COVID-19 has reconfigured life for the past year and has given new meaning to space, distance and boundaries — necessary adjustments to stop or slow the spread of the virus.
For Danielle Tapia, 29, a registered nurse at University Hospital, the boundaries define the structure of her job. While navigating them, she cares for COVID-19 patients on the progressive care unit (PCU), people who do not require the nearly constant attention of the ICU but for whom the disease is serious enough to require an extended stay at the hospital.
“(The progressive care unit) is kind of that middle ground,” she said. “And that’s why I love it. It is a unit where you get to learn so much.”
Tapia started on the unit in January. In March, she learned the unit would begin taking COVID-19 patients.
This is her first year as a registered nurse after five years as a licensed practical nurse. She knows the drill.
But the part that doesn’t get easier is navigating the emotional highs and lows of caring for patients in a pandemic. After these many months, there’s no getting used to the damage COVID-19 does to people.
Added to that, the hospital has doubled the capacity of the progressive care unit from 30 to 60 beds and reported staff shortages have put a strain on nurses and doctors.
“You know, it’s a really complex monster inside the hospital at times,” Tapia said. “We’re just simply trying to slow (COVID-19), prevent it, stop it, whatever we can do.”
Her workdays begin by crossing the first perimeter in the hospital, a gauntlet of temperature-checkers at the front. For the holidays, University Hospital’s lobby has been fully decorated: a big Christmas tree sparkles in the middle of the floor, and pine bunting with tiger-striped ribbons adorns the balconies.
Tapia likes to arrive 20 to 30 minutes before her 7 a.m. shift, coffee in hand, and read through her patients’ treatment histories before the morning huddle.
After an update from the night nurse, Tapia gets ready. Preparation and getting into gear help her toward a certain mindset. She compares it with football players putting on padding before a game.
The first step of getting into her personal protective equipment is putting her long, shiny brown hair up into a brightly colored cap. Then, she puts on a CAPR — a Controlled Air Purifying Respirator, which looks a little like a bike helmet and a little like a 22nd-century beekeeper bonnet.
A clear plastic face shield extends from the front of the helmet, and a film seals the space between the shield and her neck. Tapia goes about her day to the low hum of the CAPR filtering air; a cord snakes down from her helmet to a battery pack in the pocket of her scrubs, and a small light at the top of the face shield shows her the battery charge.
Tapia said the face shield especially benefits patients who are hard of hearing or who aren’t native English speakers. She doesn’t have to wear a mask underneath the shield, and seeing her face — and the full range of her expressions — is striking.
“But why does my face always itch when I’m wearing this thing?” Tapia said, laughing, after unconsciously reaching up to scratch her nose and bouncing off the shield.
With the sleeves of a disposable gown tucked into her gloves, Tapia is ready to see to her patients.
When patients arrive on the unit, they don’t go anywhere else. “Once you’re in the room, you’re locked in,” Tapia said. “You are not leaving that room until you’re discharged.”
By the same token, anything that goes into the room doesn’t come out — “except for our body, which has been stripped of our PPE in the room, so it’s not dragging germs throughout the hallway,” she said.
Food trays delivered to the rooms are disposable. And the nurses’ stations are surrounded by “big old plexiglass” screens, Tapia said. The hospital has made several changes to keep COVID-19 contained.
But it’s more than just the virus that nurses keep contained in each room.
“We’re walking into rooms with rapid declines, CPR or intubation,” Tapia said. “We’re dealing with death in those rooms.”
And then she moves onto the next room with a smile and a “Hey, what can we do for you?”
“We are able to flip a switch from room to room,” she said. “We can’t let our patient know something’s not right, because it’s not their problem to take on our burden.”
Not taking it home
Tapia said it’s also important to think about not taking pathogens home. Nurses can wear scrubs provided by the hospital — “one size fits no one good,” Tapia jokes. But the benefit is leaving them — and whatever they may carry — at the hospital at the end of the day.
Germs are not the only thing nurses have to worry about carrying beyond the boundaries of the hospital. Serving patients is emotionally draining.
Tapia has cried. “We’ve all cried,” she said. “We’ve laughed, we’ve bickered and joked around for our patients. We’ve held the hand of someone’s loved one as they died so that they don’t have to die alone.”
Maintaining good mental health means learning to turn it off between 12-hour shifts.
Tapia has learned a method for doing this from one of her nursing colleagues and mentors, Kate Rudolphi — Tapia’s preceptor, or an experienced nurse who teaches or trains on the floor. Rudolphi gave her a mental tool to help put the day behind her.
“I am so appreciative of her telling me such a simple thing,” Tapia said.
“She told me there will be days when I want to take home my work. There will be days where it’s almost impossible to leave it behind because of the type of things we see,” Tapia said. “She said that I need to pick a geographical spot.”
Every day leaving work, Tapia can process, even grieve if need be, up until a certain place — the stoplight at Stadium and Providence. After that, she challenges herself to leave it all behind.
“We spend over 12 hours a day with our patients, sometimes never to see them again,” Rudolphi said via email.
A shift can involve sitting at a patient’s bedside in the last hours of their life or withstanding patients’ verbal, physical and emotional abuse.
“Although we chose this occupation and it is a privilege to care for all of our patients, we go home and take those last 12 hours with us,” Rudolphi said. “But this is not sustainable.”
So she looked for a method to create boundaries. Shortly thereafter, a counselor told her about picking a geographical point on the way home, to anchor the divide in a physical spot. Rudolphi passed this tip along to Tapia.
“Taking care of ourselves, in return, helps us take care of our patients,” Rudolphi said.
With the pandemic almost a year old in the United States, Tapia and Rudolphi use the word “tired” a lot when they talk about how they’re feeling.
“The work we are doing at the bedside is exhausting,” Rudolphi said. “However, we will continue to be here for those who need us.”
“I wouldn’t say we’re tired of doing what we are doing as a health care team, but tired of the unknown,” Tapia said. “We’re tired of the conspiracy theories, tired of this being a politically driven virus. We’re tired of dealing with the rapid declines, the lost loved ones, the death, the comfort care, the hospital stays that last over six weeks for some.
“We’re tired of COVID-19,” she said. “And so to feel this and then to feel like we’re lost within our own community is like a double whammy.”
Tapia described the outpouring of gratitude health care workers received in the spring: handmade cards and letters; lunches delivered by restaurants; people checking in constantly and asking, “Are you OK? What can I do for you?”
But the support has been inconsistent as the pandemic has worn on. Fatigue has set in, and some people have slipped into denial as they have attempted to return to some semblance of normal life.
Nurses say the public should show support by wearing masks and practicing safety guidelines. Taking these measures could be lifesaving.
“We don’t need balloons,” Tapia said. “We don’t need flowers. We don’t need chocolates.
“We just need support. And that is the bottom line.”