When Jack, a 37-year-old cardiovascular ICU nurse from the Phoenix area, encounters coronavirus truthers, deniers and skeptics, it feels like a slap in the face. On his way to work one evening, Jack stopped at a gas station covered in countless signs that read “You must be wearing a mask to enter.” But sure enough — while Jack was buying a Red Bull to get through a night shift — a couple in their mid-40s walked in completely maskless, and he snapped.
“On my way out, I turned to them and said, ‘I just want to thank you so much, because people like you are the reason I am raking in so much overtime putting your parents and grandparents in body bags. And you know what? I’m probably going to be able to buy a house soon. So keep it up,’” Jack says. (Jack is a pseudonym, as are the other working nurses quoted throughout in order to prevent professional retribution from their employers.) “I felt like a jerk, but it was probably worth six sessions of therapy.”
Before the pandemic, Jack took a lot of pride in treating patients experiencing life-threatening cardiac emergencies. But now, he spends his days saving people just like the couple in the gas station — once their selfishness lands them in the hospital.
He didn’t have much of a choice, of course. As of six weeks ago — when Phoenix began to hit its peak in coronavirus cases — Jack’s former unit was consolidated to just six beds. COVID-19 patients overtook the entire ward; they even went so far as to move sick infants and children in Neonatal and Pediatric ICU to the nearby children’s hospital. Since Jack didn’t want to find another job in the middle of an economic downturn, he became a coronavirus nurse overnight.
But when Jack suits up in PPE and treats coronavirus truthers who are sick enough to be in his care, their denial is more depressing than rage-inducing. Typically, they fall into one of two categories. Some are too ill to engage in unscientific arguments, because they’re unconscious and on a ventilator, but he can deduce that they’re at least skeptics based on their families, who ask on the phone if it’s “really that bad.” The others are well enough to sit up, walk around, spout conspiratorial nonsense and watch Fox News all day.
What really keeps Jack up at night, though, is how this virus can cause deniers to take a bad turn so fast. One minute their babbling about the new world order, the next they’re crashing into respiratory arrest seemingly out of nowhere. “I can understand denial when people first come in; initially, it presents as pretty benign. With other illnesses, there’s a linear progression to it,” Jack says. “But these people, they go from FaceTiming with their families, to 90 minutes later, I’m shoving a tube down their throat.”
In Jack’s ICU, sick patients aren’t allowed visitors, so their families — who tend to share similar beliefs — take away all the wrong lessons from FaceTiming through their loved ones’ final moments. Instead of questioning their beliefs and considering that the coronavirus could be a very real illness, they double-down on it being the health-care worker’s fault. “I’ve had families threaten to come back with their firearms,” Jack says. “Everybody grieves differently, so I won’t begrudge them that — as long as they don’t act on it.”
Ben, a 40-year-old ER nurse in New England, echoes Jack’s sentiment that there’s something especially horrifying about seeing a COVID truther die of a reality they refused to accept until their last gasps. “More than once, I’ve had somebody attempt to say, between raspy breaths, ‘Please don’t let me die,’ or ‘I don’t want to die.’ Dying of respiratory distress isn’t fun,” Ben tells me.
For perspective, prior to the pandemic, nurses weren’t strangers to dealing with abusive patients. In one survey, 76 percent of them reported that they were violently attacked at least once, by either patients or their visitors, with emergency nurses being at the greatest risk. That said, Jack finds that figure laughably low, and while nurses can press charges against patients, they’re often dropped, sending a message to victimized nurses that they shouldn’t bother.
It’s worth noting that as men, Ben and Jack represent only 12 percent of the nursing population, meaning they’re usually assigned the most disruptive patients. For Jack, many of his patients are in such critical care by the time they make it to the ICU that they don’t have a ton of fight left, but he’s still very much used to getting violent patients in general. “It’s a little sexist, but it’s also what makes the most sense,” Jack, who has been stabbed on the job twice, tells me. “I get why they would assign me, a 6-foot-4 male, to a difficult patient instead of a woman who’s 90 pounds soaking wet.”
When patients are admitted to the ER with Ben, they’re not as close to death, and are more prone to lashing out when they’re scared, vulnerable and in pain. “I do care about my sick patients, but when they’re aggressive, you try to set boundaries, which may not come across as happy, white, fluffy nursing, but there’s no other way,” he explains. He adds that there’s also the unspoken expectation that he’ll step in when patients are sexually inappropriate with his female colleagues, which opens him up to more abuse. “At the end of the day, I have a family to go home to, and I do attempt to protect myself in any way I can. But the bruises and abrasions to the nose, ears and cheeks is a normal occurrence.”
According to Audrey Snyder, associate dean for experiential learning at the University of North Carolina Greensboro School of Nursing, nursing students are trained from day one to de-escalate aggressive and potentially violent patients by responding empathetically and asking the patient to sit down and to lower their voice in a soft voice of their own. “They’re taught that you don’t want the patient to be between you and the door. You protect patients’ privacy as much as possible, but usually, you’re going to want to have a door open that you can exit,” she explains.
Snyder, who worked as an emergency nurse for 26 years prior to teaching, has found that this training has been hard to shake even many years later. “I still don’t like to eat at a restaurant if they want to seat me at a table that’s in the middle of the room,” she says. “I don’t like that. I prefer to have a wall to my back.”
Easier said than done with corona truthers/patients, though — especially because the refusal to wear masks has become a new way to assault health-care workers. It’s hospital policy to refuse to let patients in the waiting room without a mask, but once they’re admitted, they usually do whatever they want. “We had a few patients who tried on purpose to cough in our faces,” Ben says. Security told them to stop, but that was really it. “When families refuse to wear a mask, they’re escorted off the property, but when patients don’t, nothing really happens to them.”
The only thing nurses can do to protect themselves against this type of patient assault is have adequate PPE. But despite being six months into the pandemic, there are still ample reports of PPE shortages, and the nurses who do have it depend on external donations, instead of the hospital system itself. As such, nurses who once changed their masks with every patient as a matter of safety protocol have now adjusted to the new normal of wearing the same mask, etc. for up to a week.
“We have face shields and helmets that were donated by the community,” says Ben, who uses the same mask all week. “At least we have masks. Paramedics had to purchase their own, or had to use ones provided by their cities for a month.”
As frightening as it can be to deal with sick coronavirus deniers without proper PPE, Jack and Ben realize that it’s far more dangerous when unmasked individuals who have tested positive refuse treatment and leave the hospital. As Jack puts it, “COVID isn’t different from any other illness. If the patient is coherent enough to refuse treatment, there’s not much we can do.”
“I have seen people in denial leave the hospital only to come back in full arrest or simply die at home,” Ben adds.
In the rare instances when coronavirus patients aren’t getting enough oxygen, which could have negative psychological effects, nurses can make a case that they’re not of sound mind and force them to stay and receive treatment. But Snyder confirms that most of the time, nurses have to let people go as a matter of policy. “If a patient was ill enough to be admitted to the hospital, and then suddenly wants to leave, the goal would be to have the appropriate documentation, complete the paperwork and try to help them exit in a safe way so someone else isn’t exposed,” Snyder explains.
Still, most coronavirus deniers would rather abuse nurses than walk away from their care — for the same reason they won’t let go of their deep denial. At their core, they’re scared. “They’re already sick in a hospital surrounded by experienced medical professionals. They wouldn’t be there if on some level they didn’t think they needed that,” Jack says. “And really, there are no good coronavirus patients. They’re all sick, dying and afraid.”
As frustrating as these patients may be, nurses maintain a level of empathy that’s part of their training, but it now invariably comes at the expense of their mental health. “The hardship for health-care workers is the emotional toll of watching people die. It’s impacting physicians, nurses, aides and all of the other workers,” Snyder says. “It’s challenging when personal choice can affect so many others. It’s hard when people won’t follow guidelines with this detrimental outcome for health-care workers who have to care for these patients.”
And with every person they put into a body bag, every living person refusing to wear a mask becomes an assault on their overall well-being. Yet, looking back, Jack regrets acting like his patients and lashing out at that couple in the gas station. “That’s not changing anybody’s mind or helping, because when you challenge people that aggressively, it’s not going to make them want to question their beliefs or consider new information,” he tells me. “You have to listen to the crazy things they say and walk them through their logic and keep asking them why they believe that.”
The more depressing aspect of his reality, he admits, is this concept of medical futility crushing his sense of purpose. Before the pandemic, his worst days as an ICU nurse were when he did everything he could in his training to save a patient, and they didn’t make it. Now, that’s an average day, and he doesn’t see an end in sight. Or as he tells me, “I’m going to have so much PTSD when this is all over — if I ever slow down enough to feel it.”