Pelzel started work in the New York hospital the night of April 22.
Carissa Pelzel, a 2005 graduate of St. Mary’s High School and daughter of Steve and Lynnae Pelzel, is a Family Nurse Practitioner in Minneapolis. Prior to earning her Nurse Practitioner Masters Degree, Pelzel worked as a registered nurse in an adult and neonatal ICU for seven years. Currently she is using that ICU experience, working in a COVID unit in a New York hospital.
“I’m working as a Registered Nurse in New York,” Pelzel said. “I am working through a travel nurse company that was looking for “crisis” nurses to work in the intensive care unit with Covid-19 patients.”
Pelzel started work in the New York hospital the night of April 22. A few days later she posted the following account of her first experiences on her Facebook page. It is reprinted here with Pelzel’s permission.
Carissa Pelzel’s words:
To all who have reached out and asked how I am doing — I am doing as well as I could hope to. I am hoping to give you a glimpse of my first few days:
It’s my first night shift. I’m here in New York on an eight-week assignment. I’m nervous and excited but I don’t really know what to expect when I arrive. I haven't done ICU nursing in over three years. I arrive at the level one trauma center out in the suburbs of New York. I figure it couldn't be as bad as Brooklyn. Will it really be like all the stories I've been reading?
My Uber pulls up near the hospital entrance that has been blockaded by police cars. My heart races as I repeat, “Thanks for what you are doing. I appreciate you. Stay safe,” as I have for nearly every other essential worker I've come into contact with since the pandemic hit. A security officer directs me to use a certain route and states that there is a TV crew on site. “The police and other first responders are here to support health care workers like you, and they're donating food as an act of appreciation. It will be on camera channel 7 news at 7 p.m.”
As I get off on my assigned floor, I spot a crowd of people all in different phases of donning and doffing PPE. It's a station, we are told, where we get ready before we enter the COVID unit that I am assigned to. It's an open unit and no one can enter without “proper” PPE, which includes an N95 mask that will be worn for every patient and every shift for the next week, a reusable face shield, a sheer gown that most certainly will not protect the clothes or the skin from any amount of fluid, and cheap, stiff gloves. I also wear a hair cap and surgical mask over my N95 to keep it clean. We wear the same masks, face shield, and gown for all patients throughout the shift.
As I enter the make-shift Tier Two ICU, I see people everywhere. It's bright, loud, busy and unrecognizable as an ICU. Meds are lying around on carts in the halls, privacy seems to have gone out the window and despite all the uncertainty, or because of it, I have a rush of adrenaline.
All the new travelers wait at the nurse’s station for their assignment. We are paired with another Med/surg nurse who hopefully is at least a regular staff at the hospital, but most certainly is not ICU trained. Nurses from all over the country are here because of the influx of incredibly sick patients, and the number of regular staff out sick with COVID themselves.
I find my patient’s room number and tentatively walk in. It's a double room with two ladies on ventilators. Every patient is here with complications from COVID-19. My patient looks unkempt. She was transferred from the Tier One ICU just a few hours before. That's how they're sorting all the patients in the ICUs — in three tiers. The sickest of the sick, who need ECMO [Editor’s note — found on University of Iowa Hospitals and Clinics website: ECMO is like a heart-lung machine used in heart surgery . . . it temporarily takes over the work of the heart and lungs so they can rest and heal] are in a Tier One unit and that's the extent of my understanding, as there doesn't seem to be any formal or even informal protocols used in defining criteria for admission to one unit versus another.
The patient was transferred to us with heart rates in the 30s. She is hemodynamically unstable (her blood pressure was labile) and she is intubated. The patient requires a large amount of PEEP, or positive end expiratory pressure (14) and is on 100% FiO2 and still only saturating in the mid to high 80s. She's my only patient and I'm comforted by that even though she's quite unstable. For now, she's just on sedatives but there are a number of drugs we've got on standby if we need.
My face shield starts to fog up and I immediately find myself panicky. My N95 mask isn't fitting the best and I'm leaking. I readjust the metal nosepiece on the bridge of my nose until it aches. I'll do this over and over during my 12-hour night shift to ensure a tight seal. I can’t risk getting sick. Not here, not now.
The Med surg nurse and I are both travelers and it's our first day. Neither of us know the charting system or know where anything is located in this make-shift intensive care unit. I do a quick scan of the patient, her room, and her supplies and I realized we need a catheter securement device, she needs an art line dressing change, and her IV tubing is going on four days old, all just little things. Then I look closely at the patient’s face. She looks as though no one has washed her face in days. Her eyes are crusty, and she's got dried blood from her nose. So that's the first thing I feel I need to do. I need to wash her face — she deserves that much.
The machine isn't working to hand out individual supplies, so there are five separate floor to ceiling bins full of random supplies. It's a free for all, which sounds like fun, except no one knows where anything is and it's chaos. I go desperately searching for a washcloth. I must have had a confused look in my eyes, and one of the NYU aides looks at me and asks how he can help. “I just need a washcloth,” I plead, “and a thermometer and is there Vaseline for my poor patient’s lips?” He comes to my rescue and I do my best to clean the dried blood from her face. She isn't regulating her temperature well and we need the bair hugger, which is a machine that blows warm air to keep her normothermic. She starts getting agitated as we wash and assess her, and is grabbing for her endotracheal tube. She needs this to breathe, to live. She will not survive without it. She's maxed out on her vent settings and she's fighting it. We need more sedation so her lungs can rest. They are stiff and aren't functioning as they should.
ARDS r/t COVID 19 is the official diagnosis. That’s acute respiratory distress syndrome related to COVID 19 virus. The sedation I give her drops her blood pressure so much and so fast. She has a mean arterial pressure in the mid 40s. I'm afraid she will code as I scramble to find the medication she now needs in order to keep her blood pressure high enough to perfuse to her vital organs. It's a battle all night long, titrating sedation with the vasopressors. Her lips are breaking down and she’s getting some pretty nasty sores. We try to move the tube in different positions in her mouth to prevent pressure ulcers but after so many days with a tube, it's inevitable.
This sounds all like routine ICU stuff, the same stuff I did for more than seven years of my nursing career. But it's different. This is one of the most terrifying scenes I have ever been witness to. The morale is low and we're doing our best, but what if our best isn't enough? I didn't even realize that my patient only understood Spanish until halfway through my 12-hour shift. This is not the nursing care I want to give. I don't want to give the bare minimum. But there's little time for anything else. I had a drink of water one time in my shift. I stood by my patient’s bedside for the majority of the shift, too afraid to leave the room and this still isn't enough.
And I’m not the only person with a rough day. A fellow team member had his patient die within the first few hours of his shift. There was nothing more to be done. Another coworker had to emergently place her patient on dialysis. Her patient has acute kidney failure related to COVID. And another nurse is slowly watching her patient’s hemoglobin drop. COVID creates microclotting in the body and nearly everyone is bedridden. Their risk for an embolism is incredibly high so everyone is on blood thinners. But this patient is bleeding from somewhere and they can’t figure out where.
Night number one is over. After my shift, I actually laughed out loud over how incomprehensible it all is… and then I cried. It feels like a dream, a nightmare.
My next few nights are more manageable, and I am able to find a little sense of normalcy and humanity in it all. I have two patients after that first night and one of them is awake and alert. It’s rare to see in this unit, to be honest. But this woman has had a rough go. She’s been hospitalized for over a month and has been intubated, extubated, trached, and decannulated in that time. She is barely audible for the hoarseness in her voice. The endotracheal tube causes trauma on the vocal cords. Her hair is a matted mess and she’ll need to shave it off if she finally gets home. I do what I can to make her feel better, rubbing lotion on her legs and arms and giving her a hand massage. I help her brush her teeth for the first time in ages and she smiles. She asks for one last thing — lotion on her face. And as I’m applying baby lotion to this woman’s face I start to tear up. I think more about her situation as I watch her fervently use her incentive spirometer at 2 a.m. She has been hospitalized for over 30 days. She’s been critically ill. And all alone. She hasn’t seen anyone else’s face in over a month — only eyes, masks, and face shields. She hasn’t been able to see or talk with her family. And this is absolutely heartbreaking.
I talk to her husband that night to give him an update and encourage him to send photos or texts to her cell phone. When I get back into her room with an “I love you” message from her family, there is a new text message waiting with pictures of her baby grandson. We go through the pictures and she can only smile with tears welling up in her eyes.
As I lay exhausted in my bed each morning, I think about my patients. They both are my dad’s age and that thought is terrifying. But at the end of the day, I am honored to be here working for these patients and with these amazing people from all over the nation. Hundreds of people are coming together to support each other amidst the pandemic. I know this isn’t it for me. I know I’ll be scared and anxious and have really crappy days, but I also take pride in knowing that I can help. This is unlike anything I’ve ever seen or been through in my entire life and I am grateful for so many things — my health, my family, my friends, and all my new coworkers. I’ll be leaning heavily on every one of those people in the next eight weeks and I can’t even begin to express my profound gratitude. Thank you all and please, please stay safe.