A Nurse on the Front Lines
It’s the morning of April 1, 2020, and Lindsay Nolan has just arrived at Stony Brook University Hospital for her shift as a nurse on the medical surgical floor, located on level 12 South. Typically, this is where the patients of least concern stay, but there’s nothing typical about this day. At least not yet.
Lindsay, a 26-year-old registered nurse, greets the night nurse she’s taking over for, who is standing in the hallway next to a closed door. On the other side are two COVID-positive patients. Two bulky, white pulse oxometer machines in the hallway each display a squiggly line and two numbers that track the oxygen levels in the patients’ blood. The chords of the machines trail under the door, connected to the patients inside by skinny white stickers. Nurses have been instructed to limit their time in the room – personal protective equipment (PPE) is running low, and not much is known about how the new virus spreads.
“He’s really sick,” the night nurse says of the dark-haired man in the room. “He’s already on 50 percent oxygen.” She finishes her shift report and says goodbye to Lindsay.
It’s hospital protocol to check on the sickest patients first. Lindsay opens the door with her gloved hand and swiftly steps inside the beige room, closing the door behind her. The 41-year-old man in the bed by the door is barely breathing. The muscles in his chest and shoulders surge to expand his lungs. To no avail.
Lindsay instantly knows he needs more than the clear, plastic Venturi mask that covers his mouth and nose. She draws the curtain between the two beds and the room dims as the cloth blocks the natural light flooding in from the window.
On average, the air we breathe contains about 21 percent oxygen. A Venturi mask administers air with oxygen levels starting at 25 percent. The patient’s mask is operating at 50 percent oxygen – its highest setting. The air pumping through his mask is saturated with more than twice as much oxygen as he’s used to, yet his lungs cannot take it in.
He has COVID-19.
Lindsay calls a “rapid” – hospital jargon for requesting backup. No one responds. On a regular day, three people from the rapid response team and a handful of other medical professionals would have arrived almost immediately.
Lindsay has worked at Stony Brook University Hospital for three years, so even though she doesn’t usually take care of severely ill patients, she knows not to panic. Her training and experience kick in – and suddenly, she’s on autopilot. At moments like this, Lindsay would explain what’s happening and try to keep her patient calm. But the man she’s treating understands little English. He strains to speak to her in Spanish but can’t get out many words. She gives him a second IV and draws his blood as gingerly as possible, trying to stabilize him while he gasps for air. The other patient in the room, an elderly man with dementia, is screaming for water.
About 10 minutes later, a man on the rapid response team finally arrives. He happens to speak Spanish. The patient agrees to an immediate intubation and calls his wife. Moments later, his English-speaking daughter asks from the other end of the line to talk to someone about what’s going on. Lindsay grabs the phone, explains the situation and reassures the teenager that they’re doing everything they can to help her dad. She puts the man back on the phone. The girl keeps an optimistic tone, but Lindsay hears her voice crack.
An anesthesiologist enters the room and begins the intubation process. A metal tool is carefully – but forcefully – pushed into the sedated man’s trachea to guide a plastic tube through his airway. A small inflated balloon is then placed inside his trachea to secure the tube as it’s attached to the ventilator, which forces oxygen-rich air through his lungs. He’s rushed to the Intensive Care Unit (ICU).
Lindsay never sees him again.
“I followed his life case,” she says months later. “Because he was just – I don’t know. Something about him.” The man was well below the high-risk age group with no pre-existing health conditions. His daughter was only 15.
“He ended up passing away,” she says. “And we had a lot of those, unfortunately. They got really bad on our floor, and then they would pass away. A lot of the stories are not great stories.”
While Lindsay struggled to keep this man alive, she herself was sick with the virus. She’d just returned to work after self-isolating for 10 days. He was her very first patient on her first day back on the job.
Lindsay didn’t know she’d been exposed to the coronavirus until her boss called her on March 21 and told her a coworker had tested positive. Lindsay had contracted the disease on Friday the 13th from another nurse on her floor who unknowingly treated a COVID-positive patient. She started feeling cold symptoms a week later. Her only COVID-specific symptoms were the losses of taste and smell, which weren’t yet known indications of the virus. It took about six weeks for her senses to fully return. Lindsay describes her sickness as slightly worse than a bout of the common cold. Her nose was clogged and there was intense pressure on her sinuses.
“I stayed home only 10 days because they needed me back at work,” she says. “So, if I was fever-free for three days, then I didn’t have to quarantine anymore.”
Lindsay never had a fever, so she waited until three days after the worst of her symptoms subsided. Still weak, she went back to work. Some of her coworkers got much sicker than she did and she says she would have felt guilty staying out much longer. Before she left, there were only a couple of patients with COVID on the medical surgical floor. By the time she returned, all 29 were COVID patients.
The next few months were a blur.
The “new normal” for most Americans consisted of working from home, wearing a mask and staying six feet away from others. The new normal for Lindsay and many other health care workers meant patient after patient like the 41-year-old man. She says she became so desensitized to death that it almost disturbs her.
“We didn’t really have time to stop and think … because we’ve gotta keep going. It’s sad that just happened, but you have four other people to take care of upstairs. Time to go back to it.” Equally disturbing was the lack of basic hospital supplies that Lindsay once took for granted.
During one of her shifts at the height of the pandemic, the hospital ran out of body bags. “We had someone pass away, and we didn’t know what to do,” she says, “we just put them in [a shroud] without the body bag.”
Supplies were rationed at the hospital like water during a drought. A limited number of masks and disinfectant wipes were allotted to her floor each day. When supplies were exhausted, they were replaced with cheaper alternatives. The disinfectant wipes became a watery, orange-scented spray that doubled as hand sanitizer and the customary plastic blue gowns became thin, translucent paper ones. Before COVID-19, the hospital would be fined by The Joint Commission – an auditing agency that enforces health care safety standards across the country – if employees were caught reusing masks. But before long, it became impossible not to do so.
“All of a sudden, the CDC, when we didn’t have supplies, was saying, ‘Oh, it’s okay to reuse masks for 10 days,’” Lindsay says of the Centers for Disease Control and Prevention guidelines at the time. “But literally last week, you were saying it’s not okay… They were only changing the rules because of the supplies – not because of actual studies. It was very obvious.”
The Strategic National Stockpile (SNS) was started by former President George W. Bush to store emergency PPE and other health care supplies to support hospitals in the event of a national public health crisis. According to Harvard Business Review, the national stockpile was inadequately funded and hadn’t replenished its supply of masks since the H1N1 pandemic – the so-called swine flu of 2009. With a global shortage looming, the stockpile was exhausted in February, 2020. Since then, the SNS has expanded its supply of PPE exponentially and restructured its operations completely.
Under the circumstances, Lindsay says the hospital did a good job working with the supplies it had. Her friends who work at other hospitals can’t all say the same. Because no rationing took place, they had to reuse more than just masks.
“They would have a gown that you wear when you go into a patient’s room,” Lindsay says, “and then when you get out of that patient room, you hang the gown up and then the next nurse uses that gown, too. Everyone’s using one gown for that room – like, everyone’s using the same gown. We were able to have our own gowns … We had to reuse masks, but within reason. It wasn’t anything that was egregiously disgusting.”
Lindsay commends Stony Brook Medicine’s allocation of supplies and expresses gratitude for the support she and her colleagues received from the community. Family members of nurses and patients would present health care workers with homemade masks, hand-written cards and gift baskets. Local businesses donated food every day – from pizza to salad to garlic knots. Appreciation from the community served as much-needed encouragement for exhausted hospital employees.
The chaos of COVID finally started dying down at the hospital last June. By August, things were more or less back to normal. Even so, the coronavirus left many vulnerable patients in its wake. Hydroxychloroquine, touted by then-President Donald Trump as a coronavirus cure-all toward the beginning of the pandemic, ended up causing further complications for many COVID patients.
“Not only is it very expensive, it’s actually really bad on the heart,” Lindsay says of the drug. “A lot of people are speculating that the hydroxychloroquine, you know, messed up these people’s hearts, and that’s why they were having arrhythmias that put them into cardiac arrest.”
By the time there was a second influx of COVID patients last November, the treatment protocol had changed. Rather than hydroxychloroquine, qualifying patients were given intravenous injections of steroids and Remdesivir, an antiviral medication.
“I feel like there was a lot better turnover the second round versus the first round,” Lindsay says, noting that men between the ages of 40 and 65 still tended to fare poorly.
“I’m not sure why,” she says. “I’m sure years from now we’ll hear more research.”
Lindsay’s parents are on the upper end of that age range, and during the first wave of COVID, she didn’t visit them in New Jersey for nearly four months. When Lindsay finally saw them in person late last June, it was a somber reunion. Their 15-year-old dog Cody – part of the family since Lindsay was 11 – had to be put down.
“Even though I’m 26, I’m like a child still,” she says, sweeping her long brown hair behind her ear. “And now I have to tell my parents we have to put down the dog.”
Since then, Lindsay has seen her parents as well as her older brother and his two young children multiple times, and under happier circumstances. She’s been fully vaccinated since January. Her crystal-blue eyes brighten when she lists the loved ones she’s visiting next – her grandparents, her aunt, her friends.
For as long as she remembers, Lindsay’s always wanted to work in health care. Her selfless nature stood out throughout the pandemic – she readily guided new nurses coming into the hospital, she sprinted to respond to her colleagues’ calls for “rapids” whenever she could, she stepped in for nurses who were assigned to COVID patients and hadn’t yet contracted the virus, she picked up a friend’s Thanksgiving shift to give her the day off with her family.
Lindsay was asked to be one of two charge nurses for a new COVID floor that opened in January with staff selected from various units in the hospital. She oversaw the nurses on the floor directly beneath her own – level 11 South. Three years of clinical experience on the 12th floor plus months of facing the worst of the pandemic enabled her to take on a job that typically requires more schooling. She assumed the extra responsibilities of this leadership position without the increased pay.
A former pediatrics unit, the new COVID floor was already ICU-equipped, and every room was turned into a negative pressure room where the air pressure inside the room was lower than that outside the room to keep contaminated air from flowing back into the hospital.
This time, Stony Brook University Hospital was prepared. But that didn’t take the pressure off health care workers.
Though intubations were rarer in the second wave, COVID still took the lives of otherwise healthy patients. One man on the floor celebrated his 50th birthday in a hospital bed. Lindsay describes him as a relatively healthy man with a touch of extra weight. After weeks in the COVID unit, he needed to be intubated, then rushed to the ICU and eventually put on emergent dialysis, a form of life support that filters salt, waste and excess fluids from the blood. One of Lindsay’s coworkers who’d taken care of him every day followed his progress. He didn’t make it.
In March, a staff shortage on the medical surgical floor meant that Lindsay had to return to her old job, though she says she would have been willing to stay on the front lines for as long as necessary.
“Not to be dramatic,” she says, “but it’s like – it feels like you’re at war with people … you had an experience with them like none other. And it was just hard.”
It won’t be long before the coronavirus waves a white flag at Stony Brook University Hospital. It’s been more than a month since Lindsay last took care of a COVID patient – a testament to the effectiveness of vaccinations across Long Island and the state and country.
“People who came out of their other jobs have been sent back because we have numbers decreasing,” Lindsay says. “Which is great. Things are thankfully a lot better.”
Because of the trials and tribulations created by COVID-19, Lindsay says she’s become a better nurse, and she believes the entire health care system is now more equipped to handle future crises. Though she hopes no similar catastrophes happen anytime soon, she’s glad to know her hospital and community are better prepared for them.
“I gotta say, years from now, talking to nurses that I’ve worked with during this time – I feel like it’s gonna be such a surreal feeling,” Lindsay says. “It really is.”