By Emily Largent
Alarms are going off. They are loud and insistent, demanding the attention of doctors and nurses. I hear them, too.
Roughly a decade ago, I was a cardiothoracic ICU nurse in Los Angeles, California. Working with patients was deeply satisfying, but I regularly encountered ethical challenges that I wanted to address. Therefore, I stepped away from the bedside to go to law school and pursue my PhD in health policy. Now, I live in Philadelphia and work on ethical issues in medical policy and practice.
Recently, though, I renewed my California nursing license and began the process of pursuing a Temporary Practice Permit in Pennsylvania. The COVID-19 pandemic requires us all to sacrifice, to serve in ways that advance the greater good. So, I located the clogs I had pushed to the back of the closet and (literally) dusted them off. My parents sorted through the boxes I’d left in their garage when I moved east for grad school; they found my stethoscope and a few pairs of scrubs and shipped them to me. The box arrived this weekend.
This was the first time in a long time that I’ve renewed my nursing license with the thought that I might need it — that I might be needed. Pennsylvania, like other states, has been issuing Temporary Practice Permits to out-of-state licensed nurses to aid in the COVID-19 response. They are calling on retired and inactive healthcare professionals to lend their assistance. So, after I submitted my paperwork with the California Board of Registered Nursing, I wrote to the Pennsylvania State Board of Nursing to see if I might be of help.
Of course, there is plenty of work for bioethicists at the moment, as the importance of bioethics only increases in a pandemic. There are no easy answers when, for instance, you have to figure out how to ration scarce resources like beds and ventilators; bioethicists can work with our clinical colleagues to address these challenges. Yet, it often feels overlooked that health care professionals — those with the knowledge and requisite experience to care for COVID-19 patients — are also scarce resources. Some patients will die for want of nurses. With growing alarm, I have realized that my skills as a nurse may soon be more helpful in addressing asymmetries between supply and demand than my skills as a bioethicist.
I have a tremendous appreciation and respect for the burdensome task shouldered by frontline clinicians in the midst of this pandemic. I have never cared for a COVID-19 patient, but I have taken care of critically ill patients requiring many of the kinds of support COVID-19 patients need. I have hung drips, drawn labs, monitored hemodynamics, run codes, and supported patients on ventilators as well as on ECMO and continuous hemodialysis circuits. I have cared for the dying, the dead, and those they leave behind. Reflecting back, I am proudest of the quiet moments between medical interventions: shaving a patient’s face one last time before withdrawing life-sustaining treatment, holding a hand, preparing a body. I am, therefore, struck that COVID-19 requires technical proficiency while impeding the deeply human interactions at the heart of care.
A few long weeks ago — before we were in the midst of this pandemic — a student I met for coffee asked about the ‘RN’ after my name. I jokingly replied that nobody wanted me near patients anymore because it had been too long. That answer haunts me now. Now, it does not seem so implausible that I would take care of patients. The prospect scares me. There still is not enough personal protective equipment for many health care workers. I have seen photographs of nurses wearing trash bags. I have read the stories of health care providers falling sick — some dying — from COVID-19. Clinicians are updating their wills and advance directives. I know that even those who escape COVID-19 infection will suffer from emotional and psychological side effects.
But as a nurse, you are expected to hear the alarm. I have, and I am ready to act.