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Virginia ER Nurse Kellen Squire at 18 Months of the COVID-19 Pandemic: “I’m Tired…But I Can’t Quit.”

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by Kellen Squire, RN

I called a good friend of mine recently, who I haven’t caught up with in too damn long. Not more than a minute or two into the call, my friend abruptly stopped the line of thought we’d been on, a concerned tone in his voice.

“Kellen,” he said, “you sound tired.”

I understood what he meant by “tired.” Not from lack of sleep … well, not from lack of sleep alone, as juggling three kids and a spouse who works day shift in the ER while I work night shift leaves precious little time for sleep. Three hours a day is great; five is unheard of. But I’m “tired” from, well… everything.

I chuckled. “Yeah,” I said. 

“I am.”

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Eighteen months.

Eighteen months in this pandemic. It’s felt like two weeks and 20 years all at the same time.

You know, I used to sometimes sigh about going to work; I had things I wanted to get done, I wanted to spend time with the kids. Mild annoyance, but obviously you gotta work to put food on the table. But I never dreaded my job. Never had my heart race with anxiety at the thought of it. Never felt a lead weight in the pit of my stomach. Never stared bleakly at the clock, wishing with all my might it’d go slower.

Now, going to work is—without exception—knowing you’re just going to get your ass beat relentlessly, and the only thing that’ll stave it off is the punch clock on the other side of twelve hours.

We’re in the middle of a surge—at the crest of it now, or so they say. “The numbers look better!” but I don’t see it yet. The delta variant has been a little different than the alpha strain, but, still; it’s a time bomb. Numbers could plummet today and we wouldn’t see real movement for at least a week or two.

Granted, a good chunk of this is my fault. I’ve been going for the last two years. I announced I was running for Lieutenant Governor of Virginia in August 2019, and I ran full speed at that—until one of my kids had a mental health crisis. I still haven’t come to grips with that. I mean, I’m an emergency department nurse. I was an elementary school nurse. I worked in pediatric acute care at a children’s hospital! My entire fucking career has been built around the supposition I’m suppose to be able to catch that kind of thing. What kind of shitty nurse and father am I that I missed it completely before it was damn well almost too late?

But that doesn’t really count. I mean, I wasn’t the one who had to go through anything—my kid was. Our kids have to go through so much shit that we never did. So much stuff that I couldn’t have even comprehended going through. Columbine happened when I was in high school, and classes effectively shut down for three days, so all of our teachers could talk to us about it, so we could process it. Now, kids plan what to say if they have to text their parents goodbye notes crammed in a closet, waiting to die.

Jesus.

And then straight into the pandemic.

There’s so much I could write here—pages and pages and pages—but even writing this much just makes me relive everything again. I’ve been asked why I don’t quit my job in the ER, both sincerely and sarcastically (“You signed up for this! Why don’t you just quit if it’s so awful!”). And I could, pretty easily. As long as I can remember, the gospel of nursing has been that “if you spend some time in the ER or ICU, you can write your ticket to any job you like!”

And y’know what? That’s not wrong. I’ve seen more experienced providers leave the bedside forever in the last year than in the rest of my career combined. For more money, with waaaaay less stress, and an infinitely better work-life balance. Most of them stayed with us through the brunt of the alpha strain … and then late spring, when we started to go a few shifts in a row without a COVID-19 case—never an entire week, but there were days we had no COVID-19 patients at all—they left.

I don’t blame them. Not even a little. I thought I’d seen tough stuff two years ago, but now? Now I’ve seen the breakdown of the American healthcare system.

I’ve seen the fault lines in our country shatter, and, as they did, the people now in crisis turn to us, because we’re the only place left for them to turn.

I’ve seen my own government ask my colleagues and I to step up and save the country—and then not only just not stand behind us, but actively work to make things as hard on us as they possibly could. And then when that got fixed in January, we watched that sabotage effort quickly replaced by a multi-billion dollar lobbying effort to downplay the pandemic and demonize healthcare providers.

I’ve seen the eyes of a young, unvaccinated patient as they realized that it was all real. That the coronavirus was serious. Deadly serious, and that there was nothing we could do to save them. I’ve seen them realize this was it, and the desperate, panicked look—but only a look, because they were too short of breath to even utter a single syllable.

I’ve seen a critically ill, but wholly cogent patient walk out of my emergency department without life-saving treatment because they found out we needed to COVID-19 swab them. Without hesitation, they told us that COVID-19 was made-up, and we were just trying to murder them for “the COVID-19 money” we were getting.

I’ve had close colleagues who were told by patients’ family members that they were going to find out where all the nurses lived and kill them for perpetrating a “hoax.”

I had a charge nurse from another hospital in Virginia call me begging—begging!—to please, please, help them find beds for the patients they had: Patients who were waiting days for critical care beds; patients who were on the verge of being put on ventilators in hallways. Patients who outnumbered their nurses 10 or 20 to one. I had to tell them that I was sorry, that there was nothing I could do. It was like I was on the International Space Station, hearing a distress call from a boat floundering in the middle of the ocean, and only being able to listen to them drown.

I’ve had to look all over the Commonwealth of Virginia, time and time again, for a bed for a patient who needed critical life-saving treatment, all to no avail. From Bristol to Fairfax and Norfolk to Winchester, there was not a bed to be had. Not one, for adult or pediatric patients.

I’ve seen more kids having mental health crises than I’ve seen in the rest of my career combined.

And it’s almost like living a double life. We go through shift after shift of holding things together with baling wire and duct tape, as we burn down fighting a never-ending wave of (largely self-inflicted) crises… and then go home to a society where people have largely moved on. Completely unaware—unless they have the misfortune to need to visit the ER—of the hell being wrought on our community, or how tattered and frayed the safety nets of our society are. In fact, many are so secure in that feeling they tell us to our face we’re wrong. “I don’t understand why it’s so busy in this hospital, this is ridiculous! Don’t tell me it’s the COVID! I saw a Facebook post from my Aunt Tilly, so I know it’s not actually that bad. Y’all just don’t want to work hard!”

I know it could always be worse. The Shenandoah Valley has been nigh-on-apocalyptic; one of the nearest hospitals to us has been using its cardiac catheterization lab not to, y’know … save the lives of patients having heart attacks, but as a COVID-19 ICU. We’re truly reaping what we’ve sown for year after year of systematically dismantling and undermining rural healthcare, driving out both primary care and critical access hospitals. Still, I thank God every day we’re not Florida or Texas; I have colleagues from there who have told me the consequences of living in a state where pro-COVID-19 governing is still going strong.

And yet I stay. Not because I’m a hero, or some bullshit like that. I’m not. I’m an okay ER Nurse, but I’m not some crack shot, irreplaceable super provider.

Maybe it’s just stubborn bloody-mindedness at this point. I’ve made it this far, and I’ll be damned if I don’t make it all the way through.

Maybe it’s seeing the actual heroes I’ve worked alongside these past months. If not for the experienced providers I’ve had the honor of working alongside, our community would have suffered the fate of so many others. Things are bad as it is, but they could have been so much worse, had these real heroes not put the entire community on their backs—sacrificing themselves, their well being, their time with their family—to hold things together when all seemed lost. I refuse to give up if they haven’t; if we go down, we all go down together.

That might be the biggest part of it: I see what the people who truly hold our community together have gone through to actually get that done, and how they get almost nothing in return. After being asked to “save the world” because they’re the only ones who can, they get nothing.

I understand exactly what the consequences will be to everyone if we choose not to fix that, if we choose not to make a substantive investment into rebuilding, revamping, and making sure none of this ever happens again. Because I’ll tell you, all those crisis resources and experienced providers? We’re going to have to rely on them more and more frequently in the very near future.

Climate change. Political instability. New pandemics. Every failure of our government to act. Without those of us on the front lines—in the emergency room, in the ICUs, the COVID-19 units, primary care offices, fire and EMS, so forth and so on—we stand no chance of weathering what’s to come.

So I’m tired. Yeah. But I can’t quit.

I can’t quit on my colleagues.

I can’t quit on our community.

I can’t quit on our future. On my kids’ future.

I can’t.

I won’t.

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