...best of all she ordered bubble tea! 😍

Last night, I received a package from my mom. It included face shields for me and other first responders!!! Her classmate from high school had paid for some and mom shipped them up! Below is one that I found on a unit last week and snagged. It is elastic stapled to the plastic. Below is a picture of a night shift travel nurse living here at my hotel who has not had a face shield. She was ecstatic to receive one and loved how it fit. Stated it provided so much more protection. When I tried one on I loved it as well, so much space for my glasses. It was wasn't squishing against my face. Thanks mom, your classmate, and the local friend making these! Once I pass out some more I will post more pictures!
This nurse also has not had any cloth masks and I was able to give her one that my boyfriend's family made and sent with me. She loved the colors and said she wanted to wear them together to match. 😎

These donated face shields are going like candy! Gave away all the ones I had today and didn't realize I gave my own away. Good thing I have a few at the hotel that didn't fit in my bag today.

Tuesday, April 21, 2020

I've still got a lot of fight left in me

This last week has been exhausting as I ended up working three days in a row, one of them being Saturday (and we all know everywhere is staffed less on the weekends)...but week two down and now on to week three.

I have been spending some time on the PICU unit which is not actually pediatric now, but more young adults. With this being said, the nurses have been taking some time to explain the ICU things to me. I was eagerly soaking it all up: ventilators, arterial lines, 7-10 drips at a time.... the whole thing. Unfortunately, I also was pulled to another unit at 10:30am. This is all too common here, but has not yet been me who was pulled. Walking onto the other unit, I have never seen such chaos.... let me paint a picture for you so you can try to imagine this

  • Charge nurse pacing back and forth stating this is not safe. 
  • Patient lying calmly on stretcher in hallway near nurses station, Charge RN notices the patient and walks over asking the name and who the patient was. (this happened again later....and turned out to be an admission that I was chosen to receive)
  • Charge RN handed me a stack of paper handouts on my 5 patients and said he had passed meds on the one he had, then walked away. No other report was provided......these patients are 2 in a room, most if not all on some amount of oxygen some on non-rebreather.....solid wooden doors which must be closed at all times block any view of patients. No monitors in patient rooms, no way to have continuous pulse ox monitoring on any patient. Only way to check their O2 saturation is to wheel in a vitals cart and then wheel back out and wipe down. (most units only have 2 carts for 30 some patients give or take). 
  • He didn't ask my name or tell me his. Didn't tell me the codes to get into clean supply or nutrition rooms.
  • I log into the computer and begin to view medications due. 2 patients had 8am insulin that had yet to be given along with BP meds etc. It was almost 1pm before I could even lay eyes on my last patient, at which time my 6th patient was found in the hall on the stretcher (as I mentioned before) determined to be the admission for one of my rooms and wheeled into the room. No one told me or the charge the patient was on their way, no one told us the patient was left/dropped off in the hall. 
  • There was one nurse aid one one side of the unit and two army nurses who tag teemed acting as nurse aids on the other side of the unit. There were no depends....anywhere.... patients get abd pads if they're incontinent without a foley.
  • One of my patients left against medical advice. 
  • I got another admission.....inappropriate to the unit and my poor charge spent over an hour calling bed board, doctors and nursing director trying to get the patient moved.
  • In the back of my mind I was praying I would not walk in and find a patient had removed oxygen and had stopped breathing. 
  • I am a type a person who likes to be on top of things, I felt I started out behind and couldn't get caught up with my tasks. 
  • Patient needed hand fed and I swear they took 2 minutes to chew one bite, but they needed to eat. If I didn't do it, no one else would. I dripped sweat and thought of my other 6 patients as I sat there and waited on the patient to chew, trying my best to appear calm and not hurried.
  • A doctor approached me and stated IV was removed on a patient but pt is dehydrated so could I just hand patient the cup every time I walk in the room. I politely stated that I have 7 patients and will not be in this room often, can we just replace patient IV? MD told me no its not necessary but he will hand patient water when he is in room and could I do the same. I tried my best. 
  • A patient passed away on the unit, not mine but on my unit. 
  • Seemingly never ending CAC (cardiac arrest code) and RRT (rapid response team) being paged overhead. 

On another note, I received something akin to gold this week! What we called a "bunny suit" at my previous jobs. A one time wear disposable zip up suit with a hood. Unfortunately, these are not one time suits during the crisis, below is a photo of my suit, one of me getting all garbed to go into a room, and one of me wiping down a colleagues suit so the suit could be folded and placed into a bag to wear tomorrow and the next day, and the next day.

Oh yes and please note the IV pumps outside the room in icu settings to decrease need for entering room due to IV beeping etc. They came up with a way to use lots of extension tubing and keep lines outside the room as much as possible.

Moving towards the more encouraging things from the week, the travel RN below had no cloth masks to wear when not providing patient care or at work, so I offered one donated by a classmate of mine. You can't see her smile, but it was huge!

Pin by Laurie McCullough on Note to self... (or this is me) (With ...
Finally, to end on a good, but emotional note, this last week the hospital began playing overhead a short clip of Fight Song by Rachel Platten whenever a patient is extubated. This brought tears to my eyes almost every time this clip played. Staff would often stop what they were doing and start clapping. The emotion that swept the unit was tangible. I had goosebumps. Go listen to this song and her voice and her statement "I've still got a lot of fight left in me."

Wednesday, April 15, 2020

The reality of how our world is changing

Good evening everyone! 

This week has had a great start for me. We discharged patients Monday and the rooms were not immediately filled back up. I then had Tuesday off of work for class and was able to meet up for dinner with the friends I have made. It was cathartic to see and talk to them and we were able to share what we have been experiencing, encountering, and enduring. It refreshed me as I had not seen some of them since our first day of orientation. 

I work again Thursday, Friday,  and Saturday and will hopefully post an update Sunday.  

I have included some pictures of how the hotel changed in the last few days. They had previously had the bar area with tables taped off but as of yesterday they taped off all seating areas in the lobby including the computer to print. 

Yesterday I was able to get out of this room and take a short walk. The sight of all the stores closed and gates down gave the feeling of a ghost town. 

Finally, on the bright side one of the travel nurses I met from Florida needed some masks and I was able to give her some that had been donated to me by a classmate from Ohio. She loves the mask!! 

Sunday, April 12, 2020

The end of week #1-- shell shocked

Yes, it is as bad as you heard.
Yes, I do have PPE (personal protective equipment).
No, I have not had a patient die yet.
Yes, I have seen deceased patients.

I am a med - surg nurse joining the Covid crisis fight in NYC. My face is breaking out from the mask tight against it 24/7 except in my hotel room. My nose is beginning to blister from the mask. I am drenched, dripping sweat the entire 13 hr shift. I never know where to find anything supply wise. My patients have no pillows. Some of them do not even have an incentive spirometer so I have been improvising and teaching them exercises to help their lungs. Med surg rooms don't have any monitoring, there is no capability for continuous oxygen monitoring. Most rooms do not even have a clock on the wall to count patient respiration and I cant look at my watch because I have 2 isolation gowns on with gloves. They make a point to open every single door and lay eyes on every patient from the doorway during report as patients have been found dead when the nurse entered the room. 
A day in the life:
  1. Walk 20 min to the hospital and go straight to the nursing office to obtain my assigned location for the day (every single day) and sign in.  
  2. Head to one of designated locations where a bag with one surgical mask and one N95 mask are provided to each staff member as they sign a form stating they have received the masks. This is the only way to get an N95 mask. Most units have boxes of disposable plastic isolation gowns, hair nets, boot covers, surgical masks, surgical masks with connected face shields, and gloves. Permanent hospital staff seems to have thick disposable isolation scrubs they get from somewhere and they wear these all day, removing only to go home at night.
  3. Find your way to your assigned unit and hope with fingers crossed it is NOT an intensive care unit and that you have no patients that are too critical for your skill set and assigned floor. Usually after 7am until all this is completed....
  4. Get your garb on-- most important step, no one hurries this or skips this. Often happens before they even consider getting report
  5. Get your assignment and hope (and pray) that they don't change staffing and send you to another unit within the first 2hrs of your shift since you already have report on these patients. They are apt to do this as they discover some units only have one nurse etc. 
Garb for the day:
  • scrubs worn from home, no layering/ bare minimum as hospital is quite hot and I know what else I will be wearing. 
  • disposable scrub set (usually only permanent staff have this)/ sterile thick surgical gown. This is worn over scrubs from first getting to unit until leaving in the evening. 
  • masks (yes plural)- first your N95 then a surgical mask over it as you may need to reuse the same n95 multiple days. (thankfully, I have not yet had to reuse, but am saving them just in case). Some nurses I met have been wearing the same n95 for a week solid and were told by nursing office they had to do this. 
  • Hair net and shoe covers
Now I am ready to get report. When preparing to go into a room, I don additional garb:
  • plastic isolation gown (so hot, keeps body heat in)
  • gloves
  • additional surgical mask with connected face shield or...
  • additional surgical mask + plastic face shield worn on head. 
  • some ppl have goggles instead of the face shields - point is eye protection
Upon leaving the patient room, the outer mask, gloves, and gown are discarded. If a separate face shield is worn, this is cleaned and used all day long (these are like GOLD and are very rare to find). If there are not any face shields and there is only a few masks with face shield attached, then you keep that outer mask with shield until you are done seeing patients for a bit. 

 I have been overwhelmed with the appreciation from my patients, the desk staff and the hotel, the lady setting up to go breakfast bags for nurses in the hotel, the nurses at the hospital, and people in the grocery store. My patient told his mom on the phone that he had an awesome nurse from Ohio and that he may get discharged home soon. His mom was tearful and saying thank you thank you for taking care of my son. Some units have received meal donations for medical staff and this made my day as I had packed a peanut butter and jelly sandwich. One unit charge nurse walked around the unit about 4pm with a bag of snacks, candy bars, and cloth masks which her friends had donated to the unit for a pick me up.

As of now, I have not coded or had a patient die, but the other nurses here at my hotel that I met have all had both of the above happen multiple times. There are not enough IV pumps, feeding pumps, or anything really. One colleague reported giving blood by drip without a filter because there was none available. I had 2 patients who needed NG feeds to be able to be one step close to discharge. After 24hrs, there was still no feeding pump available and the attending urged me to try whatever I could come up with to get some formula running.

I included pictures of a contraption I rigged up to administer based on calculated drips per min and titrated as ordered to achieve certain mls/hr. The first couple ideas didn't work and leaked, but I got a good system in the end. Pleased to say the patient was off feeds in 2 days and transitioned to regular food and on room air as he had tolerated feeds and his bipap so well. The staff and doctors loved it and I set it up for another two patients in similar situations. I took a tube feeding set, cut the tubing off from bag and discarded tubing. I then used IV tubing (as it had a roller clamp and packaging states 15 drops/ml) and spiked the feeding bag. The next problem was that the NG was a tube that could be vented and fed through not just a normal tube that can only feed so the opening was wide and needed something wedged in. I thought maybe using a foley cath would be a good connector. I cut the IV tubing end that screws into and IV off and discarded. I then stuck the foley into the NG and the end of the IV tubing into the foley to connect it all and provide enough of a seal that it would not leak. I then calculated the number of drops per minute and through trial and error used the roller clamp to get as close as possible to the ordered rate.

Every evening I am exhausted and sore when I finally arrive back to my hotel room, but it is the best moment of the day because I can finally take off the mask and breathe!! My face can get some air! I try to call my mom or text her as she begins to worry if she hasn't heard from me in 24hrs. I have people here checking on me as well. When I had to work on a day my friends were off, they texted to make sure I made it home and another time they walked to the hospital just to walk me home and ensure I was safe.

I have met some other amazing nurses from other states and thankfully have been able to walk back and forth to the hospital with a few on most days. We have made a routine of stopping just before walking in and taking a few minutes to pray before we walk into utter caos.

Tuesday, April 7, 2020

Day 3- venture into my thoughts

First I want to shout a huge thank you to my friends, family, and entire community who have sent snacks, masks, love, support and prayers. I appreciate each of you! Now to the second question on everyone's mind.... no I do not have a fever and I am currently healthy and well!

I was able to have my first day on the unit moved to Wednesday as I have a few more weeks of class to finish up my masters program and hopefully graduate in May 3rd!  I have class every Tuesday from 9am to 3pm but due to current circumstances it is all online. The other nurses that I met yesterday all had their first day today or tonight. As of now they seem to be doing well and have texted updates that they are alright so far! I look forward to hearing updates as I mentally prepare for tomorrow. From what I understand after yesterday, I will not know ahead of time what unit I will be assigned to, but will have to report to the nursing office each morning to be notified of where I will be that day. As of now, I do not have any idea of my schedule except that I am contracted to work 4 days a week for the next 6 weeks on day shift 7a-7p.... and that they will allow me off Tuesdays for the next 3 weeks.

Over the last few days, I have had some time alone in this hotel and empty town to think about what it means to be a hero, as well as the definitions of  bravery, fear and worry.
  • fear: an unpleasant often strong emotion caused by anticipation or awareness of danger
  • worry: give way to anxiety or unease; allow one's mind to dwell on difficulty or troubles
  • hero: one who shows great courage; a person admired for achievements and noble qualities
  • brave: ready to face and endure danger or pain; showing courage.
Sunday night once I arrived in the hotel I was thinking about Monday morning and what it would bring. Reflecting on my emotions and feelings regarding all the encouragement and support messages that I had received and what was said about me. The words listed above had been circling around in my mind all day. below is a picture of a devotional reading (from Jesus Calling) that helped me refocus my thoughts and calm my mind in preparation for Monday morning.

Monday, April 6, 2020

Day 2

Good afternoon everyone! I'm typing this up on my lunch break but wanted to share. I arrived safely at my hotel last night and took and uber to work this morning. I've included a picture of the plastic that the uber drivers have tacked up to protect themselves (makes for a hot stuffy ride in the back).

The streets are mostly empty of people with a few here or there. There are some cars on the road but nothing compared to normal NYC traffic. Everyone is wearing mask from people shuffling down the street to everyone on the hospital campus. I saw a man walking down the street with a surgical mask pulled down and a face shield on as he was drinking coffee under the face shield.

I've also included a picture of orientation and paperwork session with social distancing, they had us each sit at a separate table. We were hood-fit tested which was a new process for me. In Ohio, medical personnel are tested with a machine to measure particulates inside the mask and outside to ensure an N95 mask fits the employee well and protects them adequately. During this fit test, we were told to place the hood on our head and an aerosolized substance was squirted inside the hood. Once you tasted the substance (it was nasty) you could remove the hood. Then we had to don the N95 mask replace the hood, and the substance was again inserted inside the hood. We had to walk around and move our heads and speak for a few minutes to see if the mask prevented us from tasting the substance (adequate mask fit) or if it did not (not a good fit).

Sunday, April 5, 2020

The beginning

Flying to NYC to start work as an RN tomorrow morning. This is surreal. As I am sitting in DC at the airport (below) and NYC La Guardia airport (above) there is no one in sight except airport employees. Some people are wearing masks while others have gloves. My flight from Ohio had 16 people and about half were flight attendants and pilots headed elsewhere. 

Upon arriving at the hotel, I was given a welcome bag with a granola bar and water and this card shown below.