COVID’s Hidden Toll on Nurses
“I just feel broken.”
As the pandemic began raging again this fall, we talked with Linda Ruggiero, a nurse in Philadelphia, about what it’s like to be on the front lines for the second wave. She talked about how treatment has changed, what we still don’t know about the disease, and how every nurse she knows is suffering from post-traumatic stress disorder.
Linda’s portrait is included in photographer Kyle Cassidy’s Between Us and Catastrophe project, which was created to capture the challenges and changes faced by essential workers across the Philadelphia region. The Science History Institute is proud to partner with Cassidy to present an exhibition of large-scale images of some of the people featured in the portrait series that are installed on the exterior of our building at 315 Chestnut Street.
Lisa Berry Drago: Hello and welcome to Distillations. I'm Lisa Berry Drago. This fall, the Science History Institute partnered with Philadelphia photographer, Kyle Cassidy, to showcase portraits of the pandemic's essential workers on the exterior of our building. If you're local, you can come see these life-size portraits for yourself at Third and Chestnut Streets, and listen to our accompanying audio guide produced by our podcast team. It features interviews with three of our portrait subjects: a nurse, a mask maker, and an Instacart shopper. They take us back to the spring and describe what their lives were like on the front lines of a pandemic. If you're not local, you can still listen to their stories. It's the last Distillations episode in your feed titled "Between Us and Catastrophe." As the COVID pandemic began raging again this fall, we wanted to check back in with a nurse and hear what it's like to be on the front lines for a second wave. Our Senior Producer, Mariel Carr, talked to Linda Ruggiero, a nurse at a large hospital in Philadelphia. Linda talked about how treatment has changed, what medical providers now know about COVID, what they still don't know and how every nurse she knows is suffering from PTSD.
Linda Ruggiero: My name's Linda Ruggiero and I am currently, um, a nurse in, um, a Philadelphia hospital. Um, I was a Med-Surg nurse. So I worked in like a medical-surgical floor, um, that had been transformed into a COVID unit in April.
Mariel Carr: So you had a bit of a lull, from COVID over the summer. But things as we all know have now picked up again. Does it feel like you're back there in April or does anything feel like it's different now?
Linda Ruggiero: Now, I guess we have like a better sense of how to handle the disease. I think at the beginning, it was like trying to treat patients with a disease that you didn't know anything about. Like, you didn't know the progression, you didn't know all of the symptoms. Um, you didn't know how much time you had before, you know, patients started progressing, um, you know, towards needing ICU care. Now we have like a better handle of like how quickly their oxygen needs change. Um, we now know that there are a lot of other symptoms. We know that there are sometimes no symptoms. Um, we know how it affects younger people a little bit better. And so I think we're a little bit better prepared. You know, at the beginning, there was a lot of questions about: What is the proper PPE to use? Is it airborne? Is it droplets? And you're at 95, do you need a PAPR? Um, so we have like kind of better handles on that. Um, I think one issue is that everyone's tired. And at the beginning, there was this sort of like superhero mentality, like these healthcare heroes and everyone was like sending us food and gifts. And it was like this weird kind of like fame that, um, I think was sort of distracting from, like what was actually happening. And then when that kind of died down and we were faced with like, this is what's actually really happening. And I think we have like this sigh of relief when we thought it was not over, but gone for awhile. And then it came back and we were like, you know, we're so tired still, especially because in the interim, when surgeries started back up, so we were swamped with like elective surgeries and things that people had been waiting months to have done. So we were still really, really busy. It just wasn't in like a sort of critical care sort of way.
Mariel Carr: So I want to ask you to take me back to the spring and um, just, if you could tell me about what all of that uncertainty it was like. You know, what went through your mind when all of this started unfolding and what were some of the fears that you had, that you saw you know other nurses having?
Linda Ruggiero: My fear initially was that we were going to be so overwhelmed that we had patients like dying in the hallways and that we weren't going to have enough beds. And they were talking about like, you know, using the dorms of colleges as space, you know, if we needed to and just like, having tents. And I was like, I just had that vision of this sort of disaster area. Thankfully it didn't get to that and hopefully it doesn't get to that. And I think that a lot of nurses had the fear of, you know, of getting sick. And I think a lot, especially people who, like I live alone, but people who, you know, have families were afraid of like giving, you know, bringing something home to the family, um, family members. We had a lot of nurses who were brand new mothers, so had like new babies. A lot of them were staying in hotels, like away from their families. And also just the fear of like, not knowing how long it was going to go on for. Um, and if like, when we were at a point where there were so many nurses getting sick, that we were all like, well, what if everyone gets like them? Like, what happens if everyone gets sick? So I think those were kind of the initial fears and just, yeah, just like the uncertainty of, we don't know what all this virus could do. Um, and I in particular, I guess, and the nurses on my floor, especially the newer ones.... like we work with, for the most part, generally like relatively healthy people, like people who come in for like elective surgeries or they come in for like a motor vehicle accident or, you know, we don't work in an ICU. So we don't work with people who are very, very sick. Um, if they get very sick, we transfer them to the ICU. So we're not really used to losing patients, or patients passing away and people were dying every day. It was like they would come to the emergency room. They'd come up to the floor. They died two hours later. And it was just really like, you know, overwhelming. Um, and even when people do pass away, usually family is around or like the pastor or some, you know, but there was no one. It was just us and, uh... yeah, it was really, yeah, it's horrible. It's really, it's horrible. Especially that people can't be with their families.
Mariel Carr: Hearing you talk about that, about people dying every day. I just think about. You know, all these people that think this isn't a big deal or don't feel the need to take any precautions. How do you deal with that?
Linda Ruggiero: I think at the beginning, I was very emotional about it and angry about people, like not wanting to wear masks and, um, you know, saying it's a hoax or whatever. Um, I guess I just feel like I don't really, like, I dunno, I guess I don't feel like that wearing a mask is that big of a deal like, even if you think it doesn't, it's not helpful or it doesn't work or you don't need to like, so why not just do it anyway, just in case? Um, and yeah, those people that don't really think it's that big of a deal, like I hope they never have to like, you know, have someone they know or themselves, you know, get sick or, or lose someone because of it. Um, I think the issue is really like, you know, people talk about, it's not, as, you know, it's just as bad as the flu or it's not even as bad as the flu or, um, and we might find, you know, in a couple of years when we have all the data that that might be true, like maybe more people die from the flu than they die from, um, for this, but we know how to treat the flu. So the people who get the flu, like we can pretty much treat pretty easily and they're not taking up a lot of hospital beds. Um, and, if you have the flu, you pretty much always have symptoms. So, you know if you're sick. This is not like that. And the number of people getting sick from it is like exponential and it's overwhelming the hospitals. So if other people get sick, we can't help them. Um, and we're tired. Um, it's a lot of work to take care of these patients because they're very labile. They can get sick and be on a ventilator in like no time. And that, plus the PPE and doctors don't want to go in the rooms and the people who clean the rooms don't want to go in the rooms. So nurses are pretty much doing almost everything.
Mariel Carr: Tell me more about that? Doctors don't want to go to the rooms?
Linda Ruggiero: Well, initially, no one would go in the patient rooms except for nurses. Um, sometimes the doctor would go in, but at the very beginning, especially when we were unsure about whether we were going to have enough PPE, like we were really limiting the number of different people going in because we just didn't have the PPE for it. Um, but at the beginning they didn't really, they really wanted to like reduce the amount of exposure, um, for people. So they got rid of nursing assistants. Um, the phlebotomists that draw blood, like labs in the morning, they wouldn't come in the rooms. Um, housekeeping, the people who take out the laundry, the people who take out the trash, the people bring food, like they don't come in these rooms. So we do all of that now.
Mariel Carr: And then isn't that just increasing your exposure as well?
Linda Ruggiero: Right .Yes. And that's what I think a lot of nurses get upset about because, "Why should I be exposed?" And their thought is like, "You're in there anyway." But the amount of time you're in there is like increasing your risk.
Mariel Carr: Have you gotten sick at all?
Linda Ruggiero: Um, I have not. I don't know how I havent. I'd say probably, I don't know the percentage, but a lot of our nurses got sick. Um, but yeah, I did not get sick. I was tested a number of times and I got tested for antibodies. And it seems like I haven't, thankfully, gotten it, which is great. I guess, masks do work because I've had patients like literally vomit on me that had COVID and I didn't catch it, so.
Mariel Carr: Wow well, hey that should be a commercial for masks. So I want to ask you between now and the spring, what's changed, treatment-wise? Can you tell me a little bit about how like what's changed, treatment wise?
Linda Ruggiero: Um, so we now know like if they start like requiring this much oxygen, we know that they're probably going to crash, so we have to send them to the ICU sooner. At the beginning, we didn't know any of that. Um, so we have like a better, we certainly have a better handle on that. Um, and it seems like there are so many different types of treatments depending on the person, because of their comorbidities, they don't qualify for a lot of different things. I know remdesivir is being used, um, like early on for patients who... I know for patients who have oxygen issues. Um, I don't know if it's used for all patients that have like, you know, other like no symptoms or just other symptoms, um, because you'll see, like, not every patient gets the same medication regimen. At the beginning, a lot of people were getting hydroxychloroquine. Um, we don't see that that much anymore. Um, steroids. And some people don't get any medication. Um, it's just like due to the nature of like the symptoms that they're having. It's like, they kind of wait it out. Um, and then they get like people who develop pneumonia from it will get like antibiotics and different antivirals, maybe. Um, so it really can kind of depend. So they almost all get like a respiratory type treatments. Um, yeah, so kind of just depends on type. And then there's a lot of experimental drugs that I don't really know too much about, but some people will ask if they want to be in a study and they'll do studies and then some people, I think still get like, antibodies or plasma.
Mariel Carr: And what about for you personally, do you feel like anything's changed like emotionally or just how you're dealing with the stress of it all ?
Linda Ruggiero: I think I just had like a lot more energy then. You know, it was new and it was, you know, even though it was like scary, there was this sort of excitement of like this adrenaline of, you know, being on, um, And yeah. Now I just feel tired. I feel really tired. Um, and probably a little resentful. We shouldn't be in this mess again. Doing this again. Um, cause it feels like you're just running in a wheel and not getting anywhere. Like, people are just coming in and coming in. And there's so many people just come in sick and they didn't know that they had it and their, you know, kids came over and the kids went to the other person's house. And, you know, I don't know if they went to a concert. I don't know, but it's like, it just seems like a lot of it could be avoided and we could just be dealing with something that is not overwhelming the system, like just, you know, people getting it because they didn't really have an option to not get it. You know, they're a bus driver or they're someone who like, has to be out in the environment, not people who are, you know, eating at restaurants and I'm not trying to like, be judgemental over people eating at restaurants or doing social things, because I understand the frustration of staying home all the time, but you can do these things safely. Yeah, so it's frustrating because I feel like a lot of it could have been avoided for this round. I had one patient this week who didn't know how he caught it. He was like kind of an older man. And he, it's like getting the flu times a hundred. Like you, every patient that I've had, that's been like sick from it, says they're dying. Like they really believe they're dying. And they literally can't like they're gasping for air. And then the feeling of not being able to breathe makes it worse because they get anxious and the family member is on the phone trying to talk to them, they can't talk because they can't breathe. The family member is home freaking out because they can't see them. And it's just like a really awful situation that, I don't know if people seeing that would help or make a difference. Because I feel like, I think they feel that this is just an extreme case and the majority of people aren't getting sick like this.
Mariel Carr: Do you think people are underestimating complicating health factors? That are actually comorbidities?
Linda Ruggiero: I mean, I feel like almost everyone has some, like, co-morbidity like something like high blood pressure or obesity. Like a lot of like the majority of the population has one of those two, but those are two really, really high risk factors. Like they really increase your risk for getting sick when it comes to COVID like, um, so yeah, like your risk is really high. Um, yeah, there's so much we don't know still.
Mariel Carr: So, what are you doing for your own mental health? Um, and do you feel like you've been suffering from anxiety from all of this? Like I don't see how you possibly couldn't
Linda Ruggiero: I feel, and I think a lot of the nurses would say that we are all struggling from PTSD in some ways. Particularly now that it's back, I think that some of the nurses who kind of buried it are now like really in this weird anxiety mode, because it's like, it's actually PTSD of like, "I can't we we're doing this again? And I didn't think about this for, you know, three or four months." Um, but I've been trying to really be like, open about how I'm feeling and talking to a lot of people it, and, um, we have a trauma therapist at our job. I talked to her sometimes. I have another therapist that I talk to. Um, I do exercise quite a bit. I, throughout. like the height of it, in the spring, I was doing a lot of artwork around it to kind of process things. Um, but yeah, I just like cry a lot. Like, and sometimes it's over a patient, sometimes it's just over like how many times I have to put that PPE on. I mean, it's literally like, it's exhausting to just put it all on and then you're in this room. The door's shut. There's like a negative pressure filter. So it's so warm in the room. You're like in there for so long, trying to do things, draw blood, whatever, put IVs in and you can't breathe or see because there's goggles and then you like, come out, you gotta take it all off, then you gotta put it all back to go in the next room. It's like very exhausting. And then just, I worry about getting sick. I'm not so worried about getting sick as much as I am worried about having something and giving it to someone else and not knowing. Um, so I'm constantly like trying not to be around people and particularly now, when we, you know, had that lull of no COVID patients, it was a little bit easier. But now that the patients are, you know, caring for them again, it's like, I don't want to see anybody really. Or, um, yeah, so it's isolating. Nursing is hard on a good day. Like you need, like you need, you know, soul cycle and yoga and whatever else, you know, shopping, movies, restaurants, um, just to kind of, you know, get through your normal week. And so then when you don't have that and it's you have this on top of it, um, yeah, it's rough.
Mariel Carr: You mentioned earlier that nurses are now basically the only people going into patient's rooms. And that obviously seems like a huge amount of work, extra work. Um, but it also seems like a really big, sort of emotional responsibility, to be the only person that patients are interacting with
Linda Ruggiero: yeah, it's hard on a lot of levels. It's just heartbreaking. It's heartbreaking to be like the patient's only, you're only the only person they see, ever. And you're covered from head to toe. So they don't even know what your face looks like. And it's hard to give good patient care and also emotional support. Like, you just don't really have the time. And then to, you know, come out of the room and then call the family and give them updates. It's hard to do all of that, without like, you know, cutting the family members off, and sometimes you have a patient with five different family members call. And it, sometimes you can't even get to all the calls and that's what's I think heartbreaking because I just think of family members sitting at home and being worried and not having information because you know, the nurses and the doctors are just too busy to, um, get to them. And if they're in a patient room, you can't really pick up the phone and put it on your face because it's got like coronavirus all over it. But I don't know if... I'm trying to like, figure out how to deal with it. And I think I'm like brushing the surface of trying to get through it. But I feel like, I just feel broken.
Mariel Carr: It's worrying, like what is going to happen to all of these broken nurses? And how will we move forward? It actually reminds me of, um, something you were saying earlier about calling frontline workers heroes, and why that feels weird and sort of uncomfortable.
Linda Ruggiero: Also because even though I think when it first started, I volunteered to work on the original COVID floor. Um, I knew our floor would probably become a COVID floor anyway. And I was like, you know, it'd be good to get the experience. They needed the help. And I was like, I'm happy to do this. I don't have children at home. And I don't have like immunocompromised, you know, loved ones that I live with. And, um, so I would do it anyway, but we also, at the same time, feel like we don't have a choice, like we have to do it. And so it's not really heroic if like, you don't really want to be doing it. Like, I don't want to do this and we complain about it. It doesn't just, it just doesn't feel like heroic act when you have no other option, like, you have to do it, you have to do it because you're not going to leave patients. You know? Yeah, I don't know. It doesn't feel heroic and it feels like people are like, you know, you're saving lives. I don't feel like we're saving lives. A lot of people are dying. People are just dying and we're not really saving a lot of them. Um, but, I don't know, hopefully, hopefully this round will be a little bit better as far as like the course of treatments being better, and, um, maybe people be like recovering better. Yeah, I don't know.
Mariel Carr: Do you have anything else that you want to add or get off your chest or things you want people to know or do?
Linda Ruggiero: I guess I feel like it's hard to do this, especially when you've been like cooped up for so long, but to just be like a little bit more patient with each other, like, you don't know what you know, they had that saying that, you know, we're all in the same boat. Well, we're not on the same boat, but we're all in the same storm. Um, but it's true, like none of this is easy for anyone. Like no one's life has not been altered in some way. And you don't know if people are struggling with like their, you know, with mental illness issues or if they've lost someone or if they're just isolated and they're struggling or, you know, even the people who you don't agree with as far as not wearing a mask, like we just need to be a little bit more patient with each other. And I think the anger, especially in our city with all else that has been going on. Um, you know, I think we just have to allow people to feel and not be judgemental of how people are feeling. We all just have to get through this. And we're probably all doing something that we shouldn't be doing. We just all should try to do better and accept that none of us are going to be perfect. Um, but that, you know, we have to try to do what we can to like support each other, I guess. I don't know.
Lisa Berry Drago: Thanks for listening to this episode of Distillations. Remember, Distillations is more than a podcast. It's also a multimedia magazine. You can find our videos, stories, and every single podcast episode at Distillations.org. You'll also find podcast transcripts and show notes. You can follow the Science History Institute on Facebook, Twitter, and Instagram for news and updates about the podcast and everything else going on in our museum library and research center. This episode was produced by Mariel Carr and Rigo Hernandez. The Science History Institute remains committed to revealing the role of science in our world. Please support our efforts at Sciencehistory.org/givenow. For Distillations, I'm Lisa Barry Drago. Thanks for listening.