Bianca Dintino, 26, is a nurse in Tufts Medical Center’s coronavirus intensive care unit. Below, she describes what happened on her April 1 shift, as told to Globe reporter Naomi Martin.
The patient is unconscious — has been for two weeks — but I always talk to him when I’m in his room. Who knows, maybe he can hear me.
“Hi, I’m Bianca, I’m going to be your nurse today,” I say through my airtight plastic face shield, in a strangely loud voice. We have to yell slightly when we’re in our protective gear. Motors on our backs blow cold filtered air by our ears, making it safe for us to breathe — but difficult to hear.
I’m one of the nurses assigned to a 15-bed coronavirus intensive care unit at Tufts Medical Center. We each are focused largely on one or two patients at a time, but we know the surge of Boston’s outbreak is coming, and that could change.
I hope my current patient, a man in his 50s, recovers. He’s on a ventilator, in that limbo situation where you don’t know what the outcome’s going to be. Like many COVID patients, he has needed a lot of sedation to stay knocked out so he can lie on his stomach for 16 hours a day, allowing the ventilator to pump oxygen into the back of his lungs while his body fights the virus.
We don’t yet know what recovery looks like. Some of the medications we’ve had to give him may have affected his liver and kidneys. And being sedated for so long can affect nerves and muscles. Our focus now is on keeping him alive and getting his lungs healed.
I try to tell him something nice from his family every day. Before the coronavirus struck, back when families would sit nearby and talk to their loved ones who were unconscious in the ICU, we would sometimes see a calming effect — maybe the patient’s heart rate would fall. This patient doesn’t react in any way that I can see, but I still hold out hope he hears.
“I just talked to your wife on the phone, and she says she loves you and stay strong,” I say.
I never got to meet him before he was sedated. It’s sad knowing that there’s a family out there who loves this man and can’t be here. The hospital, like many others, has had to largely bar visitors to keep people safe. We barely have enough protective equipment for ourselves — we would burn through it real fast if visitors needed it, too. But it’s awful watching people die alone. Some nurses sit with their patients during their final hours. One of my colleagues rubbed her patient’s head for five hours the other day as he passed.
Treating COVID patients is unlike anything I’ve ever done.
Early on, before the outbreak exploded in Boston, my boss asked if I’d be willing to work in a COVID ICU. I immediately said yes. I’m 26 and healthy. I’d rather me go than someone else, someone who has kids, or medical issues, or who’s older and more at risk of deadly complications. Later, the hospital assigned my entire former unit to the COVID ICU because we were experienced dealing with pulmonary disease.
I figure I’ll probably get sick, but I’m trying my best not to. I’m terrified. I see every day what this disease can do to the lungs.
The patients started really coming in around March 26. They say the surge is still a few weeks away. Now, we have 40 or so patients in the hospital with the virus, but we are prepared for nearly all 400 beds to be filled by COVID patients in the next few weeks. We have cleared other ICUs — pediatric, cardiac, and surgical — to make space for more critical COVID patients.
I’m definitely nervous and anxious to see what will happen. I’m grateful for my amazing team. We try to look out for each other, make sure we’re protecting ourselves from getting sick the best we can. The operating-room nurses gave us tips to keep our hair protected from the virus by wearing a bouffant, sort of a giant bonnet hair-net thing.
The COVID patients are sedated for the most part to keep them comfortable. Some of them, we have to paralyze with medication to flip them onto their belly to help them breathe better because it helps open up their lungs. They have to stay that way for 16 hours, then they’re on their back for eight hours.
That’s the scariest part of my job — when we have to flip the patients over. So many things could go wrong. We have to make sure the IV lines giving them medication don’t get tangled or ripped out. If the breathing tube from the ventilator falls from their throat, they could die. It takes a few of us to roll them over. We yell to each other about the plan first, and then keeping yelling to each other throughout the process.
Many of our patients could go either way — survive or die. They get sick very fast. And then they take a very long time to fight the virus.
So far, we haven’t seen any of our COVID patients recover. Some have died. Nearly all the deceased had underlying medical conditions.
My patient is becoming more stable than last week, but he’s still riding a very fine line.
We check every day for signs of progress. We do a chest X-ray to see whether the level of inflammation and fluid in his lungs has improved. We lower the ventilator settings to see if his lungs can take over the extra breathing work. We test how well his lungs diffuse oxygen by taking a blood sample and running it through an analysis machine.
Today was a good day. My team that does rounds together — an attending physician, some residents, me, and a respiratory therapist — compared the patient’s latest X-ray with one from six days ago. It was phenomenally better. The lungs looked clearer, less filled with liquid, damage, or inflammation.
We smiled. We clapped.
“Good job everyone,” the attending doctor told us. “You’re doing a really great job.”
This was our first case of actually seeing things get better.
Those X-rays gave me hope, knowing that some good has already happened. I just hope that progress continues.
Naomi Martin can be reached at firstname.lastname@example.org.