Nursing student shares her experiences caring for COVID-19 patients in a New York hotspot

Her mother didn't want her to go. The destination was New Rochelle, New York, the metaphoric burning building of the COVID-19 pandemic, and her daughter wanted to rush in.

New Rochelle was a major hotspot for COVID-19 transmission, and New York's governor established a containment zone around the community. But Nayeli Bustillos, a longtime registered nurse, felt compelled.

"'You can't go, you can't go,' my mom kept telling me. ‘You don't even live in New York, and it's not your job.' I was like, ‘Yeah, I know I don't work there, but it's my duty. This is what I signed up for when I became a nurse.'
"The way I explained it to her is, imagine if all the nurses and other medical professionals just stepped back in this time, where would we be? Right? Or if you got sick. Who would take care of you?" Bustillos said.

And so, with her mother nervously relenting, Bustillos flew to New York April 11 to care for patients battling COVID-19. As a student in the University of Kansas School of Nursing, she'd be working 12 to 18 hours a day only to return to her hotel room and log on her computer to begin her homework.

Many nights, she admits, she didn't have energy for schoolwork, and she fell into bed and cried about what she'd seen. She kept a log of her days working at Montefiore New Rochelle Hospital  in New York, and portions of it are shared in italics below with her permission.

As I walked into the emergency room, I was greeted with a devastating image of dead bodies being loaded ever so quietly into a refrigerated truck. Easter Sunday was the first day I stepped foot into that ICU, and here it is today, May 1, 2020. Where have the days gone? It feels like I just got here...

Bustillos staffed the acute dialysis unit at Montefiore New Rochelle Hospital, which was packed with patients since COVID-19 can cause kidney injury requiring dialysis treatment. Even if an individual has never had problems with their kidneys before, the disease's progression can make dialysis necessary, Bustillos said.

The details Number of N95 masks she brought with her: 3. "My little brother gave me one. He works in construction, and he's like, ‘Take this up there with you.'" About her commitment: "I had initially volunteered for two weeks. When it was getting close to my two-week mark, I told my boss, ‘I don't think my work here is done. They need help.' She said, ‘Stay another two weeks.'" About the online "bridge" program, allowing registered nurses to attain a bachelor's degree: "I would like to be in a classroom, but when you travel for work, and work full time, that's not always an option. The professors are always available if you need help and very quick to respond to you. " About her COVID-19 test results: "They came back negative. That was a relief."

In her job in Kansas City, Bustillos educates others on dialysis procedures for her employer Fresenius Medical Care, a multinational company with ties around the globe, including New Rochelle. In 2017, the same company asked for volunteers to care for patients in Puerto Rico after Hurricane Maria. Bustillos signed up.

"It was a good experience, and I knew I wanted to do something like that again," she said. So, when her employer needed help in New York, she signed up again.

One particular COVID-19 patient tore at her heart. She described it to her coworkers this way.

I had been continuously caring for a patient for about a week. This patient was in her 80s, confused and had both wrist and ankle restraints when I first met her. Not once in her life had she received dialysis until this day. She was in acute kidney injury due to COVID-19.

It broke my heart while I dialyzed her because time after time she would scream, "Let me go!" Despite knowing that she was confused and desperately needed dialysis-it still shattered my heart. Can you imagine how dreadful a feeling it must be, to wake up with your wrists and ankles tied down, Bipap mask wrapped around your neck and forehead, and seeing your very lifeblood sift through tubing?

Picture yourself waking up in a space not your own, totally unfamiliar surroundings with no clue as to what is happening. No family in sight, staff walking about in what appears to be space suits. I cannot begin to imagine the fear in her heart or the instantly anxious and frightful thoughts running though her mind.

Bustillos said later, "When I first saw her, she was disoriented, confused. And through all this COVID pandemic, they're not allowing family members to come in. So what I thought about is, ‘I can't imagine if I woke up like that, or let's say, my parents, if they woke up alone and confused.' It broke my heart."

I tried my best to console and explain to her what I was doing but it did not seem to matter. She kept calling for someone. She would cry out this name of what I assume to be a loved one. I felt so horrible. I felt gutted and helpless.

During the day, Bustillos was too busy to reflect. Patients needed her help, and she concentrated on the task at hand. At night, back in her hotel room, she'd touch base with her parents and her boyfriend, sharing her day but not all the details. She didn't want them to worry.

These past three weeks are among the most mentally challenging times I've ever experienced in my life. What I can manage is the busyness and chaos that fill the days-it's the nights that I struggle the most. It's during this time that my mind has time to process the devastation that unfolded earlier that day. It's during this time when it gets rough.

It's during this time when I begin to break down. I have serious trouble sleeping and, simply put, I cry and sob out loud a little harder each passing night. When I can fall asleep, it seems every hour and half or so I wake up feeling out of breath with a pounding heart. 

When she attempted to explain, more than a month later, what led to the tears and the pounding heart, details failed her. "There was just so much death surrounding everybody that it just became normal," Bustillos said. "That was very hard to deal with."

At first, she thought this alien feeling - normalizing death - was just the New York Attitude, a 180-degree flip from the Midwest Nice she was used to. Or maybe it was a reflection of big-city living, and this Moscow, Kansas, native, raised on the ranches of southwest Kansas, couldn't find footing.

"First of all, I had never been to New York. It was my first visit," Bustillos said. "So you're going somewhere brand new, you're around new people, a new culture and nothing that you're familiar with."

And then there's death, everywhere.

"It was just very heartbreaking to go in every day and treat patients who were on ventilators. And the next day you come in, and they weren't there," she said. "This is real, you know. I don't think people are understanding the severity of this pandemic unless it's affecting their loved ones."

No matter how strong we are, seeing this amount of death is not normal. COVID-19 is not normal. What we have seen and what we live through each day is the furthest from normal it can get.

Janet Severine, APRN-NP, DNP, adjunct assistant professor at the KU School of Nursing, compared Bustillo's experience to joining the Army or Air Force. Bustillos was enrolled in Nursing 449, Nursing Care in the Health Care Organization, which Severine taught as part of the online program that allows registered nurses to obtain their bachelor's degree in nursing (BSN).

Bustillos agrees she sacrificed a few decimal points on her grade point because of the trip to New York. As balance, she said she gained confidence in her abilities. That confidence was one reason she plans to apply to medical school after her final 11 credits of nursing school are completed."She was already committed to this class, but then this came up," Severine said. "She felt the desire to go to New York and contribute to the care of COVID patients, so we carried on with the semester... I'm certain she would have received a better grade if she hadn't gone to New York. But there's also something to be said for experience. I highly commend her for having the guts to go. She could have gotten sick. But it was an experience of a lifetime."

She also has, in the plus column, this exchange from when she saw her screaming patient again. A few days after Bustillos wrote this entry, she found out the woman was well enough to be discharged from the hospital.

Today was a brand-new day! Today was unlike all others. When I dialyzed her, she was very different. Blood pressure was running low, 90s/50s and 80/40s at times. I thought to myself, "She is not doing well." When I dialyzed her last week her blood pressure was much higher. She was not hollering or fighting the staff today. She was very quiet today not like what I knew to be her usual self.

As I completed her treatment, I turned to her and asked her how she was feeling. She said something faintly that I could not understand. I asked again, "Are you feeling better?" Her response shot feelings of joy through my heart.

"Yes, because of you."

It's experiences like this that have get me though the rough times here in New York. Believing and seeing that that I am making a difference, as small as it may be.