Before Susan Dawson enters Massachusetts General Hospital, she checks off a form affirming that she has no known symptoms of COVID-19. As she works through her 12-hour shift in an intensive care unit, each of her room visits is preceded and followed by a meticulous protocol—changing her gown, cleaning her protective gear, scrubbing her hands—in order to protect the patients. And herself.
“I’m glad I had hospital experience before this all broke out,” says Dawson, a third-year nursing student at Northeastern who is serving her second co-op at Mass General. “I think I would have been a lot more scared and tentative if I had not.”
Because of the uncertainties and dangers associated with hospital work during the pandemic, Northeastern has given nursing students the option to postpone or withdraw from co-ops with full credit. Dozens of nursing students are choosing to work at Boston hospitals during the public health crisis, including the three patient care technicians at Mass General who are sharing their experiences here. These first responders, all third-year nursing students at Northeastern, have been training on the front lines at a time when the rest of us are being advised to keep our distance.
At Mass General’s COVID-19 Intensive Care Unit, where Dawson works 36 hours per week, family visits are permitted only in the gravest of circumstances. And then it’s one visitor at a time.
“Having to see them come in knowing that their family member is going to die is just terrible to see,” says Dawson, who is from Larkspur, California. “It’s just one of them alone. It’s terrible.”
Other families have been connecting with patients via Zoom video calls. Dawson has been asked to hold the iPad so that messages may be relayed.
“All of our patients are intubated, and most of them are not awake,” Dawson says. “But I think that sometimes they can hear. I was doing a Zoom call yesterday and I swear I saw the patient smile.”
Dawson had been serving her co-op in the medical ICU when the coronavirus outbreak forced Mass General to reorganize its fundamental structures. She is now working in one of the new ICUs dedicated to COVID-19.
“The patients are not just in-and-out in a few days,” Dawson says. “We see these patients each day, we get attached to these patients, even though they can’t talk—we still are attached to them, we care for them. Seeing a patient not come out of this, knowing that the doctors and nurses are doing everything they can, it just isn’t good.”
The slightest betrayals of Dawson’s emotions can be heard during an interview over the phone—the cracking of her voice, the thoughtful pauses, her ground-zero descriptions of a crisis that has overwhelmed her imagination.
“There are good days, too,” she says, and here she is referring to Jim Bello, an athletic 49-year-old father of three who became Mass General’s first intubated patient. At times he appeared to be near death during his 32 days on a ventilator. Last month, Dawson was part of the ICU staff lining the hallway and applauding Bello as he was being wheeled to a regular floor.
Dawson has watched career nurses adapt to the challenges of managing multiple intensive-care patients, while at the same time undertaking a myriad of precautions to reduce the risks for themselves and anyone nearby. Every act of prevention reminds staffers of the danger. Dawson draws strength from knowing that she is doing everything she can to keep herself safe. Which, in turn, makes her fear for all of the people who are endangering themselves because they don’t know better.
“I can see how this could be so traumatizing, because we’re definitely not all the time seeing happy outcomes,” Dawson says. “But at the same time, all of the people that are saying that they want their freedom to go outside and hang out with their friends—if you could take one look inside an ICU, I bet that you would think completely differently.”
In the early days of the pandemic, when Hannah Terry would come home from Mass General, she and her three roommates would abide by a five-minute rule.
“We were allowed to talk about COVID for five minutes,” says Terry, who is from Danville, New Hampshire. “And that was it.”
Those roommates—two students in nursing and another in physical therapy—have gone home to their families. When Terry returns from a 12-hour shift to the empty four-bedroom apartment, her clothes go straight into the wash. She scrubs herself clean, finds something to eat, and tries to relax before bed.
She is performing three shifts per week at the Cardiac Surgical ICU, and—like her friend Susan Dawson—is working an additional 12 hours in general medicine. Terry also babysits another eight to 12 hours the children of nurses who no longer have daycare. (And then there was the online writing class that she finished last month.)
“It’s a form of social interaction for me by being at work,” Terry says. “It’s hard not being able to see family. I thought my roommates would all be around, but I’m the only one on co-op. So it’s quiet.”
The threat of working in the midst of the pandemic was most frightening in its earliest days, she says. The daily routine of preventive measures have helped her adjust to the new realities of her work.
“It was terrifying because we were hearing about a 31-year-old, perfectly healthy, who was intubated for three weeks,” Terry says. “Seeing that some of these patients were so young and there was nothing [else] wrong with them—this was at the time where everyone was saying that it was only the elderly and the immuno-compromised that were getting sick.
“A lot of people were—including myself—very fearful of what we couldn’t see.”
She noticed that some of the more experienced nurses have expressed the most concern. And yet they show up for work every day, with no way to prepare for what they’ll be facing next in the cardiac surgical ICU; of its 15 patients, only four have heart issues.
“We’re seeing liver transplants, oncology critical-care patients, and trauma patients that we’re unfamiliar with,” Terry says. “We’re getting the overflow from the other ICUs so that they can treat the critical-care COVID patients. We never know how many patients we’re going to have or what kinds of patients we’re going to have.”
Terry expresses willingness to be sent wherever she is needed, which has resulted in 12-hour shifts in the COVID-19 ICU. Throughout the hospital, she has found the nurses to be generous in sharing their experiences and providing advice. When she has been reassigned to other units, the staff has let her know they appreciate her help.
After her long shifts, still in her scrubs as she walks home to the empty apartment, she looks up occasionally to greetings of “thank you” from passersby. They are jarring. It’s not how she sees herself.
It has been a strange time in the Emergency Department at Mass General. Yuchen Zhang, a Northeastern co-op from San Diego, has experienced 12-hour shifts when no patients have come through the doors. Though that has changed recently.
“In recent weeks, we’re seeing more and more patients as people are starting to be less cautious,” he says. “People are starting to go to the hospital for a wider variety of issues than they did in the earlier days of the pandemic.”
Zhang’s duties include helping emergency patients with their “activities of daily living”—visiting the restroom, brushing their teeth, washing their hands. The point-of-entry experiences have provided him with insight on the healthcare system as well as his potential role in it.
He had been questioning his career path. The Northeastern coursework and his initial hospital co-op had been more challenging than he had imagined.
“Being an insecure kid, I gravitated toward nursing because it seemed cool—it seemed to pay well, I thought I’d be a good nurse, and I like to care for people,” Zhang says. “This co-op has been very affirming, I think.”
From what is essentially the greeting room of Mass General, he has seen the highest ideals of teamwork playing out—the hospital reinventing itself, the nurses and other staffers adapting to new roles under intensive pressure, and his own department quickly diagnosing and dispatching patients to the specialists who can do the most good.
Like Dawson, Terry, and other co-ops, Zhang has maintained steady contact with his concerned family back home to assure them that he is doing everything he can to protect himself. For all of the doubts he held about nursing, he believed it was important that he work through this co-op.
“Who am I to say who I can treat or not?” Zhang says. “As healthcare professionals working at a hospital, we don’t really have a right to deny anyone. It’s what I’ve signed up for.”