A Conversation with Dominique Homza: On the Front Lines of COVID-19

Sweating under the airless plastic gown, mask, face-shielding helmet, and scrubs, Dominique Homza holds up an iPad in a hopeless hospital room. On it, the family of the unresponsive patient in front of her takes a last look at their loved one. When they start to pray, she bows her head with them.

One of the most tragic aspects of COVID-19 is the isolation of the patients and the inability of their families to be by their sides. As one of the hundreds of thousands of critical care nurses in the U.S., Homza tries to bridge that gap by using a spare moment to update families or by holding impromptu virtual funerals when there is nothing left to update.

Homza graduated with her bachelor’s degree in 2014 and her master’s degree in 2020. She began her career in the ICU but moved to home care when she started graduate school. When COVID-19 hit, Homza returned to the ICU. Most recently, she has been supplementing her work as a primary care nurse practitioner with a part-time position on the COVID floor of a D.C.-area hospital. Her responses are edited for clarity.

You’ve been an ICU nurse for most of your career. What is it like?

I jokingly call it my toxic ex-boyfriend. When I meet another ICU nurse, we get each other because it’s a camaraderie of people who just do the damn thing and hold it down when a patient is crashing. You’re there to support them in moments where they nearly escape death but you’re also the one alone in a room tagging the toes and zipping up the body bag.

What was it like going into the ICU straight out of school when you were 22? 

At 22, I was still not dealing with my own mental health issues. I had moved back to my hometown area and was working at an ICU there. It was really hard for me to balance normal friendships with my job. I’d go out partying, wanting to be a normal twenty-two year old, and then, the next day, go to one of my patients’ funerals. It was so unhealthy for me but I didn’t know where to draw the line. I just wanted my patients and their families to know that I cared.

When you start a job like that, your innocence is lost really quickly. I remember crying over my first patient. I remember the depression. I remember what it felt like when people said, “Well, at least you were his nurse,” and that didn’t feel good to me because my patient never should have needed to be in that situation. The “be positive” thinking was actually very dismissive of the grief that I was experiencing and the grief that permeated the career I had just entered.

At the same time, I had so many wonderful stories of patients who did really well and of patients who some might say had a miracle if they hadn’t seen all the work the ICU team put in. I think, overall, it wouldn’t have been so hard on me had I started it at this age. Most women at 28 years old know a lot more about themselves and how they feel about tough subjects than I did at 22.

We don’t often talk about the mental health of medical professionals who see trauma every day.

The gaslighting is one thing I’m experiencing right now, especially online where I’m seeing how some people are just “over” COVID. They have no idea how many people I saw die who never got a funeral. They don’t know what it’s like to see a mother wailing over her son’s condition in a foreign language via iPad, and being at a loss for words other than, “I’m so sorry.” There’s a lot of gaslighting-type shit that makes it hard for me not to word vomit online and seem like a crazy person because I’m trying to give a moment of silence for the dead and the ones who are going to die because of people who are “over” COVID.

Can you compare your experience in a “normal” ICU to what it is now in a COVID ICU? 

Before COVID, I would say 60 percent of my patients survived, 40 percent didn’t. When I was on my COVID contract, 95 percent of my patients died.

In April, we were running out of sedation in the COVID ICU. It was par for the course that COVID patients were put on paralytic drugs, but before COVID, it was more rare. Additionally, we had so many patients with acute respiratory distress syndrome. Anyone on a ventilator with COVID had that diagnosis. Prior, in the ICUs I’ve worked in, about one out of twenty patients have ARDS and it’s usually an elderly patient with a horrible immune response to a community-acquired pneumonia. I wasn’t prepared for the volume of this being just about every ICU case I’d see for months.

Another thing was the difference in demographics and age. In a normal ICU that isn’t trauma (basically anyone who didn’t get in an accident), the average age is 72 to 89, with outliers on either side. During my time in the COVID ICU, I had patients in their 20s and 30s. One day, I calculated the median age and it was 52, which would have been a very young patient in a normal ICU. I didn’t see patients over the age of 80 because they didn’t make it to the ICU. I also saw a lot of Hispanic patients because they were service workers who were not able to work from home.

The problem now may not be equipment shortages, but shortages of experienced staff and the burnout they feel. You can’t buy a nurse or a doctor with expertise.

Now you work as a primary care nurse practitioner. How do you view that role differently to your work in the ICU?

One of my roles in primary care is to educate and correct the misinformation that a lot of people hear. I don’t think anti-vaxxers are coming in for flu shots, but other people who hear those theories will ask about them. I try to teach them how vaccines work and once it makes sense to that person, they’re like, “How could I have ever thought that theory made sense?” That’s a little ray of light to me. I also try to educate people on COVID, given my experience treating it. The problem is that we don’t have time to do that most of the time in quick, walk-in visits.

What would be a solution to the misinformation? 

Requiring better education in primary school about diseases. The fact that so many people were never exposed to these things makes illness seem like a mystical thing that they have to make conspiracies and fairy tales about. We also need people in politics to either defer if they don’t know an answer or agree with the nonpartisan medical experts. The misinformation we’ve experienced this year was avoidable and yet, still constant. Having people in power who respect science is very important.

I think, as Americans, there’s this freedom to be wrong, freedom to choose not to believe facts when they’re presented to you, and that is also very harmful. There’s an ability to agree to disagree about stuff that is proven false, when it really should just be acceptance of what is proven true. People rely more on anecdotal evidence and dismiss actual evidence, especially in the world of Twitter where there’s no second dialogue. So, that’s another problem — accountability for things that you say that can be interpreted as valid to another person with little to no expertise on the subject.

You’ve also been to a lot of protests this summer for Black Lives Matter. How do you see the intersection of racial justice and public health?

Most of my patients on my COVID contract were Hispanic. In other areas, Black Americans were affected severely. Not only is a person’s health tied to access to education, language literacy, and affordable healthcare, but community health is tied to disparities in affordable housing. This, in particular, has led to a lot of the COVID spread. A lot of diseases can be detected before they become chronic conditions if you have access to healthcare outside of an emergency setting.

What You Can Do

We know you’ve heard it a million times before, but alas, think of the health care workers during this time. Think of the unimaginable work they are doing to keep our communities safe.

  • Stay home. When it is not essential for you to go somewhere, and you are physically able to,  just stay home. You can check out Emily Powers’ list of books to read to stay socially active while staying home.
  • Donate in helping to deliver meals to frontline workers from participating restaurants. This is a win-win in that you are supporting the restaurant business while providing the frontline heroes with meals.
  • WEAR A MASK. If you know how to sew, sew cotton masks for your neighbors to drop at their doorstep as a gift for the holiday season, starting now 🙂
  • If you are looking for more ways to help, check out BETTER by Today’s list.

–Kaei Li, Content Creator

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