Maria, day 6.

It was bright outside, the sun was shining, and as I looked at the window in Room 303, I saw the light peering through. Maria, a 78-year-old Hispanic woman, mother of three, could not move and did not see that spring had begun as she struggled to breath. She looked at me with her helpless teary eyes trying to communicate, but I could not hear the words.

I’d d been Maria’s primary nurse for five of the six days that she has been hospitalized. During that time, I had witnessed the tension and anxiety that existed within her family around her admission with Covid-19. I hoped silently that a DNR order would be initiated if her breathing worsened instead of her being placed on a ventilator. But I tried not to express my feelings to her family about this when I helped them to communicate with and see their mother using FaceTime.

Maria’s family watched as she slowly declined, and saw how she didn’t respond to treatments. Feeling hopeless and overwhelmed, I tried to schedule a time to speak to my nursing manager about how I was feeling, but she was always too busy scheduling and assisting on the floor after other staff called in sick.

Hard decisions take time.

On day 10, Maria went into cardiac arrest. My coworkers Janet and Elizabeth were in the room at the time with me, and I called for help. There was no DNR recorded for Maria, so she underwent cardiopulmonary resuscitation and cardioversion. She sustained two fractured ribs and a punctured liver during that procedure, and she was placed on a ventilator.

On day 12, the children requested FaceTime with their mother, although she could not speak or open her eyes. “I love you, Mamita,” they cried. The physician spoke to the family and told them that her chances of surviving grew poorer the longer she remained on the ventilator. Despite their discomfort about withdrawing the ventilator, the family began to think about doing so the following day.

On day 14 they made their decision. They told Maria on FaceTime how much they loved her and that they did not want to see her suffer anymore. They each sent a kiss and said a personal goodbye. Maria was pronounced dead. I was privileged to hold her hand as her life slipped through my fingers.

Nurses are also struggling with grief.

As a nurse during this pandemic I’ve seen how families struggle with the inevitable, the end of life. Many of these families have not been prepared for the avalanche of emotions that sweeps over them when the moment comes, even when they know that death is imminent.

As the hours have evolved into days, it has become more exhausting and painful to provide comfort and compassion to patients and families during this pandemic. As a nurse, I have been challenged daily by my own struggle with the intense emotions of grief. I cannot cry anymore because I must be brave for tomorrow when another patient and their family may need me. I cannot think about myself but about them and about how I can provide the best care they should receive. I’ve found myself overcome with grief on some days as a I’ve struggled to make it to work.

Our of grief, empowerment.

Grief is painful but it strengthens us. I am learning to embrace the pain of loss by developing a renewed confidence in myself. This involves being more caring and more sensitive with myself and appreciating life. As a result, I have developed an assertive part of my identity that empowers me to go on living even though I continue to feel a sense of loss. I must help these patients—when they come to the hospital, they have no one but me. I am their family, their daughter, their spouse, their sister, and their nurse.

Unfortunately, there are no quick fixes, but spring will come again to room 303.

By Sandra Maldonado, EdD, RN, CNM, FNP-BC, SANE, assistant professor of nursing, Lehman College, City University of New York (CUNY).