Heartbreak and Triumph: Speaking to a Nurse on the COVID-19 Frontlines

Photo courtesy of White Plains Hospital

Helping run the busiest emergency department in Westchester is taxing even on an average day, but during the coronavirus pandemic, it transformed into an exercise in heartbreaking loss, overwhelming work, and unlikely triumph.

White Plains Hospital’s (WPH) Emergency Department Nurse Manager Ertha Small-Nicolas, RN, has devoted her life to caring for others since joining the hospital’s staff in 1998 and today cares for thousands of patients annually across the hospital’s bustling ER. We asked Small-Nicolas for a look inside the maelstrom — including the sorrows and the joys — that has been her life as a frontline combatant in the war against COVID-19.

Tell us a bit about your role at WPH.

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I have been at WPH for 23 years now, and I have seen the tremendous growth we have experienced, especially over the last five years, improving services for patients. I have been the nurse manager since 2012, and it has been a great opportunity to improve emergency care for our community. When I began as a staff nurse, we saw about 100 patients a day. We are now up to 170 or 180, and on a busy day, we can hit 220.

What was it like during the early days of the pandemic?

I believe it was the first week in March when we started seeing patients who presented with flulike symptoms but were testing negative through our point-of-care testing. That’s when the news started trickling in about COVID-19, and we started to learn more about it…. That is also around [the time] when we had the first [COVID-19] patient in Westchester County. Immediately, we started preparing our emergency departments to have a section where we can care for COVID patients while maintaining safety for other patients within the Emergency Department.

What was it like at WPH during the height of the pandemic?

At the height, we had everyone in his or her PPE [personal protective equipment], and you couldn’t recognize who was who, so we had our names written on the outside [of the equipment]. In the beginning, you just saw doctors, nurses, and those who were transporting patients upstairs. It was so busy — I don’t want to compare it to a scene in a television show in which people are running around — but that is what it was like, except it was organized.

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“At the height, we had everyone in his or her PPE [personal protective equipment], and you couldn’t recognize who was who, so we had our names written on the outside [of the equipment].”

Were there difficult moments for you and your staff?

It has been sensitive for my staff to care for patients without their caregivers and loved ones there.… As frontline staff, you try to be very stoic, but for patients, it was difficult not having a family member there and the nurse having to step up to be the one to be there for [a patient’s] last breath or to hold their hand or wipe a patient’s tears or reassure them that we are providing the best care for them. Today, that is still the hardest thing that healthcare workers and my staff have spoken about. I think that is going to be a memorable moment for a nurse, to know that she or he was helpful bridging that gap between patients and their families.

Were there some positive or uplifting moments?

What I love the most, and what the staff loves, is when someone is discharged and music is played…. Recently, there was a paramedic who was discharged from the hospital, and it was so emotional to watch. I believe he works at the FDNY, and his family, as well as several of his coworkers, showed up at White Plains Hospital. An FDNY ambulance even came to pick him up. It was so touching. For us as frontline workers to see a family member go back to their family or to rehab to continue their healing process is the most [pleasant memory] I believe we’ve had.

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How do you think the virus will change your role ahead?

What this whole virus has done is really made me look at data more, and when there are discussions about something going on in the world, I ask how it could potentially impact us and how we can start preparing sooner rather than later. I think this virus has taught me that we have to start preparing now for what’s next and what’s worse. You can’t wait to hear about it. That’s really what emergency nursing and emergency medicine are: always being prepared for what may come through the door.

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