— Guyanese ICU nurse tells of experience working with COVID-19 patients in U.S.

“I usually get the patients when they’re crashing or about to die,” said Ronessa Mingo, a Guyanese Surgical Nurse working at the Howard University Hospital, in the Intensive Care Unit (ICU).

Prior to the emergence of COVID-19 in the United States (U.S.), Ronessa dealt with trauma cases such as vehicular accidents, gunshot wounds, stabbing wounds, injuries from falling from a building and more coming in to the Surgical Intensive Care Unit (SICU).

Now, such trauma cases have been reduced significantly as persons remain indoors. In turn, patient numbers have increased within the Medical Intensive Care Unit (MICU) which deals with a wide array of medical conditions such as lung problems, heart attacks and others which require continuous monitoring and treatment.

This sees the SICU dealing with the overflow of patients. In the last three months, Ronessa has already come into contact with about 100 positive COVID-19 patients. When she spoke to the Guyana Chronicle in an exclusive interview on Monday, it was her first day off after three 12-hour shifts over the last three days.

A few days ago, she took to social media to express her feelings, after having to tell the mother of a 26-year-old asthmatic patient that he was not going to make it. “Today is the first day I felt defeated in this COVID virus war,” she posted.

Usually, she is able to play a viable part in resuscitating patients who eventually go on to live. She and her mother — now the Manager of the MICU at Howard University Hospital — moved to the U.S. from Linden through a nursing agency and both are their only immediate family members in the States.

Ronessa has worked at the hospital for the last three years, previously as a Telemetry Medical-Surgical Nurse and the Charge Nurse of her Unit. The youngest COVID-19 patient she has attended to as a Surgical Nurse was 17 years old.

While some reports state that the older the person the greater the risk, from her experience Ronessa said that at times it seems to be pure chance.

“What I’ve seen is that it’s one of those things that are just the odds. I’ve seen people who were walking and talking and waving at me and then I come back to work and I’m like ‘where is Bed 6?’ And Bed 6 is dead,” she said.

“There have been patients who are old with comorbidities, who have cancer with metastasis to the rest of the body, who have COVID-19 and have recovered.”

The Howard University Hospital, like many others, have begun to switch up the way they administer ICU care, as it is the only way to assure greater protection for medical workers.

In respiratory cases before COVID-19, one patient in need of resuscitation would be attended to by several nurses and doctors. Now, only three are allowed in the room and some practices have been cut out or introduced to limit close contact with patients.

ICU nurses like Ronessa no longer utilise the reservoir bag for COVID-19 patients as the practice could eject respiratory secretions into the air. It is now standard practice to conduct CPR while patients are hooked to the ventilator.

They have also found that the prone positioning of patients, whereby patients lie flat with the chest down and the back up, improves the oxygenation and reduces mortality in patients with acute respiratory distress.

Ronessa said that she is not constantly fearful that she or her mother will contract the virus as they practise a standard routine which includes stripping off outside clothing at the door, heading straight to the shower, washing hands, sanitising the door knobs, eating properly, taking vitamins and more.

However, she does face a constant mental strain of working long shifts, sometimes with very emotional or unpleasant experiences. Just getting into her layers of personal protective equipment (PPE), which must be changed every time she goes in to visit or attend to a different patient, is an additional ordeal.

Before she encounters a different patient she must sanitise her hands, put on gloves, a special gown, another pair of gloves, an N95 mask covered by a surgical mask, a goggle and a shield that covers the entire face. The constant changing is meant to prevent cross-contamination as studies show that there are some 13 strains of the virus. Added to the necessary attending to unstable patients, the ICU conducts head-to-toe assessments for documentation purposes every two hours.

“It is mentally draining on a constant basis,” she said. “It’s not only the fact that you have to physically exert yourself, because there is so much more to do, but it’s also very much mentally draining that we keep losing the fight. Every time we try we lose the fight; every time we try we lose the fight. It becomes like a cycle of negativity and it’s a funk that hangs over you sometimes when you’re at work knowing that no matter what I’m doing for this guy he’s not breathing better,” she said.

With a ‘No Guests’ policy in place aimed at decreasing the likelihood of COVID-19 transmission, many families are calling in and health professionals are now faced with introducing them to the option of signing Do Not Resuscitate (DNR) forms.

When she shared her experience of the 26-year-old patient who died, Ronessa said that it is heartbreaking to see that some persons are not taking, seriously, social-distancing guideless and emergency measures in place, while others are losing their lives to the fight.

In a message to both those overseas and in Guyana, she said: “People are dying. People are dying and it’s better to stay home and spend time with your family than to go out and run the risk of potentially reaching into one of those situations. This virus does not discriminate. Whether you’re black, whether you’re white, tall, short, old, young, it does not discriminate. It is blatantly disrespectful to healthcare professionals who are working overtime at bed sides to ignore the stay at home rules at this time.”

Meanwhile, she wants healthcare workers in Guyana to know that, despite the circumstance, they must do everything to try to protect themselves, even if it means improvising in a case of insufficient PPE.

She advised: “At this point, we have to be innovative nurses; nurses that think critically and think outside of the box to protect ourselves and to be able to give our patients the greatest benefit to increase their chances of survival. Don’t be scared to take new leaps or to try new things. It’s one of the things that we’ve never encountered before but you, the nurse, have to be a pioneer in this situation to protect yourself and the people you love.”