Illustration by Molly Quillin-McEwan

Any nurse could tell you that a wound, well cared for, becomes a scar that carries only the memory of pain. A seam of gold, piecing together the broken shards I have become; something worth saving.

The smell of blood and fear and death hangs in the air like the toxic smoke of a chemical fire. The sound of alarms ring in my ears, drowning out the voices of my teammates. Mask, goggles, gown, gloves. The mental checklist; making sure I have the right layers of protection on before heading into the COVID nuclear reactor that is your room. There is something worth saving inside.

Molly Quillin-McEwan: You ask me if you’re going to die. “I don’t know the future, but we’re going to do everything we can to help you, ok.”

Over the past three years, my ICU has metamorphosed into a hellscape. Room after room of the dying — nearly all sedated into unconsciousness, stripped of their dignity, laying naked, intubated, chemically paralyzed, and positioned face down on the bed in an effort to shove oxygen into lungs that are too sick to do their job. At a time when most people are complaining about the lack of stimulation because of the pandemic, a day in the ICU is a full-scale sensory assault. Most of the time, it starts with a decision to be unvaccinated.

You ask me if you’re going to die. “I don’t know the future, but we’re going to do everything we can to help you, ok?” I pretend to be busy so I don’t have to look you in the eyes when I say it. I have seen your future. Someone sets up FaceTime with your family, looking for the number in your phone labeled “Mom.” Welcome to ICU. Your family will wager your last moments with them on a miracle that won’t come. You lay at the center of a tangled mess of lines and tubes and drains — you amass quite the collection during your stay. Ventilator, suction, dialysis lines, IV lines, urinary catheter, fecal catheter, BIS and EKG monitors, SpO2 sensor, chest tubes, feeding tube, orogastric suction. There’s a tube for every natural orifice, and where there isn’t a natural opening we slice a hole in your flesh and put a tube in. Canisters of vomit and respiratory secretions hang on the wall at the head of your bed. Bags of piss and diarrhea hang at the foot of your bed. Everything beeps. You made a choice. That choice rolled a pair of dice. You lost.

Your death will be another futile code. It’s nightmare fuel for people like me. I feel the familiar crunch of flesh and bone giving way beneath my palms as your ribs crush beneath my weight. My team takes turns at this violence disguised as lifesaving measures. Restarting a heart that the lungs cannot give oxygen to; like pulling a lawnmower cord without gas in the tank. And when it’s over, the physicians leave your room to write your death note and the nurses clean up the aftermath. We wipe off your mottled purple body, and a makeshift diaper fashioned out of absorbent pads is wrapped between your legs. If your family is even present at the moment of your death we’ll tuck the carnage of your ICU stay under the bedsheets so they can look at you through the glass door. You leak feces and vomit and blood on the inside of your body bag as hospital transporters juggle you into the morgue fridge. If there’s no room and the mortuary can’t take you, then you will rotate in and out of cold storage. We’ve had twenty bodies sharing nine spots. You won’t start rotting there. Your fingers and toes got a jump start a week ago when you were still alive. They are black, the skin slack and gelatinous over the shriveled muscles underneath. You chose this.

I am programmed to run towards the sound of alarms, but the belief that my team can harness our collective skills and knowledge to turn the tide of the battle we wage has faded. I hurry out of habit, not out of the belief that I will change your outcome. Skills and equipment, so useful in times past to snatch the dying back from the brink, are now merely prolonging the agony of the moribund. The vast array of technology has exceeded our common humanity, and we use it to torture the dying at the request of the people who love them. As a nurse, it leaves me feeling lost. This is not what I signed up for.

My team has spent years on the frontline of the most heavily impacted hospital in the region. If I wore a flak jacket, carried a gun, drove a Humvee, I could command your attention, and maybe even your respect. I look less intimidating wrapped in paper PPE, so my story is worth less in our collective national dialogue. Worth less, but not worthless. Nurse casualties from the past two years exceed the number of U.S. service members who died in combat in Afghanistan in the past twenty. Our deaths are folded into the nearly one million Americans killed by a novel virus, and the cautionary tales told by a mostly female workforce are easily ignored. The intersection of personal freedom and public health isn’t particularly convoluted. I just never imagined that large swaths of my country would be so conflicted about defending the innocent, the elderly, the young, the sick, and the marginalized. It’s no secret that the South Bay of San Diego has always had fewer resources. Like most black and brown communities across this country, the people who come to my hospital for help are burdened with higher rates of chronic disease, live closer to or underneath the poverty line, and are more likely to be underinsured or uninsured entirely. Opportunities for advancement are fewer and barriers to success are higher. The truth of these circumstances are etched in the health outcomes of the people surrounding my hospital. COVID slapped a giant magnifying glass on the disparity in healthcare and health outcomes — for those brave enough to look through it.

I remember the moment COVID broke me. By all accounts, she was a healthy twenty-something living her best life. It wasn’t hard to imagine her in different circumstances. The virus had caused a severe inflammation of her heart, and her lungs were so sick that her body couldn’t absorb oxygen. Organ systems fall like dominos, and I had spent hours trying to stop the fall. I remember that in the minutes before her heart stopped for the fourth and last time, her hand flew up to her neck where one of our physicians was inserting a central line. It’s a painful procedure. She was in there. Her heart and kidneys and liver and lungs had failed, but she was still alive! I grabbed her hand and held it, got right in her ear. “You are not alone. I will be right here with you the whole time.” I was there the whole time. Nothing makes you feel smaller than locking eyes with a desperate father pressed against the glass ICU door while you do CPR on his child. Nothing makes you feel smaller than the knowledge that another member of her family lies less than 30 feet away in another ICU room, the nidus of another ICU tangle of lines and tubes and drains. It was heartbreaking.

It was heartbreaking precisely because her death was preventable, and at night when I lay in bed not sleeping — replaying her last hours in my head — it feels like I witnessed a murder. Your story and hers are intertwined. You made a decision. Your decision may have left you unscathed, but killed her. If you drove drunk and she died in an accident you caused, you would be in prison. The willful disregard astounds and sickens me. There are dozens of stories just like hers, and the price I have yet to pay for my years as a stand-in mother and daughter in the isolation rooms of COVID has not been fully realized. There’s not a way of organizing all of these feelings into something that’s easy to live with.

COVID has shattered my faith in the moral underpinnings of my profession; broken my belief that we are all good at heart. Picking up the pieces has felt isolating, and reconnecting with meaning and joy has been elusive. In my search for meaning amid the madness, I got a lesson on strength from an unexpected source. I learned that when a ceramic bowl is broken in Japan, instead of getting thrown away, it is put back together with gold. The most beautiful aspect of the bowl becomes the trauma that it has survived, not the clay pieces that made it what it once was. The reapproximated edges are a glimmering reminder that the bowl was something worth saving. In a world fragmented by gender, political, and pandemic divides, reforming into a cohesive whole will not be so easily accomplished. I will never be the me that existed before the pandemic. Accepting that has helped to shift my narrative from second victim to second survivor; incorporating the meaningful and awful — melding the broken pieces with gold so that the scars of this pandemic become something I can see and touch and talk about without shattering anew. Any nurse could tell you that a wound, well cared for, becomes a scar that carries only the memory of pain. A seam of gold, piecing together the broken shards I have become; something worth saving.