a nightingale nurse

How it All Began

The pandemic began for me on the morning of March 3^rd.

It wasn’t that I hadn’t heard of the novel coronavirus, or that our first case was diagnosed that day. On the contrary, in the weeks before, I had been casually discussing coronavirus with my colleagues in the hospital. We had been talking with nervous anticipation about whether it might impact various plans and holidays (vacations). Panic hadn’t spread through the country; staff hadn’t yet begun to imagine what was to come.

“Panic hadn’t spread through the country; staff hadn’t yet begun to imagine what was to come.”

The case total on the 3^rd of March in the UK was 51 – I remember very clearly hearing it on the radio.

I had managed to get to the States for my holiday and return without incident and it was my 3^rd day back at work. The morning began like any other, except perhaps that I was suffering from jetlag. As a theatre (surgical) nurse, I’m accustomed to working in a very structured environment. There are routines, and we must we prefer to keep them.

Our day starts with a team brief which usually lasts 10 minutes or so. That day, however, our anaesthetist (anesthesiologist) began speaking of coronavirus in a way no one in our department had. He affirmed our fears which were starting to rise to the surface. He spoke with confidence and certainty, quoting research, painting a picture of what seemed like a post-apocalyptic world. We believed him and we gave him our undivided attention for nearly an hour.

That night I went to the grocery store to buy some essentials and I took stock of all the things I might need which could quickly become unavailable.

Changes in the Hospital

Everything that has happened since then feels like a blur and every day that passes feels like four. Government recommendations, policies, and new research all change almost hourly making it easy to fall behind on all the new information. Because of the rapid evolution of the situation, it’s also easy to lose faith in the validity of any new information. Evidence-based practice is drilled into us every step of the way in nursing school. The experience I gained in my nursing research course with Dr. Jerrilee LaMar reading through medical research, making sense of it and putting together literature reviews is more important now than it ever has been in my career.

My job has become almost unrecognizable. BC (before coronavirus) I was always in the theatre (operating room) following our comfortable, predictable patterns. Since March 3^rd, I’ve been providing a lot of education to the staff, developing procedures for our department, and attending as many teaching sessions as I can to prepare myself for the next stage of our plan to fight coronavirus. Somehow I found myself assisting with clinical simulations. They were effective, but not quite as realistic as those that Joan Feddor-Bassemier creates for nursing students at the University of Evansville. I have heard her voice in my head multiple times over the last 6 weeks reminding me never to use the word pretend – it’s always simulate.

When I am in the theatre, we are all donned in personal protective equipment (PPE). It’s uncomfortable and rather claustrophobic. Recognizing colleagues beneath the extra layers becomes difficult. Hearing is nearly impossible with masks muffling voices. Talking increases the risk of compromising the mask’s seal in any case, so I usually opt to stay silent if at all possible.

How Coronavirus Has Affected Life at Home

At times, it all becomes too much to bear. When I turn to colleagues, I often see the same fatigue and fear in them. When the lockdown was instated, my boyfriend was visiting and we decided it was best to go through this together instead of alone. I have never been so thankful to have someone around, not just because he’s spoiling me.

When I get home from work, we usually are both rather weary and uncertain. I know he has a lot on his mind and I fear I am unable to ease his worries. We look to each other for answers, knowing they don’t exist. Are you coping? Are you an asymptomatic carrier? Will I be one of the healthcare workers who becomes critically ill? Will we be ok? Should we isolate from each other? When is this going to be over? Has it even started? We try to take care of each other and I think most days we find a way to.

I hear my colleagues asking themselves and each other these same questions. The biggest fear for most of us is bringing it home to our loved ones. Just knowing we could be their biggest risk takes its toll. Unfortunately, the alternative is no easier; living alone with no support at a time like this would be enough to break me.

To feel like we have some control over spreading coronavirus, we shower before coming home. We bleach door handles, faucets, light switches. We stay six feet away from everyone else. Some of us even ask the hospital for accommodation to lock ourselves away. All of this in an attempt to calm our nerves and convince ourselves that the ones we love are safe… from us.

Drawing on the Past to Inform the Future

Last week I attended a course that is meant to prepare us for caring for patients in intensive care. I expected reality to sink in while I was sitting there, but I don’t think it did. It’s extremely difficult these days to distinguish reality from dystopian fiction. So I study the functions of a ventilator and I learn about FiO₂, PEEP, SIMV, NIV, and hoods which make patients look like deep sea divers. I watch attentively as the instructor goes through half a dozen pumps which are used to keep ventilated patients alive with sedatives, paralytics, and inotropes.

The knowledge is there from nursing school, I know it is. I have a flash back to winning the annual Critical Care Challenge during my senior year at UE. I focus my mind and I attempt to extract the knowledge from the memories of several evening study sessions with Donna Cobb. It doesn’t work entirely, but it is a comfort knowing I have a foundation upon which to build.

This course is just one part of an intricate, organized national response. In an effort to increase capacity, the UK has set up temporary facilities called Nightingale Hospitals. Yesterday we were told our hospital would be converted into a “regional surge center” similar to the Nightingale Hospitals. We will now be preparing to receive up to 310 ventilated patients which is over 10 times our pre-pandemic capacity.

Nursing school prepared me intellectually for high-risk, rapidly evolving scenarios, but nothing could have prepared me for this psychologically. It’s as if I’ve been drafted into a war that no one saw coming. It makes you question your calling and ask yourself if going to work is worth your life or the lives of those you love. I now live 4,000 miles away from my family, and it’s incredibly difficult to not know when I might see them again. For me, there are only two possible options: accept the circumstances and carry on doing the best I can or allow the weight of it all to overwhelm me and crumple beneath it.

Gratitude for the NHS

To keep going, I have to remind myself that I am lucky. My hospital has had time to prepare before being overrun with Covid-19. When I developed a mild fever, I was told to stay home for 7 days. I didn’t have to worry about the number of sick days I have available, if they would take my annual leave (PTO) to cover it, or if I was going to be paid while off sick. If it’s necessary, I will be able to self-isolate again with no repercussions. If I become critically ill, I will be cared for by a nationalized healthcare system and I won’t have crippling debt afterward.

Right now I have the PPE that I need even though there are reports of national shortages. I have amazing colleagues and we look after each other. I’ve started doing a plant exchange with a fellow nurse who shares my love of plants. She’s even provided me with reusable masks to wear to the shops.

Coping with Uncertain Circumstances

We are all finding our own ways of coping at home and I, like everyone else, have more time to spend on a number of hobbies (or perhaps I’m just desperate for a distraction). My small courtyard garden now has a tiny greenhouse filled with vegetable and herb seedlings which will soon need to be hardened off and planted out. I chuckle sometimes to think that I’ve adopted a blitz mentality and I’ve started my own victory garden. I know I am one of many in the UK tuning into Gardener’s World to see what tips Monty Don has for a bountiful harvest. Self-sufficiency may not be necessary, but the gardening gets me outside and thinking about something else, something positive, something full of new life.

Staying Connected While Living Apart

It’s easy to be consumed by negativity, but there are some good things which have come from the unusual circumstances we find ourselves in. With my family so far away, we’ve made a point to find new ways of connecting. My grandma and I are working on a project together from a great distance apart. It is a sort of heritage quilt made from handkerchiefs which belonged to her, her mother, and her grandmother. It’s something we started on my last visit, but now I am not sure how I will get my squares to her. My technologically gifted brother has come up with a cunning way to allow me to play Euchre with him and my parents and perhaps it can work with other games – maybe Scrabble will be next.

Hope for the Future

The entire world is undergoing something rather remarkable right now, that’s undeniable. Many of us are experiencing very similar things simultaneously at a time when we can receive news from across the world instantly. It seems to have brought communities, local and global, together in a variety of ways and it has made us seem more alike than different.

Here, prepared meals are being delivered to hospital staff and anyone considered vulnerable. Droves of people are volunteering. Businesses are showing their appreciation for NHS staff daily and PPE is being made for us by local businesses. The strongest sense of community I have felt has been in the last 6 weeks and I hope regard for our fellow man is something we all carry into the future.

It’s difficult to know how to conclude this. At present, some countries seem to be past the peak while some are just beginning the steep upward climb of cases. I hope it will all be over soon for all of us and “normal” life can resume. Soon, though, has always seemed to me to be an extremely subjective word ranging in time from minutes to years. Hopefully whenever soon arrives, the plans we had for this year won’t be lost but only delayed. Maybe then we will be able to look back with pride on the role we played whether that be staying at home to prevent spread and protect the vulnerable or being a key worker in the supermarkets, factories, postal service, and hospitals.

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A Note of Thanks

In 2015, I graduated from University of Evansville’s Dunigan Family School of Nursing. Jerrilee, Joan, and Donna are just three of many faculty who helped mold me into the nurse I am today. I, and many others, could not be doing our part on the frontline without the work they put in every day to train competent and compassionate nurses. Their influence reaches much farther than Indiana into many states and at least as far as the United Kingdom where I and another nurse from my graduating class currently live and work. Countless patients will benefit from the care they receive from nurses trained by the dedicated faculty at UE. I must also take a moment to recognize my mom who has always been a shining example of the nurse I would one day like to become. It is because of her I chose this profession of caring. Thank you.

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