I was looking through the
window of a Covid I.C.U. And that’s when I realized
I might see someone die. I didn’t even
know who she was. But I was filled
with immense grief as she edged closer
to death by the hour. What I didn’t know yet was
that by the time I left just two days later, at least
three patients would be dead. The vaccine offers
hope, but the sad truth is that the virus continues
its brutal slaughter in I.C.U.s like this one in
Phoenix, Ariz. The only people allowed in
are health care workers. They’re overworked and
underpaid in a deluged hospital. I wanted to know what
it is like for them now, after a year of
witnessing so much death. Eager to show us
their daily reality, two nurses wore cameras
so that for the first time we could see the I.C.U.
through their eyes. “Unless you’re actually in
there, you have no idea. Nobody can ever even imagine
what goes on in there.” [MUSIC PLAYING] This I.C.U. contains 11 of the
hospital’s sickest Covid patients. Most of them are in
their 40s and 50s. And they are all
on death’s door. It’s an incredibly
depressing place. I blurred the patients faces
to protect their privacy. But I also worried that
blurring would rob them of their humanity. The family of this
patient, the one who is rapidly declining,
allowed her face to be shown. And they readily
told me about her. Her name is Ana Maria Aragon. She’s a school administrator
and a 65-year-old grandmother. Sara Reynolds, the nurse
in charge of this I.C.U., organized a video call with
Ana’s family to give them a chance to be with her just
in case she didn’t make it. “It just breaks my heart
when I hear families saying goodbye.” You might expect the doctors
to be running the show. But it is really
the nurses who are providing the vast
majority of the care. “We do everything. We give them baths
every night.” “Rubbing lotion
on their feet.” “Shave the guys’ faces.” “Cleaning somebody up
that had a bowel movement. It doesn’t even register
as something gross.” “Look, I walk into the room. I say, hey, sounds
like you have Covid. And I might order
a chest X-ray. I might order blood work. I might order catheters. All that stuff is
done by the nurse. I may have spent 10 minutes. The nurse might spend seven
or eight hours actually in the room, caring for them. Let’s say there was a day
that nurses didn’t come to the hospital. It’s like, why are
you even opening?” “Ibuprofen.” 12-hour-plus shifts, isolated
in this windowless room, these nurses survive by
taking care of each other. “Aww, thank you.” And by finding small
doses of levity. [MUSIC - JAMES
BAY, "LET IT GO"] “(SINGING) Wrong. Breeze.” “I’m getting older now, and
there’s all these new young nurses coming out. And I feel like a
mom to all of them. Morgan, she’s got
big aspirations. She loves to snowboard,
and she’s so smart. And Deb, Deb’s just— she’s funny.” “I tease her all the time. I can tell her to do anything,
and she’ll just do it because I think she’s scared
of me because I just always say, make sure you have no
wrinkles in those sheets.” The patients spend most of
their time on their stomachs because it makes it
easier to breathe. But the nurses have
to turn them often to prevent pressure sores. There was one woman
in her 50s who was so critical that this
simple procedure risked killing her. “Even just turning
them on their side, their blood
pressure will drop. Their oxygen
levels will drop.” “Her heart had actually
stopped the day before. And so the concern was if it
was going to make her heart stop again.” “Then come over. Push.” “We were all watching
the monitors.” “I felt relieved like,
whew, we did it.” Arizona’s a notoriously
anti-mask state. And it faced a huge
post-holiday surge in Covid cases. In January, the
month I was there, Arizona had the highest
rate of Covid in the world. As a result, I.C.U.s
like this one have too many patients
and not enough nurses. “Because they’re so critical,
they need continuous monitoring, sometimes just
one nurse to one patient with normally what we have is
two patients to one nurse. But there definitely are times
when we’re super stretched and have to have a three-to-one assignment.” A nurse shortage has plagued
hospitals over the past year. To help, traveler nurses
have had to fly into hotspots. Others have been forced
out of retirement. Especially strained are poorer
hospitals like Valleywise, which serves a low-income,
predominantly Latino community. “Many of our patients
are uninsured. Some of them have Medicaid,
which pays something but unfortunately not enough.” This means they simply
can’t compete with wealthier hospitals for nurses. “There is a bidding war. The average nurse here, give
or take, makes about $35 an hour. Other hospitals, a
short mile or two away, might pay them $100.” “We lost a lot of staff
because they took the travel contracts. How can you blame them? It’s sometimes a
once-in-a-lifetime opportunity to make
a lot of money.” “Every single day I’m off,
I get a call or a text. 'Hey, we desperately need help. We need nurses. Can you come in?'” This nursing shortage
isn’t just about numbers. “Physically it’s exhausting. We’re just running. We don’t have time to eat or
drink or use the restroom.” “They have kids at home,
doing online school. And I think, gosh, they
haven’t even been able to check on their kids to
see how they’re doing.” “My days off, I spend sleeping
half the day because you’re exhausted. And eating because we don’t
get to eat here often.” Nurses have been proud to
be ranked the most trusted profession in America
for nearly two decades. But during Covid, many worry
they aren’t able to uphold the standards that
earned them such respect. “I can’t give the quality of
care that I normally would give.” “It’s absolutely dangerous.” “That’s demoralizing
because we care. We’re nurses. It’s our DNA.” Ana had been in the
hospital for over a month. Her family told me she
was born in Mexico. She came to the
States 34 years ago, first working in the fields
before eventually landing her dream job in education. She’s beloved at her school. Former students often stop
her in town and excitedly shout, Miss Anita. She was very
cautious about Covid. She demanded her family
always wear a mask and yelled at
them to stay home. Yet, tragically, she
somehow still caught it. “She had been declining over
the course of several days. It’s a picture we have seen
far too often that we know, this one is going
to be coming soon.” Because there is
no cure for Covid, the staff can only do so much. Once all the ventilator
settings and the medications are maxed out, keeping
a patient alive will only do more
harm than good. So Ana’s family was forced
to make a tough decision. “And I talked to family and
let them know that we have offered her, we have given, we
have done everything that we can, there’s nothing
more that we can do. The family made the decision
to move to comfort care.” “If I’m there while
someone’s passing, I always hold their hand. I don’t want somebody
to die alone. That’s something that
brings me peace.” “Thank you.” “Thank you.” “Dance floor is packed. People hugging, holding hands,
and almost no one wearing a face mask.” “I think like many health
care workers, I’m angry a lot. And my faith in
humanity has dwindled.” “How can you think this
isn’t a real thing? How can you think that
it’s not a big deal?” “Free your face. Free your face.” Arizona Gov. Doug Ducey
has advocated for personal responsibility over mask
mandates even though he’s been photographed maskless
at a gathering and his son posted a video of a
crowded dance party. “Even on the outside,
they go, I don’t care. I’m not wearing a mask. I’m not getting the vaccine. That’s bullshit. The second they come
into the hospital, they want to be saved. Never do they say,
'I made the decision. I’m accepting this. Don’t do anything, doctor.'” Half a million people in this
country have died from Covid. Many have been in
I.C.U.s with nurses, not family members
holding patients' hands. “I always wonder, are they
still going to be there when I get to work? It’s on my mind
when I get home. Are they going to make
it through the night? There’s one that I can
think of right now.” One patient in his late
50s was so critical that he required
constant supervision. Each of his breaths
looked painful. “There was one day
that he was kind of— he was looking a
little bit better. And so he was able to
shake his head and smile. And we set up a
video call for him. And it was just the
sweetest thing ever. I could hear his
little grandson— he was probably 4
years old or so. And I saw him on
the screen, too. And he was just jumping
up and down, so excited. 'You’re doing it, Grandpa. You’re doing it. We love you. Look at you. You’re getting better.' It just broke my heart. It broke my heart. He’s one that I don’t think is
going to be there when I get back on Sunday.” But I’d already been told
something Sara hadn’t. The patient’s family had
decided to take him off life support. “Yesterday they did? Oh. And I just think of
his little grandson. And 'you’re doing it, Grandpa. You’re doing it.'” He wasn’t the only patient
who didn’t make it. When I went back
to the hospital, I noticed that the bed of the
patient I’d seen get flipped over was empty. My heart sank. I knew this meant
she’d passed away. “What’s sad is when I go
back, those beds will be full. They’ll have somebody else
there just as sick with another long stretch of a few
weeks ahead of them before it’s time for their family
to make that decision.” I’d never before
seen someone die. And even though I didn’t
know these people, witnessing their deaths left
me sleepless, exhausted, and depressed. It’s unfathomable to me
that these nurses have gone through that
every single week, sometimes every single
day for an entire year. I assumed the nurses must
block out all the deaths to be able to keep
going, but they don’t. They grieve every single one. “I’ve always loved
being a nurse. It’s what I’ve
always wanted to do. And these last couple months,
it’s definitely made me question my career choice.” And what makes their
situation so tragic is that many of these
nurses hide their trauma, leaving them feeling
isolated and alone. “We’re the only ones that
know what we’re going through. I don’t really want to tell
my family about everything because I don’t want them to
feel the same emotions that I feel. I don’t want them to know that
I carry that burden when it— that it is a lot. I’m Mom. I’m strong. I can do anything. And I don’t want
them to see that.” Leadership in the pandemic
hasn’t come from elected officials or spiritual guides
but from a group that is underpaid, overworked
and considered secondary, even in their own workplaces. As so many others
have dropped the ball, nurses have worked tirelessly
out of the spotlight to save lives, often
showing more concern for their patients
than for themselves. I worry their trauma will
persist long after we re-emerge from hibernation. Covid’s legacy will include a
mass PTSD on a scale not felt since World War II. This burden should
not be ignored. “Thank you. Thank you. I feel, yeah. And you’re all amazing.” [MUSIC PLAYING]
as a former icu nurse, and a relatively anonymous internet user, i can admit i was definitely traumatized by certain experiences during my ICU work.
however, these nurses are experiencing just unbelievable circumstances. I've even lost a close nurse friend to covid, because he went to NY at its worst to help with the relief. He was 35. The shifts, the pay, the risk... It's exactly why some take the travel jobs. and the travel nurses I know currently sometimes get 1 day off a month
That's 1 day off from 12-hour-shifts a month. A $50,000 contract is nice. But not if you die.
I am glad this was shared and I can only upvote once, I hope more people see this because an ICU is a place that most people can't understand.
I am a covid-ICU nurse. I keep a tally of all my covid deaths in the unit. I am up to 33 now. Those are the ones that I took care of that have died, but there are many in that unit that I did not take care of that died. I have cared for over 330 now, and there has been far more in our 16 bed ICU, which at one point we had to double up in every room until we had 32 patients in our 16 bed unit. Most of our deaths are of functioning individuals, not some nursing home patient.
Early on, many of the patients died relatively quickly. Now that we are better at treating it, a quick death is relatively rare, and we have saved many that probably wouldn't have made it early on in the pandemic. The downside is that we are able to get people through the acute severe phase, and families want to push on and on and on, to the point that we have these patients go from a functioning individual to patient married to the healthcare system, where they suffer from such severe complications and are so debilitated that they come back to the hospital from rehab/long term acute care facilities/nursing homes etc, in this crescendo of visits for various ailments such as UTIs, pneumonia, bed sores, falls, etc...that ultimately leads to their death a few months after. I would imagine that there are faaaaaaaaar more deaths from covid than is being made public, simply because people are dying of pneumonia 6 months later after a complicated course of covid, and their death is listed as "pneumonia," which ultimately was a result of all the damage covid had caused. It's sad and oh-so predictable. But as a healthcare worker, you simply cannot explain to families this reality. They insist their loved one is the fighter. Literally 100% of family members say that about their loved one who inevitably dies. If they don't have our experiences, they will never make the decision to keep their severely ill loved one comfortable and forgo all of the ultimately futile treatment. I almost miss when the deaths were quicker, and I also miss when people were more understanding. Early on it was like "ohhh...we understand, the coronavirus is awful." Now, everyone wants their loved one to get some experimental treatment they read about on facebook that is usually not even indicated or just so far out there as to be basically insane.
The whole thing is a sad shit show.
Edit: To add to this, we have had 6 nurses quit since covid, citing the depressing nature of it. It is difficult to go to work every day and take care of people, many of which ignored the precautions (we know this because the families will admit to it or some of the nurses, for better or worse, like to stalk a patient/patient family on facebook), and have family members who openly ignored or were critical of the precautions on their own facebook pages. The same people who now want everything done, even when it is made clear to them that it is futile, and no expense to the taxpayer is too great for them. Except the cost of the freedom to not wear a mask or social distance, that is. And then we drive home after work, past filled bars and restaurants, and shop at grocery stores, all filled with people not bothering to wear a mask. We listen to family members and others on facebook pretend like it's all not that bad. It's like some fucked up twilight zone, and I'm ready for it to be over.
I am also an ICU nurse who has been working in the COVID ICU for the past year as a staff nurse.
One thing that annoys the hell out of me is people constantly saying "well I keep hearing nurses are getting paid 5-10k a week to work COVID, you're being properly paid for your work so you shouldn't complain about work conditions."
They fail to realize that a large majority of nurses are not travelers who get these contracts. Most hospitals are about 75% staff nurses and 25% travelers (sometimes more sometimes less). If you are working as a normal staff nurse outside of California (California has strong unions that protect their nurse's salaries and work conditions), you could be paid as low as $22 an hour and subjected to the worst work conditions imaginable. You are still expected to do the same exact work as nurses who work alongside you making 5-10k a week meanwhile you are pulling in ~$700 a week. In fact, many times, the staff nurses have much harder assignments because they are 'properly trained staff nurses' while the travelers are given the easiest assignments because they are 'traveling nurses who don't know how we do things around here'. You are put in the same risk, you work the same hours, you work with the same patients, and you deal with the same horrible staffing ratios and lack of PPE. The only difference is you get paid a fraction of what your coworker gets paid and there is nothing you can do about it.
Why don't the staff nurses just leave then? Well a lot of them have, but many of the staff nurses cannot leave to take these lucrative contracts because they have small children to take care of, elderly parents to take care of, or other obligations at home that don't allow them to just pick up and leave for months at a time. The hospitals takes advantage of these staff nurses and basically works them into the ground. When staff nurses leave because they've had enough of it or to take one of these contracts, they're often not replaced for weeks at a time and the extra workload is pretty much divided between all the remaining staff. You are never compensated for the extra workload and if you complain about it the hospitals will slap you on the wrist and tell you that you are 'not being flexible enough in these difficult times'.
When the first wave hit, they told us we will have terrible staffing ratios because of the nature of the pandemic. Nobody complained about it and we all went in like we were about to go into war. After the first wave, they told us that the hospital lost money due to COVID and we had to ramp up surgeries so the hospital could make back what they lost. We had the same terrible staffing ratios as during the first wave, but no compensation for the extra work. Then the second wave hit, and the hospital said again that we would have terrible staffing ratios because of the pandemic. Of course, there was still no hazard pay or any kind of compensation for staff nurses. People grumbled about it, but still continued working. After the second wave, they told us that the hospital lost money again due to the second wave and we have to ramp up surgeries even harder to make up for what they lost. Do you see a trend? This is our reality now.
The past year has really opened my eyes to the American healthcare system ran by large corporate hospitals who's only true concern is profits. They don't care about their patients unless they are able to pay and they definitely don't care about their workers. The irony is almost all of these hospitals are labeled as 'non-profit' or 'not for profit' (and all the tax benefits that come with that label) and yet everything that is done in the hospital revolves around how much money they can make and how little they can get away with paying their staff. When I first started as a nurse, I use to think that the hospital actually cared about me. How young and naĂŻve I was. I've realized after this year, that I'm just another cog in the wheel of a money printing machine for all these 'non profit' or 'not for profit' hospital CEOs (no medical degree, just a MBA) that make 10-25 million dollars a year sitting in their ivory tower. I don't care who you are, a paper pusher sitting at home in their pajamas on Zoom should never make more than the highest paid MD in the hospital who likely only makes 600-900k in comparison. Neurosurgeon putting their lives on the line saving the lives of hundreds of patients makes 600-900k while the CEO with a pen up his nose at home on Zoom makes 25 million. Does nobody see the problem with this picture?
"You might expect doctors to be running the show, but it is really the nurses who provide the vast majority of the care."
I am a hospitalist physician. This is 100000000000000% true. Doctors make the big decisions, but nurses make all the little ones, and they actually DO everything. Half the time, docs just order what the nurse tells them to, at least in the COVID ICU. Nurses receive a fraction of the credit, prestige, and compensation that they deserve.
This is a very moving video. I would like to translate it to Spanish, but the option is not available on YouTube. Do you OP, or anybody else here, know how could I contribute with the subtitles?
I’m an icu nurse who has been working in a covid icu since last March.
I am a completely different person now. Myself and most of my colleagues go to therapy every other week (which we now pay out of pocket because our insurance-if full time- only covers about 6 sessions) and we still feel like we’re watching ourselves get PTSD.
I haven’t kept a tally like some commenters on this thread, but I do often think of all the patients I’ve withdrawn on in the past year. And the families I have FaceTimed and cried with while they watched their inaccessible family member die. It is horrifying and draining.
I had to stop watching this series but I am SO thankful the NYT did it. Almost every time I work a shift I think to myself: if people saw what we were really doing here they would NEVER leave their houses. They don’t get it. My Province (Ontario, Canada) is starting to open up and every single nurse in my unit is stressed and just disheartened that we will be having a third wave.
Last March my icu had 25 beds. We now have 37. We are hardly able to staff it. We have to create “Pods” where we are 1:3 nurse to patient ratio. It’s not safe for the patients and it’s not sustainable for the nurses. The funding for extra beds and vents is just that: equipment. Not personal.
If this continues to the end of 2021 I will be finding a new career. After 9 years in this field I absolutely love, this pandemic has traumatized me and changed my career beyond recognition.
I’m a nurse currently working in the ICU (I also work in the ED). This was hard to watch because it is so accurate. I know how so much of that feels and it’s hard to really talk about it in a way that people will understand the pure tragedy of it all. I watched this with my husband, hoping it would help him see what I do everyday. I’m not sure it feels real unless you’ve actually been there.
Listening to a person’s final goodbye over the phone or FaceTime. Hearing them speak just before we intubate, knowing their chance of surviving isn’t great is heartbreaking. The volume of death is so high, some days it just feels completely hopeless. I honestly never thought it would be this hard.
Had been in covid ICU since it started last February. Recently quit bedside because I was unhappy and exhausted all the time. I’ve had more patients die in 1 year than I had in 14 years cumulatively. Please everyone wear your masks, wash your hands and take care- suffocating slowly to death is awful.
My boss's sister was featured in a story on CNN today because she's an ICU nurse who quit her job after 12 years in the field due to the stress of COVID. She's packed up her family, bought an RV, bought some land, and is starting a new life.
Link to the story: Traumatized and tired, nurses are quitting due to the pandemic
https://www.cnn.com/2021/02/25/us/nurses-quit-hospitals-covid-pandemic-trnd/index.html