I’m a cardiovascular intensive care nurse. I’ve provided care by touching hearts for years. To me, the center of life is a heartbeat. However, life begins with a single breath….
After working in a cardiovascular intensive care unit for a long time, I was like a fish out of water when the pandemic hit. Pandemic…. It’s a word that I’ve only heard about in classes and have never witnessed before. I found myself in the middle of the COVID-19 pandemic, which broke out because of a bat. Screams, fears, and deaths overflowing from hospitals to the streets…
It was just the right time to glorify my profession… It was like the light from Nightingale’s lamp turned into a great torch, predicting that nurses would come forward in 2020. If it’s a war, then we’ve become the fires, the trenches, and the shields. Sometimes, we were shot, and sometimes, we were killed…
We quickly adapted to the situation as a necessity of the age. We were used to living with COVID-19. Life was slowly returning to normal. We started the operations that we’d postponed due to the pandemic. During this period, we had more patients than we’d ever had before. We had one question in mind, “Is it the COVID-19 that’s triggering cardiac problems or vice versa? Researchers were discussing the relationship between COVID-19 and cardiac diseases. Morbidity and mortality were increasing with comorbidities and new symptoms.
And the moment has come… We had our first COVID-19 patient for mitral valve surgery. When I saw the patient in the intensive care unit for the first time, I realized that I knew her from somewhere. I checked her file and saw that she had a left lobectomy operation two months ago, and I remembered that it was one of my patients. She was a 31-year-old woman married with 11 children…She had ectopic Cushing’s syndrome, which was something rare. She had a moon face, buffalo hump, and purple striae on the neck and the whole body… Unstable blood glucose level, hypertension…She was discharged after a lobectomy. Then she was admitted to the hospital because of fever, cough, and confusion. They ran some tests and diagnosed her with infective endocarditis. During treatment, vegetations were detected on her mitral and aortic valves. She had a common coagulation disorder. The council decided to perform splenectomy and MVR surgeries. Her PCR test came back positive. She tested negative after she got treated for COVID-19. But she tested positive again during the surgery. She was treated according to the standard cardiovascular surgery intensive care (CVSIC) procedure and isolation methods.
I had my scrub on me, and I had my heart beating in my mouth. How was I supposed to care for her when I even couldn’t communicate with her effectively? Her mother tongue was Arabic, and she spoke little Turkish…But was communication supposed to be verbal only? No. What about non-verbal communication?…But she just can’t see me because I have a scrub, protective glasses, and a face shield on! But we had to communicate somehow, which we actually did. She communicated non-verbally to explain what was wrong with her.
On the one hand, I was feeling helpless, but on the other hand, I had Henderson’s words in my mind…
“Helping a patient achieve independence is every nurse’s goal when it is possible.”
I had to act as fast as possible for early post-operative recovery. I had to plan everything before I set foot into her isolated room. I also needed to make some arrangements in her room to use the time as effectively as possible. For example, I needed to monitor urine output hourly, so I put the urine bag so that I could see it through the glass window. We normally use manual devices to measure fever. But, we monitored her fever from the monitor.
It was pretty hard to get her to do breathing exercises when she was extubated the day after surgery. She just couldn’t use the Triflo effectively. It was almost impossible to explain to her how to use it with all the protective equipment on me. My glasses were getting foggy even when I breathed. I was having hypercarbia as I’d never had before. I felt like I was in the middle of a smokescreen…
The patient started getting fed. However, there was insufficient oral intake. So, we consulted a nutritionist and gave her low-liquid and high-energy enteral nutritional supplementation. She also had poor nutrition. So, her tired heart would’ve stopped if it wasn’t for inotropes. In this way, we also achieved hemodynamics.
The monitor indicated no problems. However, when we examined her skin, we detected purple striae and thinness and dryness of the skin surface due to Cushing’s syndrome. There was a decrease in skin turgor due to edema. We cared for her skin meticulously to ensure its integrity before she regained independence.
She had to get out of that bed to be fully independent. We made the necessary environmental and personnel arrangement for that. Two days after the operation, two people (a staff member and a nurse) lifted the patient up with oxygen support. We couldn’t get her to take more than a step or two. To be honest, there wasn’t enough space for that, either. We were normally supposed to mobilize her three times a day, but we did it five times a day because she was taking too few steps, and I wasn’t happy about it at all. How were her collapsed lungs and weak muscles and joints supposed to get better?…How was she supposed to hold on to life?…
Five days after surgery, we could clearly see that she was holding onto life with us. She was willingly participating in her care. She was like, “Isn’t it the time for medications?,” “When can I get back on my feet?,” “I can sit on the chair for a longer time,” “I wanna eat by myself.”
Her whole family was waiting on the other side of her room, and they were all very happy about the recovery process. One day, when I was on a shift, I got her to FaceTime on WhatsApp with her family. I can’t describe the feelings that I had at that moment. Here is a patient holding onto life in an intensive care unit, which is the last stop between life and death…
And the big day came. The patient was transferred to the service, which was like a caterpillar turning into a butterfly. A smile, a union, and a tough journey from one day to a lifetime…
It was the most meaningful tiredness I’d ever felt. We’ve realized that nursing is an art of knowledge, power, and zeal, no matter the circumstances. In memory of all the artist nurses who performed their art under challenging circumstances and our colleagues whom we lost along the way….
Belma AY: conceptualization, data curation, writing-review and editing, software and writing original draft.
Hafize SAVAŞ: conceptualization, writing-review and editing and writing original draft.
Sevgi HATİPOĞLU: conceptualization, review, editing
Details of the Authors
Belma AY, RN, MSc, PhD Student
Lecturer, Lokman Hekim University, Vocational School of Health Services
Sogutozu, Ankara, Turkey. E.mail: email@example.com
Hafize SAVAS, RN, MSc, PhD Student
Research Assistant, Lokman Hekim University, Faculty of Health Science, Department of Nursing, Sogutozu, Ankara, Turkey. E.mail: firstname.lastname@example.org
Sevgi HATIPOGLU, PhD, RN, PhD
Professor, KTO Karatay University, Faculty of Health Science, Department of Nursing, Karatay, Konya, Turkey. E.mail: email@example.com
Correspondence: Belma Ay, Lokman Hekim University, Vocational School of Health Services Sogutozu Ankara, Turkey. Email: firstname.lastname@example.org