Dear World,

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I was asked to be in charge of a COVID-19 only ICU for the duration of the COVID-19 crisis. I normally work in busy surgical intensive care, which means I’m used to dealing with the sickest patients who also happen to need surgery. Fortunately, what we don't see working in surgery is a lot of death.

Sure, I've withdrawn care on many patients, mainly because I've been a nurse for a long time. But never 15 people in one work week.

I’ve thought a lot about death and dying over the years, and often have had the thought of how horrible it would be to die alone alone, especially because I don't have any family here in New Orleans.

My dream for everybody is to have their family members with them when they pass, and for their passing to be a peaceful experience, because that's what people deserve.

We have the technology and knowledge to help people, and we tried to help as many people as we possibly could. Everyone I worked with used every bit of combined education and experience to treat our COVID-19 patients. Unfortunately, some things were beyond repair.

It’s been really hard, especially when you’ve been there every day and a patient finally looked like they were progressing, then quite suddenly they are back to square one with medications and vent settings, or worse.

If you’ve seen the data on our COVID-19 death rates, it goes up, then it's down, then up, then down. It comes in waves because these patients came in waves as well.

Many of these patients need significant supportive care, meaning help to support their lungs, or if their kidneys were affected, they’d need a dialysis machine. There are interventions for each affected organ system, and hopefully we can get them through without too many other complications with these interventions.

But sometimes we’d get to a point where nothing was helping them anymore. We were at the end, and the patient was just slipping away. We're max on medications. We're max on the ventilator. It's just a matter of time, and we, the treatment team and family, then have to decide what to do next. Do we withdraw care, meaning we turn off the machines and let nature take its course, or we have to do a full code?

A full code is when you initiate chest compressions — putting your hands on their chest and pushing hard, often until rib bones crack.

I can hear it, even now. It’s a memory that doesn’t go away. It's awful and it's painful for the patient.

We then push high doses of IV medications to help restart the heart or try and fix dysrhythmias. We do continuous CPR. We don’t stop for anything. Sometimes, it takes being with my knees on the bed to ensure that the blood is going to the brain with each compression.

That is not the way to die. It should be peaceful.

As a society, we never have conversations about death and dying until it's too late. But we should be having these conversations. People don’t come back better, oftentimes they are much, much worse after a code.

Recently, a patient was showing signs that he was dying.  It was the patient’s wishes not to have the breathing tube put back in.  He was struggling to breathe and needed more medications to keep his blood pressure up. The doctors talked to the family, and the family decided to proceed with making him comfortable so when he took those last breaths, it wasn't a struggle or a gasp for air.

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I always make sure the patient looks their best for their transition.

I wash their faces. I’ll put chapstick on their lips. I change their gown. And I do it because it shouldn't matter whether there's family there or not. They're human beings, and they deserve to be taken care of.

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The bedside nurse and I were with this patient the whole time. It was really peaceful. There's a rhythm to a person’s breathing when death is close. And with the last breath, a silent finality.  It was really quiet, in an instant I felt overwhelming peace in an otherwise chaotic day.

Normally, family would be there talking about what kind of person they were, what they did and what they liked, but it was just the two of us. I didn’t know what kind of a man he was, but I assume that, were the circumstances different, his wife and children would have been there.

We were there.

For me, these are people. This is someone's person. Dying doesn’t have to be awful. A peaceful transition is the biggest gift you can give anybody who has been through 45 days of pain with a tube down their throat.

Someone told me years ago: not everybody's supposed to live forever.

As long as there are nurses, you'll never be alone.


Sincerely,

I Washed Their Faces

Katie Gage

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