All through the night in the COVID19 fight

Salinas hospital’s team battles for patients on edge of life, death

SALINAS — In a glassenclosed room at Salinas Valley Memorial Hospital, a man in a green gown lies on his left side, a tube delivering oxygen into his nose from a machine doing the work his body can’t as COVID19 invades his system.

The man has short, saltandpepper hair. It is mid-January during the worst coronavirus surge since the pandemic began nearly a year ago. Hundreds are dying of the disease each day across California, and the raging virus has put 21,000 people into hospitals and intensive care units like this one, even as the rate has begun to slow.

In Monterey County, the man is one of 207 patients hospitalized with COVID19. He is breathing with help from a BiPAP (bilevel positive airway pressure) machine, the next oxygen level down from a ventilator. He is sedated

and groggy as a nurse tends to him, wearing her own breathing apparatus and spacesuitlike protective gear.

As she finishes clearing tubes and checking vital signs, nurse Liezl Duesdieker snaps off the light, removes her blue hospital gown and drops it into a receptacle before leaving the room. She peels off her gloves, sanitizes her hands, and pulls on a fresh pair. Only then does Duesdieker remove and clean the batterypowered respirator she puts on and takes off dozens of times in each 12hour shift. It’s 7:08 p.m.

Less than 90 minutes later, another nurse checking on the man will notice his vital signs ebbing and summon the hospital’s Rapid Response Team to the fifth floor.

The alert goes out just before 8:30 p.m. Someone yells: Room “5 — is currently coding!”

It means that without help right now, the man could die.

***

Salinas Valley Memorial Hospital sits in farm country, 8 miles from the ocean and about 20 miles northeast of the Monterey Bay Aquarium. Author John Steinbeck grew up on Central Avenue in Salinas, in a Queen Anne Victorian that before the pandemic hosted busloads of tourists for lunch and tours.

The rural city of 156,000 people serves as the county seat and produces lettuce, broccoli and other vegetables eaten around the world. To make that happen, some 50,000 migrant farm workers travel to Salinas each summer to pick produce.

“Early in the pandemic, we had predominantly seasonal agricultural workers who were generally younger and tolerated the disease better,” said Dr. Allen

Radner, an infectious disease expert who is chief medical officer and chief executive at Salinas Valley Memorial. The hospital typically had 10 to 15 COVID patients at any one time. By fall, those migrant workers had gone to fields in Arizona.

“Now, it’s roughly 70 to 80 inpatients in the last three or four weeks,” Radner said. People who live in the area. Patients needing ventilators — and ICU care — are also up to 10 to 20 a day, “a lot more than we’ve historically seen.”

Those dramatic increases mirror what the state saw after the holidays when people defied public health admonitions not to gather with family.

Sometimes the ICU is full. Sometimes there are beds, as patients come and go. The hospital works with other local hospitals, helping each other as needed.

The hospital operates its COVID ward on the third floor, and its COVID ICU two floors up. The Chronicle spent an evening here at a time when ICUs across the Bay Area and the state were nearly filled with coronavirus patients. Such efforts to save lives happen each day at hospitals around California, but are seldom seen by the public.

Medical workers are stretched beyond reasonable limits, but they’re not giving up as patients and families confront unimaginable horrors with fortitude and hope.

Monterey County, and the Salinas Valley in particular, are windows into the ethnic and income disparities among COVID19 patients seen across the country. Lowincome Latinos and other people of color often hold essential jobs in fields, factories and plants that prevent them from sheltering at home.

In Monterey County, 60% of residents are

Latino. Yet that group carries 80% of the county’s 35,000 coronavirus infections, according to state data. They are also 73% of the people hospitalized with COVID19, county records show.

***

In bed on the thirdfloor COVID unit, Francisco Hernández, 48, picks up the ringing phone. It’s his doctor, Jaime Gonzalez, calling from less than 5 feet away.

Gonzalez could have spoken with his patient directly, but that would have required the doctor to put on a suit of protective gear, strapping a hefty powered airpurifying respirator around his waist and covering his head with the canary yellow hood and face shield into which the PAPR’s hose pumps oxygen. He would have had to sanitize his hands, pull on gloves and tie on a fullbody plastic apron.

Gonzalez asks whether Hernández would care to speak with a reporter spending the evening among COVID patients this Jan. 14. He would.

Hernández’s voice sounds raspy, and his words halting as he pauses for frequent breaths.

“I’d like ... people to ... realize ... they need ... to ... wear a mask,” he says in Spanish.

Hernández lies on his back, his bed angled at about 45 degrees so he can watch TV or view the busy nurses just outside the glass. A highflow oxygen hose lays like a mustache beneath his nose, attached to a tank to the right of his bed.

A divorced father of two, Hernández works in Salinas and lives alone in Moss Landing, a coastal town about 20 minutes to the northwest. His son is 18, and his daughter is 22. Hernández believes he caught the virus on Jan. 4 at his job in a vegetable processing plant. A week later, a raging headache hit, and his body burned with fever.

It all changed the next day. “I felt freezing,” he says. “I took some steps, and I couldn’t breathe. So I knew.”

***

Down the hall, Carmelita Martinez is puzzled. She says her doctors told her she’d be good to go home the next day, a message she can’t quite believe. Martinez, 75, was admitted to the COVID unit the day before with a deep cough, which she still has.

“I don’t feel like going,” Martinez tells a reporter by phone from her glassenclosed bed. But she shrugs and says her husband will set up the spare room for her so she can isolate. “The doctor said if I continue coughing, I can come back.”

Salinas Valley Memorial has an outpatient clinic specifically for

COVID patients who need treatment, but not hospitalization.

“In the COVID era, we continue to assess people, and ask: Are we doing anything that can’t be done at home?” Radner, the chief medical officer, said later, noting that some people may even be safer at home. “You can pick things up at a hospital.”

A retired school cafeteria worker, Martinez appears relaxed as she chats on the phone, smiling and resting her head of shortcropped brown hair against a pile of pillows. A thin, nasal cannula tube lays against her nostrils, blowing in extra oxygen.

She says she is in no pain. She is pleased that her son in Arizona has called her in the hospital each day, and jokes that he is “a little spoiled” to call so much. Her daughter in Fresno wants to visit, but that isn’t allowed. Besides, Martinez says, “I don’t

want her to get COVID.”

Martinez says she isn’t sure how she caught the coronavirus.

She’d gone to her sister’s house in San Jose for Thanksgiving. But even though everyone removed their masks for dinner, the timing wouldn’t be right. COVID symptoms show up within 14 days, and Martinez didn’t feel ill until early January. She assumed she had the flu. “I didn’t think anything of it until the 9th or 10th,” she says. “Then I started to feel real bad.” By the 13th, her granddaughter insisted they go to the hospital.

“My husband is also coughing. He’s getting checked tomorrow,” she says. His brother has a bad cough, too, but won’t get checked. “He’s scared.”

For anyone reading about her, Martinez says, she has an important message: “People! Please, please, wear a mask at all times. Wash your hands the minute you drop your groceries at the table. Stay out of the public, and take care of yourselves. Go to the doctor if you feel sick.”

“People! Please, please, wear a mask at all times. Wash your hands the minute you drop your groceries at the table. Stay out of the public, and take care of yourselves.”

***

A stack of colorful cards sits at the nurses’ station in the center of the fifth floor COVID ICU. Decorated with red hearts and stethoscopes, they say “thank you!” to nurses and doctors. Some envelopes are still sealed, addressed to “Hospital Patient” or “Covid Patient.”

The patients on this floor aren’t up to opening letters. Most are sedated to tolerate the ventilator tube that stretches down their throat and breathes for them. They are isolated from one another, but linked by the disease that brought them here.

Bluegowned nurses study computer screens outside patients’ glasswalled rooms scribbled with messages from one nurse to the other. Bright yellow PAPRs — the spacesuitlike protective gear — hang on poles, each belonging to just one nurse. Some rooms on one side of the ICU are reserved for patients who need slightly less attention than those in intensive care.

Shortly before 7 p.m. the shift changes. As the next crew arrives, the nurses share details about patient medications, urine flow, the family dog.

In a corner, two burly men in khaki uniforms with holstered guns stand by a patient’s room. They are from the California Department of Corrections.

The guards smile but decline to speak. The patient they are guarding no doubt comes from one of two nearby state prisons, where cases have soared in January, state data shows.

More than half of the 4,800 inmates at the Correctional Training Facility at Soledad have been infected with the coronavirus since the pandemic began, and 16 have died. At Salinas Valley State Prison, 19% of the 2,877 prisoners have tested positive. Three have died.

***

“What has it been like working in the COVID ICU? It is a mix of everything. Noisy. The noise of the air swishing back and forth forcefully into the face mask as you struggle to hear the patient’s voice. Like the voice of a patient stating, ‘tell them I love them very much’ when asked (before intubation) what message should be relayed to family.”

The words are part of an essay ICU nurse Sandra Martinez, 52, wrote for a newspaper in Soledad, where she lives about half an hour south of Salinas. In it, she detailed the exhaustion of nurses working 16hour shifts, and their despair at seeing people ignore precautions that would keep them out of the COVID ward.

She wrote about the “wideeye panic look” of patients hungry for air, and the joy of seeing patients discharged. She described the pain of watching a parent say goodbye to a child as a “heart in your throat moment,” whether the child “is a minor or 70.” She signed her essay: “A Tired ICU Registered Nurse.”

Taking a moment at the hospital to talk, Martinez muses about the fatigue, emotional and physical, she has felt throughout the pandemic.

“I ask myself, why is this affecting me so much? I’ve seen hundreds of deaths in 27 years. I think because there is no break, no end in sight. And these patients who passed away: Was it preventable? Other diseases are not. But here ...” Her voice trails off.

Martinez has been vaccinated, and knows the vaccine will reach everyone — eventually. She knows hospitalizations are slowing. And yet, each day, COVID still sends patients to her ICU. Each day, she is witness to farewells.

Early on, Martinez had nightmares about being intubated herself, and being unable to say goodbye to her children. So she and her husband, a respiratory therapist, wrote them letters saying goodbye.

“I don’t feel silly for doing it,” she says. “But I never did give it. How do you say goodbye?”

***

It’s 8:30 p.m. in the fifth floor COVID ICU. Doctors and nurses are racing to the room of the man on the BiPAP oxygen machine.

He is conscious, but he’s coding. Doctors in full protective gear enter the room, in the part of the ICU set aside for people whose needs fall short of intensive care. Outside, half a dozen people stand by.

To an onlooker, it’s not clear what all the doctors, nurses and technicians are doing. But to Jeanna Beckham, a nurse watching from across the room, the role of each person is essential in trying to save this patient’s life.

“That nurse did a really good job,” Beckham says. “She knew she needed assistance, so she quickly called Rapid Response. It’s part of our profession. You have to be able to act quickly. That’s the amazing thing about the nurses we work with. We don’t hesitate to ask for help. We’re a team.”

That night, the team worked on the patient for some time. He did not die. Three days later, doctors placed him on a ventilator.

Hernández, the patient who spoke to his doctor by phone, was discharged Thursday after eight days in the hospital.

Carmelita Martinez did not leave the hospital.

She was moved to Comfort Care, a form of hospice meant to help at the end of life.

Photos by Nic Coury / Special to The Chronicle Above: Nurse Jeanna Beckham tends to a COVID19 patient at Salinas Valley Memorial Hospital’s ICU. Top: Francisco Hernández, a 48yearold Monterey County resident, rests inside the hospital’s COVID unit.

Photos by Nic Coury / Special to The Chronicle ICU nurse Sandra Martinez wrote an essay about the exhaustion of nurses working 16hour shifts.

Left: Nurse Kristen Tritt shows the protective hood of her powered airpurifying respirator. Right: A stack of colorful thankyou cards sits at the nurses’ station in the fifthfloor COVID unit.

Nic Coury / Special to The Chronicle Nurse Cassie Barber checks the temperature of Carmelita Martinez, 75, of Salinas inside the COVID unit at Salinas Valley Memorial Hospital.