2nd Wave Hits Harder

Well into the second wave of the pandemic, the moment finally arrived: Courtney Acker saw a patient die of coronavirus on her watch.

It happened during a grueling night shift in December, in the midst of a second Covid-19 wave that Acker, a Yale New Haven Hospital nurse, has been finding more exhausting than the last.

“If there’s a third wave,” Acker said, ​“I don’t think people in hospitals will be able to deal with it again. It’s so overwhelming on us and stressful.”

Acker works three, 12-hour night shifts a week, on an alternating Monday-Friday-Saturday, Sunday-Tuesday-Wednesday schedule that feels like one long, six-day week.

She technically works for the surgical intensive care unit (ICU). She ​“floats” to the Covid-focused ICUs every few weeks to help out.

This rotation was less frequent during the first wave of the pandemic, but the hospital has brought in fewer outside nurses this time to travel between units. The hospital has also not closed down elective surgeries, so the workload is higher in general as well, Acker said.

On this Saturday in early December, Acker knew that she was floating to the Covid-19 unit. She clocked in around 6:45 p.m. and learned that she was assigned to two rooms. A woman in her late 70s was dying in one of the rooms. An man in his late 60s was in a months-long recovery process in the other.

With how sick the female patient was, one nurse should have been assigned to her room alone, Acker said. YNHH doesn’t have enough staff for that right now, so Acker had to prioritize her time based on the severity of illness of her two very sick patients.

“It’s hard that we have to spend more time with one patient than the other. It’s very tough from a moral standpoint,” Acker said.

Acker learned about her patients’ conditions from the nurse who had watched over them during the day. She also found out that the family of the dying woman had been unhappy with her care and started lawsuits against the hospital. Her sense was that they were not ready to see their family member go and had just signed off on a do-not-resuscitate order that day for if her heart stopped.

That made Acker nervous. What if the patient were to die on her watch?

She went into her female patient’s room. None of the signs looked good. The patient was nonverbal and was not opening her eyes. Her arms and legs would not straighten out because her body was so stiff. She was already on two different medication drips to help her blood pressure. She was on a ventilator with the highest level of oxygen available.

Acker always talks to her patients, even when it doesn’t seem like they can hear her. She explains every step of what she is doing, just in case they are scared and wondering why she is rolling them onto their side.

She added a third medication to help her patient’s blood pressure. She called the respiratory therapist to tell them that oxygen levels were dropping despite the ventilator’s highest setting. She added an intravenous (IV) drip to help with her patient’s sugar levels and gave her a pain medication, in case her high heart rate was hurting her.

After Acker had gone through the list of potential interventions, she worked on other ways of making her patient more comfortable. She gave her a bath. She changed her sheets. She saw blood around her patient’s mouth and trachea, where a tube was helping her patient breathe, so she cleaned her face.

Her patient looked like she had stabilized some around 11 p.m, Acker degowned and prepared her set of personal protective equipment (PPE) to enter her second patient’s room.

The nurse in charge of the unit had already handled the elderly man’s medications, so Acker just focused on giving him a bath and preparing him for bed. After an hour with him, she went back to her dying patient.

“Everybody’s been really great. Everybody knows it’s stressful, so nurses try to help each other out. It’s the only way we can survive and make sure we take care of all of these patients equally,” Acker said.

Around 1:30 a.m, Acker was working on the computer outside her patient’s room and starting to eat a few bites of lunch when she heard the central monitor for all the patients go off. Her patient’s heart rate had hit zero and stayed there.

The hospital called the woman’s daughter to tell her that her mother had died. Within 45 minutes, Acker was escorting the daughter and a man, possibly the daughter’s husband, into the room. The daughter burst into tears. It was their first visit, because the hospital is not allowing visitors unless a patient has died.

Seeing families cry for their loved ones never gets easier, Acker said.

“It’s hard to find the words to say to people. I said that I’m sorry and got them a chair to sit down on. I told them, ​‘Spend as much time as you want. I’ll be right out here,’ and gave them some privacy,” Acker said.

Despite Acker’s earlier fears, the daughter did not blame her for her mother’s death. When the family left, Acker had to take care of the after-death logistics, calling the organ bank and placing her former patient in a bag to go to the morgue.

Around that time, her second patient woke up. He had gotten Covid-19 months before and was having difficulty getting off the ventilator. He wanted her to hold his hand as he drifted in and out of sleep. She brought her computer in and worked on it for an hour and a half until he calmed down and settled into sleep.

Acker was grateful that she had the time to just sit with him.

“It was nice that I had time to do that — reassure him and comfort him while he was by himself in the hospital. It was nice to do that when we’re not able to do that a lot of the time,” Acker said.

Acker’s fiancé Argenis Rodriguez (pictured with Acker above) works in the hospital too. He had visited her twice while she watched over her dying patient and she texted him when her patient died. When her shift went an hour over, he waited for her so they could drive home together.

Sometimes Acker takes care of her horse, Nate, to calm her work nerves. After shifts though, she just wants to shower and fall asleep. The sleep helps her emotions settle and makes her feel better.

She said that Sunday, she really did not want to go back to work in the evening. She was still drained.

And it looks like the second wave may last months more.

Acker got the first dose of the Covid-19 vaccine at the end of December. Her arm was sore but her hopes were a little higher.

“We have to stop this somehow,” she said. ​“There has to be way that we can at least calm down the spread so it’s tolerable.”

Previous Pandemic Diaries:

• Firefighter Fights 2 Months Of Covid
• After ICU Shift, Coming Home To Family
• Ramadan Offers Pause During Pandemic
• Nursing Home Hell
• ICU Nurse Pivots To ​“New Territory”
• Covid Claims ​“Big E”
• Ray Of Hope Slips Through ICU Glass Doors
• The View From Inside The ER
• Doc Glimpses Coming Covid-19 ​“Storm”
• Day 20: I’m A Fighter, Not A Quitter
• Cops Roll With ​“Change Of Conditions”
• The Distance Between Us Diminishes
• Seniors Stuck In Stop & Shop Jam
• Burial In The Age Of Covid-19
• My Shades Of Gray World Is Suddenly Black And White
• Covid School, Day 1: Zzzzzz….