Interviewer: Molly Zhao Editor: Tiffany Chen, Joyce Hai, Demi Leng, Shannon Tan, Tyler Vazquez, Cynthia Zhang, Leon Zhou
Interviewee: Mrs. Imelda Castro
Question: What department do you work in at the Hospital? Can you give us some insight into what your job consists of given the current pandemic?
a. I have been a nurse for 31 years now, and have spent most of my career in the critical care setting: a total of 4 years in the medical-surgical units, 1 year in the emergency department, and 26 years in the Intensive Care Unit (ICU). I have worked at the Kingsbrook Jewish Medical Center in Brooklyn for 10 years and, for the last 17 years, here at St. Peter’s Main Hospital in New Brunswick, New Jersey.
Question: Can you give me a brief account of your work schedule? (work time, lunchtime, break time, etc.)
a. Before this pandemic, in addition to working as a staff nurse in the ICU, I also helped other units like telemedicine, surgical care unit, and an endoscopy unit, if need be. Throughout the pre-pandemic, pandemic, and post-pandemic phases, we took care of very serious and critically sick patients and responded with our Rapid Response Team (RRT) and Code Blue calls. RRT is called if the patient is in trouble, such that early intentions can be carried out before the condition worsens. Code Blue calls mean that a patient is undergoing cardiopulmonary arrest. As a surge of patients arrived during this pandemic, our ICU became a battlefield zone, on top of the influx of seriously ill and critically sick COVID-19 patients. RRT and Code Blue calls happened very frequently; we were so overwhelmed. The ICU could not have made it without the help of nurses from other departments of the hospital, like the recovery room, operating room, special procedure, endoscopy, and Pediatric Intensive Care (PICU) nurses. The ICU had to transform into a double ICU. I worked full time, around 12 hours per shift from 7 AM to 7 PM, 3 days per week, as well as shifts for Friday and the weekend. We implement self-scheduling, but of course, it is not a guarantee that all our requests for days off are granted.
Question: Can you paint a picture of what you're seeing across the country as critical care nurses continue to deal with the pandemic?
a. It is well known in the nursing world that we seldom go home on time. Based on the current circumstances and patients' conditions that day, our endorsement of signing out and reporting times to the incoming shift might take more than 30 minutes. It is a matter of life and death and every minute, seconds become critical. We perform our tasks first before documenting them in our system. With that in mind, there are times where we have to run around throughout our entire shift, so we only have time to chart at the very end of the shift. We are allowed a 15-minute break in the morning and afternoon, as well as 30-minute for lunchtime, but most of us don’t find the free time to take those two 15-minute breaks. Although the ICU situation has greatly improved, I think our ICU nurses across the nation are in it for a long haul. The seriousness of what we see on the frontlines is not necessarily what everybody else sees. We see not only old but even more young people getting sicker than we have ever seen in the past; the mortality rate is very high.
Question: What is one memorable experience that you have had working with critical care patients?
a. I have many memorable experiences during this pandemic, both good and bad. I remember how we all cheered outside of the patient’s room as they were extubated from the ventilators. One woman was only in her early 50’s, and we thought she would not make it because she had been on the ventilator for quite some time. A pregnant patient in her early 20’s also came out of the ventilator, then eventually out of the ICU. Another one of my favorite memories is how we all lined up in the ICU hallways, cheering and playing inspirational hymns as a patient in her 30’s was being wheeled out of the ICU. One bad but memorable experience during this unrivaled time was how families couldn’t be with their critically ill and dying loved ones. It is disheartening to know that people are fighting for their dear lives without their families at their bedside. I am not ashamed to tell you that at times, as I facetimed with families and my dying patient in his early 40s, I was not able to control my tears. I would remember my deceased father. My father died when I was young. He was only 53. I dreamt of him for many months, and that experience was pretty hard on me.
Question: Are nurses and other healthcare workers across the country seeing shortages of ventilators and PPE? Do you and your coworkers have sufficient PPE during shifts?
a. If our government and private sectors helped and worked together to believe the data, science,and medicine, as well as the experts' predictions, we should not have a problem with a shortage of personal protective equipment (PPE) and ventilators across the country. The need for ventilators and PPE varies from state to state. NJ was second to NY in the number of COVID cases and deaths and we have experienced a shortage of gowns in our hospital. From the start of the pandemic until now, we had to reuse N95 respirator masks… We have to wear double masks now; we wear N-95 masks on the inside and the regular surgical masks on the outside that we throw on for one usage and throw out after our 12-hour shift. The N-95 masks are cleaned by autoclaves and can only be used up to five times.
Question: What are some positive things that the community has been doing for healthcare heroes like you, and what are some ways that communities can continue to support nurses?
a. In times of crisis like this, although it brings so much anxiety and grief, it may also bring out the best in people. Frontline healthcare workers, like me, are grateful for the unending support from the public. Residents, local businesses, community organizations, families, children, and people from all walks of life continue to cheer us on. They send us food to eat, words of encouragement and prayer, and their handmade cards and letters. They give us free working shoes, handmade masks, face shields, snacks, beverages, etc. Community leaders head to our hospital and greet us, showing their support and expressing their gratitude. Outside our hospital, there is a very big banner that states “Heros Work Here”. Our entry passages leading us inside of the hospital are covered with written words of thanks and encouragement. Inside the hospital, there are many cards and signs as well. These gestures warm my heart every time I go to work.
Question: What are some of your biggest concerns for nurses over the next couple of months?
a. My biggest concern for nurses over the next couple of months is the possibility of a second wave of the coronavirus, similar to that in the spring as the weather cools once more. I also fear for a potential lack of PPE and ventilators, as well as dialysis machines for continuous renal replacement therapy (RRT), and the fear that the healthcare system will collapse. That is why communities need to follow the proper guidelines, and people must ensure that they are taking the appropriate protective measures.
Question: Working such an important front line job must be tedious at times. What do you do to relax?
a. Working in the ICU during the COVID-19 pandemic is a taxing task. It is indeed tedious and demanding, both physically and mentally. Since I can’t do many activities outside of my home, I usually watch movies, soap operas, or exercise for an hour on my elliptical machine, as a way to destress and relax.
Question: How is your mental health in this period? How do you adjust?
a. This COVID-19 pandemic crisis has permanently changed all of us. We will never be the same again. None of us are superheroes nor are we magically immune to this virus. The threat that we may contract the coronavirus every day and potentially infect our families truly takes a mental toll on us as frontline workers. Fortunately, we have a group called “Masked Off”, where we can talk about our fears and worries and concerns, to support our mental health during this time. We must adapt to this “new normal”. Social distancing, wearing masks, and washing our hands frequently are necessary measures. For ICU nurses like me, we need to find ways to limit our exposure and at the same time while making sure that our excellent care for our patients is not compromised. We use extensions for machines such as IV pumps, ventilators, CRRT, such that they can be extended outside of the patient room. We need to adjust and adapt to virtual medicine and science.