Waking Up is Hard to Do...

Part 1: How I woke up from my COVID coma.

In order for you all to understand how I slowly woke up from my COVID coma, I need for you to understand a little background into my nursing career. This will be a two part series.

I began nursing in 1988. I went to my local high school BOCES Licensed Practical Nurse (LPN) program, and graduated from high school with both a high school diploma, and a nursing degree. The summer after I graduated and took, and passed my LPN boards, I was hired at my local community hospital. I worked part-time evenings as an LPN, and I went to school full-time at my local community college to earn my Associate Degree in Nursing (ADN) for my RN. I began nursing in the heat of the AIDS epidemic.

One of my earliest memories of my time working as an LPN, was when I was assigned to a patient who was diagnosed with HIV. I was told on report that this patient had HIV, and that I needed to remove his IV, and discharge him home. I was also told this patient was a celebrity. So imagine my surprise that at the age of 17, and a new LPN, that I would be assigned the HIV celebrity patient! Being the cocky gal I am, I kinda figured they were screwing the new kid. I also figured they were scared. I was a typical teenager, scared of nothing, and believing I was invincible. So I went in that room, and greeted the patient and his wife. I removed that IV, and discharged the patient home. And as a typical teenager (I have a history of this throughout my life), I had no idea who this ‘celebrity’ was. I completed my shift, went home that night, and the next day asked my mom if she had ever heard of Arthur Ashe. These were the days before HIPPA. It was here that I learned something about myself. I learned I was strong, and brave, and that I never wanted to be scared like those older nurses. I wanted to care for my patients, make them feel safe, and never discriminate. That was a big lesson at 17. I finished my RN at the age of 19, and left my small community hospital for the big lights, and big teaching hospitals of New York City. I thought I would never look back…

Fast forward to November of 2002. I was working in NYC. I was now 14 years into my nursing career, and working in an extremely busy cardiac intensive care unit. November 2002 was also one month after I met my future husband, and I was newly in love. This was also the time when SARS-CoV-1, the OG of coronaviruses hit the world stage, though SARS-CoV-1 was not quite on my radar, to be fair, I’m pretty sure it wasn’t on anyone’s radar in NYC. As far as we were concerned that was happening somewhere else, far away…like Canada. By the end of 2003 SARS seemed to be a distant memory, and I was newly married with a tiny baby boy to focus on. The only viruses I worried about were his. (https://www.cdc.gov/about/history/sars/timeline.htm)

Years blurred by, and in September of 2012 whisperings of another new coronavirus started circulating. This one was called Middle East Respiratory Syndrome (MERS). I still really had no idea what a coronavirus was, and by now I was up to 3 kids, so I pretty much didn’t care. I had 3x the viruses to worry about in my own house. After baby #3, I left the big city hospital for the comfort and shorter commute of my community hospital, the same hospital I had started my nursing career in. I had come full circle, and by 2015 so had MERS when it was announced on the local news a case had been discovered in Florida. (https://www.cbsnews.com/miami/news/mers-warning-signs-go-up-at-miami-international-airport/)

This case peeked my attention. I started following this “new” virus, well, new to me anyway. Though I wasn’t in NYC anymore, I was within 20 minutes of an international airport. This airport had brought patients to our community hospital with diseases like TB and Legionnaires disease, and God knows what else, so why not MERS? (https://hellodoctor.com.ph/infectious-diseases/respiratory-infections/mers-cov-timeline-of-events/)

It was that same year, and around the same time as the Florida case, that we had a patient in our ICU with pneumonia like symptoms. The patient had been pan cultured, but nothing grew out. The patient was an unusual case, very sick, but no actual diagnosis. I remember saying to the intensivist at the time, “Maybe it’s MERS.” He pretty much laughed at me. I was kind of surprised because I really liked this guy, and I thought he was a great diagnostician. Why would he be so quick to laugh it off? There was a case in Florida, and a big part of our elderly population were snow birds. I honestly cannot remember what happened to that patient, whether they lived or died (sad I know), but I never forgot that feeling of being laughed at by someone I respected.

MERS ended up being a nothing burger in the U.S. and so it slipped off the radar, and out of sight. But brewing in the background of 2014 was something much more sinister…Ebola. In March of 2014, Ebola was beginning to spread through Guinea. It continued to spread into Liberia and Sierra Leone. West Africa could not contain the virus and Ebola spread to seven more countries including the United States. (https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html). My ear was to the ground from the beginning on this one. I read the Hot Zone, so I was more than worried we were one plane ride away from disaster, and then the first case showed up in Dallas.

The index case, as he was known, wasn’t initially diagnosed correctly (Shocker!).

“On September 25, 2014, Thomas Eric Duncan, a Liberian who had recently traveled to the U.S., sought care for fever, headache and abdominal pain at Texas Presbyterian Hospital in Dallas. Although he told the ER that he had just arrived from Liberia, he was diagnosed with a sinus infection and returned to his fiancée’s apartment. On September 28, he was transported to the hospital because of persistent fever and progressive symptoms, and was hospitalized.  On September 30, he became the first patient to have laboratory-confirmed Ebola virus infection diagnosed in the United States. He died on October 8th.” (https://cdcmuseum.org/exhibits/show/ebola/ebola-us/dallas).

Sadly this patient died, but not without infecting the two nurses who were caring for him. I remember telling my husband that this was a total joke this patient was in a Dallas hospital. What was the government thinking? This guy should have been transferred to the NIH Clinical Center in Bethesda, MD. That’s what they do; what they are trained for. Those healthcare workers who contracted this patient’s Ebola, were not trained for this type of care.

The next 2 patients to contract Ebola were U.S. healthcare workers coming back from helping in West Africa’s outbreak. They were immediately transferred to Emory University Hospital in Atlanta. “In 2002, CDC had worked with the hospital to establish Emory’s Serious Communicable Disease Unit (SCDU) to care for CDC employees who became ill while on overseas assignments.” At least these patients were in a qualified institution.
(https://cdcmuseum.org/exhibits/show/ebola/ebola-us/firstpatients).

Now here is where the fear began to fester. It slowly became a reality that Ebola was spreading inside the USA. Our general healthcare facilities were obviously not prepared to deal with Ebola. Our specialty hospitals seemed better poised to handle this patient population. The then director of the CDC, Thomas Frieden got on national T.V. and stated U.S. hospitals were prepared to deal with Ebola cases, (at which time I looked over at my husband and told him that was a total fucking lie).

Fun fact: We don’t have enough PPE, we don’t have enough negative pressure isolation rooms, U.S healthcare workers know NOTHING about caring for patient’s with Ebola…NOTHING! To add insult to injury, the nurse who contracted ebola in Dallas, was thrown under the bus by Frieden when he basically blamed her for contracting ebola from a “protocol breach.” Again, nurses in the United States have NEVER been trained to care for a patient with ebola. (https://www.foxnews.com/health/cdc-head-criticized-for-blaming-nurses-ebola-infection-on-protocol-breach)

Ebola has a fatality rate of around 50%, with a range from 25% to 90%. Ebola spreads via contact transmission (through broken skin or mucous membranes) with:

• Blood or body fluids of a person who is sick with or has died from Ebola

• Objects that have been contaminated with body fluids (like blood, feces, vomit) from a person sick with Ebola or the body of a person who died from Ebola (https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease)

Most likely the nurse didn’t contract Ebola due to “protocol breach” because nurses are trained in caring for patient’s on transmission based precautions, but probably from a PPE breach. The PPE provided to healthcare workers in the United States is the cheapest shit going, frequently rips and tears when donning, and there’s an increased risk of contamination when doffing. Most are labeled Made in China…so go figure. Even if this nurse had a “protocol breach,” it should never have been the protocol to send a novel disease for the U.S. to a local hospital and expect an untrained staff nurse to be competent in this level of care.

I’ll admit I was nervous. The Hot Zone book had seriously scarred me back in the mid 1990’s when I first read it (I tucked that shit away…down deep…), but here it was resurfacing and I wasn’t sure how to discern fact from fiction. The media were having a field day ramping up the fear porn, which didn’t help, and yes, I was watching CNN at that time. I witnessed two nurses caring for the same patient contract Ebola, and one of them was permitted to get on an airplane. I was pissed off as well as scared. Not scared of the patients, but scared of our ability to care for this patient population with the right equipment, the right facilities, and the right leadership. I was reminded of that fear, and also vindicated in some of my beliefs after watching the film below titled “Ebola in America: Epidemic of Fear.”

In retrospect, to be totally honest, I felt a disease with a 50% mortality rate, and a system that I knew was incapable of successfully caring for these patients, should have been under tighter control. I think we had a near miss at the beginning of the Ebola scare, and we were lucky that it was contained quickly, and managed better after the hubris of the CDC receded somewhat, and the reality of what was happening on the ground sunk in. This experience left me primed for my willingness to believe that SARS-COV-2 would be another challenge to healthcare workers that we were most likely still not prepared to tackle, and my initial somnolence to a narrative that wasn’t making sense.

To be continued…