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SAN JOSE — The emergency department staff at Regional Medical Center had been through this drill 1,464 times before.
“PUI coming in,” ER manager Diana Argentino said one morning late last week.
Nurses and doctors donned N95 face masks, goggles, gowns and gloves just before emergency crews wheeled an elderly “patient under investigation” through the double glass doors.
“Are they going to be intubated?” Argentino asks.
“It looks like it,” another nurse responded.
No hospital in the Bay Area was hit harder by the coronavirus crisis than Regional Medical Center in the heart of East San Jose. It was so overwhelmed with COVID-19 patients that a refrigerated truck was parked outside ready to serve as a makeshift morgue. But late last week, this new patient with the 105 temperature was a pandemic straggler, one of just nine coronavirus patients left at the hospital that cared for 67 a day at its peak in early April.
If anyone witnessed the trauma of the virus, it was the frontline workers at Regional, where nearly one-third of Santa Clara County’s coronavirus fatalities occurred. Several of their colleagues fell ill. Yet, in many ways, they are just as torn and uncertain as the rest of the country over whether it’s safe to reopen again, whether a feared second wave is coming, whether we’re moving too fast or too slow.
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Protests in downtown San Jose, Oakland and other Bay Area cities, where police are shoulder to shoulder and demonstrators are often without masks — and wiping away pepper spray tears from their faces — only add to the angst.
“I would love for the worst of this to be behind us, but I fear that’s not the case,” said Dr. Jafar Tay, the former chief of staff and director of wound care who had just finished rounds on the ICU. “The question is, what do we do? People can’t stay holed up in their houses for a year.”
The debate over reopening has deepened political divisions — and even put like-minded leaders in conflict. Last week, as California surged past 100,000 coronavirus cases, Gov. Gavin Newsom relaxed more rules on everything from hair salons to church gatherings. But Santa Clara Public Health Officer Dr. Sara Cody — who has taken a much more cautious approach to loosening the Bay Area’s first-in-the-nation shelter-in-place order — shot back that the state was moving too fast. Early this week, however, with pressure from county officials and lower infection rates holding steady, Cody announced new rules to more closely match the state’s. Although the virus is still circulating in the Bay Area, in all but a few counties including Alameda, the key indicators are improving, from new cases to deaths to hospitalizations.
At Regional, the number of COVID-19 patients is down to the single digits. And before 10 a.m. Thursday morning, even the emergency crew that guided patient number 1,465 through the glass doors to the gowned-up team in the ER were divided over whether it’s time to move on.
EMT Dan Garcia from the San Jose Fire Department, who’s been wearing a mask on every single call since March, says he’s ready for a new reality.
“All I know is San Diego bars are open now,” said Garcia, pumping his fist.
“There has to be a point of living our lives.”
But his fellow EMT, who’s been in the business for 20 years and works for AMR ambulance company, was less enthusiastic.
“I prefer things to be more conservative,” said Paul Shikowitz, 50, as he returned to his rig. “If people could see what we see from start to finish, it would change their minds.”
Regional Medical Center, a private hospital owned by health care conglomerate HCA that also owns Good Samaritan in Los Gatos, is a sprawling campus on the corner of McKee Road and Jackson Avenue. It welcomes San Jose’s most vulnerable patients, the poor, the immigrants, the essential workers without insurance, the folks who can’t afford medical care so their diabetes and other ailments go untreated. When they started pouring into the emergency department with COVID-19 symptoms in March, 75 percent were Latino or Asian, and many deteriorated quickly.
Back then, the ICU was spilling into the hallways.
The pharmacy scrambled to keep up with ever-changing drug recommendations, and when the key medications of fentanyl for pain and propofol for sedation ran low, pharmacists scrambled for alternatives.
“We used morphine and other oral medication and crushed them to provide pain management,” said Camille Camargo Kamboj, Regional’s director of pharmacy.
In the midst of the crisis, Floor 2E was turned into a COVID recovery ward, where 45 patients holed up behind closed doors plastered with warning signs. Nurses set up baby monitors inside rooms to see and hear their patients from the hallways.
The normally noisy floor, bustling with visiting family members and nurses easily moving in and out of open rooms, became deathly quiet.
“It was so eerie,” said registered nurse Liz Thurstone. “The solemness settled in. It became a spooky tomb for the living.”
Except, that is, when patients crashed. One morning in late March, she responded to three Code Blues — cardiac arrests — before her morning coffee break. They were made all the more traumatic because the nurses had to suit up in protective gear before they could rush in to perform CPR.
“It was like a tidal wave coming at us and we couldn’t get out of the way,” Thurstone said.”You had to kind of stand your ground, and you couldn’t get washed away.”
Some tried to inject levity onto the floors. If staff members transferring coronavirus patients through the hallways encountered colleagues along the way, they would raise an outstretched hand and break into song: “Stop, in the name of love, before you break my heart.”
Last week, as quarantine rooms continued to empty out and the number of COVID patients dropped from 15 over Memorial Day weekend to 9 last Thursday and 6 on Tuesday, signs of normalcy throughout the hospital were beginning to return.
Stacked boxes of gloves and gowns and other protective equipment that had been kept under lock and key to stem shortages were being shipped to sister hospitals in Los Angeles — a sign of the virus’s undulating geographical shifts.
On Floor 2E last Thursday, the COVID cases had dwindled from 45 to five and finally, Thurstone said, “the good ol’ pneumonia, chest pain and COPD are trickling back.”
They are reassuring signs for Thurstone, who like many health care workers struggled with her own feelings of isolation and helplessness when layers of gloves and masks inhibited the often intimate bond between nurse and patient.
When she heard about pool parties in the Ozarks and packed beaches over Memorial Day weekend when people were flouting social distancing rules, “my first instinct was to cringe.”
There’s a palpable wariness among the staff who have seen the world through protective face shields for three months and worn tight-fitting N95 masks that chap and blister the skin.
No one wants a second wave.
“It’s the day-to-day slow anticipation that makes you anxious, just waiting,” said nurse leader Lee Thorpe. “We are all traumatized by this as health care providers. It’s the anticipation of the fatigue and resilience you need if it comes again.”
She worked so long and so hard, especially in the early weeks, that while those hunkered down at home worried about gaining the “quarantine 15,” Thorpe lost 15 pounds.
The purpose of the shelter-in-place orders, which are now lifting across the country, was not only to protect people from infection, but also to “flatten the curve” and not overwhelm local hospitals’ ability to care for the sick. Regional was pushed to extremes — but not New York extremes. The hospital still had plans in place and floors to open that would have allowed additional patients. And the refrigerated rig in the parking lot never became a morgue.
Dr. Sang Lee, a cardiothoracic surgeon who treated the sickest of the sick with an ECMO machine that rested the traumatized lungs, said he is certain the virus will come back, but perhaps “in a different color.”
When it does, it’s critical that hospitals are stocked with enough supplies, so health care providers like him won’t have to deal with “the frustration and the fear that we all had: What happens if we run out?”
At the same time, however, he believes that fear of the virus has had dangerous consequences.
“Now I have lung cancer patients who don’t want to come see me and get treated because they’re concerned they’ll get COVID,” Lee said. “I think the irrational fear has taken over and is troubling to me. You have to find a balance.”
Thurstone, the veteran nurse, is finding her own personal balance. She takes three-mile walks through her Sunnyvale neighborhood after she gets off her shift every afternoon and focuses on the birds chirping and the smell of fresh-cut grass.
The disease killed 42 people at Regional. So it helps when she reflects on her patients who survived. She journaled about one in particular, a husband and father of five who was deteriorating rapidly.
“I hovered over him like a hawk or mother hen,” Thurstone, 56, wrote. As he was taken to the ICU, she choked up. “I almost felt guilty knowing his fate before he did.” The patient reached out his hand and thanked her.
A week later, she was astonished to find his name back on her roster. “It was almost as if his very soul had emerged from the dark abyss,” she wrote.
When he awoke, he didn’t remember her. But when his wife sent up his clothes for discharge, she included a red rose for his nurse. And like they do every time a COVID patient is released, hospital staff lined the hallways as he wheeled by and the loudspeaker played The Beatles’ “Here Comes the Sun.”
That helps, too.
So when you ask whether the worst of coronavirus is behind her, Thurstone really can’t say.
But she knows this: “We can’t live in a bubble.” If the virus returns, she and her colleagues will be better prepared this time.
“Half the battle is the fear of the unknown,” she said, “and this is not unknown to us anymore.”
