Second Year of Nursing

- a husband and wife admitted to icu, positive for covid after sending their two teenagers back to school when it opened. She coded and died yesterday. We wheeled her body into his room so he could say goodbye to his high school sweetheart from his hospital bed. We dont expect him to survive.

- 94 year old man, married to his wife for 64 years, both tested positive after a single visit to their dentist. It was the only "outing" they had since March. Because there are so few beds available, they were sent to separate hospitals. She stroked and died shortly after. He watched her funeral on FaceTime and never got to say goodbye.

- a 25 year old who flew home from another state because his mom was afraid and asked him too. He tested positive 3 days after his flight. He died 20 days later in our ICU.

- a father/son duo who run a manufacturing company, tested positive along with the majority of their employees. They both came to our ICU. Dad died. Son was able to leave the hospital 30 days later - he learned of his father's death after leaving, for fear of impacting his recovery.

- A schoolteacher, working for special needs children, tested positive 1 week after her school mandated they reopen. She died 10 days later. Her last words before we intubated her were, "Im going to be your next survivor!" We told her she was right, but we all knew it wouldn't happen.

- a 45 year old woman with a 6 and 8 year old at home. After 65 days, she never woke up due to hypoxic brain injury. She never made it off a ventilator.

- tiered nursing models, where ICU patients are being cared for primarily by nurses without ICU experience while one ICU rn gets placed as a "supervising" nurse over 5 ICU patients, and monitors the regular nurses care over them. Your loved ones not getting the appropriate level of care deserved because we have no staff left to care for them.

- patients who should be in ICU unable to come to the ICU because there are no beds available. Left on the regular floor in hospital with no additional supervision or coverage because there's not enough staff to do so.

- patients that have been sent from out of state because their home areas have no room to take them. When these patients are close to end of life, their families are hard pressed to arrive in time to say goodbye.

- a unit opened as a tiered-staffing ICU where there is no negative pressure in patient rooms and no way to install them per maintenance. Nurses are going to be required to wear PAPR during their entire shifts without taking them off while working in that unit. So 12 hours without drinking water or eating unless you can leave the unit. Which it being tiered staffing - its not safe for the ICU rn to leave because there will only be 2 ICU nurses on the unit.

A group of 6 guys in their 30s/40s.  Low income essential workers all living in a 2 room apartment.  4/6 ended up hospitalized. 3/6 died.

A woman in her 70s who was infected at the funeral of a family member who died of Covid.  She survived but was in the hospital for nearly 3 weeks.

A married couple in their 70s.  Married for over 50 years, still independent before admission. Both infected, we put them in a room together.  He got better and was discharged home to stay with one of his kids next county over due to residual weakness.  We just kept trying to wean her oxygen but couldn’t though thankfully she wasn’t intubated so she had to stay. Found out a week and a half later he relapesed and died in another hospital and the kids didn’t want to tell her yet.

Guy in his 30s with no previous health history.  Our first ever to come off the vent.  But stuck with us for a couple months total back during the first spike. Talked to his wife so many times while she was in tears unsure how/if to tell him that his mom and uncle had both died while he was sedated.

Had a fairly healthy man in his 50s with grandchildren, literally the sweetest man in the world. Took care of him while he was on high flow, looked like he was getting better, then a week later, he’s delirious from hypoxemia and continued ICU stay, on BiPAP, screaming through the mask begging for air. Despite meds to calm him down, despite a sitter, despite everything, he died. I still hear him screaming sometimes.

A couple in their 80s. She wasn’t doing well from the get-go, intubated in ED. He got brought up to me for intubation, which got pushed off because “he looks okay right now”. We put them in a double room together. He told me, “Please take good care of her.” For a minute, he looked like he might make it out. Then he had a respiratory arrest and didn’t. She died the next day.

A man in his 30s, healthy, intubated. Became progressively more hypoxic, then blood pressure tanked. We pushed epi every ten minutes just to keep his blood pressure up high enough for his family to get there to say goodbye after we coded him. His mom was on speaker phone, at home with COVID too, unaware that her son was even sick with COVID or in the ICU on a ventilator. I can hear her wailing over the phone when his sister told her the news.

A week later, the same young man’s dad, in his late 70s, wound up in the ICU on BiPAP. Decompensated. Intubated. Put on CRRT. Family eventually made him a DNR because things looked bleak. He was maxed out on every pressor. Died while the nurse was giving him a blood transfusion.

Woman in her 30s, only history of hypertension. Early intubation, thought she might be a good candidate for ECMO. Transfer center had everything set up. Then she crumped. Too unstable. Lost her window. No more transfer. Died peacefully at least with her family on FaceTime.

Older gentleman, long, long stay at our hospital. Intubated. Family needed to decide between trach/PEG or comfort measures and decided he would never want to live in a facility with a breathing tube. Family didn’t want to come in. He died five minutes after the breathing tube was out, me holding his hand, his last human contact on this earth.

I remember extubating my first COVID patient. He cried after the tube was out. I cried too, because he was our first success and I was overjoyed to be part of it. He spent another two weeks in the hospital and two more at Rehab. He’s now at home with his family, but he wears oxygen and moves a lot slower. He’s the only patient I’ve had that was successfully extubated with no re-intubation or trach.

My own grandma, 92 years old with arthritis and dementia, got COVID from her nursing home. I asked my uncle - her decision maker - how far we were going to take this. If we would put her on BiPAP, if we would intubated her, CRRT if her kidneys failed. He decided it wouldn’t come to that, but we probably shouldn’t do those things if it did. She started out on room air, then 2 L NC, then 4 L, then 6, then high flow, and when they maxed out the high flow and her arthritis had her screaming in pain and agony, he decided it had come to that point. She was on comfort care for three days. The last day my mom wanted to go see her, but my mom is in her 60s with her own health issues, so I was hesitant. My mom said she might go see her later in the afternoon after she checked in with the nurse. The check in with the nurse was the nurse calling my mom to let her know that my grandmother had passed. With the nurse at her side, but still, alone, without her family. That shakes me to the core. I’m messed up over that.

Sharing this because:

Many teachers on this platform would benefit from this info.

This isn’t Canada-specific, but with all the mask discourse on your blog lately, I saw this Twitter thread earlier today that shows how we can all push for increased mask wearing without relying on public shaming, anger, and enforcement (the last of which will almost always involve more police).

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