My heart is in a weird place and I feel it needs to settle again.  I keep thinking of the verse in Luke 10:41, 42 ..... "Martha, Martha," the Lord answered, "you are worried and upset about many things, but only one thing is needed.  Mary has chosen what is better and it will not be taken away from her."

There are many things to "do" ... gather food, non-perishables, household supplies, (dog food!)  Check on neighbors, check on parents, check on kids' schoolwork ...

Keep up with hourly evolving CDC guidelines, gloves on - gloves off - sanitize - gloves back on - wipe with purple wipes - "oh no, did I touch that bag first?"  Don't cough, don't sneeze, don't touch your face.  Don't hug me, stand 6 feet away, "oh no, my mask broke!  Where's the stapler?"  Shit - did I sanitize the stapler first? Now I have to change gloves again ... gloves on - sanitize - gloves off.  New gloves .... Here comes another EMS gowned up ... yep another Rule Out ... back in full PPE.  At least maybe I'll sweat off weight like the wrestlers do when they wear those plastic bags ...

Come home ... shoes and clothes off in the garage (thank goodness I have a garage door!)  Scream at your youngest to hide her phone since she's FaceTiming her BFF and you don't want her to share your naked butt streaking through the house.  Streak.  Climb into a piping shower.  Scrub down ... every inch ... twice.  No three times.  Who knows what's living in my hair??  Wash it again.  Breathe. Did I get it all?  I don't know, but I hope so.  Climb out of the shower and into my pajamas, cause I'm obviously not going anywhere else.  Make dinner.  Check schoolwork - whatever, I'll give that a pass tonight!  Sit down to eat.  Kid #1 coughs .... silence.  Did I bring it home???  Did I get him sick??  Oh God .... mind racing again.  What if I did??  What if I'm an asymptomatic carrier??  Kid #1 forced to sleep in my room that night ... on the love seat ... so I can listen to him breathe.  Monitor his cough.  Check his temp ...

It's constant internal noise.  And it's been speaking over my peace and purpose the last week.  God has called us to walk by faith and in His presence ... especially in times like these.  "Rachel ... you are worried and upset about many things, but only one thing is needed."   What is that one thing?  Sitting at the Lord's feet listening to what he's saying, not being distracted by all the preparations that have to be made (Luke 10:39, 40).

The situation is real.  The fear is real.  But it does not have to control me.  Fear is always a liar intended to steal, kill and destroy the peace promised in Christ.  I am daily learning to speak TO my fear ... tell it that it has NO AUTHORITY over me.  It does NOT have the final word over my life or my family.  My GOD is bigger than my fear.  And I'm constantly having to battle that out in prayer throughout each day.   You may not believe this but up until about a year ago I had given up on praying.  For more than one reason, but I had decided it didn't work or it didn't matter.  But a whole

lot has changed in a year.  You see, this little picture below is now my favorite room in the house.    

It's where I have hashed out some hard stuff, broken some serious chains in prayer.  I've cried, snotted, yelled, cursed, screamed and slept in this little corner of heaven.  It's been my go-to for months and it's my go-to now.  Even when I don't know WHAT TO PRAY I fall on my face and weep, trusting that tears are a language God understands.  

I think God is forcing us to be STILL, to be QUIET.  To shut down the internal noise and listen for Him, to Him.  So much has been removed or taken away that we really don't have an excuse to ignore Him anymore.  If you don't know where to start I'm just going to throw out a few things that helped me over the last year and maybe they will help you too ....

These are four of the books I've read over the last few months ... they are different styles of writing and backgrounds of authors but each one has challenged and changed me immensely.  

Lastly I want to share a link to a sermon about fear that I pray will minister to you.  I challenge you to take a walk and listen.  Or find a quiet place in your house to hear.  Just 30 minutes to speak peace over your soul in the midst of chaos.  

The Invitation of God in Seasons of Fear By Jabin Chavez, City Light Church

https://podcasts.apple.com/us/podcast/city-light-church-las-vegas-jabin-chavez/id1290676886?i=1000469238388

No lie ... don't put it past me!  We are running low but we are conserving.  I've actually seen nurses staple the elastic straps back onto their masks when one breaks just to spare using another.  The outpouring from the community has been amazing ...  I have come home to find homemade fabric surgical masks made by neighbors on my doorstep, we've had numerous people bring unused or extra N95 masks for donations, local businesses are donating inventory.  And my son is spearheading a community project to deliver more than 500 homemade surgical face masks to the ED and frontliners in the next few weeks!  We are thankful, and we couldn't do this without you!

Also, we are so thankful for the outpouring of meals and snacks that the community continues to provide!  Chick-fil-a has fed us multiple times, Longhorn Steakhouse provided BBQ dinner one night, Congressman Lynn Westmoreland and Senator Matt Brass provided pizzas for the entire hospital, and we continue to receive various snacks, treats, and goodies from so many of you.  THANK YOU!  I promise .... it's the little things that add wind to our sails!  

Though volume and acuity in the ED are picking up, it's not full throttle yet ... we're still waiting.  The mornings tend to be "q-word" (I won't say the word) but it gives us time to stock up our rooms and PPE carts in anticipation for the day.  Patients begin rolling in late morning and it builds throughout the day with many admissions at night.  Most are considered R/O (Rule Out) COVID patients at triage because they are presenting in such a variety of ways now ... even what we would have considered a nephrolithiasis (kidney stone) patient under normal conditions are sometimes pinging COVID-19 when CT scanned now.  

It's a little disconcerting at work because fellow nurses and doctors are just vanishing ... you'll be half-way through your shift and realize you haven't seen so-and-so in a while.  When you start asking you find out they've been sent home or quarantined or developed symptoms.  You're not sure who's just not working that shift or who's sick.  And I do believe that overall management is keeping it quiet as to not create panic among staff.  It is true that a med-surge nurse collapsed in huddle the other morning and had to be emergently intubated.  It is true that several of our staff have now tested positive for COVID-19 but thankfully have been discharged home to self-quarantine til better and asymptomatic.  It is true that a float pool radiology tech was found deceased in her home last week and autopsy confirmed Corona.  The number of admitted R/O COVID patients is growing every day.

We are facing new situations unprecedented until now.  A family decided to withdraw care from a patient I was caring for yesterday but because of our strict no-visitor policy only his wife was able to tell him good-bye.   It's a harsh rule .... but it's necessary.  We HAVE to limit exposure ... we HAVE to break the chain whenever and however possible.  It's our BEST defense until we get ahead of this thing.  It's ahead of us, and until we catch up we've got to stay home and help flatten the curve ... 

Fast forward ..... It's been years since I've posted.  But times have changed, and I need a place to write what I'm experiencing without flooding FB.  There's enough stuff clogging up your news feed without me adding my two cents to it .... but if you want to to know what it's like being an ED RN in the midst of the COVID-19 pandemic, I will attempt to share with you as I can. The good, bad and the ugly ...



I slipped into a steaming hot bath tonight all the way up to my ears hoping that the water would somehow drown out what I wanted to scream.  The tears silently slid into the chasm of water softly covering the bridge of my nose.  It's okay to be afraid,  it's okay to cry I keep telling myself as I feel guilty hiding how I really feel from my children.  This IS a big deal.  This IS going to take lives.  This IS going to get worse, much worse, before it gets better.  Our world will NOT be the same after this ... just like 9/11.

I was one of those that initially rolled their eyes initially making fun of the people storming the grocery stores for TP and water (okay ... I still make fun of you because of all the things I've stockpiled TP and water are NOT one of them).  But I was angry that the flu didn't get this much attention ... and  we operated under FAR worse conditions two months ago that we are right now.  But it hasn't hit yet. The storm's not here ... it's just on the horizon.  Like one of my colleagues wrote,
"This is like standing, waiting on the edge of a storm that has undefined boundaries, countless possibilities, and an undetermined magnitude. Some of us may not even be fully in the storm yet or even nearing it but we know it's coming. For some, the tsunami has already hit and it may be the first of several waves. For others, we are watching the waters recede before the first tsunami breaks" (thank you Cristin Scarborough for letting me copy from FB post!)

I'm proud of our management team as they are making life saving decisions in unprecedented times.  They've had the foresight to start with our ICU and work down.  ICU is what's getting hit the hardest right now .... Of our five positive COVID-19 patients all are on vents.  The average length of stay on a ventilator for Corona patients right now is 21 days.  And they're not improving.  They are actually deteriorating.  See the virus is attaching to the peripheral lining of the lungs forming what is called "shattered glass" images on CT scans (google it .... there's lots of information and pics out there).  It basically hinders the exchange of oxygen in the tiniest vessels of the lungs.  It's being referred to as a "lung eater."   Our ventilated patients are having to be turned prone (which means face down) to improve their chances.  Research suggests that when these patients are removed from vents they are often coding because their lungs are not able to function independently any more and their cardiac EF (ejection fraction) is less that 20%.

And the virus has already mutated.  Did you know there are two strands?  One that initially presents with respiratory symptoms and one that does not?  The latter strand presents with abdominal pain and diarrhea first, then respiratory symptoms develop.  These patients didn't initially trigger protocol.  But when they went for abdominal CT scans there was enough lung imaging included to capture the "shattered glass" patterns in lower/peripheral lungs revealing they were COVID patients all along.  So it's changing ... making referred to as "slippery" by epidemiologists.

This virus is NOT attacking the elderly and the comorbid.  I take inventory of our COVID patients and Rule Out COVID patients each shift .... they range from 22 to 95 ... with a mean age probably in the 40s/50s.  They don't have extensive medical histories, if any at all.  So for those of you who think you're invincible or not in the target range think again, you're not out of the woods.

I've been exposed.  I was informed by management that I was exposed to a positive COVID patient on March 9th while not wearing any PPE (personal protective equipment).  It took occupational health 12 days to notify me due to the backlog of exposures we are now experiencing.  I now have to monitor my temp twice per day and log any symptoms.  The sucky part is that I've had a cough for 3-4 weeks now ... and I don't know if it came before or after Corona.  Tomorrow they start screening employees at the hospital employee entrance.  Anyone with temp over 100 degrees or exhibiting cough or SOB (shortness of breath) will be denied entrance.

We are running out of PPE.  Right now we each have a brown paper bag where we keep our ONE N95 mask and ONE face shield.  We are already out of goggles.  We will be reusing these for the duration of the pandemic.  Each shift we are allowed ONE surgical mask.  If it soils or tears you're SOL.  And we've been informed by management that we are going to run out of PPE before this thing peeks ... meaning in the next few weeks we will have nothing unless a miracle happens.

So ... this is a little window into the inside.  This is only a fraction of what we're experiencing.  And I'm gonna give a straight shout out to my ICU friends who are inundated right now!  They're knee deep in the battle while we're still waiting for the second wave.

If you want to know how you can help ... stay home.  I don't care how bored you or your kids are.  Please just stay home.  Pray.  Pray for supernatural protection of your front liners, pray for additional PPE to become available, pray for grants to assist financially when we are quarantined at home without pay.  Drop off a meal.  Cut their grass.  Ask to take their dogs for a walk.  Leave a note in their mailbox.  Have your kids write encouraging messages or verses with sidewalk chalk on their driveways.  Send wine!  It's the little things that are just enough to keep our tanks full!