It was tough heading into work today. I knew there were seven. All in various conditions. I also had 5 routine to see, and then there were about 4 with minor issues. I knew it was going to be a long night.
I pulled up in the parking lot, and the rain settled in like a mist. Hazy and dewy and gray. Scattered cars were around, but no one was outside. The construction crew had been sent away, and the remains of their half-finished work was visible from the parking lot. I reached into my bag and grabbed my face mask. It looks like a CPAP mask, thick, heavy, and straps around my head in three places. I keep my hair in a braid now, and have for the past 18 months, as it is the only way to gain some traction on any of the various masks Ive tried. Regardless, it slips down, and wisps of hair emerge from my braid, giving me a disheveled appearance. I don my safety glasses, that are straight from a lab, they complete the look. I grab my rolling laptop bag, and stand tall, and start walking towards the building.
I can’t say I am confident when I walk in there, but I choose to smile, and say hi to those that recognize me. Lately I have been wearing a white coat with my name on it, and it seems to help the residents know who I am. With many encounters I see them look me in the eye, then immediately turn their vision to my left to see the name, and words M.D. written after it.
The entrance is empty sans the receptionist. I ask her how her day was, and she says, “not good”. I know that nothing in particular happened today that would be considered catastrophic, I am kept aware of all things that could affect the health of the residents, so I suspect that she is just simply stressed. She confirms my suspicions when she says “We are up to seven, when I got here this morning, I wanted to turn around and go home”. I knew how she felt, I knew of the seven before I went to bed last night, and knew they were waiting for me for when I got here. She is always shy, reserved and quiet, and people describe me that way too, so its no surprise we have never really chatted before. This moment though, I felt a shared connection, and comisserated with her: “yes, I know the feeling, I wish I could have stayed home too”. I gave her an encouraging smile, checked my temperature, and headed to the nurses station, where my inbox laid.
Rifling through the stack of papers that are inevitably there, I was approached to see a patient with leg pain. We chatted briefly. I had 12 people to see, I had to determine if this issue required an actual, need to be documented, visit. The nurse had put some muscle rub on it that we had called in, and it was working, so I decided that her issue was settled, and didn’t need to be formally addressed.
I made my way through the semi-lite halls towards my office. The walls are painted a neutral tone, with a mint green trim along all the doors. Lighting, while in no way poor, would not be catergorized as bright. Fluorescent shadows fall onto everything I see. I don’t know if this is real, or if my mood is projecting sad tones through my vision. It is true that this section hasn’t been updated since probably the seventies, and there are big plans for a facelift, but the construction team has been sent away. It’s been two years in limbo.
My office is a converted storage room, down a dead end hall. On the left are the patient bath and shower, and to the right is the communal toilet. Then there is my door. It just barely fits two desks. There is a large window that has three spider webs, and an A/C installed up top. It’s either too hot or too cold. There is a crevice to the outside somewhere, as in the summer a scattered yellow jacket would find its way in and buzz around confused. My view is of an alcove, I can just barely make out the dumpsters, and the grassy edge of where the patients are able to take their daily smoking excursion. I was able to get a phone installed, and bring my own computer and monitor and printer. I hook up my laptop and pull out my to do list, circling names on lists. One discharge, two with chest pain, five that need their routine monthly check ups. Then there are the seven. I save them for last.
The discharge takes longer than I anticipated, but about as long as it always takes. As I work on my notes I get a knock on my door. It is the DON, the Director of Nursing. One of the 7’s family has not returned any of her calls, one of the 7’s family has refused antibodies, and one of the 7 was returned from the ED. Another is looking ill, she isn’t sure he will make it. He is DNR, and she is not sure if his family will want him sent to the ED if he gets worse, or just keep him comfortable here. We talk about various treatment options for all of the seven, and I find out that she was here until almost 2 am last night. It’s five pm now.
I shuffle off to see the rest of the “healthy” residents. The hallways are empty, the dining/activity center is bare, they are all in their rooms, doors closed. Masks on. I see nurses and aides coming in and out of rooms, seated at the nurses desks, gowned up, masked, trying to coordinate care. No one smiles, and their eyes look weary, exhausted, and even a little frantic.
I make my way down to the wing where the 7 are. Doors are closed, the hallway, again is dim. Warning signs are draped over doors.
DO NOT ENTER.
PLEASE CHECK WITH CHARGE NURSE
It’s an option I do not have.
This mask is new, it has a silicone seal, its softer on my face, but it makes me sweat. It bounces as I talk. It has made me a little hesitant since I bought it , maybe I should go back to the disposable duck face N95s that I wore all last year. It’s too late for that decision now. Mr F. is not doing well, he needs assessing.
First I head into Mr L and Mr D’s room. Yesterday Mr L begged me not to let him die. He wasn’t ready, he said. This morning he didn’t eat, and I was worried, but now he is feeling better. He has ordered a second supper. His lungs sound good. It’s too soon to be sure, but I am feeling pretty good about his chances. His roommate, Mr. D. On the other hand, is lying in bed, and doesn’t even acknowledge me when I first enter the room. That isn’t like him. He has energy. He moves, everywhere. For him to not be getting out of bed is a concern. His supper tray is sitting there untouched. Mr. D I said, it’s time to eat. He perks up and i give him a hand to sit up in bed. I help him swing his legs around and show him the food. He thinks I should eat it, not him. I help him with his utensils. He can’t make up his mind if he wants to use his spoon or fork. Mostly he doesn’t want to eat without me. I tried to feed him like a toddler, and he was not having it. Mentally, he was acting his usual self, and his lungs sounded fine, so I got up and ripped off my gown, and as I left, he started to eat. I was pleased. He is eating, He is alert, if not trying to wander the halls like his typical self. This is progress.
The gowns have to placed on your body prior to entering a room, and then there are the gloves. They fit under gown, but I don’t always remember the correct order. its an easy correction, even if it takes an extra step. These gloves are never ideal. My face is getting red under this mask, I am feeling hot with my white coat, I haven’t gotten a cool fresh breath of air since I left my office, about an hour ago. The gloves stick. They won’t go on easy, they tear, I am weary and drop one. As I struggled I see the kitchen staff donning gowns as well, in and out of rooms to deliver and pick up food trays. Reach into the drawers outside the room. The plastic drawers you could find from any Walmart or Target. One drawer has disposable gowns in neat little rows, wrapped in plastic. Another has the gloves, and little odds and ends. Gowns and gloves on before you enter the room. Goggles or face shield in place, remove gown and gloves before you leave the room in the red receptacle. This dressing is a ritual, and it takes time. The medical and nonmedical staff are exhausted from it, I can see it in their eyes, and it is only day #2, of many. Housekeeping is leaving the room I am about to enter. Both hands gripping tightly to the bags of used gowns and gloves. She is a thin petite woman, but she has to go sideway out the door to get the bags out without tearing them. The garbage must have been full of disposable gowns in this room I am heading into. There has been a lot of need in this room. I can feel her exhaustion, I can see it in her eyes, she sighs, and heaves the bag into the larger receptacle, and moves on to the next room, the one I just left. Finally, I have the gown and gloves on. I think, if someone was coding, they would be dead before I could get myself fully gowned up.
I am not sure why it didn’t affect me last night when I entered the rooms, or even with the early visit. Maybe it has all just sunk in, seeing the wing, seeing everyone bone tired and scared. Exhausted from taking gowns and gloves off and on. Not knowing how it got in here. But this time I take a deep breath, and put my hand on the doorknob. I feel a little dizzy, a little nauseous. I selected a door, a door that leads somewhere. A door with a sick person, a door that I do not know what it will bring. It’s almost like when you watch a TV show and a person chooses between three identical doors, and when they open their door, this white bright light shines down on them. It was like that. I was thinking “Here we go”. I sighed. My face was burning, and glistening with sweat, my feet felt like they were weighed down in sand. Instead of the bright light, it was a gray narrow corridor. I stepped into the room.
Directly facing me was Mr. B. Sitting up in bed, eating his supper. He presented me with a smile, and all the kind pleasantries you would expect of a gentleman of his generation. I asked him how he was feeling, and he looked at me with astonishment, “fine, why would you ask”. I told him that he has the virus.
I don’t think I will ever forget that look he then gave me. Naturally, he had been told multiple times by staff, but as with the dementia patients, they remember very little. His look, it was bright eyed, smiling, rosy cheeked and yet shocked. Incredulous. His head cocked to the side just so as he said it. I admit it was cute. I think he is sweet. Like so many other residents here, he remembers very little from day to day. I don’t know why, but I find him endearing. His energy, and brightness of attitude has for a fleeting moment, taken away all the gray I have seen around me. He makes me smile, then he makes me laugh. It wasn’t a loud laugh, not a guffaw, no audible sound would be perceived, but enough air pushed out of my mouth, almost the pressure of when you are suppressing a cough. My mask is not used to this movement. Every so slightly, ever so suddenly it slips, and I feel the rush of cool, fresh air sneak into my mouth and into my lungs.
It was a moment that lasted a nanosecond. I stopped laughing. Every four-letter word I knew raced through my skull. I think a part of me knew this moment was inevitable. There is just no way you can deal with this perfectly all the time. This virus finds a way. It managed to find a way into this building despite all the testing, all the vaccines, all the boosters, and all the limited contact with friends and family.
I readjust. I keep chatting with Mr B. His lungs are good, his heart sounds fine. I encourage him to eat more protein with his meals and finish out our visit.
My mind now, for this short moment, is on the cool air that got past my defenses, because I smiled, and laughed.
There is no time for further deliberation. Mr. F is in the corner of the room. He is bed ridden with Parkinson’s, and dementia. On a good day, Mr. F can be wheeled out into the hallway, and will be able to answer yes or no questions with a nod of his head. Today, for him, was not a good day. He could not speak, though he tried. He wanted something, and I couldn’t make it out. He was not able to answer any of my yes/no questions. His hand quivered, so I reached down and held it. His eye locked onto mine, and I listened to his lungs. A rattle. In and out, fair air movement, but this sound. This is the sound of secretions. This is not good. I give him a smile and tell him we are going to take good care of him. He coughs. Not directly at me, I had turned my head to the side to check for swelling in his legs. But I felt the air blow past me, past my cheek and my ear. My mask held, and for that I am grateful. There was no smiling with this visit. There was nothing more I could do for him at the bedside. So, I tore off my gown, and moved on to the next patient.
I’ve been home for a few hours now. Someone else is on call, and covering the 7, and all the others in the facility. Now I wait, and wonder, in five days, will it be my turn?
Like some many other health care workers in the past 18 months, I have tried hard to educate and help everyone in their decision to get vaccinated. Living through days like these make me want to give up. To just run away. Quit. Bury myself in a hole. Because what can I do? I am doing everything I can, but it seems like very little. Knowing this past six months of illness and death could have been largely avoided if people had been brave, courageous, or just not suspicious of our intentions. I have two days off. I don’t know when I come back on Monday if the seven will be 14, or 50. I don’t know if we will have lost any. I don’t know if it is going to be my turn. I am tired, weary and scared. I am exhausted, and almost beyond hope. But I still show up for work everyday, because if not me, then who? I know the nurses, aides, maintenance, administration, housekeeping, dietary, and all the other support staff feel the same way. When will it stop? When will we be able to go back to our jobs as we knew them? When will we be able to let these residents see their families? When will we not be scared for our lives, and our children’s lives everyday? When will it be our turn? I just don’t know.
-written in 2021