COVID Nurse in Germany Diary: When’s This Shit (I Mean, Stint) Gonna End?

It was in March 2020, when I received news that moving forward, I can forget about Diabetes because my station will (surprise, surprise) focus on taking in patients sick with a new illness which startled the entire world: Coronavirus. I was skeptic enough to be a nurse again, and now I’m a COVID nurse in Germany? That WTF moment carried on for days, weeks, and now we’re over half a year through as Corona Station. We stay this way officially until December 2020; unofficially and questionably until March 2021.

Related post: Wait… Me? A COVID-19 Frontliner?

The above-related post was my last blog entry. Why? Because in the last 7 months, I focused on staying alive (very important). Secondly, I was too lazy and demotivated; just like any other regular human being at this weird time of the pandemic. Thirdly, I’m not quite sure how to write another post without making it look like I’m bragging and wanting to be called a hero. Because clearly, I’m not. I actually feel uncomfortable hearing claps or ‘hero’ remarks (especially if they came from people who doesn’t cooperate to contain the virus) because for me, it’s just mere coincidence that I’m here: I didn’t choose the task and I just basically go to work every day doing the job I have studied for, period.  But sure, thanks for appreciating. Lastly, I didn’t publish another post until today because with too much content on the Internet, people were locked down and they created stuff, I felt like my story wouldn’t be as significant.

However, Germany recently recorded some of its highest Coronavirus cases ever, over 4,000 new cases per day. Also, Stuttgart, the city where I live, was listed as Risikogebiet (Risk Area) over the weekend.  I have a feeling then, the coming days wouldn’t be very easy.

My intention for this entry then is more as documentation for me than as entertainment for you.

6 Months Covid RN 2

Entering the COVID Station for the first time

Let’s go back to March 2020. I remember getting a bit of rest after “The Big Move” when we cleared our station of Diabetics to make way for those infected with COVID-19. When it’s my time to go to work again, boy was I so scared. I first saw the sign in the cover photo above, which means:

“No Entry! Attention Risk of Infection! Closed COVID-19-Station”

Thought Bubble: “Shit”.

I also noticed small tables containing gloves, masks, gowns, and caps before each room. From experience, I know these tables indicate that the doors beside them lead to isolation rooms (see photo above). In our case, all rooms have these tables.

Thought Bubble: “Yup, they weren’t kidding. We are indeed COVID Station now”.

I then looked in and ask a colleague if I can enter wearing only my uniform and she said something like “Yes, we don’t have any patients yet (in German, of course)”.

Thought Bubble: “Whew”.

The first week, that was end of March 2020, wasn’t too bad. I remember spending most of my shift watching an instructional video on how to wear my PPE properly, practicing how to wear them, disinfecting this and that, and reading a makeshift book our team made about all things Corona.

Speaking of PPE, at first, we only wore them before entering the patient’s rooms and then dispose of the gown and gloves before going out. The mask, goggles, and cap stay until we remove them outside the room. Daily testing (more on this later) and food for employees became perks of working in our COVID Station. We order and receive food trays 3x a day from the hospital kitchen. Not bad. Apply na, LOL. We also received food donations from establishments or common people, but I was too skeptic: I only ate what’s from the hospital kitchen.

Our patients were at first, suspected cases: those with a bit of symptom like fever, cough, diarrhea, etc. They got tested in the Emergency Room and admitted to us. We usually wait 12 hours (or 24 hours, takes even longer on weekends) until the results came in. Negative cases were immediately sent home or transferred to normal stations.

 

6 Months Covid RN 3

COVID Testing

Back then, daily testing for COVID-19 was required for everyone working in our station (doctors, nurses, and cleaning staff). It’s completely free and we administer the test ourselves because if we ask another person to do it for us, that colleague must wear complete PPE. With the swab being very uncomfortable, we might cough and infect him/her should we be positive of the virus. So yeah, I swab my own throat and nose in front of a mirror every single day *rolls eyes* and then wait until I receive the result via SMS.

I kind of got used to poking my own throat and nose and though uncomfortable, I’m very thankful for the easy access to testing. At least I know where I stand while fighting the virus. Whenever I feel a bit sick or was somewhere suspiciously crowded, a quick swab allows me to sleep peacefully.

One problem here though is that only the staff from COVID stations are tested regularly. My housemates and their patients, for example, who are in normal stations, have no idea of their statuses. Patients in normal stations are also allowed to go outside their rooms and be visited by relatives, in COVID stations, nope. We all know that many positives are asymptomatic, you wouldn’t know from whom you can get it. Those at normal stations may seem to be at lower risk than us, but I don’t agree. Not very long ago, a student nurse assigned in a normal station tested positive and they had to quarantine the patients and the other nurses with direct contact with her. They had to stop admitting patients and we even received additional workload because of them. Instances where patients suddenly develop symptoms and test positive are also familiar.

In my station, however, we treat everyone as COVID positive until a negative test is present. We are protected with complete PPE from Day 1 and everyone we face is tested regularly. I believe our risk is even lower. It just sounds scary to some when I introduce myself as a COVID nurse, but in reality, it’s much, much safer.

 

And then our first COVID-19 positive patient arrived…

Our monumental first week hasn’t even ended yet when things changed: one confirmed case was transferred to us from another hospital because that patient needed Dialysis. We already knew we were handpicked to be the lucky (or not) COVID station because of our proximity to the hospital’s Dialysis Area. Both areas lie on the same floor and it’s easier to contain the virus and maintain hygiene protocols this way.

So yeah, we received our first positive patient and again was I so scared. I don’t understand why I was surprised when I saw her though; she looks like any other patient: old lady, about 75-80 years old probably, speaks German, looks quite weak, complains a lot: typical. I wasn’t sure why I was surprised, I’ve read a lot about COVID-19, was I expecting some sort of alien-looking creature as a patient? Haha, I really don’t know.

Not long after our first confirmed case was a gush of admission. I’ll never forget that one Friday PM shift when we transferred 6 negative cases and ended up with 7 positive cases. How that happened in one shift, ask me not. Most of these positive cases came from one Dialysis center wherein the patients developed a fever after the procedure and then rushed to our hospital where they all tested positive. I remember being dead tired from changing PPEs and pushing beds from one room to another.

Our game plan then was with 5 positive cases and above, we close the station. “Close” meaning we only admit positive cases and consider the entire station contaminated. This plan became applicable after that very shift. We then upgraded our PPEs to thicker Operating Room gowns and wear them the entire shift. We go from room to room wearing the same PPE and only dispose them of during breaks, when they get contaminated by patients’ secretions, when we need to transport the positive patients elsewhere (we change to a fresh set), and when we go home.

Since the entire station is “contaminated”, we then eat, drink and use the bathroom in a separate room outside, but not without stripping to our underwear. We were provided with fresh uniforms every time we go out.

6 Months Covid RN 4 We have no personal stuff on us on the ‘contaminated’ station so I took this photo of my colleagues standing from the “clean” area.

Embracing Life as a COVID Nurse in Germany

This story continued for about a month and a half, with 16 positive cases as our highest census. It was a challenge carrying on with our routine with an extra layer of clothing from head to toe. We were lucky though because one station was made on stand-by in case of an outbreak (no patient was admitted to this station) and all the staff from there were asked to help us. There were also nurse volunteers so even though some days were more difficult than others, we managed. I don’t remember when exactly I became comfortable facing COVID-19 patients daily, but I somehow got the hang of it all.

I found Dialysis days (3x a week) seemingly chaotic: we had to prepare the patients very early to push their beds to the Dialysis area and then when they got back around noon, their vital signs are all over the place. Some became delusional. I remember them being mentally fit and responsive upon admission then, later on, had hallucinations or worse, couldn’t speak a word in German. I’m like, WTF? It was a mystery I suspect was either due to the Coronavirus, Dialysis Disequilibrium Syndrome, or depression because of isolation. Unfortunately, I never found out the answer. There was even a time most patients are on DNR, DNI status I only keep in mind those who are not.

That was one hell of a phase but you know what’s surprising? Germany continues to have a very low mortality rate.

I once wrote my observation in a Facebook post:

Five months after writing the above FB post, I changed my mind. I now think that Top Immune System wasn’t the magic formula for the low mortality rate: it’s Early Detection and Isolation. Because testing was free and quick for all, we get to know who was infected, and then isolate and treat their symptoms immediately. I got to appreciate Germany’s health care system during this pandemic: though with many loopholes and really, almost 300 EUR monthly for health insurance is a lot, I feel proud this money helped save many lives. None of the testing, Corona stations, or PPEs for medical professionals would have been possible without money. Sad but true.

Another good example of this early detection and isolation is what happened in my station. Since everyone was being tested regularly, we knew immediately when 5 colleagues (4 nurses and 1 doctor) got infected. This is considering most of them had zero symptoms. Should we had no regular testing, they could have continued working and infect us all. Or worse, continued working until they exhibit symptoms too late to be treated. After they got info that they tested positive, they were able to isolate themselves immediately at home. Two to three weeks after, they are all back very much alive.

In our case, a positive test will be confirmed by the laboratory or company physician via phone call – very scary if you ask me: I remember almost fainting when I receive calls from unknown numbers, LOL.

Thought Bubble: “Fuck, who could this be? Did I already receive a negative {COVID result} SMS? Oh yes” And then I answer the call haha

How we treat our COVID patients

Please don’t quote me on any of this. I’m no doctor and these are all just my observations.

I still stand to my Facebook post in April that we aren’t doing anything special in the Coronavirus treatment. It’s a ‘virus’ obviously, so only the symptoms are to be treated. Unlike other countries who are aggressively using not yet proven drugs for COVID, our approach is more conservative. I’m sometimes surprised how our limit for fever example, is seemingly high before we administer Paracetamol, or how we wait for a negative COVID result before we nebulize or do something about a patient’s cough. But again, it somehow works. 

I’d like to believe our approach is more staff than patient-oriented. Upon admission, our patients receive a note from our team instructing them to wear a mask whenever someone enters their room and to cough or sneeze in the opposite direction as the other person inside.

I don’t know though what approach they have in the Intensive Care Station/Unit (ICU) or other hospitals. My experience also is quite limited (see next paragraph). I’ll look around more and see what I can add here.

By May 2020, our positive cases decreased. I was actually on vacation most of April (my supposed birthday homecoming in which I spent 3 weeks watching Netflix and online musicals in my room). When I got back, my station was no longer ‘closed’: our Dialysis patients were discharged, we admit suspected cases once again, we wear our PPEs only when we enter the patient rooms, and we swab ourselves every 2 days instead of daily. Thank God. 

By June 2020, our last positive cases were cleared and sent to home isolation (Yehey). From then on, we became an Admission Station for suspected COVID-19 and other infectious cases like MRSA, Clostridium Difficile, Tuberculosis, Epstein Barr Virus, Acinetobacter Baumanni, etc.

July, August, and September 2020 went by and it was a to and fro of policies which change too often, I gave up keeping track. There were times wherein we became a Step-down Intensive Care Unit, Isolation Unit, Monitoring Station, Suspected Covid Cases Station etc. These policies change with consideration to our night shift nurse who always works alone. Those were certainly some luxurious months as we had very low number of patients. The challenge lies though to how in need of treatment these patients are and how we had to provide them with their needs while protecting ourselves and maintaining strict hygiene protocols.

The entire hospital also functioned like pre-pandemic so our volunteers went back to their respective stations. We had to order nurses from leasing companies to augment our staffing. When I think of it now, I realize we’re rolling an entire COVID Station with only 10 nurses, wow. To be fair though, we are still able to use our vacation leaves and we rarely work overtime.

October 2020. We are currently an Admission-Discharge Station where patients arrive with a bit of symptoms, stay for a night, when negative, moved elsewhere if there’s room for them. If you think this is easy, then think again: donning and removing PPEs 15 to 20 times per shift, transferring patients who stayed merely hours there wasn’t much to endorse, pushing beds 3-4 times my weight (alone), and calling the cleaning staff to yet again disinfect the rooms though it wasn’t long when they were there last. Not fun at all.

The number of Coronavirus cases continues to rise and as mentioned above, we record 4,000 plus new cases daily. This can be because the capacity of testing laboratories was expanded and returning travellers are required to get tested for free, otherwise, they’ll be fined heftily. According to the news, despite the rising number of COVID cases, our hospital beds continue to be empty because those positives are young and fit compared to those in March and April who are older and already with existing comorbidities (like the patients I had). Let’s not forget though that this young population could have old parents, grandparents, or neighbors. 

So again, since Germans are over planners, starting this week, my station’s focus is Corona patients again. How long we will stay this way, ask me not.

Excessive Shopping 2

Corona Bonus

Oh, we received Hazard Pay amounting to about 150 EUR monthly and a Corona Bonus of 400 EUR. This bonus had created a huge discussion because Health Minister Spahn already announced in March that all nursing staff in the country will receive 1500 EUR Corona bonus, only for this announcement to be retracted come April. Eventually, only those working in nursing homes received the amount (with discretion from the employers). According to Spahn, this is because they earn less than us working in hospitals. Another WTF moment, the way I see it, nursing homes send patients to hospitals immediately once they exhibit symptoms as they have no capacity to treat them and the risk of infection and death is high as their other patients belong to the very high-risk bracket. Some nursing homes wouldn’t even want to take these patients back in without 2 negative Corona tests and 14-day quarantine. Don’t get me wrong, I’m happy for them for receiving the money and I’m not really aware of how badly the pandemic hit their workplaces, but in my opinion, it wasn’t fair.

Since many people complained, our hospital then decided to give 400 EUR to all employees including the cleaning and kitchen staff, etc. and not only the nurses. I found this good that they were also considered as essential workers. However, some still find it unfair as even those who have nothing to do with Corona, like those working in normal stations, received the same amount as we, who are directly in front. The head nurses and doctors though, including our own, received nothing because again, they were already earning more. Whew, this logic I’ll never understand.

There was another promise of 1000 EUR Corona Bonus from Spahn but as of writing, we haven’t received any update.

Again, this experience is entirely my own, I know people who also work in COVID stations here in Germany and has never been tested, provided with enough PPEs, or given hazard pay. Harsh inequality.  I sometimes can’t believe my luck.

Also, whoever said the world is fair, Peng?

6 Months Covid RN 5

Our PPEs when handling suspected COVID cases (left) vs when we were a closed COVID station (right)

Challenges as a COVID Nurse in Germany or Anywhere Else, Probably

1. Personal Protective Equipment (PPE)

Our PPE includes FFP2 mask, goggles, cap, gloves, gown, and shoe cap. For a country as rich as Germany, our PPEs are seemingly basic: we use no respirators, face shields or Hazmat (overalls), at least in our case. But it works; I’m still COVID-19 Negative to this day, remember? Everything is disposed of after use so maybe that’s why we use no Hazmat (too expensive). Face shields and FFP3 masks are only used when patients are coughing uncontrollably or for aerosolization procedures like nebulization or intubation. Fortunately, I’ve never needed them. Our patients are stable enough not to be intubated and we don’t nebulize them unless they test negative.

This COVID nurse experience taught me to take my time on what’s truly important: my safety. My mantra for the last seven months goes “Sicherheit geht vor. Immer.” (Safety first. Always). I learned to turn a blind eye and a deaf ear from the irritating buzzer so I can have enough time to wear and check my PPE before entering the room. I know a lot of people think that the task is huge and heroic, but for me, I’m just a normal human being with a nursing degree. I can be infected so I need my PPE. I’m not immortal.

Aside from time-consuming and utterly tiring, being in PPEs daily isn’t too great for my skin: pimples, facial wounds where the mask and goggles pinches, bruises from opening doors with my elbows, dry skin and hair for showering daily, you name it, I have it all. The worst was when I had back pain on where my kidneys were located. This is because at that time when we were ‘closed’, we couldn’t drink or use the bathroom for hours. Luckily, after one Paracetamol dose and hot compress, the pain went away.

2. Maintaining Strict Hygiene Protocols

Since our COVID station also sometimes cater to infectious patients, hygiene is an everyday struggle. Just imagine what of a catastrophe it would be if someone comes in because of COVID and goes home with another infectious disease, right?

I learned to organize my tasks so I could limit my exposure to the patients while adhering to hygiene protocols. As much as possible, I prepare all the stuff I need, wear my entire PPE, and bring everything in as I enter the patient’s room. It was also a matter of teamwork, one colleague should be available to assist in case the one inside the room needs anything. But in cases when no one is around? Like my shift tonight, there’s no one to ask help from so if I need something from outside, I would need to remove the entire PPE and wear a fresh set all over again: each time on EVERY. SINGLE. ROOM. Dizzying.

I actually prefer it when we were still ‘closed’ and all our patients are COVID positive. I could then go from room to room wearing the same PPE. No switching of masks, so the risk of touching my face is lower. Just no drinking or urinating though for hours, yikes.

3. Language Barrier

As Germany is a country of diverse nationalities, I’ve had Turkish, Italian, Portuguese, Polish, etc. COVID patients who don’t speak a word in German/English/Tagalog: very, very difficult times. Some even want to go out of their rooms, my God!!! And here I am thinking Coronavirus is a universal word. Whew, inhale, exhale.

4. Hospital Politics

When I first learned I’ll be a COVID nurse in Germany, I thought that so long I have PPE and access to testing, I’m good. Little did I know that my team will be in constant argument with other hospital personnel, no less. Some only see the meager number of patients we have, but no interest on how dependent these patients are and how even the most basic thing as answering to a buzzer becomes complicated in an infectious station. Or why patients who have obviously nothing to do with COVID are admitted to us. It’s the exact reason why we limited our admissions.

Some see our plight as luxurious but strangely enough, no one wants to trade places with us.

5. Keeping my Immune System strong

Being not very talented in the kitchen and also to reduce my chances of infecting anybody should I cook food, I was lucky to have housemates who completely fed me the first few months of Corona. We had vegetables day and night and even cook wearing mask and gloves sometimes, LOL. My intact immune system I own to them. 

With fitness studios being closed, I resort to doing my workouts at home. But even though they already opened in June, I cancelled my membership as I don’t want to risk it: some people are careless they don’t disinfect the machines and people breathe heavily during workout. No, thank you.

My immune system was also greatly challenged because I don’t go home without taking a bath after my shift, even after night shift. I used to do this immediately in the hospital’s locker rooms; I didn’t want to still bring any trace of the virus on my way home (I live one train ride away from my workplace). So I wash my hair and body thoroughly trying to clear any virus my PPE would’ve missed. Of course, I didn’t have much time then to dry my hair completely. I later learned that wet hair and temperatures below 20 C or sometimes 15 C make up a perfect recipe for the common cold. I remember one time I had to call in sick as I feel I wasn’t 100% fit for my COVID nurse shift. For me, if I feel my immune system is less than perfect, even just 1%, I’m staying at home. This is non-negotiable especially if we have positive cases at the station. Like what I wrote in my last blog post, I’m never, ever, endangering my only life for people I barely know. No, thank you.

6. Protecting my housemates

I currently live with 2 other Filipino nurses. Last January though, one of them invited her mom to visit Germany so that made the 4 of us in the apartment. For the purpose of this blog, let’s call my housemate’s mom, Tita. Because of the Philippine lockdown, Tita couldn’t go back home. Imagine her as a 72 y/o living with 2 COVID nurses in one small apartment (my other housemate also worked briefly at my station).

It was crazy. We disinfected the commonly-touched things daily, we practiced social distancing even if our corridor is too narrow, we barely ate together: all in the hopes of not infecting Tita. We even had a contingency plan like what we are to do, where we are to isolate in case one of us tested positive. We packed 2 weeks amount of clothes and asked our employer if they can spare some place for employees who have no means to isolate should they be COVID positive. Unfortunately, the reply was negative. But fortunately enough, after countless flight cancellations, visa extensions, and 7 months staying in German land, Tita was able to fly back safely and COVID-free in August. *Sigh of relief*

I once thought that maybe, if I live alone, it would be less stressful for me to be a COVID nurse. But then I realize that having housemates helped me be more aware, more careful, and considerate knowing an actual high-risk person is living with me. If I was on my own, I probably wouldn’t bother that much.

7. Being away from family

Frankly, working in a COVID Station half the world away is quite an advantage: the risk of infecting my family is very slim. On the other hand though, I sadly couldn’t help them in protecting themselves from the virus. Just recently, my mom was hospitalized as a suspected COVID case 10,000 kilometers away from her COVID nurse daughter.

I have full trust in the medical capacity of my former hospital employer so I wasn’t stressed at all. What I don’t trust is the fact that my mom would stay alone in isolation until the results prove her negative of the virus. I thought of 26 y/o Filipino vlogger Lloyd Cadena who tested positive of COVID and died of a heart attack in his sleep. Should he had someone in his bedside to call the nurses; he could have received CPR and probably lived.

So we didn’t allow my mom to be admitted alone and my sister went in and joined her in isolation. I mean they live in one house, if my mom is indeed positive, then the entire household is already long infected, what difference would it make then, right? Thank God after 3 days of waiting, my mom tested negative and was sent home. All is good now and it wasn’t really a major incident, but I just wish I was there with them.

 Related post: Wait… Me? A COVID-19 Frontliner?

In my last blog post, I wrote that I stayed here in Germany and accepted the challenge of working in a COVID station out of curiosity. You remember that list? Now I’d like to add something to that.

I’m now curious of how long more I can tolerate this entire shit.

I’m curious of until when my curiosity can hold me.

I’m curious if all the hassle is still worth it.

Or aren’t we just all bound to have COVID sometime in our lives? I wouldn’t be surprised if, in the future, it’ll be seen just like the common flu. Because it seems like there’s no end. It’s demotivating: one moment we were doing very well and then now we have to repeat everything. We have to go through the same hurdle, who knows now how many patients and staff will get infected and how many will make it alive.

I know I’m in a better position than some people I know, and for that, I’m extremely thankful. I don’t want to sulk in toxic positivity though and pretend that everything is perfect, work is not tiring, rules are not confusing, etc. Everyone, even this COVID nurse in Germany, is entitled to wonder how long more she can put up with this all. 

Fortunately, my colleagues and I make up a good team and we all know better and have a bit more experience now than at the start of the pandemic. I guess I’ll just use all this new knowledge and do just what I can. Nothing more. No pressure, no stress. 

Do you also have a pandemic story to tell? I’d like to know, comment it below. And please stay safe.

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