Jennifer Dixon, RN, has been a nurse for 20 years. The current Master of Science in Nursing (MSN) student at the USC Suzanne Dworak-Peck School of Social Work is part of the emergency department of a hospital in Georgia.

About a month ago, the first COVID-positive patient Dixon took care of was a healthy, strong, man with no underlying conditions. He was also a friend. Sick at home for about six days, when he arrived at the hospital he was pouring sweat, his skin was grey and his oxygen saturation was 65%.

Dixon was partnered with another experienced nurse the day her friend arrived, and they did what they were trained to do—they gowned up, masked, gloved, double masked, pulled their hair up―and Dixon entered the room to help her friend, while the other nurse stayed outside and handed Dixon the items she needed.

The new guidelines set by her hospital in Georgia are one nurse to a suspected COVID case, to limit the amount of personal protective equipment (PPE)—goggles, masks, gloves and gowns—being exposed.

“I just sat and looked at my friend, the labs kept coming in bad, he was in trouble,” Dixon said. “He had clots, blood clots in his lungs. He was starting to go into something that we hadn’t expected—his blood was coagulating. I was just so sick to my stomach for my friend, terrified because this virus was not behaving the way a respiratory disease should behave.”

They had all been told the coronavirus was going to be like a flu, Dixon said, but every day, what they understood it to be was changing, and it still is.

“We were told old people with COPD, or smokers were going to die from this, that’s how it was presented to us,” Dixon said. “Not healthy strong men and women my age.”

Dixon has witnessed patients coming in as if they almost do not know they are starved of oxygen. They may have trouble breathing, but no cough, shortness of breath or fever.

Abdominal pain has been one of the biggest symptoms that has thrown the medical staff. A 40-year-old woman came into Dixon’s ER with abdominal pain, so they brought her back, got her vitals, started an IV, did some blood work and sent her to get a CT of her abdomen. The radiologist called the doctor immediately and said the patient was full of the COVID-19 virus—he could see the bottom of her lungs in the abdominal scan. She presented with no cough or fever.

Preparing for the surge

According to Dixon, Georgia is expecting to have a peak number of COVID-positive cases toward the end of April. The projections also estimate the state will be short 800 ICU beds. As of April 19, one of the two largest medical centers in Atlanta was already out of ventilators, and the next biggest center in Augusta was running out.

“We’re running out of gowns and we’re running out of masks,” Dixon said. “We have been asked to just wear a cloth mask, even though the science says that you have no protection with a cloth mask. If I’m going to be on top of a patient, helping to either intubate or resuscitate, or start an IV or get blood of a patient that is sick with COVID-19, and I just have a cloth mask, it’s not helping me at all.”

They are trying to conserve their masks by wearing their N95s all shift. They wear surgical masks on top of them so they can protect them being contaminated by any droplets or particles in the air. Then, after eight hours of use, they put the N95 in a bag because they cannot throw them away, and in three days they hope the virus is dead and they put the N95s back on their faces.

At Dixon’s emergency room, while the number of incoming patients has slowed down at bit, those that are coming are really sick, and they are seeing more COVID-positive cases.

“I’m not the fear-evoking emergency room nurse because the majority of these patients are going to do okay,” Dixon said. “But the ones that get sick, there is just no rhyme or reason. Why are young people dying? Why are the people who are going on ventilators doing so poorly?”

Dixon has been following the writings of a New York City doctor running a COVID ICU where 80% of ventilated patients are dying and doctors need to do something differently with the ventilators. “He’s scared,” said Dixon. “We’re all scared.”

The burden of responsibility

Dixon wears double masks, double gloves and still the risk of contaminating the next patient weighs on her.

One of her duties is pulling patients out of cars and ambulances, and she worries about contaminating someone who is, for example, unresponsive because of a heart attack. She could expose them to something she may have in her hair. “That’s what’s heavy on all of our minds in the medical community,” Dixon said.

She wishes all healthcare workers could get tested, at least for immunity. But, they are not currently being tested unless they have fever or other symptoms.

“We're not sleeping,” Dixon said. “I think we're all drinking more, and we wake up because you're not supposed to drink more to sleep. But we sleep because our body aches so bad and we're so stressed and worried.”

Dixon feels responsible for every person that comes in. She questions whether she is doing the right thing to save each person’s life; if she is doing everything she can to protect the next person or comfort a person who now cannot be with their family.

Everyone that works in her emergency room is extraordinarily on edge, Dixon said, fearful for people dying that should not and doing their best to contain the virus. They still have babies coming in with ear infections and cancer patients for treatment.

To care for herself during this difficult time, she bought a treadmill as an early Mother’s Day present and just turns on the music and runs. Spending time with her kids has been glorious; she cuddles with them when she can, and they try to play outside on her days off. She lives close to a lake and loves looking out at it.

“Even in all this I am so lucky,” Dixon said. “And blessed. I wouldn’t do anything else but be a nurse. I love what I do. I feel lucky to be able to do it.”