FROM UNDER THE MASK; COVID19-ERA 2020

           From under the mask; Covid19-Era 2020

 

I remember returning from a global health mission to Africa and feeling so appreciative for all I was able to give but also grateful for what I had to work with here in my first world hospital. I felt so thankful, for the abundance of equipment, patient to nurse staffing ratio, ventilators, protective equipment; all the things I usually took for granted, but most of all the ability to save a life. I remember sending home a picture, proud of an innovation we came up with while on a trip to Kenya, where we got one oxygen tank to connect to multiple makeshift nasal cannulas via using IV extension tubing. I remember thinking that I would never have to improvise like that in the US. I was horrified when we had to extubate a patient prematurely in order to intubate another patient while working in an ER in Haiti. Never, would I have thought that, that same ethical decision would be something I would relate to back at home in New York.

I’ve been a nurse practitioner working with cancer patients undergoing plastic reconstructive surgery, as well as an ER nurse treating the needs of many sick NYC humans; from those dying from heart attacks to those dying for the hospital provided tuna sandwiches. It is April of 2020. Now, I just feel like a character in a Zombie film, moving along and treading each day, unprotected and with a new unknown. While most of the world stays home, I go from work to home, and then do it all again. I show up to work, every day a new schedule and a new plan, but with an old mask.  I see patients incognito, from under a mask, and sometimes a face shield. We limit interaction, when it was once encouraged. We stand away and limit our touch, when touch and closeness hold so much power to heal. They ask questions, but we don’t have answers. Families are far away, and so we glove up, and hold yet another dying hand in their place.  We are the stranger they say their last good bye to. And from beneath our masks, we try to communicate words of comfort and say the dying prayers with our patients. We have marks from our masks, and they have marks from the IV lines and breathing tubes. We struggle to leak a fresh breath of air from beneath our masks every few hours, and they need long tubes to push their breaths in and out for them.  My heart is heavy when I think that I was the last face my holocaust survivor patient, saw before they got intubated and eventually died.

There are times as a nurse that I guide my patients towards health, and other times, I guide them towards a peaceful death. Now, I feel like I can do neither. Our algorithms for care, change by the hour; as do our staffing and available equipment. Our research is too new, and weak. There is much unknown, and everyone reacts differently, so we treat symptoms and hope that it heals.  When it does not heal, our gloved hands, which usually held one on the patient and one on the family grieving nearby; is still gloved, but holds the dying person’s hand, alone, as the family worries in a far distance.

From under our masks we watch our patients struggle for their next breath.  We wonder if they notice our eyes smiling or worrying for them. From under our mask, we cover them when there is no breath left to fight for. From under our mask, is our sweaty face, also struggling to breath, but manages yet another breath of surrendered despair. Another life lost; from under the mask.

The mask etches lines of indentations and beads of sweat on our tired faces. Every day, under the mask, also carves cracks into overworked hearts, for those lives we couldn’t save and those we are still struggling to save. Some days we get a new mask, but we will forever bear the old scars that this CovidEra is etching into our hearts. The cracks heal, but the scars remain; tribute to every life lost, and every life struggling to be saved and kept safe; including our own.

 

Devorah Goldberg MSN, RN AGPCNP__­­ Covid19-Era 4/2020