I Spend All of My Time Being Angry These Days Part I

So I finally retired in March of last year. 43 years being a nurse and I got to the point where I knew it was time. Past time really.

I survived three years as a nurse in Inpatient Acute Psych Unit.  I learned about schizophrenia simultaneously while I learned electronic medical records. Nothing like trying to chart on a computer with very ill people screaming in my face.  The learning curve was steep, but I learned a lot in a very short period of time. I worked with remarkable people who truly cared for those who had a separate reality from most of us. God bless them all.

From there I opened the final chapter in my career. Four years in Inpatient palliative care.  I remember being ecstatic to have found the position and then thrilled to get the job. It had a lot of ups and downs. It took a couple of years for the team to settle down. Members came and went, and not all voluntarily. The remaining team was comprised of the finest professionals I had ever worked with. Office space became minuscule and responsibilities increased but the team matured and became respected by most disciplines. I got my one and only official warning of my career. I learned that sometimes there is an unknown agenda and you become collateral damage, so moving on is all you can do. I foolishly thought that was the worst thing I would experience as a nurse. I was wrong.

In January of 2020 we started to hear about a virus appearing in China. Some sort of SARS but it seemed to be limited to China.  Although the virus was scary, the intentional misinformation was far scarier. The former occupant of the White House kept saying it was "like the flu" and would soon be gone. We now know he knew the truth but he chose to lie to protect his own graven image.

COVID found it's way to California and my city officially by March, (but likely earlier) and now we had to figure out how to deal with it. 

 From AJMC:

March 6 — 21 Passengers on California Cruise Ship Test Positive

March 11 — WHO Declares COVID-19 a Pandemic

March 13 — Trump Declares COVID-19 a National Emergency

March 19 — California Issues Statewide Stay-at-Home Order  

"California becomes the first state to issue a stay-at-home order mandating all residents to stay at home except to go to an essential job or shop for essential needs. The order also instructs health care systems to prioritize services to those who are the sickest."  

The nightmare was official. People were initially staying home, but Healthcare Workers were walking into work not sure of what to expect. I was lucky because I had reduced my hours by 50% in anticipation of eventual retirement.  I was going to work until 70, so I only had to get to 2022. I had a sick feeling it was going to be bad, but only time would confirm that. And it didn't take much time.

Everyone with a pulse likely remembers how hard it was in the beginning. Physicians were learning on the job. The virus revealed itself to kill not only by pneumonia, but with blood clots and multi organ failure. Hospitals filled up. We all learned something new everyday. It was hard, really hard, but people knew we were on their side.

In patient palliative care is difficult under normal circumstances. Few want to talk about disease trajectory before there is a crisis and honestly, the team is treated like they are Grim Reapers. We were often confused with hospice. Our job was to make sure patients understood where they were in their disease process and to look at maximizing meaningful care and minimizing futile care. We would only see patients when invited by their physician. Business took a big leap when COVID showed up.

Remember, I am speaking of the original COVID-19, not the Delta variant.  Some people did get well enough to leave the hospital. Some would discharge to a nursing facility for "rehab". But some people could not recover in spite of maximum care. They were never going to leave the hospital alive. If it is physically possible and the family desires to take the patient home to die, we move heaven and earth to make it happen. This virus, this damn virus wasn't letting this happen. People were dying in the hospital because we couldn't get them home to die. The largest issue was oxygen requirements. We could get some home, but those on the highest levels of oxygen were not likely to survive transportation home, so they were dying in the hospital. Because of the contagious nature of the virus, families were not allowed to be with the patient when they were dying if they were still testing positive. People were saying good-bye to their loved ones over either a phone or a tablet. 

I will never forget speaking to family members after seeing their loved ones and confirming with them the prognosis was grave. I was used to breaking bad news, and I frequently did it over the phone. This was different. The speed at which someone could deteriorate was all over the place. Some hung on and their symptoms waxed and waned for a bit giving some hope. Some came in and did a swift unremitting decline. The common factor was they did not have the comfort of their family when they took their last breath. It was soul crushing to hear the sobs from the family members over the phone. The patients were so ill at the end most couldn't cry. Those on the ventilator were sedated and were unable to communicate. All we could do was apologize for a virus we couldn't control. The bedside nurses took the brunt of everything. The physical risks, the daily "new plan", and the pain and anger from the families. If you can't be angry with God, be angry and your bedside nurse. Physicians, nurses on the floors and in the ICU, respiratory therapists, nursing assistants, physical therapist, pharmacists, housekeepers all experienced moral injury because of the damned virus and the circumstances out of our control. This went on for almost a year. The first wave, the second wave...

Then we got vaccines. We could prevent most infections and if not prevent the infection, it would likely be much more mild. Our prayers had been answered.

My healthcare system was prepared months in advance to roll out a vaccine. They had the appropriate storage, they had a plan to roll it out to employees and the community after that. I got my first vaccine on Christmas Day, 2020. I cried because I thought it was the best gift I had ever received. I was fully vaccinated three weeks later. It was then I made my plan to retire. I felt like the worst would soon be over because we had a vaccine. March 3, 2021, I hung up my stethoscope for the last time. My sweet co workers gave me a nice send off. The Social Workers made me an unofficial social worker and gave me flowers. My twelve year old financial advisor told me if I was VERY careful, I would have a decent retirement. All was right with the world. 

At least for a little while. I was even working on getting my sense of humor back.

And that didn't last very long...