This. Shit. Is. Real.
We honestly thought we were doing well. Several of the facilities are now Covid 19 positive facilities... they take in the positive cases so that the other facilities won't get overrun. But once those inmates are healthy and past any symptoms, they need to be watched but not necessarily held at those positive facilities. So earlier this week it was decided that one of our closed down units would open back up as a 'step down' unit. Inmates that had tested positive, but were now considered safe, would stay in our unit for a week or so just to make sure it wasn't premature. Then they'll move on back to their own facility, or if their facility is under quarantine, to another facility. Having that unit, which technically sits outside of our secured perimeter, is a burden on our nursing staff.
I'm kind of all over the place on this, so maybe it's better if I go in a more linear time based fashion.
So, our first big action as a department was to close all facilities to non essential visits. Only legal based visits could happen. No families. No friends. At the same time, all people working in the facilities would go through a basic screening. You'd be asked several questions about covid style symptoms (new cough? new sore throat?...) and have your temperature taken. If you were over 100.4 degrees (or over 100 degrees for a healthcare worker), or you answered yes to any of the symptom questions, you were sent home for at least 7 days. You could return after those 7 days if you were symptom and fever free for at least 3 days (without the use of meds that would reduce fever) or you got a covid test that came back negative.
Almost immediately, a couple nurses got tripped up on the questions. Note that the questions were for NEW cough or sore throat. If it was for cough or sore throat, I'd never get in as my smoking makes those conditions chronic. Well, many officers and several nurses answered yes and got sent home.
Testing inmates goes by the same standards of any person in our state. An inmate makes a complaint of cold like symptoms. They're seen almost immediately by nursing and if they meet certain requirements or just 'look bad' to the nurse, they're seen immediately by the medical provider. If the medical provider believes they may have covid, the inmate is tested for influenza (we have instant tests for that). If the test comes back positive, they're simply held in place and treated for the flu. If it's negative, they go to the department of health and human services and request covid testing. More or less, they're always given permission as they've been through extensive medical screening at this point.
A few days after we put all that in place, the department got our first positive inmate. A few days later, when that number blew up to 9 positive inmates, the department got our first positive employee. Those numbers started to increase regularly and spread to several different facilities, but our facility was left fairly unscathed.
When the numbers got big enough, they opened a specific unit for covid 19 positive inmates. While the location was perfect, their staffing level was not. As our staffing level was at full, they took our staff. 4 RNs, 3 LPNs, and one of our supervisors.
A quick aside; while I love nurses being called superheroes, we just aren't. Yes, we put ourselves at risk, yes we work hard jobs for long hours, yes it's often thankless for our biggest successes and often damned for our most minor mistakes, but that's part of the job and doesn't deserve exalted status. So, with that in mind, our nurses getting pulled from their comfortable positions in a covid free facility was more than a little unnerving. They didn't want to go. We didn't want them to go. But this is an emergency and as a state agency, they have the power to put their staff where it's needed.
That facility got barely staffed and we got shorted to minimum. Then one of the nurses that got transferred got really spooked and quit. I can't blame them and I won't blame them, but it still hurt a lot. That didn't stop the state, and they just took another of our nurses. Then we went through a time where nurse after nurse fell to the covid screening. I honestly don't believe they thought they were covid positive, and had the knowledge of how to answer that screening to get in the gate. Instead they took the 'break' of a forced week off and put more pressure on our remaining staff.
Now with covid positive patients getting better, they needed that step down unit and our story picks back up there.
The same day our step down unit opened, another nurse quit. Well, technically they didn't quit, but they said they were nervous about working in a facility that had past positive inmates and wanted to take a month away. They're a contract employee, so we could 'approve' that leave and just let them come back. They just don't get paid by us (I'm sure the enhanced unemployment and stimulus checks would keep them in some money). But we're not going to allow them back unless we are beyond desperate. We made it clear both to them and to their contract agency that them leaving at this point was directly hurting the remaining nurses and we needed them to stay. We'd keep them away from the scary step down unit, but they needed to stay and take shifts. They said no. When they try to come back in a month (or more, if that unit is still open), our answer will be the same. No.
Then another nurse quit. 5 hours before her shift. Her words were along the lines of "I'm just a nurse and my family wants me to stay safe". Just a nurse? FUCK YOU. Nurses might not be superheros in my eyes, but they are FAR from being JUST a nurse. She later recanted and said she'd come back, but she's as good as gone. She's one of our midnight nurses and it's a true hardship if I have to mandate nurses to work overnights as well as their day/afternoon shifts, so I'll keep her on for now. But as soon as I find a nurse to replace her, she's gone. GONE. I don't need, nor do I want someone that thinks of themselves as 'JUST' a nurse.
One little step back... just before they told us about opening up the step down unit, I honestly thought it was a matter of time before we got hit. There's just too many employees going to and from work, filling up their gas tanks, going shopping, and doing other daily tasks, to not have one of them get infected. As they can spread the virus for days before they show or feel any symptom, they would spread that to our population. Once inside, it will spread like wildfire. We'll of course do everything in our power to stop or slow it, but it's like physics.... it will happen and won't be stoppable. With that risk present, I figured it was only a matter of time before I had a larger than normal chance to get infected myself. By the time we had a positive inmate or employee at our facility, I may have well gotten it and spread it to mom. Mom MUST be protected as her age, diabetes, and COPD make her a prime target to get hospitalized, get vented, and die from this.
My plan was to move into my aunt's house. My cousins approved it as it would keep their aunt safe. But when we sat down as a family (remember, my house now has Mom, me and my brothers R and B all under it's roof), we realized that both R and B are risks in their own right to mom. So the plan changed from me moving out, to Mom moving out. We got her as comfortable as she could be, moved my niece and nephew in with her, and told them all that they are on complete lockdown. They can order food in, they can order groceries that me or my brothers will pick up and deliver, but they can't leave the property.
That sucked. I know mom would be more comfortable here, but she insisted and I believe lettering her insist gives her some agency over her life and that's' worth the discomfort I believe she's experiencing.
Anyway, the step down unit opened and within a couple days we had to send one of the inmates out to the hospital in an ambulance. For acute respiratory distress. He couldn't breathe. For a few hours we were all certain that this was it... the step down unit was hit and they'd either all have to transport back to a positive unit, or we'd just end up as another positive unit. Then when we got a chance to look into his health record, we saw that this inmate had a history of pulmonary fibrosis. Basically it was inevitable before all this covid situation blew up, that he'd get into this position. It probably had nothing to do with covid beyond covid wearing his system down.
When they took our supervisor to the positive unit, that put me in charge of one whole side of the facility. As that was happening anyway, my boss decided we'd flip sides with the other supervisor taking my and the departed supervisor's positions and me taking hers. So with all this going on, I'm also trying to learn her position and set up an office that's conducive to me working efficiently. And then we get our first positive case... on my new side of the facility.
We scramble to separate out the inmates. People with symptoms here, people that were close to the positive case there.... but we keep getting people that need testing which necessitates separating more inmates. We have to do assessments to all the separated inmates whether they have symptoms or not, plus we have to screen all the inmates in their former infected units. That's daily screenings of about 300 inmates and full on assessments of, as of yesterday, 80 inmates. The assessments are done in full protective gear. Gowns, gloves, face shields, N95 masks. It's hot, uncomfortable, and scary looking to the inmates. I can't blame them for being scared. To their eye, the medical staff is taking great precautions to protect themselves while they're housed next to other possibly infected inmates with no protection.
And then we got another positive case.
Most of this that I've written about has happened in the past week. It's a nightmare that's leaving me emotionally and physically exhuasted and when I can catch a breath and relax, the fear comes in. Fear that I am ultimately powerless to protect the men under my care. Fear that I'm ultimately powerless to protect the nurses under my supervision. Powerless to protect myself. Powerless from getting infected and infecting my brothers. Powerless from my brother getting infected from me and spreading that infection to the housing units he works at.
Fear that I might die.
I'm not a superhero and I'm not invulnerable. Mom is high risk, but according to the CDC, so am I. I'm a smoker with limited lung capacity. I am diabetic. Both of these take my normal risk and practically double it. What risk? Risk of even catching the virus, in addition to risk of being hospitlaized, being vented, and dying.
I don't know what to do with my fear. Do I share it with my brothers? I can't possibly share it with mom. I don't dare share with those that I supervise. My boss and fellow supervisor have already shared their fears with me and I'm being their support, so I can't share it with them. I have to do the worst thing you can with fear... internalize it. Hide it. Eat it. I'll shake and cry alone.
Please, don't let me die.
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