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Reflections From a Deployed NYC COVID-ICU Nurse Practitioner

By Currents Editor posted 06-03-2020 08:13

  

By Mary Presciutti, NP, CCRN, CNRN, Mount Sinai Hospital, Department of Neurosurgery

Weeks before deployment, my fellow advanced care providers (APP) and I were told that our New York City hospital was in the process of rearranging healthcare personnel to meet the impending surge of patients with COVID-19. Like most of us, I was filled with anxiety and many questions:  How will things be? What will our path be moving forward?

Two weeks later, I received my schedule and learned that I had been assigned to the COVID-ICU. Prior to my current position as a nurse practitioner (NP) in neurosurgery, I worked as a bedside critical care neuroscience nurse in a university hospital for two decades. Having left critical care for almost 4 years, I was certainly filled with worry and apprehension.

On my first day in the COVID-ICU, I was grateful for having been paired with a senior critical care NP. Upon entering the unit, my fight-or-flight response was immediately activated. I will never forget the first time I had to wear full PPE. With emotions raging, I had to tell myself, “I can do this.”

It was difficult and certainly overwhelming in the beginning. We worked all day as admissions came, one after another. I had read the experiences in Italy beforehand, and it was clear that the virus had arrived in full force in our ICU.  By the end of my first shift, we had seven admissions and two emergency intubations. My colleagues and I were amazed, wondering what lay ahead.

As days turned into weeks, we grew as a team. Different physicians, surgeons, APPs and nurses joined our team. Some of us would gather in the middle of the nurses’ station at the beginning of our shifts for a brief meditation. Soon after, more formal meditation and health-caring stations were set up.

Along with the meditations, we also huddled prior to starting our shifts, tuning in to our colleagues’ needs and acknowledging the different specialties on board. We were fortunate to have rounded with attendings that reminded us of positive events in all what we did.  Being with a great leader made all the difference. Somehow, they carried an invisible sign of hope on their forehead, right on top of the thick face shield. One can see the smile behind the masks, if one gazed at the side of their eyes. One memorable example of this was when one of our attendings asked us, “How can I support you so that things are a little easier?”

The virus definitely imbued a noble fellowship as we treaded along. Respect for each discipline and appreciating each other’s strengths were part of the recipe for success. After each huddle, we went off in teams, always making sure everyone was doing OK.

Some of our team members worked remotely, updating families on the phone since the patients could not have any visitors. Zoom visits quickly became the norm. I had participated in one memorable family Zoom conference for a patient who was close to death. The patient’s family told us about the patient’s life prior to being sick. There were many tears shed — their love was palpable. How do you reconcile with letting go of your loved one when you cannot be with them for their last minutes of life?

Shifts increasingly became difficult as death seemed to surround us. At the end of each week, I began to share messages of encouragement with my colleagues in our group text, hoping to lift their spirits — not in false optimism but in hope. This virus has affected all of us in more ways than we can ever know. I kept reminding myself, “Now, more than ever, is a period of reflection and meaning.” I suppose that was my coping mechanism.

Next week, I will be going back to my regular post in the neurosurgery step-down floor. Working in the COVID-ICU for 9 weeks, I found that working together as a team brought out the best in all of us. We worked with a common denominator, the purpose of why we chose to be in healthcare: to love and care for our patients. I often think about our patients and their families, those who we lost, those who survived and those still facing a long recovery.

I am glad to be of service, to have cared for others and to have loved my patients. I am glad I was deployed. I return to my regular post in peace and gratitude.

Below are the text messages I shared with my colleagues at the end of each week, following my second week on duty.

Week 2:

Thank you, team, for your CHARITY and VALOR.

Week 3:

Grateful to have seen the TRUE ART of medicine on display. Amazing work despite the great hazard we face. Forward march into the next week.

Week 4:

We continue to heal and comfort the sick (patients and families), though I am becoming more aware that it is they who heal us INTERIORLY. As the new week unfolds, I am reminded to embrace my fears, and am paradoxically EMBOLDENED to be CENTERED, weighted, balanced.

Week 5:

Cheers and celebration! We discharged our XX-year-old patient to her home with support. These victories stir our hearts with hope; though we don’t forget those who were LOST to the virus.

COVID-ICU has imbued a NOBLE FELLOWSHIP, a living history of service and dedication. 

Week 6: 

Thank you to our colleagues (physicians/surgeons/APPs) who joined us in the fight against COVID; for being a part of the XX community. As you move on, note that 

I learned so much from you, therefore, I am better. 

Those of us remaining here, we will continue to battle in a concerted effort, in tune to the rhythm of the virus. 

Presently STEADFAST; deeply GROUNDED in HOPE. 

Week 7:

We continue to care for those IMPRISONED by the virus. Through this experience has arisen a profound appreciation of the gift of good health, FREEDOM from illness. 

Week 8:

As the DARKNESS of the pandemic begins to shed, we continue to walk with constancy in hope; in blinding CLARITY. 

Week 9:

Despite the virus straining us, we must remember that it is HOPE that lifts and animates.

Take care and be well!

#LeadingInsights
#COVID-19

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