When Nightingales Cry

“Meron daw sa 5^th floor.”

It started with the rumors that one of the pay floors was catering to a COVID-positive patient. Hearsays of the virus entering the hospital premises brought chills down our spines. PGH is the National University hospital, after all. It is only a matter of time before we actually receive admissions of such cases. There were verbalizations of early retirement and AWOLs if the service wards were converted to COVID wards. Little did we know that we only have a few months before the reality sinks in.

“Hindi yan aabot sa atin. Paano na lang mga pasyente natin?”

The UP-Philippine General Hospital is a tertiary, multi-disciplinary hospital catering to people from all walks of life. This is what we were taught during our orientation on my first year of being a nurse. Tertiary. It is the last step of the referral system if the provincial hospitals start referring patients to us. Multi-disciplinary. We boast of the country’s greatest names in medical specialties, even subspecialties, as part of our robust healthcare workforce. There were already talks of converting PGH to a COVID hospital but given the spectrum of patients we have to deal with on a daily basis, we were confident that it would not push through. Or if we have to handle COVID cases, at the very most, a ward or two would be allocated. We have never been so wrong.

“Mahirap mamili sa staff ko pero sana maintindihan mo bakit ikaw ang pinili ko.”

It was a Friday afternoon. I was almost done with an exhausting eight-hour shift, and I was preparing my Kardex for endorsements when our chief nurse called for an emergency meeting. One of the wards would be converted into a COVID Unit and every Chief Nurse had to turn in one nurse to assemble the Unit’s staffing personnel.

“Bawal ang may-edad. Bawal ang may sakit, lalo na sa baga.” I wasn’t that old, I’m actually one of the younger members of our staff but I have asthma so I never thought I would be inside the head nurse’s office, being told that I would be our chief nurse’s ‘alay’ to the COVID Unit. At first, the shock did not hit me. Only when I started erasing and re-writing notes in my Kardex did I feel something wasn’t right. Suddenly it hit me: the idea of being in direct contact, albeit in complete personal protective equipment (PPE), with COVID patients is becoming more unquestionable. More substantiated. More real.

“I know you feel fear. Anger. Anxiety. These are ALL valid feelings.”

The succeeding week was a blur. All the nurses sent by the chief nurses underwent an orientation on the COVID Unit – the Unit’s physical set-up, demonstration on donning and doffing of PPEs, and a debriefing to process our emotions. Many were afraid and anxious of their predicament. Some were angry of being chosen. While a few were actually excited – a pinpoint of light in this darkness enveloping our dear Pagamutang Bayan.

Back in the wards, patients who were deemed fit to be discharged were sent home, may they be pre-op or post-op. Elective admissions were stopped. These measures led to a drop in the hospital’s patient count. For a brief period, the halls were devoid of the usual crowd of patients, bantays, and medical personnel. It felt tranquil, but we all knew it was far from over. It was nothing but a lull before the storm.

“Endorsing 10 patients. 9 PUIs, 1 one of which is intubated. And 1 COVID-positive.”

Since the Spine Unit was still undergoing renovation to become a COVID Unit, we were assigned to complement the staff of the units already managing COVID patients that time – Ward 14A and 5RCB2. On my first day (or night since I was working nights then) as a COVID nurse, I was assigned to the pay floor to Mr. C, the very first COVID-positive patient of the hospital. Despite listening to the news and reading the latest updates on the disease, nothing prepares you in facing a patient positive with the virus. Since we were advised to minimize exposure, I decided to enter the room only once for my shift and do everything in one patient interaction – getting the vital signs, administering the medications, checking up on the patient, giving patient education, among others.

As the clock struck five in the morning, I donned my PPE making sure that no part of my body would be exposed. I prepared my medications, ran through my To-Do list in my mind, and uttered a quick prayer. With a deep breath, I knocked on the door, announced my arrival, and entered the room. Mr. C was sound asleep so I placed my stuff on the table and as I tried to remember my To-Do list, my brain just went…blank. Maybe it was the fear drowning my logic or the hypoxia as I tried to hyperventilate while wearing an N-95 mask, but I tried my best to snap out of that blackout. “Deep breaths, Paulo” I told myself and my mind started clearing up.

I approached Mr. C and woke him up to take his vitals, quickly assessing him, checking-up on his status, giving his medications, and instructing him to always wear a mask and to ring us a bell if he needed anything. In less than 10 minutes, the brief patient interaction was over but it sure left a lasting impression on me as I tremblingly doffed my PPE, praying to the highest of heavens that I religiously followed each step. Mr. C used to be just a statistic in the hospital’s daily COVID census for me. Until that very moment.

“Sinulit mo naman ang relieve mo sa amin, sir.”

The following night, I was pulled-out to relieve in the emergency department, which acted as a holding area for Persons Under Investigation (PUIs) awaiting disposition. Being relieved to the ER on a regular, pre-pandemic day was stressful enough, let alone to an ER catering to PUIs. Given the high acuity of the patients in the area, we were advised to wear the PPE for the entire shift so we can monitor the patients at the bedside, while a counterpart documentation nurse will carry out the orders at the station.

This meant eight-plus hours of shallow breaths beneath an N95 mask, limited foggy visual field, zero input and zero output, (not so) insensible losses via excessive sweat under all the PPE, and mumbled prayers of staying strong and keeping it together. On top of all these was the fact that we had to attend to a code twice that night. Sadly, the patient passed away and I still had to attend to several other patients under my care.

It was during the post-mortem care that I felt the tears running down my cheeks. I was startled by the unexpectedness of it all. I have always kept myself strong: distant from the emotions, but close enough for the bereaved. This time, there were no relatives to console. This time, I felt the emotions closing in and I am but human. In that moment, I just let the tears flow.

“Magbubukas na ang COVID Wards soon.”

Changes were rapidly happening around the hospital as we became one of the region’s COVID-referral hospitals. More clinical areas were being converted to accept COVID-positive patients. For the meantime, the Spine Unit was fully-operational and had the ideal set-up to manage both PUIs and COVID-positive patients but it can only accommodate a limited number of patients. Since cases started to increase exponentially, we had no choice but to open additional areas to admit more COVID patients – including my home unit, Surgery Ward.

Aside from physical set-ups, changes in the staff schedule were also implemented. Seven straight days of work followed by a two-week quarantine period. Sounds like a good deal, but working for seven straight nights took its toll on me. Despite having a relatively small patient load at that time, several factors were at play: the fatigue of working while wearing full PPEs; the anxiety whenever doing bedside activities; and the emotional burden of seeing patients who do not have watchers by their side. All of these plus the inherent exhaustion of working against the body clock, that most healthcare professionals are very much familiar with. I was practically grinning while I was doffing on my seventh day of duty, looking forward to two weeks of quarantine. A time to look back at the week that had been, and a time to rest and recuperate for the week ahead.

“Toy. Salamat sa pag-alaga mo sa amin ha. ”

We are more than a month since being declared as a COVID-referral hospital. Our capacity has already reached its limit. Even our very own healthcare workers have become part of the growing statistics of the disease. But since when did PGH ever back down to a challenge? Even before this pandemic, we have creatively found solutions to an overcrowded emergency room with an incomplete staff. A sixty-plus full house census managed by three nurses? Not a problem. We are just going through a rough patch, that’s all. But I do hope once all the dust has settled, we would find systemic ways to prevent these ‘rough patches’ from happening again.

Fred Rogers once said, “When I was a boy and I would see scary things in the news, my mother would say to me, ‘Look for the helpers. You will always find people who are helping.’” We might be People Giving Hope to our patients, but we are also in need of these ‘helpers’. To all the individuals and institutions who never wavered their support to PGH, who moved heaven and earth to provide donations in cash and in kind, and who lent their services, we thank you. You have made living in these bleak times a little bit easier. And a little more worthwhile.

Finally, to my fellow healthcare workers who are called to serve our countrymen who fell ill to the disease, this is the daunting reality we have to face but never give up hope. We may be in the middle of a grueling war against the virus but everything has an end to it. Let us all focus our energy in helping the patients recover from this awful situation. An illness that plunges the patient into complete literal isolation. A disease that robs the opportunity of the family to hear the patient’s last words. Let us be reminded that we are treating patients, not the virus. That these patients are not mere numbers. They are a mother. A brother. A friend. And we treat them with utmost care and compassion, more than ever.