Becky Cherney is shivering again. It is the middle of April, but the temperature hangs around 40 and the air is raw and damp. Wearing a knit hat, heavy wool socks, and three layers under a gray fleece jacket, she has been outside for hours in the back of Ann Arbor Distilling Company’s parking lot with two other volunteers from Operation Face Shield, a grassroots organization that enlists locals with 3D printers to make protective face shields for essential workers. Her pink tortoiseshell glasses are fogged above a too-large N95 protective mask—it would definitely fail the fit test at the University of Michigan hospital where she works—but she has given up trying to keep them clear. Compared to what Cherney sees at work, frozen hands and fogged glasses are minor annoyances.
By the start of spring on March 19, Michigan was in the throes of one of the nation’s worst Covid-19 outbreaks. Daily new infections broke 1,000 on March 23 and hit a peak of 1,533 on March 30. In the first week of April, the infection rate in the Detroit area—the epicenter of the outbreak in Michigan—rose to approximately 350 in 100,000 people, roughly triple the national average. (Daily deaths in the state would reach a peak of 232 three weeks later on April 21.)
Michigan Medicine, the University of Michigan’s hospital system, decided to come to Detroit’s aid by taking on transfers from some of the hardest-hit hospitals. Preparing for an influx of hundreds or even thousands of Covid patients, Michigan Medicine drew up plans to construct and staff a field hospital in one of the university’s track and field facilities. Owing to the effects of the governor’s stay-at-home orders and social distancing, the nightmare scenario never materialized at Michigan Medicine. To no one’s disappointment, the plans for the field hospital were shelved.
Apocalypse averted, the crisis still hit with full force inside the hospital, especially in units that took on Covid patients. In just 10 days—from March 28 to April 8—Michigan Medicine’s Covid inpatient population jumped from 76 to 229. No one could predict with any certainty when the wave would crest. Frontline nurses—at Michigan Medicine and around the world—were ambushed by a complex set of demands on their time, their skills, and their emotions. Becky Cherney is one of those nurses, and this is her story.
Since November 2014, Cherney, 32, has worked as a nurse on floor 8D of University Hospital, a moderate care unit that serves patients who are too sick for general care but not quite sick enough for an intensive care unit. That role changed abruptly when the Covid surge overflowed the permanent ICUs at Michigan Medicine and filled all 50 beds in the special Regional Infectious Containment Unit, or RICU. From one shift to the next, 8D became a pop-up ICU and Cherney became a temporary ICU nurse, adjusting on the fly to cumbersome protective equipment while learning how to care for acutely ill Covid patients. Operation Face Shield became a coping mechanism for Cherney, a way to channel anxiety into something useful without ever dropping the pace.
While the volunteers work, cars pull up to the distillery to pick up orders of booze and free artisanal hand sanitizer. Every so often, a car slinks past the long brick building to dump homemade 3D-printed headbands into barrels filled with bleach solution. That night, in preparation for a delivery to a nearby nursing home, Cherney stuffs bundles of the multicolored headbands into garbage bags while Molly Smith, a pre-kindergarten teacher, runs transparency sheets—which will serve as the shields—through a three-hole punch. Molly’s brother, Chad Smith, a furloughed autoworker, slides disclaimers into protective sleeves to accompany each set.
Cherney heaves four of the garbage bags into the back of her olive Nissan Rogue, enough headbands and transparencies to assemble 200 face shields. She settles in behind the wheel, turning up Wilson Phillips’ “Hold On” before setting off for Glacier Hills Senior Living Community, which is in the grips of an outbreak that has already killed one resident and infected 10 others and four employees. A miniature flip-flop hangs on a cord from the rear-view mirror, a memento of the trips to Myrtle Beach, South Carolina, that her family has taken almost every summer since she was a kid. Cherney’s mother has not canceled this year’s reservation yet. Glimpsing the flip-flop, Cherney thinks: There’s still hope.
At the entrance to Glacier Hills, Cherney gestures through the disabled automatic doors to a pair of employees sitting at the reception station. One of them cracks the glass door a few inches. Cherney explains the purpose of her visit and Operation Face Shield’s mission. “They’re made by the community,” Cherney says over the buzz of the alarm. “We’re here to help you, whatever you need.”
As she hands over the bags, she says, “You might want to wear gloves, just to be super safe.”
“Thank you so much,” the woman says. “We’re grateful.”
Even with her face hidden under a mask, Cherney can read the tension in the woman’s eyes and hear it in her voice.
It is a look Cherney knows well after half a decade on 8D, one she is seeing more than ever in the weeks since Covid struck. It is the reason she spends nearly all of her free time sanitizing and packaging face shields, fumbling to respond to texts from donors with numb fingers and fogged lenses, and helping to organize deliveries all over southeast Michigan and beyond.
It is the same look Cherney saw in the eyes of the phlebotomists, janitors, and fellow nurses in March before 8D became a Covid unit, when the floor was serving as a way station for “rule-out” patients who were sick enough to be hospitalized but still waiting for Covid test results. At the time, information about transmissibility of the virus was still hazy, and test results took days to come back. Hospital workers were still learning how to don and doff protective equipment and familiarizing themselves with constantly changing protocols for avoiding infection.
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Cherney glimpsed the new fear for the first time in late March when she requested a blood draw for a possible Covid patient. “I’m not going in there,” the phlebotomist shot back. A second phlebotomist refused, then a third. When one woman finally agreed, Cherney made sure she was comfortable with the steps of putting on her PPE and removing it. “It was so brand-new,” Cherney says. “I could sense the fear was rising.”
At home, on work mornings before dawn, Cherney sees the fear in her own eyes when she looks in the mirror. “I’m thinking, ‘What am I going to walk into today?’” she says. “Sometimes I have one or two scary thoughts, like, ‘Is someone going to die on me today?’”
A few minutes before 5 am on those mornings, Cherney lets her dogs Georgie and Lucy outside to pee. While she waits in the darkened doorway, she gives herself a pep talk.
“Don’t let the fear get to you,” she tells herself. “You’re not alone.”
At about 2 pm on Monday, March 23, Cherney and a half dozen of her fellow nurses filed into the conference room on 8D where they normally gather for a shift report. After five and a half years on 8D, Cherney is a seasoned hand, someone whom the younger nurses look up to in the same way that she had looked up to more experienced nurses like Danielle Lueck when she was new. Lueck was Cherney’s “preceptor” when she first arrived on 8D, charged with shepherding her through her first six weeks on the floor. Nurses on 8D can wear whatever color scrubs they prefer. Lueck wore black, and she always wore her hair in a bun. Cherney marveled at Lueck’s ability to build rapport quickly with patients and their families. Nine years older than Cherney, Lueck seemed to have earned everyone’s respect, from other nurses to physicians and nurse practitioners. “She had a presence,” Cherney says. “She knew so much. She was fast, witty, and extremely smart.”
Lueck was one of several mentors, including Sam Judkins, Cherney’s current nurse supervisor, and Deb Eastman, 8D’s clinical nurse specialist, who helped her acclimatize to the tempo and the intensity on the unit. It was Judkins who stood before the day shift nurses now at the front of the 8D conference room, Eastman at her side, as if she were about to give a report—but there was nothing ordinary about what she had to say. “We are going to be transitioning to a team nursing model, and that means people are going to get redeployed,” Judkins said. The hospital was preparing for an onslaught of Covid patients, and the overwhelmed ICUs would need backup. “We have to have an answer from you if you’re interested in volunteering,” she said. “It’s all hands on deck.”
As Judkins spoke, the nurses seated around the circular table exchanged glances. Cherney was one of several who volunteered on the spot to redeploy to an ICU. “I felt really proud to be in that room with that energy,” she says. “I could tell, we all took it seriously. We were like, ‘Shit, this is happening. This is it, here we go.’”
For the rest of that week, Cherney ruminated on what lay ahead. There were the relatively simple concerns, like how to become an ICU nurse in a matter of days, which would require learning how to administer an array of sedation medications that she had never used before and how to care for unconscious patients on ventilators. That part seemed straightforward enough, but her mind reeled when she imagined the amount of death and exposure risk she and her colleagues would encounter in the Covid ICUs. “How many of us are going to come back sick?” she wondered. “How many of us are going to come back traumatized?”
Cherney feared some of her friends might not come back at all. As rumors swirled that only one visitor would be permitted for each dying patient, nurses mused openly about who they would prefer to have at their bedside while they lay unconscious and dying—mother or father, spouse or sibling? “It was real talk,” Cherney says. “We didn’t know how bad it was going to get, if one of us was going to get intubated or super sick.” On Thursday, March 26, the hospital relieved some of the tension when it released its new Covid visitation policy: Dying patients would be allowed two visitors, not one.
In 2015, long before Covid took over her life, when Cherney was fresh out of orientation and new to the rigors of nursing on 8D, she learned just how lonely and frightening it can be to care for the sick. She also learned that labels used to differentiate 8D from the ICUs—terms like “moderate,” “intermediate,” and “progressive”—did not insulate her patients from the worst fates. Cherney jokingly refers to 8D as the hospital’s “green room”—a staging ground for seriously ill patients on their way to or from somewhere else. Among other afflictions, 8D patients might be awaiting transplant surgeries or healing from them, recovering from a stay in one of the hospital’s ICUs, or hospitalized due to a disorder like cerebral palsy. The unit was almost always full, and there was no telling what each day would bring.
For several weeks, she had been caring for a patient recovering from a bilateral lung transplant. Since the man was still unable to breathe on his own, he had a small hole cut into his windpipe beneath his vocal cords—a percutaneous tracheostomy—through which a breathing tube hooked to a mechanical ventilator supplied his new lungs with air. The man could not speak, but Cherney was able to communicate with him through hand gestures, mouthed words, and fragments of shaky handwriting on a whiteboard.
Cherney asked the man about an antique lamp that someone had left in the corner of the room. “It’s from my job,” the man wrote on his board. It was not a life story, but it was something. Later, she learned that the man’s son had followed him into the same trade. This made the man proud.
One night, the man gestured repeatedly toward his abdomen, making facial expressions to signal discomfort. “What’s wrong?” Cherney asked. The patient shrugged. “Something doesn’t feel right,” he scrawled in barely legible writing. When Cherney turned on the suction catheter to clear mucus from his airway—an essential task in tracheostomy care—she noticed an unusual amount of blood coming up through the silicon tube. “My nurse instincts could tell something was wrong,” Cherney says, “but all of his vitals and his oxygen saturation levels were fine and stable.” She would never downplay her instincts again.
Around midnight, the man began to cough blood. Cherney was in the next room dealing with a delirious patient on a feeding tube who kept pressing the button to lower the head of his bed, which put him at extreme risk of choking. Suddenly, she heard the respiratory therapist shouting, “Somebody help! Somebody get in here, this man is bleeding!”
Cherney flung the curtains open and rushed over, slamming the code button on the wall behind the patient’s head. One of the man’s pulmonary arteries had ruptured, and blood gushed from his tracheostomy, saturating the tan recliner where he was sitting and spilling onto the floor. Cherney grabbed a suction catheter in a frantic and futile attempt to control the bleeding. The code team arrived, and two nurses began infusing drugs, while two other nurses took over chest compressions, opening the incision across the man’s chest wider with each thrust. Cherney tried to squeeze blood into the man’s body by hand, but the pressure in his arteries was too low to pull from the bag.
“You’re OK. You’re going to be OK,” Cherney said over and over. “You’re going to be just fine.” Even after the man’s eyes rolled back in his head and he lost consciousness, Cherney and her team kept trying to resuscitate him. They lifted him from the recliner to the bed to try to get a better angle for the compressions, but he was dead.
On the tan fabric of the recliner, a dark red stain made a perfect outline of the man’s body. Cherney stepped quietly into the hallway and then ran to the 8D conference room. Closing the door behind her, she doubled over and sobbed.
When the man’s family arrived an hour or so later, Cherney’s coworkers offered to break the news. “No,” she told them. “This is something I have to do.” She told the son what his father had told her about being proud of his decision to continue the family’s legacy. “He loved you very much,” she told him, stifling tears. “He died quickly, but he wasn’t alone.”
“I almost didn’t come back from that,” Cherney says.
Cherney had been on night shifts when the death occurred. About six months later, she switched to days, becoming the first new day nurse in more than a year. The day team—Lueck’s team—was tight-knit and unused to welcoming newcomers. In a unit that “makes or breaks you,” as Cherney says, she had to earn her place. “Hang in,” Lueck would tell her. “It will get better, keep trying.”
Now that they were working together again, Cherney’s professional admiration for Lueck grew in tandem with their friendship. Their conversations would sometimes turn to the loss that had shaken Cherney’s confidence and was still throbbing in her mind. A master at putting patients and their families at ease, Lueck was nevertheless a tough and unflinching nurse. She was not given to sugar-coating things. “I don’t know how I would handle that,” Lueck would tell Cherney, giving her a pat on the back. “You have a good heart, and it shows. You fought your way back.”
Sam Judkins told the 8D volunteers to expect their redeployment orders by email on Saturday, March 28. Cherney psyched herself up, telling herself that she was ready to go anywhere she might be needed. Most likely, she would redeploy to the Critical Care Medicine Unit, or CCMU, on floor 6D, or to the RICU on the 12th floor of the Mott Children’s Hospital. Both units were bracing for transfers of severely ill Covid patients from the Detroit area. With her experience, Cherney would be able to be the “big sis” to younger nurses that Lueck and Judkins had always been to her.
“I was watching the younger nurses getting scared. They were nervous and anxious, and I was just trying to support them,” Cherney says. “I have already seen the worst,” Cherney reminded herself, looking back on the disaster she lived through in her early days on 8D. “How can I help be a rock?” she wondered. “How can I be strong and be there for them?”
Cherney was finally beginning to feel her strength come back when Covid hit. Four months before that, in December 2019, she had been lifting a patient when she heard a popping sound and instantly felt a searing pain shoot from her shoulder to her neck. She had pulled a tendon connected to her C7 vertebra. The pain was worse by far than what she had felt when she broke her tibia playing soccer in high school, and the recovery would be more difficult, too, requiring months of painful physical therapy. She had just finished her therapy exercises in her home office on Saturday, March 28, when she sat down to read the much anticipated redeployment email from Judkins.
The email confirmed her expectations—most of the 8D volunteers would be redeployed to the CCMU on 6D. As she opened the attached spreadsheet to see her own assignment, she noticed a second email from Judkins. “I’ve been told CCMU cannot accommodate your restrictions,” Judkins writes in the second email. “Please do not show up for shifts until I hear what I am supposed to do.”
The sudden realization that her injury would keep her from supporting her friends in their most difficult moment was crushing. “Everyone kept saying in the week leading up to it, ‘We’re in it together, we’ve got each other’s backs, we got this,’” she says. “I felt like I was letting them down.”
Cherney did not wallow long. It had been a little more than a week since she had seen a pair of Facebook posts from former 8D colleague Kevin Leeser in which he wears a disposable plastic salad container on his face, secured to his bald head with a rubber band. “Might look a little stupid. But the hospitals will run out of eye shields soon,” Leeser writes. “Time to get creative.” Cherney jumped into the discussion under Leeser’s posts, and a few days later, Operation Face Shield was born.
By the time Judkins’ emails arrived, Cherney had assumed a leadership role in Operation Face Shield, helping organize the logistics of a homespun PPE operation that was already fielding requests from all over Michigan and across the country, from states as far away as New Jersey and Louisiana. “I had this revelation, like maybe this is happening because there’s no one else out there doing Operation Face Shield, and we need someone on the ground to get it up and moving,” she says. “I just decided, OK, this is my role right now.”
Operation Face Shield’s headquarters is a 1976 Bendix Aristocrat camper trailer with stripes the color of orange and yellow shag carpeting. The funk of distillery wastewater fermenting in giant PVC vats wafts over the scene, which looks more like a hobo camp than the headquarters of a complex logistical operation with its own private air service. The camper belongs to Leeser and has two 3D printers inside running nonstop, turning spools of plastic filament into the multicolored plastic headbands that can be fitted with transparency sheets to make face shields, an adaptation of Czech inventor Josef Průša’s open-source design.
Cherney’s leadership has been instrumental on the logistical side of Operation Face Shield, but she lends a hand wherever she can, from sanitizing and organizing donations, to picking up supplies and food for volunteers, to running deliveries. On March 31—three days after receiving the email informing her that she would not be redeployed—Cherney and another volunteer, Rachel Krause, coordinated with a local pilot named Hans Masing to deliver a load of 500 face shields to Temple University in Philadelphia—a 940-mile round trip. It was a thrilling success, and in the weeks since, Masing’s single-engine 1968 Mooney M20F has airlifted face shields to Indiana, Nebraska, Wisconsin, and the Upper Peninsula of Michigan.
Leeser’s banged-up camper is one workshop in a cottage industry that now involves more than 1,200 people in Ann Arbor and the surrounding region running dozens of printers around the clock and inventing new prototypes of PPE. The people running the machines are high school students and teachers, community makers, laboratory scientists, university librarians, autoworkers, and engineers. Like all ad hoc undertakings, the movement quickly evolved into a few different groups, including Protect-MI, a nonprofit developing an inexpensive version of a powered air purifier. They are all united by a simple mission: to provide essential workers with potentially lifesaving equipment. In seven weeks, Operation Face Shield and its partners have churned out and delivered 25,000 reusable face shields to medical facilities, homeless shelters, ambulance companies, grocery stores, and nursing homes—all without charging a dime.
For Cherney, Operation Face Shield has been much more than an exercise in goodwill—it has been an outlet for energy that might otherwise consume her.
“It made me realize who I was again,” she says.
As fortune would have it, Cherney’s worries of being sidelined at the hospital were short-lived. It was her reduced hours due to her injury—she needed to work 8-hour shifts instead of 12—that prevented her from being redeployed, but Judkins needed her urgently on 8D and said she could make the hours work. In a matter of days, Covid patients had swamped the ICUs where some of Cherney’s colleagues had redeployed. The unit was mustering into action as a pop-up ICU to take on the overflow. That meant Cherney would not have to redeploy to care for Covid patients—they would be coming to her.
When Cherney returned to work on the afternoon of Tuesday, March 31, she and her fellow nurses rushed to prepare carts outside the rooms with the materials necessary to put in IV lines and to make sure dispensing machines were stocked with the array of sedation, paralytic, and blood pressure medications essential to caring for ventilated respiratory distress patients. After a week of unusual calm, the unit was suddenly bustling. By the end of the first week of April, all 20 beds on 8D were full—some with severely ill non-Covid patients transferred out of the normal ICUs to clear space, some with Covid patients at varying stages of illness.
Cherney was unfamiliar with some of the new medications, but she was prepared by years of experience with delirious patients for the moment when her first Covid patient panicked and tried to pull out his endotracheal tube—a dangerous event that can release a bloom of virus-laden aerosols into the room and leave the patient gasping for oxygen with no secure airway.
Watching through the window as the man grasped at the tube stretching from his mouth to the ventilator, Cherney resisted the urge to rush in as she carefully donned her protective gear. She secured the battery pack of her powered air-purifying respirator to her waist, then pulled on her gown and gloves, then pulled the hood and mask of the PAPR over her head. A few eternal minutes later, she attached the ventilation hose to a hole in the back of her PAPR mask unit and switched on the fan.
“Right before I went into that door,” Cherney says, “I was scared.” She paused to make sure air was circulating in her hood, then stepped into the room, alone.
“The first thing I did was look into his eyes,” she says. “I grabbed his hands and I held them, and I was like, ‘Hi, how are you doing? Are you OK?’ I don’t know if he was tearing up because he was scared or if he was just tearing up because the tube was uncomfortable, but he was definitely alert and conscious enough to respond to some of my questions. I told him, ‘You’re OK. You’re fine. Everything’s going to be OK. You’re in good hands, you’re fine.’ I just kept repeating it over and over.”
Cherney could see her own fear reflected in the man’s face. At first, she thought she might have to put him in restraints to prevent him from self-extubating or tearing out his central line and starting an arterial bleed, but as she held his hands and talked to him, the man began to relax. After about five minutes, Cherney’s team nursing partner, a skilled ICU nurse, came into the room to help. The presence of the more experienced nurse made Cherney feel better. “Well, at least I’m not alone,” Cherney told herself. “Let her guide you.” While her partner adjusted the man’s medications, Cherney wiped away the sweat from his brow and gently stroked his head with a gloved hand. “You’re going to get through this,” she told him. “I don’t know if he was listening,” she says, “but it just felt comforting for me to talk to him.”
“I’ll pray for you,” she told him just before she let go of his hand, “and you pray for me.”
Caring for elderly patients who are fearing for their lives has forced Cherney to relive the most painful chapter of her own life. When she was 15, she was at a spring soccer camp at Disney’s ESPN Wide World of Sports Complex in Orlando, Florida, when her own father, Edward Prokopiak, collapsed on the sidelines in what appeared at first to have been a stroke.
Back in Ann Arbor, Prokopiak’s doctors at St. Joseph’s Mercy Hospital determined that a blood clot was the cause of his blackout. To catch future clots, Prokopiak’s doctors installed a wiry filter in the shape of a daddy long legs into his inferior vena cava, a major vein that routes deoxygenated blood back to the heart. But the clots were not the underlying cause of his illness, and despite the filter, Cherney’s father grew paler, thinner, and weaker, until eventually he had to be hospitalized. In January 2003, less than a year after he collapsed on the soccer field, Edward Prokopiak was diagnosed with lymphoma.
At the time, Cherney was heading into the second half of her sophomore year at Pioneer High School. Whenever she went to visit her father at the hospital, she would stop on the way to his room to fixate on a display case outside the gift shop that contained flowers and stuffed animals. One day, she bought her dad a pillow from the gift shop with a dog printed on it. They nicknamed the dog “Lamb Chop.” Sometimes, she would put on a set of green Scooby Doo scrubs that she usually wore as pajamas. “I’m your personal nurse now,” she would tell her father. Whatever he said in response is lost to her, but she remembers feeling like he was glad to have her help.
As her father drifted in and out of sleep, Cherney would watch the television in his room. She remembers being mesmerized by the snowboarders soaring above the halfpipe at the winter X-Games. That’s how she knows that her father’s first hospital stay after his cancer diagnosis stretched from late January into February. As the nurses floated in to attend to her father, she would pepper them with questions. For the first time, she thought, “Maybe I could be a nurse.”
Prokopiak came home a few times throughout the winter and spring of 2003. Cherney had broken her leg playing indoor soccer and needed help getting up the stairs on her crutches. Her father could not help her, but she was there to catch him when he collapsed in her arms after a trip to the bathroom. “I kept willing for him to get better, for there to be treatment,” she says. Cherney had only just started feeling like she was getting to know her father. “He and I were very much alike, so a lot of times we would butt heads. But then the last two years before he got sick, he started understanding me,” she says. “He started showing me the world through his eyes.”
On August 29, 2003, Cherney and her mother, Lynda, drove to the emergency room at St. Joseph’s Mercy. The nursing home where Prokopiak had been transferred that same day in hopes that he might be able to come home again had called to say that he was already being rushed back to the hospital. Outside the emergency room, Cherney and her mother watched as several ambulances drove up—but none of them carried Prokopiak. There had been a miscommunication. Prokopiak, 63, had died alone in his bed at the nursing home without ever making it into the ambulance.
Cherney drifted into her junior year of high school a few days after losing her father, drowning in fathomless grief. “Your world changes, and some things just don’t matter as much anymore,” she says, recalling the anger and numbness that followed her through college and into her twenties. “The stupid things that you cared about—like what you wear or popularity—didn’t matter to me anymore. Humanity mattered to me.”
For years after her father’s death, Cherney kept the Scooby Doo scrubs in a wooden drawer with a gold-plated handle under her bed, along with the pillow she bought him at the gift shop.
“I think that’s why sometimes I can understand loss,” she says. “I tell people that it’s OK to give yourself days or a week to not get out of bed. It’s allowed.”
A decade had passed since her own father’s death by the time Cherney lost her lung transplant patient, but the pain had barely dulled. Her own trauma came surging back as she broke the tragic news to the man’s son. The doctors and nurses on the floor that night reassured Cherney that she had done everything right, that even if they had been able to get the man to the OR, as one surgeon told her, the man still would have died. Remembering how she felt in front of the emergency room at St. Joseph’s, Cherney struggled again with an immovable truth: sometimes, these things just happen.
Determined to understand exactly what went wrong, Cherney read everything she could find about lung transplant complications and tracheostomy care. With time, she came to accept that the fatal arterial rupture was beyond her control. But when it came to tracheostomy care, Cherney saw an opportunity to make a difference—to ease the fear and pain even if she could not take it away.
Educating patients and their families about medical hardware, drug dosages, and wound care is a major part of a nurse’s job, and in Cherney’s case, it includes training family members to take care of patients with tracheostomies at home. Over the years, Cherney had noticed a disturbing pattern: When she would teach family caregivers how to use the suction catheter, some would act overconfident, as if they had understood everything perfectly on the first pass, while others would glass over and stop talking, looking like they wanted to flee. “The average person is overwhelmed when they see a trach,” Cherney says. “They’re scared that they’re going to hurt the patient.”
The fear is justified: patients discharged with tracheostomies often have to be readmitted, sometimes within 24 hours—usually because of a complication with their airway. Clearing mucus and fluids from the lungs with a suction catheter is one of the most vital tasks that Cherney and her colleagues teach, and one of the most intimidating. Without proper suctioning, a patient’s breathing tube can become clogged, depriving them of oxygen, and harmful bacteria can proliferate in the tube and in the lungs, which can lead to pneumonia.
“A lot of people are afraid to suction their loved ones because it can initiate a cough response,” Cherneys says. “Sometimes it looks painful, and you have to be really careful not to over-suction, because you can cause shearing or trauma if you hit resistance and keep going further.”
The fragile three-way intersection where the trachea meets the bronchi that lead to each lung—called the carina—is particularly susceptible to damage from the suction catheter. Bleeding can cause clotting, which, like a mucus plug, can impede airflow and create a potentially life-threatening situation.
“The biggest thing I was worried about is emergency life-saving skills,” Cherney says. Those skills include “bagging”—using a football shaped hand pump called an AMBU bag to squeeze 100 percent oxygen directly into the airway—in the event that the patient’s oxygen levels drop too low. Signs of dangerously low oxygen saturation include shallow breathing, facial gestures of severe discomfort, and when things get really bad, blue lips. “These situations are really scary for people who aren’t used to them,” Cherney says. “I wanted to make a program that makes it less scary.”
After reviewing more than 400 articles on tracheostomy care and education, Cherney developed an educational program called TrachTrail that is now in use in several units at Michigan Medicine, the University of Michigan’s hospital system. She won the support of the Healthcare Innovation Impact Program at the school of nursing and is now working with her innovator coaches, Olga Yakusheva and Ann Fitzsimons, to expand the program to other hospitals.
For Cherney, the most important validation came from one of the first family caregivers to receive the training. “I had a lot coming at me at once,” the woman told Cherney. “This helped me calm down and realize that maybe I can do this.”
The Covid crisis has distilled Cherney’s sense that her purpose in life is to help people feel less alone in times of hardship. Helping family caregivers master an intimidating task, holding frightened patients’ hands, providing essential workers with homemade face shields, showing an example of strength and calm to younger nurses—all of these actions spring from the same essential motivation. As far as Cherney is concerned, even the dead deserve to be comforted. She turns on soothing music for deceased patients and talks softly to them as she prepares them for the morgue.
As for the living, Cherney tries to care for them with the same devotion that she showed to her own father, as if she is still living out the pledge she made by his bedside—“I’m your personal nurse now.” Seeing elderly patients written off as an “at risk population,” somehow less worthy of care and concern, fills Cherney with a blend of anguish and rage. “They have people that love them and would be lost if they were gone,” she says, “their whole world will be turned upside down.”
One of her patients—a man in his 70s who is awake again after a long period of sedation—cherishes FaceTime sessions with his wife, who cannot come to visit him because of the visitation restrictions. There are no gadgets available on 8D for propping up a device, so Cherney holds the man’s phone in front of his face until her arm is burning, as long as 45 minutes at a stretch. The man cannot talk, but he clings to every word his wife speaks—her running commentary on life outside the hospital, the state of his facial hair, how dry his lips appear. They blow air kisses back and forth. He makes no sound when he mouths the words, “I love you.”
When Covid delivered respiratory distress patients with tracheostomies to 8D, Cherney’s pulmonary care expertise and her ability to carry a heavy load of emotional stress became invaluable. She sharpened her reflexes and shaved time from her PPE routine—maybe only a minute or two, but enough for it to feel substantial in an emergency. One day, in the last 10 minutes before shift change, Cherney happened to be in a patient’s room when the woman’s oxygen levels spontaneously plummeted. Cherney pressed a button on the ventilator to deliver a dose of 100 percent oxygen, which helped, but her oxygen saturation soon began to drop again. The woman’s heart rate had also plunged from a relatively safe level in the 80s to the low 40s and was still falling.
Cherney put her hand on the woman’s chest and could feel that she was struggling to breathe. She suspected there was an obstruction in the woman’s airway, a common occurrence in Covid patients with heavy pulmonary secretions. She would have to disconnect the ventilator and use the suction catheter to clear mucus from the breathing tube, which would probably cause an eruption of aerosols. “Just do it,” she told herself. “You have a PAPR on.”
Sure enough, a fountain of porridge-like secretions spewed from the hole in the woman’s neck as soon as she cleared the plug. Instantly, the woman’s oxygen levels and blood pressure began to rise. Soon, her heart rate also returned to a safe range. Cherney had been minutes—possibly seconds—from calling the rapid response team to resuscitate the woman, and now she appeared stable.
As Cherney cleaned up the mess and sanitized her gear, she noticed traces of opaque liquid on the faceshield of her PAPR. She left the hospital that night with a bad headache. At the end of her shift three days later, she felt short of breath. Demasking and gulping down fresh air on the way to her car after a shift was usually a luxurious moment of liberation, but that night, she felt no relief. Her headache persisted and she was unsure whether to chalk it up to dehydration (masks make it difficult to drink water), to rebreathing her own CO2 all day, or to the early stages of Covid.
“Don’t let the fear get to you,” Cherney tells herself before one nursing shift. “You’re not alone.”
Photograph: Elliott WoodsAfter guzzling water and getting some sleep, Cherney felt well enough to rule out Covid, but she started to wonder what so many medical workers are wondering now: How long will she live with these mere discomforts that are adding up, day by day, to a mountain of fatigue?
The adrenaline of the first days of the Covid response has drained away, leaving sore muscles, heavy hearts, and a creeping awareness that the grind is here to stay. In the mirror before work, Cherney no longer sees the fear in her own eyes so much as the skin peeling from the bridge of her nose in the spot where her mask constantly rubs. In the eyes of friends who’ve returned from their redeployments to the hardest hit Covid ICUs, she sees weariness that surgical masks and N95s cannot conceal—vacant, haunted looks that fill her with sorrow.
By the middle of May, demand for 3D-printed face shields had flattened along with the curve of new infections. As the weather finally warmed enough to make outdoor work bearable, Leeser began packing up Operation Face Shield headquarters in order to expand a partnership with Ferris State University, 130 miles away in Big Rapids, Michigan, where the plastics department’s injection molding equipment will produce more than 2,000 face shields each day. Amid all the changes, Cherney has decided to scale back her volunteering.
With her extra time, she plans to reclaim her yard from an onslaught of dandelions and to take long walks with her dogs, Georgie and Lucy. She will also devote more time to developing her tracheostomy education program, and she will finally allow herself some rest. She has started, at last, to worry about life after Covid.
For all the high drama of frontline nursing in the time of Covid, the daily work must get done, and it is the less screen-ready parts of the job that still require the most attention. Cherney and her colleagues spend hours of their shifts tending to the banal aspects of patient care—charting, bathing, feeding, “code browns.” These chores are the nursing equivalent of filling sandbags, stringing barbed wire, and digging latrines—the unromantic labor that is the purest essence of the job, even at the front lines. The drudgery cannot be triaged.
These days, nurses carry out all bedside tasks in protective gear that is hot, uncomfortable, and disorienting. Cherney likens wearing a PAPR in a negative pressure room to standing in an airplane hangar with a jet engine running and a leaf blower next to her head. The upside: she has become expert at reading lips.
As communication disintegrates, interactions that would normally escape notice have become heavy with meaning. This is particularly true with patients who are mostly unconscious and might be hooked to a ventilator for weeks. Several days after Cherney halted her patient’s spontaneous deterioration, she was assigned to the woman again. “She responded to me when I said her name!” Cherney told a nurse practitioner on the care team. “I asked if she was in pain and she nodded her head yes.” Cherney gave the woman some Tylenol and left the room feeling a little lighter herself.
This time, she could wonder, “Did I save her?”
As of May 15, Michigan Medicine had discharged 473 Covid-positive inpatients and only 59 remained hospitalized, a low not seen since March 26. The worst of Covid’s opening act may be over, but normal seems impossibly far away. For many in Michigan and around the world, normal will never return. The state has lost 4,880 people to Covid since March, out of some 50,500 confirmed infections. With a death rate of about 10 percent of confirmed cases, Michigan straddles a morbid line between Italy (7 percent) and New York (12.5 percent), but these statistics remain in flux as confirmed cases and deaths continue to be tallied. They are useful points of comparison, but they mean little to people who are planning virtual funerals, healing from the trauma of a Covid hospitalization, or dealing with the fallout of the twin viral and financial crises.
While thousands of families in Michigan wrestle with grief, illness, and anxiety about a second surge, the state and the country are lurching back to business. Michigan Medicine did not escape the first wave unscathed and it will march into this new phase with a pronounced limp. By canceling elective surgeries, closing clinics, and suspending most procedures, the hospital system shut down its main financial engines. The downpayment on the all-out effort, according to an announcement from CEO Marschall Runge, will be up to $230 million in lost revenue by the end of June, with losses expected to continue into 2021. As part of its economic recovery plan, Michigan Medicine will lay off or furlough 1,400 full-time employees and use a hiring freeze to keep 300 positions unfilled.
There will be little time to rest. The growing population of non-Covid patients whose treatments and surgeries have been deferred has been weighing heavily on doctors and nurses throughout the crisis. As of mid-May, some of those patients were beginning to trickle back. “We are gently increasing our surgery volumes for time-sensitive procedures for patients for whom further delay would create harm,” says chief medical officer Jeff Desmond in a press release from May 14.
Though its Covid population has fallen, Michigan Medicine is still in pandemic mode. Patients will be required to wear masks at all times, to observe social distancing requirements, and to rigorously disinfect their belongings—all of which may add to a baseline of anxiety about being in a hospital. “It is understandable that people have concerns about leaving their homes and being exposed to Covid-19,” says Desmond. “However, it is just as concerning to us that people may be delaying appropriate care and getting sicker as a result.”
Some of those patients will inevitably make their way to 8D, where Cherney and her colleagues will hear their names for the first time during a morning or evening shift report. The conference room where nurses gather for those reports has also served as a gathering place for potlucks and a hideaway for quiet lunches. Recently, it has provided space to set out platters of food that local restaurants have donated to boost the morale of hospital workers. Amid broader efforts to reassert normalcy, hospital authorities decided the free lunches would have to end. “This is due to logistical reasons and to avoid disruptions as patient care ramps up services in the days and weeks ahead,” reads the message from Michigan Medicine.
That characterless room has become a repository for some of Cherney’s most intense memories. It is where she cried behind a closed door the night she lost her first patient and where she volunteered to serve in a Covid ICU. Now, there is yet another memory archived in that space: the image of the counters piled high with brown paper bags used to store each nurse’s N95 mask between shifts. There is no bag with Danielle Lueck’s name on it. Cherney’s closest friend and mentor on 8D had been diagnosed with cancer in 2016. Surgery and radiation bought Lueck a brief period of remission, but the cancer returned in October 2018. Despite a year of chemotherapy, Lueck’s cancer continued to grow and spread. On March 3, she left the hospital on sick leave, uncertain about when she might return.
On April 20, a day off from the hospital, Cherney took a break from Operation Face Shield to drive to the Karmanos Cancer Center in Detroit, where Lueck had been hospitalized for two weeks for a clinical trial. During all that time—as Lueck dealt with the terrible side effects of harsh drugs on top of the emotional weight of her prognosis—she had not been allowed to have a single visitor to her room.
Cherney could not bear the thought of her friend suffering alone, so she found a piece of poster board and some markers at Operation Face Shield headquarters and scrawled out a message in bubble letters: “Danielle—you are a rock star!! Keep those platelets up!”
She got into her car and drove to Detroit, circling around the hulking hospital with Lueck guiding her in by phone. When she pulled into the Karmanos parking lot, Lueck pressed a white washcloth to her window on the 10th floor to show which room she was in. Cherney got out and held her sign in the air, laughing with the phone pressed to her ear, snow flurries swirling around her.
Lueck’s window was high enough to see over the rooftops of the adjacent buildings, to where the Ambassador Bridge stretches across the Detroit River into Windsor, Canada. She couldn’t read Cherney’s sign from all the way up there, but it didn’t matter. She knew exactly what it meant.
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