With the number of confirmed COVID-19 cases rising rapidly in the Philippines, our frontliners are working harder than ever to fight this global pandemic. But what’s it really like when you have to deal with this problem on a daily basis? We asked Mish Evangelista, a Filipina staff nurse who works in the Cardiovascular Unit (CVU) of a local hospital, to describe what it’s like to be on duty before the outbreak and once COVID-19 cases started escalating.
A typical night shift before COVID-19
4:00 – 5:00 p.m. I wake up to my alarm, take a bath, and get ready for duty. I usually bring a tumbler filled with water to work, pati na rin extra snacks.
5:00 – 6:00 p.m. If my dad is available, he takes me to the hospital, but most of the time, I take a jeep. The travel time is around 30 minutes to an hour, depending on the traffic. I grab a cup of coffee before I clock in and drop by the chapel to ask for guidance before my shift.
6:00 p.m. – 6:00 a.m. The CVU has a maximum of six patients who require a Level 3 to Level 4 nursing care—these patients *need* to be monitored by a nurse. One nurse can only handle three patients (max). In one shift, our staff consists of two bedside nurses, one charge nurse, and a nurse aide.
The charge nurse carries out the doctor’s orders and relays everything that happens during the shift; the bedside nurses are the ones who monitor the patients; and the nurse-aide helps the nurses in accomplishing their tasks.
As soon as a shift starts, outgoing nurses endorse the patients assigned to them—their history and everything that happened in the prior shift. Next, there are initial rounds—taking vital signs (which is done every hour and/or as needed), turning patients so they don’t get pressure sores, and cleaning them, if necessary. We feed them either orally or through gastrostomy tubes every four hours. The telemeter helps us in identifying abnormal rhythms, so when the alarm goes off, we rush to the patient, assess, and relay to the resident doctor for treatment. We also always have to make sure that the patients’ medications and supplies are complete.
Final rounds are done at around 6:00 a.m. the next day. When I clock out, I usually drop by the hospital’s chapel to thank the Lord that the patients are stable and that no one died on my shift.
Friday, March 13
I am aware that there’s been a rise in COVID-19 cases, so I wear a mask for protection. The gravity of the situation doesn’t sink in until the first person under investigation (PUI) is admitted in the ICU—which is just a door away from our unit. The patient, a healthcare provider, eventually tests positive for COVID-19.
4:00 – 6:00 p.m. I get ready for work. My dad offers to take me knowing there’s probably traffic due to the anticipated community quarantine. I grab a coffee and clock in for duty.
6:00 p.m. – 6:00 a.m. I am the bedside nurse handling three patients, doing the usual routine. We all know there is a PUI waiting for his swab test results in the ICU (our sister unit, so the ICU and CVU staff, including the doctors, just go back and forth). We aren’t bothered because the patient has his own room.
PUI 2 got in contact with PUI 1 weeks before they got sick, and they are both healthcare providers.
Then we get a call that another PUI will be needing intensive care and monitoring so he is immediately brought to the ICU. PUI 2 got in contact with PUI 1 weeks before they got sick, and they are both healthcare providers. Proper and complete PPE’s are provided. What makes this night more frightening for is that my boyfriend is the ICU nurse. He’s taking care of both of them.
7:00 a.m. I get off duty. My boyfriend has to change his clothes so he doesn’t infect anyone outside of the hospital. We both wear masks and practice physical distancing from each other. I go home in a jeep and notice that everyone is wearing a mask.
Saturday, March 14
9:00 p.m. My dad takes me to work because the community quarantine is in effect.
10:00 p.m. I start my duty as the charge nurse for this shift. During this shift, the ward nurses constantly call us about patients who need intensive care and monitoring—some of them are PUIs. The healthcare team is working on a plan to handle the PUIs, specifically, where to admit them.
6:00 a.m. My shift ends and I drop by the chapel to pray. My throat feels itchy and I’m coughing slightly so I decide to self-quarantine at home, separating my eating utensils from my family’s. I stay inside my room and wear a mask when I go out. I take some Vitamin C.
Sunday, March 15
5:00 p.m. My dad takes me to work and is getting worried about what might happen to me.
6:00 p.m. During my shift, there are only three patients: one is considered to be a PUI so we immediately place the patient on airborne, contact, and droplet precaution. I try to ask the hospital for N95 masks, but they don’t have any. We make do with a regular mask and pray that we don’t get the virus.
I wear a mask, gown, gloves, and goggles when I enter a patient’s room and remove everything when I go out. The charge nurse has been awake for almost 24 hours. We admit another PUI patient in the ICU.
The next day, there are only two nurses on duty in the ICU. It hits me hard. I know these people. They are part of the team. I think about how hard it’s been for the healthcare community.
The people who are on duty after our shift has to be screened if they’ve been exposed to a PUM or PUI or if they’re showing COVID-19 symptoms. Most are sent home for quarantine; some are admitted—these are nurses, nurse-aides, and resident doctors. The next day, there are only two nurses on duty in the ICU. It hits me hard. I know these people. They are part of the team. I think about how hard it’s been for the healthcare community.
6:00 – 7:00 a.m. My supervisor is the one to relieve me because the ICU doesn’t have enough nurses. Most of them were sent home for quarantine. I’ve been advised to be screened; there’s a long waiting line.
1:00 p.m. I get home late because a lot of nurses and medical residents are getting screened. I isolate myself in my room. No hugs or personal contact with my parents or siblings.
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