A Baltimore nurse chronicles how she's bracing for the surge

Everyone knows, generally, about the grueling job, rough conditions, and valiant work by doctors, nurses, and aides on the frontlines of the fight to save lives from the coronavirus pandemic. Baltimore nurse Rosem Morton provides the details in her journal of eight days at the front.

At the hospital where Morton works, staff are balancing caring for patients with a limited supply of personal protective gear, while trying to keep track of shifting protocols. Morton, also a photographer and a recipient of a National Geographic Explorer grant, has been chronicling her day-to-day experiences. From being fit for a N95 mask to worrying about her hours, she and her colleagues are up close and personal with the virus every day. Read on to find out what it's like to be a nurse in the time of coronavirus.

Work Day 1: March 17, 2020, Tuesday

Days since the first confirmed case of coronavirus in Maryland: 12

Days since the first known coronavirus patient was admitted to the hospital where I work: six

6:00 am

As I scramble to leave for work, I realize my routine has changed. My lunch box is replaced by a plastic bag. I used to carry a glass container, a cloth napkin, metal utensils, and a water bottle. I cringe at the waste from single-use plastics, but I tell myself that minimizing items I bring home lessens the risk for everyone. I leave behind my purse and stuff my pockets with my badge, scissors, and a pen.

6:40 am

I arrive at work before sunrise. The main rotating door is closed. In front of it is a sign reading “COVID Response,” showing the new rules that limit entry to the hospital. Hospital employees form a silent line, spaced for social distancing, to filter in through a side door. Today is one of the last days I would call “business as usual.” While much of the administrative staff has moved to working remotely, everyone else is still here.

11:30 am

At lunch, coronavirus is all we talk about: Labor and delivery nurses have been moved to the emergency department, another hospital has only a four-day supply of personal protective equipment. Are we all wondering the same thing? What does this mean for us? (Follow our comprehensive COVID-19 coverage.)

Work Day 2: March 18, 2020, Wednesday

Confirmed cases of coronavirus in Maryland: 85

6:55 am

Today is the first day that medical workers will perform only emergent and urgent operations. After all the cancellations of other surgeries, there’s more staff than usual to help out. I serve as a scrub nurse assisting the surgeon for neurosurgery, one of my favorite specialties. I realize then that a lot of the surgeries I help in are emergent and urgent. Maybe I won’t feel the disruptions of COVID-19 that much after all.

12:00 pm

Many of us finish early and wonder what’s next. As a longstanding per diem employee, I know it will only be a matter of time before they cut my hours, unless I prove myself useful.

8:30 pm

My husband, an RN, comes home from taking care of the first high-suspicion coronavirus patient in his unit. He was a charge nurse and didn’t need to take care of patients today. But he volunteered, because he recognized that many of his coworkers were nervous. This is a beautiful example of what healthcare providers all over the world are doing. (This is what physicians do and don't know about treating coronavirus.)

Day off: March 19, 2020, Thursday

I get a text asking if I’m willing to be floated to other roles in the hospital. I say yes.

Work Day 3: March 20, 2020, Friday

Confirmed cases of coronavirus in Maryland: 149

6:50 am

I walk up to the front desk of the operating room to check my assignments for the day. Several powered air-purifying respirators (PAPRs) hang on an IV pole as though on display. Rows of batteries blink as they charge on a metal table. There is a box of PAPRs off to the side. Something is brewing but I don’t have time to investigate.

I enter the operating room to be scrub nurse for a neurosurgery case. I throw myself into a steady rhythm, just as I have done for many years: Gathering supplies, checking sterility, and arranging instruments. I am in my own world, a mental reprieve. It's short-lived.

The anesthesia staff walks in with PAPRs—hoods that go over the head and are attached to a machine that filters air. We learn that the hospital’s new recommendation for respiratory procedures, such as intubation and extubation, is for medical staff to wear PAPRs or N95 masks, because of the risk that the COVID-19 virus will spread through the air.

The recommendation seems late, given how the pandemic is progressing, and difficult to fulfill. The majority of us have not been fitted for a N95 mask. We only have 30 PAPR machines in our unit to share among hundreds of staff members. The solution? Anesthesia staff get PAPRs and N95 masks and the rest of us leave the operating room during respiratory care. But if COVID-19 is indeed in the air, there wouldn’t be enough time for those particles to settle by the time we return. This is our first true glimpse of our limited resources. It doesn’t bode well for what’s to come. (Here’s why the U.S. doesn’t have enough medical supplies.)

Work Day 4: March 24, 2020, Tuesday

Confirmed cases of coronavirus in Maryland: 349

Total deaths in Maryland: four

6:40 am

My walk through the hospital is unsettling. There are “no visitors” signs everywhere. I wonder how our patients are faring, being hospitalized alone.

6:50 am

Halfway down the stairs to the operating rooms, I pause at the sight of a crowd below. The morning staff is packed into the main hallway, wearing masks. Supervisors are giving us a quick rundown of the new rules. Procedures are changing day to day, sometimes every few hours. For now, we are shutting down some operating rooms and staggering surgeries to share the machines that power the PAPRs. It’s a huge relief to have better protection than last Friday.

A few minutes later, I hear my name called, and a PAPR is placed in my hands. There’s an emergency case that needs COVID-19 precautions, and I am staffing it for the day.

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Work Day 5: March 25, 2020, Wednesday

Confirmed cases of coronavirus in Maryland: 423

6:50 am

I am assigned to another surgery, one that enters through the patient’s nose. I ask for a PAPR and realize there aren’t any. Someone decided that this isn’t an airway surgery and that staff don’t need protection. An unspoken dialogue passes between me and the other nurse. We ask for personal protective equipment before we agree to staff this surgery. We are provided with the equipment.

12:00 pm

The hospital has decided on hard rules for protective equipment. As a nurse in the operating room, I get a PAPR. But I worry that I will be limited by the number of PAPR machines we share. I use my break to get fitted for an N95 mask, just in case. There have been long lines for them throughout the week.

I assumed the fit testing, as the process is called, would consist of teaching us how to wear the masks properly. It was so much more than that. Over the N95 masks, we are asked to wear a large white hood. To test the seal of the mask, a supervisor sprays a test substance through a hole in the hood and checks if we detect a bitter taste. We move our heads side to side and up and down. We read a lengthy paragraph. We walk around. It took me a couple of tries to perfect the seal.

I think about the public, the people who bought their own N95s and never had access to a fitting. They are under the false assumption that they are protected. A small mistake in sealing the mask could be fatal.

5:30 pm

After another surgery, I rush to a class called “Donning and Doffing.” We practice putting on and removing the personal protective equipment health workers use in units designated for COVID-19 patients. We practice hand hygiene before donning a yellow gown, multiple layers of gloves, a bouffant scrub cap, a reusable respirator, and a face shield. We try to commit the steps to memory. Removing the protective gear is an even more meticulous process.

Work Day 6: March 26, 2020, Thursday

Confirmed cases of coronavirus in Maryland: 580

6:50 am

Staff are stationed in each hallway to help remove personal protective equipment. They serve as runners to minimize comings and goings in airborne precaution rooms. They make sure PAPRs are wiped for reuse. At a desk near the operating rooms, staff distribute the machines. They are keeping very close tabs on them. We cannot afford to lose a single one. People murmur to each other, “Have you been fit tested yet?”

Work Day 7: March 28, 2020, Saturday

Confirmed cases of coronavirus in Maryland: 992

Total deaths in Maryland: five

6:50 pm

There is one more procedure to go for the day, another airway-related case. I carefully don my PAPR over my surgical mask and hat. I wear a flimsy yellow gown over my scrubs. It comes with thumb holders to secure my sleeves. I tie the gown tightly in the front. I grab the smallest blue gloves to cover my hands, and I enter the operating room.

7:00 pm

The surgeons have been waiting for some time and want to get going but the surgical technologist has no PAPR hood. We have run out. Another nurse with a hood takes her place. During the surgery we argue about the new policies and procedures. Things have been changing so frequently that we all have different information. It has become difficult to discern fact from fiction.

Work Day 8: March 31, 2020, Tuesday

Confirmed cases of coronavirus in Maryland: 1,660

Total deaths in Maryland: 18

6:25 am

As I swipe my badge on the time clock, a new screen pops up. It asks if I have any symptoms of cough, sore throat, and fever. I click no and wonder what happens when people say yes. I hope I never have to say yes.

Rosem Morton is still healthy and working as a nurse in Baltimore. At the time of publication, Maryland had 2,758 coronavirus cases and 42 deaths, four in Baltimore.