SPECIAL TO OKNT: MAKING THE FRONTLINE’S INTERNAL THOUGHTS EXTERNAL

by Tarisa Watson, MHA, BSN, RN

I get ready in silence every morning wondering who’s going to win today. Is this going to be the day that we win and the tide turns? Or will this be the day we find out another co-worker is positive? Those days always bring it home. I only allow myself a second to run through the faces of the ones we’ve lost. It could be me. This could be the last morning that I get ready, the last opportunity to kiss my husband and my baby on the way out the door. Did I tell my parents I love them? But how long ago? Are my affairs in order if I don’t make it back home tonight? I don’t remember the last time I laughed freely, but that last thought makes me snicker as I put my dramatic side in check. “Even if you fall sick on shift, you wouldn’t be admitted for a few days…”. I tiptoe through the house like a soldier in the early hours before dawn, tugging my hat down tight and preparing to go to war. By the time my sleeping family rises, I will be in the thick of the battle. (story continues below)

Preparing to go to my own war against an unseen enemy that sucks the life out of us…literally.
We spend most of our days watching cautiously through glass windows covered in our shorthand hieroglyphs for the slightest sign of improvement, silently praying through dread in the moments of decline. If their families could only understand that we are watching every breath, every pause. When they stop, so do we for a moment…until it starts again. Or doesn’t. We cheer for them and announce our tiny successes proudly to each other. “I got him down to 12 liters!” It’s amazing what we consider success these days. We commiserate in their setbacks. We learn their likes and dislikes. We learn the unique battle patterns of this warrior- the heart wrenching twists and turns that become all too familiar as we see it play out over and over and over. Our minds drift to faces, each one that has come before them, momentarily flashing in our minds before they run together like watercolors on wet paper.
Some days we drive towards the fight in a silence that is deafening because we just can’t take any more alarms or sudden jolts of energy. Stop lights burning their bright red glow in the early morning hours before dawn are an eerie reminder of flashing monitors, indicators of rapid heart rates, dropping oxygens, raging fevers. Then there are days when the music just can get loud enough to drown out the noises of the world and the thoughts that scream through our heads like freight trains.
You can’t take too much time noticing the world around you. You have to keep pushing; running as though the floor were falling out from underneath you with every step you take. There are days when you long to be alone, not from your family, not from the world but away from the constant sadness. You start to feel as though you wear it. It’s there in your eyes, in the depth of your sigh. You become more intentional after a while. Noticing things around you that you were always told not to take for granted but now it begins to really hit home. Sunshine, the birds, parents picking up their children- not worrying if they could potentially make them sick with each touch, each kiss. And you become bitter. Bitter in the moments when you see others taking risks, unintentionally criticizing your struggle through their carelessness. You silently scream inside each time someone says they’re going on a trip or a party or some new, carefree, or maybe just blissfully ignorant celebration. They don’t intend to minimize your struggle, to appear haughtily entitled to their leisure at the detriment of your sanity, but it’s like they live on another planet or another dimension. Dancing on glass, unaware of the writhing monsters that live just beneath the surface…that’s our world. We fight that beast so they can dance.
We pull into the lot, silently walk onto the floor, unwilling to speak the day into existence yet. Exchanging knowing looks and feeble smiles, maybe a sarcastic line meant to bring a laugh. Get our assignments, pack on the battle armor. Thin yellow paper, some gloves, paper shoes, steamy goggles, a flimsy face shield and the warhorse of your arsenal- a swiss cheese hairnet. That’s your protection. That is what we fight the beast in. We depend on each other, trust that our brothers and sisters will ensure all our skin is covered as best it can be. We’ve seen each other at our worst by now- no makeup, do-rags, maskne. No one judges and no one cares. This is when the new definition of isolation comes in.
This is our island. One way in and one way out-an industrial metal door with vents, covered in plastic and signs, basically telling everyone not to enter for their own good. But we do. We are in here, barely recognizable in our baggy, impersonal regalia. Knowing that, until our relief gets here, we are on our own in no man’s land. No one comes here.
Timid knocks on the door tell us to open the door, pull a heavy tray cart over the threshold and make deliveries. No rush though because there’s no one waiting for it. They’ve all scattered before you open the door and will call in an hour or so to say they need their cart, but you’ll need to push it out into the “clean hall”, through that door again before they will come get it. Then the phone calls come. First lab, then the others, all with reasons why they “can’t come to the unit ‘for safety’ and could you please do this for the patient and let them know when it’s done?” We know why. We think to ourselves what would happen if we allowed ourselves to stay home out of fear. This is where the cynicism takes hold. One by one we gather everything you could need or want to care for someone along with handfuls and an armload of bags of meds for one patient. We glance around as if asking the walls to wish us luck, and then walk into their room.
The deafening roar of the negative air pressure system assaults your ears and the rustle of paper and plastic as you edge through the crowded space fills your consciousness with the realization that it’s in here with you. Coiling around you like a serpent. You measure your breaths, carefully avoiding bumping any surfaces, praying you can get at least 5 minutes of assessment in before your goggles fog up and you’re literally blind in here. The visor is grinding into your forehead as you lean close to the person in the bed to listen to their lungs. The patient begins to cough though you’d hoped it wouldn’t escape into your face. It sounds like someone rattling a chain link fence. You strain to hear heart sounds through the cheap throwaway stethoscope. You watch as their eyes get wide and you can see the fear in their face as they work to get a breath. For a moment, you forget the beast and you do what must be done. You teach, reassure, give them milestones to mark their progress, anything to pass the time and preoccupy them so they don’t hyperventilate watching their monitors. You fuss with their lines and change linen. You encourage them to walk, turn over, breathe, take meds, drink. An hour passes. Sweat stings your eyes, glasses fog over, and then when you can’t take another minute, your head throbbing from the mask, hands slippery in their glove casings, you emerge covered in the invisible terrorist. Now you have to chart your encounter and return the 5 phone calls from relatives, upset with you that they cannot visit and certain you’re sitting there with your feet up on the desk. They cry and pull your heartstrings, telling you who the person in the bed is when they aren’t ravaged with sickness and you ache to find something encouraging to tell them or you ache to tell them it’s time to let go. But you listen. You inform, you explain and explain again. You try to establish a plan of milestones and you pray that they make it together. Everyone says “thank you” and for now, they mean it. By this afternoon, they’ll hate you again for keeping them away. Your hunger burns but you can’t go to the cafeteria. You’re persona non grata there – a pestilence cloud encircles you and they remind you that “you can order a tray and after all the others are out, they’ll try to make yours.” You order another bowl of Jello that you won’t get to eat and look at the clock. It’s already 1300. A rumble in the wall alerts you to life outside your island. More medications. The tube brings things for you to do but you cannot send anything away. They want nothing you’ve touched. You long for any contact from those outside the island, on the other side of the door. But you are sentenced to this. “You chose this.”
Snap back to reality – Alarm bells… oxygen dropping. Whose is it this time? The 6th time since breakfast. More hoses, more wires, more oxygen. It is unrelenting. You have to push through all of this failure to get to the light on the recovery side of the tunnel. It seems so far away. You’re hot, dirty, tired, anxious and emotionally aching. When you have nothing left to give, you are finally allowed to open that door and rejoin society. That’s when the stares come.
In the elevator everyone moves away from you as if they can see marks of your battle all over you-and to them, you are… “Contaminated.” When someone speaks it feels like daggers. “She looks tired. See this is why I wouldn’t want to be a nurse.” But I thought we were heroes- some hero. We trudge to the car and see the sky, black as an abyss, the same as all the nights and mornings before. We haven’t seen the sun in days. Head home in silence. Recounting our steps, recovering from the disappointment that your patient has not “turned the corner” yet. Maybe tomorrow.
A faint light ahead signals it’s time to move again. Our bodies react to lights and sounds as if on autopilot lately. The gray and yellow highway yawns on ahead of us and the next thing we know we are home, but don’t remember the trip. This is sleep deprivation but there’s no time for that. Snap back to action- remove all your clothes, shoes, belongings before you bring your cloak of pestilence inside to your family. In the shower, guilt washes over you with the water. “Could I have done more?” “Did I bring it home to my family?” You search your family’s eyes not realizing it, quickly assessing for any signs that they may have fallen victim to your “occupational hazard”. Satisfied, you cautiously hug them tightly, producing an aching in your heart that comes from your growing profound appreciation for life and love. Somehow, these short moments are just enough to recharge you for another day. You don’t look into their eyes too long though- you can’t risk anyone asking you what’s on your mind.
On your mind, in your mind, same difference. A cacophony of thoughts twisting and mixing sadness, joy, fear, anger, resentment, regret… it’s an abusive relationship within your own head. “You could’ve done more, but you SAVED them, nobody believes in this, why bother”… interrupted by “CODE BLUE ROO” No time to think, there are drips to run, meds to push, compressions to do. Thank goodness. The sweet adrenaline rush is like a wave that carries you away from those thoughts, the faces. This is what we do, this is what gets us through hour…by…hour.
Originally a political science major from Florida, Tarisa moved to Oklahoma in 2008. Caring for her grandparents at the end of their time planted a desire to better understand and to help others understand their health and how to advocate for their health and wellbeing. After earning her Bachelor’s Degree in Nursing from the University of Oklahoma, Tarisa began a career at bedside on a very busy medical-surgical/oncology unit.
While working on the unit, Tarisa advanced to the position of Associate-Director of Med/Surg while earning a Master’s degree in Healthcare Administration from Oklahoma State University.
In the Fall of 2019, Tarisa moved on to a new facility, Duncan Regional Health, and went back to the bedside to reconnect with her passion for patient care. A few short weeks later – COVID! After the last surge in Spring of 2021, Tarisa accepted a position as the Infection Preventionist. She continues to be passionate about bringing the frontline nurse perspective to those who may otherwise not see what goes on behind the scenes.