Sharon Going, Nurse Practitioner Hospitalist

“Hey, you okay?”

I have been asked this question more than any other in the past few months… by colleagues who understand when my only response is a terse laugh or a sarcastic quip. By friends from afar who have messaged me after seeing my local area make national news as infection, hospitalization, and death rates have skyrocketed over the past few weeks. By close friends turned family, who see the strain so plainly on my face, even when I plaster on a smile.

My response is almost always the same. “Yeah, I’m okay,” I’ll say, brushing off their concerns as quickly as possible. It has to be quick… I can’t dwell on the truth for too long or the facade I’ve struggled for months to maintain will crumble.

The truth? I’m not okay.

The past few months of my career have been among the hardest I have ever faced, both professionally and personally.

I have worked at the bedside, first as a patient care technician, then a registered nurse, and now as a nurse practitioner, for over a decade. To say that I have seen some things is an understatement. But the past few months of my career have been among the hardest I have ever faced, both professionally and personally.

As of November 10th 2020, the COVID Tracking Project in The Atlantic reported that “The United States is experiencing an unprecedented surge of hospitalizations across the country. Today, states reported that 61,964 people were hospitalized with COVID-19, more than at any other time in the pandemic. For context, there are now 40 percent more people hospitalized with COVID-19 than there were two weeks ago.”

That article was written over a week ago. Things have gotten worse in the days since that article was published. An hour south of me, El Paso, TX has made international headlines. The city’s convention center has been converted to care for patients sick with COVID-19; there are so many patients that local hospitals are over capacity.

Here in Las Cruces, NM, local hospitals are also feeling that surge in COVID-19 hospitalizations. As I write this, almost 40% of current inpatients at the hospital where I work are admitted because they are sick with COVID-19. Take a moment to let that number sink in… it’s huge. And those numbers are only expected to get worse. We can only guess as to when, but we all expect that one day, and that day will come soon, our local hospitals will be at and above capacity, overwhelmed with sick patients and unable to provide care for all of them.

This is not okay.

One day soon, I fear that I will be tasked with making the decision of which patient gets the last ventilator and has a chance to live and which patient does not and is sentenced to die.

I receive daily email updates on the current status of the number of beds, both floor and ICU, as well as the amount of available essential equipment, like high-flow oxygen machines and ventilators. We are nearing critical capacity, and local healthcare providers are already having daily discussions about how best to utilize our limited healthcare resources. For now, we have the ability to care for our patients, but I fear we are rapidly approaching the day where that will not be the case. One day soon, I fear that I will be tasked with making the decision of which patient gets the last ventilator and has a chance to live and which patient does not and is sentenced to die. I don’t want to have to make that choice, but I fear that’s what challenges lie ahead.

This is not okay.

And it’s not just a matter of available beds and equipment… COVID-19 patients are often incredibly sick and require a lot of care. Our nurses, patient care techs, respiratory therapists, case managers, and so many other healthcare providers are already stretched thin. We are trying, but we are tired… physically, mentally, and emotionally. This pandemic has taken its toll on us. Several of my colleagues have quit their jobs and left the field altogether; the horrors of this pandemic were too much for them.

I don’t blame them in the slightest… I understand. I’m not okay, either.

In the past few weeks, I have pronounced more patients dead than I have in the past eleven years of my career combined.

Local hospitals, mine included, have brought in refrigerated trucks to serve as additional morgue space. We have seen so many patients die in the past few weeks that we have exceeded the space in our small hospital morgue.

In the past few weeks, I have pronounced more patients dead than I have in the past eleven years of my career combined. Telling someone that their loved one has died is never easy and never gets easier, but lately it is particularly hard. My heart aches for my patients and their families. We aren’t allowing visitors in the hospital in an attempt to control the spread of the virus, so when a patient dies, all I can do is call their family to inform them… and listen helplessly to the absolutely heart wrenching screams of grief through the phone. I have made too many of those phone calls in the past few weeks and months.

This is not okay.

Many of my colleagues have themselves fallen ill with COVID-19. As healthcare providers, we are at a high risk of contracting COVID-19 due to our frequent and continued contact with the virus, despite the use of personal protective equipment. Most of my colleagues have recovered. Some have returned to work, ever dedicated to taking care of others. Some have died and will be forever missed.

This is not okay. I am not okay.

I’ve worked at the bedside through some previously scary times… H1N1, ebola, zika. I was never once afraid to go to work, never once feared that my dedication to caring for my patients could very well be my ultimate demise. I wish I could say the same now, but I have seen far too many otherwise young and healthy people succumb to COVID-19. Some have been my colleagues and friends.

I wonder when, (not really if anymore, just when) I will myself catch COVID-19. Will I experience no symptoms and unknowingly spread this deadly virus to others who might not be so lucky? Will I experience just flu-like symptoms? Will I require hospitalization? Will I die?

I’m 37 years old and overall pretty healthy, but that didn’t stop me from writing an advanced medical directive in April of this year, detailing my wishes in the event that I’m unable to speak for myself. It’s attached to the side of my microwave, and my named health care power of attorneys have copies as well. I’ve told them in no uncertain terms what I want them to do should the worst case scenario occur.

I am not okay.

Insult is added to injury when I get on social media and see callous comments or conspiracy theories about the pandemic… people proclaiming that the dangers of the virus are imagined or inflated as part of some conspiracy or attempt to exert government control. The same people mock the wearing of masks and social distancing practices and claim that health care providers are falsifying death certificates to increase their reimbursement, or insist that, because they are young and healthy, they aren’t at risk for catching the virus because it only really affects the elderly or those with multiple other health conditions anyway.

I’ve spent a lot of time contemplating how to convince these people otherwise, how to make them see reason and place more weight on scientific fact than their own opinions. I’ve come to the conclusion that… I can’t. These people will believe what they believe because they don’t see the horrific things that I see day after day after day after day.

I can’t afford to crack now when there is still so much work to done.

Part of me wishes they could come with me to the hospital and see the gut wrenching reality of the pandemic for themselves firsthand. Another part of me would give anything to spare others from seeing what I have seen. I have seen so much suffering and heart break and death in the past few months, and there is no end in sight.

This is not okay. I am not okay.

I won’t ever say those words aloud, of course. Giving voice to all of this somehow makes it feel even more real, more powerful. I can’t afford to crack now when there is still so much work to done. My patients and my colleagues need me. I have to be okay for them.

I’m not scheduled to go back to work for a few days. I will spend them taking care of myself… silly little things like taking long hot showers, cooking recipes my grandmother taught me, and playing fetch with my dog. I go for solitary hikes and watch the sun rise and set over the Organ Mountains and remember that there is beauty in the world. These little moments of normality remind me that there is still good in the world and that one day, I will be okay.

But today, no… I am not okay. And I’ve come to realize that’s okay, too.

But okay or not, in a few days I will go back to work in the hospital, back to fighting back the seemingly endless tide of suffering and heart break and death, back to doing the only thing I know how to do, the thing that both rips me apart and puts me back together… I will do my very best to care for my patients, their families, and my colleagues every single day. Even when it’s hard. Even when I’m tired. Even when I’m overwhelmed. Even when I’m scared. Even when I’m not okay.

So please believe me when I say that I want this pandemic to end as much as, if not more than, you do. It has consumed my professional and my personal life. It has forever changed my career and the world. I would give anything to go back to the way things were before.

So I am begging you: please continue to be diligent and committed to practices that we know help to prevent COVID-19 transmission. Wear a mask. Wash your hands. Practice social distancing. Limit nonessential travel. Avoid social gatherings.

I know that’s a big ask, especially as the holiday season approaches. Trust me when I say that I would rather spend the holidays with my friends and family than alone. It’s hard to stay the course, but we cannot falter now. Yes, there are promising vaccines on the horizon, but we have to make it through the winter first. And it is going to be bad.

Strike that… in my local area, the situation is already bad. And it is going to get worse, much worse. We are facing a long, hard winter.

So again, I beg you: this holiday season, love each other from afar, so that next holiday season no one else is missing when we gather again. Please take care of yourselves and each other. Those of us in the health care field are trying so very hard to take care of all of you. Even when we ourselves aren’t okay.

And we are not okay.