The alarm goes off at 0535. And again at 0545. Can't trust myself to hit snooze when the first one goes off. Since the beginning of COVID I started taking a sleeping pill before dayshift. Otherwise it's just tossing and turning, wondering what the day will bring...

My dayshift routine is always the same: lunch made for upcoming days the night before. Shower in the evening, clothes laid out. Coffee maker ready for go time when my feet hit the floor. These days I leave 15 minutes earlier due to the staff screening line up...

Are you experiencing any fever, cough, diarrhea? Almost always I must sing the Pepto song: nausea heartburn indigestion upset stomach diarrhea. We all have a nervous laugh while they wait for me to answer. No.
In the past two weeks have you travelled outside of the country? No.

Have you been in close contact with a known case of COVID? My ICU badge is visible and we have a staring contest... She continues, without proper PPE?
No.
Ok have a good day.
I walk to the table, wash my hands and grab a mask that is now mandatory at all times in hospital...

Next stop: waiting room. There is a security guard there with our assignment list. If you are in a COVID bay you get a paper bag with N95s. If it's not COVID, surgical masks. Our supply has increased so we now get 4 masks a shift. It's our new normal to wear a mask for 3 hrs

I am not assigned COVID today. I get the surgical masks. My coworker is dejected as she collects her N95s... "I was hoping to see my mom this weekend..."

It's like roulette. Or lottery. It all depends on what's in your paper bag.

My assignment is a sweet lady who probably should have come to hospital sooner but she was afraid of catching COVID. I spend the day playing catch up... She's not intubated yet but I can tell it's in her near future.

As I'm getting her washed up she apologizes for not shaving her legs. She didn't think she was going to be admitted. Her husband dropped her off outside emerge and the rest is a blur. We discuss how sick she is, talk about a breathing tube and what to do if her heart stops.

"Well I'm here now, you might as well do everything"
I need her to be clear about intubation, chest compressions and defibrillation. She needs to know what "everything" entails. It's uncomfortable but better to have the conversation now while she's able.

Her husband calls. He's just come in from feeding the cattle. After updating him he asks if he can visit. It's a punch in my gut every time. I apologize but say because of COVID visitors are restricted to palliative patients only. We settle for a screen call.

While he is telling her he misses her and he's sorry he can't be with her, her oxygen levels start to drop. They are both in tears. I need her to focus on her breathing while we prepare for intubation. To get him to hang up I promise I won't leave her side.

By the end of my shift she is intubated, sedated and on high dose pressors. I take a minute to call her husband and let him know.
"Can I talk to her"
I explain again the situation but without the visual it's hard for him to fully understand.

The next morning I come in and find that things have gone from bad to worse. I'm worried she is not going to make it through the day. Per policy, I discuss with various levels of leadership about having the husband come it. It's approved.

Begrudgingly, I dial his number...

Hello Mr Smith*? This is your wife's nurse. We spoke yesterday.

Ah yes hello there. I was just about to head out to the barn. Is everything ok?

Well that's why I'm calling you. Your wife has taken a turn for the worst and we would like you to come to the hospital

Silence...

But you said the only time someone can visit is if...

Yes Mr Smith, and I'm sorry but we think you should come.

NO! No! No no no no no!

This he fully understands.

He says he will be here within the hour.

As I'm getting her washed up she wakes up through the sedation with terror in her eyes. She is squeezing my hand so tightly it tingles. I try to console her while programming the sedation pump with my free hand. When the grip loosens I know I can continue.

Mr Smith arrives and after he has been updated by the team I give them some alone time until the alarms go off again. Despite full support of every system, nothing is working. It's time to switch gears.
By mid-afternoon she has passed.
Mr Smith is inconsolable.

Through his sobs he says "I just dropped her off. I didn't even get to say goodbye. Or kiss her. I didn't even help her in to the ER. But this?! This I get to be here for?! She needed me throughout it all. Not when she didn't even know I was here! Only to watch her die"

I do my best to console him. It's hard with no touching. No hand on his shoulder, no side hug. Instead I sit on the other side of the bed & let him talk. I tell him how embarrassed she was to not shave her legs. He chuckled and said that sounds just like her.

And then I set him up with a basin of warm water, soap & shavers and let him shave her legs. A tiny intimate gift that he had been robbed of. Of course there would be no funeral. Despite being negative, COVID ripple effects have been felt in every faucet of this stay.

As I'm leaving the unit I bump into my co-worker taking off her N95.

"How was your shifts?" I ask her.

"So busy! You were lucky you were not in a COVID bay"

I feel tears burning my eyes.
Every bay is COVID bay.
Every bay.
Every day.