Critical care nurse finds life — and death — in the ICU utterly transformed

Mia Torres is a staff RN on the intensive care unit at the Peter Lougheed Centre. For the past year, she’d been back and forth every two weeks between her work at the Lougheed and her job as a flight nurse, stationed out of Nunavut. On Jan. 30, sitting in her apartment north of the Arctic Circle, she watched as the World Health Organization declared COVID-19 an international public health emergency.

“Like a lot of people, up to that point I was thinking, ‘This will stay contained, this won’t hit Canada,’” says Torres, BN’15. She came home to Calgary from her last rotation as a flight nurse on March 11 to find “everyone panicking about toilet paper.”  That was the day the WHO upgraded their declaration to ‘global pandemic.’ 

Torres hit the ground running almost immediately, with a 12-hour shift on the ICU. On March 12, Calgary confirmed 23 cases of the virus; public events of more than 250 people were cancelled; Albertans were asked to reconsider travelling outside the country; and the province was beginning to weigh the idea of closing schools. The hospitals had some new precautionary measures in place, but neither Torres nor her colleagues could have imagined how rapidly their world — indeed the entire world — would change over the next 22 days.

Intensive care units cater exclusively to patients with life-threatening illness or injuries who need constant care and monitoring of the equipment and medication that’s helping keep them alive. ICU staff care for these individuals whose tenuous grip on life can change in a heartbeat. Even experienced nurses like Torres are often assigned to just one patient per shift. Given the extraordinary level of knowledge and devotion required to notice and meticulously attend to every nuance of a patient’s well-being, competently caring for even one such fragile human is more than most of us can fathom.

Since Torres’ full-time return to the Lougheed three weeks ago, she’s had to arrive at the hospital at least 15 minutes before her shift to line up for a mass screening.  “We’re all asked questions to see if we might be at risk — we have to be really aware about recalling where we’ve been,” she says, adding that she’s not seen her nearby parents or grandmother in six weeks.

“Then we stand in another line to get our temperature taken.” Until recently, the lineups were stationed outside the building. “That was pretty cold,” says Torres with characteristic geniality. “It’s better now and everyone’s been really understanding.”

ICU usually a busy, family-centred place

Unlike some Hollywood depictions, life on the ICU is not all severe shush-ing and quiet reverence. On the contrary, says Torres, the ICU is generally a “bubbly, loud place with visitors coming and going all the time.” It’s one of the things she’s always loved about it.

“In the ICU, we’re very family-centred — it’s a little different than the rest of the hospital,” she says. “We’re relaxed about letting whoever might be important to the patient come visit, anytime — we don’t follow usual hospital hours.”

If a family member isn’t sure a loved one is getting better, they’re encouraged to come even during the night. Sometimes, entire families show up. Torres has seen 30 people in a room at once to share the moment life support is taken away from someone they love. “That’s an incredible thing,” she says.

It’s always very sad, but to be surrounded by so many loved ones in that moment — that brings dignity and peace to someone who’s dying, and that’s beautiful.

Last week, Alberta Health Services announced that, as a precautionary measure to ensure those most at risk of contracting COVID-19 are protected, no visitors would be permitted to see patients at AHS hospitals. That’s not just COVID patients, it’s all patients.

 If your loved one is currently on life support following an overdose or waking from a major surgery, you are not permitted to visit. It’s an exceptionally painful pill for patients, their families and hospital staff to swallow.

Complete isolation 'unsettling'

By then, April 3, there were more than 1,000 cases of COVID in Alberta, the vast majority here in Calgary. Five people had died and several more were, and still are, in ICUs across the city. Caring for patients with the virus has been a strange new experience for a nurse who has seen a lot in her five years on the floor.

“COVID patients are in negative pressure isolation rooms, which prevents airborne contaminants to drift and spread around the room, and makes is safer for us to open the door and go in,” says Torres. She says she wasn’t nervous for her safety but found the room unsettling in its complete isolation. “It’s just… it’s so quiet.”

Before going in, Torres will observe the coma-induced patient through glass, and consider everything she might need, from linens to hygiene supplies to any additional medications.

“With another type of patient, I might determine they have a bit of a fever and I can go back out for Tylenol, for instance.” With a COVID patient, she has to take everything in at once because, as she puts it, “my visits are numbered.”

Torres diligently dons the required PPE (personal protective equipment) including a mask, face shield and gloves. She will spend 45 minutes with the patient, cleaning them and then repositioning them on their side to alleviate back pressure; in her 12-hour shift, she’ll go in twice more to do the same, and spend the hours in between monitoring the individual from behind glass.

Torres says her main fear is that, in taking a turn for the worse, a COVID patient who needs resuscitation would have to wait for an entire team to put on their PPE. “We’d absolutely have to take that step in order to be safe before we go in, but those are crucial minutes for a patient and that’s scary.”

Torres cares about her patients and thrives in her work. Still, since the no-visitors policy, life — and death — on the ICU has been transformed. “I always deal with death and dying in an ICU,” she says. “But now, it’s harder.” A patient waking from a major surgery opens their eyes to Torres and her colleagues rather than to a loved one.

“If that was my mom or dad? I’d be heartbroken.” Patients on the ICU, says Torres, “need someone to be their voice, to advocate for them when doctors and nurses are busy, someone to be in their corner, raising their concerns.” Now? “It’s me — it’s nurses.”

Indeed, the World Health Organization seems prescient in declaring 2020 the Year of the Nurse and the Midwife. Torres and her fellow frontline health-care workers are being put into the unique situation of being the ones present for COVID patients, on behalf of their families. They are doing the physically and emotionally demanding work they always do, but in remarkably challenging circumstances during which they’re tacitly, and quite suddenly, required to be there for all patients to an astonishing new degree.  

“It’s awful to know that people can’t visit with loved ones — and some can’t die with the peace that having family nearby brings,” says Torres. She and her fellow nurses have no choice but to provide additional comfort and advocacy where they can for those they watch over. Torres is deeply compelled to do so.

“We know there’s so much hurt, and we feel it.”

 

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