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Amita Avadhani, Ph.D., DNP

Amita Avadhani, Ph.D., DNP, CNE, DCC, ACNP-BC, NP-C, CCRN, FAANP, FCCM, is a nurse practitioner at Saint Peters University Hospital and an associate professor at Rutger's University in New Jersey.

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Amita Avadhani

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Treating Covid-19 Patients in the ICU Nearly Broke Me, But Now I’m Stronger for It

There were days I was so sad and afraid that I wanted to give up on nursing. Now I know I'll never quit.

Real Women, Real Stories

As told to Nicole Audrey Spector

May 12 is International Nurses Day.

Imagine a sudden hailstorm — the kind that forces you to duck for cover under a canopy or whisk away into a cab. Only in this scenario, there is no canopy, no cab. There is not even an umbrella or a raincoat. It's freezing out and the storm is worsening.

Now imagine that the violent rain is starting to flood the streets and sweep people away. You're hanging onto a lamppost for dear life, yet everyone else is looking to you to save them. This is what it was like to be a nurse practitioner in central New Jersey in March 2020, when Covid-19 struck our hospitals.

Having been a nurse practitioner (NP) for the past 18 years and in critical care nursing for most of my career, I've seen no shortage of heartbreaking cases. But until then, I'd never experienced a global pandemic.

Typically, in the sanguine pre-Covid days, I would get to work, chat with colleagues, make my morning rounds to check on patients, then head into my office to prioritize orders, update my notes, and communicate with patients' families.

Covid, of course, upended all of that.

It's no exaggeration to say that entering the 27-bed ICU at Saint Peter's University Hospital that spring was like walking into a war zone.

Normally, we treated patients with all kinds of needs, but by then it was all Covid, everywhere you looked. IVs and ventilators clogged the halls. But what else could we do? If we left the machines in the rooms with their patients, we would have to put on new PPE each time we entered the rooms. That was a luxury we couldn't afford, as we were worrisomely short on supplies. An N95 mask that would normally have been chucked after a single use had to be worn at least five days on end.

Though our hospital administration worked diligently to keep its staff safe and informed, there was only so much that could be done in a completely unprecedented situation. Usually, with any virus or disease, there is a trove of research to reference, a series of road maps. But Covid was new to all of us. The road map was in the making.

I kept (and still keep) my sanity by sticking to my tried-and-true self-care routine: A half-hour on the treadmill and several minutes of meditation and deep breathing. I'm certain that this morning ritual saved me during the peak of Covid in the ICU. Certainly, it provided me the energy I needed to get through the draining day. But it did not keep my spirit from suffering.

In the beginning of the pandemic, I was able to enter a patient's room brave-faced and feeling truly fearless. But over the weeks, the onslaught of tragedy wore me down. There were just so many people dying all around us. No matter how hard we worked to save them, so many died. And the virus operated so insidiously: One day a patient would be so improved they were able to be discharged. Then days later, they would be readmitted in far worse shape and soon after, pass away.

I'd chosen a career in critical care nursing not only because it was so challenging but because it was so rewarding. A nurse could really make a difference in the world. But how was I making a difference now? I was up against something that was so much bigger than anything in the history of my generation. And there was no end in sight. Furthermore, I felt guilty and nervous all the time, worrying that I was bringing infection home to my husband. I practically banished my grown children from visiting us for fear they'd catch Covid from me.

I knew of some nurses who were transferring out of their ICUs — switching over to outpatient care or dermatology — anywhere that wasn't in the eye of the Covid hurricane. I could leave, too, I thought. I didn't want to — but I was aware it was an option.

But then, something happened that shifted my entire perspective and enabled me to let go of my own anguish for a moment.

A young man in my care was deteriorating rapidly because of Covid. He didn't have much time left. I de-gowned and went outside to break the terrible news to his wife.

"I think you should say goodbye," I told her, explaining that although she couldn't come into the ICU as she demanded, she could at least see her husband on an iPad.

"No, that can't happen," she said, sobbing yet adamant. "We have a one-year old daughter. She can't be without her father."

I was dumbfounded and speechless. My old scripts of how to talk to the loved ones of someone with a terminal condition fell away. The young woman was right. This couldn't happen. None of this could happen. And yet here it was, happening! Tens of thousands (and now hundreds of thousands) of Americans were dying from something that shouldn't be happening. And it struck me then: We're all in this together — and no matter how run down and miserable I feel, the suffering I know is nothing next to that of the people losing their lives to Covid. It's nothing next to the suffering of their loved ones living through it.

At last, the young woman agreed to see her husband via iPad. When she saw him on the ventilator, she gasped and cried even harder. He looked nothing like himself. That young man died the following day.

It's been more than a year since then, and my spirit has been tested plenty of times. But I have never considered leaving the ICU. I don't blame any nurses who decide to leave critical care because of the stressors of Covid-19, but for me, I now understand that, contrary to what I once thought, this is what I signed on for. I signed up to help people who are suffering.

And so, I will go wherever the flood takes me, and I will do everything I can to get you to safety.

Amita Avadhani, Ph.D., DNP, CNE, DCC, ACNP-BC, NP-C, CCRN, FAANP, FCCM, is a nurse practitioner at Saint Peters University Hospital and an associate professor at Rutger's University in New Jersey.

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