Into the Fire

by Jennifer Kelly

“Don’t tell a patient that it will be okay.” Our nursing professor strolled the aisles of the cramped classroom one hand clutching her cane. The walls were dusty pink, and we sat at rickety desks, the kind where you had to push a wad of cardboard under one of the legs to keep it from wobbling. The arms of the clock by the door were broken, frozen at 1:11, and a crucifix hung at the front of the room, a silent observer. It was my first day of nursing school, I sat with my head propped on my hand. Her words lingered in the air, shrouded in gravitas. Standing at the edge of my new beginning, I wanted to grasp any nugget of wisdom offered to me.

“It bears repeating.” She paused at her desk and half-sat on the ledge, “Don’t tell a patient that it will be okay. Or not to worry!” My eyes focused on the perfect crease that ran down the leg of her powder blue pantsuit. “You don’t know it will be okay. They are looking to you for comfort, for answers. You must be honest. Listen. Hold their hands. Be present.”

Eighteen years later, and I am so grateful for those words. Nurses teach each other through action in challenging environments. Some show their tender touch in a difficult conversation, or how nimble their fingers can be while inserting an IV, or how they can be an encyclopedia when a doctor questions them while running from the linen closet with fresh pillowcases and blankets or standing up to the Chief of Surgery to advocate for their patient. I learned early not to say it would be okay, and over time I learned how to listen, hold their hands, and promise no matter what I would never give up on them.

The first week of March 2020 brought the first COVID patients to our hospital. About a week later, the entire world shut down. It felt like a strange dream; we were all watching the horrors occurring in Italy and knew the tidal wave was coming; it was at our doorstep, and we couldn’t hold it back.

Time bent into a zigzag while our communities were locked in, no toilet paper or cleaning supplies to be found; shut into our homes we waited for the storm to pass that didn’t. By the end of March, the tsunami descended upon New York with Queens struggling to keep up with the volume of patients and death that came on so fast. Images of freezer trucks outside the doors of the hospitals on the news were gruesome and ominous. I was working from home in the IT department analyzing patient charts, working on performance improvement projects. We thought it would be for a few weeks, not the years it stretched into.

I remember our director getting on our weekly call with a somber tone. She usually had a voice that commanded confidence and warmth. Her voice quavered, “The hospital is requesting members of our team to go to the bedside to take care of patients. I will give them a list—they can rotate through the team, or I can take a group of volunteers.”

Most of our team was made up of RNs that work on chart review and quality improvement and have not touched a patient in years. But there was no pause in reply.

“I’ll go Donna, I’ll go.” A few of us were speaking at once.

I pushed my voice forward, “I’ll go.”

“Me too, I’ll go,” others chimed in.

There were about a dozen of us that stepped forward that day to spare our teammates from the unknown. Many of them had newborn babies, or someone they were caring for at home. We already had been talking to our colleagues on the frontline about staying at hotels, in basements, or garages to keep away from their families. New York City was the epicenter of the pandemic—we knew it was time; we heard the call. Fear bubbled under my skin, but my heart felt calm because I was listening to it.

Our little cohort quickly formed a text support group and did what nurses do—we shared practical information: where to order scrubs, where to find Lysol to spray our shoes since most stores were out of supplies. We texted pictures of our decontamination stations in our doorways and talked about how we were dealing with our loved ones and our wishes if something happened to us.

We had no idea what we were in for and even though we had taken care of highly infectious patients before, back then we had supplies, protection, and knowledge about transmission. There was no shortage of gowns, masks, and gloves. We filled trash bins with these materials every time we left an isolation room. That was before COVID. In a moment we were at the inflection point of BEFORE and AFTER to mark the shift in our reality without knowing how far it could stretch.

The morning of my first shift arrived with haste. I forced my cereal down. A chill sprouted on my skin I couldn’t shake. I was going to a hospital in Queens, right into the burning building. I prayed on my drive there, “God, please walk with me today, please help me take care of them the best way you see fit. Please don’t let me get anyone sick when I return home.”

The roads were empty by JFK airport at six o’clock on a Tuesday morning. It was desolate, like one of those post-apocalyptic zombie movies. No traffic on the Van Wyck, no tolls to be paid at the drawbridge. Just a handful of cars were on the road, as the only people allowed to be out at that time were ‘essential’ workers. It was eerie and unsettling, my stomach flipped again, not with butterflies, but angry hornets.

I met my coworker in the lobby; it was her first day too. She was brighter and calmer than I could pretend to be. We reached the Command Center, a conference room with people seated around a long oval table. There were boxes of isolation gowns, gloves, and wipes strewn all over the room. Phones were ringing, laptops were out and there was a whiteboard with my name scrawled in black marker.

A tall, smiling man in a wrinkled suit that said he spent the night in the conference room approached, “Good morning, ladies! Thank you so much for volunteering. Where are ya from? Did you bring scrubs?”

Tanya and I looked down at our sweats, we did not. I ordered some, but it would still be another week before they would arrive, everything was so backed up.

“You can’t send them up there in their own clothes.” Another voiced chimed from behind a laptop.

“You’re right, let’s call the OR they must have scrubs.” A short while later he walked us down the long corridor to a locker room, gave us the punch code for the door and got us set up with scrubs from a vending machine. “Let’s see if Sarah can get you something to cover your hair.”

Sarah was seated in what looked like a closet across from the locker room with piles of paper, shoe covers, and boxes of masks.

“Hiya Sarah, do you think you can find a couple of surgical caps for these two nurses?”

“Hmm, lemme see.” She folded her body into a bin behind her to look around. Her arm emerged with two caps in her hand, success!

“Keep this, you can put it in the wash, but not the dryer.”

My lips began to move but stunned shut—these were the disposable surgical caps that felt like paper. She handed me a pair of shoe covers.

“Tanya, you’re going to the ED, Jen you’re going to 11N, the elevator is down this hall on the right. Good luck ladies, thank you again for coming,” he said.

Tanya and I exchanged a small wave, and I started down the corridor alone. The elevator ride was the longest and shortest I ever experienced, a dissonant ‘ting!’ and the doors opened.

The unit was chaotic—a cacophony of activity, nurses were scrambling to hang meds, calling out instructions and requests to one another hurrying down the halls while shrill alarm bells rang. Organized chaos on a busy medical/surgical unit is not unusual, but this was scary—the lights were even flickering in the hallway, stray gloves lying on the floor, and the smell of bleach and illness coalesced in my nose. Groups of clinicians all with different masks and coverings, some of them wearing gasmasks, plastic face shields, entire helmets that made them look like astronauts hurried down the corridor. Everyone was covered, not one inch of skin exposed, except for me. I had a red surgical cap, a blue surgical mask, and paper fabric shoe covers. I rubbed my arms to slow the gooseflesh. I approached the nurse’s station and asked for the Charge Nurse.

“Are you a nurse?” A woman who identified herself as Charge greeted me with her eyes through all the layers of protective covering.

I nodded. She motioned for me to follow her to the medication room where there were isolation gowns under lock and key. She handed me a gauzy yellow gown.

“You have one for the day, unless it gets soiled.” She found disposable goggles for me. “Use a bleach wipe for these and keep it safe for the rest of your time with us. And what size N- 95 do you wear?”

I struggled to clear my throat, still processing ‘one’, “Small.”

“You’ll get one for the day.”

My stomach tightened. These items were things we never would have thought twice about throwing out after each trip into a person’s room, not the shift. This moment solidified the feeling that I would be radioactive to those in contact with me outside the hospital if I did not decontaminate properly. The hospital was one giant isolation room by now, all COVID patients this first week of April. There was a makeshift unit in the cafeteria. There were hospitals being created out of tents and athletic fields to help triage patients and care for more stable ones across the city.

We were on a pop-up unit that was no longer in use by the hospital but had through the miraculous relay of dedicated staff and volunteers transformed overnight into a bustling medical floor treating COVID patients. We were a team with no history, no relationship, coming from various departments and even volunteers from across the country, but had a shared mission.

I found a vital signs machine and box of thermometers and went into the patients’ rooms to take their blood pressures and perform assessments. I saw the same scene in every room: patients flipped over on their bellies, prone, the hissing of oxygen reverberated throughout the unit. They were wearing non-rebreather masks, the oxygen turned up all the way.

All of them.

The sight was stunning—I never saw so many critically ill patients on a medical floor. Ever. I never saw families in the same room as patients together. Couples cohorted together, both ill at the same time. Proning patients, turning them on their abdomen to expand their lung capacity was the norm, not the exception. The patients were not well enough to complain about the noise, the food or their televisions not working. I would have welcomed a complaint, a sure sign that they were feeling better. The ones well enough to speak gripped my hands, fixed their gaze on my eyes, and begged for more oxygen, cried for more. They were terrified, and we were helpless to comfort them. We let them know we were there—we wouldn’t give up on them. And we didn’t. We were at war together fighting for these patients and we felt like we were losing.

We lost so many that first day. I worked alongside a nurse that lost at least three of her patients in one shift. We had a woman die in our arms as her husband also sick looked on in fear and shock. The scene still haunts me; an elderly couple arrived early in the evening. She had bright eyes and a warm smile and just a short while later her chest and cheeks were puffing unable to get enough air. The oxygen was hissing, and there was a group of us working to get her turned prone on her abdomen, performing Chest PT, a percussion technique cupping our hands to bang on her back with the hope of opening her lungs and bringing her oxygen saturation up. Her nurse reminded us that she was DNR, we couldn’t do chest compressions, no extraordinary measures if she lost consciousness. We struggled to turn her limp body over; we were losing her.

I was at her feet, my fingers palpated the top of her left foot, I couldn’t feel anything. I went deep into her ankle. “I don’t have a pulse!” It was as if her soul slipped out of my fingers at her feet.

The doctor also moved to her carotid, defeated he said, “She’s gone.”

Her husband sat at the edge of the bed, his legs dangling, his non-rebreather mask tight on his face, a cloud of fog inside the mask watching his wife. An alarm blasted overhead calling the team to the next fire, my heart ached for him.

The pace was so intense that we did not have a moment to process, there was another alarm down the hall, and it would repeat. The patients who were well enough to speak could hear the codes announced overhead and asked, “What is that? What’s happening?” The code announcements were never ending: RRT, CAT, RRT, CAT, STROKE TEAM that seemed to be a loop. The calls also came from our unit. The response team was there all the time moving from one room to the next. A voice would come through the loudspeaker, and we would freeze, bracing ourselves in whatever task we were doing to hear where the fire was, praying it wasn’t one of the patients on our unit. Five years later, I can still hear the ringing alarms and hissing oxygen in my ears. We fought hard, saved our tears for car rides home and showers to wash away the days that wouldn’t leave us.

On my second day, I was transporting a patient to the step-down unit, I was joined by a transporter so we could maneuver the stretcher together. The transporter was a calm presence; 9 his large hands gripped the stretcher. We wheeled our patient to her new unit and helped the nurse set her up, connected the IV, the oxygen, all was well, and he and I left the unit together. I carried the oxygen tank to the elevator.

“I’ve never seen anything like this,” I said.

His eyes met mine through the double mask, surgical cap and gown, there were tears there. “Yesterday, for twelve hours all I did was transport bodies to the morgue.”

Overhead the cardiac arrest code went off for the unit we just left. Our eyes locked—we were silent, but could feel the same thought, ‘Was it her?’ We parted ways and I never saw him again.

We thought of the patients still alive, but barely, who would die without their loved ones by their side to say goodbye and stroke their hair one more time. Nurses and doctors talking about how sad and frightening it all was, offering words of comfort to each other at the nurses’ station and then shaking it off to go back into the fire. We had never been so open in the BEFORE. BEFORE, you had a friend on the unit that you could talk to in the privacy of the medication room or the linen closet for a few minutes and then pretend it was all okay when you went back out there. The uncertainty and darkness in those early days were so intense we took comfort in the brief moments we had with a group of strangers that became a team overnight fighting to hold the light steady.

A couple of long weeks later we began to discharge patients. Overhead, they played Don’t Stop Believing when someone was discharged, and everyone would stop to cheer and clap them out of the unit, down to the lobby and out the front doors of the hospital. COVID brought us to our knees, but we picked each other up, all strangers, we became a team reaching our hands out to help each other across a finish line we couldn’t see.

At seven o’clock in the evening, the wailing of sirens and applause, the banging of pots and pans, air horns and cheers would greet us in our communities. They had no idea what we saw, but they knew it was terrible and cheered us on with their love. It moved us. My time on the unit lasted only a few weeks in those awful early April days, yet writing these words teleports me there. That acute period, the DURING imprinted me. I think of the nurses who are still on the units years later, tired but resilient. They keep showing up, keep holding hands, not ever giving up. It is the commitment we made when we raised our hands in a promise to our patients and before God. I think back to my first day of nursing school and remember something else my professor said, “You will always be a nurse no matter what you do, even if you move away from the bedside. Wherever you go, whether it be another country or a backyard party, nurses always find each other—it’s the bond we share because of what we’ve seen, battles we fought, and those we had the honor to care for.”

Note: All names and identifying details have been changed to protect the patient's, families' and coworkers' privacy.

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