This is nurses week, the internet is swirling with recognition for nurses in the midst of two months of talking about the frontline heroes. It makes me squirm a bit. While it feels good to have a moment to recognize the work we have chosen to do, I don’t feel like a hero. Before the pandemic put us in the limelight, we were doing the same work, just different dangers and on a different scale. We have always paid attention to hand washing, wearing masks, isolating patients at risk for infecting others or at risk for becoming infected. But we face more dangers than infection on a daily basis. We deal with an inordinate number of patients who have poor coping skills and treat us badly for trying to provide care to them. They verbally abuse us, threaten us and assault us, then accuse us of not caring. As an ER nurse, I am presented with unknowns with each patient and have to balance protecting myself with making that patient feel like a human being and not a potential threat. I am thrilled when I have a patient that appreciates my care, one who says thank you, or even just doesn’t yell at me. I think the worst thing someone can accuse me of is not caring. I care so much that I put my health on the line to come to work every day. I care so much that I work at a public facility for lower pay because this patient population needs care. I care so much that I strive to hear each patient and look into their eyes with reassurance. I care so much that I risk being wrong or ridiculed when something just doesn’t seem right with that patient and I drag a doctor to the bedside. I care so much that I want to learn everything I can about this current pandemic so I can answer their questions, so I can keep my family safe, so I can keep working and support my coworkers. So when a patient screams at me that I just don’t care and storms out of the ER unhappy, I am brought to tears. I realize that this is an indication of how overwhelmed we all are. I usually have a tougher skin at work, and I know the insults are really the patient’s lack of coping skills. Yet this is how fragile I am.
Our hospital has not been overwhelmed by COVID-19. Nor have other hospitals in SF. The bay area has been successful in flattening the curve and keeping the death toll low. I watch what is happening in other areas of the country in horror. I read about the experiences of the doctors and nurses in those areas and my heart breaks. I worried at the beginning of all of this what I would do if faced with having to choose which patients to tend to, knowing that others would suffer. To be honest we were already doing this before the pandemic when our waiting room routinely had 40-50 patients waiting hours to be seen. We always seemed to find room for the ones that were truly at risk of losing life or limb, but others also with genuine complaints had to wait. I hated telling patients that I could see they were suffering but there were no open beds and another patient was in worse shape. As triage nurses we know that some need immediate care and some can wait, and we are skilled in discerning the difference. However as a human being, I also know that all suffering is real suffering and everyone deserves to be heard and receive care. The hard part was that we couldn’t provide what many of the patients needed, such as warm, dry shelter, regular nutritious food, connection with people that care about them, purpose in life, healing for their trauma that landed them in the place that they are. In the end they all get seen and cared for if they are willing to wait, though for many a tylenol, a sandwich, a clean shirt and socks, and a bus token is all we can truly offer. Most of these patients are not coming in right now. They are scared, they don’t want to get sick, and if they are able to cope a little bit, they stay away. We are definitely seeing more suicide attempts, more intoxication with alcohol and drugs, and more peopleunable to cope with the anxiety and depression. I get that, I have resources and coping skills and I also feel it. This week we are starting to see more accidents and fights which makes me think some people are at the end of their patience with the shelter in place order and are going out anyway.
I think we are coming to an understanding that we have to balance the risks we are willing to take. The risk of being ill, or infecting others vs the risk of the mental health effects of sheltering and not connecting with people vs the risk of a failing global economy. As we learn more about how this virus works it becomes clearer that we can emerge from sheltering in a controlled way. The scientist in me understands that we won’t have herd immunity or a vaccine for quite a long time, and this virus is proving to be very infectious and quite dangerous for anyone with chronic health conditions. By using a reliable antibody test in a widespread way we can find the people who have likely developed immunity and can safely circulate. We know how to protect vulnerable people from infection, we have done that for patients in cancer treatment, who have HIV or other immunocompromising conditions. We should be able to shield or shelter the elderly and the ones with chronic health conditions while we slowly have others get back to more social interactions. It will be a new normal; groups will be small, people will wear a mask, more hands will be washed and attention to cleaning commonly touched surfaces. We will continue to test both for the virus and for the presence of antibodies to understand how this virus is spreading and how we as people are responding. We will need patience with the medical and scientific community to digest and process the garden hose flow of new data. We will need patience with our governing leaders to help us organize how to be in society with each other. We will need patience with each other and our various levels of acceptance and anxiety around the pandemic. And lastly we will need patience with ourselves as we adjust to a new normal and regain some balance. Breathe, and be grateful for that breath.