‘I feel defeated’: A nurse details the unrelenting pressures of the frontlines

As coronavirus cases in Maryland increase, photographer and nurse Rosem Morton shares her frustrations, fears, and coping strategies.

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Rosem Morton makes her daily drive to work. Her commute used to be before sunrise, but because of the COVID-19 pandemic, her schedule has changed and she gets to enjoy a sunny drive.

As coronavirus patients have filled hospital wards, medical staff across the country have had to adapt quickly to shifting working conditions. For Baltimore nurse Rosem Morton, this means monitoring her hospital’s limited personal protective equipment (PPE), dealing with delays in surgical procedures, and grappling with grief and anxiety around her. On their days off, she and her husband Ian, a nurse at a different hospital, try to relax and enjoy their time together, but the mental and emotional toll of the crisis lingers.

Morton, a photographer and recipient of a National Geographic Explorer grant, has been documenting her daily experiences as the novelty of the pandemic wears off and the crisis becomes normalized. This is what it’s like to be a frontline medical worker fighting against COVID-19.

Read Morton’s journal from the first eight days of the pandemic here.

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These signs of gratitude and encouragement for frontline workers bring a smile to Morton’s face when she leaves the hospital.

Work Day 9: April 1, 2020, Wednesday

Confirmed cases of coronavirus in Maryland: 1,985

Total deaths in Maryland: 33

6:50 a.m. I meet a supervisor privately about a potential exposure. I am asked to self-monitor and check my temperature for the next 14 days. My anxiety is changing to resignation. This likely won’t be my last exposure.

12:00 p.m. My husband Ian, who is also a nurse, texts me that he took care of a patient who tested positive for COVID-19 after two negative tests. I guess we will be self-monitoring together.

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Morton’s husband, Ian, is a nurse at a different hospital, and they rarely have time to talk except when they both have a day off, which they use to decompress.

Work Day 10: April 2, 2020, Thursday

Confirmed cases of coronavirus in Maryland: 2,331

Total deaths in Maryland: 33

6:35 a.m. As I cross the street to the hospital, I see the brick sidewalk is covered in messages and art drawn with chalk. “Thank you,” “God bless,” “Heroes work here,” “Thanks healthcare workers.” A huge smile spreads on my face. I don’t think I have smiled walking to the hospital in a long time.

7:00 a.m. I am assigned the main role in the distribution of my team’s powered air-purifying respirators (PAPR) machines—hoods that go over the head and filter contaminated air. Or, as we have named this role, “the PAPR police.” At times it feels daunting, as my decisions impact whether surgeries can proceed. Since there are only 40 PAPR machines for about a hundred staff, every day is a challenge: there’s a first wave of surgeries and the next wave must wait until the machines come back. We have to know how long procedures take and manage resources to keep surgeries going despite delays. Some doctors are more patient than others. I often have to tell attending surgeons that due to PPE limitations, they can only have one assistant. I have to remind myself to keep some spares for emergencies.

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Morton takes her temperature before heading to work. She and her husband have reconciled themselves to the fact that one, or both of them, will be exposed to COVID-19 at some point.

Work Day 11: April 3, 2020, Friday

Confirmed cases of coronavirus in Maryland: 2,758

Total deaths in Maryland: 42

7:00 a.m. I am back to staffing the operating room [OR]. We don the PAPRs for intubation (when we give the patient a breathing tube) and extubation (when we take it out). Any procedure involving a patient’s airway aerosolizes particles that could possibly contain the coronavirus, which the staff could inhale and get sick, so we wait about 20 minutes to let any potentially infectious droplets settle before reentering the OR. All these new procedures make surgery much slower, and we have less help than usual because we’re limiting traffic in the OR. But I know this is the new normal.

 

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Morton’s hands are dry from constantly applying hand sanitizer.

Work Day 12: April 7, 2020, Tuesday

Confirmed cases of coronavirus in Maryland: 4,371

Total deaths in Maryland: 103

 

10:00 a.m. I no longer feverishly check the number of confirmed cases in my state and in my hospital. I don’t know if this is a sign of calm acceptance or weary defeat.

 

Work Day 13: April 8, 2020, Wednesday

Confirmed cases of coronavirus in Maryland: 5,529

Total deaths in Maryland: 124

8:00 a.m. While my friend is covering the first half of my shift, I meet with frontliners and learn their stories. They tell me that we are starting to get so many COVID-19 patients that the biocontainment unit alone can’t take care of them all. They tell me their hardest moments: watching patients die alone, fielding calls from family members begging to be let inside the hospital, separating COVID-positive mothers from their babies. What do you say to help ease their pain? All I could offer was a look of understanding from six feet away.

10:30 a.m. As I walk through the hospital, everyone is staring at me. It seems like I missed a memo. Everyone is wearing a face mask, as per the new rules. Just a few days ago I was being stared at for doing exactly that. Now, it’s the opposite. It’s eerie to be out of place.

I am trying to make myself wear a single mask per day to conserve PPE preemptively. But there are so many logistics to consider. Do I bring my dirty mask all the way to my car? Should I have a designated or mask and a mask for everything else? What method allows me to conserve and also not put myself or others at risk? I have yet to figure it out.

Work Day 14: April 9, 2020, Thursday

Confirmed cases of coronavirus in Maryland: 6,185

Total deaths in Maryland: 138

10:30 a.m. The pandemic has changed so much of our workflow. Surgeries are slower and longer. My day shifts have been changed to evenings until the end of the month. I only see my husband when he’s about to sleep, and we don’t really have much time to talk unless we both have a day off.

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Some days Morton only sees her husband Ian as he’s going to bed. Here she kisses him before leaving for work.

Work Day 15: April 10, 2020, Friday

Confirmed cases of coronavirus in Maryland: 6,968

Total deaths in Maryland: 171

5:00 p.m. When caring for a COVID-positive patient, the staff must stay in the operating room for the entire case in order to minimize contamination. The OR is stripped of most its equipment. I spend my afternoon as a runner, carrying supplies through the OR halls. I wear my N95 under a surgical mask.

7:00 p.m. I have marks all over my face from the N95. I only wore it for two hours. I cannot imagine what it is like for many providers who have to wear their N95s all the time. It’s tight and uncomfortable, and makes it hard to breathe. I try not to move my mouth too much when I talk because I worry about breaking the seal.

 

Work Day 16: April 14, 2020, Tuesday

Confirmed cases of coronavirus in Maryland: 9,472

Total deaths in Maryland: 302

1:00 p.m. In between subbing for OR staff so they can go on lunch breaks, I am pulled to be cross-trained in case I get deployed to other areas of the hospital. The training involves skills I learned in nursing school but have never used, like handling tube feedings and IVs. It’s a bit daunting to go back to zero after so many years.

Work Day 17: April 15, 2020, Wednesday

Confirmed cases of coronavirus in Maryland: 10,032

Total deaths in Maryland: 349

10:00 p.m. More and more of my colleagues are losing family members to COVID-19. Unfortunately, my friend Liam lost his mom, a nurse exposed to the virus this past weekend.

 

Day off: April 18, 2020, Saturday

Confirmed cases of coronavirus in Maryland: 12,308

Total deaths in Maryland: 463

3:30 p.m. I shave my husband’s hair for the first time. It is a new level of trust since I have no experience. The buzzing sounds, our quiet breaths. It feels surprisingly intimate.

Work Day 18: April 21, 2020, Tuesday

Confirmed cases of coronavirus in Maryland: 14,193

Total deaths in Maryland: 584

10:00 a.m. Today I feel tired and frustrated. Not everybody is on the same page. Since many of our patients are not tested, some staff are less cautious. It’s a lot to manage when you are already taking care of patients and policing yourself. I also have to police others, including my superiors. After six weeks, I just feel defeated.

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Morton suffers from anxiety that locks up her knee and prevents her from moving. It happens every few months depending on her stress levels.

Work Day 19: April 22, 2020, Wednesday

Confirmed cases of coronavirus in Maryland: 14,582

Total deaths in Maryland: 631

11:00 a.m. If my count is correct, at least four of our coworkers are COVID-19 positive. But the law prevents us from knowing their identities. This is an ethical grey area we are struggling to navigate. How can health workers take appropriate safety measures when they do not know the extent of the exposure? My coworkers worry for their children and other vulnerable loved ones at home. They want to know if they were exposed so they can at least live in a hotel or self-isolate for a few days.

My coworkers and I discuss possible workarounds. Perhaps healthcare workers could be given an option to disclose their COVID-positive status to their units. I don’t remember everyone I ran into each day at work, but I know they would remember our encounter if I said I was positive.

 

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Morton and her two dogs, Maia and Akira, greet Ian when he comes home from work.

Work Day 20: April 23, 2020, Thursday

Confirmed cases of coronavirus in Maryland: 15,737

Total deaths in Maryland: 680

6:00 a.m. I jolt awake from what seemed like a benign dream: I was deployed to a different nursing unit during COVID-19. When I wake up, I have a panic attack. It takes me a long time to settle and I lose my grasp on sleep. I thought I was coping really well. When people check in, I always respond that I am fine. I realize I have simply been numb.

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Morton, who has not been sleeping well since the pandemic started, lies in bed contemplating the start of her workweek.

Work Day 21: April 28, 2020, Tuesday

Confirmed cases of coronavirus in Maryland: 20,113

Total deaths in Maryland: 929

10:30 a.m. More changes. Procedural consent forms will no longer require patient signatures; this will minimize the risk of transmitting COVID-19 between patients and providers. Many nurses are concerned about the safety risk this poses, especially for patients who cannot consent for themselves. Although these changes are unsettling there is a ton of acceptance from the staff. The constant heavy news cycle has desensitized me from my own troubles. I have grown to accept that this is how it’s going to be for a while.

Work Day 22: April 29, 2020, Wednesday

Confirmed cases of coronavirus in Maryland: 20,849

Total deaths in Maryland: 985 deaths

8:30 p.m. Healthcare workers can find humor even during difficult times. I’ve seen people draw amusing things on their masks and shoe covers. My friends and I make a TikTok dance video at the end of our shift.

Day off: May 3, 2020, Sunday

Confirmed cases of coronavirus in Maryland: 25,642

Total deaths in Maryland: 1,182

11:20 a.m. On our days off, Ian and I have started doing a tea ceremony. We put away our phones, sit by the window, and pour tea in a series of steps that end in tiny cups. This way, we are able to slow down and focus on being present.

 

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Morton and her husband have started doing tea ceremonies on their days off. They put away their phones and focus on slowing down and being present.

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The couple enjoy a sunny afternoon off. The warmer weather has helped their moods.

Work Day 23: May 4, 2020, Monday

Confirmed cases of coronavirus in Maryland: 26,400

Total deaths in Maryland: 1,216

6:40 a.m. There was a significant jump in the number of patients overnight. We are now in the high double digits. The number of infected staff members is also in the double digits.

 

Work Day 24: May 6, 2020, Wednesday

Confirmed cases of coronavirus in Maryland: 27,117

Total deaths in Maryland: 1,390

8:45 a.m. New patients are arriving and we have started testing them for COVID-19. If they are negative, we still use enhanced precautions when caring for them because there is a possibility that the tests are inaccurate. We also protect ourselves during aerosolizing procedures. I appreciate the added layer of protection, but the grey areas confuse many of the staff and lead to non-compliance. If we don’t believe the tests, people argue, then what is the point of testing? I shrug and hand them the PPE.

Work Day 26: May 12, 2020, Tuesday

Confirmed cases of coronavirus in Maryland: 34,061

Total deaths in Maryland: 1,643

8:45 a.m. A nurse tells me my patient was swabbed for the coronavirus test this morning and is awaiting results. I put on my N95 under the surgical mask and a yellow gown over my scrubs. As I put on gloves, I realize I have no eye protection over my glasses. I ask around, but nothing is available. Everyone else has their personal face shield with their N95, but I never received one. Since I have glasses I decide to risk it.

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Morton puts on her mask before walking to the hospital. She is still trying to figure out the best way to conserve personal protective equipment while keeping herself safe.

I assess the patient, then leave the room, and take off my PPE. When I check her chart, I see in bold letters “COVID positive.” I should know better. I should have advocated for myself better.

9:20 p.m. My drive home is quiet and full of worry. I have been a strong advocate for the safety of others yet I struggle to advocate for myself. I berate myself again and hope to be better next time. I also hope that I won’t pay dearly for this mistake.

Rosem Morton is still healthy and working as a nurse in Baltimore. At the time of publication, Maryland had 39,762 coronavirus cases and 1,903 deaths, 237 in Baltimore.

This work was supported by the National Geographic Society's COVID-19 Emergency Fund for Journalists.