I was lucky: I wasn’t one of the first nurses assigned to COVID patients. When I took my first COVID patient a few months ago, the nurse briefed me on things that were different and what she’d learned to make the job easier. As I charted my first assessment on the computer in the room, with my PAPR (powered air purifying respirator) hood, mask, and gown on, I noticed that no one had been charting breath sounds all day. I later asked my supervisor whether we weren’t supposed to listen to lung sounds on COVID patients.
“It’s a gray area,” she said. “Some people aren’t comfortable with it, because COVID can survive on objects, like the stethoscope in the room, and bringing an object to your ears could be an infection risk.” One of the Respiratory Therapists walked by and said, “I don’t listen to lung sounds for COVID patients. You can, but I’m not taking the risk.”
My supervisor reiterated: “You can if you want to, but you don’t have to.”
It took me a minute to think it through and realize that my ears were essentially the only exposed surface on my body when I was in the patient’s room. The only place it could approach my lungs. I’d never thought of listening to lungs as inherently risky — I wipe my stethoscope with alcohol before bringing it to my face — but, as a friend said early on, the pandemic is helping us all see the wind. The ways we are affected by each others’ breath, movement, and cells, are amplified by a virus that can kill us. We can actually see the invisible forces that have been affecting our lives for so long; we can see what we assumed to be normal.
It felt like my body was dangerous. The very things I’d learned to do to save lives and help out could suddenly kill the people around me.
That shift, I wore green, hospital-issued scrubs. Coworkers passed by and said, “Oh, you’re a dirty nurse,” with a scowl. They stayed far away. At that point in the pandemic, COVID nurses weren’t allowed to even go in the rooms for non-COVID patients, so if a nurse needed help for a non-COVID patient, or if an IV was beeping in her room and she wasn’t available, I wasn’t allowed to go in. My body moved to go help, but I had to stop myself. It was a physically jarring experience, like a pedestrian jumping out in front of my car. It felt like my body was dangerous. The very things I’d learned to do to save lives and help out could suddenly kill the people around me. Everything I’d learned about working as a team went out the window. I was a COVID nurse and could only attend to COVID patients.
I learned at my first job that nursing assessment was the cornerstone to my practice. My preceptor said, “When you enter a room, what are five things you notice?” I learned from her that we are always noticing things about other people’s bodies: whether their lungs move symmetrically, whether they make eye contact, whether they move their limbs and with what kind of strength, how awake they are, how the color of their skin reflects their lungs. “Is her skin blue or grey?” she asked pointedly. “If someone is dying, you’ll see it in their skin.” I learned how much the human body communicates if we’re willing to pay attention.
Lung sounds were a mindfuck. I struggled to discern between what the words “rhonchi”, “coarse” and “crackles” meant: the difference between congestion requiring suctioning, versus pneumonia requiring antibiotics, versus fluid filling the lungs, requiring medication to help the kidneys move fluid out. The sound I heard communicated the texture of moving air. When I finally got it, my assessment was how I felt grounded; it was how I knew I was doing my job. My assessment allowed me to speak with confidence about the condition of the patient with doctors, nurses, and the patient’s family members. Without listening to lung sounds, I wondered if I was even doing my job.
I felt fortunate when the pandemic hit: I work staff in a place where case numbers were initially low, at a hospital where I felt genuinely cared for and supported by the management. Despite that, the first weekend I took care of COVID patients was so hard because I had to reroute everything about how my body moves through space. I had to change my scrubs before taking report on the patients. I couldn’t help my coworkers; they couldn’t help me. I had to strap a mechanical filter onto my hip, weave the tubing up my back, and don a PAPR hood, before putting on a gown and gloves. I had to tuck the gown in extremely specific ways so that it wouldn’t get caught in the filter’s air vent.
Even if the patient was in danger, I had to put my PPE (personal protective equipment) on before rushing into the room. Putting PPE on itself was a process of trial and error – the filter beeped angrily at me while I was caught in the COVID room, unable to figure out which position I could stand in to free up the vent without touching my “dirty” gloved hands against my scrubs. It took minutes to enter a room and, when I was getting ready to leave the room, I found myself talking to myself. I triple-checked the volume left on all the medications running through IV pumps; I used my fancy nurse-walkie-talkie to call out for supplies if I’d forgotten something. I clustered care like I’d never done before because the stakes simply felt so high. Every time I left the room, I knew I’d have to go through the laborious process of donning PPE on my way back in. When I was finally ready to leave the room, I read the nine-point list of instructions on how to properly remove PPE to avoid exposing myself.
As I’m writing this, I’m thinking, this is kind of boring, right? The actual experience of what it’s like to be a COVID nurse in a pandemic isn’t particularly easy to talk about. It’s fucking hard. It’s hard in unexpected ways; it’s hard because I’ve been trained to care for others while using a framework of evidence to say, “This is why we’re doing exactly what we’re doing.” And yet, when there’s something so new that there’s not enough evidence to support any kind of interventions, or, when caring in the ways we’ve done before could put our lives in risk, or, when the government agencies that are supposed to guide us through evidence are being silenced, underfunded, and redirected because it’s an election year, well fuck! I feel like I don’t know what to do!
What I’m trying to say is I felt helpless.
What I’m trying to describe is that every professional you trust to care for you feels helpless sometimes.
What I’m trying to say is that our systems fail us, yes, but that when the foundation of my nursing care —assessment — is called into question, I feel like I’m failing myself. My patients. Everyone who’s relying on nurses to be “heroes” without acknowledging that within each hero is a human with emotions.
Nursing has taught me that care is the foundation of human connection. It’s how we are able to feel seen, held, and worthy of love; it’s when we are cared for that we become free enough to heal. It’s what allows us to rest, to receive, to recover. As a caregiver, this makes me feel both competent and connected to the hurt, pain, and vulnerability that all humans go through. I learn from the difficult processes that I witness. It’s an immense privilege to be able to offer someone the means to heal or a listening ear when they’re struggling, and I don’t take the power I hold, or the amount of trust that’s required for someone to be cared for, lightly.
The first time I took care of COVID patients, I felt helpless. I’d lost access to my purpose, to my spiritual practice that lives within deeply connecting to my patients and their bodily processes. I felt undeserving of human connection.
But, the first time I took care of COVID patients, I felt helpless. I’d lost access to my purpose, to my spiritual practice that lives within deeply connecting to my patients and their bodily processes. I felt undeserving of human connection. I’d become a “dirty” nurse. I cancelled plans with people because I didn’t want to put them at risk, even a little bit. I was cancelled on by people who I’d thought would pull through for me. It was only other nurses who physically showed up, who said, “We understand the risks, but COVID mamis need love too!” It was other nurses who also knew how important care is to both give and receive, and who saw me struggling with being able to receive care when I felt like I was so unprepared to give it. It was my nurse-friend Claire who cooked for me, took me to her lake, gifted me salmon she’d caught herself, and even gave me a masked head massage.
The week after caring for COVID patients, I developed hives with no discernible cause — hives which kept me up all night scratching, hives which made me scared to go to bed, hives which made it hard to even walk down the hall at work without tearing my skin off. Hives etched scars, built thick callouses onto my inner elbows and thighs. Hives made me turn the A/C to 63 degrees because it seemed like cold could help. Hives pushed me to the edge and made it hard to imagine living like this.
I woke up every night scratching and, in this space of unconsciously hurting myself, when I was simply trying to rest, I felt so, deeply unworthy of being around other people. I couldn’t think about anything other than the hives. For almost two months, I stayed away from friends, cancelled plans, or straight up didn’t respond.
The hives consumed my entire life and then, required I restructure everything. I’d had hives before in college, when I was trying to fit into a new vegan friend group and tried soy milk. I kept drinking soy milk and eating tofu, despite my obvious allergy, and waited for my body to acclimate to my desire to be liked. Now, as a COVID nurse in a pandemic, I was working harder than I ever had. Grief and despair and helplessness were bursting through my skin as I worked to save lives, but I gained a new understanding: I should not have to do anything to fit in; the world should be catering to me. I don’t deserve to be treated like shit anymore; I don’t deserve to spend my nights scratching so someone else can live; I deserve to be catered to.
Grief and despair and helplessness were bursting through my skin as I worked to save lives, but I gained a new understanding: I should not have to do anything to fit in; the world should be catering to me.
What do we do when we’re in crisis? When the challenge of caring for COVID patients is compounded by a physical crisis of raging skin? These last eighteen months of personal crisis — leaving an abusive partner, caring for a dying family member, helping my family completely restructure, confronting my own codependent tendencies, tearing everything away so that I might live anew — alongside the global pandemic and the Uprising for Black lives have made me somewhat of an expert in my own coping mechanisms.
A couple years ago, I would have spent my time at bars, gotten drunk and adventured on mountaintops, and pretended nothing was wrong. Now, four months into Pleasure Coaching with Che Che Luna, I turned inward. Pleasure felt so out of reach, but my skin was calling my attention. I foraged for wild medicines on Dena’ina Land. I looked at my own pussy every day. I drove myself to the ocean, so my skin might feel a blast of cool salt air. When I felt myself itching, I placed a hand over the spot and breathed deeply—sometimes grunting with each exhale—until the itch went away. I massaged poultices and salves and ointments and lotions on in half hour intervals. I drank lemon water. I slept with an ice pack at my bed so that, when I inevitably woke up scratching my broken skin, I could cool it until I fell asleep.
It didn’t take the hives away, but those self-soothing mechanisms made me not want to die. They required I become honest: I confronted dynamics at work that both frustrated me and compromised the safety of my patients; I opened up a conversation with lovers who I’d felt neglected by; I communicated with the people I’d been avoiding. I recognized that despite the immense amount of suffering in this world, my suffering also mattered.
I still have hives. I’ve had so many theories about them: that I’m allergic to my asthma medication, that it was all a healing crisis, that COVID nursing itself gave them to me, that I’m allergic to whatever the hospital-issue scrubs are laundered in. My unit still has COVID patients. More often than before, some of them get better. It feels like a miracle every time it happens — I’d gotten so used to misery and death. We know more about what medications to use, but many of us still don’t listen to lung sounds.
I’ve listened to breath sounds for a decade, but it wasn’t until a pretty girl asked about the stethoscope on my floor that I heard breath through a non-nurse’s ears. I bent the eartips into her ears and held the diaphragm to my chest. I took a deep breath and exhaled, letting her hear the whoosh of my clear lungs, air pushing only through the spaces it’s always known. I held my breath and let her hear my heart, just my heart, and then I breathed in normally. “It sounds like the ocean,” she said, and I physically leaned back because I knew then that I was falling in love. I smiled and said, “Yeah, you’re right, I never thought about it that way.” In the isolation that caring for COVID patients brought me, I’ve shed my own layers of self-protection and the assumption that I must give care in order to receive it. I’ve let myself love someone who is consistent, present, and caring, even when I’m crying over COVID deaths and scratching my skin off.
Since the night she heard my breath, I’ve listened differently. When I hear a heartbeat, a strong heartbeat, I feel all the fibers contracting and expanding that make that blood flow. In lung sounds, I feel the texture of air. I feel the reverberations against my ear, one person’s heart and breath transmuted into my own body, the vibrational impact of life onto life. My body has been imprinted with thousands of people I’ve taken care of. I’m only now seeing the wind.