Interviewer(s): Henry
Interviewee(s): Willow

Willow: January to March. I really I mean, I knew it was a thing, but, you know, living through H1N1 and Ebola, which we had so much time and education on and we saw like three cases of it a lot of the fellow nurses that I work with we were pretty unfazed. We didn't really think it was going to be that big of a deal.

We thought it was going to be like a bad year of the flu kind of thing.

I think that there's a lot of which is highly incorrect. Obviously, we live in a global society and travel and all of that happens. But I think there's a lot of like, oh, it's not going to happen here.

So probably like in February, I personally traveled to Mexico, February 2020, and somebody was like, Oh, do you think it's going to be a big deal? I'm like, It's probably going to suck a little bit, but like it's not probably going to be that bad.

I'm a very, like, stick my head in the sand kind of girl and deal with the, the consequences later and even like March, like literally the week before they shut down everything and canceled elective surgeries I went to Boogie Nights in Atlantic City, so and partied with a bunch of New Yorkers. So I think it really hit me personally when my friend was like, you need to go and buy food, because I wasn't really watching the news very often because I don't like to watch the news because it makes me sad and my friend was like, You really need to go out and buy food.

There's no food anywhere and there's a curfew. And I'm like, Yeah, I know but I'll be fine. But then when they cancelled elective surgeries, that's kind of when the the It hit me pretty hard. I realized that it was probably going to be a wicked year, where a lot of my coworkers were like, Oh, it's going to be a rough time until May. My college had a whole class dedicated to the pandemic preparedness, which clearly I didn't take super seriously.

But my my professors then my program was definitely like, You're going to live through a pandemic. We're overdue. The way the global situation is, it's going to be worldwide. We need to prepare for it now. So on and so forth.

My organization that I'm working, that I work at and I still work at currently when they said they were going to shut down surgeries, when the surgeon general said all elective surgeries were canceled, they basically said that my job, because I'm an OR Nurse, is no longer needed during the pandemic but they didn't want to pay us. So they were considering just laying us all off and told us that at the beginning, like March 15 they said that we would still do emergency surgeries, but you would only need probably one third of the staff that you actually needed.

And they said we would never do COVID cases, we'd never do an OR COVID case in the beginning of the pandemic. And I said, that's bullshit because people are going to have covered and they're going to get sick and we need to know, you know, if a patient has a bowel obstruction, a large bowel obstruction requires emergency surgery, you're not just going to be like, oh, you're going to we're going to let them die because they have COVID.

But management was sure that we weren't going to do that.

At first they didn't let anyone wear masks at all. Yeah. And then they switched to procedural masks, which are like very light weight O.R. the people that were left, myself included, because we were like a skeleton crew. They basically they said that they weren't going to lay us off after they frightened everybody and said they were going to lay us off.

They realized that they needed us in different parts of the hospital. So they transferred us to other units to help the Covid runners in the ICU or go back to the floors. Because what started happening is one floor, we weren't wearing masks. The only people that were wearing N-95 were OR personnel and ICU personnel. We would get one N95 a week, they would break, and then they would be like, you can try and tie it back together.

Which they're not meant- they're not even meant to be in for 1 12 hour shift. And we were wearing them three days in a row. They gave us little paper baggies to put our masks in so that we could save them in our locker but we were the lucky ones because we were one of the units that was allowed to wear N95s so all of a sudden people were coming in with abdominal pain and then they would start crashing and they'd go in respiratory arrest.

And we realized that the symptomatology was changing and stomach ache wasn't originally like abdominal pain was not originally one of the symptoms, but we realized very quickly when we started getting all these patients admitted for abdominal pain, going into respiratory arrest, going to the ICU and the floor where all the abdominal pain patients were going, all of those nurses were just wearing the small like the very thin procedural masks and doing up close patient care.

And so an entire floor of nurses got Covid. some were like hospitalized for like, like three months.

And then they had to staff that with people who had never been on that floor before.

Yeah.

Henry: Wow.

Willow: Um, they didn't want N95s in the emergency department and so, so sorry.

Henry: Who's they?

Willow: The administrators at my hospital. Administrators. Chief of nursing. The people who… the higher ups, the CEOs, CNOs, all the, the big, the big people. We would get updates every week but then management, lower management and above management would change the rules every 5 seconds. Based on the needs or based on the amount of masks that we were getting. There were mask shortages, but we weren't allowed to bring in our own N95.

I had a lot of friends who got transferred to the emergency room and I managed to procure N95s from very generous friends who said, oh, I know you're like in the hospital. I know there are shortages here. Can, can you use these? And so people started, nurses started grabbing and 95 from people where they could and we weren't allowed to use them because they weren't tested yeah.

And finally in like May they were like everybody needs to wear N95s. So from March to May nobody was. And security staff0 I ended up doing a lot of the fit testing to make sure that the N95 fits properly. So I had to not only do a lot of the people in the hospital, but in the rehab centers and management, like lower management, was still telling people like security, for example security was told not to wear an N95 when in the emergency room with alive patients but when transporting dead bodies of patients who had COVID, they had to wear their N95 which doesn't make any sense because it's a respiratory disease so

and dead people aren't breathing. It's not like Ebola where the bodily fluids were a source of transmission. Um, what else um, khkhkhkh so originally they weren't isolating the COVID patients. They were trying to. But as we, as numbers got higher and things got crazier, it was harder to separate the COVID patients from the non COVID patients. So we, especially in the emergency room because there would be overflow.

So they were trying to put them into closed rooms that are only big enough for one person, but they were being filled two people, sometimes three at a time.

We had a lot of patients really early with O.G. COVID come in. They'd be like 40 years old marathon runners, really otherwise healthy individuals, they would come in and then they would have massive strokes and so we were doing emergency surgery to help unblock the stroke, the plots that were happening. And then we ran out of room in the ICU.

These patients were going into multisystem organ failure, so their kidneys were shutting down, their liver was shutting down their lungs were completely whited out, which means it's just full of fluid and gunk. We were proning. The patients in the ICU. I didn't spend a lot of time up in the ICU, but I did have to go up there to perform ECMO, which is basically a procedure.

It's a last ditch effort to try and get oxygen into the patient's lungs.

So that they can. Yeah, breathe because they were finding it wasn't a ventilation. It was a ventilation problem like the lungs moving in and out. But it was also a perfusion problem. They weren't getting enough oxygen. Even if you were breathing normally, your oxygen levels in your blood were lower… where was I going with this? Oh, so we very quickly ran out of room in the ICU.

And so they started trying to make makeshift ICUs in other places. But instead of thinking about how we were going to do that, management did not think about it. And at the one campus because we have several campuses in the area, the one campus that got hit really hard, they put the I- the COVID ICU through the regular ICU.

So if you had a COVID patient, you were transporting a COVID patient through the non-COVID ICU, and then the nurses and the doctors and all the people around were like This is really dumb. Why did you do this? And so then they had to switch so that the COVID ICU was first, and then they moved the other one to another department completely. Well, then you had to use staff.

So they were asking staff to come in on weekends to just move an entire unit with patients to another area because nothing was thought through.

Henry: Do you remember when that was.

Willow: That was probably April.

Henry: OK.

Willow: Yeah. Um, yeah.

Henry: OK. I mean, this is very interesting stuff, um, where do you work again? So, so just to be clear, if you're directly quoted in this, in this paper, it's going to be under a pseudonym and any reference to your organization is not going to name the organization directly. Mm hmm. OK.

Willow: OK, so I work at [hospital]

Henry: Is that in PA or New Jersey?

Willow: New Jersey, we're the New Jersey branch of [group]. So but we're really technically a small we're three there's a set of three community hospitals that were part of the [group] system that got bought out by [group].

Henry: And you're an OR nurse, correct?

Willow: Correct.

Henry: And that's what you were doing in January. 2020?

Willow: Yep. Yeah.

Henry: So we can you've already answered many of my questions, but I feel we can go back to them just in case.

Willow: Yeah. Yeah.

Henry: So can you tell me about when you first heard about COVID.

Willow: It was probably January, I remember hearing about it on the news like I said, I don't watch a lot of news but I mean, I was looking at it but and this is also a thing I think that I feel is kind of common among nurses in general. It might not be entirely true, and maybe I'm just a little more blasé, but you're kind of always like there's always going to be a thing, you know, like every other year, flu is terrible.

So I just thought it's bad. And, you know, a lot of the information that we were getting I feel like wasn't necessarily we weren't getting the full picture of like the ICU until like maybe like February, like late February, early March. Like we started hearing stuff. I did get a little concerned when I heard about New York City but I just never really thought that it would be so bad you know, as an O.R. nurse, like you think your job, I'm always going to have a job.

I'm always going to have something. There's always surgery to do. I think that's like when it really hit me, like, this is really bad. Like we do not have beds and staffs and ventilators and and anesthesia staff. We were still doing emergency surgeries in March and April and May and you would hear COVID, you know, protected, protected respiratory alert, ICU, or protected airway alert, emergency room or whatever.

And what that meant is a COVID patient needed to be intubated. And so the people that intubate are anesthesia personnel. So normally typically you might have two at my hospital. You might have to intubate one or two people a week in the emergency room. We're not a level one trauma center. We're not like a community hospital. We're not dealing with like patients that are gunshot and stuff like that.

When we have a trauma alert in the hospital, the trauma alert is not really a trauma alert. It means that the patient is dead and somebody just needs to come down and pronounce them. Whereas at my old hospital, we would have the patients like chest cut open, massaging the heart like we don't do that at my hospital. That's just not that's not us.

But you would hear these protected alerts and then anesthesia would have to go running to all over the hospital to intubate these patients. So we would be sitting in the O.R. with a patient, and we're like, we can't go to sleep yet because we don't have the anesthesiologist. Like, we don't have staff. We couldn't do cases even though they were emergent because somebody was literally dying on another floor and needed to be intubated.

Yeah. And that's when it was like, oh, OK. I get, I think yeah.

Henry: So can you describe how you were feeling about this time?

Willow: Oh, complete and utter panic.

I had just finished my master's program and I was super exhausted and tired and I had put on a lot of weight because I had emotionally eating. So I was really unhealthy in March. 2020. And so I panicked because I was like, I am not in good shape. I know I'm young, but I'm not in good shape.

I work with a lot of older women and they were afraid to go around COVID patients, so they'd always shove all the younger people to go do the COVID case kind of things.

And yeah, they just thought, Oh, I'm going to get it and I'm going to die. Like, that's what I thought. that anxiety probably lasted like that. Intense anxiety probably lasted for like probably till May.

I was sleeping maybe an hour a night so at one point I was I was working in the O.R. and then I go home for a little bit. They cut our hours, so they cut my hours for 36 hours to 32 hours. But then they asked, I ended up making more money because they would have you do other things. So I would complete a shift in the O.R. and then I would maybe go home for a couple of hours, eat something, and then like, come and work all night.

Not anything like crazy it was like they needed one to ones because the people that do one to ones on psych patients, were like, getting COVID and I just figured I'm going to get COVID. So once I got past the like, the super anxious phase, it was better. Like the summer, it was OK, because I felt like you know, you're outside, I felt better being outside with people and doing things like that.

Like I didn't go do stuff inside or anything with people, but like if somebody invited me over to their pool, if it was like my coworkers, I'm like, well, we're eating lunch together in the same lunchroom right next to each other. A lot of my coworkers got COVID from the lunchroom and then they didn't fix the lunchroom situation until like October of 2020.

They were like, Oh, people have been getting sick. Yeah.

Henry: OK. So, OK, so I'm going to come back to this, these organizational management issues. But you've mentioned that you've mentioned that you, you heard about it and you thought that you didn't think it was that big of a deal initially.

Willow: Initially.

Henry: And then you then at some point you realized.

Willow: In March.

Henry: Can you talk about that transition at all?

Willow: It's when we started seeing it, that's when we started seeing it.

It's when, like I said, every there would be like seven stroke alerts and an hour and the anesthesiologist would say, Oh, it's another 40 year old with COVID it was when you could look at the bed board and you saw the emergency room was just red with like the biohazard symbol. And you could like scan over it. Like, I'm not looking like it doesn't show patient names, but it shows like basically the status of the hospital when they started talking about taking the recovery room and using the recovery room as an ICU, they were going to take our ventilators from the O.R. and put them in the in the recovery room.

When the refrigerator trucks came, when we started getting O.R. patients that were super, super sick and they were like, the only thing that we saw was COVID. yeah. It was just like everything hitting the fan at one time. And then it got better for a while in the summer. Like, numbers got better in our area.

But I knew that once the weather got cold and things got you know, when fall came, fall is like my favorite time of the year. Halloween is like my favorite. I usually love it. September 2020. I was crying like every night because I was like, I don't want October, November, December like, I don't even want those months to come.

Because I knew people were going to start, like, gathering inside again. And just like the flu, the flu starts you know, flu season starts like November, December, sometimes October. And I just knew that COVID was going to be like that. But like way worse, you know, yeah. Oh, when I went up to the ICU, that's how I knew it was bad, too.

When I personally was going up to the ICU and I work at a community hospital. A community hospital ICU is nothing like a trauma ICU. Like you. You'll never, almost never see a walkie talkie in an ICU in a trauma center. Like everybody's intubated on a ventilator. But at my hospital, you have walkie talkie patients like they're not as sick.

The acuity level in my hospital is typically not as sick as a trauma center or like a big a big university hospital. Usually if you're really sick, you're skipping us, you're going to like a big center but when I went up there, it looked like a trauma center ICU. Everyone was intubated, everyone- the hemodialysis machines were outside the door with all the lines running into the patients.

I've never I've never seen a hemodialysis machine on our ICU floor until COVID. And then they were everywhere so that was like, oh, shit. Yeah.

Henry: So did your hospital do anything to prepare for this? Like in January, February, March?

Willow: Um, they would send out emails saying like, we're looking at the situation. That’s like about it. Then when March came around, they were like, We're looking into the mask situations, we're looking into purchasing masks and N95s. There was an alcohol like hand sanitizer shortage. They were looking into getting sources for that. It was a lot of discussion on PPE, trying to get PPE. There was a lot of emails regarding that, but a lot of it was just like, Oh, we haven't secured anything yet.

Or We're working on it. Or We did purchase things and but they haven't arrived yet due to shipping issues.

Yeah. So there's a lot of stuff like that. The O.R. did at the behest not of our hand or not at our management, but at the behest of our staff. Developed COVID policies based on AOA and which is the Perioperative Nurses Association recommendation ones that were coming out at the time. our O.R.s are all positive pressure. So basically it's the air movement pushes out and the idea is right.

Generally speaking, it's supposed to keep germs away from the field but in the case of COVID right, we're pushing COVID everywhere and a lot of bigger hospitals, they have the ability to individual O.R.s have the ability to change from positive pressure to negative pressure. We do not have that ability so they determined that we had to get special filtration systems and we blocked some of the doors, which is like totally a fire code violation.

But I you know, and so we had whenever we had a COVID patient, we would have to use these filtration systems and we had a whole policy in place on what to do specifically for COVID O.R. patients. my immediate manager has diabetes, and she said that she was immuno compromised due to her diabetes. And so she managed from Zoom for a year and a half year.

Henry: The one who told you not to wear N95s?

Willow: Uh huh, yeah. Yeah. Yeah. Well. Mm hmm.

Henry: Did anyone discuss that with her?

Willow: Oh, at length at length.

We had one nurse that took over. So that manager was the director of Peri or is the director of Peri Operative Services so that includes pre-op area O.R. and the Recovery Room, as well as endoscopy. The Endoscopy Suite and IR- interventional radiology. And so the O.R. specific manager was one of our nurses, and she she came in during the pandemic, and she was really great about, like, making sure that we got supplies where she could. She fought for us.

So say if we had 2 hours of work, the boss above her would say, you have to go home after 2 hours. And we're like, can we help somewhere else? Because we can't live on 6 hours a week with so she would try to send everyone home. But Maureen, who was our manager, was like, You can't do this to these people.

Like, they're not even going to qualify for health care if you if they don't work a certain number of hours. So you can't you can't do that to them. They people have homes and families and children, and they can be used elsewhere in the hospital. Like, why are you not utilizing your staff when other people are drowning? We are a very specialized type of nursing.

We're very different than every other type of nursing. So it doesn't always translate very well to other departments, but there's always a use for us somewhere. Yeah. So she was on her zoom calls, making her money, telling us all to go home after 2 hours.

Henry: Sounds like Maureen was trying to get the hospital to do more.

Willow: Maureen was great.

Henry: Especially in the but- in this in this pre-crisis phase, from January to March, was anyone sounding the alarm?

Willow: Not not really. No. There was one doctor that I talked to from the ICU that I know, and I was like, What are your thoughts? And he goes, I'm not sure, but I don't have a good feeling you've like. I'm hoping that it won't be bad, but I think it might be bad. ‘Cause he knew people up in New York. I mean, the people I work with are not very well educated though. we had ten call outs because the booster shot was due and nobody wanted to get their shot because ‘Merica and Freedom, but really.

Henry: Right OK, but you know, if this one doctor was trying to get the hospital to prepare better.

Willow: I believe that he had spoken with like the director of the ICU about masks but I don't think it went much further than that.

We did start they did start developing a plan for, like I said, isolating COVID patients. But it very quickly, I mean, all the preparation and the minimal preparation that we had done very quickly was outstripped by the rapidity of the amount of people that got sick. They were like, oh, we're going to have this one unit as a COVID unit.

And at one point there was only one floor out of the entire hospital that wasn't Covid. And then we ran out of room there. And then they started talking about taking like like our education rooms and putting beds and stuff in there. But there aren't oxygen hookups- the amount of effort that it would take to take an education room to make it into a room where a patient could be hospitalized is just not particularly feasible, y’know?

Henry: OK, so in the period from January to March, though, what do you wish that they would have done differently?

Willow: I wish that we had started getting hand sanitizer, PPE, masks, visors, just all the that's the stuff that we ran out of very quickly.

And we had to lockdown a lot of our stuff. We installed locks in the O.R. in like the storage areas because people were coming up. They knew where like cleaning alcohol, like like the cleansing cloths, like the chlorhexidine stuff that we use and like we didn't even have stuff to clean the O.R.s at one point. Like we didn't have like to just even clean or like they had stuff, but it was like it wasn't strong enough.

You know, you need a percentage of alcohol and the stuff that we were getting was 50%. So I'm just like, we're just spreading stuff all over. And this was at the point where we didn't know, you know, I had heard we had heard, you know, they were finding viral material in cruise ships on surfaces and they weren't sure if that was contagious.

At the time. So we didn't we had no idea we had no idea all the ways of transmission. It ended up being less horrible than we like transmission wise, like ways we could get it. You know, it was was like from the groceries.

Henry: At least there was no fomite spread.

Willow: Right? Yes, exactly. Exactly. Which we weren't even sure of that at the beginning. We ran out of gloves. We didn’t have gloves.

Henry: So you were following the cruise ships then?

Willow: A little bit.

Henry: So how did that whole saga make you feel?

Willow: I was pretty this pretty. Pretty it was pretty it was pretty nerve wracking. I I kind by whenever they started saying that, that, you know, they weren't seeing transmission. They were only seeing it like respiratory kind of issues, like seeing it transmitted that way. I relaxed, but for a while, I was just like you know, it was like the girls that I work with would, like, put on a glove to, like, touch the elevator button to get out of the hospital.

Or they'd like alcohol like every surface. And I'm like, but now we don't have any not going to have any cleaning products because we're like wiping down the elevator every 5 seconds.

I started following when everything when the curfew when the curfew happened. and like because Montgomery County was the first one in our area in P.A. to have a curfew.

Henry: When was the curfew? I wasn't in PA.

Willow: It was so it was right before I forget what the date was. I think it was March 13th, but the that the surgeon general was like no more elective cases. I think it was probably like March ninth or 10th. Yeah.

Henry: That I didn't realize you had one there. I mean, that was before George Floyd then yeah.

Willow: Oh, yeah, yeah, yeah. Hundred percent.

Henry: OK, my timeline is a little off.

Willow: I'm pretty sure, because that was the first thing. Montgomery County shut down very early.

Henry: OK. So you mentioned your own original, your own personal behavior in this. You know, maybe some risks you took. Is there anything you would've done differently as an individual?

Willow: Hmm… I am comfortable with the risks that I took. Like I said, it was kind of we did our own pod thing so… and it was only during the summer that I saw these people and they were people I directly worked with. Like I said, we were outside. We were literally like putting our chairs like six feet seven feet, eight feet, like in a circle or whatever and hanging out or whatever that way.

I don't feel bad about it, but I know my mom and my dad were really mad at me they're 73 and 71. They both have multiple comorbidities. I would be like, I want to hang outside they hated that. They said I was being a drama queen.

We got in very many fights. We didn't talk for a while.

They just lived their life like nothing happened, like nothing was happening. My mom was like, I can't wear this mask. I can't breathe. they're still not vaccinated, which makes me crazy. But I can't. They got Covid twice.

Henry: (sarcastic) They're extra immune.

Willow: Yeah, that's what they keep telling me.

Yeah.

Henry: So I have a few wrap up questions. I mean, you've really been extremely helpful. Your like, really some that your whole story really has is really good guidance on where I can head with this project. So just to wrap up, what would you like to tell me about the way you felt in early 2020?

Willow: I like I said, I was absolutely terrified. It made later on in the pandemic, particularly around holidays. That Christmas made me really angry. I don't even really like nursing anymore. I don't want to do this anymore. I was already not particularly happy. I had done my master's degree. It was a lot of work and it didn't feel like it was worth it for me.

And then I feel like this whole experience showed me the futility of health care. I always knew it but you know, you take care of a person, a drug addict, for example, and they keep coming back. We keep treating them for whatever abscess they have, broken a needle in their arm, whatever or you have a patient who we're doing a cabbage, a heart, heart surgery on because they ate like crap for 50 years.

And now we're doing that. We could have prevented this and we didn't and now we're just fixing the complex or the, you know, the the consequences of people's actions. So I always knew that that was the case, but but it didn't affect me because you couldn't get me sick from your choices and we would have patients that went to Christmas and we're like, I'm going to do Christmas with all my family.

50 people. And then 40 of them get COVID, and then I get to spend my Christmas by myself or with the one person that, you know, at the time with [name]. And that was it. He's the only person for the entire pandemic the whole time, like so I got to stay at home. You get to be with your family.

You put everyone at risk, and then you come in begging for help, begging for help. I don't want to help them anymore. So that sounds horrible, but that's the truth of it, because now you're putting me in danger because of your actions and begging me for help and then saying, Oh, COVID is real. Cool. So that's how I feel about it.

Henry: You know, I think that's a really well articulated point, actually. But, you know, like, usually you do this like these surgeries and these people make decisions and they don't affect you. And now they do.

Willow: Yeah.

Henry: OK, is there any is there any question that you think I should have asked that I didn't, that you think I should go into.

Willow: No, I don't think so. I think you did a great job. Thanks.

Henry: And anything else that you'd like to tell me no.

Willow: I think I think I said it all. I think.

Henry: Anything you want to.

Willow: Ask me thing on message. You know.

Henry: I'm might ask you some follow up questions.

Willow: Absolutely.

Henry: But is there anything you that you want to ask me?

Willow: You know, just I want to I want to hear about the finished product product when you're all done.

Henry: For sure. Yeah, yeah, yeah. I'll send you a copy of the paper when the thesis, when it's written. What's your masters in by the way?

Willow: Nurse practitioner.

Henry: Oh, and you can be the one on Zoom next time.

Willow: Yeah, I don't I don't even know what I want to do with my life.

Henry: Must be some way to fake like diabetes. So you say you can.

Willow: Well, it was really funny because my my best friend in the O.R., like, she's lovely, and she's my work wife. She has multiple sclerosis, and her husband had to go down to the E.R.. Her husband works in the recovery room, and, like, she's like, I'm doing all the COVID cases, like, her and I were the COVID. We were the COVID Queens.

And she's like, I have MS.

Which is legitimately like an immune system thing, and you've got diabetes, and you're not allowed to come into work. But I'm allowed to be in the COVID rooms all the time and go to the COVID ICU. She's like, I want to be here. That's not the thing. Like, you know what I mean? It's just the irony, the irony of it all.

And send her husband who could give her COVID down to the COVID ICU. So anyway, yeah, so now none of us got COVID, the three of us.

Henry: Congratulations.

Willow: I Know so far, I mean, my aunt got covid on Easter. So.

Henry: So far so good.

Willow: So far so good. Yeah.

Henry: OK, so thank you so much for this. And it's been nice seeing you happy. I'm happy to see you're healthy and that you're doing OK, I guess. so to speak.

Willow: Yeah. Yeah.

Henry: I'm going to turn off the recording.