The sore, red faces on critical care health workers as they tore off their masks after 12-hour shifts. The sweat that covered them as they removed their protective gear. The exhaustion so plain to see as they prepared to clean up, dress in fresh clothes and return home to loved ones.
These are among the memories of a novel coronavirus crisis that Nikita Caratelli expects to carry throughout a medical career that barely has started.
“This pandemic has shown me the strength of all health care workers and their ability to put others first,” she said.
Caratelli works twice a week as an immediate treatment assistant in the Mercy Hospital intensive care unit, and will soon graduate from the University at Buffalo School of Nursing.
She is among hundreds of prospective nurses across the region whose education took a profound turn with the arrival of Covid-19, including an abrupt end to classroom training, distancing themselves from friends and loved ones, and lessons that even their teachers could not have imagined at the start of spring semester.
“The past daily irritations or aggravations seem menial now,” said Patti Nisbet, coordinator of the UB nursing school Psychiatric Mental Health Program. "Ego is out the window."
Caratelli marvels at what she has witnessed during her eight-hour shifts in the Mercy Hospital cardiovascular ICU: supervisors, managers, nurses, doctors, respiratory therapists, assistants, technicians, environmental services workers and others helping treat some of the region’s sickest patients, including those with Covid-19.
“Our nurses have been working together and supporting one another, listening to one another vent about their fears, and checking in with each other often,” Caratelli said. “They are holding up, but they are all human. Everyone is full of various emotions and just wants to do their best.”
Caratelli, who turns 22 in June, was so fascinated going to the pediatrician as a child that she decided long ago she wanted to work in health care. She grew up in Afton, outside Binghamton, graduating in 2016 as part of a high school class of 40 students.
“We didn’t even have a traffic light in town,” she said.
The UB nursing school includes 250 undergraduate students, 200 graduate students and 70 faculty members.
Caratelli spent her first two years taking required classes and prerequisites with an aim to get into the school. The two years since have included a mix of coursework, clinical rotations in various health-care settings and part-time work helping other providers at a skilled nursing home, Mount St. Mary’s Hospital in Lewiston and, since last October, Mercy Hospital in South Buffalo.
Covid-19 deepened her desire to work as a critical care nurse.
First, she must graduate.
That became trickier as the pandemic intensified while Caratelli and her classmates were on spring break the week of March 16.
“Considering most of my friends are fellow nursing students, we all took it seriously,” she said. “But before it came to the United States, a lot of us underestimated how serious it would be. We saw each other in classes and clinical (work) before spring break, said good-bye for what we thought would be a week, and then social distancing started to get serious.”
Adjusting to change
Nursing students generally pursue their education across a variety of medical disciplines. Their school leaders and teachers quickly grasped that the crisis would drastically disrupt the rest of the school year and provide an extra layer of worry because their students serve on the front lines of health care.
Programs across the region quickly decided with hospital and nursing home leaders to pull most undergraduate students out of clinical rotations as Covid-19 settled into those settings.
Many upper-class students already had locked onto health care jobs to enhance their training and earn money. Caratelli and others continue in those jobs as they juggle shifts and online coursework.
Caratelli lives in a South Buffalo neighborhood much quieter than earlier this year. Shoppers at a nearby grocery store wear masks and gloves. Most do their best to keep at least six feet of separation from others.
“I have not seen my friends in weeks,” she said.
Students continue to connect on social media, where they express shock and awe with what they have seen, concerns over their immediate future and, if they aren't there already, a desire to return to the front lines of medicine.
“They’re adjusting to change with dignity and grace,” said Cheryl Spulecki, director of the UB Nurse Anesthetist Program.
Still, students are unnerved, Spulecki said.
“Once the nurse anesthesia students were removed from clinical sites, they feared they wouldn’t meet the obligations for graduation or to be eligible for the boards," she said. "Once they understood the tremendous amount of work they have completed and how the program is structured, they realized it was going to be OK.”
Certified registered nurse anesthetists have been allowed to work more independently, including with critically ill Covid-19 patients, inserting IV lines, preparing for emergency airway management and, in the best cases, helping in recovery.
“We are always exposed to unknown infections and use universal precautions,” Spulecki said, “but the depth of Covid-19 brings extra vigilance in our day-to-day operations.”
Marsha Lewis, dean of the UB School of Nursing, said students after the pandemic underwent a clinical conference to review infection control, got extra disaster preparedness and emergency response instruction, and received related weekly tips and reminders.
“Supporting our students is extremely important to us – not just in academics, but also their mental health and well-being,” Lewis said.
Nesbit said students have voiced concerns about challenges that can include balancing school, work, childcare and financial resources. Many also have had to process the fear and confusion experienced by sick patients with or without Covid-19. Some worry they might bring the new coronavirus home to loved ones. Some, including those from other countries, live far from their closest loved ones.
Nursing school leaders meet online every morning to discuss those and other concerns. They and other faculty members are available to students by phone and videoconferencing. UB and the nursing school also have emergency funds for students who need a financial lift.
An unusual transition
Meanwhile, the clock keeps ticking.
Caratelli will graduate next month with her bachelor’s degree.
“As of right now, I want to hone my nursing skills and build my knowledge as a registered nurse before deciding on graduate school,” she said.
That means looking for a job.
She finished her course work last week. She and fellow students will spend the next two weeks taking exams and finishing final projects. After that, as many as 180 students will graduate in a ceremony that will take place online.
Though Caratelli understands why, “it’s upsetting to realize there won’t be a nursing pinning for all we have accomplished as a class,” she said.
She harbors a cautious optimism as she becomes a nurse. A close friend and fellow schoolmate who also works in an ICU – one with many Covid-19 patients – shares that view.
Caratelli’s boyfriend works in an emergency department. He expresses worries about the ability of the health care system and its workers to handle a lingering pandemic.
“On a normal day, outside of a pandemic, we always have a high acuity in the intensive care units," Caratelli said. "But these patients are not usually highly contagious. This virus does not discriminate. Health care workers are still human and run the risk of getting sick, too. That is why social distancing is so important, to flatten the curve of this virus.
"It upsets me to hear that some people aren’t taking this seriously, but I have to realize that they don’t see the severity of this situation from the hospital like us health care workers do.”
Those determined to help can do the most good by staying home, donating PPE if they have it, and regularly washing their hands, she said.
Meanwhile, Covid-19 has given Caratelli a greater appreciation for all who help keep her workplace humming.
“I see myself thanking more people throughout the day for their contribution to patient care,” she said. “For example, our environmental service workers are doing an excellent job at keeping us safe by keeping the hospital clean. Now everyone is realizing they are unsung heroes.”
As for the future?
“I hope this continues to bring people together,” Caratelli said. “I hope this is not forgotten after it ends. I hope that the world as a whole will be better prepared for the next pandemic. It is not a matter of if it will happen, but when.”