How an ICU Nurse’s Focus on Mental Healing of Patients Grew Despite COVID
Written by Melissa Schenkman, MPH, MSJ
Nurse Rachel Robilio all suited up with her COVID-19 protective gear and ready to care for her patients.
When Rachel Robilio decided to become an intensive care unit (ICU) nurse, she envisioned treating every patient just like they were her beloved grandmother. That’s because as her grandmother’s caregiver when she was in the ICU, Robilio watched in shock at the terrible care her grandmother’s nurse provided.
“She didn’t care or pay any attention to my grandmother, so I kind of made it my goal in life to be the best ICU nurse that I could be. And that’s what I’ve been doing.” Robillio said.
In her almost five-year nursing career working in the ICU, 27-year-old Robilio has been involved in every aspect of patient care, and she has really enjoyed the critical thinking the field allows for each day.
She started out in a medical surgical unit in Memphis, Tennessee, where she is from. There, she learned a ton between seeing ventilators placed at the bedside and watching and participating in the placement of many intravenous lines emergently. Two years later, she decided to expand her knowledge to pediatrics and oncology, joining St. Jude Children’s Hospital.
But after caring for children, she came to miss her adult patients, the ones that caring for her grandmother originally called her to serve. So, she went back to caring for older adults, joining a smaller hospital in Memphis. That’s where she was when the pandemic hit.
COVID-19 Hits Memphis
Before Coronavirus 19 came to town, Robilio remembers getting lots of patients with pneumonia, something she and fellow nurses thought was really strange. In hindsight, it may have been COVID-19. When her colleagues first heard about the coronavirus, they thought: “It’s just like the flu, and it’ll pass.” Little did they know what they were in for.
It was slow at first and then three months into the COVID-19 pandemic, things started to get really bad. A lot of nurses left working at the bedside. Her hospital also had a lot of older nurses who could not handle the personal risk of infection and an overwhelming amount of care COVID-19 required.
Robilio was working overtime—four or five days of 12-hour shifts each in a row. At one point she heard that they might have to spend the night at the hospital because they were so short-staffed.
Every day she went to work having to be very cautious. Her team had to rethink morning meetings and handoffs of patient information from night- to day shift because they couldn’t huddle together in one, tiny room anymore.
“It was a really confusing time for us, especially because we didn’t ever think it would get that bad,” Robilio said.
Another change: family members could not be there when nurses were reporting information—a huge loss, she said. Due to COVID-19, families had very limited, if any, access to the ICU.
“Families are very helpful to us because they will tell you things someone might have missed, and I think their absence affected care,” she said. “They bring a lot of comfort to patients as well.”
Nurse Rachel Robilio with her grandmother who inspired her to become an ICU nurse.
An Unforgettable Patient
Robilio did her best to bring that kind of comfort to a young man she cared for and will never forget. He had recently gotten engaged and couldn’t have his family by his side. She was holding his hand the whole time when he was struggling to breathe. “He kept repeating, ‘I don’t want to die,’” she remembers.
Unfortunately, her team had to call a code and put in a breathing tube. It was rough, so she did not want to leave, despite having already worked a 12-hour day shift. But her colleagues assured her that they would take care of him and that she should go home.
When she came back early the next morning, he had passed away an hour before she arrived. He was only 36 years old.
“It was really heartbreaking to see his fiancé there. We allowed loved ones to gown up at some point to say ‘goodbye’ and that was really hard to see,” Robilio said. “You just feel like a failure in a way, even though you know some things are out of your control, it really weighs on you.”
As a nurse, she had been taught that she cannot show her emotions and needed to be a rock. But that day, she just couldn’t be. Actually, Robilio and a fellow nurse sat in a room and cried together.
“Usually, you would not do that. So, to have someone else crying with you made you feel safe in a way because you could see someone else who was struggling like you and trying to do their best,” she recalled.
An Emphasis on Mental Health
Emotional support between colleagues was something that she began to see more often during the pandemic.
At every hospital she has worked at since the pandemic (three and counting), she has seen a greater emphasis on the mental health of nurses, physicians, and other healthcare staff. People spoke to her teams about therapy groups and a confidential hotline to call. Nurses even started sharing positive care experiences at daily meetings.
After a patient died, the nurses who had worked on that patient would stop and take a kind of timeout. It really helped her to sit for five minutes and get her thoughts together, especially because the stress at work was overwhelming and people were just expecting her to be okay with it.
It’s hard to talk with people like your family members who aren’t experiencing what you’re witnessing firsthand caring for patients with COVID-19, Robilio said. So, sharing experiences with colleagues was key and made her and her team closer.
“I could not have done it without my fellow nurses,” Robilio said. “In order to give the best care, we have to be in the best mindset.”
Rachel Robilio and her boyfriend out on a date night.
Triumph in the Face of Tragedy
Through finding moments of positivity and learning to grab onto pieces of hope, she could tap into positive thinking during hard times.
She believes one of those pieces was the arrival of a seven-months-pregnant patient with COVID-19 to her unit. “It was g-d’s way of showing me that hope still existed,” Robilio said.
The woman was on a ventilator and had lots of medications. At one point, Robilio and her team had a hard time finding the baby’s heartbeat so the obstetrics nurses had to come, and they found a heartbeat. But the woman pulled through, delivering a healthy baby via Cesarean section and surviving the virus.
When the team found out that their patient did not have insurance to receive the physical therapy she needed to fully recover, Robilio and her amazing unit raised money to make therapy possible.
Robilio credits her personal resilience not only to her colleagues’ strength but also to being a millennial.
Being a millennial made me more open minded. It made me more willing to try new techniques and to help my team. I feel like what makes millennials stand out is that when we are put in a position to do something, we’ll get it done.”
And that’s what she and fellow millennial frontline workers have been doing throughout the pandemic.
Facing Challenges Outside the Hospital
It hasn’t been an easy road by any means. Robilio has lived alone during the pandemic, a good thing in preventing her from potentially exposing others, but it could make her feel alone too. She could not see her sister who was pregnant, and that was really hard because they are close.
When she started dating her now-boyfriend, they could only really date in the beginning by FaceTime or meeting outside. He was even afraid to tell his mom that his girlfriend worked in the COVID-19 ICU, something Robilio understood completely.
“It was lonely, but you have to remind yourself why you are doing it and who you are doing it for, “she said about being a nurse.
It was especially difficult when she would see people on Facebook posting how they didn’t believe how bad the coronavirus was or saying ‘it was only a virus that affected older or unhealthy people.’ Meanwhile, this clearly was not true.
“It was really frustrating after seeing so many people suffer,” she said. “People who are unhealthy or overweight, they don’t deserve to suffer like this, and saying that it and seeing it are two different things.”
Rachel Robilio with her niece and nephew.
Life on the Frontlines
Even though she has worked in critical care for years, she had never seen so many deaths as she has during the pandemic.
On top of that, nurses were expected to take on multiple roles, and she felt like she could not do so successfully. None of them could, but they did their best.
For instance, when a nurse goes into a COVID-19 patient’s room, it’s for a while. If you are there when a family member calls, you can’t help it, Robilio said. At times, she would be trying to do patient care and comfort scared patients while also trying to talk to families and communicate with doctors.
I think when you wear so many hats, especially during a pandemic, its so hard to juggle it all sometimes. There were times when I would have three patients, who were all really sick and you feel like you are juggling, but you are going to drop something at some point.
That was hard for me professionally because I always wanted to be a nurse to be the best one I could be, and it was hard for me to realize that I am human and that I’m not going to be perfect.”
She tried her best to adjust the way she did things. Realizing that she was a family’s lifeline for communication, she would call patients’ families every morning to share that day’s plan and when she would call.
But after caring for patients at three different hospitals in two states (Georgia and Tennessee), the constant change in doctors’ treatment protocols and the sheer magnitude of deaths took their toll.
“In order to be the best nurse that I could be, I realized that I needed a break from that, so I left the bedside. And acting on that realization was really important,” Robilio said.
Since then, she moved into outpatient plastic surgery in Atlanta, where she gets to spend time with patients who are healthy.
A New Beginning
What the coronavirus has taught Robilio is that there is a great need for better mental health overall. She’s thankful that she has seen patients survive COVID-19, but knows they may have trauma ahead.
There’s been a lot of research on people who have been intubated for a long time and on medications, and how it affects their mental health. It can cause depression and posttraumatic stress disorder, she found.
Her experiences on the front lines have led her to want to go back to school to become a psychiatric nurse practitioner.
“I think there needs to be a greater focus on the mental healing of a patient,” said Robilio, who is very excited about this next chapter in her career.
“It’s been one of the positive things that Covid has brought to light for me. The pandemic has been terrible, but I also think it has instilled in us the strength and willingness to overcome things we never thought we could.”
This story is a part of YMyHealth’s COVID-19 Stories from the Field series. We will continue to share personal stories from millennials who are essential workers, caregivers, and those close to them, as long as the pandemic continues.
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