“It doesn’t take a doctor to figure this out.” —a daughter, referring to her treatment plan for her mother that she has figured out after some time on the internet. FYI, her plan to fix her 96 y/o critically ill mother with covid19 who has been on a ventilator for 2 weeks and is 7 (out of 10) days through the severely ill Remdesivir clinical trial but now has to “pause” the antiviral treatment due to kidney failure: “just keep giving her the Remdesivir and then cure her kidneys with Lasix.”
I spent 2.5 hours on the phone with 2 different daughters because of this foolhardy notion. The problem is: I can explain clinical trials, multi-system organ failure, creatinine/GFR, and the mechanism of Lasix till I’m blue in the face. But A) they still won’t understand, and B) it won’t help them come to terms with the impending death of their mother and begin the grieving process. Still, I tried to help with both those things. There was one moment, when I paused to let a message sink in. And one of the daughters drew a shaky breath, followed by only silence. In that moment, I’m hopeful something got through.
Since quarantine, more pleasantly known as shelter-in-place, started & all the shops went wonky to adjust their hours for for more intense cleaning and vulnerable populations special early morning hours—all of which I’m fervently in favor of—it’s been really hard for me to get supplies.
As a night shift nurse, I start officially at 19:00. I can usually get gas or maybe pick up something from the drug store in my way to work, but not much else than that. If I really needed to grocery shop, I always did it right after shift, which officially ended at 07:30–although I’m never fully out the hospitals doors till more like 8 since charge nurse report usually goes long, ugh. Anyway, pre-pandemic, I could stop in my way home. The stores were open… but now, even if they’re open, there’s the line and social distancing and it is a tad complicated for having just worked overnight.
Add to this the panic-induced household goods buying—and even if I get to the store at a convenient time for me (say 2 in the afternoon on my day off), there was definitely a long period where toilet paper, Kleenex, paper towels, hand soap, and even meat, pasta, rice, and things like canned tuna were unavailable. It was ok though, because there were plenty of fruits & veggies! It honestly makes me laugh because the Bay Area has to be the biggest “eat keto” “no carbs” place ever and the stores are still usually sold out of pasta!!! The pandemic has really changed people’s diets.
One thing I was a little nervous about though was the toilet paper situation. At the start of quarantine I had just opened your standard large but not crazy pack of Cottonelle from Target. I was not stressed about it, but I did count my rolls just as an FYI. I had 9 rolls of toilet paper as of March 13. My roommate (and sister) had the same. She keeps track of the TP supplies and our “days in confinement” on the chalkboard calendar on the wall. She’s an extrovert, can you tell?
Cottonelle, you’re my favorite toilet paper.
I had no idea how long 9 rolls of TP would last me but after trying and failing to go grocery shopping a few times, I knew I had to make it last. Eventually my neighbor who knows I work night shift as a nurse came to check and see if I needed any supplies—specifically toilet paper or hand sanitizer. He had bought an entire case, nearly 100 rolls, and a GALLON of hand sanitizer from a restaurant supply store who was not currently supplying many restaurants. This was about a month into quarantine and I did admit to him that I was a little nervous about never being able to buy toilet paper again since it’s not in stock by the time I get to the store— and you can’t order it online. He generously gifted me 5 rolls to add to our house stash…
Now, I do see toilet paper out in the world for purchase. It’s not Cottonelle, my favored brand, but it works the same way. This pandemic has really given me insight into who in my life and at work prefers what kind of TP—and exactly how much they need to feel safe (aka, how much of a hoarder they are). Apparently there is a big divide between the Charming and the Cottonelle crowd. Who knew. I guess it’s like Crest versus Colgate. When you choose, you choose for life.
So how much toilet paper do I have right now? I’m not sure, as we’ve cobbled together a few 4-packs from various places. I think the household (3-4 adults) has 12 rolls. That’s sufficient. But is it _pandemic_ sufficient?
I am proud to report that I now know exactly how much toilet paper I use! I just put my last roll up (of the nine originally counted). I use one roll of TP per week. I mean, I guess I can only say that I use one roll of Cottonelle per week. Not all TP is created equal. Also, new rules instituted during quarantine: 2 squares per pee.
My hope for Stage 2 reopening next week: that I can find some kleenex…
May is Mental Health Month, and I haven’t addressed it at all yet. But I have a lot of thoughts. Every time I sit down to try to write about nursing and mental health -even just in the context of only my own life -I become overwhelmed with the enormity and complexity of the topic.
A year ago next week, actually, I had to take a leave of absence from work due to what I thought was burnout. It actually turned out to be PTSD, and over the last year, I have learned exactly how far back in my life trauma goes. But the strange and traumatic event that happened to me one night at work, and brought about my need to go on leave–it is still hard for me to believe that things like this at work can be so traumatizing. Why? Maybe because these types of events are so common. Maybe because being an ICU nurse is fraught with high-level stress and emotional highs and lows, as patients “miraculously” get better or succumb to their illnesses. And supporting the families in both of the these instances is so very difficult. It just seems like I should be able to handle it, because it’s my job…
So, how has the pandemic affected nurses’ mental health? This article (found almost by accident), really conveys a lot of what is going on, and offers some great tips.
Healthcare workers in hospitals with COVID-19 patients reported higher than usual rates of depression, anxiety, and insomnia, according to a survey published in the JAMA Network Open journal in March. Among those with the most severe symptoms were nurses. This is especially concerning when you consider that they already have higher suicide rates than the rest of the population, according to a study by UC San Diego Health published in February.
Molly Longman, 5/8/2020, “Nurses are facing a mental health crisis,” Refinery29
Here in my area, we’ve been lucky (maybe prepared) enough not to get a surge of novel coronavirus patients. And with the lack of elective surgeries, my hospital census is getting shockingly low. We’ve shut our dedicated COVID floor because the few patients we have can be accommodated elsewhere without increasing infection control risks. Our “disaster ICU” was open for 2 nights as a trial—it worked—and now even the idea of needing it seems so remote that the assignment board was dragged back to the normal ICU.
And since we got our first case in that first week of February, we’ve never had more than about 8 COVID patients at one time in the unit. Sure, there was the one day in late February when lord-knows-who approved 9 surgeries and EVERY.SINGLE.ONE came to the ICU afterwards because they developed a fever intra-operatively and now needed to be ruled out for… you guessed it … COVID. Surgical services finally got their socks on the right feet, though, and now we screen everyone pre-op.
But wait, this is a lot of story for a post that seems to indicate it will be about getting cancelled. I needed to set the stage. That day in late February when surgery sent us all their patients—that was the last time our ICU was full. 36 patients. Do you know how many nurses it takes at a minimum to run our 36 bed ICU? 25. That’s our base staffing number—the number of nurses that is recommended to be scheduled every shift. It’s actually pretty hilarious how many nurses we actually need; sometimes 25 nurses for 25 patients. And that’s not really uncommon…
Last night, however, we were already overstaffed when I arrived at 19:00, and patients just kept getting transfer orders and going upstairs to less acute floors. We had cancelled about 5 people before the shift and then at 23:00, 2 more people needed to go home. I volunteered because it made sense with my assignment, but many people are starting to get worried about how slow it is. The per diem staff are getting cancelled every shift, and unless they’re willing to work at a moment’s notice & odd hours, there’s no work some weeks at all for them.
Benefitted staff generally fall into 2 categories: the ones that work their set hours (no more & no less) and the ones who love overtime (and in some cases need it to pay the bills). It’s a hard situation. People want to maintain their financial security, especially with high-profile West Coast hospitals making the news, such as Stanford cutting salaries across the board by 20%.
As nurses during a pandemic, we didn’t think we’d be sheltering-in-place, worried about losing our jobs like the rest of the economy’s workers. But now, at a time when treatment protocols are in flux, when drug regimens are changing quickly, when we ourselves as nurses fear that we will get COVID and perhaps die, we are getting cancelled. We are left to sit at home. We thought we knew one thing: there is work for us to do. But now we’re not even sure about that.
Snack of champions, and sometimes dinner too. Peanut butter on the spoon.
No PHI, it’s been cut off when portioned for scrap paper use. Nobody said we aren’t frugal. Also, nobody said the patient that telemetry strip belonged to lived. No pulse with that rhythm…
Last week was brutal. For some reason, the day shift medicine team consisting of one Intensivist in charge and something like 2 to 8 interns & residents (baby docs, as I call them) did NOT make a very good “plan of care” to guide our decision making. And so midnight rounds was like the blind leading the blind, except most of the blind had left the hospital and there were no instructions for the other blind— and so the baby docs just stood there like frightened drunk toddlers while I (the charge nurse who had no time for coddling) barraged them with questions. Is the patient negative? Would you like them to be? Are they NPO because you plan to extubate tomorrow? On 80% Fi02??? Well, maybe we should at least give some LASIX and improve their chances? At first, the night time intensivist tried to defend them, he being another doctor and all— but by the end of rounds, he was furrowing his brow and calling for LASIX too. So, when I couldn’t sleep later that day (the same day, for those of you following night shift calendars and my run-on sentences are home), I made a meme…
Who are we? People with more medical experience than you!!!!
And by my third night in a row, this little meme was pinned on every nurse and taped sarcastically to every WOW. Point made? Not at all… the baby docs are oblivious to this. But we found it funny.
