ABC Post 10--Interview with a Covid/Hospice Nurse in Chicago

For today's post, I interviewed my sister Rebecca. She is a nurse in Chicago. Join us for a glimpse of a specialized medical field and the stories that few of us will ever see.

Please tell us who you are and where you live.

I'm Rebecca, Dorcas's sister.  I live in the southwest suburbs of Chicago.  



Describe your work pre-Covid 19.

I work as a hospice nurse.  Hospice is a service offered to those who medical professionals have determined have 6 months or less to live.  Patients may have cancer, Alzheimers disease, COPD, or a myriad of other diseases.  Hospice is a Medicare covered service that provides visits by nurses, chaplains, medical social workers, and home health aids, also medical equipment like hospital beds and oxygen, and  medications called 'comfort medications' that help with the typical symptoms that come with the dying process.  Our patients can be in privates homes, nursing homes or in hospitals.

My work entails visiting our hospice patients, doing a thorough assessment on them, especially focusing on managing typical end of life symptoms of pain, shortness of breath, agitation etc, as well as providing emotional support to the patients and their loved ones.

I also sign patients into the hospice system, called a Start of Care, as well as death visits when a patient passes.  Up until Covid-19 I was working in the hospital with our hospice patients maybe 10% of the time. The rest of the time I was with patients in their homes or in skilled nursing facilities.    

Describe your work currently. What has changed with Covid 19? What has stayed the same?  

My job description has not changed with Covid-19.  My goal is still symptom management and emotional support of patients and families.  What has changed is that we have a growing number of hospitalized hospice patients who have Covid-19. 

So instead of being in the hospital 10% of the time, I am now there 80% of the time.  And since nearly all of our hospitalized patients test positive for Covid-19, that means that most of my time in the hospital is with Covid-19 patients. 

What is it like for your patients i.e. how sick are they when admitted, and are they able to recover from Covid?

Because they're already in hospice, patients generally don't go home if they're positive for covid. So there's comorbidity-- Covid plus another condition that had them in hospice. 

Many of them come from extended care facilities that don't do this level of care, oxygen and all that. At this point they're way too sick for nursing homes.

So no, they don't usually go home from the hospital.

What is it like emotionally for them and also for you? Are any of them allowed to have visitors? If not, how does that change your work and/or the emotional load for you?

Having hospice patients with Covid adds a huge layer of emotional stress. It's already hard, and the family is struggling, but before Covid, the family would be around the bed, holding their hand.

Covid adds a huge layer of stress for nurses. The patient is alone in the room, with the door closed. You feel like you're all they've got, not only to comfort the patients but being that connection with family.

If you can, you set up a phone call. I had a patient last week who had been married 60 years, and of course they couldn't be together. He had an Ipad, so I FaceTimed his wife. I was holding up the Ipad, and she was on the other end of the call saying, "Honey, I love you! Can you say you love me?"

He could still hear, but he couldn't respond. She was begging him to say that he loves her, to blink an eye or something. But he just wasn't able to. There was such pain in her voice.

Before Covid, I was already being clear with the families about what was happening, and giving support on the phone as needed. But now, with the families not able to see their loved ones, I'm doing lots of emotional support over the phone.

It's a drop in the bucket to what they need, but it's all you can do.

Can you share more stories of actual people and how it's been for them?

One patient I had recently was a woman who was a ward of the state. There was no family to contact, and there was no family involved in her admission to the hospital. The state had assigned her a legal guardian. There was no emotional attachment there, only a legal responsibility for her affairs.

She passed away and there was no family to call, no family to care that she was gone. It was a whole new layer of grief as a nurse.

How do you process all that?

Through a lot of prayer—with the patients and on my own. That burden of being the last kind touch that the person receives, that's very significant. Even though it's an added layer of hard, it's an added layer of rewarding as well

Another of my patients was in the hospital for a surgery, and the family of course couldn't be with him. But he was able to come home. I was doing the start of care at the house when the ambulance brought him home from the hospital. 

Watching him and his wife reunite after weeks and weeks, and being part of that reunion, was just the happiest job situation yet. The man has dementia but still knew who she was. She refused to leave his side. I had to do all the forms and everything right there, because she was staying right beside him. It was so sweet and so wonderful to see them being together after being apart so long. 

How would you describe the Corona virus situation in Chicago at this point?

I don't follow the news and stats religiously, but what I understand is that Illinois has the 4th highest number of Covid cases by state, following NY, New Jersey, and Massachusetts.  The vast majority of Illinois' residents are in Chicago so as a city we are suffering, not like NYC, but still, the numbers are high.

So far in IL there have been nearly 46,000 cases and 2000 deaths.  Most of those are in Cook county in Chicago, which is the county we live in.  The hospital where I work has about half of the inpatients testing positive for Covid-19.  So far, there have been enough ventilators and PPE to go around, though we do ration and reuse PPE that normally would be considered disposable. 

First one wing was all Covid patients, then a second wing, then a third, and now half the hospital is Covid. This hospital has about 400 beds, so about 200 are Covid patients. Most of them are in their 50s—not elderly. The youngest is 28. Thankfully, most are recovering.

We try to keep the hospice patients in their own areas. We have our own hospice office at the hospital. 

We're always interacting with the nursing staff and doctors, giving voice to our patients and making sure their symptoms are being managed.

Covid just makes an added layer of stress for medical workers in every way. For example, you wear extra layers of PPE, but still everything you touch is dirty. Like I'll have to write something down. OK, now my pen is polluted. Or I need a bandage. I can't run get a bandage from the supply closet without taking all my gear off. It's challenging! 

Anything else you want to add would be great, just a view from the inside that those of us holed up at home might not think about.

This affects so many people at so many different levels. I did a death visit, and the son had tears in his eyes. He said, "I can't even buy flowers." They can't have a funeral either of course. He said, "My mom would have wanted flowers."

The fact that so many elderly have Covid makes me wonder if we have all been exposed, especially since the elderly that live at home hardly see anyone, and somehow they were exposed. I do feel that social distancing is important, though, because I recognize that we have limited ventilators and ICU beds. If we're all out together we can overwhelm the hospital capacity.

With my job, though, you're with people all the time, and there comes a point where you can't protect yourself any more.

How do you reconcile yourself with the danger?

This job has been a dream of mine for many years. It's been a huge gift to me—I love my job. I feel like I'm here for such a time as this. I believe the Scripture that my times are in his hands.

I'm not cavalier—I'm very careful—but I don't feel anxious.

How can we pray?

For me, you can pray for my safety, that I won't get sick. For physical and emotional strength to hold up. And that I'll be able to have compassion and care for patients well.

For Chicago, you can pray for the curve to flatten and the numbers to decrease. The numbers are still really high.



Thank you, Rebecca, for all you do, and for taking the time to give us a glimpse of your work world. Blessings to you and all the others like you.