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Tales of COVID: Marissa Pietrolungo, ICU Nurse

“We’re the only family they have in this ICU right now.”

June 29, 2020
Marissa, ICU Nurse

Marissa Pietrolungo, 29, a cardiac intensive care nurse at Temple University Hospital for eight years, volunteered to work fulltime in the COVID-19 ICU in the Boyer Building on March 28. She remembers the day.

“My manager came up to me and another nurse,” Pietrolungo recalled, “and said, `I don’t know what I’m going to do for tomorrow. I need 14 more nurses.’ She wasn’t even asking us to work, but that really resonated with me. The other nurse and I looked at each other and said you can put us on the schedule for tomorrow.”

“In the Boyer building?” asked the manager.

“Yeah, in the Boyer Building,” said Pietrolungo.

“They had no one else,” Pietrolungo explained, “and I wanted to do everything I possibly could do to beat this virus and care for our patients.”

In her first few days, Pietrolungo said, the COVID-19 intensive care units in the Boyer Building weren’t full and the patients weren’t as sick as they would soon become.

“The first day I did something simple like help my patient brush her teeth,” Pietrolungo recalled. “She’d been in there for three days but we were all so worried about transferring the disease that I don’t think anyone had thought about brushing her teeth. I brought in a toothbrush and toothpaste and mouthwash, and I set her up on the end of the bed. She was a Spanish speaker and we couldn’t really communicate, but she kept blowing me kisses.”

Things in Boyer changed fast. The hospital filled with extremely sick COVID patients, many on ventilators. Normally, a cardiac intensive care nurse at Temple will care for one patient, sometimes two. Pietrolungo was soon caring for three ICU patients at a time – and quite often three to a room.

A huge burden has fallen on nurses, along with doctors and respiratory therapists, the only ones allowed in the COVID ICU rooms.

She mops the floor. Empties the trash. When patients are able to eat, she delivers the trays and carries them away. She takes the labs, gives the medicines, adjusts the ventilator settings, takes care of patients when they go to the bathroom. It’s a full sprint morning to night.

There are times, literally, she breaks into a sweat.

“I’m wearing my blue scrubs,” she says, “my isolation gown. I’m double gloved when I’m in the room. I wear a mask over a mask. I wear a k-95 the hospital gives us and my friends’ mom made us surgical masks to cover the k-95 and over that I wear a face shield. You look like an alien.”

She has one memory etched into her brain that she will long remember.

She had one patient who had COPD and COVID and she had refused to be intubated and put on a ventilator. Every day her daughter would call, and the woman would tell her daughter she was fine, not wanting to worry her daughter. But the woman’s blood oxygen level was falling daily. And on this particular day, it was well under 70 percent, dangerously low, and still falling and it was clear to Pietrolungo that the patient was dying.

“I called the daughter,” the nurse said. “I felt she needed to know the truth.”

By late afternoon, the patient was extremely agitated because of the oxygen deprivation, which is a normal reaction, grabbing Pietrolungo around the waist, thrashing. The nurse gave the patient morphine, hugged her, embraced her, talked gently to her, telling her she was not alone. “I try to comfort her as best I can. I don’t know if she knows she’s dying.”

At that instant, as she is on one bed, comforting an agitated, dying patient, Pietrolungo looks up and sees that a second patient in the room, a few feet away, is staring at them.  The second patient is on a ventilator but alert enough to understand what is happening, taking it all in.

“I was so sorry this other patient had to see this,” Pietrolungo said. “I said, `She’s okay. And you’re okay.’ You can’t say anything else. What can you possibly say in that moment to make it okay? It’s not okay.”

The intubated patient in the second bed can’t speak, Pietrolungo says, “but I know what she’s thinking. Is this me? Is this my fate? I want to go over to her and comfort her, but I can’t. I give the first patient some morphine, to settle her, to try and make her comfortable. And when she’s calm, I go over to the second patient and talk to her, and tell her it’s okay, and hold her hand, and sit with her. And then I go to the third patient, whose dialysis alarm has been beeping for the last half hour, and take care of her.”

The first patient died an hour later.

“I felt like at least I gave her some support,” Pietrolungo said. “She didn’t die alone because of our hugging and because I was with her there that last hour. We’re the only family they have in this ICU right now.”

Many Temple nurses have gotten sick themselves with COVID, and Pietrolungo spoke about her own fears.

“The first time I went in the room,” she said, “I was like `Oh my gosh, trying not to breathe.’ But there’s no way you can do that. And I’m in that room so much that I just honestly hope that my protective gear is protecting me.”

Pietrolungo did have a headache and feel tired for a few days early in April, and she’s hoping that she got the virus then, and now has the antibodies to protect her.

“Otherwise,” she says, “it’s just a gamble every single day.”

Michael Vitez, winner of the 1997 Pulitzer Prize for Explanatory Journalism at The Philadelphia Inquirer, is the director of narrative medicine at the Lewis Katz School of Medicine at Temple University.