An Excerpt from Year of the Nurse: A Covid-19 Pandemic Memoir

Hi there — I’m Cassandra Alexander, a Bay Area ICU RN who worked with covid patients all last year, and who wound up having a suicidal crisis and being diagnosed with work-related PTSD this past summer.

As I’m also an author, my therapist suggested I write about things while recovering, and the Year of the Nurse was born. It’s a chronological collation of my emails, journals, tweets, and includes original essays about how being on the frontlines and a witness to so many needless deaths felt — and it’s also about my journey back to the person I am today.

What follows is an excerpt from my book, from March 2020.

Warning: at the time I was pretty angry.

You were there. You might have been too.

The shortage of face masks is so severe that the CDC is now advising nurses and other health care providers that they can “use homemade masks” like a “bandana” or “scarf” “as a last resort” — even though it admits the effectiveness “is unknown.” (3/18/20)

3/18/20 — twitter

If I have to start wearing a bandana to protect myself at work, I will embroider it with FUCK TRUMP first.

3/19/2020 — password-protected journal, visible only to certain close friends

I have a few days off here. The calm before the storm. Been unable to concentrate on anything really, although I have book edits I need to do.

All the nurses in other countries are all wrapped up. In bunny suits, in practically Ebola gear.

And we’re just… not.

We’re on mask rations and going into rooms with skin still exposed because that’s not normally a worrisome thing… until you see photos of nurses from Italy and China who’re all heavily geared up, no skin at all visible. And now they’re saying that health care workers who get it are more likely to die from it….

It doesn’t feel good. I’m actually pretty scared. And y’all know me, I’m usually the person running into the spinning knives with abandon, heh.

I don’t mind mitigated risk situations. I don’t mind being slightly more in danger. I’m stoic as fuck, and I’ve seen shit you wouldn’t believe (and not just in a Blade Runner sense). But I don’t want to feel like my time and efforts are being wasted, you know? I don’t want to be thrown into a meat grinder because this country doesn’t know the difference between its ass and a hole in the ground.

So yeah. That’s where I’m at.

I had two Ativan day the other day, one when I got home, and another so I could sleep four hours later because the first one didn’t touch me. That’s kind-of how panicky I am.

And I think I may have another now, and just take a blissful three-hour nap where I’m not worried about my next shift or my coworkers.

This feels a lot like being drafted for a war that some people still don’t even believe we’re in.

Original Essay:

I don’t think there’s a way I can encapsulate the horror of knowing we were running out of supplies for you, the way every nurse across America lived it.

I have written 30+ books in my lifetime, and my metaphors still run dry. I can make attempts, but that is truly all they are.

It was like being a firefighter and told to go into a burning building without gear on.

Or being a teacher, teaching in one room, while there was an active shooter down the hall.

Or perhaps like going to war, knowing you didn’t have enough body-armor on to protect yourself from bullets.

Here’s where all those metaphors fail though — they’re time delineated.

Firefighters do not spend 100% of their time running into fires. The threat of an active shooter on campus, while utterly horrible and tragic, is usually limited to just one day. And even in a war, a soldier has downtime, traveling from base to base, or hiding between bursts of frenetic activity.

And?

In most of those circumstances?

The government — mostly — has your back. (Please don’t get pedantic with me right now. I hate the NRA as much as you do; I realize how they’ve gutted our ability to do systemic gun violence studies, and I fucking hate that whole, “Stop the Bleed!” class that teenagers are given, so that they can, what, fucking pretend to be battlefield medics because we as a country cannot be bothered to protect them? Trust that I loathe hypocrisy in all its forms.)

But let me hop back a bit, first.

Do you release how frequently and aggressively nurses are audited? Some hospitals have entire managers who wander around looking at how your room is stocked. Not enough towels in the linen drawer? What else on earth could you have been doing!

I’m sure you don’t believe it though, so let me prove it to you — you can close this book briefly now if you promise me you’ll come back — go Google “nurse,” “memes,” and “whiteboard.”

See how many memes there are that nurses have made because management has gotten mad at them for not “updating their whiteboard”?

Like writing down what day it is on a busy day is more important than saving lives?

I know it makes people happy when they see their nurse’s name written up there, and I sure do like to write my patient’s care goals up there — IF I FUCKING HAVE FREE TIME TO DO SO.

My hospital’s pretty great about understanding this, actually, but I know from friends that there are skads of hospitals that aren’t, who just have middle management roaming around like sleepless sharks looking for reasons to write you up, all the better to pretend they’re doing something useful and you’re not worthy of a raise.

I mention this because I want you to understand that, by and large, we’re watched like hawks. And to some degree — issues with whiteboards notwithstanding — this makes sense, right? We’re taking care of sick and helpless people. We have access to narcotics. We’re expected to step up and accept accountability for our actions at every level.

So, while I can’t speak for every state and every hospital, I want you to know this — in California, there are some offenses that are so outside the realm of acceptable patient care that, were you to be witnessed doing them, you would be assumed to be a danger to your patients and fired outright.

Do you know pre-covid, what one of these offenses would be?

Reusing isolation gear.

Imagine, your entire nursing career, you play by all these rules — don’t recap needles, make sure you waste any unused narcotics or pharmacy will drop on your head, and if we catch you re-using a cheap plastic gown or an N95, we’ll assume you’re an idiot and you’ll be written up or even fired.

And then, within the space of a goddamned week — week-and-a-half? — we were supposed to be okay with that?

Really?

Do the rules mean anything, or not?

Have we been living in isolation theater our entire careers?

Or, was it what felt more likely — that the government did not care if we died?

3/19/20 — twitter

Can’t stop thinking about how other countries are wrapping up their nurses practically head to toe and we’re just not…or can’t.

Can’t stop thinking about my friends at work today.

So we started mask-drives.

Because in addition to saving lives, in addition to the stress of working at a hospital during a pandemic, it was important to get out there and do social networking TO TRY NOT TO FUCKING DIE.

I was going to write “I’m sorry if I sound pissed” — but, no, I’m not going to.

We were told to go out there and scrounge for our own protection.

Let me repeat that: WE WERE TOLD TO GO OUT THERE AND SCROUNGE FOR OUR OWN PROTECTION.

Can you even begin to imagine how fucked this was? How it felt?

It might’ve been different at the end of a war or something — supplies are low, everyone has to ration for the effort, after there’s some coordinated national attempt that makes sense — but no, this was RIGHT AT THE FUCKING BEGINNING.

The first hospital I’d ever worked at wound up being one of the centers of covid for the Bay Area. They got hit. Hard.

And no one at the federal level cared.

Now, imagine being a person who knows that getting masks wet makes them unusable and unsafe.

Then imagine hearing Donald Trump, lamenting the “throwing away of the mask,” because they can be “sanitized and reused,” and claiming that “we have very good liquids for doing this,” when you know very well no such thing exists.

Does it kill your soul quite as much as it killed mine?

3/21/20

It’s a good thing being a Millennial has been all about learning how to side hustle, seeing as right now my side hustle is finding people PPE so they can stay alive.

3/23/2020

California is looking for 595 million masks and a billion gloves, according to Newsom. Goddamn.

The Lt Gov of Texas says on TV that “grandparents would be happy to die for their children.” (3/23/20)

And around this time last March was when childish libertarian-slash-state’s-responsibilities assholes rose up from the ground like so many supply-side Lazaruses, talking shit about how hospitals should’ve had enough material for this in stock, like they’ve ever worked in materials management before.

A major hospital in NYC goes through a million masks a week — just masks! Not even gowns, or gloves! — in normal circumstances.

Covid-times were not normal times.

There would’ve been no possible way for any single facility to be prepared for covid at one institution, much less at all institutions in a hospital system — or across a state! — simultaneously.

The reason no hospital was sitting on a month’s worth of isolation supplies at any one time, ahead of time, hoarding them like Smaug’s gold, was this: Where the fuck would you store it all?

There likely aren’t even a million blades of grass in your front-yard, libertarian-sir.

You don’t own a million of shit.

So how the fuck was every hospital in America supposed to have locked in 2–3 months of supplies, Suzie-fucking-Ormand emergency-style, just in case, for a ONCE-IN-A-LIFETIME EMERGENCY?

This was why we needed the federal government to take charge.

Desperately.

But it wouldn’t, because Trump and the GOP couldn’t profit off of competence… and then stuff like this started to happen: Larry Kudlow, Trump’s top economic advisor on FOX news said, “The president is right. The cure can’t be worse than the disease. And we’re going to have to make some difficult tradeoffs.”

“The cure” — by which he meant the methods we might use to save lives, like going into total lockdown with adequate universal basic income to make it so that everyone could afford to eat and pay rent while they’re staying safe, and encouraging widespread mask use….

“…than the disease” — by which he means the virus that will go on to claim six hundred thousand lives.

They could not be bothered to save lives.

THEY COULD NOT BE BOTHERED TO SAVE LIVES.

The GOP would rather piss on the ashes of six hundred thousand people than lift a reasonable finger to do anything to stop them from being harmed.

If that doesn’t tell you all you need to know about the GOP, well, I don’t know what to say. (I know I’m preaching to the choir here, most likely. But sometimes it’s good to hear someone else say what you’re thinking. It helps you to triangulate yourself.)

And before you get all, “Well, it was only the elderly,” go fuck yourself. “It was only the black or brown people.” Go fuck yourself. “Only the fat people.” Go fuck yourself. Or “Only the people with diabetes”? You can go fuck yourself, too.

What kind of miserable trash human are you, to decide that someone else’s life is not worth living?

Who appointed you God-king of life and death?

Fuck, man, I’m the one sitting at the bedside at the end with the morphine, and even I don’t feel that fucking power.

What the fuck is wrong with them?

This is a great time for a segue, since I’m on the topic.

Who the fuck do you think watched six hundred thousand people die in the United States so far? Because I bet you no more than a few thousand of those people managed to make it home to die, with hospice or without, since we would never send someone home with active covid to infect the rest of their family.

But let’s pretend maybe a hundred thousand got out — fine, that still leaves us with half a million corpses.

Who held their hands, or tried to, through gloves? Who held phones and iPads up so that they could hear your last words and maybe see your face one last time? Who took care of them for hours, days, weeks, months, greeting you on the phone by name, until your loved one’s final passing?

Who tried to give them dignity, in a place and time where it was sorely lacking? Who tried to show them the compassion when portions of the outside world were saying that covid — the very thing that was clotting their blood and stealing their breath — was a lie?

It was us. The nurses.

It was only goddamned March, we were hip deep in the first wave, and the government’s already asking us to go into battle without gear on and talking about acceptable casualties.

I think I finally found my metaphor.

Nursing then was like being asked to save lives on a sinking ship, knowing that you and everyone aboard was going to drown.

I hope you enjoyed this excerpt from Year of the Nurse, although perhaps ‘enjoyed’ isn’t the right word to use.

I wrote this book to bring myself catharsis, and so that I and millions of other nurses could feel seen.

If you work in healthcare and are angry, if you’re a layperson who wants to know what it was like to be bedside at the hospital last year, or if you’re someone who appreciates Ted Cruz getting dunked on on Tiktok and you think, “I might like to read a book’s worth of that,” then pull up a chair — Year of the Nurse comes out on 7/19.