As people gathered in defiance of stay-at-home orders in Idaho last Friday to protest Gov. Brad Little’s COVID-19 restrictions, Lewiston nurse Marybella Cole was answering a call for help on the front lines.
It was her second shift at Long Island Jewish Medical Center in New York City’s borough of Queens, and she didn’t know if she could handle another.
Cole, normally a medical surgical nurse at Ozeran Plastic and Reconstructive Surgery in Lewiston, is among hundreds of nurses to go to New York City after its hospitals sent out a nationwide plea for assistance. She found a placement through a staffing agency. Like many nurses, she traveled there at her own expense. The day she arrived, she and 45 other reinforcements were greeted with cheers and applause by medical staff.
“I have other friends that have also come to help out,” Cole said in a phone interview Sunday before her fourth shift. They warned her what to expect, she said, reading from a text from one of them:
“It’s crazy, sad, insane, so busy, over 150 (on ventilators), every floor an ICU unit … working with plastic bags over our heads … everyone has it, literally everyone.”
“I was preparing for something really bad,” Cole said, her voice weary.
It is worse than she could have imagined.
Working in a COVID hospital
Long Island Jewish Medical Center is about the size of Providence Sacred Heart Medical Center in Spokane, she said, and nearly every unit has been turned into a COVID unit.
The situation she describes is not the fault of the hospital, she stressed. It is a Magnet Hospital, a prestigious honor that ranks it among the best.
“To still be having these trials, it’s a testament to how huge this is,” she said. “It’s not like hospitals practiced for the COVID epidemic. They’re doing the best they can.”
She works the night shift in what used to be the maternity ward. She begins by showing her badge to receive her personal protection equipment for the day. They have plenty of equipment, she said, but it is carefully monitored.
In her unit, single rooms have been turned into doubles. There are beds in the hallways. They brought in old-style, crank-shaft beds to meet the demand. These beds don’t have alarms, so patients cannot call for help.
“Without alarms or call lights, we check on our patients and they’re already dead. Literally, you can be in there one minute and 30 minutes later they are gone. You can’t check on them that often because you have so many patients.”
“It’s a loud buzz all the time; it’s never calm,” Cole added, describing constant alarms for low-oxygen saturation rates and “Code Blues,” a term that means someone is experiencing a life threatening medical emergency. Scanners used to double-check patient’s names with their assigned medications don’t work on her floor, leaving room for human error. Some doors have signs that say the patients inside are involved in experimental trials.
Nurses are constantly pulled in different directions. For example, she said a man who defecated all over himself pulled out his nasogastric tube and was attempting to pull out his dialysis tube, posing a tremendous risk of infection.
“How do you take care of him and someone who’s coding (dying)? You’re just drowning all the time. On the second day I thought, I can’t do this.”
But she went back.
“I literally love people. I love what I do. There is no greater joy. I couldn’t have found a better profession and have so much pride. My patients mean everything to me,” said Cole, who is studying to become a nurse practitioner. “This is a huge, large-scale, enormous tragedy, but everyone is working together. Everyone is so kind, and they love the patients.”
Every day, local restaurants send carryout food to the hospital staff to show their appreciation and support. They even remember the night shift, she said.
“That’s huge. Generally the night shift doesn’t get anything. They’re taking care of everyone in the hospital. It’s the community that’s doing it.”
Dying for air
Dr. Steven Ozeran wasn’t surprised when Cole asked him if she could leave work to go to help out in New York. Things were slow at the clinic. COVID restrictions put a hold on elective surgeries like breast implants and facial contouring. During the shutdown, he and his staff are treating people with lacerations, broken bones and lesions. It takes some pressure off area hospital emergency rooms, he said.
“She’s got a good heart. She wants to help people; that’s her thing,” he said.
He’s asked her to put together a presentation for the staff on her experience.
“We really have no idea what she’s doing over there,” he said.
On social media, Cole sees people back home in Lewiston and Clarkston getting restless, asking when social distancing will end.
“If they could see how bad it is, they would probably stay inside,” she said, her voice growing quiet. “You wouldn’t take the chance at all. Everyone in New York wears masks, everyone. No one goes outside.”
For people who die from it, “it’s torture,” she said. “It’s an agonizing death.”
While emergency-room admissions have dropped from 150 a day two weeks ago to 50 a day last week, the death rate remains the same, she said. “We have a very high mortality rate. I definitely stay inside after seeing what I’ve seen.”
Her floor is not an ICU unit; there are no ventilators. For those at that stage, there is a huge, bed-to-bed room full of intubated patients elsewhere in the hospital, she said.
But patients on her floor struggle to breathe. A respiratory rate is the number of breaths a person takes per minute. A normal rate for an adult at rest is around 17 breaths, she explained. Saturday, one of her patients was at 72 respirations per minute. His lungs were filled with carbon dioxide.
“It’s horrible watching them; you can’t make anything better. They can’t even talk to you. You see the pain and suffering … . They can’t even sleep because they can’t breathe.”
She roots for them and does everything she can. Her greatest pain is those who die alone. With no visitors allowed, nurses are often the last people they see.
“I think about one of my codes the other day: She was in there without a call light and just passed away all by herself. It makes you feel so guilty as a nurse. I should have been there. But when you have 10 other people doing the exact same thing, it’s hard. It’s really hard.”
Cole is married with a 12-year-old daughter and a 6-year-old stepson at home. When asked if she worries about getting COVID-19 she said, “Yeah, all the time.”
Her perspective on the virus shifted when she discovered one of her patients was a pharmacist. She has patients in their early and late 20s without pre-existing health issues.
“You can think it’s just people with comorbidities, but it’s not,” she said. “When you see younger and successful people, you get worried.”
Doing the greatest good
Cole’s shifts are supposed to be 12 hours but they are 14. At the end of her workday, she calls an Uber and goes to her hotel room at a pricey Hilton she didn’t expect to be paying for. She orders breakfast from Uber Eats, which many New Yorkers rely on for meal delivery.
She’d heard that nurses who go to New York City were given free places to stay. Upon arrival she found “that wasn’t exactly true.”
She used a link for a COVID-19 hotel program and signed up for a free room, but when she got there she said “it was pretty much a brothel. It was just disgusting. I bit the bullet and got a pretty expensive hotel, until I find a free one.”
The hotel is a long way from the hospital, and Uber fares there and back add additional costs. Her other meals come from the hospital cafeteria.
This is her first time in New York. The streets are empty, she said. People there call it a ghost town. The sound of ambulance sirens echos through the city at all hours. A field hospital was constructed in Central Park. People who defy social distancing rules are fined $1,000.
“We’re lucky in Idaho it’s not so heavily, densely populated,” she said.
She thinks all the time about what she would tell those demanding that stay-at-home orders be lifted.
“For people back home, it’s hard to grasp what is happening,” she said, adding that people at home in New York don’t see how bad it is either.
“Seeing it, death is just waiting on everyone’s doorstep. People are just fighting to stay alive.”
Optimally, everyone would stay inside to get rid of this virus, she said, but people from different backgrounds have different values.
“Some people believe that your freedom is worth more than your health, that if you can be free and enjoy life for five days, it’s better than to stay inside and help out the masses. People talking about their liberties being impeached on, it’s hard.”
She wasn’t sure what she would say to those people. She might explain her situation and tell them she has to put herself at risk every day — but they don’t have to.
That night, her shift began with finding a patient slumped over on a toilet, unresponsive.
“He’d just taken himself to the bathroom,” she said.
She and another nurse administered chest compressions but it was too late. He didn’t make it.
Later, Cole asked one of her patients, a woman with a 7-year-old daughter, what she would tell people who want to go outside and reopen jobs and stores.
“Stay inside, I wouldn’t wish this on anybody,” the woman said. “It is so scary. I’m so scared to fall asleep. I’m scared I won’t get to see my daughter again. This is so scary — so, so scary.”
“Maybe that’s what I would tell them,” Cole said.