Before becoming a certified registered nurse anesthetist (CRNA), I was a surgical intensive care unit (SICU) nurse for decades. During that time, I often saw patients during their greatest time of need – trauma victims, transplant recipients, patients with brain tumors, ruptured aortas, and septic shock. I thought I had seen it all, but working in an improvised COVID-19 ICU has taught me to expect the unexpected, and has required me to apply a lifetime of didactic and practical experience to ensure the best possible outcome for patients.

The floor I am working on has been transformed for COVID-19 care. The 12-patient ICU I am working in now was formerly a six-room floor. Every room now houses two patients. The beds are turned with patients’ feet facing the back wall, so the important tubes, lines, and wires are visible to the care team through the window in the door.

Ventilators are also angled for optimum visibility. The intravenous (IV) pumps are kept outside the door so that drips can be titrated without us having to don full personal protective equipment (PPE), which needs to be conserved. Multiple extension sets drape from the patient to the pumps. At the far end of the room, a large HEPA filtration unit sits by the boarded-over-window and an industrial HVAC duct snakes from the fan through the plywood to make a negative pressure space.

My shift starts at 6:45 p.m. every day. I’m volunteering to cover 12-hour shifts six nights of the week because the need is that great. I wear the same N95 mask and face shield for the entire shift. My role is multifactorial: a resource for medications and titration, proning specialist, airway management, respiratory therapist, central and arterial line placer, CXR reader, 12 lead EKG interpreter, trash emptier, and hand holder for all patients.

There is an attending physician covering several ICUs, and a hospital nurse practitioner mans the computer to write notes and enter orders. Four nurses, who were floor nurses last month, are now heroically caring for these critically ill people. If we’re lucky, an ICU resource nurse is assigned to help.

We round on all patients in the first half-hour or so. A list of priorities is developed according to the goals of care for the shift, and we all hit the ground running. It’s not a well-oiled machine, but it is as close as we can get. I check in with each of the bedside nurses to let them know I’m here to help.

The rest of the shift consists of ventilator changes, respiratory mechanics, peak pressures,  plateau pressures, driving pressures, P/F ratios, ABGs, proning, supinating, suctioning, EKGs, QTCs, dysrhythmias, electrolytes, A-lines, pressors — a second pressor — a third, propofol, dilaudid, paralytics, blood sugars. Then, insulin drip, bicarb, steroids, microemboli, heparin, Lovenox, TPA, code. Call families. Hold a hand. A new admission.

It’s nonstop. The team is great. We encourage the bedside nurses to take a break – drink a few bottles of water, use the bathroom – saying, “We need you healthy and able to come back tomorrow night. You’re an ICU nurse now.”

Around 5:30 a.m., we update the windows on the patient doors with a dry erase marker. Our markings tell the story of the night.

At 6:50 a.m., the team members for the next shift start to arrive. It’s a relief when all members return, and none have had to be quarantined or tested positive for COVID-19.

As the sun starts to rise, I change out of scrubs and back into street clothes. I go back to the hotel. Decontaminate. Wash everything with bleach spray. Eat. Pray. Sleep. Hopefully, I won’t have any nightmares.

The next day, it’s the same routine. But I keep going. Not because I’m a “health care hero” – please don’t call me a hero. But because I’m a nurse, and that is what nurses always have done and will continue to do.

The author is an anonymous nurse anesthetist.

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