This morning I was working out in our basement, which gives me ample time to contemplate the accumulated rubbish of our year here. There’s the broken microwave, a barstool that doesn’t fit anywhere, and my old sturdy UCSF faceshield. Also a pair of thick plastic goggles that, when I wore them way back at the start of Covid, made me sort of feel like I was snorkeling in Hawaii. Without the warm water or tropical fish of course, and yet with a chance of drowning.
The sturdy faceshield made me think back on the early days of Covid, and I realized that the pandemic is now old enough for me to have a kind of nostalgia for the beginnings of it; a sort of warped yearning for the weirdness of the early days, the sharp awfulness, the quiet. I remembered putting that faceshield on in the windy parking lot of a California nursing home back when I got dressed in my PPE according to the instructions on a flimsy sheet of paper. The parking lot was cold. The wind kept threatening to whip my instructions away. My plastic bag blew down from where I had secured it, ready to hold my dirty PPE when I was done.
This was back when PPE was being rationed out weekly in ziplocks. Back when Covid was tearing through the nursing homes and the deaths went unrecorded as Covid deaths, but we all knew. Back when I would come out from a visit and take off my gear slowly, carefully, according to the instructions on that flimsy sheet, and tie it all up in a plastic bag and walk it around to the trash bins in back of the nursing home and get in my car and carefully sanitize my hands and then tear out those little saniwipes and wipe down my keys, my phone, my steering wheel, the gearstick. Mostly I was thinking how crazy this all was and how could I possibly get sick with all the precautions I was taking. Sometimes I was crying from fear.
And here we are today: Covid was kind of over for a minute, but not really. Restrictions were lifted, but they’re back. Numbers were down, numbers were vastly underreported, numbers are flying up, numbers are inflated. Covid’s over, Covid’s here to stay. Option e: All of the above.
So how does a hospice nurse respond to the current moment? We follow the protocols that are handed down to us. They change every few weeks. I have three documents, decision trees about what to wear to a visit, depending on whether a patient is vaccinated, whether their family is vaccinated, whether they have been in the hospital, out of state, had visitors from out of state, if so which state. It’s dizzying to just write about. My trunk is full of different kinds of masks.
When someone is suspected of having Covid, or of having been exposed, they become what is called a PUI - a Person Under Investigation. So CIA! I personally think the term was invented by an FBI agent-wannabe. Then there are UVPs: unvaccinated persons. They don’t necessarily have symptoms or exposure, but we have to wear a special kind of mask for them anyway. Nothing says get the goddam vaccine like our special kind of mask.
And yet hospice goes on being hospice. People go on dying in the ways that they always have, and some new ways: because whatever you can say about death, you cannot say that it is predictable.
Last night before I went to bed I checked my work phone. I do this when a patient is close to death. With some of them, I cannot help myself, I check my phone before bed, when I wake in the night, and first thing in the morning. Last night I learned that my patient, a 45 year old mother of two, had died just after 8pm. There was a flurry of texts among her day team and the night staff. The death was excruciating, fast, brutal and chaotic. When I visited yesterday morning, her family did not even want to admit that she was dying, yet I could see that she only had hours to live.
She was from a different country, the family spoke another language, and they had very different rituals around death. It was a crash course for me in their culture, about which I knew little. To communicate with them, I had to use the language line on my phone. I spoke in English to a translator, they spoke to the family, the family answered, the translator told me what they said. Any conversation so parsed would be tedious. I stood in their kitchen, it was my second time in their house. My side of the conversation went something like this:
Please tell them she is very close to the end of her life.
Please tell them I am so very sorry.
Please tell them that giving her food now will cause her more distress.
Her body cannot tolerate food any more. Her body cannot tolerate fluids.
Please tell them I know this is terribly hard to hear.
The translator made my words into unintelligible sounds. The family listened, wide-eyed. They cried. They had many questions but really they were all the one question: what can we do now?
Please tell them that the best thing they can do for her is sit by her bed, touch her, tell her that they love her.
They did this. I gave her some pain medicine, and I left them there by her bedside. Outside her house I sat in my car for five minutes to gather myself and then I drove to my next patient. In the old days I might have taken a half hour to recover from this visit. But my caseload is so high, there is no time between patients for anything but trying to stay caught up with the mountainous workload.
The night nurse said that when the patient died, her mother threw herself on her body and cried hysterically. I tried to imagine lying across the body of my daughter.
Hospice goes on being hospice in the time of Covid. Mostly, people keep dying of the things they have always died of: cancer, heart disease, poor choices. Despite the virulence of the Delta variant, being vaccinated made a huge difference to the fear factor of my job. Boosters are on the horizon. And with vaccination rates slowly climbing, I’m wearing fewer and fewer paper gowns.
Nineteen months in though, burnout among healthcare workers is increasing. Nurses are quitting the field. I love my work, and I am clear I don’t want to do anything else. But I’m about to have nine days off, my longest vacation in two years, and I’m going to clear the trunk of my car of all traces of PPE. It can go in the basement with my sturdy plastic faceshield and the spiderwebs. And my work phone. I might put that down there too. Right after I change the outgoing message to I’ll be out of the office until September 27th and I won’t be checking voicemails…
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