Content warning: This piece mentions death and suicidal thoughts. —Editors
February 2020: “I don’t want to see anyone in the hallway with a mask on,” the manager said.
We were standing at the nurses’ station, in what was to be the Covid unit. “Um, the CDC is saying this is airborne,” I said. “Not only do we need masks, we need N95s!”
Other staff agreed; they hadn’t volunteered for this. This floor was always slated to be the disaster unit, if ever occurred—but they don’t mention that when you get hired. Me, I’m a float nurse; I go where I’m needed for the day. I know almost every unit and every person working them.
We were on edge. No one knew what to expect, but we knew we weren’t as efficient as China. We wouldn’t be assembling a new hospital within a week and staffing it somehow. We were it.
We wore surgical masks anyway.
ESSENTIAL, JUST LIKE US
March 2020: I checked my unit assignment: Covid. I knew what was about to happen. Sure enough, the two Covid patients on the unit were both assigned to me.
I argued: “Why only me? I’m not taking both patients. We have to share the risk.”
Someone said, “Eventually we will all have Covid patients.” I said, “Eventually is not today!” They changed the assignment.
Nonetheless, after caring for one patient for 12 hours, I was infected. I had been wearing all the necessary personal protective equipment (PPE): a fit-tested N95 mask, goggles, shoe covers, and an isolation gown. I cleaned my hands obsessively.
My patient was the sicker of the two. The other one refused to let her door be closed, which it had to be to comply with airborne precautions. I was thankful someone else had to take care of her.
My patient could hardly speak. She was weak and could hardly eat. She could not flush the toilet for herself; I had to. This is how I got infected.
I prayed for her every day. Months later I learned she was the second to die in our hospital. I cried because every thought I had dedicated to her was fruitless.
Patient after patient declined, crashed, died. Most of them Black and Brown. Most of them “essential workers”—people who had little or no choice about being exposed, just like us. That was agonizing.
Adding insult to injury, a sign outside the hospital in big colorful letters, “Heroes work here!”
BONDED IN TRAUMA
The change and backtracking were constant. First we were told, “Don’t wear a mask.” Then, “You can wear one, but not an N95.” Then, “You must wear an N95, but you have to reuse it six times.” Then, “We can clean the N95s with this unproven method. You still need to reuse it six times; we are counting.”
But when a nurse’s husband, two nurses, and two support staff from clean units died, there was silence from the administration. Actually, sometimes we still got reminders about being late with medications or charting.
Every shift we prayed at the nurses’ station. We had isolation gown-folding parties where anyone with a spare second helped fold, because the linen department couldn’t keep up. We came running when co-workers called, even if it was just for a straw. We all knew what it took to go into a Covid room. Multiple trips are not possible.
The unit staff became fused together in a way none of us can ever undo. I guess that’s what a trauma bond is. We coped by ordering matching Covid shirts and buying scrub-cap/mask sets. And we ate, so much. It was all we could do.
WE ALL GOT SICK
Nurses and techs were the only ones going into rooms. Doctors called their patients on the telephone or iPad. Dietary just dropped off the trays in the hallway. Housekeeping left their mop out for us while we pulled the trash.
One by one we all got sick. Some were gone for weeks, some months, some much longer. There was a Covid antibody plasma drive for one nurse who was on a ventilator for weeks. I worried he might die. He didn’t, but I don’t think he’s the same; none of us are.
The ones who got sick were not the only ones to suffer. Everyone did, mostly without a word. The mental work it took—the constant worry, the incessant cleaning, the isolation from your loved ones, only leaving your house to go to work.
Worst of all was the constant battle with hospital administration. To them we weren’t really heroes; that was just for public image. We were workhorses, and if a few of us dropped dead in the field, that was okay.
We voiced our safety and staffing concerns. They blamed us for causing an outbreak while having a potluck. They offered us a respite room and a mental health hotline to call: more performance.
The respite room was locked, and no one had time to go to it anyway. Someone won an award for that idea. The hotline was staffed by our colleagues; I don’t know of anyone that called it. It wasn’t safe to call and say what you really felt. Not for me anyway.
AN UNSPEAKABLE SECRET
I had a secret. It was unspeakable. I didn’t tell anyone, not even the people closest to me. I couldn’t.
When a nurse admits a patient, there are certain questions we ask everyone. The questions I asked each patient about thoughts of suicide—where an affirmative answer would have triggered assigning a sitter to be with them at all times—were questions I wouldn’t dare answer myself. If I were to answer that question honestly, who would be assigned to watch me? Nurses don’t get sitters, they relieve them for their lunch break.
The greatest risk factor for a person’s ideation to become an attempt is a plan. I had two. And I thought about them every night—in the car, on the way home, on my days off when I could not will myself out of bed, except while I ate every feeling I had.
I knew I was in real danger—not from Covid, I had already beaten that, but from my own thoughts of suicide. Still I said nothing. I would be removed from my job. I couldn’t pay for inpatient treatment. I would have been denied the refinance on my mortgage. I would let my co-workers, my patients, my people down. No one would get my life insurance. Who would take care of my cat? Seeking safety, for me, was not safe.
I stayed silent. I couldn’t have been the only one. But the time was coming where I would learn to use my voice.
‘THE UNION LOUDMOUTH’
September 2020: Our union, the Illinois Nurses (INA), fought and negotiated—we got hazard pay, N95s, a universal masking policy.
We went on strike to secure our next contract. We stood outside the hospital—nurses alongside support staff represented by SEIU Local 73—and we said, “This isn’t the way things should be, pandemic or not.”
It was my chance. I couldn’t be silent anymore; I saw a way out of my darkness.
I got involved. I became a person who disseminated information—I knew everyone anyway, and they trusted me. In that week-long strike I was asked to speak up, to say something for all of us. I had no title, but when a reporter asked me, I dubbed myself “the union loudmouth.” I haven’t shut up since.
In our contract, we won a commitment from the hospital to maintain a 90-day supply of N95 masks available at all times, with a weekly report of supply levels, and an agreement to hire 160 additional nurses—getting us just short of the staffing ratio we had demanded, no more than four patients per nurse. We won other things too, but our priorities were safety for ourselves and for our patients.
It felt good to win something, especially while we were all losing to Covid. It built us up, and showed other unions they could do the same. More nurse strikes have happened around the country than ever before. I don’t know how nurses at the non-union hospitals are surviving. They have no protections.
A PATH OUT OF DARKNESS
Since that time I have found a path forward. I found hope in my personal and professional life, partly through the union that backs me. They helped me speak up for myself and for my union siblings; in turn, I was able to verbalize my thoughts of suicide and find help privately. I am safe—from myself, at least.
There are still fights with administration daily: contract violations, staffing shortages, Covid variants. There are still vaccine deniers, and public policies based on economics instead of public safety. But they don’t seem as hopeless anymore, and I don’t feel voiceless either. I know that whatever my employer does to dehumanize me, it is not a reflection of my inherent value as a person or a nurse. I see a light and a way forward. My union helped me find that.
There is still a darkness all around. Go to any hospital or speak to anyone who works there, and you’ll hear it in our stories, in our dark humor, see it hidden behind our masks.
We, as a collective, are still not o.k. There are record numbers of nurses leaving the bedside or the profession altogether. I joke that at any given moment I am six seconds from quitting. Sometimes it’s not a joke. It’s still bad, worse than I’ve ever known it to be in my 11 years of nursing. We won’t stop fighting Covid or fighting the hospital administrators.
BROKEN ON PURPOSE
Conditions in hospitals have always been strained, and not because they have to be. The system is broken on purpose—the priority is profit, rather than people.
The INA and other union groups have shown me real-life, research-backed examples of how health care could do better. A Safe Patient Limits bill is one solution and is possible statewide and, eventually, federally. They’re already doing it in California: four patients to one nurse, maximum.
We have enough nurses per capita to enact safe patient limits in Illinois and elsewhere. But if we don’t give health care workers what they need to survive Covid—PPE, staffing, appropriate public safety policy, and respect as humans and professionals—will we still have enough left when Covid is no longer the scapegoat for our long-failed system?
Kristen Perez is a nurse at an inner-city safety-net hospital in Chicago.