‘We’re all they’ve got’
At Houston hospital, overworked staff provides critical care
Had the woman opened her eyes, she would have met her nurse’s gaze through a small gap in a protective body suit.
The coronavirus patient at the north Houston hospital would have seen the RN’s irises shift, flitting to the doctor who replaced an IV in her groin, now spotted with blood. She groaned. The nurse leaned in close.
“Hold my hand, you’re almost done,” Jerusha Harshman said, shushing her like a mother to a whimpering child. “I know.”
The staff barely spoke as they tended to the elderly AfricanAmerican patient, who contracted the virus while on dialysis and living in a nursing home. When they did talk, they raised their voices above the echoes of their masks, face shields and hoods.
It was Day 30 for the physicians and nurses in the COVID-19 unit at United Memorial Medical Center.
Their work makes up a small piece of Houston’s coronavirus response, but they have become recognized for their relentless efforts to help curb the pandemic here. The hospital was the first to offer a free drivethru testing site and set up free testing elsewhere with the help of U.S. Rep. Sheila Jackson Lee. They’ve received donations from Beyoncé.
After leaving the senior woman’s bedside, the team hit every room in the wing for their rounds, usually making sure patients were stable and sometimes performing ultrasounds on their lungs. When they finished the small leg of their marathon, they walked through a plastic partition at the end of the hallway and resealed it behind them, emerging from a different world.
Only then did they remove their sweaty head gear, loosen the suits that zipped up their necks and breathe deeply.
“It’s hard,” said Tanna Ingraham, a nurse. “It’s physically hard. It’s mentally hard. It’s exhausting.”
She couldn’t trade it if she
wanted to.
“We’re all they’ve got,” she said. “From the moment they step in, it’s only us.”
Removed from the bustle of the Texas Medical Center, the for-profit private hospital sits in Acres Homes, one of Houston’s most diverse and historically low-income neighborhoods. Its patients reflect the surrounding community — though not all come from the immediate area — in a ZIP code with some of the highest numbers of coronavirus cases in the region.
Making up the COVID-19 intensive care wing one day in late April: six black patients and three who are Hispanic or Latino. They are day laborers, nursing home residents, health care professionals.
Another seven people in the COVID-19 nonintensive care wing were also all people of color.
Chief of staff Dr. Joseph Varon recalled that the unit has admitted just three white patients since it opened — a reflection of the fact that the deadly virus is hitting minorities the hardest. Ages vary widely, and roughly 70 percent of the people they see don’t have underlying conditions, infectious diseases specialist Dr. Joseph Gathe estimates.
Varon particularly worries about the health of the young black men who come through the hospital. He has seen reports of the population being released after treatment or turned away from care, only to die upon returning home.
“Young African-American men are dropping dead,” he said. “I don’t know why.”
Varon wants answers, although he doesn’t have much time for guessing. He’s in the businesses of saving lives — and as of May 2, he says not one person has died at his hospital.
The pulmonologist treats his patients with a cocktail of steroids, blood thinners and vitamin C, and they’re all on hydroxychloroquine, the controversial anti-malaria drug touted by President Donald Trump and rejected by many in the medical field for its lack of research. He said it’s working “like a charm.”
Some physicians in the medical community have questioned Varon’s treatments, however, adding that they should be considered experimental and unproven. Hydroxychloroquine has been known to carry cardiac risks, and vitamin C treatments have never been shown in controlled studies to benefit patients, said Dr. Robert Atmar, a professor of medicine in infectious diseases at Baylor College of Medicine.
Steroids have also been associated with causing more harm than good, Atmar said, and it’s unclear whether blood thinners are needed for all COVID-19 patients.
Varon countered the criticism. For the patients in United Memorial, he said, the treatments have worked. A few of them have been on ventilators and survived, and even more have experienced clotting in the lungs, he said. Close to 50 people have been treated in the unit.
“Regardless of what everyone says, if the outcomes are 100% survival, I will continue to use them,” he said in an email. “More importantly, our protocols are based on science and not politics.”
Varon is conducting research on the vitamin C treatments in particular, and he and his staff believe that’s what is keeping so many of their patients off respiratory machines.
“We literally throw the kitchen sink to them,” he said. “Look at their survival rates.”
Gathe points to a 90year-old former patient as an example. Sitting with Varon in the waiting area of the hospital, he held up a photo of the woman who had metastatic colon cancer but beat the coronavirus. Wearing a face mask, she sat in a wheelchair and held up a sign that read “Nice try COVID … I survived!”
“She rolled out the front door,” Gathe said.
More than two dozen people have been released from the hospital after successful battles with the disease. But right in Houston’s peak of the virus, the facility admitted people at a steady pace.
The hospital has a capacity of 20 in the COVID ICU and 26 to 38 patients in the nonintensive COVID unit, both of which are separated from the rest of the facility. Across the two wings, 16 people took up beds that day in April, Varon said.
United Memorial isn’t like the stories out of New York City — this hospital has plenty of personal protective equipment and still hadn’t filled up entirely — but for a unit short-staffed with only two nurses and a handful of doctors, any influx of patients can make for a long shift. Varon and his colleagues took in four new patients the evening before.
“Last night was a night from hell,” Varon said during his rounds.
Jermon Robertson was one of those patients, and like everyone else in his hallway, he had pneumonia. Physicians told the 27-year-old that the disease caused clots to form around his heart, but he seemed to be faring better than some of his neighbors, who couldn’t even speak. Robertson was able to walk freely in his room, and he could sit up when doctors checked on him.
Still, COVID-19 was a much different outcome than he expected after coming to the hospital for an apparent spider bite.
Robertson, who is black, hadn’t suspected the disease. He wasn’t necessarily surprised when his test returned positive, either, as he had been taking three buses a day out of necessity.
“It was a big possibility,” he said. “You never know who you’re walking in to.”
Across the hall, 43-yearold Juan Carlos Peña slumped in his bed, covered in blankets. He had barely touched the soup, apple juice and Cheerios on his side table.
He had spent a week at home with a fever and body ache before being admitted. He coughed as he spoke but said he already felt some improvement after less than a day in the hospital.
Peña was relieved to be in good care, he said, but he felt alone. He didn’t have a phone, and knew only that his wife had been calling the hospital for updates.
“It feels really bad to not be able to see your family,” Peña said. “You start to think you might not see them again.”
Nothing in the room could really remind him of his spouse and two daughters, ages 2 and 5. He had one plastic bag of his clothes and belongings, tied at the top and resting on a high shelf.
To make the rooms a little more friendly, the nurses taped paintings of flowers and hearts on the wall across from Peña’s bed.
In the handwriting of nurse Ingraham’s daughter, one read, “Get well soon.”
Others in the unit marked longer stays, and like Peña, they knew all about the lonely fight.
Thomas Rubio has no family to check on him and no phone. When the doctors walked in his room, he sat up, his curly hair sticking out under the straps of his face mask and his eyes crinkled at the corners in a smile.
Rubio, 54, has never seen the faces of the people tending to him, but he knows what they look like from the printed photos they tape to their chests.
He has trouble recounting some of the specifics that led him to the hospital. He remembers a burning sensation in his neck — “It’s like somebody threw acid in my face” — and driving to the ER. Rubio left without being seen, only to wake up in jail on a charge of driving while intoxicated. He was released on bond and took a bus home, he said.
He held up a sign to a neighbor displaying his ex-partner’s contact number, and they brought him to the hospital. After a few days there, Rubio had sores all over his neck and legs but was finally starting to feel better.
“They saved me,” Rubio said.
After reviewing each patient’s case with Varon — the last part of their rounds — the staff members relaxed. Ingraham placed her arm over Harshman’s head, and the other wrapped her arm around Ingraham’s waist, forming a knot.
Harshman laughed with Varon one minute and pleaded with him to find more nurses the next. She and Ingraham are the only two nurses in the unit, and they’re not technically employed at United Memorial Medical Center — they’re Varon’s friends, whom he called in after most of his nurses took paid time off.
They said they wouldn’t be there if they didn’t believe in everything the hospital is doing. The two have been working 14- to 16-hour shifts with rare days off, and Varon is working 20-hour days.
That could be an issue for them if there is a second peak and a bigger wave of cases in the fall.
“We’re going to need nurses,” Gathe said. “It’s going to be a manpower issue.”
The most the nurses could do was try to get sleep when they could. As her coworkers ate lunch in the breakroom, Harshman stopped by to say she would be taking a nap. But as the minutes passed, she dashed up and down the hallway, adhering to tasks that would keep her from rest.
They were expecting five more patients.
“Even though we’re tired, we’re loyal,” Harshman said. “It’s history-making.”