COVID-19 Frontlines: Nurse Eases Isolated Patients in Their Dying Moments

Recently Infection Control Today^®got the chance to talk to Nicole York, BSN, a telemetry nurse at Penn Medicine Princeton Medical Center, in Plainsboro, New Jersey. York talks about how the slow trickle of COVID-19 patients at first, turned into a torrent and how the community surrounding the hospital has shown its support for York and other healthcare workers. York also talks about having to be the person helping a patient in isolation-isolated from family and friends because they can’t go near them-through the dying process. 

Infection Control Today^®: Can you tell us a little bit what’s going on out there? 

Nicole York: It’s overwhelming. The most significant event I could never imagine experiencing as a nurse in this profession. That’s been pretty wild. It fortunately started as a slow progression in the beginning of March. And it started as just a trickle of patients at first Because we didn’t really have the right testing for the patients. The tests would take a long time to come back. It was hard for us to tell exactly how many numbers of patients we had at first. But I was one of the first nurses to start taking care of the patients when they started coming in on our unit.

ICT^®: Did you know about COVID-19 by then? 

York: Oh, absolutely. It was it was something that was in discussion, but I don’t think any of us anticipated it was going to be as bad as it was. Even though it had been something that had been on the news for a couple months. None of us have ever experienced a pandemic or crisis like that before. I’ve personally always been kind of interested in doing disaster response and that’s part of the reason I wanted to do travel nursing. That had actually been in my plans. I was going to be leaving the hospital around June to start doing travel nursing, but obviously that is all changed right now.

ICT^®: The whole world’s plans have been changed.

York: Exactly. Everything’s kind of at a standstill right now. And I just got to count my blessings that my family’s safe and I have a job right now, because a lot of people can’t say that the same. 

ICT^®: I guess there were a lot of tough days. Does one stand out to you as being more challenging?

York: I would say so. It kind of felt like every day after that was more challenging than the than the previous. Because at first, like I said, it was a slow trickle of patients. And maybe we’d have four or five or six COVID on our floor and then there was a day I went home and I came back two or three days later and half the floor was COVID. Had isolation carts outside the rooms. And I came in and my heart started racing and I was completely overwhelmed because I didn't think it could happen that quickly. And then you look over in the ICU, and you see the nurses being pushed to their limits over there taking care of these vented patients. Because there’s only so many nurses that are trained to take care of patients on sedation drips and taking care of this level of acuity for patients. It’s just overwhelming. 

ICT^®: Did you have to tell loved ones that they can’t see their sick relatives and the sick relative would have to die alone? 

York: Absolutely. That’s been one of the one of the big challenges too, because our hospital never had visitation policies in the general floors. I think in the critical care unit, it did have restricted hours, and maybe in the pediatric unit as well. But on our floor, 24 hours a day, families were welcome to come in. And it was a drastic change. And we get a lot of the same patients. We call them frequent fliers. People come back that have been there before. So, they’re used to the rules prior to this pandemic. And now, they have to experience this completely new set of rules in order to try and prevent the spread of infection. But it’s been really tragic because we have patients that get really sick and families don’t get that closure of being there and with them and trying to help and support them through that end-of-life process and people are dying younger than anyone should be dying. Because a lot of the patients that are really sick are younger, between 50 to 70 years old, which is a big loss for everyone. And it makes us all really scared, too. Because even though I might be in a lower-risk population because I’m younger, I have a mom at home that I have to protect, too. And I just have to pretend like, even if I’m asymptomatic, I might be a carrier. I’m also on immunosuppressants, which might make it so that I’m more likely to be an asymptomatic carrier, because my body wouldn’t show the same responses as other people who contract the virus. So, I have to always pretend like I’m infectious and like I could potentially spread that to my family or my boyfriend. It’s isolating.

ICT^®: You’re unit usually handles heart patients. While a lot of this was going on, I suppose your regular patients had to rescheduled? The elective surgeries had to be rescheduled? 

York: Oh, yeah, that caused so much frustration for a lot of our patients too, because we’ll have to discharge patients that need a whole bunch of other tests to be done in order to treat the normal reasons why someone would come to the hospital, and they can’t be done right now. And it’s like, OK, well, when will it be done? And like, after this. That’s what everyone wants to know: When is this going to end? When is this going to get better? I’m starting to see the levels on my unit, the levels of patients, kind trickle down, which is good. It means everyone’s been following the social distancing protocol. We haven’t been getting as many new patients. It also means that a lot of people have died, so we don’t have as many patients on the floor anymore. But as soon as the businesses open back up and people go back into the world and maybe they’re less strict with their infection prevention, we might get a surge again with more patients.

ICT^®: Now the spike at your particular hospital happened around early April and it died down a little bit by mid-April. Is that correct?

York: It seems that way. It seems like around then we started getting fewer and fewer patients on my unit. The ICU though, has still been like kind of full to the brim the entire time. And I think it might just be that patients have died that that might be the reason that we have fewer and fewer people coming in, because they’re following good practices outside of the hospital, which is good.

ICT^®: I always felt that being a nurse or being a doctor is sort of akin to being a police officer or a firefighter where you need to develop a thick skin or you’d be too easily emotionally bruised. You’re not doing your patient any good. Was it difficult to maintain that distance? 

York: That’s part of the job. That kind of absence of self is the best way of putting the patient first. Patient-centered care. It’s kind of essential to our job in order to do what we need to do and also to not allow ourselves to feel all of the gravity of the emotions of what’s going on around us and how little control we have. And all we can do is as much as we can at any moment for the patients that are in our care. We just have to get up, go to work and get the job done. It’s very emotionally challenging. I’ve been a nurse for two and a half years. There’ll be a lot of trauma when we’re experiencing losses of patients and stuff, but it’s a loss, and then you can cope with it and move past it. But with this, it’s harder because we don’t know when it’s all going to be over. But at least there’s been so much support from the fire department, and it’s funny that you mentioned that from the fire department and police department. I think it was around like April 12 or 11. The fire department and police department and all local communities came and surrounded the hospital and did a parade. Well, I was so happy I was working that weekend. Because all of us were crying. They paraded around the hospital with the fire trucks and police cars and were honking their horns and raising up flags on the big ladders. I can’t believe that a fireman can get up on those ladders. They are tall. They’re like taller than our building. I can’t imagine getting on one of those. It was overwhelming to see these heroes saluting us. It was cool. And lots of local businesses have shown their support too. We’re so well fed. Fantastic. They’re giving us lots of food during the day. For night shift too and people are all trying to do their part. Wawa gives out free coffee. Although I feel like I can’t go in there like with my scrubs on. Because if I’m in scrubs, there’s kind of like a stay over there [reaction], which is understandable. Because I look infectious if I’m wearing scrubs.

ICT^®: I think you told me that you haven’t been able to hug your mom in a couple months, right?

York: Yeah, that’s starting to really bother me. But we talked from across the hall. I’ll rub my skin, wash it like crazy and then I’ll make us dinner and then I’ll leave it outside the room for her to get stuff. 

ICT^®: Mother's Day is going to be coming upon us before you know it.

York: I know. All of us are struggling with that. I’m just glad that it happened, if it was going to happen, when it did because if it had been a couple months later, I might have already not even been in the state anymore. I need to be here with my family, with my co-workers who are my family at this point. This has brought us all so close together. They’re all my heroes, the people I work with every day.

ICT^®: What have you learned about infection prevention because of this? 

York: I’ve learned to be really, really cognizant of every surface I touch. I feel as a nurse, you’re already pretty aware of the bacteria all around you, the viruses all around you. But now more than ever, I come on and whatever station I’m at, I make sure you’re wiping it down before you even go there. If you ever touch anything at all, it never comes near your face at all. You go 10 minutes and you feel like you need to scrub your hands. I think I’ve been a lot more aware now than I’ve ever been of infection prevention. 

ICT^®: Is there a patient or two that stand out as far as how they met their end and what was that like? Were you the last person to say goodbye to them?

York: It’s interesting you say it like that. Because with a lot of these patients, because we have to do this whole clustering of care to preserve our PPE, our gowns, protective equipment and stuff. A lot of times the nurse, especially in the beginning, is the only person to go into the room and be with the patient. So, the patient feels extremely isolated. Because they don’t have family there. And we have to limit our time in the room as well. Reduce our viral load and preserve the gown usage. But I’ve had a couple patients that I’ve been the only one in the room and having to care for them and it can be extremely backbreaking. When you’re the only one, moving the patient and changing them, taking care of them. But when it comes to a patient declining to the point of being close to death unless they’re on hospice…. If they end up choosing comfort measures, which is what hospice patients are, they choose to not do anything to preserve their life and then you try and just make them comfortable and help them through the dying process. I’ve had a patient that chose that while she was still oriented. While she still knew what was going on, she chose that. And I was the one that was with her while she was still…. The dying process can take a long time, but I was with her while she was still alert. And I called up her family so that they could talk to her on the phone. But that’s all she got was just to talk to them on the phone. It was pretty overwhelming. But it was an honor to be able to be with her through that. 

ICT^®: I guess the silver lining is that hopefully, sooner rather than later, we can get back to our normal lives.

York: Absolutely. You know, everyone’s been doing their part in trying to make this be in the past as soon as possible. I think that there are lots of lessons we’re going to learn after all this happens and in terms of preparedness, Because, you know, bugs, bacteria, viruses, they’re just going to keep getting stronger because they’re adapting. And we also need to adapt with them. We need to be prepared because I feel like from a global perspective, we weren’t ready. No one was ready for the impact of a pandemic. We haven’t experienced something like this in many, many, many years. So, I think we need to build up our defenses for when this happens. Have lots of PPE available. Maybe consider the environment, too, and have lots of things that can be washed and reused. Because we’ve been throwing out so many gowns and plastics and everything. We’re just going to end up killing the world too with that. So, there’s a lot to be learned from what we’re experiencing now. And when it comes down to it, I think a lot of people have kind of pulled together and are sticking to the practices that are necessary, like staying home and working from home. I’ve been impressed by the general public response.