The I.C.U. Nurse: A Symbol of Endurance

An alphabet soup of respiratory illnesses has been spreading misery across the United States, once again pushing hospital staff to the brink. But Gena Oppenheim, an intensive care nurse in Santa Monica, Calif., was taking it all in stride last week as the bed count at Providence Saint John’s Health Center continued the ominous rise that had begun around Thanksgiving.

Like countless other health care workers throughout the country, Ms. Oppenheim, 32, feels emotionally battered by the past three years and the loss of so many Covid patients under her care, many of them young people who lingered on life support for months.

But as family members of those patients texted her with holiday greetings in recent days, Ms. Oppenheim found herself feeling oddly comforted even as she was subsumed by melancholy.

“I still value the fact that I can connect with those people,” she said, noting that before the pandemic it was unusual for I.C.U. nurses to stay in touch with the relatives of those who didn’t make it. “In this case, it’s like we’re the only link they had to their loved one. It’s an experience we share.”

Nursing is in crisis, fueled by burnout, exhaustion and the politicization of a virus that left many frontline workers feeling unappreciated and, at times, abused. But the tale of how the pandemic has decimated hospital staff counts and dented patient care tells only half the story: For every bedside nurse who has left the field or transferred to a less stressful job at an insurance company or a school clinic, there are stalwarts like Nick Vargas, Bonifacio Deoso and Mariana Marquez, who, like Ms. Oppenheim, have endured and in some cases thrived.

“At its core, if you love your job and that’s why you became a nurse, as long as you take care of yourself and you have good people around you, you’re going to come back to nursing,” Ms. Oppenheim said. “That’s how I look at it.”

Ms. Oppenheim has an unusually powerful connection to Providence Saint John’s. Her father, who was chronically ill most of her life, spent many nights there. She last saw him in Room 2230 shortly before he died.

A month later, she applied to nursing school, and in March 2020, just as the novel coronavirus began its deadly cascade across the country, Ms. Oppenheim took a job alongside the nurses who cared for her father that final night.

“Even in the darkest times at the hospital, I feel my dad there,” she said.

When Ms. Oppenheim saw that Hanny Virginia, a 24-year-old nursing student, had been wheeled into Room 2230, she thought, “OK, Dad, do your magic.”

Although Ms. Virginia was heavily sedated, Ms. Oppenheim spoke to her new patient as if they were old friends. She explained various medical procedures and the extracorporeal membrane oxygenation machine, or ECMO, that was keeping her alive. Perhaps the information might seep in and help prepare Ms. Virginia for the exams she had been planning to take before she fell ill.

“Come on, hurry up, get better, so we can give you a job here,” the staff members would whisper in her ear.

By the summer of 2021, the nurses found themselves caring for surging numbers of patients in their 20s and 30s. The demographic shift, after months in which most patients were older, was bracing for the I.C.U. nurses at Providence Saint John’s, many of whom were also young. “It’s like looking at yourself in the mirror,” one nurse, Andrea Taylor, said.

From left, Ms. Oppenheim placed a comforting hand on Ms. Virginia’s forehead; holding an iPad so that Ms. Flores’s sister, Dolores, could see her; the grave of Ms. Flores, who died Aug. 26, 2021, with a bottle from her favorite bar, San Fernando Brewing Company, where she would sit and draw.

They saw themselves in patients like Angela Kim, a 30-year-old social worker for at-risk youth who had hoped to become a foster mother and who spent summers building ramps for disabled children in Mexico. She died in July 2020 not knowing that her father had succumbed to the same virus three weeks earlier.

Despite such unfathomable loss, the Kim family savored the lasting bond they had forged with the people who had administered the intravenous sedatives, kept an eye on the whirling machinery and brushed their loved one’s hair in those rare moments of calm.

The bonds were fortified by the long, painful months of forced separation that rendered staff members the only link between patient and family.

At Ms. Kim’s funeral, her sister looked up to find four of Angela’s nurses sitting among the bereaved.

“I think they will forever be a part of our lives,” the sister, Cathy Kim, said. “If you really want to know a patient, you have to talk to a nurse.”

Connections over time

There is a deep intimacy that forms between an I.C.U. nurse and their patients, most of whom are heavily sedated. Over time, nurses can sense when something is wrong, sometimes even before the arrival of confirmatory diagnostics and data.

“It’s kind of like with a spouse or a family member, where you can just tell when something’s off,” Mr. Vargas said. “Just by small little signals on their face they’re making. It just becomes like a sixth sense.”

Ms. Oppenheim was constantly in motion. One moment, she was entering digits into a file, then dashing to mute a sharp beep from a vitals monitor before squatting on the floor of Jessica Flores’s room to change a bag of fluid from a dialysis machine.

“I’m just going to wipe your eyes, OK? Don’t be scared,” Ms. Oppenheim said in a playful voice as she dabbed the eyes of an unconscious Ms. Flores, 32, a visual artist and freight office manager.

Bonifacio Deoso, a night shift nurse, spent much of the pandemic sitting in silence with patients like Catalina Gonzalez, a housekeeper from Santa Clarita who survived 119 days on an ECMO machine.

“It becomes a little more intimate for us at night,” Mr. Deoso said. “That’s the time you have your patient all to yourself and you grieve with them.”

Against all odds

Ms. Oppenheim rarely hears the voices of her patients, and when their condition improves, she is often the first to hear them break what can be a monthslong silence.

“I don’t want you to be discouraged,” Ms. Oppenheim said, leaning over Manny Garcia, 26, a construction worker and avid soccer player from Oxnard whose respiratory distress meant he would have to be intubated again.

A day later, he was alert for the first time in months. He deliriously mouthed “I love you” to his girlfriend as Ms. Oppenheim held the phone to his ear. Later, she held a pad of paper beneath his hands as he penned a series of dots that might one day become words.

Mr. Garcia had been given a slim chance of survival when he was first hospitalized. But two months later, he emerged from slumber to recall vivid dreams filled with dinosaurs, car crashes and social media posts mourning his untimely departure.

“When I was asleep, I thought I was dead,” Mr. Garcia said.

His only true memory was that of a nurse standing at the foot of his bed.

The nurses were always there. They followed him as he took his first steps down the hallway, and when he made it to the hospital’s rose garden, where his father took a knee in disbelief and gasped, “It’s a miracle.”

It is stories like these that helped health care workers endure the pandemic’s darkest days.

Yet as Mr. Garcia was taking those first halting steps toward recovery, Ms. Virginia was ailing in Room 2230. She was bleeding profusely from her nose, and Ms. Oppenheim had a knot in her stomach.

“Are you OK?” Jake Childs, another nurse, asked as Ms. Oppenheim sat down in front of her computer and tried to push down the emotion.

“Yes,” she said, unconvincingly.

Two weeks later, Ms. Oppenheim held the arm of Ms. Virginia’s mother, Fitri Sho, as another nurse tried to explain that her daughter was nearly brain-dead. Ms. Sho listened with disbelief. “She looked at me to save her,” Ms. Oppenheim recalled afterward.

On Oct. 5, 2021, Manny Garcia was discharged. On the same day, two doors down, Hanny Virginia died.

Questions on life and death

Nick Vargas left his shift as Ms. Virginia’s family members were gathering around her bed for their final goodbyes. Once inside his car, he burst out sobbing.

Mr. Vargas, 38, reflected on the sense of invincibility he carried in his 20s. He empathized with Ms. Virginia and imagined that like her, he might have chosen to avoid being vaccinated. “That could have been me,” he said.

A year later, Ms. Oppenheim, Mr. Vargas and the other nurses were still reckoning with questions about why some patients survived and others died despite having received the same level of care. Their deaths felt mysterious, and in vain.

Some view nursing as a combination of creative art and science. Others emphasize the importance of spirituality and human tenderness.

Nurses like Mariana Marquez, who sang hymns to the intubated, have grown more confident in the healing power of holding a patient’s hand. “Praying with the patient absolutely relieves a lot of sadness and pain for me,” said Ms. Marquez, who has been a nurse for two decades and can still recall patient names from her first year on the job. “I will never forget them because they became a part of me.”

Andrea Taylor, another I.C.U. nurse agreed. “I see their faces. I see the rooms they were in,” she said. “It is a part of nursing to carry with you.”