Acker (left): I’ve never worn so much PPE in my life.
Yale New Haven Hospital nurse Courtney Acker is used to seeing blood and the aftermath of serious accidents. What scares her more these days is the silence in Covid-positive patients’ rooms.
Until the Covid-19 pandemic hit, Courtney Acker cared for patients who had just gotten out of a surgery or survived a traumatic event like a car crash.
The pandemic has thrown her surgical intensive care unit (ICU) on the sixth floor of YNHH into a new role. All of the surgical patients have been relocated. The beds are now reserved for patients severely ill with Covid-19.
“This is new territory for us. We don’t know much about Covid, and we are trying to take care of these very sick patients. It’s kind of a learning curve,” Acker said.
Last week, Acker faced a new kind of challenge. Her name was up on Monday to “float” to a different unit, meaning she would spend one shift on a different floor with different coworkers. Her assignment for the night was the medical ICU, the ground zero of Covid care.
“I’ve never worked on that unit, and I didn’t know where anything was. It’s a little overwhelming. You don’t know how your night is going to go,” she said.
An Afternoon To Prepare
Acker takes care of her horse, Nate, on her days off and when she needs to calm down before work.
Acker works the night shift at the Yale New Haven Hospital with her fiancé Argenis Rodriguez. She sleeps during the day.
On Monday of last week, Acker woke up in the afternoon with the sense that she would be assigned to the Covid-19 patients in the medical ICU. She knew that everyone else in her unit had done their floats that month and that it was her turn. She also knew that the medical ICU was a possible location because Rodriguez had just done his float there.
Acker was nervous about what might happen that evening. She reminded herself that there is always someone available in other units to answer her questions.
When Acker gets nervous about work, she goes to her horse, Nate. He lives in Durham, 15 minutes away from where she lives in Wallingford. As far as she could remember, she took care of him that Monday afternoon too.
“Nate is the sweetest. He loves people. I say he’s like a dog but much bigger. If he could, he would sleep in your lap,” Acker said.
Acker said that she usually brushes Nate down, cleans his stall and makes sure he gets some exercise. She spends roughly an hour with him before she heads back home to pack her lunch and get ready for work.
A Quiet Shift
Contributed Photos
Registered nurse Courtney Acker on the job.
Acker got into work that Monday around 6:30 p.m. She saw on the board that she was correct; her assignment was at the medical ICU.
She was scheduled to take care of one Covid-positive patient who was having such trouble breathing that the hospital had paralyzed and sedated him. With no energy going to any other body part, his lungs could focus on doing their work, Acker explained.
“I was lucky. I only had one patient. I could have had two at a time,” she said.
If the patient got any sicker, Acker would need to prone him — flip him onto his stomach so his lungs could expand more easily. She had learned how to do this procedure during the pandemic after practicing a few times with a dummy.
“I’ve never seen that in my life before. It’s a little frightening that they’re so sick that you have to do this to them,” she said.
The procedure works most of the time and the patient’s progress is visible on the screens that show their oxygen levels and other key indicators, Acker said.
Acker gathered her personal protective equipment (PPE) from the unit she was visiting. She put it all on — gown, N95 mask, face shield, gloves and shoe covers — right when she entered the patient’s room for the first time at 8 p.m.
“When you go into a Covid room, it’s kind of intimidating. You’re the only one in there. It’s a negative-pressure room, so you have to shut the door. If the door was open, you could talk to the nurses outside. You kind of feel like, ‘How am I going to get help?’” Acker said.
“I’ve gotten used to it, but it’s still weird to have it be that quiet.”
Acker got started on her nursing assessment first, she said. She looked at the indicators on his monitor, listened to his heart and lungs and took his temperature. She checked how much urine and stool he had produced and how much IV fluid was left in the room.
The procedure with Covid patients is to handle all of the necessary tasks in short bursts, to minimize the nurse’s exposure and decrease the amount of PPE used every night, Acker said. If she needs to bathe a patient or give them medications, she does it at the same time as her assessment.
Acker degowns and takes her gloves off in the patient’s room, she said. Then she washes her hands, put on new gloves and washes her face shield with cleaning wipes. The face shield goes into a bag. She takes off her gloves, puts on new gloves and does the same routine to take off her N95 mask.
After doing all of the steps required to preserve PPE, she settles down to wait for around two hours. During that time, she enters all of the information she gleaned from the patient into a computer set up outside the ICU room. She also uses the time to gather any other materials she might need for her next visit. She said that she has a window into the room, so she can watch the patient during the wait.
In The Place Of Family
Acker and fiancé Argenis Rodriguez when they announced their engagement.
The patient’s family called the medical ICU around 10 p.m, Acker said. She talked to the patient’s niece, who then translated Acker’s words into Spanish for the benefit of the rest of her family.
Acker told the niece that her uncle was doing fairly well. He did not need to be flipped onto his stomach after all and he was showing some progress in other areas.
Acker said that talking to the families of Covid-positive patients makes her emotional, because the families are barred from visiting their loved ones themselves.
“These patients don’t have family members holding their hands. We’re taking the place of a family member right now. If my family wasn’t there, it would destroy me,” Acker said.
“It’s hard on us as nurses to do this, and it’s worth it to hear family members thank us for what we are doing for their father or brother.”
So Acker makes sure to do the little things to make sure the patients feel cared for. She said that she holds their hands and talks to them, even when they are sedated and cannot hear her.
“Sometimes I tell the sedated patients, ‘So-and-so called you on the phone. They asked about you.’ It makes me feel better,” she said.
Acker said that she usually takes her lunch break around midnight. The hardest tasks are done by then and there is a lull in work. That night, she asked another nurse in the medical ICU to watch her patient while she ate lunch with her coworkers on the sixth floor. In return, she watched his patient when he wanted to buy a soda.
She clocked out at around 7 a.m. on Tuesday. She drove home with her fiancé, in silence.
“I relive the night in my head: Did I do this well enough? Did I do enough for this patient? Could I have done something better?” she said.
By the time she got home and showered, it was around 8:30 a.m and time to sleep.
“Overall, it was a pretty decent night. I got the float out of the way. I’m grateful that I got my work done and it wasn’t that nerve-wracking,” she said.
Previous Pandemic Diaries:
Tom Patterson's sections of the book, The Perfect Predator, give one an idea of what people in medically induced comas are thinking. Tom had some wicked hallucinations, but was generally aware of everything around him while in a coma for months. Before trying an experimental therapy, his wife told him to squeeze her hand if he wanted to live. At the time, he was hallucinating that he was a snake, possibly because of the ventilator tube, and it took him a while to figure out how to wrap himself around her hand and squeeze it, but he did.