Feature writing

A New York ICU nurse tells Tim Teeman about seeing the unit empty as COVID-19 patients died, why therapy should be mandated for staff, and whether he would return to the frontline.

When he envisions the now-empty hospital ICU, the New York City nurse imagines “all particles of the virus falling to the floor and withering away.” He added quietly, “Hopefully, the virus is dying in that room, being starved, because there is no one left for it to feed off.”

It is seven weeks since the nurse, who spoke to The Daily Beast last month about his intense experience treating COVID-19 patients, first joined the 12-bed ICU, one of three such units in the hospital he worked in.

There were now no COVID patients left in the ICU where he worked, the nurse said. “Only one or two of the 12 ICU patients where I worked, lived. The others, as far as I understand, all died.”

The hospital, he added, was “much smaller than the bigger New York hospitals like Mount Sinai, and it is my understanding the two other ICU units still have some COVID patients, but they are not as full as they were.”

At the time of writing, 20,237 New Yorkers have died of coronavirus, with 184,319 confirmed cases in the city. A total of 181 COVID-19 patients died in the most recently released daily figures for the city.

It has been two weeks since the nurse left his ICU duties; today marks his last day of quarantine. Today, the nurse will finally be able to hold his partner of 14 years again. Tonight, for the first time in seven weeks, they will be able to sleep together in the same bed. They will be able to kiss and hug one another.

As he did when The Daily Beast first interviewed him, the nurse has requested anonymity for professional reasons, and to speak freely. He also said he didn’t want to “diminish” any other frontline medical worker’s story, especially those who have been doing greater numbers of hours in the ICU than he did. “I hope this can be everyone’s story, and not just mine,” he told The Daily Beast.

“Overall, I’m fine, but it’s all still there. It’s kind of waiting,” the nurse said. “There is so much uncertainty. That’s the hard part. I don’t know what will happen next as we open New York again. It won’t be the same city. Will there be a second wave? I’m a pretty positive thinker, I’m certainly hoping for the best. It is still raw, the emotion of it all catches me off guard. I think that’s pretty normal, dealing with the grief, and also the loss of New York life as we knew it. So much has changed. It definitely can be overwhelming.”

In his 25-year career, the nurse has worked in San Francisco, Sydney, and other hospitals in New York City, employed variously in other ICUs, a bone marrow unit, and an oncology and chemotherapy out-patients unit. He also did AIDS-related voluntary work in Africa.

For the last eight years, before the COVID-19 crisis, he has provided home-based care to veterans who served in World War II, Korea, and Vietnam.

In our first interview, he spoke about the suffering of COVID-19 patients, the relentless demands on the ICU staff, and the distress and fulfillment associated with working on the frontline.

“For at least a couple more weeks, the ICU remained as intense as I described it in the first article,” the nurse said. “It’s kind of all a blur to me now, it’s really amazing, just like a dream. It’s a surreal experience. Admissions slowed down. As patients died, they weren’t replaced by other patients. We had more time to spend with the patients, but it was still difficult to work within the environment given the risks associated with the virus.”

The nurse had spoken to The Daily Beast about his frustration at being restricted from doing the basics of nursing, like touching a patient and spending time with them.

“A big deal for me was finally being able to bathe and shave, and wash the hair, of one patient,” the nurse said. “Like a lot of ICU patients, he wasn’t conscious. He looked dramatically different, so much better, afterwards. His breathing tube had been replaced with a tracheostomy tube which went into his neck, and his face was freed up so I could clean him up. That was a moment for me to connect with him, and make him presentable.”

This patient was the first person that the nurse had “significantly” moved. “Because of COVID precautions, we touched so few of the patients—really only if they had defecated and then we would clean that up.” He held the hands of patients as he disposed of waste materials, “and spoke to them, and told them that somebody was there, that it was ‘me again.’”

The man he bathed was the patient the nurse spent the longest time with. “I finally made that connection, as a nurse, to a COVID patient that I longed to make desperately—but which all the necessary safety precautions kept preventing me from doing.” The nurse paused. “He was the last patient in the unit, and I heard he died last weekend.”

While he was working at the ICU, the nurse was also continuing to work, by video calls, with the veterans he looked after as a home-care nurse.

“Our biggest fear was that they, as older people, would not survive COVID if they contracted it. In all, we have lost eight clients to COVID, about 15 percent of our total number. I called one of the patients one day, and he was being taken away by EMTs at that very moment. I asked him why he answered the phone, and he said, ‘I wanted to hear your voice.’ He passed me to the EMTs, who told me his heart rate was 170 to 190, and unstable. He died a week later.”

On another day away from the ICU, the nurse—concerned that the team had not heard from another home-care client—went to the client’s apartment. “There was a horrible smell coming from inside. I pounded on the door, and there was no answer.” The nurse called paramedics, who discovered the client’s body in his bed.

“The paramedic was very kind. He said I shouldn’t see the body. He could see how upset I was.”

“We have to find a way to meet the psychological and emotional needs of our healthcare workers”

As time went on in the ICU, the number of new COVID patients abated.

“It lightened things up for everybody,” said the nurse. “There was less pressure on us as nurses, and we had more time to interact with colleagues and more time to discuss the patients and our own situations. People began to share how they were feeling. I had conversations with other ICU nurses about their home lives. It was so interesting to discover how each of us was experiencing it.”

One nurse had recently gotten married. “She told me, ‘I couldn’t not be with my husband.’ Initially she had, like we all did, gone home, taken her clothes off, showered, and then kept up with social distancing. But, she told me, she and her husband just couldn’t keep doing that. ‘Our decision was to take the chance and share our bed again,’ she told me. It was incredibly difficult and scary for her.”

Another nurse not only lived with her husband and children, but her parents lived with them too, and she was socially isolating herself from everyone in the basement.

“She was terrified of endangering her loved ones’ safety,” said the nurse. “She hoped she could be away from COVID patients for long enough to resume her life with her family.”

The nurse was concerned about how medical staff would be expected to do this all over again if a second COVID-19 wave materializes.

“I don’t know how ICU nurses, physicians, and respiratory therapists could be cycled in for two weeks on and then two weeks off. It makes it impossible for people to have personal lives. It’s OK to say, ‘OK, for two months, there’s this emergency where I am going to give it my all.’ But I can’t imagine it going on for months and months for the staff. You are just not able to take care of yourself. That situation cannot last.”

“We have to find a way to meet the psychological and emotional needs of our health-care workers in a pandemic situation, and give them a respite from the work and the patients in order to nurture themselves, feed themselves, to be with their families and loved ones—before they get back into that working environment again.”

The nurse was “surprised” at the lengths that some doctors went to in order to prolong the lives of patients. “Some patients had renal failure, some were on forms of dialysis, some had respiratory failure eventually going to liver failure. I’m not a physician or epidemiologist, but they were clearly not going to make it. But the physicians did not give up. Is that always the best thing to do?”

“The lesson, for me, was to do all you can to stay out of the ICU, where the mortality rate is high. The expectation was they weren’t going to make it.” (A recent study posited that a quarter of COVID patients requiring ventilators in New York City ICUs had died.)

Every patient’s death “left a void,” said the nurse. “The loss of any patient makes you think that this is somebody’s friend, lover, parent or child. In the ICU they were appropriately sedated, they were not physically suffering, but you thought of the emotional suffering and rollercoasters of those close to them.”

Those groups encompassed both family and dedicated medical staff. “I heard one of the attending physicians say, ‘I could have done more to save this patient’ after one death,” the nurse said. “And I thought, ‘No, you’ve already gone above and beyond to a great extent. You’ve done all you can. We weren’t going to win this battle.’ To hear someone so committed say that made me realize the toll this was taking on all my colleagues. And then I saw the story of the emergency room doctor (Dr. Lorna M. Breen) who died by suicide.”

“I think the long-term impact on medical staff of COVID will be pretty significant,” the nurse said. “You have been in the middle of all this energy, anxiety, fear, and uncertainty. Then it’s all gone. And then what? It will have a big impact. I hope people know enough to reach out for help and professional guidance in dealing with that sense of loss not just of patients, but the loss of purpose in dealing with patients. I think staff should have therapy, and that therapy should be a requirement, and not optional.”

The nurse thinks another lesson of the crisis should be to rethink the layout of hospitals for the benefit of both patients and staff, “so in the next pandemic or wave it can be a safer environment for everyone. We were not ready for this in any way. We need more negative pressure rooms, or more spaces for people with infectious diseases.”

The nurse’s family do not want him re-entering the workforce if COVID returns with an equivalent ferocity.

“My friends and family and partner all say, ‘This is it.’ They say that I’ve done my duty, and not to put myself through it again. That’s difficult, but maybe fair. It impacted way more people in my life than I thought. They say, ‘You’ve done your share, let the younger nurses do their part.’ I have to take that into consideration. I can’t bulldoze into doing something without thinking about the ramifications for those around me.”

If he “lived in a bubble” and wasn’t in a relationship, the nurse said, he would definitely re-enter a COVID ward if required, as long as there was respite planned into his service. “But I don’t think that could happen. I don’t think there are the resources to make it happen.”

The Trump administration’s handling of the pandemic has been “a complete disaster,” he said. “He should have learned and listened to the medical and scientific experts on this and not be someone who just speaks without any knowledge. We need to have confidence in our leadership and if we don’t have that it’s so unsettling. It’s very unfortunate. With strong leadership we would have been able to get through this much more smoothly than we have.”

The nurse said medical staff welcomed all the banging of pots, pans, cheering and applause at 7 p.m. every evening (friends had sent videos of their children doing it, some had even come to clang away on his driveway), although he confessed to feeling “a little embarrassed” by it too, “because I don’t like to draw attention to myself.”

“It will be a great joy and semblance of life as-we-knew-it to have that intimacy back”

The nurse has now returned full-time to his job providing at-home care for veterans. One, who fought in World War II, is getting used to videoconferencing, fascinated that he and the nurse can see each other. “How is this working? Is it just going through the air?” the veteran asked the nurse, smiling. The nurse is glad to be back on the job, his colleagues are “super-happy that I am not in the ICU any more, and as grateful and supportive as they can be.”

Away from work, the nurse has been decompressing by doing chores and renovations at home. The intensity of the ICU behind him, he is relieved to have “this huge weight lifted off my shoulders,” but said he missed “the energy of everyone working together for a common goal wanting to make a difference, and, I guess, making a difference.”

The nurse was speaking just two days shy of the completion of his 14-day quarantine. “If I’m negative, as I think I am, that would be pretty amazing. It means I didn’t contract the virus, the PPE worked. In two or three weeks, I’ll find out if my co-workers were as fortunate.”

The nurse has missed intimacy with his longtime partner. “Not having that person who is your rock is unsettling. I don’t like to wish away time, but I’m looking forward to Wednesday. It will be a great joy and semblance of life as-we-knew-it to have that intimacy back. In the last seven weeks there have been moments where we have gone towards each other, or to grab each other’s hand, or kiss or hug, and we have had to step back. It’s been so strange.”

The nurse paused. “We’re grown men, and we have not been able to hold each other in the privacy of own home. It has reminded me of growing up, in a time where you couldn’t express yourself because of homophobia and the culture back then. It’s been weird and shocking to live in a different, better time, and then to have to suddenly step back into that world.”

“My partner thinks it has brought us closer together, which is nice to hear. It made me realize how much it impacted his life. He doesn’t want me to go back to a COVID ICU ward if there is a second wave, and it is probably best for me if I don’t do it.”

The nurse’s voice cracked a little. “Hopefully, we will both be able to sleep through the night. I don’t think either of us have been able to do that, separately, since this all began. We are so lucky to have what we have. We consider ourselves incredibly fortunate people to have each other. We are blessed in life in so many ways.”