PANDEMIC
Anna is on call today, and comes to talk to me about a patient I had seen yesterday. He’s one of our chronic patients, a sweet little older man, but riddled with comorbidities. He had recently returned from getting a medical procedure done in Edmonton, and had come to see me about his insomnia.
“He was doing alright,” I tell her. “He didn’t complain of anything except the insomnia. He was breathing a little hard, but that’s his baseline.”
Anna knows this patient well from many years of working in this community. “Yes, he looked good yesterday,” she agreed. “I even chatted with him when he was coming out of your office. But his family says he’s gone completely downhill – hallucinating and acting weirdly. They’re bringing him in now.”
I tell her to get me if she needs help, and I head off to draw bloodwork on all the patients booked this morning.
--
I walk past later to see Anna wearing a protective gown and an ill-fitting N95 mask.
“I think he’s going into septic shock…and I’m wondering if he might be a COVID case. Come look at his xray.”
I follow her to look at the image, where big infiltrates have whited-out much of his lungs on the screen. We exchange an anxious look.
“He’d be in that window of travel…he got back from Edmonton just over a week ago. But he’s had no symptoms.”
“I know,” she says. “He didn’t have any symptoms before, but he just spiked a fever. And there are petechiae all over his body today. I’m worried his blood is clotting abnormally. We’re going to medevac him.”
--
Twenty minutes later, I hear Anna yelling for me from down the hall.
“Gen, I need you in here. He’s arrested. Make sure you gown up before coming in here.”
I look at our measly box of masks and face shields and put on what little we have. The mask is huge, and there’s a massive gap underneath my chin, but there’s nothing else to use. I run in to take over CPR as Anna calls the doctor to run this code over speaker phone. We call in everyone and have just enough nurses to manage the airway and push medications.
Our little team does pretty well in a pinch, but I suddenly miss my ER team at home, which is a pretty well-oiled machine when it comes to running arrests. Here, our two minute pulse checks are a little haphazard, and everyone isn’t quite as familiar with the crash cart. I try breathlessly to explain to Myra how to prep the syringe of epinephrine as I pump away at the patient’s chest. When the doc asks what rhythm is on the cardiac monitor during our next pulse check, no one else is quite sure, and I thank the Lord that I recertified my ACLS a week before coming up.
“It’s an idioventricular rhythm,” I tell her. “We’re running a PEA arrest. We can’t defibrillate this, so we’ll continue CPR.”
I rotate back in for CPR, and feel that familiar sensation of a sunken-in chest beneath my hands. I’m sure we’ve broken all his ribs by now. We’ve been working on him for thirty minutes, and as our team looks around at each other, I think we all know there’s not a chance we’ll get him back. Considering all the comorbidities he had, I’m not sure we had a chance to begin with.
His wife comes into the room, and we continue working on him just a little longer, to give her a chance to process the news and say goodbye. We finally stop, and I watch her huddled on the floor next to him, her body shaking with anguished sobs. We can’t even let any other family into the room to keep from exposing them.
The regional infectious disease doctor calls us back later that day to say he thinks it’s unlikely to be COVID, but we won’t know until the swab result comes back. Nunavut is still free of cases for now, but once COVID reaches here, it will spread like wildfire. The Inuit communities have had a long history of being completely ravaged by infectious disease like this one, and I pray that today’s arrest will not be a representation of what is to come.
-------------------
When I finished nursing school in 2015, I went off to Nepal for two weeks to do a medical placement. The two weeks were eye-opening and a wonderful experience, but nothing quite prepared me for what happened on our last day. As my friend and I were travelling on a little bus up in the mountains to fly home from Kathmandu, the country was hit with a massive earthquake that killed 9,000 people and injured tens of thousands more. After a few tense days navigating the devastation in this little country that was almost completely destroyed, we managed – with the help of many generous, kind people – to find shelter, stay safe, and still make it home.
As international travellers all scrambled to book flights home, I heard stories of friends who decided to stay. Little groups of people gathered together to travel towards the epi-centre in the immediate aftermath, to isolated villages while the country was still being shaken with aftershocks. The situation was so volatile that international humanitarian aid groups were still assessing the situation before they could safely send their staff in. But these groups knew that there was no time to wait to bring first aid and supplies to these people, so they ventured in, with full understanding of the unknown dangers that lay ahead of them.
With a plane ticket home already arranged, it would have been foolish not to leave, but I think I have always been haunted with this question: if I’d had the opportunity, would I have gone with them? I can still keenly remember the fear and desire for self-preservation that blanketed me during those days. Sometimes I still wonder if I would have been too selfish or afraid to go.
--
We have known for months that at the current rate of spread, we don’t have the resources to keep up with COVID-19. The shortage of personal protective equipment is coming much faster than our politicians would have us believe, and we are already trying to ration masks on the frontline. Around me, I see the posts and comments from frontline workers protesting this, drawing on legislation to say that they cannot be mandated to work under unsafe conditions. And it’s true – no organization can or should force their staff to walk into known danger.
We can demand that our governments and employers give us the supplies to work safely, but the sobering reality of finite resources is this: if we don’t flatten the curve soon, we may find ourselves in a world where the shortage is something no one can solve. When we run out of masks and gloves and gowns, we may have to decide who still goes to work unprotected. When we run out of ventilators, we have to choose who stays on and survives, and who will be left to die. If one day, we find ourselves in a world where there is no way to care for patients safely, then the question that looms overhead becomes a deeply personal one for each of us: Should I go where I am needed? Will I go?
Yesterday, a priest in Italy, who had given up his ventilator for a younger patient, died of COVID-19. Not all of us will be called to great heroic acts, but equally important are the daily moments when we ask ourselves: what are we willing to give up for the people around us, both those whom we love, and those who are complete strangers? It could just be one less trip to the grocery store, resisting the urge to hoard supplies, one more day in obedient self-isolation, or venturing out to donate blood. I hope we all hear the voice calling us to sacrifice a little for the good of everyone – and perhaps, this will be the only way we will make it through.
-------------------
I am sitting at my desk catching up on my charts that had been thrown aside during this morning’s arrest when I hear someone come into my room. I assume it’s one of our support staff members doing her afternoon round to clear my garbage and shredding. I’m right, but as I turn around, I’m thrown to see her holding her face and sobbing uncontrollably. I close the door and sit down with her quietly.
“I just saw the police officers by the emerg room and the wrapped body, and all I could think of was my daughter again,” she cried.
I wasn’t here when it happened, but just two years ago, her daughter had gotten into a terrible accident. The RCMP had brought in her daughter's mangled body to that very same emerg room, and the resuscitation had been unsuccessful. Through her tears, she tells me about all the family she’s lost over the last few years, leaving her with just her granddaughter.
“When I was little, I looked up to my grandma so much. She lost almost everyone, but she was always strong and brave and took care of us. I told myself I wanted to be just like her. But some days, I just don’t know how. The pain is so unbearable sometimes that I don’t want to live anymore. I can only hold onto my granddaughter – she’s the only thing giving me hope.”
My heart is still raw from the patient we lost this morning. I gently remind her what a pillar of strength she is for her granddaughter, just like her grandmother once was for her. But I am helpless to offload this indescribable pain from her, so all we can do is sit and hold on to each other.
--
The next morning, I come to work to find a little crocheted angel on my desk and a note.
You’re an angel sent to me, Gen. Thank you for listening when I needed to cry.
I am humbled and floored by this gesture. Sometimes the weight of this job feels so heavy that all I want is to go home and not have to shoulder any of it. But time and time again, I find myself being asked to just show up for people, and stop fearing the pain and discomfort that comes with walking beside them.
When the time comes, and life asks me if I am willing to serve people where they are afraid and lonely and suffering – even when it may be unsafe – I hope I will learn to say yes.
“He was doing alright,” I tell her. “He didn’t complain of anything except the insomnia. He was breathing a little hard, but that’s his baseline.”
Anna knows this patient well from many years of working in this community. “Yes, he looked good yesterday,” she agreed. “I even chatted with him when he was coming out of your office. But his family says he’s gone completely downhill – hallucinating and acting weirdly. They’re bringing him in now.”
I tell her to get me if she needs help, and I head off to draw bloodwork on all the patients booked this morning.
--
I walk past later to see Anna wearing a protective gown and an ill-fitting N95 mask.
“I think he’s going into septic shock…and I’m wondering if he might be a COVID case. Come look at his xray.”
I follow her to look at the image, where big infiltrates have whited-out much of his lungs on the screen. We exchange an anxious look.
“He’d be in that window of travel…he got back from Edmonton just over a week ago. But he’s had no symptoms.”
“I know,” she says. “He didn’t have any symptoms before, but he just spiked a fever. And there are petechiae all over his body today. I’m worried his blood is clotting abnormally. We’re going to medevac him.”
--
Twenty minutes later, I hear Anna yelling for me from down the hall.
“Gen, I need you in here. He’s arrested. Make sure you gown up before coming in here.”
I look at our measly box of masks and face shields and put on what little we have. The mask is huge, and there’s a massive gap underneath my chin, but there’s nothing else to use. I run in to take over CPR as Anna calls the doctor to run this code over speaker phone. We call in everyone and have just enough nurses to manage the airway and push medications.
Our little team does pretty well in a pinch, but I suddenly miss my ER team at home, which is a pretty well-oiled machine when it comes to running arrests. Here, our two minute pulse checks are a little haphazard, and everyone isn’t quite as familiar with the crash cart. I try breathlessly to explain to Myra how to prep the syringe of epinephrine as I pump away at the patient’s chest. When the doc asks what rhythm is on the cardiac monitor during our next pulse check, no one else is quite sure, and I thank the Lord that I recertified my ACLS a week before coming up.
“It’s an idioventricular rhythm,” I tell her. “We’re running a PEA arrest. We can’t defibrillate this, so we’ll continue CPR.”
I rotate back in for CPR, and feel that familiar sensation of a sunken-in chest beneath my hands. I’m sure we’ve broken all his ribs by now. We’ve been working on him for thirty minutes, and as our team looks around at each other, I think we all know there’s not a chance we’ll get him back. Considering all the comorbidities he had, I’m not sure we had a chance to begin with.
His wife comes into the room, and we continue working on him just a little longer, to give her a chance to process the news and say goodbye. We finally stop, and I watch her huddled on the floor next to him, her body shaking with anguished sobs. We can’t even let any other family into the room to keep from exposing them.
The regional infectious disease doctor calls us back later that day to say he thinks it’s unlikely to be COVID, but we won’t know until the swab result comes back. Nunavut is still free of cases for now, but once COVID reaches here, it will spread like wildfire. The Inuit communities have had a long history of being completely ravaged by infectious disease like this one, and I pray that today’s arrest will not be a representation of what is to come.
-------------------
When I finished nursing school in 2015, I went off to Nepal for two weeks to do a medical placement. The two weeks were eye-opening and a wonderful experience, but nothing quite prepared me for what happened on our last day. As my friend and I were travelling on a little bus up in the mountains to fly home from Kathmandu, the country was hit with a massive earthquake that killed 9,000 people and injured tens of thousands more. After a few tense days navigating the devastation in this little country that was almost completely destroyed, we managed – with the help of many generous, kind people – to find shelter, stay safe, and still make it home.
As international travellers all scrambled to book flights home, I heard stories of friends who decided to stay. Little groups of people gathered together to travel towards the epi-centre in the immediate aftermath, to isolated villages while the country was still being shaken with aftershocks. The situation was so volatile that international humanitarian aid groups were still assessing the situation before they could safely send their staff in. But these groups knew that there was no time to wait to bring first aid and supplies to these people, so they ventured in, with full understanding of the unknown dangers that lay ahead of them.
With a plane ticket home already arranged, it would have been foolish not to leave, but I think I have always been haunted with this question: if I’d had the opportunity, would I have gone with them? I can still keenly remember the fear and desire for self-preservation that blanketed me during those days. Sometimes I still wonder if I would have been too selfish or afraid to go.
--
We have known for months that at the current rate of spread, we don’t have the resources to keep up with COVID-19. The shortage of personal protective equipment is coming much faster than our politicians would have us believe, and we are already trying to ration masks on the frontline. Around me, I see the posts and comments from frontline workers protesting this, drawing on legislation to say that they cannot be mandated to work under unsafe conditions. And it’s true – no organization can or should force their staff to walk into known danger.
We can demand that our governments and employers give us the supplies to work safely, but the sobering reality of finite resources is this: if we don’t flatten the curve soon, we may find ourselves in a world where the shortage is something no one can solve. When we run out of masks and gloves and gowns, we may have to decide who still goes to work unprotected. When we run out of ventilators, we have to choose who stays on and survives, and who will be left to die. If one day, we find ourselves in a world where there is no way to care for patients safely, then the question that looms overhead becomes a deeply personal one for each of us: Should I go where I am needed? Will I go?
Yesterday, a priest in Italy, who had given up his ventilator for a younger patient, died of COVID-19. Not all of us will be called to great heroic acts, but equally important are the daily moments when we ask ourselves: what are we willing to give up for the people around us, both those whom we love, and those who are complete strangers? It could just be one less trip to the grocery store, resisting the urge to hoard supplies, one more day in obedient self-isolation, or venturing out to donate blood. I hope we all hear the voice calling us to sacrifice a little for the good of everyone – and perhaps, this will be the only way we will make it through.
-------------------
I am sitting at my desk catching up on my charts that had been thrown aside during this morning’s arrest when I hear someone come into my room. I assume it’s one of our support staff members doing her afternoon round to clear my garbage and shredding. I’m right, but as I turn around, I’m thrown to see her holding her face and sobbing uncontrollably. I close the door and sit down with her quietly.
“I just saw the police officers by the emerg room and the wrapped body, and all I could think of was my daughter again,” she cried.
I wasn’t here when it happened, but just two years ago, her daughter had gotten into a terrible accident. The RCMP had brought in her daughter's mangled body to that very same emerg room, and the resuscitation had been unsuccessful. Through her tears, she tells me about all the family she’s lost over the last few years, leaving her with just her granddaughter.
“When I was little, I looked up to my grandma so much. She lost almost everyone, but she was always strong and brave and took care of us. I told myself I wanted to be just like her. But some days, I just don’t know how. The pain is so unbearable sometimes that I don’t want to live anymore. I can only hold onto my granddaughter – she’s the only thing giving me hope.”
My heart is still raw from the patient we lost this morning. I gently remind her what a pillar of strength she is for her granddaughter, just like her grandmother once was for her. But I am helpless to offload this indescribable pain from her, so all we can do is sit and hold on to each other.
--
The next morning, I come to work to find a little crocheted angel on my desk and a note.
You’re an angel sent to me, Gen. Thank you for listening when I needed to cry.
I am humbled and floored by this gesture. Sometimes the weight of this job feels so heavy that all I want is to go home and not have to shoulder any of it. But time and time again, I find myself being asked to just show up for people, and stop fearing the pain and discomfort that comes with walking beside them.
When the time comes, and life asks me if I am willing to serve people where they are afraid and lonely and suffering – even when it may be unsafe – I hope I will learn to say yes.
This one almost had me in tears <3 thank you for sharing.
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