Former Hondo nurse reflects on time at NY COVID hospital

By Diane Cosgrove

Anvil Herald News Editor

 

     “Every single person was COVID,” Christine Cosgrove, RN, said of her first day on the job April 13 at a designated COVID-19-only hospital in New York. St. John’s Episcopal Hospital in Far Rockaway was one of many NY general care hospitals which had been redesignated to care for the thousands of corona virus patients contracting the highly-contagious viral infection which became a pandemic and paralyzed the world. She estimates that there were 200+ patients on all floors of St. John’s when she arrived, including those in the Emergency Department.

     A former nurse at Medina Regional Hospital in Hondo, she had been working as an LVN at Brooke Army Medical Center (at San Antonio Military Medical Center) while attending nursing school to become an RN.

     Cosgrove earned her license as a Registered Nurse in February and gave notice at BAMC, after she was hired to work at a downtown San Antonio hospital as an RN. Then the coronavirus hit Texas and her new job was put on hold. As did many across the country, she then found herself between jobs.

     Looking for something temporary until the hospital position was available, she learned of a temporary  “travel nurse” position to treat COVID-19 patients in her native New York. She applied and was offered the job. The day before she left, her aunt called to tell her that her grandmother, who lived in NY, had died of COVID-19 complications. Cosgrove had not seen her since 2011, and had been looking forward to possibly visiting her while there.

     Asked what it was like for her to walk into that hospital the first day, Cosgrove said, “Eerie. Everybody was covered, head to toe – gowns, gloves, masks – you don’t see anyone’s face. All you see are their eyes.

     “The ER was absolutely loaded with people (seeking care for the virus),” she said. “You couldn’t get up close to them,” she said of the difficulty presented by the necessary masks and full PPE (personal protective equipment). “You couldn’t build up much of a rapport with something as simple as smiling at them. They can’t see it.”

     To connect, Cosgrove said she spent time with them and talked with them. All were lonely and frightened, and almost none could have the comfort of friends or loved ones to cheer them. At the time when she arrived, she said about 800 people per day were dying in New York City.

     “The first couple of weeks I was there was right around the peak. Some of the patients required a higher level of care than I was used to,” she continued. “It wasn’t like an ICU or a stepped-down unit (as she was used to working), where we’d do monitoring of patient vitals constantly. 

     “Here, it was patients who weren’t stable for very long. We coded somebody the first day,” she said of one of her first patients, who was dying and had to be revived. “No matter what we did, we couldn’t keep their oxygen level up – their lungs are just too damaged and inflamed. That was a rough one. 

     “The unit that I was in on that first day, was converted from a clinic within the hospital to an in-patient unit, because they needed more room. The post-anesthesia-care unit, where someone goes after surgery to recover, got turned into an ICU – there’s no surgeries going on. They needed that space, they needed those nurses who specialize in critical care to take care of patients. They were converting everything they could.

     “It was when I was going in on orientation day that I saw the refrigerated trucks in the back. Knowing those were there, and why, was scary – to think there were so many people dying that there just wasn’t enough room in the hospital to store them, until the funeral home would come or the family could claim them. 

     “When I did the interview over the phone for the job, they told me that I would have a new N-95 mask every day – and it helped that (NY)Gov. Cuomo mandated that. I asked if we would have gowns and gloves and all of the PPE and they said yes. We didn’t necessarily have all the supplies that I’m used to having, but we worked around it. 

     “That first day was nerve-wracking. You don’t know anybody, you’re an out of state nurse. You could just see the weariness in all the staff members’ faces. They were run ragged, numb, emotionally drained. Numb, that’s really the only word to describe it. The clinics and specialties are closed down, so the residents and internists are pulled in and they are opthalmologists, psychologists, podiatrists – people you normally wouldn’t see responding to codes – because they need so much help. That’s how short-staffed they were. Everybody was ‘all hands on deck.’”

     One of Cosgrove’s Facebook posts from her first days there was sobering. “Today was hard. It was frustratingly scary, things got really hairy, and I’ll admit I went to my car at lunch and cried my eyes out. COVID isn’t the flu, it isn’t like anything I’ve ever seen. I don’t think I’ve ever felt as helpless as I did today.” 

     Her patient was an “older person” with some underlying health conditions, but otherwise was healthy before contracting corona virus. “Their breathing was ‘agonal,’ they were going into respiratory failure, so the doctor decided to intubate them. He put a tube down their throat to have a machine breathe for them. 

     “The patient’s heart stopped nine minutes later, and we had to keep that person there – there was just no room in the ICU for them. I had to take care of that patient, (whose needs were) above my skill level; the doctor was there the whole time. They didn’t do well, they didn’t do well at all, and it took a long time to get a bed for them in ICU. You wouldn’t think an ICU would fill up to where you couldn’t take in  a patient.

     “Their lungs were a mess; when you looked at the x-ray, they weren’t the lungs you wanted to see. You want to see black, because that’s air; their lungs were white, which means there’s stuff in there. 

     “(The patients) coded again, and we brought them back, then had to bring them back again. That happened several times. That person ended up not making it; he passed later on that day, after getting to the ICU,” she said.

     Another Facebook post, from May 28, included a video report from the New York Times, which began, “In early March, doctors at St. John’s hospital in Far Rockaway identified the first COVID-19 patient in Queens. Now, there is an uneasy lull and the staff fears a second wave will come.”

     Cosgrove’s comment read, “This hospital is where I’m working. This Zip code has the second-highest death rate from COVID-19 in NYC. It’s been stressful, emotional, heartbreaking, and every other emotion you can think of.”   

     Comforting patients who had no support people with them was difficult, Cosgrove said. “Sometimes you really even can’t, because things just got so busy – there was so much happening. When you call a code, there’s like 10 people in the room, and the rooms are so small.

“You’re putting pads on their chest, getting them intubated, getting blood drawn so we can see exactly what’s going on. We’re pushing medication, chest compressions, all of that. There’s not a whole lot of comfort you can provide when you are focused on keeping them alive. 

“You tell them, ‘It’s okay, we’ll do our best.’ For the ones that are ‘Do Not Resucitate’ (DNR), you just try to keep them as peaceful as possible. We clean them up, change their clothes. 

     “I had a patient we knew was going to die. The family was able to come, which was unusual for this time.” She said she made sure the patient and the bedding was clean, so they felt presentable. “You make it as easy as possible,” she added.

She recalled another experience. “The patient was a DNR; we weren’t going to take any measures, just comfort care only. She was basically comatose; there was no response. Her daughter had been to see her and asked to see her mother’s face – she had a big, bulky mask on and it blocked her face,” Cosgrove explained.

     “When I got report that morning, they said, ‘She is going to die today.’ There are times when you look at a patient and you know they’re not going to make it, and sometimes you know they’re going to die on your shift, just by how bad off they are.”

 While the daughter stepped out to go to the cafeteria, her mother’s doctor came by and Cosgrove told him of the daughter’s request. “The doctor ordered the little nasal canula and so we put that on her. I called the daughter, but before she got back upstairs, she was already gone. 

     “I had already called the doctor to come back and confirm, because she had stopped breathing. As I was going back to the room, the daughter came and I had to tell her, ‘You need to prepare yourself. The doctor’s coming to confirm that she is no longer here.”

Cosgrove said that looking back over the patients she’d cared for who eventually died, “There were just so many. It got to the point where I just expected that somebody was going to die.It was harder on the ones you’re coding, because you are doing the chest compressions, especially on these older patients. It’s not easy; it’s actually kind of violent.” 

     It was the first time she’d ever experienced losing a patient right before her. “Before this, I’d never even done compressions on an adult. I’d had patients die, just not on my shift. Never me personally. It was after they’d leave my care.  It sucks, it really does. 

“But, I’m going to the ER,” she said of her new position at a hospital in San Antonio. “It’s not something I want to get used to, but it’s something I need to learn to work with. It’s going to happen. Death is part of life. But this virus?

     “Some of the patients have been in the hospital for so long that they are testing negative for COVID, but there’s just so much damage. Some were so bad that they were wearing a Bi-pap, like for sleep apnea. They had to have it on 24/7. They had it on so long that it was causing the skin on their faces to break down and bruise. The only other option they have is to get a tracheostomy,”  a tube placed in an incision made in their throat, which is connected to a machine that helps them breathe.

     One thing that surprised her was patients who experienced blood clots as a result of the virus. “They’d have blood clots in multiple places in their bodies, or there’d be people who had them, but were not normally at risk for blood clots. 

     “We’d see younger people – in their 30s or 40s – who are on 100% oxygen and they can’t maintain their oxygen saturation. They’d be fine one day and the next have a temperature of 104º, can’t breathe and are turning blue. We’d be like, ‘How are you reacting so badly to this?’ 

She didn’t see any of the experimental treatments such as melatonin being used at St. John’s, although she did see Hydroxychloroquine, the anti-malaria drug used, but it was discontinued before she left. 

     Cosgrove said the whole experience left her feeling a little jaded. In one of her final weeks she felt, “It was tiring going back to work knowing somebody else was going to die. I know it’s going to happen in nursing, it’s part of the job, but to have it happen so much definitely burned me out a little bit.

     “It’s going to be nice to have a couple of weeks off before going to work. I  miss my kids, I miss my husband. It’s hard being away from them,” she said. The family stayed in touch with daily video calls and pictures she texted or posted on  Facebook.

“Chris (her husband) was the one holding it all down at home, you know, homeschooling the kids (a fourth grader and second grader at the time) and dealing with the puppies. My dog gave birth a week after I left. 

     “I’ve learned a lot, especially when it comes to critical care aspects of things. I will always feel that a little part of me has died, too, just because of the amount of death. We couldn’t do proper post-mortem care. We just had to bag them and get them out of there, somebody else always needs the bed. And the refrigerator trucks are back there – waiting.”

     Seeing what she saw while in NY, knowing what she does of the ravaging affect COVID-19 has on patients and how rapidly it can spread, she said she’s disappointed with people’s insistance on reopening too quickly. “People who are not here don’t understand. There’s millions of people here – New York is the perfect place for a virus.”

     A native New Yorker, she joined the Navy and moved away, then ended up in Texas married to a Hondo boy she met in the Navy. Being back on the NY streets during the pandemic she said was very surreal. “It was weird to see the city so empty – the ‘City that Never Sleeps.’

     “There’s hardly anybody on the street. Seeing so few people was eerie, because I know how many peoople live here. I know New York; I lived here two-thirds of my life.

    On her time off, she visited Times Square and other familiar places, but all were bereft of the normal crowds. She marveled that the subway shut down from 1-5 a.m., to enable crews to sanitize the cars. “They never shut down the subways! And there’s no trains running (at night) – that has never happened.”

     Now, happy to be home, Cosgrove said she’s glad she went. “I grew up there. Texas is home, but they needed the help. I had my best friend up there with me,” she said of her roommate, another RN who also traveled from San Antonio to work at the same hospital. 

Final thoughts? Just what we’ve been hearing from our local officials. “Wear your damn mask,” she said. "Keep your distance and wash your hands! It’s still out there. It’s not going to be that hard for it to turn into another New York.”

Christine Cosgrove, RN, in full PPE

Christine Cosgrove, RN