The life of a COVID-19 intensive care unit nurse right now is one of fatiguing hours, constant vigilance and, when a patient recovers, moments of joy. Diana Tejada, 28, is a critical care nurse at Novant Health Presbyterian Medical Center. Over the course of several days this summer, Tejada captured her experiences on the pandemic’s front lines. Her diary entries have been edited for length and clarity.
June: Fearful patients and a determined team
My shifts normally consist of three to four days a week, and can be over 12 hours. This morning was my second of three shifts in a row and it took all five of my alarms to wake me up.
I currently live with my fiancé, and our two boys, Leo, 5, and Randall, 1. Due to this pandemic our normal sitter cannot watch our boys, so my mom has been helping me while my fiancée and I are at work. My boys either spend the night with their grandparents or leave for their house very early in the morning.
I really dragged this morning because I was so tired. On the drive to work I played some music to relax, but as I neared the hospital, I gazed through the windshield at the walkway on the third floor wondered: What would this day bring?
I rolled into the parking garage, filled out my online COVID-19 pre-screen to enter the hospital and ran to my unit, clocking in at 6:40 a.m. I walked through the COVID side of our ICU. I counted how many COVID patients we had and said hi to the night-shifters. I quickly went to the locker room and changed into scrubs.
At 6:45, morning huddle had begun and our assignments were called out. I was assigned to the COVID side. I got a report from the night shift nurse, reviewed my patients’ charts, and then slid into my personal protective equipment (PPE): N95 mask, face shield, hair cap, gown and gloves. Normally we give a patient’s report at the bedside, but now it’s held outside the room.
Right before 8, I did a head-to-toe assessment on my first patient, looked over all the IV medications and started ordering the ones that were about to run out. You have to stay ahead on a COVID-19 patient’s meds. One patient was on norepinephrine due to shock – and let’s just say you can’t run out of this medication — their blood pressure will tank, and fast.
I also talked to the respiratory therapist and discussed the ventilator settings. Both my patients were on life support and both have medications that I had to titrate (adjust), both were in restraints to keep them from removing their lines, and both were sedated. After I administered their medications, I got help from another nurse to turn them. We do that at least every two hours to prevent bedsores.
Spiking fevers, proning patients, calling family
At 10 a.m., it’s time for rounds with the intensivist and team members from dietary, respiratory, palliative care and pharmacy. It is very intimidating as a newer nurse speaking with the full team, but the doctor normally discusses the patient’s background and then we, the nurses, have a list of things we have to discuss so that we are on the same page and know the plan moving forward. During rounds today, we discussed proning one of my patients who had a hard time getting enough oxygen.
To prone a patient means we flip them on their stomach to help their breathing and leave them on their stomach for at least 18 hours. After rounds I got together with respiratory and discussed a time because proning requires a team of at least three people and even more – depending on the number of IV lines, chest tubes, and wires the patient has connected to him or her. We proned my patient around 11 a.m. After this it was time for another assessment of both my patients and reviewing new orders. The patient I had to prone was also septic but had spiked a new fever that I reported to the doctor – which meant getting new blood cultures and fluid samples to send to the lab. The rest of the day galloped by: Charting each thing I did for patients. Communicating nonstop with family members looking for updates. Tracking down a medication with our pharmacy team. Arranging for a physical therapist to work with a patient and helping my co-workers. We also took in two new COVID patients and, on a positive note, transferred two of our existing COVID patients out of the ICU to a less-critical level of care. We all worked together so well. I am so grateful for this wonderful team at the Presbyterian Medical Center medical intensive care unit!
The one thing that makes my day is talking to patients even though they can’t talk back. I do this all day long. I also enjoy communicating with their families via FaceTime or Zoom. It’s great to see how happy it makes the family. The ICU can really be chaotic and scary because things can go sour very quickly but what is great about where I work is that I feel supported by management, the doctors, and most important, my colleagues from respiratory, wound care, physical therapy and the nurses who are next to me during this pandemic.
I reflect on my day as I drive home around 7:30 p.m., and once there, I immediately shower, wash my clothes, and then eat a late dinner. My kids will stay at my mom’s house. It’s time for bed, so I can be back at it the next morning.
July: Exhaustion sets in
Today I’m working as team lead. As I look around all I see is that almost all our patients are on a ventilator. Our COVID numbers have increased. I can't help but feel bad how lonely our patients are! I have two patients – a sweet older man and a young man who is COVID-positive and requires continuous dialysis. It’s hard to take care of two patients and then check on everyone else but it makes the day go by fast. I can see in every team member’s face how tired they are and it's only Monday.
I get my morning meds and go assess my two patients while requesting blood products for one of them. One of my patients runs out of sedation and starts waking up trying to get out of bed, setting off ventilator and bed alarms. I had to rush in there but had to take the time to put on my PPE to protect myself. My patient is intermittently awake, but I can tell he is scared. After settling my patient and bathing him I circulate the unit again, asking if anyone needs help. Almost everyone on the COVID side is prone (belly side down) to hopefully help their ventilation and oxygenation status. The phones are ringing with calls from families. The monitors are beeping nonstop.
‘I miss my children’
Afternoon brings a flurry of activity. I take one of my patients to get a CT scan, get labs on the other patient and bathe and turn him.
We have two incoming transfers coming in the ICU, so I get the rooms ready and help the nurse settle her new admission. After running around, I look at the time and realize it's 6 p.m. — time to make the schedule for the upcoming shift. Thankfully tonight we are not short-staffed and the lead will actually have no patients! This is a win for us because our census is high, our acuity (or how sick a patient is) is high, and there are not a lot of critical care nurses available. As I head to my car I call my mom and talk to my sweet children. They are spending the night there again because I am working multiple days in a row. I miss them so much.
August: A new life, and a life hangs in the balance
I have recently found myself thinking how sad it is in the ICU since this pandemic started. There have been a lot of deaths — but death in a totally different way than I have ever seen as a nurse. Patients die without a family member beside them.
But that’s not the whole story. I have to stop myself and think of all the great moments we have seen in the ICU, too. One patient that comes to mind is a pregnant mom of three who was just 24 weeks along and was diagnosed with COVID. Unfortunately, she ended up getting intubated and they had to deliver her baby early because the mom was so sick. She only spoke Spanish and you could see the fear all over her eyes.
Her baby survived, and we kept Mom updated. That baby had so many supporters and prayer warriors. Almost every time I would work, I would go talk to her in Spanish, which is my native language. I was born in Peru.
Every time I spoke to her you could see her face relax and her eyes start to tear as she nodded or attempted to communicate. She was in the ICU for over a month and as the disease worsened we feared for her life. Would she get to take her baby home, I wondered? Finally we were able to extubate her (remove her from the ventilator) and we were able to put her on Optflow – a system that delivers high oxygen through a nasal tube.
‘This is what makes working here so great’
She became delirious but after days of trying to communicate with her, telling her where she is – she came to. I remember one day I was talking to her about her kids and she cried – and it took everything I had in me to stop from crying myself.
I told her she is strong and that she has to keep trying for her babies. We printed a picture of her beautiful baby and placed it next to her. Everybody on the team focused on helping her recover. She didn’t know this, but so many people were involved in her care. It’s not every day that a baby is delivered in the ICU.
The best day came when I got to deliver the good news – she was leaving the ICU! I braided her hair to make her look even more beautiful than she already was … and we got everyone in the unit to be by the exit to applaud her as she left. I knew that she had a huge smile under the mask because her eyes said it all.
This is what makes working here in the Novant Health ICU so great: seeing people get better and be able to leave to go back to their families. Everyone, as a team, made an impact in her care.
COVID did not beat her, she beat COVID. And I like to think, we did, too.