The coronavirus pandemic has dramatically revealed our most fundamental needs and wants. Central to this struggle is the conflict between social responsibility and social interaction, which is particularly evident in lower-risk groups: teenagers and young adults. Thus, emerges a new conflict; how does classic rebellion in youth translate to action during a pandemic? Young adults are experiencing constant competition between all that being young entails, and at the same time being responsible. In Boulder, Colorado, Payton Cloyes is experiencing precisely this dilemma. She works as a certified nursing aid (CNA) at a local nursing home, but also lives with four of her college-aged friends. The so called “work-life balance,” in this case, takes on a whole new meaning.
Payton’s work day begins with a temperature screening, her palms sweating as she hopes today won’t be the day she has contracted the virus. Then comes a questionnaire: “have you or a member of your family recently traveled? Have you or a family member experienced symptoms such as a cough or fever? Have you been exposed to anyone known to have COVID-19?” Today Payton is lucky; none of her responses have been affirmative. If they had, she would be sent home from work immediately. Breathing a sigh of relief, she heads into a small break room, the lights dimmed and filled with the smell of bleach. Those breaths are the only ones of the day she won’t need to worry about, as the environment in the break room is relatively sterile. Her work day outfits aren’t particularly glamorous; as soon as she is cleared to work she is covered head-to-toe in thin, light blue personal protective equipment. She slips on shoe covers, a gown, gloves, and a mask. Payton is a petite 21-year-old, and the gown falls below her feet, tripping her up during her shifts. “I feel a little better about working,” she says now that she’s been fitted with a N95 respirator mask, the standard for medical front-line workers. She is reminded that this isn’t just a normal work day when she begins to overheat under the PPE. After only months working in a nursing home now affected by 5 positive COVID-19 cases, the greatest challenge to her fledgling nursing career began in March of this year.
In the skilled unit in which Payton works there are roughly 110 residents. Although her nursing home provides both assisted living housing and a skilled nursing unit, her work is centered around those residents who cannot complete their ADLs, or “activities of daily living.” While some residents have diminishing cognitive function and others are ill to some degree, many are only in the skilled nursing unit for rehabilitation. The pandemic has meant that Payton’s day-to-day activities have changed; each resident requires an even more watchful eye in order to ensure both their safety and that of the staff.
Before working with her first resident, Payton washes her hands. She knocks on the door to see if the resident she is attending to is awake. “Mary?” She says. “Can I come in?” When she enters, the room is quiet, except for the light buzz of the air conditioning. It is a small, well-appointed room with more embellishment than one would expect, but sparse in furniture, making it appear more like a high-class hospital room. The walls are decorated with stock photos, and a garish wallpaper covers the wall behind the bed. Mary is laying on the bed, her white hair mussed on the pillow as she faces away from the entrance. Payton takes her temperature and listens to her breath. A few shallow breaths in and out. She takes her blood pressure with a cuff and determines Mary’s pulse. She records all of this, and then helps the woman out of bed using her own body to support her weight. They head to a small bathroom, littered with personal effects, and Payton glances at the mirror as she gently combs Mary’s hair and brushes her teeth. She doesn’t seem to notice or care that Payton is covered, head to toe, in PPE. Payton makes polite conversation with Mary, who has been less than cheerful since visitors were denied access to the nursing home. As soon as she leaves the room, she washes her hands and sanitizes herself once more. “All that takes forever,” she explains. Before she can take her break, however, she needs to do “charting,” taking a thorough record of each patient’s condition, including behaviors, skin conditions, lucidity, etc. She washes her hands and wipes down the computer with a bleach wipe before the process begins. After lunch, Payton’s work is primarily devoted to charting, answering call lights, and, of course, sanitizing her hands constantly.
“The lack of visitation… has made everyone super depressed,” Payton says. “Not being able to leave their rooms has caused problems as well… a few residents have had declining physical conditions as a result.” A bright spot, she says, has been when family members come to greet residents from outside the walls of the nursing home. Some will tap on the window glass to get a resident’s attention, while others will stand outside on the grass; husbands, wives, and children alike will wave and yell to their parents, grandparents, aunts, and uncles inside in the sweetest of efforts to keep in contact. “It’s really very emotional,” Payton says. Both visitors and residents show a wide range of emotions in the brief moments they have together, in stark contrast to the sense of cold detachment existing now inside.
Conditions are made worse by staff shortages. Fear of personal illness and fear of contaminating at-risk family members have led to fewer and fewer staff members working. Adding to that tension are the workers who have threatened to walk out for exactly that reason; nurses who are coming in for shifts are intensely overworked. Nurses are being pulled out of retirement or their only part-time schedules in order to compensate for those who cannot or will not work. “Because we’re so short staffed, I can barely spend time with the residents. Normally I can chat with them, get to know them… but now, I have so much to get through that it’s impossible… showing that you’re not scared –Payton explains– is really important for both the staff and the residents.” For the nurses that are coming to work, shifts require far more focus, energy, and positivity.
Yet a very different picture of the pandemic is painted when she arrives home. Her 5-bedroom home is located in the center of “the Hill” in Boulder, which is the central area of student housing in the city. Throughout the Hill, student homes are packed full of 5-10 students, if not more. In normal conditions, the Hill is the epicenter of student social activity; music blares constantly from rooftops as students play drinking games outside or study in restaurant patios or chat on a street corner. Girls in bikinis will tan outside as boys chatter loudly nearby in desperate efforts to get their attention. Yet it seems the pandemic has not altered this atmosphere much. “Yesterday on the Hill it was really nice and everyone was outside just playing music and hanging out together … it felt like normal. A few days ago, my friends had a full-on party, too,” Payton says with concern. Students are avoiding government advisements to social distance and remain home, which poses a unique challenge for Payton, whose roommates do not directly share her responsibility as a front-line worker and, as such, are not taking precautions seriously.
Payton and her friends have always been “social butterflies”; they are members of a sorority at the University of Colorado, Boulder, and have active social lives including wide-ranging friend groups and significant others. Parties, study groups, tailgates, and dinners are all parts of her daily routine. Without a strict 9-5 job during the school year, socialization is an important and omnipresent part of Payton’s, and many others’ college experience. Additionally, as student housing is often packed full of students, more roommates often means an ever-growing social network, which makes coronavirus containment among students very challenging. Together with this, there is less of a sense of responsibility for one another’s care.
Payton comes home from work around 9 PM. Her roommates are sitting on the couch with three friends she hasn’t seen before. They chatter excitedly as music plays, a bottle of vodka placed centrally on the coffee table. “Hi,” she greets them nervously, feigning friendliness when truthfully their presence in her home concerns her. She kicks off her shoes, thick, well-supported things that hold her up during the work-day but leave her feet sweaty and sore by the end. Ignoring urgings by her roommates to hang out, Payton walks quietly to her room and glances at the mirror. The strain of the working day has affected her appearance, she notes. She feels, if possible, even shorter, and her tan skin has dried out from the constant hand washing. Her brown hair is thin and knotted from the stiff bun she wears at work. With her brown eyes revealing her exhaustion, Payton curls into bed. As she tries to fall asleep, she thinks about all the things those three friends touched: the couch, the table, the TV remote, the door handle. She will clean those surfaces while her friends sleep hungover in the morning.
This situation has changed Payton’s perception of her nursing career. “Anyone working in the front-lines is being exposed right now. Nurses are putting themselves and their families at risk every single day. This experience has made me realize how valuable the work we do is… helping care for people.” Though now she works as a CNA, Payton will be attending nursing school this coming academic year to receive her RN license. At this point, it is difficult to tell how coronavirus will impact the rest of her career. Despite Payton’s best efforts and the efforts of front-line workers like her, the need for normalcy and social connection ultimately wins out, both in small and large ways. The need to feel young and have fun is difficult to shake, so how can we move forward in a way that maintains individual freedom and prevents the very real side effects of social isolation while still protecting the public good? Only time will tell. •