For reasons she can’t explain, Liz Adams has always been a Red Sox fan. But up until two weeks ago, she’d never been to Boston. Or farther north than West Virginia for that matter. Born in Louisiana and raised in Huntsville, Ala., she didn’t know much about Massachusetts, and the coronavirus felt like a distant fear.
Then she took a job as a traveling nurse at Mass. General Hospital. On her first day in a converted intensive care unit in early April, Adams glanced at intubated patients and asked with doe-eyed innocence if any of them had COVID. They all did.
“You have to understand, I’m from Alabama, where many people are still deciding if this thing is real or fake, so it was a very chilling moment,” she said.
The 35-year-old is one of more than a thousand traveling nurses who saw the contagion take aim at Massachusetts and decided to head into the storm to help in the state’s overburdened COVID units.
Travel nurses are accustomed to being thrown into unfamiliar and unsteady situations. In normal times, the profession entails a string of three-month assignments at the hospitals experiencing surges or staffing shortages. Ski towns, for example, take on surplus emergency department nurses in the winter to help with broken bones and dislocations, while metropolitan hospitals may hire a travel nurse to temporarily fill the spot of a staffer on medical leave.
The rotating assignments afford travel nurses career flexibility, since they choose which jobs to take, as well as the chance to explore new places and hospitals. Operating room nurses are usually in the highest demand because of their niche skill set, but job openings in that specialty have plummeted in recent weeks with the cancellation of elective surgeries, according to several nursing agencies, including Aya and LRC.
Meanwhile, the demand for COVID-qualified health care workers has soared in hot spots. On NurseFly, an online marketplace in the health care staffing industry, opportunities for Massachusetts travel ICU nurses and respiratory therapists increased by 705 percent and 821 percent, respectively, from February to March. Seventy-five percent of those applying to these jobs are female, echoing a report from The New York Times that found that women make up the majority of the labor force on the front lines of the pandemic.
With nearly a decade of experience as a nurse in intensive care and step-down units, Adams was a prime candidate for a COVID position. She had just finished a year-and-half tour as a travel nurse in West Virginia, Tennessee, and Alabama when the pandemic began to take off in the Northeast. She hoped to return home to spend time with her recently widowed mom, who also was recovering from a liver transplant.
Many in her county of Madison, which Donald Trump won by 17 points in the 2016 presidential election, were downplaying the severity of the virus and labeling national media reports about its spread as fake news. But Adams paid close attention to the grim dispatches from Italy and realized how dire the situation could soon become in the United States.
“My dad passed away suddenly last year. I watched the amazing care he got, and I’ve felt so empty since. I saw what was happening, and I realized I could be the person to treat a patient like they treated my father, especially because family cannot be with patients right now,” she said.
Less than 24 hours after submitting her application in mid-March, she had an interview. Two weeks later, she and her Honda CRV embarked on a 1,200-mile journey through nine states via empty roads reminiscent of “The Walking Dead.” She crawled into Boston at last light on April 5.
Adams began work in a fledging COVID unit — one of many regular floors converted in preparation for a surge in cases — four days after her cross-country road trip. The transition hasn’t been without its hiccups. Her staffing agency originally placed her at a hotel in Braintree, but she struggled with the commute.
“I tried driving. Oh my gosh. I don’t understand ya’ll’s roads. I mean those circles, they don’t make any sense,” she said, referencing a rotary. “By the time I got to work, my heart was going 120 beats per minute and I was sweating. So long story short, they moved me.”
Her new colleagues at the hospital tried to explain how right now is probably the most peaceful time to drive in Boston, without the honking and bumper-to-bumper traffic jams.
“It just makes me sick to my stomach to think about,” said Adams of the notion of Boston traffic on a typical day.
Since March 10, the state has issued 1,021 temporary nursing licenses. Mass. General confirmed it has hired some travel nurses, but could not specify exact numbers. Adams said there are at least six on her floor alone, making the unit a bit of a melting pot.
Occasionally, she will run into language barriers with her fellow nurses. She thinks “rock” in a Boston accent sounds a lot like “rack.” She still can’t pronounce Yankaueur — the common name for an oral suctioning tool — in a way that her co-workers can understand.
But when it comes to patient care, they work as a unit. Adams and her fellow registered nurses apply lotion to intubated patients’ feet, shave their faces, and brush their teeth.
“I get chill bumps even saying it. As someone whose father was in their shoes, that’s everything to me," said Adams. "We’re not doing it to put on a show — there is no one there to even impress — we are doing it because it is the right thing to do.”
Before her northward adventure, Adams rarely posted on Facebook. Since starting as Mass. General, she has provided biweekly dispatches to her friends and family back in Huntsville. Some read as awestruck diary entries of a tourist in a new city, but most describe the cruel reality of the virus and the mounting burden placed on workers.
To date, with just 5,654 positive tests, the entire state of Alabama has registered fewer coronavirus cases than Suffolk County alone. Just 197 have died statewide. Adams admits that for many in Alabama, the reports out of New York and Boston differ greatly from their own experience, meaning “you can’t help but wonder if this is all being exaggerated.”
But now she sees daily consequences of a contagion allowed to spread and how quickly and mercilessly the virus can ravage patients. The ICU unit is full of worst-case scenarios and patients teetering on the brink. Those fortunate enough to recover even slightly are moved to step-down units and replaced by more dire cases. Adams’s Facebook posts double as a form of catharsis and a way to give her friends and family a voice they can trust.
“I’ve seen sick. . . . This is different. It hurts me when people say this is just like pneumonia or it’s not that bad. Because no it is not. No the hell it is not,” she said, her voice shaky.
Travel nursing assignments typically last 13 weeks, but the length of COVID positions is contingent on the trajectory of the outbreak. Analysts at Mass. General believe that the crush of very sick patients at its doors is unlikely to get worse, but data still show 100 to 150 state residents dying daily from the virus. Adams, who added two weeks to her contract Monday, plans to return to Huntsville mid-May.
Under a cheery veneer, Adams harbors a gnawing fear. She worries about the novelty of the virus and therefore the uncertainty of her care.
“Two years from now, will we look back on this and think everything we did was wrong? We are doing the best we can and I believe that with my entire heart, but it’s different to know you did everything you could for a patient and they still died. Today, we don’t know,” she said.