In the Beginning

A Nurse’s Reflection back to March 2020

This happened at the beginning. Before the tyvek suits, and the extra ICU beds. Before the empty streets howled with what we’ve all lost. When Italy served as an example of what we must not become, when we still had hope we could “flatten the curve.” Before we had all held the hands of the dying in place of their family, before every room was filled with a coughing, proned patient, before we knew what we were doing. 

In early March 2020, I was the first nurse to go into a room with a suspected Covid-19 patient. The tests were taking a week to come back at that point, we only had a few suspected patients. Since I didn’t live with family or roommates, I was the safest choice, so I was the first one in. Those first few cases were discharged without results, none of them ended up coming back positive, we were still waiting for our first confirmed case. We knew it was coming, it was only a matter of time before one of them came back positive. 

In this in-between time, I met Robert. He had been discharged from our floor less than a month before. He had a significant respiratory history: at home he lived on a constant 8L of oxygen, but it had gotten harder for him to breathe. He lived with his brother who had just attended a funeral, and some attendants had just come back positive. Robert’s brother hadn’t been feeling well, but it was Robert who ended up with us, in a room at the end of the hall, with a steadily climbing oxygen requirement. That first night he was sick, but stable. The next night I came back to find something different. We had never seen it before, but we would see this escalation again and again in the coming months. No amount of oxygen was enough. I was in that room every 10 minutes increasing his oxygen until he was on the maximum amount we could currently offer on the floor. 

Robert was very clear: he was a DNR/DNI. There would be no ICU for him, so instead he got me. While I was in his room turning up his oxygen, he told me about his years as a wedding planner, about a bride who had left her dress at the airport, about how he could spot who would make it and who wouldn’t. But when I could turn his oxygen up no further, our conversation switched. Just as he had known which couples would last and which wouldn’t, he knew what his outcome would be. He looked at me and said through his oxygen mask, “It’s okay, I’ve had a good life, I’m ready.”

I had never had this conversation before. I had only been a nurse for a year at this point. On my floor, when someone was imminently dying, they were usually not this aware. But this was a different kind of death. “Will I go tonight?” he asked. 

“I don’t know,” I responded. “We’ve never seen this before.” 

I don’t know if he saw the tears slowly rolling down my cheeks as I medicated him. If he did, he didn’t say anything. So I sat with him, monitored his medication, and held his hand while he slipped into unconsciousness. 

I work the night shift on a medical floor. I start at 7:00pm and end at 7:00am. All of this took place before midnight. I felt like I had already run a marathon. I left Robert’s room while he still breathed but no longer responded, blinded by the bright lights of the hallway. Though we didn’t have his results yet, somehow all the nurses knew: we knew we were seeing something different. 

While Robert struggled to breathe at the end of the hall, I turned to face my coworkers and other patients. “John is causing problems,” they told me. 

John was another patient of mine. He was on an involuntary psychiatric hold, and completely healthy. He had told the Emergency Department he had a cough, so they swabbed him for Covid and sent him to us. We were woefully ill-equipped to handle psych patients, especially with Covid. We had him confined to his room because he was potentially infectious. He would stand at the doorway, pacing like a caged animal, shouting abuses at the staff who monitored him for safety. 

John was desperate for a cigarette. He had been pacing his room for four days, antsy with no entertainment, no freedom, and no cigarettes. I had already been giving more nicotine gum to him than I probably should have, but it wasn’t making a dent. He alternated between screaming at staff and pleading with us. Offering us a mix of abuse and bargains, screams and apologies. My coworkers were right, he was escalating. John was leaning outside his door while the nurses' aides tried to shoo him back inside. We called security, who came up to linger in the hallways, and we called the doctors. It was decided that for everyone's safety we needed to get him sedated. I filled two syringes, one with Haldol, one with Ativan, and with one of my best friends by my side, suited up and walked into John's room. We didn’t know what we were going to get with him, so I very gently said, “John, we have some medication, it is going to calm you down, is that okay?” 

Much to my surprise, he responded, “Okay.” 

“My friend and I are going to inject you at the same time, one in each arm, okay?” 

“Okay.” 

Quick and easy, no issue, full cooperation. The doctor left, security left, I took off my protective gown, my gloves, I washed my hands, and as I was walking away, John seized his opportunity. He bolted out of his room like a drunken racehorse at the starting gate. The sedatives had started to kick in, and he wobbled his way down the halls, hooked a sharp left and sprinted haphazardly past the elevators. One of the nurse’s aids and I started after him. He wasn’t allowed to leave, and he was potentially spreading Covid with every surface he crashed into. “John,” we shouted, “please stop, come back!” 

But with a determination brewed over days of nicotine withdrawal he continued to rocket down the hallways, past the room in which Robert lay dying, and launched himself into the back stairwell. We were hot on his heels as he plummeted down four flights of stairs and shot out the doorway at the bottom, opening out into the hospital driveway. 

He had reached freedom. The cold March air invigorated him and he pressed forward, towards the main street, while the two of us trailed behind him, shouting his name. Security followed us out the door shortly thereafter and we caught up to him just as he was about to run out onto the road. I held his arm in my ungloved hand and he immediately surrendered to his recapture, allowing himself to be steered back to the main door. 

As we passed through the doors to the hospital, John looked at me, my hands bare, my face uncovered, and with such genuine remorse said, “I’m sorry.”

It took everything in me not to laugh. The whiplash between my two patients had me reeling. This contrast between intense, frenzied chaos and small, tender moments of sadness would continue throughout the rest of this pandemic for me and my coworkers. This was only the beginning, after all. 

After administering a few more sedatives, I tucked John into bed and tried to make it until morning. An hour after my shift ended, before I had even gotten a chance to leave the hospital, John’s test came back negative. He was sent to psychiatry a few hours later. Robert died later that day. He died before his results came back, but he was our official first case. First case and first death, all in one night. 

I went home with my best friend and coworker. We had a few early morning drinks and braced ourselves for the months to come, finding moments of joy and hilarity. Who would’ve expected that at the end of our first year as nurses we would find ourselves in the middle of a global pandemic, watching people gasp for life and chasing patients through the halls. 

Nell Robinson, RN, works at an urban public hospital in Massachusetts. Since March 2020, she has primarily cared for Covid-19 patients.