1. Daunt, Debbie J. MSN, RN


A medical mission volunteer bears witness to nightmarish inequalities.


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As nurses, it is our duty to help those in need. That obligation led me to answer the call of the governor of California to all health care professionals. Despite being a university professor, I hoped I could make a contribution, and submitted my application to join the California Health Corps. On Friday, May 15, 2020, just as I was wrapping up my grading for the semester, I received notice that nurses were urgently needed to join the California Medical Assistance Teams (CAL-MATs). I submitted my grades to the university registrar and boarded a plane to Pasadena that Sunday.

Figure. Illustration... - Click to enlarge in new windowFigure. Illustration by Janet Hamlin.

The mission was to provide aid to a skilled nursing facility where 11 staff members had tested positive for the coronavirus and more than 40 patients were infected. On day 1, I knew we would be fighting a war of attrition. The navy, the National Guard, and the Veterans' Administration had all been unable to accept this mission. More patients were becoming infected every day, and staff members were refusing to come to work because they feared being infected.


The conditions I saw were shocking, even to an experienced nurse. I saw soggy diapers on the floor at the heads of many beds on most mornings. One day a bedbound patient needed the bedpan. I searched every closet and drawer but there were no supplies. I filled a basin with warm water and cut up a PPE gown to make washcloths to clean the patient. On the second day of my deployment I realized that many of the patients were dehydrated. They had no access to water. A patient with dementia was sipping juice from a cup. I glanced in the cup and saw floating fly carcasses.


One afternoon a CAL-MAT team member pointed down the hall and said, "That's not right-is it?" A petite CNA was holding the doorknob of a patient's room and bracing the door with her body to stop the patient from opening it.


The ferocity of my response startled the CNA. "You can't do that! It's illegal. Take your hand off the door!"


"But then he will get out," she responded.


I realized that she meant no harm and didn't know the severity of her mistake. She quickly released the doorknob and scurried away.


Most patients were full codes and were transferred to community hospitals when symptoms of COVID-19 could not be adequately managed. It felt like they were being sent away to die under someone else's watch. I facilitated the change of one patient's physician orders for life-sustaining treatment (POLST) form and cared for her in her final hours. I watched her oxygen saturation level decrease as she slowly slipped away. Time of death: 1000, Memorial Day. My patient was added to the growing count of coronavirus deaths in U.S. nursing homes.


Days went on. Health inspectors came and went. I was invited to a meeting of the facility owners and the city health department, where I described my observations while offering suggestions. To my surprise, the next day many of my suggestions were implemented. Yet I approached the end of my mission feeling that it was not enough. Stories of patients being bathed only monthly and visions of old men hobbling around in only soggy diapers haunted me. The virus had stressed the meager resources of this establishment to the breaking point. Two weeks of intensive support was simply not enough. My deployment of 14 consecutive 12-hour shifts had come to an end.


I questioned how many improvements had been made just for show. This skilled nursing facility had a long history of health code violations. The situation posed an ethical dilemma. Was my work providing the best outcome for the patients? The facility still lacked the ability to provide the most basic of nursing care. I knew the patients would be better off in a different environment, but in light of the pandemic, where would they go?


On June 8, I received a text that put my mind at ease. The CAL-MAT team was pulling out, and the decision had been made to close down this facility. The patients would be transported to other facilities.


The media has shown COVID-19 patients in clean hospital settings, not in the conditions I witnessed-conditions hidden from view only blocks from the homes of a very wealthy community. In the last two weeks of May 2020 I saw, firsthand, the inequality of the U.S. health care system. I can only believe that the closure of this facility gave its more than 60 patients better lives. Yet I wonder how many times this picture has been repeated throughout our country. How often are the poor left to suffer unseen, right under the noses of the privileged class?


Let this pandemic serve as the catalyst to improve our health care system by exposing the reality of forgotten patients in nursing homes in California and throughout our nation.