THE WASHINGTON POST – First, arrive at work before dawn. Then put on a head cover, foot covers, surgical scrubs, and a yellow plastic gown.
Next, if one is available, the N95 mask. Fitting it to your face will be the most important 10 seconds of your day.
It will protect you, and it will make your head throb. Then, a surgical mask over the N95. A face shield and gloves. Cocooned, you’ll taste your own recycled breath and hear your own heartbeat; you’ll sweat along every slope and crevice of your body.
Now, the hard part.
Maintain your empathy, efficiency and expertise for 12 or 18 hours, while going thirsty and never sitting down,
in an environment that is under-resourced and overworked, because your latest duty – in a profession with limitless duties – is confronting the most frightening pandemic in 100 years while holding people’s hands through it, through two pairs of gloves and a feeling that tomorrow could be worse.
“The job’s hard,” said Angela Gatdula, 31, a nurse in Santa Monica, California. “It’s been really hard,” says Sasha DeCesare, 34, a nurse in Orlando.
“I’m anxious, because it’s a very stressful time to be at work,” says nurse Brenda Keys, 25, who recently returned to MedStar Washington Hospital Centre after recovering from her own bout with COVID-19. “I’m excited, though, to get back and help my coworkers because I know they need the help.”
Nurses have always been the glue. They are the link between patient and doctor. They don’t want your pity, and they don’t want to be called a hero; what they want is for you to stay home, stay well, stay alive.
For 18 years in a row, nurses have been rated the most honest and ethical profession, according to Gallup surveys of Americans, outpacing doctors by 20 per centage points (and members of Congress by 73).
In an era when no one seems to trust anyone, we trust nurses.
“But I don’t think that means people really understand what nurses do,” said Laurie Combe, president of the National Association of School Nurses. It’s a complex job, requiring knowledge of both biochemistry and psychology, in myriad environments.
Nurses are helping your fourth-grader learn to track her insulin levels at school, and they are putting pressure on a gunshot wound at 2am while noting that the victim has no pulse. They are monitoring both your heart rate and your spirit.
When they touch your arm, in what would appear to be a simple gesture of friendliness, they are also testing if you’re hot, swollen, dehydrated, tremoring.
“I can observe what is on your bedside table that you’re reading – if I can talk with you about that, I can strengthen our connection to build trust,” said Combe, who has been a nurse in the Houston area for 45 years.
“I can see who’s in your room visiting, what the interaction looks like, and see whether that’s a trusted person or not, so I know what I can talk about during that visit.”
The novel coronavirus has changed the world, and it has changed what nurses do, too. They are deploying to unfamiliar hospitals, transforming their units into coronavirus triage, working in extreme conditions without proper equipment, running testing sites in remote locations, facilitating virtual goodbyes with dying family members, organising protests against hospitals and the White House, and consenting to the reality that simply showing up might be fatal.
At the drive-through coronavirus testing site in Bear Mountain, New York, an endless stream of cars pulled up, piloted by passengers sick with terror, and the only cure for the terror was Brenda Lagares, who’d been given 15 minutes of training to potentially save their lives.
Before the pandemic, she’d been working as a night nurse, monitoring infirm patients in their homes across all five boroughs of New York City.
When the pandemic came, Lagares was recruited into one of the more crucial new roles within her profession: She would be a sampling nurse.
Armed with a long nasal swab – similar to what she’d use for a regular flu test – she would test for SARS-CoV-2 while cars passed through as if by conveyer belt. She wore a mask. Many of her patients wore masks, too.
“This is how you can tell what a patient in a mask is feeling,” Lagares said. “You see the eyes glistening, because they’re about to cry. You see dilating of the pupils when they first pull up, because they’re scared. But then you tell them what’s going to happen, and when they’re ready, their pupils would constrict. And that’s important. Because you only have five seconds to connect. You need to know they’re with you. You need to be there, together.”
Swab, seal the swab, next car, next patient.
“After the test, what they wanted was reassurance,” she said. “So I would always say, ‘I hope you feel better.’ As the car drove away, I would wave at them and put my thumbs up. We all did that. Thumbs up. Because when we were in our full PPE, that was the best way to communicate that we’re in this together.”
“We have people who are afraid they’ll get us sick, and people who are afraid we’ll get them sick,” said DeCesare, the Orlando nurse who is also working at a drive-through testing site, at the Orange County Convention Center.
“They’re afraid to talk to us. We hand them their (intake form), and they Lysol the paper.”
DeCesare went to nursing school in Venezuela. “But I always knew I wanted to move to America,” she said, “because I always heard how great it was to be a nurse here.”
She still believes that. She still appreciates the respect her job affords, and that it’s a female-dominated profession, filled with strong and smart women.
But now, she was on her 22nd day of working without a day off. She was sleeping at a hotel, which now housed only medical personnel, so she wouldn’t expose her husband and two daughters.
She had a placard in her car window reading “Department of Health,” to allow her entry on convention centre grounds. To avoid cross-contamination, she drove there alone, she drove back to the hotel alone, she went to bed alone.
In between, she saw 350 cars a day, with 350 possible COVID-19 cases, and occasionally she would seek five minutes of relief in the “dirty tent,” where she could stand in her contaminated PPE under a cool blast of air-conditioning.
It’s impossible to talk about nurses without talking about the lore and the lure of them. What they do, what we think they do. What they mean, what we think they mean.
The traditional tale of modern nursing begins at Barrack Hospital on the front of the Crimean War. It was filthy: lice-ridden, mouldy, overpowered by the fug of overflowing latrines and rotting flesh. In 1854, Florence Nightingale had left her previous post with London’s Institute for the Care of Sick Gentlewomen in Distressed Circumstances – excellent name, right? – and arrived at the hospital to be of service. It was, she’d soon write, like stepping into the “Kingdom of Hell.”
Nightingale and her team pried open boarded windows for better ventilation. She turned a rented building into a laundry to provide clean clothes for soldiers still wearing the same bloody clothes they’d staggered in with.
She standardised nutritious diets; she fundraised like crazy. The death rate for admitted patients fell by more than half.
She wasn’t only a caretaker. She was a revolutionary.
When the war was over, she wrote about it: “Notes on Nursing” became a bible for modern care. “We’ve always had different groups of people who were nursing – but how do you describe nurses?” asks Barbra Mann Wall, director of University of Virginia’s Eleanor Crowder Bjoring Centre for Nursing Historical Inquiry.
“In America, our enslaved labourers were nurses taking care of the sick. Sometimes sailors were first responders. Women were taking care of people within the homes. The Catholic Sisters have responded, as part of their religious duties.”
The profession was gender neutral until the American Civil War, when men were fighting and some 20,000 women volunteered to fill the gap.
Then came germ theory. Then came standardisation: a nursing education went from a two-year apprenticeship based mostly on skills – wound care, bedsores prevention – to a four-year programme equally based on science. Hospitals had been a place where patients would go to die; now they were becoming a place where they would go to live.
Eventually, nursing would encompass a range of specialities and career paths; a nurse anesthetist might make USD175,000 a year, while a nursing assistant might make USD14 an hour.
During the 1918 flu pandemic that infected 25 million people in the United States (US), killing 675,000, nurses in Philadelphia would make up to 40 house calls a day.
Then, as now, there wasn’t a cure. Then, as now, the best available medical treatment wasn’t a vaccination but a collection of instructions: rest, hydration, hygiene – the pillars on which Nightingale had built her practice. “It was the nursing care that worked,” Mann Wall said.
Philadelphia’s Health Commissi-oner Wilmer Krusen, assured the public that beds and doctors were in sufficient supply.
However, “If you would ask me the three things Philadelphia most needs to conquer the epidemic, I would tell you, ‘Nurses, more nurses and yet more nurses.’”