Two patients. Two lives. Two approaching deaths.
And one nurse had to pick between them.
“People shouldn’t die alone,” said Rachel Basham, an emergency department nurse at a Phoenix trauma center.
Basham has held fast to that point. That's part of what drove her to become a nurse 13 years ago — to provide care to patients and solace to their families in their worst situations.
During the COVID-19 pandemic, that principle has been challenged.
Basham had one of her hardest days of nursing in mid-May. She's used to being pulled in multiple directions and daily has to estimate chances and prioritize care, but one especially painful choice stays with her.
She could stay to comfort an elderly woman dying alone, or to rush off to care for a critically ill man with COVID-19 coming off an ambulance. Guided by medical ethics, she chose the man, who was soon sent to the ICU.
When Basham came back to check on the woman, she had died. In an unfamiliar hospital room all by herself, with no one there to hold her hand.
As far as Basham knows, the man died later that day, too.
“Both the situations with the patient deaths really broke my heart,” she said, choking up in an interview with The Arizona Republic.
COVID-19, which has killed more than 1,000 Arizonans as of Friday, has changed hospital settings and caregivers’ practices. Nurses have felt the effects firsthand and strongly, Basham said.
With family members not allowed in the hospital to be with their loved ones, providing bedside comfort and making phone calls to relatives fall on nurses’ shoulders.
And with the influx of COVID-19 patients, nurses are pulled in multiple directions to help the patients who need them most.
Choosing between 2 dying patients
The elderly woman had Alzheimer’s disease and had been transferred from her hospice care facility earlier that day for a sudden respiratory problem, but not COVID-19. Basham called the family, and after reviewing their options, they decided the best way to honor their relative’s wishes would be to let her pass peacefully rather than intervene medically.
Basham was in charge of making her patient’s last hours as comfortable as possible. She gave her pain medication and let her rest, expecting that she would hold on for a little while longer. With no family surrounding the bedside — and nurses stretched thin tending to COVID-19 patients — the patient typically was alone when Basham or the doctor weren’t in the room.
When Basham got word of an ambulance pulling in with a very sick COVID-19 patient coming from a nursing home, she knew she had to go to help receive the man and get him immediate care, leaving the elderly woman alone for some time.
"Do I go take care of this new critically ill patient that’s alive, or do I stay with the person who’s dying?” Basham asked herself. She knew she had to choose the patient who was less certain to die.
“As an ER nurse, I work on triage priorities, meaning my brain and my muscles are trained really well to recognize the most life-threatening situation or the patient that needs me the most right this minute and to respond to that need,” she said. “I’m seeing my sickest patient.”
It felt like a painful but obvious decision to her, one that typically would be blunted by having family in the room so the woman would have continued comfort and company. But given COVID-19 restrictions, the woman was by herself.
Basham was gone for 30 minutes helping the man who came in with COVID-19. Fifteen minutes in, she asked another nurse to check on the woman, who appeared comfortable.
Another 15 minutes later, when Basham checked on her, she had died.
Basham hadn’t expected her to slip away so quickly.
Basham cried, held her hand, said her name and rested her palm on the woman’s forehead.
“I'm sure there were a lot of people who loved her and would have loved to be there, and I grieved for them,” she said.
An hour after her first call with family members to discuss options, Basham had to call back to tell them their relative had died.
Meanwhile, the man was sent up to the ICU, where Basham said he likely soon died.
“I didn’t see any chance that he would live,” Basham said.
‘It feels awful, it feels wrong’
Since the pandemic began, Basham has spent the majority of her time caring for critically ill COVID-19 patients in the emergency room. She deals with prioritizing patients’ needs, providing critical care and continuing with that work the next day, and the next, even when deaths are heartbreaking.
Nurses often have to build an emotional wall to seal themselves off from the grief they experience and to move on without getting too emotionally involved, she said.
But that day was one of her hardest yet.
“I had a human moment in the room after she died,” Basham said. “We see horrible things and you don’t really cry and you don’t really have those human moments almost ever at work.”
Basham continued with her shift, including caring for a dying man whose daughter was waiting in the parking lot desperate for updates and a chance to say goodbye.
Basham said she convinced her supervisor to make an exception to the no visitors rule for a five-minute visit. The daughter came in and prayed at her father’s bedside. Basham stood by crying under her face mask, devastated that in a minute she’d have to interrupt the daughter’s prayers and walk her out, cutting short a family goodbye in a way she’d never imagined.
At the end of that day, Basham arrived home so emotionally and physically drained, she could barely greet her kids. She went straight to bed and the next morning cried for an hour as she told her husband everything that had happened the day before.
She said she still grapples with the fact that because she had to turn to the other COVID-19 patient, the elderly woman died with no one at her side.
“I’m trying to think of the right words, because it’s mostly feelings,” Basham said. “It feels awful, it feels wrong. People shouldn’t die alone.”
Her heart still hurts from their deaths, she said, and she hasn't put aside her memories of that day. Thinking about her patients from a human perspective helps make her a better, more compassionate nurse, she said.
Basham had times at the beginning of the pandemic where she couldn’t sleep because she kept thinking how horrible it was that people were dying without loved ones, and then thought of herself in their position. It was so traumatic, she said she had to just push it out of her mind.
"I just had to stop thinking about that. I have to go to work. We have to pay the bills. And I have to sleep, so I just stopped thinking about it,” she said.
“It’s hard, though. It’s hard, because then you have to come back and do the same thing the next day.”
Reach the reporter at Alison.Steinbach@arizonarepublic.com or at 602-444-4282. Follow her on Twitter @alisteinbach.
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