A group of nurses sits on a sidewalk in late April shortly before sunset. They are holding candles. When 136 people from around the world have joined the vigil by videoconference, they light their flames for Celia and touch them with a wick.
Two days earlier, Celia Yap-Banago died alone in her room weeks after treating a suspected-19-year-old patient at Research Medical Center in Kansas City, Mo. Celia was not only a registered nurse who allegedly celebrated its 40th anniversary the profession that month. At 69, she was the figure of the mother of 4 North, with a simple voice, slightly inappropriate and curious, the cardiac telemetry unit that had become an overflow service for patients with covid-19, the disease caused by the new coronavirus.
“I just wish …” said Jenn Caldwell, a nurse at Research who spent years working alongside Celia after the wake up. “I wish things had gone very differently. “
But instead, Celia left, one of hundreds of American health workers – not only nurses and doctors, but also EMTs, paramedics and medical technologists – who died fighting a virus against which humans have no known immunity. There is no official count of their deaths. More than 77,800 have tested positive for the coronavirus, and more than 400 have died, according to the Centers for Disease Control and Prevention, which recognizes that it is a significant undercoverage. The nation’s largest nursing union, National Nurses United, puts the total much higher: 939 deaths among health workers, according to chapter reports across the country, social media and obituaries. Nurses account for about 15% of these deaths, said the union.
And these are perhaps only the first victims, with new cases of coronavirus increasing in parts of the South and the Wild West and the possibility of a second wave of pandemic in the fall.
Colleagues of those who died were left not only to manage grief, but a mixture of anger, frustration and fear. After all, health care is as much a vocation as a job for many of them; during a pandemic, learning that a co-worker or relative is infected or worse means an almost daily calculation – not only with one’s own mortality, but also with a growing feeling of helplessness.
“It has been more important than anything I imagined,” said Lilian Abbo, an infectious disease specialist in Miami who, in January, began advising Jackson Health System on how to prepare for the virus. “We have worked so hard for so many months. But we are not gods. “
Just showing up for work can mean playing with your life and the odds increase when masks and other personal protective equipment become difficult to obtain. At the end of January, Nurses United sent a letter to hospitals asking it to increase stocks of PPE, such as N95 respirators and eye covers.
“We recommend that the hospital get ready now,” the union wrote Jan. 24 to HCA Midwest Health, a branch of the national conglomerate that runs the Research Medical Center.
Four months later, a nationwide shortage of PPE has become one of the most inflammatory side effects of the pandemic. Healthcare workers held protests to honor their missing colleagues and to demand that their employers – and President Trump – provide additional equipment. Some hospitals have disciplined workers who flout equipment conservation policies: a Chicago nurse with asthma said in a lawsuit that she was fired after warning her colleagues that she thought the masks provided by his hospital was not adequate; in California, 10 nurses were suspended after demanding protective gear (then reinstated after union intervention).
In Kansas City, some of Celia’s colleagues and family members believe her death could be attributed to Research’s decision to carefully control access to PPE, and some nurses say staff discourage asking for it. According to interviews with hospital staff, protective masks and other equipment were removed from nursing stations and stored in a conference room on the first floor.
HCA Midwest spokeswoman Christine Hamele said the system followed CDC directives to keep the equipment while facing an uncertain future.
“We knew that our need for PPE far exceeded the supply and we could not predict how long the pandemic would last or how long it would take to get supplies,” Hamele wrote in an email statement to Washington. Post. “A central location and the process for PPE is the best industry practice. “
The workers said that when they needed items, they had to provide their full name and ID number alongside the request. As the virus spread and workers’ schedules became chaotic, some did not worry.
“We get such a hindsight that sometimes you don’t feel like it’s worth saying anything, because no one is listening and no one cares,” said Charlene Carter, nurse overnight at Research. “You want to defend what you know is right, but you know you are going to be reprimanded in one way or another. “
On March 22, Carter’s patients included a woman whom she suspected of having covid-19. Before going home that morning, she told the nurse that she would be relieved to be careful and wear protective gear. A few days later, Carter and Celia would both be positive for the coronavirus. Carter, 36, has recovered. The patient and Celia did not.
Now Carter is with his colleagues on this dimly lit sidewalk, and soon this vigil begins to take on a feeling of protest. Caldwell looks into a camera and swears that Celia’s death will not be in vain. Carter challenges other nurses to fight for what they need.
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Another nurse, Leo Fuller, steps forward and solemnly reads a list of deceased health care workers from the United States: Jeff Baumbach, 57, from California; Aleyamma John, 65, from New York; Araceli Ilagan, 63, from Miami. No one can say how many of these people died as a result of insufficient PPE, inadequate testing or other problems. What is undeniable is that everyone puts their lives on the line to take care of others because that is what they do. Some also lived and worked in communities with widespread transmission. However, a series of “what ifs” haunts some of their friends, relatives and colleagues.
Fuller turns the page. She left Research last October, begging Celia to accompany her so they can travel the world. But Celia continued to work, not to be put off by age or even a deadly virus, and now she still had one thing in common with the names Fuller reads: Daisy Doronila, 60, of New Jersey; Kious Kelly, 48, from New York; Freda Ocran, 50, from the Bronx.
Fuller turns the page again and continues to read. With 54 names to announce, she returns it.
Before her death, Celia had plans, like so many healthcare workers whose lives ended because they had fought a deadly virus. In a year, she and her husband, Amado, will travel to their native Philippines to celebrate 35 years of marriage and renew their vows. Josh, their youngest son, would be Amado’s best man; Jhulan, their 28-year-old man, would accompany his mother down the aisle.
“We planned everything,” says Jhulan.
In South Florida, 67-year-old internist Alex Hsu was delighted to spend time with his grandchildren. In the Bronx, 59-year-old surgeon Ronald Verrier had thought of a family reunion in Atlanta, where his daughter had recently bought a house. In New Jersey, a 24-year-old paramedic, Kevin Leiva, and his wife dreamed big: get out of debt, buy a small farm in Maine, have two children.
In Detroit, Lisa Ewald, a 53-year-old nurse, was looking forward to tomorrow morning, because that’s when Roger Chow sent his daily texts.
“Hello Lisa,” he sent a day in March.
“Hello Roger! Lisa replied.
They called themselves friends, although people who knew them wondered if they were something more. They met in 2004 on a Star Trek cruise, went on vacation together, ended conversations with “love you” and heart emoji. She was planning a trip in April to Rockville, Md., Where Roger works in information technology, and for her birthday, Lisa wanted to see the cherry blossoms along the tidal pool. If one of them did not respond to a text, the other worried that something was wrong.
Roger had become increasingly concerned about the coronavirus, and he told Lisa that a colleague had tested positive. She told him when she cared for Covid-19 patients at the Henry Ford Health System, where she worked; she also told him of the death of one of these patients and the reuse of protective equipment. Lisa told friends that she was not provided with a mask even when she was assigned a suspected patient, and by the beginning of April more than 700 system workers had tested positive, said hospital officials in a statement.
“I’m sure I will get it,” Lisa wrote to Roger March 21, and the next day predicted that the epidemic in Michigan would be serious.
She was, in fact, right on both counts. In late March, state-confirmed cases doubled every three days, and Lisa told Roger on Tuesday that she had been exposed – but that the hospital would only test her if she had symptoms. They joked that you had to be a politician or a professional athlete to get tested.
“Hello Lisa,” replied Roger one morning.
“Hello … I really don’t feel well,” replied Lisa.
Hours passed and Lisa responded to a survey that advised her to contact employee health services at Henry Ford. Her calls went straight to voicemail and were not returned on departure. Lisa was discharged from the emergency room even though she had a fever of 103 degrees; a drive-through clinic to which the emergency department referred her was closed. Her skin became sensitive to touch, and chills and body aches prevented her from sleeping. She curled up with Max, her cat, and apologized to Roger for complaining about her symptoms and frustrations.
“You can say whatever you want with me,” he wrote, but he would wonder later if he should have said more to Lisa – including urging her to go back to the hospital.
Almost a week after her suspected exposure, Lisa sent Roger a photo of her positive coronavirus test. She was still waiting for an employee health doctor to call her, hoping that she would be prescribed medication. She said she felt lonely. A couple who lived next door left medicine and food on their doorstep, but knowing all too well how quickly the virus spread, Lisa refused to force the door until they were out of sight.
Health system spokeswoman Henry Ford said in a statement about privacy concerns by refusing to answer questions about why an employee was not immediately tested and later discharged from the hospital. The statement does not deal with Lisa’s access to PPE, but indicates that the system prioritizes employee testing and the provision of masks, gowns and other protective equipment. “Fresh supplies” were kept for the team members, said the spokeswoman.
Days passed, and if Lisa waited impatiently for the mornings, she now dreaded the evenings. It was then that the fever increased and her symptoms intensified. She tried to make herself comfortable, to have hope.
On the last Monday in March, a few hours after learning that she had contracted covid-19, Lisa sat on her sofa and watched television. At around 7:30 p.m., she told Roger that she was feeling bad.
Twelve hours later, he texted as usual.
“Hello Lisa,” he wrote.
She did not answer. The neighbors would later find her still standing on the couch, the TV still on. But that day, as the hours passed, Roger continued to hope. He called. No answer.
And in the afternoon, he texted again.
“Hey,” he wrote. ” Are you there … “
Throughout most of her career, Celia’s colleague in Kansas City, felt almost intoxicating joy when a patient’s condition improved. Someone had been assigned to him what could have been the worst day of their lives, and Carter could improve it.
“I made a difference,” she would say, and although the changes can be exhausting and the years can be blurred, the rewards of nursing make it more than a profession. “It’s big. I can’t think of too many things that are bigger. “
The changes flew not only because of a cascade of responsibilities, but also because his unit was filled with characters and gossip. Almost no one tampered with information like Celia. She interviewed her single co-workers they were dating, insisted on being a bridesmaid if a co-worker was planning a wedding, never had a problem telling a domineering nurse to push him.
It was Celia, but after four decades in hospitals, work was also a big part of who she was – an undoubtedly common feeling in this line of work. When Verrier, the Bronx surgeon, had a heart attack six years ago, all he talked about was apparently going back to work. Paul Novicki, 51, loved being a paramedic near Detroit so much that at the end of his shifts, he usually set fire to television programs about first responders; even when Novicki retired from his local fire department, he went to work for a private ambulance company. In Brooklyn, 61-year-old medical assistant Madhvi Aya had been a doctor in her native India, and even decades after losing her father to a heart attack, Aya thought she had the power to save money. other families have such pain.
In Kansas City, Celia entered nursing because her family had worked in health care in the Philippines. It stayed in the job because it offered an accomplishment, a goal, an excitement. Being at home was boring, she would tell her colleagues. Travel can be stressful. And if someone joked with Celia about her retirement, she always replied the same way: they will have to drag me.
In early March, Celia and her colleagues knew that the coronavirus was arriving while the hospitals were running to be ready. Research workers whispered in frustration when new policies were announced “every three to four hours,” says an emergency nurse. Disease experts have warned of a considerable need for additional personnel, additional ventilators, and increasingly scarce equipment, such as N95 masks, which can filter most airborne particles.
Caldwell, a longtime RN at Research and a hospital union representative, was temporarily transferred to 4 North in March when cases of covid-19 spilled over, spilling into other departments. The first day, said Caldwell, he was given a disposable robe but told to not throw it away; she had to wipe the robe, glasses and mask if she was treating a suspected patient of covid-19. If a patient’s status was not confirmed, nurses were encouraged to wear their mask in a paper bag so that particles that attached to the mask were contained between uses. The overshoes were not delivered, says Caldwell, and the equipment had to be returned to the conference room at the end of each shift so that it could be sterilized and reused.
“Like lambs at the slaughterhouse,” she said. “In the end, that’s how it feels. I am not a soldier, I am not a hero, I did not sign up to give my life. But if we still don’t have what we need, that’s basically what will end up happening. “
HCA Midwest spokesperson Hamele acknowledged that the items had been collected and stored at Research but flatly refused to allow the materials to be reused. In an interview organized by the hospital system, emergency nurse Andy McClure said that he had never felt unsafe at work due to insufficient PPE.
“I know our leaders are doing everything they can to protect us so that we can be the best nurse and be there for our patients,” said McClure, who, because he is in management, is not a member of a nurses union. “We are getting what we need in a way. I never had a refoulement or anything to ask for 10, 15, 20 more N95. I have never. “
Carter, however, said that she did not feel comfortable asking for certain equipment unless a patient was confirmed to have coveted-19 and felt intimidated to “do a huge deal” with her superiors. This Sunday in March, Carter said, she wore no mask while treating the patient tested for the virus. When her shift ended and Celia prepared to enter, Carter said she had warned her colleague that she could walk in.
A few weeks later, Carter would feel a bit guilty.
“I said something,” she will say. “But maybe I should have said something more. “
She pauses, pushing back her tears.
“Maybe I should never have entered this room,” she said. “Maybe I should have made such a big adjustment that they had to listen to me. “
Four months ago in Miami, Abbo, the infectious disease specialist, monitored the growing crisis in Asia as well as forecasts for the United States. She started working on a plan to respond to the pathogen. Jackson Health, one of the largest hospital systems in the country, would not only need to take on PPE, which a spokesperson for the system said it did by quadrupling N95 respirators between January and March and by doubling its inventory of overshoes and coveralls. Employees would need in-depth training not only on wearing unknown equipment, but also on how to treat the sick and comfort the dying.
“We don’t have to be like New York,” Abbo would recall, thinking that weeks went by, the virus was coming and spreading, and many hospitals were overwhelmed.
But as cases soared in the country’s largest city, health workers there regularly subverted instructions and followed their instincts. Often hospital staff in New York City have sinned on the side of compassion – even if it puts them at increased risk. A nurse explained how they were ordered not to perform certain procedures without full protective equipment due to the risk of aerosolization of the virus and infection of staff. But when she was confronted by a patient who spoke for a minute and then stopped breathing outside the doors of the emergency department, she said that she did not have time to put on additional equipment. So she broke the protocol and started chest compressions.
Paramedics, ordered not to enter homes without head-to-toe protective gear, found themselves rushed to wear partial gear because if a patient’s heart stopped, seconds could separate life from the death. A nurse reported how a patient’s ventilation tube from the Covid-19 detached and, without immediate action, the patient would die. With the nearest N95 masks in a hallway, the nurse held her breath, ran in and reconnected the tube. In the days leading up to the death of Kious Kelly, a registered nurse at Mount Sinai West Hospital in Manhattan, the nurses posted photos of themselves on social media, wrapped in garbage bags due to the lack of PPE. Mount Sinai challenged the shortage of supplies, saying the hospital system still provides “all of our staff with the critical PPE they need to do their jobs safely.”
Abbo hoped to avoid such a catastrophe. But at the end of March, his phone rang. Her great-uncle and great-aunt were sick, their conditions worsening, requiring intensive care. “A stab in the heart,” said Abbo, and she made the 21-km drive to the hospital in nine minutes before admitting the elderly couple two beds apart.
Besides being a parent, Isaac Abadi had been Abbo’s most demanding teacher when she attended medical school in their native Venezuela. Now 84, he still saw rheumatology patients there before a visit to Miami in early March. When Abbo reached his bedside, Abadi maintained a clinical fascination with the virus that is now killing him. He researched anti-inflammatory drugs and asked his niece to text her the results of her own x-rays and blood tests. Although it is not orthodox, Abbo forced it.
Days passed, and as Aunt Aviva showed improvement and would be released, Uncle Isaac kept getting worse. Among the protocols that Abbo had helped implement was a strict no-visit policy in the areas covered by the 19 hospitals. But it was her uncle, so she put on full protective gear and brought food to Abadi’s room. She fed him, talked to him, held his hand.
“I was ready to do things that nurses might not want to do,” says Abbo now.
She prayed with her uncle and allowed him to determine his treatment plan: no dialysis, no intubation, no resuscitation. She stopped several times a day to monitor him. Abbo was afraid that if she went home, her uncle would die alone, like so many others.
“My husband, my parents, my children ask:” Why are you going to expose yourself? ” “, She says. “I have to do what I have to do. “
When the end came for Abadi, he was indeed not alone. Abbo gave his aunt a mask and led her to a door to say goodbye. Then Aunt Aviva left, and Uncle Isaac’s niece held her hand as he took his last breath.
When it was over, Abbo went back to work. His mission remained, although it is now linked to a growing sense of futility.
“He is someone I loved very closely and very closely,” she said, “and not being able to save her life …”
She walks away.
“Everyone says, you’re Wonder Woman, and calls you a superhero,” she says. “And I say to myself:” No. I’m not.’ “
A little over a month ago, Charlene Carter was waiting in the parking lot of the Research Medical Center and could feel her heart racing. It was his first day back to work since the signing of covid-19.
What would happen if she went inside and started her shift? Could it be reinfected? Would she have access to masks and other equipment? Would she feel safe?
“Things are going to be better,” she remembered.
It was 11 days before Celia died of the same virus that Carter had somehow beaten, although her chest still hurts and she worried about permanent lung damage. Considering that she had always identified herself as a nurse, Carter now felt that her employer had not disappointed her. She felt betrayed. Some of his colleagues told him that they were still frustrated. Although research has added protective equipment, some have said that N95 masks and portable air purifiers are still rare. Since Carter went out sick, staff have now come in and out with a single set of automatic doors, the hospital has restricted visitors, and workers have taken workers’ temperatures before issuing a surgical mask.
After Celia’s death, RN Caldwell would say that a change now meant struggling with an impossible choice: stay at home and keep yourself safe, or continue the fight of a lifetime – even if it could kill her?
“It’s a little hard to come home every day,” she said.
In early May, Celia’s family organized a small funeral – 10 visitors entered while 10 others left – and the hospital celebrated its 40th anniversary by announcing a nurse’s scholarship on her behalf and presenting her family with her stethoscope. Her husband and sons continued to talk about her in the present, filling a plate for her at dinner, leaving her television on the Hallmark channel every night because that’s how she liked to fall asleep.
Then, a few weeks later, they filed a workers’ compensation claim against the hospital, alleging that Celia requested PPE but was refused. (In a statement, HCA Midwest Health credited Celia’s impact as a nurse and mentor, and said that officials hoped for a “speedy resolution” to court proceedings.) Sometimes her son Jhulan wonders if, then as the virus got closer, he should have insisted his mother retire or simply take time off. But Celia was Celia, and he knows what her answer would have been.
“It was his calling,” he says. “She knew the risks and always wanted to help. “
That evening in early April, Carter sat in his Dodge and tried to ward off a panic attack. She thought of her 11-year-old daughter and briefly considered restarting the car and going home. Mais elle ne l’a pas fait, car une autre pensée lui est venue à l’esprit.
« C’est ce que vous faites », se souvient Carter en se disant, et elle ouvrit sa porte et traversa le garage.
Son cœur battant toujours, son esprit errant toujours, elle imagina à quoi ressembleraient les heures et les jours suivants. Elle se demandait ce que ressentirait 4 North maintenant; si cette expérience l’avait changée. Mais elle s’est avancée, les portes automatiques se sont ouvertes et Carter a pris une grande inspiration et est entrée.