A memoir of the COVID years: a Vanderbilt ICU nurse remembers patients who died, families who wept, and discovers the importance of hearing “thank you” and caring for herself
"I realized that my mechanism of avoiding and ignoring death in the workplace had taken its toll on me."February 4, 2022
Rebecca Tucci. Photo by Erin O. Smith
Editor’s note: Rebecca (Becca) Tucci, RN, BSN, CCRN, works as a charge nurse in the Surgical Intensive Care Unit at Vanderbilt University Medical Center. A Washington, D.C., native, she has been working at VUMC since graduating from Villanova University’s M. Louise Fitzpatrick College of Nursing in 2018. This piece is included in the forthcoming book “Shattered: Trauma and Grief,” to be published in March by the Hospice Foundation of America.
Working in health care has always been a thankless job. Even before the coronavirus pandemic, “thank yous” were hard to come by, regardless of your role in health care. The stress of caring for another person’s life for 13 hours straight tends to take a toll on the caregiver’s body and mind; those 13 hours spent caring for someone else are 13 hours you don’t spend caring for yourself. Coupled with your three days of mandatory 13-hour shifts and on-call shifts that you most certainly will work because of constantly short-staffed hospitals, the lack of opportunity for self-care adds up.
Holding an iPad up to an unconscious patient while her husband weeps with the love of 45 years knowing that he will never again see his wife alive because of COVID-19 is an experience I don’t wish on anyone…I had never helped a family member say goodbye to their loved one over an iPad. There would be 14 more times like that in a month.
Working in an intensive care unit (ICU) of one of the biggest medical systems in the country, you are exposed to a lot of situations that seem fictional until you see them with your own eyes. Hearing family members wail in the corner of the room as you land your hands upon their loved one’s chest, feeling the sternum crack beneath you as you try to pump their heart from outside the body, is not something that can be easily described, but, unfortunately, it is not all that uncommon. You tend to become numb to the sounds of family members who watch their loved one leave this world; that’s the only way you’ll survive. After an hour of sweat and blood, time of death is called. Your job isn’t over though. You now turn your attention to the family member who sat in the room watching you pound the chest of their loved one. Sometimes your presence is met with hatred and blame; other times, a family member will crawl into your arms, only to pass out once they see a lifeless body. You comfort the family member and do all that you can, often fighting back your own tears as you’ve gotten to know the family and the patient over the past few days. Your co-workers will politely ask if you’re okay and you will say yes. Your charge nurse will ask if you need to take a break and you will say no. Not because those are truthful answers, but because you are conditioned as an ICU nurse to not let things get to you. The culture of the ICU is one of tough-minded, adrenaline-fueled professionals, not one where you need to take a break if your patient dies.
With COVID-19, the death of a patient has changed, but that doesn’t mean it’s any less personal. There are fewer codes, and more withdrawals of care, as there is truly nothing more we can provide for a person at a certain point. As we realize his wife’s life is ending, we quickly set up a Zoom call with her husband while we have the opportunity. Her blood pressure is plummeting, her heart beating faster, and her oxygen saturations dropping. I stand in personal protective equipment, only my eyes showing behind a plastic shield, mask, scrub cap, gown, and gloves, and introduce myself to a man with whom I’ve only talked to through the phone to deliver the bad news. I hold the iPad in the face of an intubated, unconscious, chemically paralyzed patient, maxed on all medications, maxed on all possible ventilator settings, trying to make myself invisible so that a husband and wife can have their last moments together. Holding an iPad up to an unconscious patient while her husband weeps with the love of 45 years knowing that he will never again see his wife alive because of COVID-19 is an experience I don’t wish on anyone. I stand there for at least an hour, sweating in a room, overheated for the now hypothermic patient, and listen to a husband sob for his wife until he tells me he is ready to let go. I turn off medications, and the monitor sounds loudly, signaling a lack of heartbeat. I continue to stand there in silence as he yells and screams for his wife, unable to visit her not only because she has COVID-19, but because he too is at home, miles away, battling COVID-19 himself. I had never helped a family member say goodbye to their loved one over an iPad. There would be 14 more times like that in a month.
More recently, another intubated, chemically paralyzed patient, just in her early 30s, was barely halfway through her second trimester when she was admitted to the hospital because of COVID-19. Two weeks later, she spontaneously delivered. Her husband had been informed and had requested stillborn photos and handprints. It was our job, as nurses, to swaddle the months- early stillborn and to obtain handprints. I had never imagined, in my time as an adult ICU nurse, I would be responsible for swaddling a stillborn or attempting to create a sense of a person through photos and handprints.
My method, and most of my co-workers’ methods, of ignoring the horrible things we see every day at work, had caught up to me. My ability to separate work from life and my general mental stability had shattered…I became apathetic to everything around me. My friends’ concerns seemed trivial; I felt as if I didn’t love those I knew I loved.
I didn’t fully realize how traumatic a patient dying was until the coronavirus epidemic. The frequency of death became so normal that death itself seemed all too normal. I once had a co-worker say, generally speaking, “if [nurses] can’t handle a person dying, then they should probably find a different profession.” At the time, I laughed and agreed with her, not really thinking much of the comment. But in January of 2021, I realized that my mechanism of avoiding and ignoring death in the workplace had taken its toll on me. My method, and most of my co-workers’ methods, of ignoring the horrible things we see every day at work, had caught up to me. My ability to separate work from life and my general mental stability had shattered. There was a month where I suffered from crippling anxiety and depression and was unable to sleep, frequently having nightmares about work and situations that I had encountered at work. I was diagnosed with post-traumatic stress disorder (PTSD) from working in an ICU and working with COVID-19 patients. My personal and professional lives were both greatly affected. Because I had been working so much and so hard, under what I can now say are unlike any other conditions, I became apathetic to everything around me. My friends’ concerns seemed trivial; I felt as if I didn’t love those I knew I loved.
Writing this now, it’s clear to see how these types of situations could easily cause someone trauma. But it wasn’t until I was actively in therapy and seeing a psychiatrist that I realize how exposed I was to trauma. My therapist had to continually emphasize the idea that what I was doing and seeing every day was not normal. I started medication to help ease panic attacks, help me sleep, and ease my PTSD symptoms. I continue to go to therapy, which I find to be a helpful way of caring for myself. I meditate regularly and make myself do something I know will bring me joy every day, regardless of how tough work has been. I have found co-workers who have experienced similar situations, or who also suffer from PTSD, and I talk to them about struggles related to our work. Since the pandemic began, a lot of nurses I know have left bedside work to go into areas that do not involve patients at all, whether that’s COVID-19 contact tracing for schools, medical sales, or just a completely different career. They have sought work where brutal death is not a daily, inescapable experience.
Looking back on my experience of being a nurse during a pandemic and reflecting on still being a nurse during a pandemic, I wish that I had sought professional help sooner.
Looking back on my experience of being a nurse during a pandemic and reflecting on still being a nurse during a pandemic, I wish that I had sought professional help sooner. I think that my mentality of ignoring uncomfortable things, especially death, took a large toll on me. I frequently tell co-workers to go to the counseling office at work if I feel they have experienced something traumatic. Whether they actually go and seek help is up to them, but I think the culture of having someone encourage you to get help is sometimes the first step that many people are unwilling to take on their own. I often wonder if I should switch to a different profession, or if maybe leaving the ICU would be beneficial for me. I know that in some ways it would be a great step for my mental health, but in other ways, I know that I would find myself missing the ICU and sharing some great moments of recovery with patients, their families, and my co-workers.
Whenever I was previously met with a “thank you,” I used to respond by saying “no problem” or “no worries.” Now, after months of ignoring my own feelings, and spending even more time working to regain those feelings, I reply with “you’re welcome.” I say that not because I feel the need to be thanked, but because of all the personal work I’ve had to do so that I can better care for others, regardless of the circumstance. I cherish the “thank you” that I may hear once a week or once a month and tend to become emotional when hearing it because I know how much I’ve had to grow in order to say “you’re welcome” in return.
The full book, “Shattered: Trauma and Grief,” ISBN: 978-1-893349-25-4, is available for order at hospicefoundation.org. Rebecca Tucci’s contribution to the book is reprinted here with permission.
If you are a Vanderbilt employee and would like to connect to the counseling and support services available to you, contact the Work/Life Connections-Employee Assistance Program at 615-936-1327 or by clicking here.