The woman was dying alone in a hospital bed.
The only person with her was a 38-year-old nurse relatively new to the field. Tiffany Busby held her patient’s hand tight, rubbed her head gently and whispered in her ear that everything was going to be all right.
Except it wasn’t.
Busby knew that. But nurses must maintain a calm façade, especially in the face of a pandemic. She took out her iPhone that day in early April, plopped it in a laboratory bag and called the woman’s children on FaceTime so they could say goodbye. Then she watched as the woman took her last breaths, another victim of COVID-19.
“She was too young to die,” Busby said.
The woman’s children thanked her on Facebook for her kindness. Still, Busby feels disappointed months later.
“It’s hard for me because I feel like I failed them,” Busby told NJ Advance Media as she fought back tears. “We couldn’t save their mother even though we tried so hard. We lost so many people.”
At the height of the pandemic last spring, Busby’s unit at Jersey Shore University Medical Center in Neptune sometimes lost more than 10 people to the coronavirus in one shift, she said. And after every death, nurses were the ones who carefully cleaned the bodies and prepared the room for the next patient.
The painful routine eventually left them numb.
“I had to excuse myself many times to the bathroom because I couldn’t withhold my sobbing,” Busby said. “How do you ever truly recover from seeing so much death?”
It’s a question hospital officials, nurses and health experts are mulling as COVID-19 cases in New Jersey continue to surge. The state reported 3,207 new cases Saturday — the highest number of daily positive tests since April 27, around the peak of the initial outbreak — and 1,392 hospitalizations, the most since June 11.
“They continue to show that the second wave of the coronavirus is no longer something off in the future. It is coming, and it is coming now,” Gov. Phil Murphy said recently. “We have been seeing the numbers of new cases grow exponentially across the past several weeks, and along with that, the numbers of patients being treated in our hospitals has similarly been on the rise.”
The soaring caseload will put only more strain on emotionally exhausted nurses.
In May, the World Health Organization issued a report detailing the pandemic’s impact on mental health, highlighting health care workers as a population of concern. Not only are these workers witnessing so much death, the report said, but they are experiencing heightened levels of anxiety from fears of contracting the virus and bringing it home to their families.
“There have been reports of suicide attempts and suicide by health-care workers,” the report stated. No agency keeps statistics on how many health care workers have died by suicide.
The anxiety was compounded when these workers lost their usual stress reducers — the elliptical at the gym, happy hour with friends, the escape offered by a movie theater. Months later, it’s still hard to enjoy these diversions. And the current uncertainty only makes it worse as cases once again mount, although they remain far below the peak of 8,000-plus hospitalizations in April.
“Dealing with the unknown leads to a lot of anxiety,” said Dr. Chantal Brazeau, a psychiatrist and chief wellness officer at Rutgers Biomedical and Health Sciences. “There’s a bit less unknown for the second surge since we have learned, thankfully, from the first. Yet there are still some unknowns that we face.”
Frontline health care workers, Brazeau said, may still feel the repercussions of the first surge, which is a significant concern.
“When you’re in the thick of it, it’s hard to stop and process the different emotions that you feel in great detail because you have to go on to the next crisis and the next situation,” she explained. “People take stock (of their emotions) after the surge. But with this one, we’re going into this other surge already fatigued from the first one.”
Nurses have whimpered in their cars after shifts. They have endured sleepless nights. And they have sought refuge in each other.
There have even been nurses who have questioned their purpose and whether caring for the sick is their calling.
“I think a lot of our nurses — some realize it and some don’t — that they do have post-traumatic stress disorder,” said Sheryl Mount, a nurse of 35 years and president of the local nurses’ union at Virtua Memorial Hospital in Mount Holly. “I can hear it in some of the things they’re saying to me. Some people are saying, ‘I want a different job’ or ‘I can’t take any more of this.’”
In addition to younger nurses rethinking their careers, there are older nurses close to retirement who have decided it’s time to exit.
“We’ve had a record number of retirements,” Mount said.
At one hospital in New Jersey, 30 nurses have retired, according to Debbie White, the president of the Health Professionals & Allied Employees, a union that represents 14,000 nurses and other frontline health care workers. She declined to disclose the hospital.
Some nurses won’t experience symptoms associated with PTSD until they’re back in the same stress-inducing environment, White explained.
“A lot of them, to be honest, don’t really want to talk about how bad it was, which shows you how stressful it was,” she said.
Their silence is a double-edged sword: Health care workers are supposed to keep their emotions in check, but bottling up those feelings can take a toll on their mental states. It is part of the difficulty in fighting fatigue among those professionals.
“It’s important for us to debrief,” said Janine Llamzon, the director of nursing and system operations at St. Joseph’s Health in Paterson. “A lot of us sought help from our therapists or we do a lot of mindfulness, finding refuge in things that can cleanse our minds and our soul.
“If I close my eyes right now and relive what happened then, I can tell you tears will start falling from my eyes,” she continued.
It’s the little things that trigger Llamzon.
The sound of a jacket zipper reminds her of the closing of body bags that became ubiquitous in March, April and May. The ping of the microwave brings back memories of cardiac monitors.
On March 3, St. Joseph’s received its first patient who needed a coronavirus test. Llamzon, being the head nurse, decided it would be best to handle the case herself.
“It was important for me to do that, to show them that, although I’m scared… you have the skills and training to protect yourself and make it safe,” Llamzon said.
Nearly eight months later — and with a second wave spreading across the state — she is leading by example once again by seeking help for her mental well-being. That includes meditation, yoga and therapy.
“I hurt,” Llamzon conceded. “I’m anxious, and I gain some perspective on how I can get back in and move forward. It’s not easy.”
Like a lot of nurses, she said the pandemic is the hardest thing she’s been through. Period. It tops being a single parent in her home country of the Philippines.
Barbara Boyler has been a nurse for 19 years. She’s never seen anything like the pandemic in her tenure at Jersey Shore University. Concerned about contracting the virus, the 64-year-old nurse went part-time a month ago.
However, health care workers are resilient and can prevail through difficult situations, said Brazeau, the Rutgers psychiatrist.
Boyler refers to her co-workers as the “most amazing people” — especially the younger nurses, many of whom are juggling not only their professional responsibilities, but also parental duties at home, such as helping their children with remote learning.
“These nurses are strong,” Boyler said. “What they have in their favor is they have a lot of energy physically. It’s a great learning experience as long as you come out of it not having gotten COVID.”
The physical safety of their employees is paramount, hospital officials said. But their mental well-being is also critical.
“We really need to commit to our team members so they can continue to care for our community,” said Nikki Sumpter, senior vice president and chief human resources officer for the Atlantic Health System.
Hospitals around the state, concerned about fatigue among their workforce, have implemented programs to help improve their employees’ mental health.
At the height of the pandemic, the Atlantic Health System rented all but a handful of rooms at a Morristown hotel so its employees could stay there and ease their fears of possibly bringing home the virus. It is prepared to do that again if need be, Sumpter said. Atlantic also has set up peer-to-peer groups, virtual exercise groups and offers child care opportunities.
At Holy Name Medical Center in Teaneck, the executive staff set up “resiliency rounds” aimed to get employees to share their experiences with each other, said Michele Acito, executive vice president and chief nursing officer.
Acito said a “good chunk” of the staff took advantage of the program early in the pandemic, but attendance has dwindled in recent months. The hospital also provides private counseling, Acito said.
Holy Name has learned plenty about the virus from the first surge, and it is better prepared for a second wave, which should help combat fatigue, Acito explained.
“Our planning in the past helped us understand how to be prepared for the future,” she said. “They feel comfortable should this uptick become more than that.”
Though hospital programs exist, some nurses said it’s hard to seek help from the very organization at the root of their stress.
“None of our members have taken advantage of it, so I can’t speak to how effective it is,” Mount, the nurse at Virtua, said of its employee assistance program. “It’s hard to go to a place that you have suffered the trauma to get help. … You go somewhere else that’s away from the stressor.”
Busby, the Jersey Shore hospital nurse, said she and her colleagues sought help from a licensed therapist who ran a group session pro bono.
“It helped greatly to be able to discuss our fears, frustrations and feelings during that time,” she said. “Sometimes when I look back at that time, I do not know how we made it through it.”
Along with confiding in her peers, Busby found little things that helped her get through the day. Before every shift, she would listen to Andy Grammer’s “Keep Your Head Up” in her Hyundai Elantra during the 45-minute drive to work from her home in South Brunswick.
The upbeat lyrics would blast through the speakers, a not-so-subtle way to get her head in the right space.
“I knew that day would bring more loss and little hope, because for a long time we just couldn’t save anyone in the ICU, which is not our norm,” Busby said. “We’ve never felt as helpless as we did during that time, and I hope we never will again.”
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