By Mary-Kate Appanaitis
Ema McCool takes a deep breath behind her mask knowing it will be a while before she can escape the feeling of being smothered.
She puts on elastic shoe covers over her scrubs, a surgical gown that ties behind her neck and behind her back, a scrub cap over her hair, two layers of surgical gloves, an N95 face mask, and a large plastic face shield.
Antiviral wipes in hand, McCool pushes the door open to check in on one of her several patients. It’s a one-sided interaction. Her patient is intubated, silent, and motionless. The only noise in the room is the shuffle of her shoe covers against the sterile floor and the persistent whirl of the ventilator.
McCool takes the patient’s vitals and updates the medical chart notes each day; continually becoming less hopeful as the damage of COVID-19 spreads and worsens.
McCool observes that the patient’s oxygen levels are lower than the day before. Aware that the patient’s time is most likely coming to an end, she prepares for the bed transfer, the paperwork exchange, and the new file that will be placed by the door when a new patient will be brought in.
When she signed up for her job, she was not expecting to become the last face that many people would see in their lifetime.
As a junior at North Carolina State University, aiming to become a physician’s assistant, McCool knew she needed hands-on experience in hospitals.
In a dark stroke of luck, Duke Hospital was desperate for positions.
The pandemic spurred a healthcare worker shortage, and the need was felt sharply throughout all units. McCool applied in September of 2020, and by October she made the first of many half-hour drives from her Raleigh apartment to the hospital in Durham.
On her first day of work, McCool arrived at Duke with no information other than the building address and her agreement to work as a nursing assistant.
She accepted the position knowing there was a high possibility that she would be around COVID-19 patients in any unit that she could be placed in, but her suspicions about her proximity to the virus grew as she greeted her new colleagues.
McCool quickly figured out that the procedures she was learning in her orientation were far beyond the scope of standard COVID-19 policies in hospitals. Extensive personal protective equipment covered all the features of her colleagues around her, leaving only their exhausted eyes visible.
Her group leader solemnly confirmed her worries. She would be working in the SICU.
The SICU, or Surgical Intensive Care Unit, acts as an overflow unit for patients affected by any illness, but in recent history, it has been teeming with those affected by the coronavirus.
When Duke’s hospital beds are full, those who have missed the cut-off are sent to the SICU. They remain there until either another bed has opened, they have recuperated enough to leave, or most likely, until they have passed.
While her family beams with pride at the work she’s been a part of, her roommates did not feel as enthusiastic.
Two of McCool’s roommates moved out by the end of the month in fear that they may be infected by McCool possibly bringing home COVID-19 from the hospital.
Despite all the precautions taken by McCool at her job, her four-person apartment shrank.
Hospital clothes were discarded in the parking garage before leaving the hospital, masks were worn indoors around others, and once home she immediately showered and placed all potentially contaminated clothes in the washer. But the fear of the coronavirus was too strong.
Over the past 11 months, McCool has watched a never-ending stream of patients come in and out of the SICU. As soon as a bed becomes empty, a new patient has arrived to fill their place. There is no time to mourn, or to process the loss, before another patient in failing health is placed into care.
Though she has accumulated notebooks full of knowledge that will set her ahead for her medical career, one of the most important skills McCool has obtained is the power to compartmentalize.
Every element of the SICU is overwhelming. Sweltering heat magnified by layers of protective gear, the stinging smell of disinfectant on every surface, and a constant fear that an inhaled breath near a patient was a little too deep and a little too unlucky.
But there is no time for any thoughts other than moving forward and assisting the next patient.
“You just can’t think about it,” McCool said. “You don’t let yourself think about any of the details because if you do, you know that you won’t be able to keep going.”
And so, the three twelve-hour shifts a week simply became another part of her routine.
With NC State returning to in-person classes, McCool’s calendar is strategically outlined balancing homework and studying with patient care. But the ability to separate work from everyday life is growing to become a challenge, as people closer to her own age, 21, are beginning to appear in her unit, requiring her care.
McCool has a front-seat view to both sides of the unfolding story. As a student, she watches as well-intended college parties become hotspots for the very disease that she watches kill her patients.
When her coworkers feel safe returning home to their families, McCool returns to a campus, where she feels there is still a high chance that she could be exposed to COVID-19. As a student, the need to be on high alert doesn’t fade for her when she leaves the hospital, unlike the rest of the staff in the SICU.
She watches as classmates refuse to receive a vaccine, and then appear in line for an overflow bed at Duke, praying for relief from the virus.
McCool’s ability to separate work from her own feelings dwindles with each dreaded zipping noise of a body bag closing, signaling space being cleared for a new patient, and a family’s loss.
A grandfather who spends his final days surrounded by photos of his family, when none of them were allowed into the building.
Zip.
A young mother who asks for McCool’s help in making concrete imprints of her hands, in the hopes that her three-year-old son could try to remember her touch.
Zip.
One of Duke Hospitals’ own workers, destroyed by the disease she fought to save her patients from.
Zip.
The sound of one phase of the cycle ending, and another phase of the cycle beginning. It doesn’t stop.
While the burnout from the work that McCool does may be growing, she has no plans of letting it stop her. Instead, she lets it propel her forward.
She sees each new patient as a new opportunity to help any to degree she can; to use her skills and knowledge to aid those who are sent to her unit when there is nowhere else for them to go.
She puts on her personal protective gear, sanitizes herself and everything around her, and prepares herself to do her job – to take care of her patients.
One more deep breath in, and she enters the next patient’s room.
Edited by Jake Jeffries