Coronavirus Diaries is a series of dispatches exploring how the coronavirus is affecting people’s lives. This as-told-to essay is based on a conversation with Brannon Marshall, an acute care nurse practitioner. It has been transcribed, condensed, and edited for clarity by Shannon Palus.
I was a critical care nurse practitioner in Baltimore, and I moved back to Alabama to be closer to family. I got back in November of 2019, and I had started looking at a hospital here in Birmingham, a big university hospital. I was set to interview with them.
My mom came down with a respiratory illness very much like COVID, it could have been flu, in January of 2020. She ended up in the ICU, and so I stayed with her pretty much every day, since I was an ICU nurse practitioner. I was like, “I’m not leaving.” She ended up passing away about a week later.
I had them push the job interview back. I had just come from sitting in the ICU for seven days pretty much every hour, mom passing away, and then I go and I interview at this medical ICU.
I get the job. I start working. It ends up being the main place in Alabama where everybody sends their COVID patients. So we had a 100 percent COVID unit in the ICU.
Normally, pre-2020, you would go in at 5 or 6 in the morning. You go over charts; you put in orders for the day on all of your patients. You look over all their charts, see what happened overnight, what you need to address during the day, kind of make your plan for the day. You round with the doctors, and the doctors will give you input.
Throughout the day, you’re sometimes doing procedures, or sometimes other stuff will happen, an emergency. You’re maybe going to a code and maybe something else comes up—a blood pressure drops. You’re managing your patients. Sometimes just putting out fires all day. You have to be very flexible, and you have to handle stress. I mean, you could be busy working on one patient and have another patient’s heart stop beating next door and you have to address that and still make sure you get everything else done.
So normally being an ICU nurse practitioner or nurse involves a decent level of stress. Baseline, that’s kind of where it’s at. You have to love that. Most people who are in that kind of want that adrenaline.
There’s a question often asked in job interviews: Would you rather have a great team, or would you rather feel like you were challenged every day? And I’m like, “Hard question. I’d really have both. But if it all comes down to it, I would really like to be challenged in my job.”
So early on in the interview for this medical ICU position in Birmingham, they said, “We’re starting to get COVID patients. Are you going to be OK with that?” And I was like, “Yeah.” It was still early on. This was April of 2020. I don’t think we realized it was gonna be 100 percent COVID. That there wouldn’t be a break from COVID, that you can’t go to a different patient population. You couldn’t have, like, a bleed or something else and take your mind off COVID for a little while.
But pretty early on in the new job, I was like, “Whoa, this is gonna be rough.”
Our ICU was at the large university hospital where COVID patients in Alabama and some people from the Southeast, as far as Mississippi, would come. By the time a patient got to us, they’re pretty, pretty sick. We would be giving 110 percent, and nobody was making it out of ICU. There’s just this thing with COVID; there’s not many wins. People were just walking into the building with this negative attitude in the back of the head, like, “We’re gonna give 110 percent, and we don’t know how many patients we’re gonna lose today.”
There weren’t many wins. I could work two weeks, and we would have maybe one or two patients get out of ICU. More than likely, we would have lost five or 10 patients during that time. You’ve got to call the families, and you have to psych yourself up to somehow. I was always a more in-person person—over the phone, it’s hard to get across how much you care about these patients. We had nurses break down. We always had people cry, like NPs and nurses. Sometimes families would kind of lash out and just say, “You’re not caring for them. What if this was your mom or your dad?”
It was just so hard. There was a day where we lost three patients in one day. Probably 10 percent of the time you were given good news and the good news was just we haven’t had a step back. But usually it was pretty bad news.
Nobody from other specialties wanted to come into a COVID unit. You’d have people crying in the morning, “I need cardiology and neurology.” And they’d be like, “Is that patient positive? We can’t see him. Do this.” It was like you were out there on an island all by yourself. One of the most amazing things I saw—we had a patient dying, had the family come up. They had to be careful; they had to make sure they were negative. And we called the chaplain up. And the chaplain comes up, and he’s like, “Oh, is this patient COVID positive?” And we’re like, “Yeah.” And he’s like, “I can’t go in there.” And three of the NPs just broke down. It was unreal.
And with me, going about my days, there was a little bit of PTSD. Sometimes I would be at a bedside and see a ventilator, and flashback to my mom. It’s like daydreaming, I would say. A very short, short daydream. For a second, I would put myself back in that situation at the bedside, holding my mom’s arm or looking at a monitor or ventilators or medications. This daydream, which is pretty much a day nightmare, where I’m just putting myself back in the situation of me being with my mom.
But again, I like the challenge. Maybe this is just a challenge, I thought. I’ll keep working on it. I’ll get through.
Every once in a while administrators will throw out, “Oh, you should do self-care.” And send a newsletter to the hospital about self-care. But at the end of the day, are they really actively trying to do something to keep people making sure they’re taking care of themselves and they’re doing well mentally and emotionally?
When I got around to looking for a psychiatrist, the middle of 2020, the system was just full. They’re like, “We can’t see any more patients. Everybody’s double-booked already.” I was almost probably a year out from my mom’s funeral before I actually got to start seeing a psychiatrist. The psychiatric system was so overwhelmed that nobody could get into it. And then it was another couple of months, two or three months, before I actually got to see a therapist.
I stuck with working in the COVID ICU for eight months. My leaders were like, “Brannon, this is not good. We’ve got to do something else.” They were nice. They were like, “We really love working with you. But we can tell this is rough and not helping anybody, you or the patients, with where you’re at with the depression and everything. You’re not doing well.” In that meeting with the administrators, I was asked to resign from the ICU position that I held.
I was a little disappointed, but at the same time, I can’t be because I probably wouldn’t have managed it any better from the other side. But I feel like they were missing a lot of the psychological side for everybody. You should probably have some kind of team meeting at the end of the day say what went well and what went wrong. Or have a therapist come in and have a group meeting with everybody at the end of the day. It was that rough.
It was kind of weird. As I was leaving, I was apologizing to people because they were already short-staffed, right? Everybody’s under stress. I was apologizing for not being able to step up and help out with everybody and take some of the load off. A handful of people literally looked me in the face and were like, “I think you’re getting out the easy way.” Or some kind of phrase like that. Like, “We wish we could go with you.” It was kind of an odd thing. People just so stressed out that they were saying, “I wish we could be with you unemployed.”
There’s stress to be an unemployed person and going to a therapist and finally getting back to looking for other health care jobs. But at the same time, my girlfriend and other people that know me are like, “Brannon, we have never seen you this happy.” I was just so miserable. I feel like the best-case scenario would be getting a job somewhere in research where I can still help people, but more on the science side of it.
I’ve always been into the stock market. Now, I make up some of my income trading stocks on a daily basis. But a large part of the stuff I do is going to therapists and talking about how to get back into the field. My biggest therapy is dogs and plants at home. I’m a flower person. Some of my day is taken up with playing with dogs and taking care of my plants.
I still want to help people; I just don’t feel like I can do it as well at the bedside. But I need to pick all my caring powers and put them somewhere else where they can be useful.