It was noon on the day after Rufus’ birthday party, and Amber texted him. “I’m trying to get in touch with Penn. Do know where he is?”
There was no reply. So Amber sent another text to Rufus, again asking him if he knew where Penn was. Again, no answer. So one more time, she texted Rufus about Penn’s whereabouts. When there was still no response, she decided to call him.
Rufus woke with a start when his phone blared the opening guitar riff from The Immigrant Song. Although he loved Led Zeppelin, he swore he would get a different ringtone ASAP. He groaned and wondered who might be calling him at such an ungodly hour. And why!
“Good morning, sunshine,” Amber said brightly. “How does our birthday boy feel today?”
His mouth was bone dry, his muscles ached as if he’d run a marathon, his stomach was as woozy as if it was on an extreme roller coaster, and his head hurt like someone had split it with a sledge hammer. “I feel like crap, caca, Number 2, feces, guano, merde, sh–.”
“Merde. And you said you don’t know French. Très bien!”
They were good friends but Rufus was getting annoyed. “What do you want, Amber?”
“Oh, Rufus. I do feel badly that you have the bottle flu. But you will live to drink another day.” Her tone turned from saccharin to solemn. “I’m trying to get in touch with Penn. He isn’t answering texts and calls go to his voice mail.”
“He was probably smart enough to turn off his phone,” Rufus grumbled. “So what’s so urgent that you’re trying to reach him?”
Amber replied, “I just want to ask him something about this COVID stuff. I was reading about it online and I want to see what he thinks. You know, because he’s a nursing student.”
“I think he’s asleep on our couch. Let me awaken the sleeping prince. Text him in ten or fifteen minutes.”
With that, He padded into the living room of his parents’ house and found Penn, sleeping soundly, on the couch with his clothes still on but his phone turned off. Quietly, Rufus stole into the kitchen and brought out two big metal pans. Then he slunk back to the living room and clanged them together several times.
“Wake up, dude,’ Rufus hollered. Penn stirred slightly but didn’t awaken. “WAKE UP, DOOOD! Nothing. Rufus then sang an off-key rendition of Reveille: “You’ve got to get up, you’ve got to get up, you’ve got to get up this morning.”
Penn weakly opened his bloodshot eyes and groaned. “Is it morning already?”
“It’s past noon!! Wake up! Amber has been trying to get in touch with you.”
Penn muttered. “What does she want?”
“She wants to know about COVID. You’re almost a nurse. You understand this stuff.”
“Don’t worry, old chum. We didn’t drink any Corona so we can’t get coronavirus”.
Penn chuckled at his own joke. “No, seriously, I’m not sure what to think of it. I kind of think it’s going to be no big deal and we’ll return to normal soon. I’m sure my epidemiology professor will be geeking out about it. I’ll email her when I’m coherent. And then I’ll text everyone.”
Later that day, Penn received a couple of emails from State’s College of Nursing. As he expected, his epidemiology professor was psyched, gushing that this was a unique opportunity for the students to learn about a pandemic from the very start. The Dean advised the students that there would be no more in-person classwork, suspending even the clinical practicums for a time. All coursework would be conducted online, and arrangements would be made to reschedule the clinicals without disrupting the trajectory for graduation. Lastly, he read a most intriguing and unexpected email. He and his cohorts would be able to work at the hospital, which would cover the hands-on clinicals, and they wouldn’t have to complete their coursework and be given their midterm grades as their finals. The students opting for this would even be permitted to take their state nursing exams early. He texted his advisor, Dr. Judy Kopper, immediately.
“I am definitely interested in working at the hospital in lieu of clinicals and online coursework. And taking the licensing exam early sounds great!”
“Penn, I am so glad you are going to do this. You’re one of our top students, and this will be a great experience since you want to work with critically ill patients when you graduate. You’ll be in the Emergency Room (ER), so you’ll do trauma and take care of patients with COVID. Can you start your orientation Tuesday?”
Penn thought for a nanosecond. “That sounds great!”
Dr. Kopper smiled at Penn’s response. He was always the first to volunteer and was eager to learn and serve. “Remember, shelter-in-place starts tomorrow, except for essential workers—like you!”
After the text conversation was over, Penn rubbed his forehead, grimaced, and shook his head. Shelter-in-place. Maybe the pandemic wasn’t going to be over quickly. Maybe it would last longer and be more widespread than anyone knew. He went to the refrigerator, grabbed a craft beer and some cheese and summer sausage, and turned on his TV. Maybe the Golden State Warriors were playing basketball. Or maybe there was a hockey game on TV. Great! The Seattle Kraken were playing against the San Jose Sharks. Prudence was an avid Sharks fan, and she and Penn had a friendly rivalry over which team was better. The loser would have to buy burgers and beer the next time they went out together. Rufus liked hockey, too. He found the fights to be cathartic and he liked the opportunity to shout and be as loud as possible. He and Penn also had a friendly rivalry whenever the Berkeley Golden Bears played the San Francisco State Gators, again with the loser having to buy food and drink after the game. It didn’t matter what sport they were playing—football, basketball, hockey—the main point was to see each one’s school defeat the other’s team. Oh, right. Penn planned to text Rufus about the shelter-in-place orders but the Kraken scored and Pru sent him a message trash talking Penn’s team, so he forgot.
Tuesday, Penn arrived at the ER well before his shift began. He wore a freshly pressed scrub suit and a new pair of Jordans, and he was sipping on a 31-ounce iced espresso. He chatted with several of his classmates, including Judy, Beth, and Nancy. Everyone was excited and upbeat about the opportunity to utilize what they’d learned in nursing school—and get paid!
At 7AM sharp the nurse manager, Doris, greeted the students and shuffled them into a conference room where she plied them with doughnuts and muffins. Penn wasn’t sure what to think about her. She was a rather fluffy, slightly messy woman with the demeanor of a spoiled Shih Tzu. This was a nurse manager? She also gave them paperwork that would be necessary for their jobs. They spent most of the morning going over the policy manual, filling out forms, getting their photos taken for their hospital IDs, and listening to Human Resources explain their pay and eventual benefits. Much to everyone’s delight, they would be paid a little less than RNs but once they passed their licensing exam, they’d get RN pay and full benefits.
After an unpalatable lunch of disappointing cheeseburgers and slightly soggy slices of pizza, Doris helped the eager but still-hungry group sign in to the Computers on Wheels, aka COWs, that they would use for charting. All charting was to be done via a new electronic medical record system, the third such software the hospital had had in the past two years. None of the students in Penn’s orientation group had used that particular software, and it took much of the day to introduce it to them. She also got them into the pyxis system. This was a central machine that dispensed medications, thus decreasing errors while ensuring nurse accountability that medications were given to the right patient, the right drug, the right dose, the right time, and the right route. Penn recalled the numerous difficulties he had with the pyxis not accepting his data when he did his clinicals. Whenever he was going to give a medication, he had to get a nurse or his nursing instructor to get the med out of the pyxis for him. He hoped he wouldn’t face a similar challenge now that he was working at the hospital and should be in the system permanently.
Later, Doris assigned everyone to nurse preceptors whom they would shadow for the rest of the week and then act as resources when they started working independently and taking their own patient assignments. She introduced him to Margaret, a former mental health nursing instructor who looked put-upon and annoyed at the prospect of mentoring a student. Penn spoke up, “I’m so glad to meet you and I look forward to working with you.” Margaret muttered something unintelligible. Penn was supposed to follow Margaret for two shifts, and the third shift he was tasked with providing patient care under her supervision. Margaret was off until Thursday on the 7AM to 7:30 PM shift, and she worked Friday as well.
The senior nursing students only worked ten hours that first day, but they were scheduled for 12-hour shifts the rest of the week. Penn was so grateful that he was able to leave at 5:30 that afternoon. He suspected that the hospital hadn’t given him and his peers a complete orientation, but there was nothing they could do without risking their assignments.
On the way out, he encountered Nancy. “That was intense,” he exclaimed. “I hope it isn’t always going to be so crazy.”
“It’s a little overwhelming,” Nancy replied. She was an admirable student, someone with a level head and tons of patience. “Hey, I was thinking about something. Your friend—the one who had the birthday—is he self-isolating? I mean, he was kissing a lot of people that night, and he might have gotten exposed to COVID.”
Penn realized he hadn’t told Rufus about shelter-in-place. He probably knew it by that time, but Penn texted him anyway when he got to his car. “Dude! Do you know about the shelter-in-place orders? Are you isolating yourself?”
Rufus texted him back. “Yeah, I read about shelter-in-place. I’m at home, but Ellowyne is with me. She’s come over the last couple of days.”
“Ellowyne’s there? Is she spending the night?”
“Penn,” Rufus texted, “we don’t have that kind of relationship. Not yet anyway…”
Penn laughed for the first time that day. He texted, “You dog! ”
“All we’ve done is make out a little on the couch. Okay. A lot. But she goes back to her house to sleep.”
Penn furrowed his brows. “You both need to quarantine. If you did manage to pick up COVID, you might have exposed her. So you need to isolate yourselves. Of course, you could quarantine together. Your folks are still gone, right?”
Rufus paused. “Yeah, they are. Ellowyne’s family has been gone for a few days, too, so even if Ellowyne has it, the family shouldn’t be at risk. But I will make the supreme sacrifice and have her stay here.”
When Penn and Rufus finished their conversation, Penn smiled and said, “About time!!”
Penn was grateful to have Wednesday off. He braved the stores to stock up on toilet paper and some surface cleaners. He also picked up some stuff for a care package for Ellowyne and Rufus, since they might not be leaving the house anytime soon. He had text conversations with them as well as with Prudence, Lizette, and Amber. Feeling like he truly accomplished a lot, Penn fell into bed and was asleep by 9:00.
Thursday, he arrived at the ER well before the 7AM shift change. Margaret informed Penn that he was supposed to shadow her and not any of the other nurses. Some of them poach the orientees to help them with their work. Today and tomorrow, you are mine.”
They went into a conference room for the change of shift report. Penn gulped his 31-ounce iced espresso because he wasn’t sure he’d get another chance to finish it. He was right.
Margaret showed Penn where the masks, gloves, and paper isolation gowns were kept. “Yeah, we’re supposed to have rebreather masks but all we have are those flimsy disposable ones. There’s a shortage of N95s because all of the healthcare institutions—and the lay public–want them. I think we should wear hazmat gear but there’s a shortage of that as well. Damn hospital only cares about nice, new construction but should the nurses ask for adequate staffing and personal protective equipment and suddenly there’s no money. I don’t know why you want to be a nurse. It’s the worst job in the world and every day it gets worse.”
Penn, usually a gregarious, garrulous fellow, was subdued and silent when he followed Margaret into the patient care area of the ER. They saw one patient after another after another, which reminded Penn of doing triage. The difference was that most of these patients had COVID. There had been a motor vehicle accident with both drivers and a passenger who had non-life-threatening injuries, and there was a gentleman in his seventies who was having a stroke. Otherwise, the ER and the waiting room were filled with persons presenting with high fevers, general malaise, and respiratory distress. Many of those patients were sent to the Intensive Care Unit (ICU) while others who weren’t as sick stayed in the ER until regular rooms were available.
The rest of the shift was a blur. Other than a five-minute bathroom break, Margaret and Penn saw a seemingly endless stream of patients, all in apparent respiratory distress. They triaged the patients, checking temperatures, administering diagnostic tests, and assessing the severity of symptoms. The sickest patients would be stabilized and sent to the ICU, while those who were not as ill went to regular floors, preferably to negative pressure isolation rooms, which decreased the flow of infectious pathogens to the outside of the rooms. The trouble was that the ICUs were close to being filled to capacity, and there weren’t enough isolation rooms to accommodate all the patients with suspected COVID. Penn noticed Doris on the phone to other nurse managers, trying to get the ICUs to move their less-critical patients to other floors and the regular floors to empty out as much as possible to provide room for other patients. It seemed to do little good. Some patients ended up on gurneys in the ER halls, and the onslaught of sick new patients continued. It was almost a relief for Penn when Margaret was assigned to the care of someone with a suspected heart attack. Something other than COVID!
The hospital cafeteria quit serving at 2PM, so Margaret told one of the other nurses that she and Penn were taking a break. “A break?” one of them asked. “What’s a break?”
Penn anxiously looked at Margaret and she said, “We’re supposed to get a half-hour meal break and two fifteen-minute breaks every shift. That never happens. We’re lucky to get any break, much less a meal break. Bathroom breaks are few and far between. Everyone laughs about developing ‘nurse bladder’. You’ll see what I mean!”
Margaret continued the discussion about the frenzied pace of the ER when she and Penn got to the cafeteria. When he was halfway through his cheeseburger—which was still disappointing but tasted so very good because he was so very hungry—he asked Margaret if the ER was always that tumultuous. She sighed and said, “Sometimes it’s worse. Multiple vehicular accidents, patients who are drunk or high, drug seekers, patients who have ignored dangerous symptom of stroke or heart attack. We even had a mass shooting not long ago. But you’re an Army medic and have been in combat zones, right? You should be able to cope. At least you won’t have anyone trying to shoot you here. Hopefully.”
Penn choked down the rest of his burger. Worse than this? Worse than trying to save lives in a combat zone? As they headed back to the ER, Margaret advised him, “You might want to bring your own lunch, maybe some snacks. Something you can scarf. But you might want to downsize your morning coffee. We can’t always take the time to make our bladders flatter.”
The rest of the shift was as dizzying as the beginning. More patients with respiratory distress. More patients with fever. More patients who needed the uncomfortable diagnostic nose swabs. The faces, the races, the gender, the age were all different from one patient to another, yet they all seemed the same because they were sick, some of them so very sick, sicker than anyone Penn had ever treated as a medic or a student nurse. Luckily, the shift ended and Margaret told Penn she would see him in the morning. His gut level reaction was to say, I don’t think so, but Penn would never shirk a responsibility. When the shift was over, he got some fast food tacos, headed home, and opened a beer to enjoy with his food. He collapsed in his bed within the hour.
Friday, Penn got to the ER early with two 21-ounce coffees, one for him, one for Margaret. Surprisingly, she appreciated the gesture, but she told him she preferred a lot of cream in her coffee. Penn shrugged. Margaret was indeed a prickly soul. They finished their drinks during the change of shift report. One of the nurses quipped, “Same—sh—uh, stuff, different day.” Another nurse related that at least twelve patients died during their shift and a good dozen more were transferred to the ICU or isolation rooms on the general floors.
He steeled himself for the oncoming shift. Yes, it would be hard work. But he had gotten good sleep and he had popped a few granola bars in his backpack. “It’s not as bad as combat,” he told himself. “It can’t be as bad as combat.”
After he and Margaret triaged over ten patients before noon, Penn started to think that maybe it was as bad as combat.
To be continued…