December 2019 mutterings of a novel virus in China began, at that time it was in the back of my mind however I did not lose much sleep over it, boy would that change. First a little about myself and our facility I have been a RN since Dec 1994 with a primary focus in critical care and interventional cardiology and electrophysiology, infection prevention about 6-7 years ago. My current and then facility is small although not critical access located at the top of Texas on the East side we are licensed for just under 100 beds with rarely staff for more than 30 at the high end, ICU and ER both are only 8 beds. We are surrounded by critical access facilities with the closest large facilities about 55 miles away in Amarillo Texas. I was over the Cardiac Cath Lab, Employee Health and Infection Prevention supported in employee health by a wonderful, caring and selfless LVN. January, I begin to send out emails, notifications and we had a table top surge plan review specifically as it would apply to COVID, I am posting travel signage for Wuhan but let’s be realistic no one from Pampa Texas population 16000 is going to travel to that part of the world. Evacuees from various points of international travel were brought to San Antonio and Houston with reports of positive cases emerging amongst the evacuees. My awareness is heightened for sure at this point but I remain hopeful we will see minimal impact and then in March Florida quite literally shuts down including the cruise industry and kids are sent home for Spring Break with uncertainty of whether they will return. What we didn’t know at the time was kids would not go back until the 2021 school year and that provided another unique set of challenges for working parents. March 11th WHO declares that COVID is a pandemic and the Texas governor declares a State of Disaster 2 days later. Our first cases were derived from a nearby prison inclusive of both staff and inmates, we prepared for incoming waves of patients hearing news of the inability to ship South to larger facilities. The COVID taskforce met daily and waited with baited breath for the prison influx and surrounding nursing homes which thankfully we never saw. Our Health Department support is not in the city 55 miles away but 179 miles away in Lubbock Texas. Right away I reminded our team that the support for our community was going to be on our shoulders. We could barely get our support on the phone or to respond to an email their demand far outweighed their supply. Our Chief Medical Officer at the time paused his primary care practice and was deemed our County Health Authority, with him in this role we kept a pulse on what was happening in our community and where the potential hot spots were. It took until Fall of 2021 into the new year for us to see our sustained Surge, and as surges by definition do it seemed to happen overnight. We quickly had a full ICU with vented patients and our medical floor had been fully converted to a COVID unit requiring us to open an unused area for non-Covid patients. We had many PPE plans and tossed around a lot of contingencies however thankfully we kept a reasonable supply including nurses from all over the United States some of which stayed for 4 months largely in thanks to our Regional Advisory Committee. The stress and emotional toll it took on the bedside providers was palpable they were caring for patients sometimes from other States and as far away as 500+ miles. Walking out to the parking lot took a toll there were family members posted outside sitting in their vehicles or chairs hoping to feel or see something and hoping their loved one felt their presence inside. Finding a balance between the need and compulsion to keep staff safe and protected while supporting them emotionally while trying to know when to allow a moment for a simple chat or a hug. The amount and the toll of loss is something we or our nurses many of whom have never worked anywhere else will likely never see again. Feeling the weight of the world on your shoulders all the while dealing with frustrated employees and providers as guidance changed faster than we could keep up with took a physical and mental toll beyond words. The inability to share your fears of them becoming ill or even worse is nothing I hope to experience again, the last year altered the course of my being in more ways than I could ever put into words. There is not a day that I don’t think about the past year and what I would change if I could and what I would say or do differently but I think like everyone else we did the best we could with what we had. We certainly all realized who we would want to be in the trenches with and who “had our back” but the psychological internal battle of wondering if you are that person to others is hard to wrestle with.