EDINBURG — Two COVID-19 patients in one of DHR Health’s coronavirus wards went into cardiac arrest at about the same time Monday.
The doctors and nurses gathered around them in growing numbers as they tried to save their lives. You could tell they were growing more desperate under their gowns and face shields.
Medical staff knocked some stuff off a table next to one of the patients. A nurse wheeled up a cart from the hallway.
Someone started performing CPR on one of the patients, his belly flopping up and down rhythmically each time they pressed on his chest.
One of those patients survived, and as of Friday seemed to be recovering well. A victory, hopefully.
The other is dead. One of the latest in the Rio Grande Valley’s 900 defeats to the virus.
In a societal struggle against something that’s too small to see, the struggle against the pandemic is candidly and shockingly visible in that intensive care unit.
It’s a grueling struggle, with daily battles and disturbingly frequent casualties that place an immense emotional burden on the doctors and nurses who walk into Serious Infectious Disease Unit 2, SIDU-2, every day.
SIDU-2 is in what was formerly DHR Health’s rehabilitation hospital, off behind a pharmacy and a law office near the corner of McColl and Dove in Edinburg.
There’s a bustling Mexican food restaurant within walking distance, onion fields half a mile away. A quiet neighborhood to the rear and a strip club down the road.
Compared to what’s outside, the inside of SIDU-2 may as well be Mars. Inside, there’s the constant sound of air being pushed through the building, the sound of monitors beeping and air tanks clanging hollowly as they’re changed.
You’d have to ask a patient what it smells like inside. No one else knows.
Nurses and doctors walk through the unit wearing a face mask covered by a face mask covered by a face shield for however many hours they work. Sometimes they just wear a respirator. They wear two pairs of gloves, booties over their sneakers, a bouffant over their hair. A plastic gown and a cloth gown over their scrubs.
All that gear can get hot.
“My first shift, I sweat so much,” Mary O’Neal, an RN and nurse educator, said. “I could wring out my scrubs, they were so soaked. Now we have better air conditioning, but before — you’re in so much PPE, and I’m not a big person — but I was dripping sweat down my body.”
O’Neal, chipper and positive, trains doctors and nurses and anyone who goes into one of DHR Health’s COVID-19 units in the use of personal protective equipment, outfitting the people on the pandemic’s frontlines with the armor they need to survive it.
It’s hard to see through all that equipment, O’Neal says, and medical staff learn to recognize each other’s eyes, the only distinguishable feature to cling onto.
“You feel like you’re in an alternate universe,” she said.
Slender and chipper, O’Neal, gives that instruction with the aplomb of a flight attendant, walking her students through a complex process of procedures: what order the gear should be put on; how gloves should be taken off; how it’s OK to ask for someone to tie up your gown in the back.
She even has advice for women’s hair: A low bun is the best option.
O’Neal’s students and every member of the medical staff in SIDU-2 don and doff that equipment daily, usually more than once a day. They have to take it all off before they leave for lunch or go home for the day.
They have to take it off before they have a sip of water.
Despite being buried by all that cloth and plastic, nurses often joke and chatter in SIDU-2. O’Neal, who was drafted onto the front lines to help care for patients at the beginning of the pandemic, says there was a real sense of camaraderie. New reinforcements from the government and private contractors have arrived to swell the ranks of the medical staff at DHR Health, and it’s harder now to recognize all the eyes peeking out through the face masks.
They’re trying to reforge that connection though.
“Oh you’re Annette?” O’Neal said amiably to one of the new arrivals Monday. “I’ve heard of Annette.”
From O’Neal’s perspective, looking through all of that gear on the inside of SIDU-2, you’ll see that not all of the patients are in dire condition.
Several of them were awake and active Monday, looking at their phones.
One patient shouts as a doctor walks by. There’s a family member in the parking lot with her cell phone and she wants it desperately. A phone is an indispensable tether to real life from that alien place.
“Imagine being locked up in a room by yourself for 30 days,” Dr. Armour Forse, chief academic officer and general/bariatric surgeon said. “Your family is not able to come in to see you. Yes, maybe we can provide you with a video image of it, but it’s still not the same. And at some point in time there you may have lost track of time and place, right? And if you’re on a ventilator and paralyzed for a period — that’s what some of these patients are going through, so the mental part of this is extremely, extremely traumatic.”
Not being on a ventilator doesn’t mean you’re not suffering.
Forse, a tall, spare Canadian, is the kind of man who quotes doctors long-dead and tends to spout off the findings of academic COVID-19 studies instead of offering anecdotal opinions. He’s the kind of man who seems to approach the world logically and academically. The kind of man who sees the big picture.
Despite the academics, he says the small picture — every individual patient, every individual battle with the coronavirus — is what really matters.
“What was it Sir William Osler said, ‘A good doctor treats the disease; a great doctor treats the patient with the disease,’” he said. “That’s what we can’t lose. We can’t lose the ability to treat the person with the disease, and that’s the empathy part.”
Empathy in SIDU-2 is fetching a cellphone from the parking lot or speaking with a patient’s family. It’s placing a gloved hand on a patient’s shoulder when you tell them they need to be ventilated.
Empathy in SIDU-2 is talking to a patient through all those layers of facemasks, raising your voice to be heard over the air conditioners.
Empathy in SIDU-2 is keeping your heart from getting too hard while you watch your patients suffer and die all day, every day, despite your best efforts, and then having to tell the people who love them they can’t visit.
“All day long,” Sherri Abenroth, DHR Health’s director of emergency management and disaster preparedness, said. “‘I am so sorry, but I cannot let you in.’ It becomes very difficult to do.”
It’s especially difficult to avoid hardening your heart in SIDU-2’s intensive care unit.
In the general COVID-19 ward, nurses talk and joke sometimes. In here, things are more serious.
Overwhelmingly, the COVID-19 patients in ICU are elderly, but that’s not entirely the right word for them. The correct word for them, emotionally, is grandparents. Many of whom likely have two or three generations worth of descendants worrying for them and crying over them and praying for them. It would be a wonder to measure those prayers in inches, to know how many inches worth of rosary beads have been worn away by anxious thumbs fretting over the people in that grim room.
Whatever the sum, it is not enough, not if you step into the intensive care unit where that patient died Monday. The people in ICU are a sorry sight.
They lay in different positions, some on their back, some on their side and some on their belly. Their mouths hang agape, tubes running down their throats and strange machines beeping beside them.
They look like people in some science fiction movie, put into hibernation on a voyage through space. Some of those people will wake up again. Some won’t.
It feels bad to look at them. It feels intensely rude to stare at someone in such a miserable condition, when they can’t look back, or talk back, when their own family can’t look at them and when no one they ever knew may ever look at them alive, ever again.
“I’ve been a nurse for a long time, but it hurts seeing them this sick,” Yvette Alaniz, a nurse in SIDU-2, said.
Like most of the doctors and nurses in SIDU-2, Alaniz starts talking about her time in the unit matter of factly. Like most of her comrades, if you ask her to reflect on her time there, her voice cracks and you can almost hear the tears start to well up behind her face shield.
It’s not hard to see why.
Every breath those patients in ICU takes seems like a minor miracle. You watch them, wondering if that breath might be the last one, if their chest might stop moving and some alarm might start beeping and nurses and doctors will gather around them growing increasingly frantic, like they did Monday afternoon.
Hundreds of doctors and nurses do look at them, daily. They care for them and work for them and try to preserve some shred of dignity for them in what is by necessity a not very dignified situation.
It is no small task.
“I just have to take a step back and take a deep breath and remember why I became a nurse,” Alaniz said.
Dr. Ephraim Vela, OBGYN and chief executive physician for women’s health, compares doctors and nurses coping with the pandemic to soldiers coping with war.
“Ask the guy who goes to Afghanistan and who does tour after tour after tour,” he said.
Compared to many of the nurses and doctors in DHR Health’s COVID-19 units, Vela is an old campaigner. He and Forse both were in the trenches a decade ago during the AIDS epidemic.
“When I was a resident, we had to take care of the AIDS patients,” Vela said.
Vela, like every other doctor and nurse fighting the pandemic, has sacrificed for the cause. He lives next to his kids and grandkids, but because of his proximity to COVID-19 patients, he can’t be with them.
The best he can do is look out his window at them while they’re swimming in his pool.
“I know that if they got sick, who’s going to get them sick?” he said. “Me.”
He doesn’t know when he’ll be able to be with them again.
“Hopefully by Christmas,” he said.
“The incident command center and the modeling says that it’s going to peak sometime down here in October, that’s what the modeling says,” Dr. Forse said.
The tragedy of SIDU-2 is that patients can be treated and can recover, but they can’t be cured. The tragedy of every COVID-19 unit in the Valley is that no matter how much work medical staff do in the unit, they can’t cure the pandemic.
“There’s only so much we can do with all this,” Vela said.
Like any major war America has ever fought, they say this one will be won or lost on the homefront.
“Masks, social distancing, wash your hands. The three golden rules, these are like the new golden rules,” Forse said.
Until then, they say, those nurses and doctors will slog on.
Monitor Staff Writer Berenice Garcia contributed to this report.