“I don't think a single medical team member will come through this and say that their life has not been forever changed,” said Andrea Nofi, a clinical staff nurse at Sutter Santa Rosa Regional Hospital.

Nofi has been an emergency medical technician, spent time working in UCSF’s neurological unit and served in the United State’s Air Force as a flight nurse. But early on, Nofi knew she wanted to work in the intensive care unit, where she’s been at Sutter Santa Rosa for the past sixteen years 

“As most ICU nurses are, we are very driven, we are very type A and anal retentiv,” Nofi said. “And so I went to nursing school knowing that I would be a critical care nurse.”

And almost two decades into Nofi’s career, the pandemic hit and she and her colleagues started caring for the sickest COVID-19 patients.

“The challenges of the pandemic kind of come in waves,” Nofi said.

The first wave was figuring out how to treat COVID effectively.

“We were being faced with something that we weren’t prepared for, from a staffing standpoint, from a knowledge standpoint, from a PPE standpoint,” Nofi said. “And so, it was pivotal that we attained as much knowledge as we could about an unknown.”

Nofi said trying to answer patients’ and loved ones’ questions was extremely difficult.

“Our patients would ask, ‘will I be able to get excavated,’” Nofi said. “‘Will I be able to go home? Can my family come and see me before I get intubated?’ It was difficult because the statistics that were out there at the beginning of the pandemic, were not very optimistic for patients who ultimately required ventilatory assistance.”

And as time went on and more COVID information and research came out, Nofi said her team became more confident in patient care. But not having enough personal protective equipment, or PPE, persisted.

“That was another wave of just concern, frustration, advocacy from nursing and fellow medical team members, to do what's right,” Nofi said. “And fight against having to reuse personal protective equipment.”

And Nofi said she was not only advised to reuse PPE but was told  to resort to non-medical face coverings when masks ran out, even by state leaders like the CDC. 

“There was a point where they're, like, ‘just wear a bandana to work, because we have PPE shortages,’” Nofi said. “And nurses in the medical field, we call that crazy. I'm not going to wear a bandana to work, I'm going to make sure that I have the appropriate PPE  with the appropriate standards.”

And the next wave was the winter surge, before the vaccines were widely available, when essential workers filled Nofi’s unit. 

“Our migrant farm worker population, our indigenous population, our under-educated population, we were seeing a lot of people who had to work,” Nofi said.

Nofi said some of these COVID patients were also facing PPE shortages themselves, so local nurses and unions started fighting for their patients’ rights for protection at work, in addition to their own.

“Not only are we fighting this horrific infection called COVID-19, but now we're also trying to advocate as hard as we can for our vulnerable population, to have the equipment that they should have had in the first place,” Nofi said.

And as the winter surge progressed, without accessible vaccines, Nofi’s team watched the most critically ill patients fill the ICU. At times, the majority of the 12-bed-unit was occupied. 

“We saw families losing their grandparents, we saw brothers and sisters passing away, we saw husbands and wives dying within weeks of each other,” Nofi said. “It was incredibly defeating to be in medicine at that point in time.”

Nofi said leaning on co-workers, what she referred to as “wingmen,” was central. Being there for one another while taking care of COVID patients, in addition to the other sick ICU patients in the unit.

“We all had each other’s backs,” Nofi said. “We were all incredibly supportive of each other. I honestly think that’s the way we were able to make it through this pandemic.”

Like having two minute dance parties to Rue Paul’s “ You gotta work” in the middle of a shift.

“We were all dancing in our PPE,” Nofi said. “We were like ‘o.k, it’s time, we need to have a break, we need to have some fun.’”

Or riding her motorcycle home at the end of a long day caring for patients.

“I would go take a shower, literally decontaminate from my day, and then get on my bike and ride my bike home, so that I could be present with my family,” Nofi said.

Nofi felt and heard the stress of her teammates, experiences of PTSD, nightmares, trouble sleeping.

“I can't tell you how many people have come to me and just said, ‘I don't think I can handle another wave. I'm still trying to get over the experience that we had with the first wave,’” Nofi said.

But now, Nofi and her team are facing another surge with the emergence of the highly transmissible delta variant. And while the medical community has learned how to better care for COVID patients, the volume of COVID positive patients in the ICU is reminiscent of the early  days of the pandemic. 

“Way back in the day where half of our unit was filled with positive patients, we are seeing that again,” Nofi said. “We had a month, deep breath, and now we are going back into it. It’s incredibly heartbreaking because there's an option out there.”

Besides encouraging residents to get vaccinated, Nofi asked that community members continue to advocate for healthcare workers.

“We will stand strong for you, please continue to stand strong for us,” Nofi said. “We will get through this.”