Frontline Nurse Finds Hope in a Hoop

By Charles McKenzie, May 10, 2020

Alumna helps COVID patients at the epicenter of the pandemic.

Katie Paccione '12 (center) is a critical care nurse at New York-Presbyterian/Columbia University Medical Center.

(Photo submitted)

When the frantic upside-down world spins out of control around Katie Paccione ’12, she knows exactly how to slow it down. She goes upside down and spins with it.

Isolated in her living room, she trades in a three-ring circus of a global pandemic for one ring: a hula-hoop on steroids dangling from the ceiling of her Bronx apartment. Hanging out in an Ithaca College T-shirt, heather gray like the sky outside, the aerialist spins slowly. Fridge, couch, TV, table, fridge, couch, TV, table. Like most of us, she’s recalling a life “before all of this happened.”

After a grueling lead up to a live aerial performance that had been just days away, her final rehearsal had fallen on “The Ides of March.” The next day, her studio closed along with much of New York. The show must not go on.

Somehow, even that crushing disappointment still feels better than quarantine, so today she again cues up the song from her canceled act and starts into her routine. She and the haunting song hang in the air like fog. The classic rock hit has been slowed to a crawl and covered by a soulful, breathy woman, “Every breath you take, every move you make, I’ll be watching you.”

Paccione in her protective gear. She said she's nearly passed out from the heat while wearing it.

Within a week, those words would prove prophetic and eerily comforting. At her day job at New York Presbyterian Hospital, Paccione covered as much of her body as she could, held her breath and walked in to treat her first COVID case. Although her patient was already deathly ill (and deteriorating quickly), the critical care RN was still in a way practicing preventive medicine, at least for her coworkers. Other nurses on her floor have children and families they could infect. Some were older or had health problems that could combine with COVID to produce dangerous and even deadly results.

“I didn’t want to put them in that position, and I knew I didn’t have the risk of bringing it home to anyone, so I volunteered to take care of the COVID patients early on,” said Paccione, who has a health sciences major at IC.

“Early on” as when the pandemic was still new and even more mysterious and terrifying. “Early on” as when the neurology nurse was still relatively inexperienced in treating such patients. But she exemplified the way that COVID turned everyone and everything into something new. ORs became ICUs. Urologists became emergency physicians, and soon, refrigerated trucks became mobile morgues. Even Paccione’s 61-year-old mother, a nurse for now-canceled elective procedures, asked to be re-assigned to the ER in her hard-hit Westchester hospital , New York-Presbyterian Lawrence Hospital. Apparently, early on, Paccione learned from her mother how a nurse makes sacrifices.

“It still feels heavy, and especially by the end of the shift, everything hurts because of that weight, but it felt especially heavy that first time.”

Kate Paccione '12, on the PPE gear she wears

She still remembers that first time she donned the full personal protective equipments (PPE) and walked into the COVID room. “There was a moment of holding my breath, not because I thought that if I breathed in, I would get infected. I was like, ‘Okay, here we go. We’ve been hearing about this. It’s real now, and you can’t turn around.’’’

She understood the weight of the moment better than she’d understood the weight of all the gear.

“It still feels heavy, and especially by the end of the shift, everything hurts because of that weight, but it felt especially heavy that first time.”

PPE’s are hot and sweaty too. More than once, her face shield slipped off completely, and she also nearly passed out from the heat, all potentially serious accidents that she lightly files under, “Oh, Snap!" moments. Her worried father even jokingly offered to loan her his SCUBA gear.

She says the question has never been whether she will get sick but when.

“Every time you walk into that room you have to wonder if this is it.”

The twisted irony for medical personnel terrified of catching the virus is that merely treating COVID patients leads to many of the symptoms of being COVID positive. Fever? Muscle pain? Shortness of breath? If you’re running around moving immobile patients, feeling exhausted and hot in your heavy PPEs, check all of the above. Headaches? Of course. Exhaustion? Naturally.

woman in graduation gown and mortarboard with mom

Paccione with her mother Anne (left) at her nursing degree graduation.

Shielding some of her colleagues from contact would only last so long though. Her fellow nurses were soon all pressed into service on the mostly COVID floor, and soon after that, an estimated 10 of 40 in the ICU had become COVID patients themselves. All recovered, but some of those with existing medical issues still feel the effects. For everyone on the team, caring for one another doesn’t start when a colleague falls ill.

“The doctors and the nurses and everyone have really come together, not only in my unit but in the hospital as a whole. It’s great to see everyone treating each other with so much respect and being so helpful and kind. We feel that support among ourselves and from the outside community too.”

Those rays of hope and comfort illuminate the dark times.

“For about two weeks, we were having patients coding and dying on every shift. That was the worst, seeing my coworkers struggling so much because we were working so hard, and we were feeling so defeated. Nothing we were doing was working.”

Medical dramas are filled with doctors and nurses trying round after round of chest compressions, valiantly trying to bring patients back from the precipice. Like most other things, COVID complicates that now. Along with intubations, chest compressions can easily spread the virus to medical staff and even other patients.

A policy allows medical personnel to limit how many rounds of compressions they do on a COVID patient who is not likely to come back or have basic quality of life if they do.

“And we still constantly override that to keep going and keep trying at the expense of ourselves. Seeing so many patients die despite our best efforts made it feel like it was all for nothing. We were going above and beyond, but it still was not enough.”

And even among all the grief, Paccione still hasn’t become numb or gotten used to the sudden deaths.

“It's always just as shocking because we never know when it is going to happen. There were patients we thought were getting better, and all of a sudden they'd decompensated again.”

“I had this dream that I was sick, and I couldn't talk. I was trying to warn people, but no one could hear me screaming because no sound was coming out.”

Katie Paccione '12

Those who haven’t died aren’t necessarily better off. Some patients in her care for almost two months have shown no signs of improvement. Last October, Paccione got an odd, superficial glimpse into a slow death during a pandemic. She and another nurse went to England together and visited a museum celebrating Florence Nightingale, the mother of modern nursing. In one area dedicated to the Spanish Flu of 1918, visitors were each assigned a patient that they would track as they moved to different stations. At the end, they learned the fate of the “character.” Paccione’s died.

“You go step-by-step through that room and read about all of the things that your character was enduring and then the person still died at the end. That was really moving.”

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Sadly, not all of the lessons of that pandemic were learned. Crusading nurses including Paccione and other medical personnel have long warned of pending shortages and other gaping wounds in the American healthcare system. They’ve gone almost totally unheeded. Early in the pandemic, the nightmare of her waking hours bled into her sleep.

“I had this dream that I was sick, and I couldn't talk. I was trying to warn people, but no one could hear me screaming because no sound was coming out.”

Still though, even for her, a modern pandemic like the Spanish Flu was unfathomable. In the museum, the two nurses had remarked how lucky they were.

“We were almost joking around like, ‘Oh, thank God this would never happen now. New Yorkers wouldn't survive. We live on top of each other. It would be the worst thing ever. Thank God for modern medicine.’ But now to see it actually happen is insane.”

Today, Paccione is living in that pandemic reality, although sometimes she still manages to carve out her own, even if it’s just in her living room. Sitting in her hoop, she describes it in much the same way she describes nursing. In every moment, there are a lot of elements she must keep track of and procedures to execute with no room for error. But the hoop surrounds her with two things missing from nursing through a pandemic: escape and control.

Paccione performs as an aerialist in New York City.

“It calms me down because it brings me back to that place of training to be in the show and I start thinking about a time before all of this,” she says, describing mid-March as if it were decades ago. “I'm able to clear my mind when I'm in my hoop. I'm just focused on myself and my body and the music. It's a weird kind of Zen and a weird kind of meditation that I feel like I'm missing now.”

As their song “Every Breath You Take” continues, she and her hoop gently spin together, until she hooks one leg over the top of the hoop, gracefully in control of all moving parts.

“Maybe that’s why COVID has been so hard. There’s no evidence or protocol or cure, and I feel no control.”

She suddenly swoops, sending her hair fanning out like a Cirque du Soleil performer in a shampoo commercial. She stops in a kind of freeze frame. Finally, she’s able to just hang around, let her hair down and just breathe.

Still though, she grieves not doing her act before a live audience. “It feels a lot like having my wings clipped, which is such a cliche but it really does.”

So for now on yet another day off spent at home, she sits on her perch, a modern Nightingale waiting to once again take flight.