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As thousands of COVID-19 patients fill ICUs across the state, intensive care nurses face the daunting and exhausting job of caring for them.

Among them is Sandy Keenan of Tufts Medical Center, who describes going to work as "surreal." From the moment she walks into the hospital, she said, it's clear things are very different now.

“It's nothing like I've ever seen in the 30 years that I've gone to work,” she said.

“The hallways are empty,” she said. “We can only go in one or two entrances and are met by security guards. We have to show our badge. We get a mask that we have to leave on at all times. All the seating areas have been dismantled.”

But it’s the patients in the ICU that are most different.

“They are on the edge all the time,” Keenan said. “You know, we try to keep them stable and get them better. But they're the sickest group of patients I've really ever seen. And they do deteriorate pretty quickly, you know, when they do deteriorate.”

And they need a lot of nursing care.

“We're starting IVs, we're suctioning, we’re drawing labs, we’re starting medications,” she said. “If they're able to talk, we talk to them. If they're on a ventilator, then, you know, they're not able to speak to us or probably even hear what we're saying.”

While we’re all trying to stay away from people, just in case they might have the virus, nurses like Keenan have to get close to people because they do have the virus.

Keenan — who’s from Hanover — said medical staff tries to stay safe by wearing a lot of personal protective equipment, or PPE.

“Our PPE consists of a gown, double gloves. We wear PAPR masks, which are powered air purifying respirators. It's like a hood and a shield and it's attached to a little motor that straps around our waist and it blows positive pressure air into our mask.”

The blowing air creates a whooshing sound in her mask.

“It's kind of like driving on the highway with all the windows down or maybe in a convertible,” she said. “It's really loud and it really affects your hearing.”

Which makes it hard to communicate with other nurses when they have to work together to help a patient.

“Many of them have to be proned, which is we put them over, face down on their on their belly because it helps with expanding and profusing areas of the lungs to help them oxygenate better,” she said.

And turning a patient who is connected to all kinds of lines and tubes takes time. The patients are in no position to help, and sometimes it takes as many as five nurses.

“It takes a very long time to prone someone, it takes a long time to intubate [and] put lines in,” she said. “And you try to cluster your care because you don't want to be going in and out of the rooms too much. So you try to do as much care as you can at one time when you go in the room. So you're potentially in there for hours.”

The days are long. Keenan worked a 16-hour double shift on Sunday.

“We're seeing more and more patients,” she said after that long day. “It's getting busier and busier.”

One thing she keeps coming back to is how grateful she is for the professionalism of the medical staff around her.

“The nurses all work exceptionally well together, and we are becoming really good at what we're doing with these patients,” she said. “But, you know, as more come in, we are spread thinner and thinner and it gets harder and harder.”

Keenan understands how hard this is for the patients' families. They are terrified, and they can’t be there at the bedside. Some of the nurses have done cell phone video calls, so family members could see their loved ones, even if they weren’t conscious.

“So I guess if I could send a message, I would like to tell the families how hard we are working and that we are doing our very, very best to take care of your loved one,” she said. “I don't know if that's reassuring or not. But I hope it is, because it's the truth.”