Hospitals in metro Detroit have seen an avalanche of desperately ill patients over the past several weeks. There are still many people sick with COVID-19 in ERs and ICUs — but things have calmed down a little. We wanted to know what front-line health care workers are thinking about what they’ve seen.
This essay comes from an ER nurse, and was voiced by an actor. To protect the healthcare worker's job, we are not using their name.
Monday, March 30, 2020 was one of the hardest shifts I've ever worked. I've been a nurse for five years — ICU and ER. I’ve seen a lot, and not much gets to me. I'm accustomed to high-stakes, high-stress, fast-paced situations. What I'm not accustomed to is playing God.
On that Monday night at one of the Ascension hospitals in metro Detroit, it seemed like everything was at a standstill. Like the emergency room was its own island with no ability to get assistance or resources. The hospital was at capacity; the ICU was full; the step-down unit was full; we were sending ICU patients to the cardiac floors because there was nowhere else to put them.
Up until that night, we hadn’t really had an issue with a lack of equipment. But then we ran out of one of the most valuable resources: ventilators.
We already had many vented patients in the ER at this point. I believe every nurse had at least one; some had two. And patients were still streaming in. Patients in their upper 30s were coming in with severe distress from COVID-19 and requiring ventilator life support.
Now, every emergency nurse is trained in mass casualty triage, and we’ve all been told that in situations like this, you have to do the unthinkable. You have to make a call as to who is healthy enough to get through this illness and have some sort of quality of life at the end, and who isn’t.
This type of triage is typically reserved for military casualties, or in times of biological or chemical warfare. I never thought we would have to implement it in a major U.S. city in 2020. But here we are.
On that Monday in March, the respiratory therapist and I, with the physician's order, terminally extubated three patients, so that younger, healthier patients who stood a better chance at survival could have a ventilator.
The first patient to be pulled off of a ventilator was in her mid-50s. She had a history of a chronic terminal condition. She came into the ER in severe respiratory distress and was intubated immediately. After three hours, she showed no signs of improvement. We knew that she had a low chance for survival. But there is always a chance.
Around this time another patient arrived at the hospital. A female in her 30s who was pregnant. She was in severe respiratory distress and had an extremely high fever. We needed to get her on a ventilator to give her and her baby a chance at survival.
The 50-year-old’s family agreed to take their family member off the ventilator, and we put the pregnant woman on. The 50-year-old died, alone in her room.
Typically, when a person dies in the hospital, family is surrounding the patient. If family can’t be present — nurses, nurse assistants, and sometimes even doctors remain in the room. Comforting the patient any way we can. Holding their hand, massaging their shoulders, and giving medications to break through the pain. This did not happen that day.
These are challenging times for everyone. People are laid off work, supplies are scarce, families are separated, loved ones are dying. All the casualties of this virus. But I know as a society we can get through this. I do not want to keep experiencing days like this. I hope I never have to play God again.
