COVID-19 at the Hospital

Have you ever seen Game of Thrones? There's this particular scene that I always used to think humorously and accurately represented the state of my hospital when COVID reached the US back in 2019/2020. It's this little clip of John Snow standing alone while epically drawing his sword at the Battle of the Bastards, bracing himself for the oncoming stampede of cavalry.

In the gif, John Snow represents us, the medical staff at the hospital at the start of COVID, preparing our units for the incoming wave of COVID-positive patients. It truly felt like what's depicted in that gif. I can honestly say I've never seen anything else like it, and I've worked at the hospital for over 5 years.

Hospital administration decided to convert my unit, along with many others, into full COVID units. We immediately and urgently discharged or transferred all patients who didn't absolutely HAVE to be there, such as pre-op patients who would just postpone their surgeries or patients with no cardiac history that didn't need to be monitored on a cardiac unit. It's a 24-bed unit, and in a day or two, we went from full to having 20 open beds. The unit had never been so quiet and almost lifeless as it was then. They even had to start cancelling nurses and techs because the unit census was so low, offering Emergency Time Off (ETO) pay, something I've never seen again.

Many policies were added or changed at that time. Masks became mandatory at all times, and at the start of each shift, every single staff member had to take their temperature and record it in a logbook. A fever meant going home immediately. Only two people were allowed in the breakroom at a time and had to stay far apart from each other. Visiting was no longer allowed as the Shelter-In-Place order came around. I think after a while they changed it to allow visitors for patients imminently dying only. Staff members would change into hospital scrubs when they arrived at work and then leave the scrubs there when their shift ended. De-gowning after leaving a COVID room required a witness to be sure we did it right and didn't risk carrying the virus to others. Doctors started seeing patients by video from the hallways rather than going in. COVID patients who were coding had to wait for staff to put all isolation equipment on, something that was very hard to do when our first instinct is to rush in and start CPR. Additionally, codes were actually run by doctors from the hallway. Only people doing compressions/giving meds/giving oxygen could be in the room. Employees who contracted COVID had to quarantine for 2 weeks at the beginning (this changed many times as the years passed). All patients had to have continuous oxygen monitoring, something my unit rarely saw before that. Meetings were held on Zoom, and my residency final project was cancelled completely, along with many other events.

Pretty quickly, shortages of certain equipment occurred, especially masks and isolation gear. This led to more policy changes regarding isolation equipment and PPE. At first, we had to discard masks after one time going into a room; later, we were allowed to use them for one full shift. N95 respirators were sent out to be cleaned and returned, and we would put them in a bag with our names, date, and unit for them to be returned to.

Some policy changes were actually kind of nice. For example, hospital policy required that we limit exposure to COVID patients as much as possible. This meant we no longer had to go into rooms for EVERY. LITTLE. THING. Patients call for the tiniest things all the time, and since they are technically "customers", we have to do those little things when we get the time. However, in early COVID, we got to tell patients they will need to wait for their next medication due time when we would cluster care and do all those little things at once. Forgot to ask for a third pillow last time I was in there? Tough... It'll have to wait 2 hours. Such is the nature of operating a hospital in a pandemic. I can't say that part bothered me.

I remember when they developed the flu vaccine, it became a big point of contention that a new vaccine with limited research was required of all staff, or you couldn't work there. We lost quite a few staff members that way and ended up with a severe nursing shortage on weekends especially. It became so desperate that they offered enormous pay raises for nurses working weekends. And then, THE BONUSES. The bonuses for picking up shifts reached as high as $1,000 for a 12-hour shift. That shit was so crazy...

The one other big thing I remember from COVID was the trailer... There was this trailer outside the morgue that appeared one day, and I wondered what it was for a while but didn't think much of it. Finally, the rumors spread and reached me. It was reserved for dead patients who were COVID positive. It gave me chills to pass it on the way to and from my car each workday.

As months and then years went by, things ever-so-slowly started to make their way back to "normal". After a while, admin realized we were losing too much money from delayed surgeries after turning surgical or peri-op units (including ours) into full COVID units and switched some of them back. We returned to being a cardiovascular progressive care unit with many pre- and post-op vascular patients after 2 weeks of being a COVID unit. We would still get COVID patients, but it wasn't exclusively COVID for us anymore. The quarantine period for being COVID positive became shorter and shorter for employees. Eventually, we were even allowed to come to work with active COVID infections, as long as we didn't have a fever or severe symptoms. Initially, calling out for COVID was excused. Now it's just another call-out. Masks are no longer mandatory at all times, only if the patient requests it or if a patient is on droplet or airborne isolation (i.e. for COVID, flu, RSV, rhinovirus, etc.). Visiting hours took years to return to normal and were changed countless times until then.

Moral of the story: The tumultuous times of COVID created so much change and chaos in the hospital that I still marvel at how much has happened and changed since it started. Not wearing a mask in a room feels so awkward now. I think we are closer to the old "normal" now than ever, but after 6 years of this, maybe this is just the new normal for the long-term. I guess only Time will tell.

- Bella, RN