‘It is relentless’
The hidden toll the pandemic takes on Houston health care workers
As a nurse, LaTonya Rafe has developed a sense of knowing when death is closing in. She felt it the moment she walked into the room of one of her favorite COVID-19 patients, the one she was sure would beat the virus overtaking her small Houston hospital.
Not him, too, she thought. The team at United Memorial Medical Center rushed in to try to save the Hispanic man in his 60s as his blood pressure dropped.
Their hospital is ground zero in Acres Homes, one of the city’s hardest-hit neighborhoods. Rafe speaks no Spanish, her patient spoke no English. She worried he would be frightened, so she scrolled through her phone to find Spanish-language ballads on YouTube to calm him. She stroked his hand because no family was there.
“Friend,” she said, “I brought you as far as I can take you. It’s OK to let go.”
Time of death: 4:16 p.m. July 15. On that same day, Texas shattered a record for new cases of COVID-19, rising nearly 11,000 in a single day. More than 10,000 were hospitalized statewide. In the Houston region that day, the overall death count was 697, according to a Houston Chronicle analysis of state data. By Saturday, the number of deaths in the region had climbed to 1,708, a nearly 23 percent increase in just over two weeks.
“It is relentless,” Rafe said. June was worse than May, July worse than June. The 50-year-old veteran nurse wept in
late July for the first time for the patient she lost the week before, finally allowing herself to grieve.
“I’m just so, so tired.”
Nearly five months into this health crisis, a more hidden toll is emerging as those on its front line are becoming exhausted, overworked and overwhelmed both physically and emotionally.
The strain has hit everyone up and down the medical chain in hospitals, from doctors to support staff. They all say they feel it, disheartened by a pandemic with no finish line. Often, though, the brunt is being borne most by the hands-on workers, those who hover after the doctor has left the room, monitoring conditions, administering medication, stepping in as surrogate family.
Nursing shifts are sometimes stretching 17 hours or longer with few if any days off because there are often not enough staff at some facilities to relieve them.
Fear of bringing the virus home to family or falling sick themselves is a constant. At Harris Health System, for instance, which operates the city’s two safety-net hospitals, just over 5 percent of the nearly 9,000 overall employees have tested positive since the beginning of the pandemic, officials there said.
At United Memorial, two nurses working in the COVID units were recently admitted to their own hospital after falling critically ill with the virus.
The unpredictability of a disease that can worsen without warning requires heightened vigilance, and that leads to a continuous reshuffling of resources — be they in beds, protective equipment or people. There were nursing shortages before the crisis, health officials said, and the pandemic has only sharpened them.
“We play this game of musical chairs where you never get to sit down,” said Roberta Schwartz, executive vice president and chief innovation officer at Houston Methodist.
In May, she said her hospital’s flagship location in the Texas Medical Center had two units devoted to COVID-19 patients. Now there are 10 with 30 beds each.
There is concern that the unyielding pressure may leave scars even within a profession where long hours and high stress come with the territory.
“It’s traumatic,” said Cindy Zolnierek, CEO of Texas Nurses Association. “It’s like whiteknuckle driving all the time.”
In the past three weeks, the Texas Department of State Health Services has made 750 contract nurses available to hospitals in the region to help fill staffing gaps, said Darrell Pile, CEO of the Southeast Texas Regional Advisory Council, which coordinates the region’s emergency medical responses, including during Hurricane Harvey. “I’ve never known of a situation where that volume of nurses has been needed,” he said.
The U.S. Army also recently sent a specialty medical unit of about 85 doctors, nurses and other health care workers to Houston to set up in an empty wing of United Memorial to help take transfers from other hospitals in the city. The Army has provided few other details about its Houston relief operation.
Dr. Joseph Varon, chief medical officer at United Memorial, said that while he welcomes the reinforcements, he worries it still might not be enough.
As of Saturday, Varon had worked 135 days straight.
“I’m living on adrenaline,” he said, “and running on fumes.”
In recent days, Houston medical officials have reported glimmers of stabilization as the number of new cases statewide has showed a marked decrease. So, too, have reported hospitalizations. The word “plateau” has entered the conversation, just as it did in April.
But health officials warn that even a flattened mountaintop is still high.
“This virus is still fiercely among us and remains at onceunthinkable levels,” said Pile, cautioning against any overly optimistic assessment that some corner has been turned.
He worries that if people let their guard down, even a little, the worst could come roaring back.
“Everyone remains a potential COVID victim,” he said.
For instance, internal SETRAC counts, shared with the Chronicle, show that as of July 29, even as the number of hospitalizations was starting to go down, there were still 144 patients in the region waiting for a hospital bed, including 28 who needed intensive care. Those patients presumably were stuck in hospital emergency rooms, in hallways or in special isolated areas, waiting for specialized care, Pile said. It is unknown how many were infected with the virus.
Since the start of the summer surge in Texas, there has been growing concern among frontline medical workers and public health officials that the number of publicly reported “available” beds sounds reassuring but is potentially misleading.
On Saturday, the Texas Department of State Health Services listed on its website 11,674 available beds statewide. Similarly, Texas Medical Center data, compiled from area hospitals with headquarters in the city’s medical complex, showed that as of Saturday there were just under 2,900 “available (unused) beds.”
“But just because you have a bed does not mean you have the staff, or the right staffing, for it,” said Dr. Esmaeil Porsa, CEO of Harris Health System, which includes Ben Taub Hospital and Lyndon B. Johnson Hospital. “All beds are not created equal.”
An ICU patient requires more medical technology and specially trained staff. Generally, the standard is a 1-to-1 or 1-to-2 nurseto-patient ratio. In other COVID-19 acute care units, 1 nurse now cares for up to 6 patients, depending on the seriousness of the case.
Lately, though, as ICUs have reached or even topped their capacity to take COVID patients, some who might otherwise be admitted to intensive care are instead placed in other units.
“These ‘non-ICU’ beds are equipped with monitors, supplies and other resources needed; however, they aren’t designed for the level of monitoring required by the sickest patients,” said Zolnierek of the Texas Nurses Association. “It is a less-than-ideal environment, but nurses are making it work — they have to.”
Zolnierek called it “meaningless” to count how many beds potentially can be pressed into service without also addressing staffing.
One Houston nurse put it this way in a now-deleted social media post: “We only have the nurses we have,” she wrote. “It’s like opening up 3 extra lanes at the grocery store but with no cashiers.”
Chris Van Deusen, director of media relations for DSHS, said last month his agency had no plans to change the way available beds are reported to the public.
Reji Cherian, a respiratory therapist at United Memorial, and his 17-year-old son have been living on separate floors in the same house since March out of fear the infection will follow him home. Sleep remains elusive, maybe four to five hours at best, he said. He has noticed a short temper that was not there before, and even when he is home he can’t seem to turn off what is happening at the hospital.
The hardest part: There is no end in sight.
In the beginning of the pandemic, the tributes to health care workers were effusive, from the nightly applause in New York City to the flood of television commercials honoring warriors doing battle. Now, nearly five months in, that adoration seems to have waned.
“During the initial surge, everybody loved health care workers,” said Schwartz at Houston Methodist. “That was the sprint, but that doesn’t last for the marathon.”
Zolnierek said the trees in her Austin neighborhood were once covered in white ribbons. Those are now gone.
Christina Mathers, a nurse at United Memorial, said she was recently photographed for NBC News during a 14-hour shift, crouched in front of a portable air conditioner, exhausted and drenched in sweat under layers of protective clothing. When the picture began circulating on the network’s Twitter account, some mocked the severity of the virus and accused her of staging the picture, one person even speculating she was merely tired from making TikTok dance videos.
On July 22, Mathers, who unknowingly had become infected, was admitted to her hospital’s COVID unit after nearly collapsing at the end of her shift.
Pace yourself. Get sleep. Eat well. Take vitamins. That is the advice Kelly Rodrigue now gives to the nurses in the huddles at the beginning and end of shifts. The clinical nurse and interim director of emergency services at Memorial Hermann The Woodlands Medical Center sees the toll on her staff — and herself.
“I tell them every day we will be dealing with this for a long time,” she said. “I tell them they are no good to our patients if they are not well themselves.”
What haunts them most are the deaths.
Unlike patients who were sick for a long time and death was probable, these deaths are often jarring, now striking young adults and the middle-aged who days or even hours before were walking and talking.
When a patient dies, Rodrigue said, everyone in the room stops and falls silent. They call it a sacred pause. But then they close the door and move on.
Other patients need them.
“It’s traumatic. It’s like white-knuckle driving all the time.” Cindy Zolnierek, CEO of Texas Nurses Association