Now, the hard part. Maintain your empathy, efficiency and expertise for 12 or 18 hours, while going thirsty and never sitting down, in an environment that is under-resourced and overworked, because your latest duty — in a profession with limitless duties — is confronting the most frightening pandemic in 100 years while holding people’s hands through it, through two pairs of gloves and a feeling that tomorrow could be worse.
“The job’s hard,” says Angela Gatdula, 31, a nurse in Santa Monica, Calif.
“It’s been really hard,” says Sasha DeCesare, 34, a nurse in Orlando.
“I’m anxious, because it’s a very stressful time to be at work,” says nurse Brenda Keys, 25, who recently returned to MedStar Washington Hospital Center after recovering from her own bout with covid-19. “I’m excited, though, to get back and help my co-workers because I know they need the help.”
Nurses have always been the glue. They are the link between patient and doctor. They don’t want your pity, and they don’t want to be called a hero; what they want is for you to stay home, stay well, stay alive. For 18 years in a row, nurses have been rated the most honest and ethical profession, according to Gallup surveys of Americans, outpacing doctors by 20 percentage points (and members of Congress by 73).
In an era when no one seems to trust anyone, we trust nurses.
“But I don’t think that means people really understand what nurses do,” says Laurie Combe, president of the National Association of School Nurses. It’s a complex job, requiring knowledge of both biochemistry and psychology, in myriad environments. Nurses are helping your fourth-grader learn to track her insulin levels at school, and they are putting pressure on a gunshot wound at 2 a.m. while noting that the victim has no pulse. They are monitoring both your heart rate and your spirit. When they touch your arm, in what would appear to be a simple gesture of friendliness, they are also testing if you’re hot, swollen, dehydrated, tremoring.
“I can observe what is on your bedside table that you’re reading — if I can talk with you about that, I can strengthen our connection to build trust,” says Combe, who has been a nurse in the Houston area for 45 years. “I can see who’s in your room visiting, what the interaction looks like, and see whether that’s a trusted person or not, so I know what I can talk about during that visit.”
The novel coronavirus has changed the world, and it has changed what nurses do, too. They are deploying to unfamiliar hospitals, transforming their units into coronavirus triage, working in extreme conditions without proper equipment, running testing sites in remote locations, facilitating virtual goodbyes with dying family members, organizing protests against hospitals and the White House, and consenting to the reality that simply showing up might be fatal.
At the drive-through coronavirus testing site in Bear Mountain, N.Y., an endless stream of cars pulled up, piloted by passengers sick with terror, and the only cure for the terror was Brenda Lagares, who’d been given 15 minutes of training to potentially save their lives.
Before the pandemic, she’d been working as a night nurse, monitoring infirm patients in their homes across all five boroughs of New York City. When the pandemic came, Lagares was recruited into one of the more crucial new roles within her profession: She would be a sampling nurse. Armed with a long nasal swab — similar to what she’d use for a regular flu test — she would test for SARS-CoV-2 while cars passed through as if by conveyor belt. She wore a mask. Many of her patients wore masks, too.
“This is how you can tell what a patient in a mask is feeling,” Lagares says. “You see the eyes glistening, because they’re about to cry. You see dilating of the pupils when they first pull up, because they’re scared. But then you tell them what’s going to happen, and when they’re ready, their pupils would constrict. And that’s important. Because you only have five seconds to connect. You need to know they’re with you. You need to be there, together.”
Swab, seal the swab, next car, next patient.
“After the test, what they wanted was reassurance,” she says. “So I would always say, ‘I hope you feel better.’ As the car drove away, I would wave at them and put my thumbs up. We all did that. Thumbs up. Because when we were in our full PPE, that was the best way to communicate that we’re in this together.”
“We have people who are afraid they’ll get us sick, and people who are afraid we’ll get them sick,” says DeCesare, the Orlando nurse who is also working at a drive-through testing site, at the Orange County Convention Center. “They’re afraid to talk to us. We hand them their [intake form], and they Lysol the paper.”
DeCesare went to nursing school in Venezuela. “But I always knew I wanted to move to America,” she says, “because I always heard how great it was to be a nurse here.”
She still believes that. She still appreciates the respect her job affords, and that it’s a female-dominated profession, filled with strong and smart women.
But now, she was on her 22nd day of working without a day off. She was sleeping at a hotel, which now housed only medical personnel, so she wouldn’t expose her husband and two daughters. She had a placard in her car window reading “Department of Health,” to allow her entry on convention center grounds. To avoid cross-contamination, she drove there alone, she drove back to the hotel alone, she went to bed alone. In between, she saw 350 cars a day, with 350 possible covid-19 cases, and occasionally she would seek five minutes of relief in the “dirty tent,” where she could stand in her contaminated PPE under a cool blast of air-conditioning.
It’s impossible to talk about nurses without talking about the lore and the lure of them. What they do, what we think they do. What they mean, what we think they mean.
The traditional tale of modern nursing begins at Barrack Hospital on the front of the Crimean War. It was filthy: lice-ridden, moldy, overpowered by the fug of overflowing latrines and rotting flesh. In 1854, Florence Nightingale had left her previous post with London’s Institute for the Care of Sick Gentlewomen in Distressed Circumstances — excellent name, right? — and arrived at the hospital to be of service. It was, she’d soon write, like stepping into the “Kingdom of Hell.”
Nightingale and her team pried open boarded windows for better ventilation. She turned a rented building into a laundry to provide clean clothes for soldiers still wearing the same bloody clothes they’d staggered in with. She standardized nutritious diets; she fundraised like crazy. The death rate for admitted patients fell by more than half. She wasn’t only a caretaker. She was a revolutionary.
When the war was over, she wrote about it: “Notes on Nursing” became a bible for modern care.
“We’ve always had different groups of people who were nursing — but how do you describe nurses?” asks Barbra Mann Wall, director of University of Virginia’s Eleanor Crowder Bjoring Center for Nursing Historical Inquiry. “In America, our enslaved laborers were nurses taking care of the sick. Sometimes sailors were first responders. Women were taking care of people within the homes. The Catholic Sisters have responded, as part of their religious duties.”
The profession was gender neutral until the American Civil War, when men were fighting and some 20,000 women volunteered to fill the gap. Then came germ theory. Then came standardization: a nursing education went from a two-year apprenticeship based mostly on skills — wound care, bedsores prevention — to a four-year program equally based on science. Hospitals had been a place where patients would go to die; now they were becoming a place where they would go to live. Eventually, nursing would encompass a range of specialties and career paths; a nurse anesthetist might make$175,000 a year, while a nursing assistant might make $14 an hour.
Back during the 1918 flu pandemic that infected 25 million people in the United States, killing 675,000, nurses in Philadelphia would make up to 40 house calls a day.
Then, as now, there wasn’t a cure. Then, as now, the best available medical treatment wasn’t a vaccination but a collection of instructions: rest, hydration, hygiene — the pillars on which Nightingale had built her practice. “It was the nursing care that worked,” Mann Wall says.
Philadelphia’s health commissioner, a man named Wilmer Krusen, assured the public that beds and doctors were in sufficient supply. However: “If you would ask me the three things Philadelphia most needs to conquer the epidemic, I would tell you, ‘Nurses, more nurses and yet more nurses.’”
We’re in this together, but some of us are more in this than others. People keep saying that nurses are on the front lines, but they are actually behind enemy lines, surrounded on all sides. They are trying to save us, and save us from ourselves. Nurses are protesting protesters, standing in their scrubs and masks to glare at “freedom-loving” citizens who spew insults as they rally for the economy to reopen. Nurses are taking to social media to convey the extremity of their situations: They talk about war zones, about titrating a dozen IV drips while troubleshooting fluky ventilators, all without reliable stockpiles of supplies.
“We’re out of Tylenol,” a nurse in Detroit said, incredulous, in an Instagram video last month. “Like, we’re out of Tylenol.”
“We’re facing our own mortality every day that we come to work,” says Elizabeth Bigos, who works at a test site in New York. “If I specifically dwell on it too long it will paralyze me. But every day we get through, we’re one day closer to it being over. That’s what I tell myself: That’s one day closer to this being over.”
“I feel like we’re cannon fodder,” says Elizabeth Lalasz, a union steward for National Nurses United, which backs Medicare-for-all. “There’s so much uncertainty. It’s very disconcerting for us to not know if we’re going to be protected.”
Lalasz became a nurse in her 40s, after working for years as a secretary. She remembered the oncology nurse who took care of her dying father. Doctors wanted her dad to remain hospitalized; he wanted to be at home. The nurse advocated for him against a phalanx of male superiors, and he got the death he desired. Now, 35 years later, Lalasz is on an all-covid unit on the seventh floor of Chicago’s John H. Stroger Jr. Hospital. She says that a lack of protective equipment led to her contracting the coronavirus last month; she tested positive and was out of work for 18 days, with a cough, sore throat, night sweats, chest pain. She returned to her unit April 11, still worried about supplies, concerned about reinfection.
“We already knew something needed to change,” Lalasz says of an American health-care system that, even prior to covid-19, left front-line workers feeling burned out, with high rates of attrition and suicide. “And this is a massive wake-up call for us.”
In Santa Monica, Jack Cline was one of 10 nurses suspended at his hospital for refusing to work without an N95 mask. The hospital, following CDC guidelines, had told him he needed only a surgical mask.
“A plain surgical mask has all of these gaps around the edges,” Cline says. “I’ve been a nurse for 25 years. Those might be the CDC guidelines, but I know better. I know when someone is coughing in your face, it’s not droplets — it’s aerosol.”
Cline and his colleagues were reinstated last week (“Nothing is more important to us than the safety of our patients and caregivers,” Providence Saint John’s Health Center said in a statement). The same day, outside the White House, National Nurses United protested the “failure of the Trump administration to protect American health-care workers” — over 9,000 of whom have been infected with the virus. A small group of nurses stood sentinel, spread out on a brick pathway in Lafayette Square, holding photos of colleagues who have died of covid-19.
“Our Nation’s front line workers in the fight against COVID-19, including nurses, are the true heroes in this ongoing war, and they have the President’s admiration for the lives they are saving,” the White House deputy press secretary, Judd Deere, said in a statement, adding that “the White House has been working with governors and their teams since January on COVID-19 coordination and supplies.”
ICU nurse Charles Dalrymple, 26, held a sign of gold lamé with letters made of electrical tape: 20 SECONDS WON’T SCRUB THE BLOOD OFF YOUR HANDS, it said, with “HERO” in quotes.
At MedStar Washington Hospital Center, Dalrymple spends hours in negative-pressure rooms, bathing coronavirus patients, using a felt-tip marker to scribble on a room’s windows to communicate with the outside, so he doesn’t have to change out of his gear. He’s had to tell family members that they can’t come in to say goodbye to a loved one. He’s held the iPad as that goodbye is conducted virtually.
Why is the word “HERO” in quotes on his sign?
“I feel that it’s being used to placate us — gaslighting this entire situation,” Dalrymple said. “A ‘we signed up for this’ kind of thing. But we didn’t. We didn’t sign up to go into a room without proper gear. . . . They can’t be throwing this word around just to make it seem like, ‘Oh, it’s okay that they’re dying. It’s because they’re heroes.’ . . . It’s just frustrating. That’s all.”