Welcome to the Masquerade
Here, where I am, everyone wears a mask. The doctors are masked, the nurses, the staff, and the patients, the non-intubated ones, that is. This one, the one I am tending to now, is on a ventilator; he has tape around his mouth to keep the tube in and his tongue out of the way.
To care for him, I have to don an isolation gown and gloves and bunny shoes and put a personal air-purification respirator over my head, a big white dome with a respirator hose going to a machine that’s strapped around my waist. It makes me feel like an astronaut treading on the surface of the moon.
I keep my mask on underneath the helmet. I wear a surgical mask over an N95 mask that fits my face so tightly it leaves lines and creases on my skin. My fellow nurses and I call them ‘mask wrinkles’ and wonder if they will be permanent. We’re afraid we’ll look old before our time.
‘You’re no beauty rose, either,’ I tell my patient. He’s exhibiting signs of macroglossia, meaning his tongue is pretty swollen. It protrudes out of his mouth, lolling off to one side of his breathing tube. It looks like he’s sticking out his fat tongue at me. ‘Read my lips, buddy,’ I tell him in response, which, of course, is impossible because I am masked. Seriously, though, I am alarmed by Dan’s appearance. I am concerned that his swollen tongue may compromise his airway.
Covid-19 brought him to my hospital. Dan was transferred to the ICU after his pulse oxy declined precipitously and he became hypoxic, meaning his brain cells were beginning to die. We had to get him on a ventilator right away. He was given a sedative before we threaded the breathing tube down his throat and past the vocal cords into his chest. Now, he’s poised somewhere between delirium and unconsciousness.
Sometimes Covid patients build up a tolerance to the sedatives we give them, causing them to go in and out of consciousness. When this happens, when they enter this twilight zone, they grow agitated and anxious. Some may even need to be restrained to keep them from pulling out the breathing tube. They place a constant strain on nurses like me who are dealing with an overflow of patients during this pandemic and can’t always be at their bedside to boost their medication.
Agitation is in the air. You can feel it. I feel it. Dan is its poster child. His arms chafe against his bed restraints. His body shudders with every breath he takes.
‘Takes’ is the operative word. The ventilator pushes air into his lungs and it pushes air out. The diaphragm and the intercostals don’t play the same role that they do in normal breathing.
I murmur some words of encouragement to my patient. He just keeps sticking out his tongue at me.
I understand where he’s coming from, but it’s not like Dan and I are pals. We haven’t had a chance to talk, to really get to know one another, and his blinks don’t correspond to any code I know. I wasn’t born yet when that American POW used Morse to blink out ‘T-O-R-T-U-R-E’ during a North Vietnamese propaganda video, but I’ve read about it, and that guy could teach old Dan a thing or two.
In lieu of that kind of nonverbal communication, or a heartfelt chat, what I’ve come to learn about Dan, I’ve gathered from his chart.
His chart says he’s 36, a year older than me, but still quite young for a coronavirus patient.
The first one, the very first Covid patient they brought here, was 84. He and his wife contracted the disease in a nursing home. The wife survived; the husband didn’t. She was still in quarantine when he passed; consequently, he died alone.
I infer that Dan is single: his chart lists his sister as his emergency contact. Because of Covid, she isn’t allowed to see him.
I pat Dan on the arm with a gloved hand just to let him know someone is here.
Unless he’s especially intuitive, which I rather doubt, Dan knows even less about me than I do about him. All he sees of me are my eyes. The eyes are supposed to be the windows to the soul, but I’m not sure Dan thinks I have one.
I’m the warder who keeps him imprisoned here. I’m the evil bitch who shoved a plastic hose down his throat and put him in bed restraints.
Dan doesn’t know my name because he can’t see my badge. It’s pinned to the scrubs I’m wearing underneath my isolation gown. He can gauge my height and my weight, I guess.
I’m not as fat as I look in all of this PPE.
I used to care about my appearance. I used to really care. I used to look forward to changing out of my scrubs and putting on something chic and sassy once my shift was over. I looked forward to letting down my hair. I used to like to go out with friends after work, have a couple of drinks, and flirt with guys at some bar.
Not anymore. The bars are closed, and all of us are afraid of catching Covid.
When I was new to nursing, I used to worry about needlesticks. They can give you hepatitis, HIV, and a bunch of other diseases. Over time, I learned to relax and didn’t worry so much about getting pricked. Now, patients like Dan have given me something brand new to worry about.
Now, after my shift is over, I go straight home. I don’t even shop at the grocery anymore. I have the store deliver or I do kerbside pickup. Most of the people I come in contact with wear masks, thank God, but there’s still plenty of risk. Sometimes, the masks slip, revealing the dorsum of the nose, the columella and the philtrum. Sometimes, people just don’t know how to wear them, forgetting to cover their noses or letting the masks dangle below their chins.
Then, too, there’s always the danger of bumping into an anti-masker, one of those real fun-loving types who think personal freedom is a licence to spread disease.
I don’t know how Dan caught Covid. He probably doesn’t either. Maybe he got it at some super-spreader event. Maybe he caught it from a colleague. Maybe he just happened to be in the wrong place at the wrong time.
I hope and pray he doesn’t pass it on to me.
I’m starting to think Dan and I are a lot alike: We’re both living inside each other’s nightmares.
I live alone. I live in my own separate solitude. I was married once, but it didn’t work out. Fortunately or not, my ex and I didn’t have children. I used to think I’d like to have kids, but now I’m not so sure: the pandemic has heightened my fears for the future.
Meanwhile, my biological clock is ticking. I would like to meet someone, to be in a new relationship, but it doesn’t seem likely now that Covid is rampant and I’m working 12-hour shifts.
In my free time, when I have some, I am learning to speak Italian. I had planned to visit Italy before the pandemic started. Now, of course, that’s on hold. In March, I was listening to News in Slow Italian when I heard about a nurse who killed herself after she developed symptoms of the virus. A fisherman found her body in some reeds in the Piave River. The nurse worked in an infectious disease unit at a hospital near Venice, which is one of the places I had planned to visit – the city, not the hospital.
I wonder how she killed herself. I know she drowned, but I wonder how she did it. I wonder if she put stones in her pocket to weigh herself down like Virginia Woolf did when she walked into the Ouse or if she threw herself off a bridge like the poet Paul Celan did when he jumped into the Seine.
I don’t wonder why she did it. I don’t wonder about that at all. Burnout is at an all-time high in my profession. We’ve all sunk down, as Paul Celan said, into the bitter well of the heart.
When I’m not studying Italian or brooding over fate, I read. My tastes, as you might guess, are eclectic. I’m drawn to Gothic novels and hysterical, I mean historical, period dramas. I’m currently reading The Betrothed, an English translation of a famous Italian novel. It’s a love story set in Milan against the backdrop of the 1630 plague.
I don’t think I will find romance during the coronavirus pandemic.
‘Hey, buddy boy,’ I say to Dan, ‘Covid has brought you and me together.’
When I first became a nurse, I worked bedside on a trauma unit. Later, I did a stint in the ER. I also spent some time in a telemetry unit before coming to the ICU and getting certified as a critical care registered nurse. Surveying my career, it occurs to me that I’m a bit like Prince Prospero in that Edgar Allan Poe story, the one about a fancy masquerade ball. In Poe’s story Prince Prospero walks through a series of rooms in his castellated abbey, each room packed to the gills with costumed guests, until he arrives at the last one, where the avatar of Death, robed and masked, is waiting. For me, the ICU is like the last room in Prospero’s abbey: I hope to finish my career here, but for some of my patients, it’s the last place they’ll ever see. Death stalks the room, waiting to take its mask off and reveal itself.
Just not today. AQ