EP 65: It Broke Me

Episode 65 of the Hope4Med podcast features nurse practitioner Marina. She is a COVID-19 nurse practitioner who worked crisis when the pandemic first started and has struggled with mental health and PTSD. Now, she’s working in primary care and wants to share her story. She shares the traumatic experience of working on the front lines of the COVID pandemic, being the last ones to hold a patient’s hand as they leave us during a time families were separated from their loved ones. She shares her feelings of helplessness, loneliness, and the post-traumatic mental health effects she has from this experience. We are honored to feature her powerful story.

[00:00:00] Dr. JB: Welcome to Hope4Med.

[00:00:04] Welcome back to the Hope4Med podcast. I am your host, Dr. B and today’s featured guests is nurse practitioner marina. She is a COVID-19 nurse practitioner that worked crisis when the pandemic first started, it has struggled with mental health and PTSD. Now she’s working primary care and wants to share her story. Welcome to the show.

[00:00:33] NP Marina: Hi, it’s nice to meet you.

[00:00:36] Dr. JB: I’m so happy. I’m so excited to hear your story. So let us start from the beginning. Please share with my audience, your origin story.

[00:00:44] NP Marina: So I– like origin as in?

[00:00:47] Dr. JB: To health healthcare.

[00:00:48] NP Marina: So I was actually a psychology major and my grandmother got really, really sick and she ended up going to the ICU and I remember being maybe 18, 19 taking college classes, really gung ho about doing psychology. And I remember walking into her room because she was in ICU and I remember just having this overwhelming feeling of not liking the way the lines– to sound silly– but the lines that she had going to the ID bags and stuff, I didn’t like how they were tangled and disorganized. And she hadn’t been repositioned at all and she looks so uncomfortable and there’s no nurses around, really to talk to. So that kind of put the spark in me to change career paths and go down the nursing route, which would make me the first nurse on both sides of my family to graduate with a bachelor’s degree and a master’s degree. Then after that, I went straight into ICU right after I graduated, after she had passed away, because I felt like I was supposed to be there. And I spent maybe 6, 7, 8 years in ICU and trauma, that I floated to the ER a lot. And then I graduated nurse practitioner school right around the pandemic. And that’s when things got a little spicy.

[00:02:09] Dr. JB: Okay. Okay.

[00:02:11] NP Marina: Got real spicy. I mean, do you want me to go into COVID? Are we ready? Are we free falling?

[00:02:18] Dr. JB: I’m falling, I’m falling.

[00:02:20] NP Marina: We’re going to free fall into the COVID Crock-Pot, here we go. So I had just, just graduated nurse practitioner school totally fine staying in the, in the ICU. I really didn’t want to go anywhere, I was comfortable, but we started getting these patients in and we didn’t know as healthcare workers, what to do. Here’s something we’ve never seen before, how are we going to fix it? There were days where, you know, and this is the majority of my days, unfortunately, what I was just in the ICU as a standard nurse, when this first started I was wearing the same mask for weeks on end. If I wanted another in 95 mask, I’d have to call my house supervisor, which I was refused a new mask no matter what happened to my old one. And I wore the same gown and it was really scary. Yeah.

[00:03:14] I remember coming home and, nobody wanting to be around me at all because they didn’t know what if I could get them sick. So that had to probably have been the loneliest time of my life because I didn’t have any family around and I didn’t have a boyfriend or, a best friend. It was just me. And God forbid, I go to the grocery store with my scrubs on to pick up a micro waivable meal without getting dirty looks just to get food. So I ended up having to get my groceries delivered.

[00:03:45] I got to a point where I didn’t want to be on the floor anymore. And I wanted to pursue being a nurse practitioner. I ended up taking a COVID crisis contract and Albany, Georgia. And that’s when things got really, really spicy because I was a brand new nurse practitioner and here I am going into, I don’t know, you know what I mean? What am I going to face against? How am I going to handle this? Who’s going to talk to me. Who’s going to, like, it was incredibly lonely, but I felt like I was supposed to be there, like I had a calling to be there. So I ended up going to the hospital there and I remember hotels refusing to take me because I was a COVID nurse practitioner, then want to be anywhere around it. So I ended up staying in a dorm room about 10 minutes away from the hospital. They put all the nurses and the doctors in a dorm room and it didn’t matter. They didn’t care whether we could have been sick or not, they just piled us in there and kind of cross their fingers. And that was a really daunting experience to sleep on a really small, tiny dorm room bed after working a 13, 14 hour shifts.

[00:04:57] And kind of, no one, I just remember being really lonely.. The only thing I can tell you, cause like, even though you have a roommate, your roommates going through it too. So my roommates coping mechanism was to drink after work. Mine was just the lay face down in bed and cry. So I was there. It wasn’t bad. It was kind of the same thing, but people were dying left and right. And there was nothing I could do. You hear a code button go off and you’re running over there just to run over into another room and the same thing’s happening. People can’t keep their saturations for their oxygen up. You got doctors yelling at you. They don’t care that you’re a, mid-level like at this point, you’re just, you better put that order in for me or else.

[00:05:50] And a lot of the times I would come home, and I think the hardest thing for me was I felt responsible for my patients who passed away. And because I feel like, and I’ve never told anyone this, like, I feel like I promised them, like it wasn’t the typical mid-level, you know, I was still a nurse inside. We all are. And I remember just going in there holding my patient’s hands all the time and telling you it’s going to be okay, you’re going to be fine. You’re strong. You can get through this. And then I, they would die and I felt responsible and, you know, I don’t feel like anybody should feel responsible for something like that because I did the best that I could do in this situation. I did every medicine, I talked to every doctor, and I felt responsible and I still do it still bothers me. Cause I always questioned like, what if I had done this differently? Or what if I had, talk to this person and or got a second opinion, but I guess it didn’t matter, once they’re so sick, it’s like, how do you, how do you go backwards?

[00:06:59] So I, it was like that for awhile. And yeah, I was so in the moment I felt numb to the entire situation. It’s like, you didn’t feel anything. It was like, you’re living in this, this tunnel and you’re just kind of existing, you have no feelings at all other than just numbness. And then the day came where my patient, who I loved very much, I had been with her for quite some time, she ended up coding and it still haunts me. That when you have all that equipment on and you have the negative pressure rooms and all of that, it’s hard for people to hear that you need help.

[00:07:43] I remember hitting the code button and we were so short staffed that all the staff members couldn’t hear the code because they were all in another room. So I was coding and bagging a patient by myself and it took them five minutes to find me. And I didn’t want to leave the patient. I kept yelling out the door for help. And it was like, I, I look back at it now and I’m pretty sure it’s the worst feeling I think I’ve ever felt in my entire life, because that was somebody mom. And I know that she was sick and I know that there is nothing else I could do. We did everything.

[00:08:27] But the one thing I always kept doing was is I open up the window after they passed away thinking that their soul would go out the window and they would be free from all the pain and the suffering that they went through. This happened so many times with patients dying on my shift that one day I had enough and um, My patient again, up in awake, I’d taken her outside, we established the sunshine protocol because of me, which is when we would take our patients outside to see the sun, if they were healthy enough or at least a little bit better so their loved ones could drive by, or they could see the sun. And I had taken my patient out there to see the sun for the first time in four months and she looked at me and she said, this is the most beautiful thing I’ve ever seen in my life. And I looked at her and I was like, it is, isn’t it? She goes, can I stay out here? And I had her on high flow oxygen, like I had her all propped up and like, we sat out there for a good solid 10 minutes it’s. And then she, she passed away when I wasn’t there one day and it broke me, I think that was like the final straw.

[00:09:50] I ended up walking off the unit and I didn’t return, and I’ve never told anyone that that’s why I left. I came up with some reason that, had an emergency, but the truth is, is that I was broken and I didn’t know how to fix myself because how can you take care of someone else? If you can’t take care of yourself?

[00:10:15] Flash forward to the second year you were in the pandemic. I was working urgent care thinking that I escaped because I didn’t, I was seeing over a hundred patients a day with COVID by myself we were so short-staffed. Over a hundred for one mid-level. And the final breaking point at that job, because it turned into this money making thing with people like they just wanted to get people COVID tested and charge him this and that and charge the cares act, it stopped being about the patient. It started being about how many can you see in a day?

[00:10:58] Had the most beautiful African-American woman come into the clinic, she was 94 years old. She was beautiful. And I felt this like connection with her, the instant I, I met her and she goes, I’m really not feeling well. And I said, okay, go wait in your car. I’m gonna come out to you. You look tired and I don’t want you to expose to all these sick people in here. So I go out there and bring all this stuff with me, the vitals machine, everything COVID swab all the things. And her stats were 82 so we’re trying to get oxygen out there and she’s scared. I’d already had COVID so I didn’t care at this point, I crawled into the passenger seat with her and I held her and I sat her up and we laughed and talked and giggled, and EMS finally got there.

[00:11:52] I was the last conversation that she had with somebody, she died on the way to the hospital. And you know, like I don’t need to cry, but it’s like, you know, I’ve never shared it publicly about how much it’s affected me, but it’s like, like I still feel guilty. Like I could’ve done more, but I think the thing with COVID is it doesn’t care like who you are, what you look like, and I think that the aftermath of all of it is that nurses have– and medical doctors, everyone across the board all the way down to environmental services– everybody has taken a beating in healthcare, the worst speeding of our lives and we’re tired. And now we’re kind of stuck in a place where we’re like, how do we recover from telling somebody that they’re not going to make it or telling the wife of the husband of 50 years, that her husband’s dead, but she can’t see him. Like, how do you move forward without beating yourself up or dwelling on it?

[00:13:08] And that’s kind of where I am and I’ve never shared my story. I just haven’t because I think I’ve been embarrassed that I’ve been emotional about it, cause I’m supposed to be strong in my career. But I don’t feel like it. And I feel like it’s taken a really huge part of me. I can’t even hear a zipper on a bag without immediately wanting to cry cause I’ve zipped so many bags up of people who are no longer here. So my whole point of talking to you today was to one, share my story and let people know that it has affected us and it still affects us, even though it’s slowing down, it doesn’t matter.

[00:14:00] But I think there needs to be some changes with staffing and there needs to be some changes with not capping anybody’s pay or hearing people say, we let you keep your job during the pandemic, that was your reward. We’re more than that. And maybe I’m wrong, but I don’t think I am.

[00:14:28] Dr. JB: Marina, first and foremost, I want to say, thank you. Thank you for sharing your story. As a fellow healthcare professional, it’s hard to hear these stories, because just like you were crying, it, it made me emotional.

[00:14:51] NP Marina: Sorry.

[00:14:53] Dr. JB: No, it’s fine though. It’s fine because we need this space. We need this place. That’s why Hope4Med was created, to allow us to have these conversations because we’re not heroes. We’re not heroes. We are human beings, with human emotions, with human reactions.

[00:15:25] I’m an emergency medicine physician. So when you’re telling me your experiences of seeing patients dying, of being the last person to hear their voice, of patients looking you in the face before you intubate them, and the last words they say is, please don’t let me die. Then they die. That’s so traumatic. Because you start thinking, what could I do differently, you know? What, I promised this, this patient that I was going to do, that everything was going to be okay– you’re not going to, you’re never going to tell somebody, oh, everything’s not going to be okay right before you intubate them or do anything like that, right? Because you need them to be hopeful, so we’re going to say everything’s going to be okay, even if we remember that five minutes before the patient next door you just died. And that the possibility of you being okay is small, but it’s not zero. Right? And so when they are not okay, then there is this, this, these feelings of guilt of what could I have done differently? What if I was only there five minutes before, would it have done anything different? If I wasn’t off that day, if I was just present, would that have done anything different? And truthfully, the answer is no.

[00:17:21] NP Marina: I think that’s just hard to accept and I think the other thing that really bothered me, so we had have COVID outbreaks in the jail that they would keep the patients shackled to the bed, even after they died. I wanted every, I wanted– I remember very vividly I had a patient who was in jail for something very bad, that someone would say was unforgivable, but they had him shackled to the bed and when he was no longer with us, and I remember begging the security guards to let him be free. And they said it, it’s not, it’s not our problem. He’s a product of this. And I remember covering up the chains with blankets and towels, I don’t know why. I just didn’t think that anybody should die like that. I didn’t think it was fair. At least let him go with dignity, no matter what every patient deserves love and dignity.

[00:18:28] And I left a window open for him and– I’ll never forget this– I took him downstairs to the morgue with the charge nurse, because we’re so short-staffed like, we, we gotta help your team at this point, and we had run out of room in the trucks for patients, and we had a storage unit with a mini fridge in it, some kind of like refrigeration device, And they had built slats and I remember having to physically pick him up and put him in there. And then it was raining and I had to walk across the street to do it, like to bring him over there, and I remember it just being so quiet on the way over there. No one said a word because I think we were just so numb and I think they knew how much it bothered me that even in death, he was imprisoned, like you couldn’t even take the shackles off this man. He has a family, but am I wrong for that? Am I wrong to think that in death, people deserve to continue to be shackled? Like, I don’t feel like I am. I don’t think he deserved that. I really don’t and that bothers me too.

[00:19:55] Dr. JB: Have you been able to talk with anybody, any of the people that you were working with during that time period, or even now? Have you been able to have any semblance of a conversation like we’re having?

[00:20:11] NP Marina: You know what? Not really. No one wants to talk about it. And I honestly, I don’t blame them. I think what we try to, I think what we try to do is like carry on like nothing happens. Like, this is just part of a job. It’s like we continue forward. No big deal.

[00:20:36] There’s one person, I feel like that I am able to talk to, and that’s my former roommate, Corey, from when we were travel nursing together and he worked PICU, so he was seeing kids with COVID. However, we can only, he will only share 30 seconds of what he saw ‘ cause he can’t handle it. And because of all of this, he’s permanently left the bedside as a nurse, he will never return. Not even as an NP, he’s almost done with his NP, he will never return. And I will never go back to a hospital. I will never set foot in the hospital again, I refuse. And I know that’s bad, but I am traumatized like I, like, it’s like, you get to a point where you’re like, all right, well, now what? That was bad. It’s just like a scabbed over wound at this point.

[00:21:36] But I think that people need to start coming forward in healthcare and talking about this because our mental health matters too. And, I have a therapist and it’s been like her hammering me every week to get me to talk about it. Sometimes I can say little things like I’ve said to you today, and other times I can’t say anything and we just stare at each other. So, it’s like, it takes time. It doesn’t happen overnight, but this is the first time I actually shared my story in depth. It’s very freeing, but I can say on a lighter note, that sharing our stories with other healthcare providers and doctors and nurses, everybody it’s very healing because we’re not alone anymore, like we, we felt when we would come home. And I think that’s the biggest thing I want to get across is, I don’t want anyone to be afraid to share their story about working COVID. And that you’re not crazy. And that it’s okay to cry about it. It’s okay to love patients so hard that when they pass away, you’re you’re upset too. That’s allowed .Should never not be allowed because we love them too.

[00:22:58] Dr. JB: Because we’re humans and we’re surrounded by so much suffering, like we’re not robots.

[00:23:06] NP Marina: No. And I don’t know why people think that we are, cause it’s like, we’re expected to like show up, we’re ready to handle the day, no matter what it is, you’ll be fine. But it’s like, you and I are not robots. We, we have very powerful, vibrant, loving souls, even though we contain ourselves in the moment when a patient passes away or things are bad, when we go home, it’s like you fall apart. You do. But I think falling apart is okay sometimes cause then you get to put yourself back together and start over.

[00:23:44] Dr. JB: I think it’s important to be able to have a place and a space to release.

[00:23:50] NP Marina: Absolutely. And I, I want to get to a point where you feel like in healthcare where people can take 10 minutes to regroup for their mental health, no matter what. And I mean, and that means everyone, from top to bottom, every single person who sets foot to that hospital needs 10 minutes to breathe. And I don’t know why we, as a society right now, don’t think that’s okay. Cause I don’t know any nurses right now or physicians or environmental service people who are getting breaks. I don’t, I don’t, I don’t see it. You know, you clean one room, now we need you to clean the other room now. She has a family too. He has a family. Like they need a break, so there has to be a change and we need to start talking about and we need to start sharing what we’ve been through as a whole, as a community in the, in the pandemic, because it hasn’t been so black and white when people are, are having a hard time.

[00:25:11] I can tell you the majority of my primary care patients now are nurses having all these health issues now because of COVID . Back problems, depression, PTSD. You know? And I don’t want, I don’t like I I’ve made it my life mission I feel like right now to offer, like, have a service line for that, those people because there’s just not enough of it. And I don’t care if they don’t have insurance, that’s the other thing. Not all insurances are really covering the bulk of what people need to be mentally healthy. That’s just kind of where we’re at. I don’t know how you feel about it, but I mean, that’s how I feel about it.

[00:26:03] Dr. JB: Well, I am completely aligned with how you feel about it. That is why Hope4Med was created, like I can’t, I can’t stress that even more. Hope4Med was created because we, as healthcare workers are dying. We’re dying literally, high suicide rates amongst us.

[00:26:26] NP Marina: Yep. It’s bad. It’s– I had former nurses, I worked with in Florida who are no longer with us because of COVID and they decided they didn’t want to be here anymore, and that. That’s tough. And we are, we are dying, and that’s not a, that’s not a happy thing, at all. I don’t want this to keep going. I want people to be able to talk about it, come up with solutions and understand that good medicine is, is still here, but we’re all just having a hard time after getting hit for two and a half, almost three years now. I mean, we’re still seeing cases and are still treating patients post COVID, with long hauler, and, and just the– it’s hard to…

[00:27:16] like, I feel like now I definitely, and I obviously, I still like go back and think about, all the things I coulda, shoulda, woulda, but I try to think about it more constructively as in, well, if I would’ve done that, would it have changed the circumstance? Hmm, probably not. But did I make them really comfy before they went? Hell yeah. People yelling at me to get out of the room and that there’s nothing else I can do, just be done. No, I sat there, even if they weren’t a full code and they were on comfort care, I just, I pulled up a chair and my PPE and I sat there. You’re not dying by yourself today. Sorry, it’ll hold your hand before you go. And you know what? I, maybe I put myself at risk for getting COVID doing that because I’ve been wearing the same mask for weeks, but I don’t care. At least I can, if I did get sick, at least I would know that I was doing what the universe and whatever you believe in would want me to do. And that would be to love, no matter what. But I can’t say that I don’t think I would be where I am now doing what I want to do if COVID didn’t happen.

[00:28:41] Dr. JB: What do you mean by that?

[00:28:42] NP Marina: I feel like it made me really, really strong, as painful as it was, because now, like in my practice with my attending, there’s nothing that I can’t handle. I handle it with, with grace and there’s nothing and no one that’ll turn away, because I’m just grateful that they’re alive and breathing and being able to have a conversation with me and that’s something I wanted for so long. Actually opened a transgender care line at my office so people can get what they need without feeling judged because I’m in the Bible belt so not a lot of providers want to help my friends, but I do. And I take everybody, every single person and like, I will never change. I have kids that come in who are in foster care and I pay for all their prescriptions and their visit. I don’t, I don’t care, because I think I realized that life is so short after working COVID and that people just deserve to be loved because you don’t know when your time’s up or when their times up. And maybe then I’ll be judged for that, I don’t care, I’m taking care of people.

[00:30:14] I feel like, I know the last place I worked, it was like, if I paid for patients’ prescriptions, it was like, why would you do that? Now they think that healthcare is free. I knew that wasn’t the place I was supposed to be for sure, but now being where I am, I just feel like is that happy, beautiful place, but I also still struggle with certain things. There are some nights I don’t sleep because I have bad dreams about what I went through, and then there are some days where I hear like a zipper of a bag and I immediately like just freeze in my place and I’m just like, okay, I’m not there. That’s, that’s not what you think it is, it’s just a backpack. And I think it’s crazy that sound like that can like puts you back in that place again, I don’t know if you’ve experienced that, but like certain alarm sounds for a while, like EMS sirens and stuff, really bothered me, but I tried to take each day at a time as I’m sure you are too.

[00:31:35] But my main question is, is how do, how do we get to a point, how do we get here? And when are people gonna realize that I’m not your pandemic hero anymore? I’m a person and a year ago, I wanted to die from what I was doing. Heroes don’t die, or wanna die so I don’t feel like a hero. I feel like a human being, so I’m just glad I was able to share my story without reclusing into a hole for once, which seems to happen often.

[00:32:28] Dr. JB: You know what, I can, what I can honestly say about your story is that you’re not alone. So many of us has have gone through the exact same thing that you’re, that you’ve experienced, have been surrounded by so much suffering, so much death, so many people dying all alone. And we’re left to try to figure this out independently without a community. In our minds, we realized, of course, I’m not the only nurse here, I’m not the only doctor, like intellectually, we understand that, but you know, it’s that being vulnerable with each other, that piece, there’s not a space, or there hadn’t been a space, to allow for that.

[00:33:24] NP Marina: And there hasn’t, and I feel like there should be. Like I feel like we need to be vulnerable, it doesn’t have to always be black and white, down to business, here I am. I feel like we should be able to take each other aside and be like, Hey, do you have. Can you have a snack with me for a second? There’s some things I want to talk to you about. As a rarity to like, find that right now, with the exception of maybe a handful of people. But like I said, I can’t even my best friend to talk about it with me, without him completely breaking down, because he’s terrified to set foot in the hospital again, because he’s dealt with kids with COVID, so I can’t imagine, I don’t even want to put myself in his place, but I can say is that there has to be a shift and I want it to get to a point where we can share stories with each other and also support each other and connect with each other. Because one thing that I can tell you out of the past almost three years, that has not changed in my heart, because I can tell you a hundred percent that people don’t just disappear when they pass away. They don’t. There are too many weird things that have happened like, that I can’t explain like the job I’m currently at, I had nothing to do with it. There was that woman in the parking lot at urgent care, she got me this job. Because the day she passed away is the day that the medical director texted me and was like, oh, Hey, I saw you the other day at, at your job, you, you seemed really compassionate. I know it was her. He got my information for my boss he texted me. And I feel like not all like doctors and nurses believe like always that, there is maybe an afterlife, but I think there is because you can’t tell me that someone who is so vibrant, just disappears, like you can’t,

[00:35:50] Dr. JB: Marina, I can’t thank you enough, just letting your guards down and sharing. I mean, your story is so powerful. You were able to put into words your experience that many people have a very difficult time doing. Your story is going to touch the lives of countless others. And I am so fortunate that you felt comfortable to come on Hope4Med’s podcast and share it with us.

[00:36:42] NP Marina: I appreciate you listening, I really do. I feel like I’ve found a friend, somebody I can share this story with, but anybody who knows somebody who passed away from COVID who’s not in medicine. I just want them to know if they watch this, that I loved them too. I may have not shown it in the moment cause I wanted to support you, but I loved them too.

[00:37:14] Dr. JB: Yeah. Who says a doc can’t rap? D O C T O R J B. The greatest doctor to ever touch the mic. The greatest podcast ever broadcasted or prerecorded. Come learn some. Each one, teach one. I’m done.