By Melissa Perner
The Ozona Stockman
Cynthia Garcia was going to come home to Texas to see her family, when she learned nurses were needed in New York City to help with the COVID-19, coronavirus, pandemic.
On April 10, the 2013 Ozona High School Graduate finished up her latest nursing assignment in Arizona. By April 13 she landed in New York City and started her orientation two days later.
“They needed help right away. I am young and I don’t have any underlying health issues. I don’t have kids,” Garcia said in a video interview through Facebook messenger.
Garcia, who now lives in San Antonio and works as a travel nurse, volunteered to go to the place that has been called the “epicenter” of the virus.
As of Monday, New York City had 181,034 cases and 18,580 deaths. Compared to the entire state of Texas, which has 31,548 cases and 867 deaths. The city’s largest mass casualty event in recent memory, the terrorist attacks of Sept. 11, 2001, claimed only a small fraction as many lives, according to an article in the New York Times.
For Garcia, the decision to go was one that felt like a must.
“I was just thinking about if my family was in that situation. I would not want people to turn away. I would want people to go help,” Garcia said.
This is Garcia’s fourth assignment as a travel nurse and her first time in New York City.
In the Manhattan Hospital she is working at, she is on the 17th floor. The hospital is full of patients with COVID-19. Garcia said her patients have been in the hospital since the end of March and are still critically ill.
The hospital has also had to open several new units to have enough rooms for COVID-19 patients.
“It’s kind of what I expected. The hospital takes care of the nurses well. I had already prepared myself mentally to be in this situation,” Garcia said. “People are just very sick. I can’t tell of any of my patients are getting better. It reminds me of long-term acute care patients. They are all pretty sick.”
The nurse to patient ratio at her hospital is two to one. Some hospitals in New York have a six to one ratio.
Garcia is working 12-hour shifts, 48 hours a week. She said some nurses are working four to five shifts.
“I have friends working 21 days straight,” she said.
She said the first thing that surprised her was the age of the ventilators the patients were using.
“They are very old. I’ve never seen a ventilator like this. It’s this little box that sits on the chair,” Garcia said.
Due to so many patients using ventilators, Garcia said she has had to learn how to make adjustments on the ventilators and give breathing treatments. Jobs that normally a raspatory therapist would perform.
“We have so many patients on ventilators that raspatory therapists can’t constantly come in and out rooms,” Garcia said.
The stricter protocol was also something Garcia had to learn. She said she must do “cluster care” where she has to have all her tools and equipment she needs before going into the patient’s room.
“I can’t just come in and out of the room. Yesterday my mask broke in the room. I was in the middle of fixing my patient up. I had to stop and immediately walk out of the room. The protocol is stricter,” Garcia said.
Garcia said she receives one N95 mask each week. She also must wear face shields in the patient’s rooms.
“It gets really hot,” she said.
The type of care Garcia must give each patient can take up to two hours per patient. Tubes must be cleaned and emptied. All her patients must be checked for blood clots. Medications distributed and documented.
There have been comparisons made on social media between the flu and COVID-19. Garcia said she wouldn’t compare COVID-19 to the flu unless you are speaking of respiratory illness in general.
She said a lot of the patients in the hospital come in walking and talking, but have low oxygen levels. Patients also develop mucus plugs in their airways, which leads to a lot of heart stopping or going into lethal rhythms, Garcia said.
“At my hospital, we were able to trach a lot of patients and we have enough breathing treatments we can give to help loosen the secretions so that we can have a better chance of them not plugging, but there’s facilities out there who do not have enough of these medications, so imagine how many of their patients must be plugging,” she said.
Patients are also having “tiny strokes” from blood clotting, or sometimes small hemorrhages from blood not clotting enough.
“Sometimes it’s hard to find a balance of what medications to be giving them. I haven’t seen a normal hemoglobin in any of my patients, which helps transport oxygen in your blood. I’ve never seen this before with a respiratory illness. Like SARS and H1N1, some of these patients are experiencing cytokines storms, which is when the body attacks it’s own cells because it’s trying to kill off the whatever it is that’s hurting the body, and they’re being left with damaged lungs. So, it’s not like our normal flu,” Garcia said.
She said the patients are often very tired and not smiling.
“The patients don’t have their families there. I can’t imagine how I would feel. We do what we can as nurses,” Garcia said.
At times, the hospital has so many patients “code,” or stop breathing, that the hospital is having to limit the amount of life-saving medications given to patients. Also, only three people are allowed in the room when a patient has “coded.”
“We cannot enter the room without proper PPE (personal protective equipment) no matter what is happening,” Garcia said.
Last week, Garcia said she had her first COVID-19 patient die.
“He declined rapidly, out of nowhere. It was sad that he couldn’t have his family with him. It was just the doctor and me in the room. I think being an ICU nurse, we’re use to seeing death, but we’re not use to only letting three people in the room or being limited on medications that we can give. I think we feel more helpless now,” she said.
In the same week, there was also joy as the 1,000th patient was discharged.
“We have music playing on the intercom when a patient gets to go home. So, there is some good happening too,” she said.
Garcia said she spoke to the NYC nurses about when the virus hit it’s peak in the city last month. She said the nurses had so much anxiety about coming to work that they would leave their shifts in tears.
“Nothing would be documented. There was not enough time to give ‘scheduled’ medications. They stopped packing their lunches because they were expecting not to eat for the 12-14 hour shifts. Every single shift, there were so many unstable patients dying. They would be neglecting their other two to three patients if they had one that was crashing, and just because one patient is crashing doesn’t mean that there other patients can’t be crashing as well,” she said. “There’s not going to be an unlimited supply of ventilators, IV pumps, medications, or staff to take care of these patients the way that we wish we could. Not every hospital is this lucky. Everyone is trying their best with what they have and sometimes they have to pick and choose which patient is able to be salvaged. I just hope people continue to respect the social distancing guidelines. I wouldn’t wish any of what these patients are going through on anyone.”
On her Facebook page, Garcia has posted pictures from around the city. In those photos, there are empty streets and sidewalks as people are staying at home.
“Everybody I talk to says, ‘it’s never been this way.’ This is not how New York City usually is,” Garcia said.
New York State Governor Andrew M. Cuomo laid out a plan to reopen his state Monday. He said openings would start upstate mid-May. However, Cuomo did not suggest any loosening of restrictions on New York City in the near future.
In New York, the daily count of new cases statewide has generally been trending downward, though the numbers have sometimes varied significantly from day to day and they rose toward the end of last week, according to the New York Times.
For Garcia, her stay in New York City is expected to last until June 6.
She said she is not worried about catching the virus, but more worried about passing it along to someone else.
“I think everybody knows people can be carriers without any symptoms. I think people should take extra precautions, especially for anyone who is elderly. I think about Ann Shaw because she has to stay at home,” Garcia said. “People should prioritize our health a little bit more.”
Garcia said she misses her family and is homesick to see them.
When she does return to Texas, she will quarantine herself for two weeks.
She said her Facebook posts, where she has had a huge response from friends and family, gets her through.
“I can’t wait to see my family again,” Garcia said.