Olaf Growald
For 17 years, Kristin Jarrell, ICU R.N., has worked in the Medical/Surgical and ICU departments at Texas Health Harris Methodist Hospital Fort Worth. Last year was the worst. Kristin lives in Aledo with her husband, Kyle, and their two teenage daughters, ages 15 and 17. Like many nurses, her profession is also her calling. She was drawn to a career in the ICU because of its low patient-to-nurse ratio, which fosters deeper connections. “With two or three patients, you really get to know those people and know their illnesses, know their families, and know how they’re dealing with everything,” she explains. “That’s what I wanted out of nursing.”
Handling life-and-death decisions is just another day at the office for ICU nurses. The Type-A superhumans must operate in a highly controlled setting with meticulous organization and whip-smart critical thinking. Along with specialized skills and an extensive knowledge of disease pathology, an ICU nurse must have an even-keeled disposition and stay calm, cool, and collected in the intense environment. “It’s not for the faint of heart,” admits Kristin. “You have to have a very strong core inner strength to watch it day in and day out.”
But even the most experienced ICU nurses found themselves challenged like never before when a tiny viral pathogen appeared on the scene in early 2020.
Tuesday, January 21, 2020: The Centers for Disease Control confirms the first U.S. case of the illness caused by the novel coronavirus. It is not yet named COVID-19. Like most of us, Kristin was not overly alarmed by the early news of an infection spreading out from Wuhan, China. “I thought we might get one or two sick people at our hospital,” she recalls. Even when the virus began to spread in New York City, she had yet to grasp the seriousness of the situation. “They live in such close proximity to each other, I could see why they’re getting so sick. But sweet little Fort Worth? I couldn’t imagine it coming this far.”
But soon the sickness had slipped into the city. In the first week of March, a couple of patients trickled into her hospital who were suspected of having the virus. “I remember the first one. Everybody was so afraid to take the patient.” The suspected COVID cases were isolated in negative pressure rooms and assigned two nurses each. “We had to put all this PPE [personal protective gear] on, and then make sure the other nurse had all the PPE on correctly. There were all these checks systems.
“It went perfectly … we hit the ground running,” says Kristin. “I feel like [Texas Health Resources] was prepared for the pandemic even before it got here … I feel very safe being in our unit. We have all the PPE we need. I could be covered head-to-toe probably for another year. Anything we’ve needed has been readily available, and I feel like that’s because they’ve been preparing for this since the Ebola incident.” The first Ebola case in the U.S. was confirmed in Dallas in the fall of 2014; although it died down quickly, the experience gave local health workers a blueprint for future outbreaks — and a valuable wake-up call.
Tuesday, March 10, 2020: The first COVID-19 case is confirmed in Tarrant County. The trickle soon became a steady stream of patients who were either suspected of having COVID or already confirmed positive. It was the week before spring break for Kristin’s daughters, and the family was planning an RV trip together to Big Bend. On her last day at work before she left on vacation, her ICU was transitioned to an all-COVID unit. She spent her entire 12-hour night shift moving 21 regular patients out of the unit and replacing them with 21 new COVID patients. Holy cow, she thought. This is no joke.
During her trip to West Texas, Kristin felt the dark cloud of coronavirus gathering overhead. “It’s my personality to take things day to day. I don’t get worried about what’s to come, I really don’t have a lot of anxiety,” she says. “But you could start to feel the worry from the country. We were down in Big Bend — it’s the most wide-open space you can find — and they were shutting the park down. The little restaurants there were closing down. You could feel this buildup of what was about to come.”
Tuesday, March 17, 2020: Tarrant County announces its first COVID-19 death. Kristin returned to the ICU the following week. “It was almost like walking onto a brand-new floor. I didn’t even recognize the place.” Instead of empty hallways, she saw supply carts and IV pumps lining the walls. Much of the equipment from inside the patients’ rooms had been pulled outside of them to minimize exposure time for the staff. All manner of PPE was stashed in the corridors and slathered on her colleagues. “Everybody was gowned, and we had face shields, goggles, and masks. We wore these surgical caps, so you couldn’t even see anybody’s hair.” She struggled to recognize friends she had worked with for years.
“I just walked around in awe. Like a fish out of water.” Despite almost two decades of experience, it felt like her first day in an ICU. “It was such a sudden change. All this had happened basically overnight, and you didn’t have a chance to gradually become accustomed to what you were about to take on,” says Kristin. “That was probably the most anxiety-provoking issue for me.”
Thursday, April 2, 2020: A stay-at-home order goes into effect across Texas. After a couple of weeks, the initial burst of chaos and confusion had cooled off as America hunkered down at home. Colleagues clad head-to-toe in PPE were now a familiar site to Kristin, and the cart-filled halls produced no more anxiety. But the virus was just getting started — and the patients were fighting for their lives.
Treating the poorly understood disease was an exercise in uncertainty, and nurses often found themselves powerless to help. “We had no idea what to do to treat these people … it was just a wait-and-see game,” she says. “That was one of the hardest parts. As nurses, we don’t like having our hands tied. We like to be proactive. We’ll do anything we can do to help you improve, and when we can’t do that … that’s when the tears come. The frustration, the anxiety — that’s when it gets us.”
The ubiquitous nature of the pandemic didn’t help. Dealing with death is part of the job description for an ICU nurse, but Kristin had always been able to leave the accompanying stress behind at the end of her shift. “When you have a death, you just want to come home and let it go,” she explains. “Before COVID, you could do that. Nobody talked about the flu on the news. Nobody talked about pneumonia or COPD.” But everyone was talking about the virus. “You come home, and everything everywhere is COVID COVID COVID. You get on social media: It’s COVID. You get on the news: It’s COVID. Your friends, your family, everybody wants to ask how it looks at the hospital and talk about it.”
But Kristin didn’t want to talk about it. She wanted to enjoy her family and grill outside in the sunshine. “You want to have some small corner of the world where you don’t have to think about it. You just have to, for your own mentality,” she says. “It was really hard to get away from it. It still is.”
Giving her brain a break from COVID was crucial because Kristin would need all the mental energy she could muster to confront another new challenge: isolated patients. “The sickest people were young, previously healthy, they didn’t have a lot of underlying conditions … and they’re fighting alone because their family can’t be there,” she says. “It’s really hard to watch a mom talking to her son on the iPad when he’s intubated, and he can’t talk back.” Nurses had to fulfill the role of the family as best they could. “I can’t imagine what that feels like to be isolated. They’re in a room, the door’s closed for isolation, they’re just stuck there … we did a lot of sitting at the bedside and holding hands, keeping them positive.”
To keep herself positive, she found hope in the rare victories — like the survivors. One patient had been on a ventilator and dialysis for almost a month, and his outlook was grim. “I really never thought for one second that he would survive. But he did.” The unit had a huge celebration when the man was discharged. “It still brings tears to my eyes,” Kristin remembers. “There has to be one to give you hope that there’s going to be a whole lot more. And that was the one.”
Thursday, July 2, 2020: Governor Abbott issues statewide mask mandate. A summer unlike any before had arrived, and as the temperature increased, so did our understanding of COVID-19. “We got smarter. We learned how to treat it better. Kristin also learned how to handle the pandemic’s persistent presence. “I stopped watching TV. I did not get on social media. If I had a bad day and wanted to talk about it, my family was absolutely ready to listen. But they learned really quickly to not ask.” What was once a normal household question — How was your day? — was shelved until future notice.
Not shelved: family time, with plenty of precautions. “I wouldn’t even speak to my children or my husband until I had my shower and was clean. I probably should have been doing that for 17 years, with all of the things that I could have been bringing home. But nobody was afraid of the things that have been around for a while. Now there’s this brand-new virus, and we’re all very afraid of it. So, everything becomes very deliberate.”
Only after decontaminating herself could Kristin relax. “I could have some breakfast, clear my mind, watch some TV. My kids and I love to watch ‘The Simpsons.’” She didn’t let the pandemic affect her interactions with her husband and daughters. “You’ve got to have some kind of connection or you just lose it altogether,” she says. “I’m not a natural worrier. I do everything I can to prevent infection or spread, but I’m not going to isolate myself from my family.”
She also found solace by hitting the pavement. “I learned to exercise. A lot,” she laughs. “I’d always been a runner and just got back into it. It’s amazing how far you can go when you are frustrated or irritated. Just put on the shoes and start running. It’s a good way to clear your mind for sure.”
By August, coronavirus cases in North Texas began to drop. “We kind of had a lull.” Her all-COVID ICU had been filled almost to capacity for months — and finally, it wasn’t. They reconfigured half of the unit to a regular ICU, reserving only one-half for COVID patients. “Everybody was ecstatic,” says Kristin. “It was like it was a new day. We were so excited.”
Saturday, September 12, 2020: Tarrant County has 201 hospitalized COVID patients, the lowest number since early June. The excitement didn’t last long. In less than a month, the unit had to switch back to being all-COVID. “It hits you hard … I just thought maybe we had seen the end of it.” The turnaround was difficult for Kristin and her ICU family. “We take care of each other,” she says. “The comfort of having your family there made all the difference in the world. You’re never afraid that you’re by yourself when these patients get worse. You always have somebody to back you up. There’s a support system there all the time.”
Her teammates kept an eye on each other, ready with hugs whenever needed. “We do a lot of talking together. And then sometimes you just say, ‘I’ll be back; I’ve got to have 5 minutes.’ And you have to take some time for yourself and regroup. Clear your mind, walk outside, do something other than sit and watch your patients through a window.”
Still, the situation was better than it had been in the spring. “There was more turnover,” she recalls. “Patients left; we would get new admits; it was kind of a revolving door. But it wasn’t as stressful as it had been. You could still feel that [the numbers were] coming down.”
And then the holidays arrived.
The most wonderful time of the year it was not. “It was really, really tough. December and January hit, and it was just nonstop … [like] a freight train that comes through and knocks the wind out of you,” Kristin says. “Back in March, we thought 150 or 160 positive patients were a lot. In December, it was 200, 250. Those days were harder because you had already felt like there was an end, and then it just reversed and went right back.”
Wednesday, January 6, 2021: Tarrant County hits its all-time high of 1,528 hospitalized COVID patients. The patients seemed sicker, and recoveries became scarce. Death stalked the hallways. Before COVID-19, if one patient died in a week — it was a really bad week. “Now we’re getting three a day. It really drains your momentum. If we would get one person off the ventilator, we would do a dance of joy. It was the most exciting thing ever. We would stand in the halls; we would clap for them. It was awesome. And then the next day, we’d have two more deaths.”
The unflappable ICU nurses were being pushed to the limits, frustrated by the disease and angered by its unfairness. Kristin didn’t realize how much stress and anxiety she was experiencing until she began seeing it play out in other areas of her life. “I would get angry pretty easily,” she confides. “I would get angry at my husband — you take it out on the people that are standing right there. I have lots of animals in my house, and they got a lot of lectures.”
She found herself struggling to sleep and eat. “I wake up about every three or four hours … there’s never really rest. You always feel like your mind is on,” she says. “I try to have normal food, but sometimes it’s just hard to eat. You’re not hungry, not getting enough fluids, a little bit dehydrated. All those things just compound.”
But even during the darkest days, Kristin fueled her spirit by focusing on the tiniest improvements in her patients’ conditions — and on the lucky individuals who walked out of the hospital. “There are going to be terrible, terrible moments, but there will be a good one that comes. The people who get to leave our unit are those little rays of hope.”
Thursday, February 25, 2021: The number of hospitalized COVID patients in Tarrant County falls to 489, and new cases and deaths are also trending downward. More than 3 million Texans have received at least one dose of the vaccine. As another spring dawns, so does new optimism in the war against the disease. “It’s looking better and better. Our numbers have come down.” Millions have received the vaccine, but it’s not a cure-all yet, Kristin warns. “We all have to remember that this is a virus, and viruses are very good at surviving.” Still, she adds, “I think there are lots of things in play that shine some light at the end of the tunnel. I do feel like it has to come to an end. We can’t live in fear forever.”
For Kristin, the worst year of her career has not been without a silver lining. She’s a better nurse now. “COVID has made my senses sharper. It’s made me go back to my basics.” She’s also found a new sense of gratitude for the people of Fort Worth, who stepped up to deliver reinforcements to the health care workers on the front lines: meals, snacks, water, Gatorade, cards, and letters.
“Just to know that your community is that supportive — it helps tremendously. When you think that everybody is watching you fight this pandemic and there’s not much you can do to help … you feel useless. But to know that the community is praying for you, it just gives you this sense of honor,” says Kristin. “I’m honored to take care of these people. They’re entrusting their lives with us. It’s an honor, and to know that people actually see that, and recognize it, and support you — that’s huge. Huge. So, thank you to Fort Worth.”
Kristin is saving our loved ones’ lives from COVID-19 while risking her own, returning day after day to the combat zone — and she’s thanking us for it. Add “practicing gratitude” to the list of tactics she uses to find light in the darkness: Celebrate little victories. Take care of yourself and each other. Have a break when you need one — and turn off the news. If this strategy can help an embattled ICU nurse to keep her faith in the victory to come, then it can help us, too. “It’s coming,” she affirms. “Every day I feel like there’s a little more hope.”
