Column: Through the eyes of an ICU nurse
today at 11:05 am
The below column is written by Francesca Altobelli, an ICU nurse in the suburbs of Chicago
Every day, now more than ever, I contemplate life. All the added questions I have now, as if I didn’t have enough. Questions I never thought I would ponder, especially being 23 years old. How can I keep the people I care about safe? Will my dad walk me down the aisle at my wedding? Will my mom help teach me how to be a mother? Will my brothers all get the chance to hold my future children? Will I get the chance to hold and spoil theirs? Questions with answers that we all just assumed we were originally entitled too. But in a time like this, I learn now more than ever, that every day is a blessing. Maybe even for you, more than me and my experiences.
It’s hard to fathom it was only a couple years ago I was sitting in a cold blank silent room with no noise aside from my own heartbeat as I sat to take the Nursing Boards. I didn’t know what was worse— having the muffling head phones off to hear everyone’s anxious clicking to answers or to have the muffling headphones on that only made my heart beat more intensified.
It was a time when I thought that would be one of my biggest challenges to overcome in my life. When I passed the boards, I would have never thought I would be blessed enough to be an ICU nurse right away. Almost two years later, I have experienced more hardship than most encounter in their whole nursing profession in the midst of a global pandemic.
This needs to be heard.
This isn’t what any of us expected. We are greeted at the door with a thermometer and mask, we reinhale our own exhaled stale CO2 all day long and stand in the presence of the sickest patients ever imagined. Witnessing a husband speak to his wife through a phone to tell her he thinks this will be the last time they will talk, takes a toll. I have had a patient grab my hand begging me to be intubated so that his misery would cease to exist, when I stand there knowing his chances of getting off of a ventilator are slim. I have stood gowned up in a hot room for 4 hours cleaning a patient’s repeated incontinence, then assisting to intubate him, and then waiting in the same room, in the same gear, for needed emergent medications. I stood in that same room titrating the medications all while praying he wouldn’t code on me. I stand in those man-made negative air pressure rooms praying they are actual negative air pressure rooms. I stand in those rooms that are so loud that I have no choice, but to put my head close to my patients face so I can hear what they are saying. I stand in those loud rooms needing to write on a white board when I need someone to bring me something because they can’t hear me through the door. I have prayed outside of patient’s rooms hoping they would not code so my co-workers and I wouldn’t have to compress someone’s chest compromising our protective equipment breaking off or shifting off our face.
Death. A hard topic to discuss. A hard topic to grasp. A topic with no proper explanation. But a necessary topic to survive in the medical field. Death for us is different, especially for a critical care nurse. Death becomes our enemy. Death becomes our war. I have seen more death in the past three months than I have seen in my first year as a nurse.
Our nursing reports and goals are simple now- Keep them alive. How do you even pick the “sickest” patient to see first?
The truth is dark.
I haven’t met one individual that I work with that doesn’t love their job. It’s true, we love what we do; an unexplainable love for the job and for each other. Something I personally wouldn’t trade for the world. Every nurse in the world would agree that we signed up to help people, put others first, make them healthy again, advocate for them in their times of need, support them in their times of doubt, and lift their spirits in their moments of defeat.
But there is a sad certainty; we don’t wish to see you at our work. The second someone roles up on a stretcher to an ICU means we are their last option- their last possible remedy for survival.
Sometimes we feel like someone’s last glistening hope. Other times we feel stoic or heartless sharing yet another poor prognosis with pure honesty. It’s one thing to share bad news to someone’s loved ones in person where you can comfort them, hug them, touch their shoulder, but it’s another to share the unexplainable rationale of last efforts, complex medical information, and unbearable news through a phone call. I have entered dying COVID-19 positive patient rooms just so a phone call could be transferred to allow the family to say their goodbyes through a phone. We are likely to be strong, gentle, compassionate, but honest all at the same time. Expected to share information without fogging the truth, yet feeling brutal when that was our last intention. But who are we to take away families hope for a miracle? But who are we to allow the family to feel unprepared for their possible loss of a loved one? We are your loved one’s lifeline to you.
The second we step foot into the hospital we lean on each other, support each other, stand by each other in moments of literal impossibility. We need each other now more than ever to cover everything that needs to be accomplished in a shift. Every person in that hospital plays a role and a vital one. Yet, we go home every day and have moments of feeling the opposite. Like all our efforts were not enough to change an outcome.
Being an ICU nurse has taught me more about myself than I thought I even had to learn. It taught me it is possible to be strong and weak at the same time. It is possible to be put together and lost simultaneously. It is possible to be smart and still have the world of knowledge to absorb. Bottom line is, we are just as human as everyone else.
ICU nurses are trained to be quick to think, unbreakable under pressure, and precise. It is strange what comforts one person can cause another one to panic. We titrate your medications, we clean you, we sedate you to make sure you aren’t in pain, we paralyze you to give your body optimal compliance with the vent, we assist the doctor who intubates you or puts central access in your veins and arteries, we flip you from your back to your stomach all the while you’re limp from medications to oxygenate your deprived lungs, we watch your dusky cyanotic skin return to pink perfused skin, and even when you can’t talk or open your eyes, we hold your hand.
They always teach you risk versus benefit. Does the benefit outweigh the risk? With this disease it’s unclear. Now it’s also risk to others of exposure versus risk to the patient.
Too many machines, too many alarms, too many medications, too many failing organs. Alarms that we normally jumped for, but now it’s the new “norm”. Interventions could be done, but are you even stable enough for those interventions?
Your pupils are now unequal. Could be a hemorrhage? Now you need a STAT CT of the head. But you’re on too many life supporting measures- a ventilator, nitric oxide, and oscillator to help you breathe, a tube in your nose giving you nutrition, five to ten medications running through your veins to maintain your vitals, a cooling blanket to lower your uncontrollable fever that’s resistant to Tylenol- risking a transport to a CT scan could be risking your life even more. We gown up and enter your room again anyways. We adjust your vent settings even more to attempt to increase your oxygen. Your heart rate drops. Push atropine. Your blood pressure drops. Push Epinephrine and hang Levophed. You’re acidotic. Push Bicarb. Your monitor still has an EKG rhythm and a heart rate of 40, but your arterial line dampers on the monitor and then flat lines. Check a pulse. No carotid pulse- pulseless electrical activity. Family on the phone wishes no chest compressions or defibrillation anymore. You’ve been through too much.
It’s hard to balance the fact that you haven’t sat down all shift, yet you haven’t had the time to bathe, clean, or care for your patient’s how you wish someone would have cared for yourself or your loved one simply because of priorities of life saving measures. Not only do I wish I had time to care for you that way, but my other patients who need me as well. Because just when I get the time to clean your eyes or face of its natural oils and lotion your perfectly innocent skin, my other patient is having an emergency. It’s hard to feel accomplished when you wanted to do so much more.
You leave questioning if you mentioned everything to the physician, documented everything you did, questioning if your patient will still be there when you return, but most of all, questioning am I really doing what they’d want because they can’t tell me for themselves?
I lay down in bed to look at my ceiling trying to run through the events of the day and realize the sound of stillness exists, but it’s still somehow overwhelmingly chaotic.
I am honored to be a part of something like this every day. I wouldn’t trade this job for the world. It’s oddly beautiful. We take care of you regardless of the color of your skin, your religious beliefs, your sins, your economic status, or your political views because the second I encounter your face, you become my priority.
This is a journey, one we will overcome with the support of each other, even if we can’t be there for one another as we wish. All I ask is, that you never take any moment for granted.
Stay safe. Stay kind. Stay hopeful.
For those of you who have lost a loved one in this time…
Those we love don’t go away, they walk beside us everyday
Unseen, unheard, but always near
So loved, so missed, so very dear.
~Francesca Altobelli, ICU-RN~