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After a rough sleep at her temporary Portland apartment, Brynn Cafazzo would rise at 5 a.m. for her shift at a Lewiston hospital. She cannot eat that early but would try to get a bagel when she got to work around 6:45 before a first round of checks on critical care patients.
Cafazzo, 31, is a traveling intensive care unit nurse. She takes jobs at hospitals across the U.S. for three months at a time. She just finished a stint at St. Mary’s Regional Medical Center, working in the intensive care unit as the coronavirus spread across the country to Maine.
Two weeks ago, she packed her things for another job in a hospital outside of Maine and closer to the outbreak in Boston, she’s more scared than ever.
“I’m taking for granted that I’m going to get this,” she said of the virus. “There’s just no way I’m not.”
As hospitals are stretched thin with staffing concerns and lack of resources, traveling nurses like Cafazzo have unique access to the ways hospitals are responding to the virus in different parts of the country. Her experience working at St. Mary’s was stressful but OK, she said.
Her new location — a New England hospital that she preferred not to name — is understaffed, unprepared and “a lot further into the process,” she said. Cafazzo cared for virus patients on her first day. Some have died in the two weeks since she first started.
As one of few nurses trained in critical care, Cafazzo has little time to step away from her patients. She gives and monitors medications, puts patients on breathing machines and administers intravenous care. Other patients have had accidents, surgeries, overdoses, withdrawals, organ failures or gunshot wounds. “You name it, I’ve seen it,” she said.
The pandemic has fundamentally changed hospital protocols. The floors and hallways of the hospitals have been rearranged into coronavirus and non-coronavirus areas. She still has her usual responsibilities, but now helps to train nurses in critical care procedures.
With protective gear in short supply nationally, one of the developments to most worry Cafazzo has been the decline of standards that conditions have forced onto workers.
For instance, she was trained to throw away protective masks after each encounter with a sick patient. At her new hospital, she was given one N95 mask that she is expected to use for her entire three-month tenure. The U.S. Centers for Disease Control and Prevention’s guidelines for extended use of the respirator masks say they are safe for up to eight hours of use.
Cafazzo and other critical care nurses are typically responsible for overseeing two or three intensive care patients at a time, a caseload strained by the severity of the virus. She said the frequency of sick patients who need prolonged attention is unsustainable, since nurses are stuck in a room wearing protective gear trying to save someone while others are unmonitored.
A few days ago, one of her patients went into a “potentially fatal heart rhythm,” requiring Cafazzo to suit up in protective gear and administer urgent care for hours. The next day, another of her patients experienced the same thing.
“If they both had it at the same time, what would we have done? What do you do in that situation?” she said. “Every other nurse has two other patients they’re trying to take care of.”
A spokesperson for St. Mary’s Regional Medical Center said that the number of traveling nurses the hospital employs has not increased during the pandemic. More often these days, nurses trained in other areas of care are retrained for intensive care service in either coronavirus or non-coronavirus departments to help protect against a surge of patients needing critical care.
That surge has largely not hit Maine yet. While there were 867 confirmed cases in Maine as of Sunday and 34 deaths, there were 46 people hospitalized with plenty of available critical care beds and ventilators for the sickest patients. But hospitals are still on guard with five outbreaks in vulnerable long-term care settings.
Cafazzo, who grew up in Portland, lived alone in a short-term rental in Portland’s Munjoy Hill while working in Lewiston and before moving to her next job. In Portland, she would occasionally sneak out early enough for a run on the Eastern Promenade, but it’s been difficult since she’s had trouble sleeping at night.
The mounting exhaustion has made it hard for her to focus. The virus seems inescapable from work to TV and social media.
Reports of people — especially those in power — who “belittle the situation” and question the severity of a crisis that she witnesses every day is discouraging to her. So are the constant expressions of gratitude for hospital workers who still lack basic resources.
“All of a sudden we’re heroes who are supposed to be fixing everything, and we [still] don’t have what we need,” she said.