The night before Dr. Lilia Cervantes started work in the COVID-19 ward at Denver Health, she went online to make a will.
It was hard to sleep, her mind stuck on what would happen to her two young daughters and her husband, who has asthma, if she were to become infected with the new coronavirus and expose them.
Cervantes, an internal medicine hospitalist at Denver Health, was scared. She got through her first week of service in the ward by isolating herself from her family in the master bedroom and following a careful regimen that included touching the doorknobs in her house only when she was holding a disinfecting wipe. She also bawled her eyes out in her car as she drove home each night.
“It scares me that at the end of all this we all might know two or three people that died from this. That makes me really sad,” said Cervantes, who is 41, a long-distance runner and a researcher who has specialized in kidney disease. She spoke to The Colorado Sun after her first week in the ward. “It scares me that I could leave my children. I want to be here. I don’t want to be gone.
“My biggest fear is getting my husband infected. I need to protect my husband because if something happens to me, he needs to be around for my children.”
Denver Health repurposed a general hospital ward into a COVID-19 ward, reengineering patient rooms with lower air pressure than the rest of the hospital so air would not flow out. The ward opened two weeks ago. That first week, the physician and practitioner working in the ward saw only PUIs — “patients under investigation” for COVID-19, the disease caused by the new coronavirus.
But last week, when Cervantes began her first rotation in the ward, things got real.
Denver Health got its first positive test results of COVID-19, and by Thursday and Friday, some of those patients were extremely sick and needed ventilators to breathe. The hospital got the capability to run its own tests for the disease on Thursday and is now getting results within eight to 12 hours. It confirmed a handful of patients with COVID-19 by Saturday, though the hospital would not release exact numbers.
“Last week it was like, ‘Oh my God, it’s opening,’” Cervantes said Friday. “This is the first week that we have PUIs that are positive, and we are also getting some that are really, really sick.
“I can’t imagine how this is going to be if this is just the tip. It was starting to feel really tight. We are going to run out of room really quickly.”
Each patient is in a private room. No visitors are allowed. The only people who enter their rooms are in head-to-toe PPE — personal protective equipment. They are scared, and when their doctor comes in, they ask whether they are going to die.
“They feel alone,” Cervantes said. “Suddenly they have this disease that everyone is talking about all over the country.”
Cervantes checks their breathing, asks about their muscle aches, and whether their cough is better or worse. Each visit is emotionally draining because she is trying to ease their anxiety. It’s that intense human connection — and everything else — that makes her cry in her car.
Before she entered a patient’s room, Cervantes put on a pair of gloves and a yellow gown over her scrubs. Then she put on a second pair of gloves, plus a surgical mask and a clear plastic shield to cover her eyes.
After seeing a patient, but before leaving their room, she rubbed sanitizer on the outer pair of gloves, peeled off the yellow gown, and tossed them both in the trash in the patient’s room. She sanitized her hands again while still wearing the first pair of gloves, opened the patient’s door and sanitized her hands again before tossing those gloves in another trash can. She used a wipe to clean her stethoscope for two minutes. She repeated the ritual with every room.
The gloves, masks and gowns are used just once, and hospital staff across Colorado have expressed fear they will run out. Cervantes has a stash of masks and gloves at home that were dropped off by friends and neighbors after she put out a plea on Facebook and her husband, a biology professor at the University of Colorado Denver, asked for help on Nextdoor.
To conserve protective equipment at the hospital, workers are trying to minimize their visits to patient rooms. A doctor or nurse might also bring in the patient’s cafeteria tray, for example. Or the nurse checking vitals might also deliver medications on the same trip.
“We’re not out. I know we are running low,” said Cervantes, who’s heard stories of Italian doctors working without proper protection. “It’s something that everyone is worried about. I don’t know when we will be fully out; that’s a big concern. What scares me the most is the possibility of all of us getting infected and getting to the point to where there are just a few of us on the front lines.”
Cervantes kept her cell phone in a sealed Ziploc bag, pulling the plastic tight so the phone would still recognize her face and unlock its screen. She used a second Ziploc — a new one each day — to protect her hospital badge and a credit card.
The vibe at the hospital is anxious, she said. Nurses, doctors and clerks have expressed concern about coming in for their shifts. People who are normally nice have lashed out at coworkers. Some who work in other areas of the hospital are standoffish and nervous around those who work in the COVID-19 ward, Cervantes said. She allows that she “might have” yelled at a couple medical fellows last week.
“It’s just like I can’t even explain how hard this has been,” she said.
But at the same time, Denver Health clinicians working on confirmed and suspected cases of COVID-19 are closer than ever, Cervantes said. She wrote a long email to her colleagues, offering advice to those who will rotate through the ward. Most hospitalists, whose job is to care for admitted patients, will take turns in the COVID-19 ward — unless they have health issues that put them at higher risk. Regardless of how much work there is, pick a time when you will meet for lunch, she told them. Cervantes and her team ate outside together on sunny days last week and, when it was snowing, gathered on an upper floor and looked out the windows.
She also offered more practical advice: Ask a colleague to observe as you “don and doff” personal protective equipment to make sure it’s done correctly. And write the room numbers of patients you need to see in person on your left forearm with a pen, which will save time spent pulling out paperwork or logging into a computer.
“Writing those numbers on my forearm has made rounding fast,” Cervantes wrote in the email, which she shared with The Sun. “Plus, it looks like I have a cool tattoo.”
When Cervantes learned she was assigned to the COVID-19 ward, a fellow hospitalist who is single and without children offered to take the shift for her. She considered it. But when she looked at the upcoming schedule, Cervantes saw that almost all of the doctors assigned to the ward the week after her had families, too.
“That’s when I realized we are all in this together,” she said. “I went into medicine for a reason — I love taking care of patients.”
Hospitalists caring for patients in the COVID-19 ward are now in communication multiple times each day with the critical care team from the medical intensive care unit. Cervantes walked away from a planning meeting with the group “with a sense of humility but also pride at how this is really bringing us together as clinicians,” she said. “We are all in and we are all supporting each other.”
Coordination with the critical care team, including pulmonologists, is important because those are the doctors who will intubate COVID-19 patients who need help to breathe. For now, Cervantes is confident Denver Health has plenty of ventilators, she said.
Nothing in Cervantes’ career so far compares to working during a pandemic. But the last week reminded her of her time as a resident, when she was on call for up to 36 hours straight.
“It was very real and raw, the experience of residency,” she said. “We were all in the trenches.”
Residency was the last time Cervantes, who almost always wears a dress and nice shoes to work, wore scrubs. After her first day in the COVID-19 ward, she wrote in her journal about what it was like to work in scrubs again. She journaled every night last week to help process the experience, and she took a sleeping pill to make sure she could rest.
Cervantes’ husband, who is now working from home while the university campus is shut down, read the journal entries to their daughters, ages 9 and 12, while Cervantes was at work, part of their new ritual of isolation. Before she left the hospital each night, Cervantes dressed in clean clothes and disinfected herself — even wiping down her hair and neck with a disinfecting wipe. She wiped down her steering wheel, then sanitized her hands before touching it. Cervantes went directly to the master bedroom and bathroom to shower. Her husband wiped the doorknobs she touched.
For dinner, her children prepared a tray of food and left it outside her bedroom door. The meals came with sweet notes — “Never give up. Amazing docter (sic)” and “We are going to be petting Paprika (one of the family’s four baby chicks) for you.” Friday night’s dinner was pizza with a side of cooked spinach, ice water and rosé wine in a paper cup.
Cervantes ate alone in her room while FaceTiming her family, who sat in the kitchen. She didn’t come out of her room until she left for work before dawn the next morning, holding a wipe in her hand as she touched the doorknob.
She’s annoyed by social media posts from people complaining about hanging out with their children all day in isolation.
Her children have been asking questions about the coronavirus since the outbreak was still confined to China. They’ve talked about how it spread from animals to humans. They know it is killing people throughout the world. When it comes to their mom, they believe that if she is infected, she will survive.
That she could die is the one thing she and her husband haven’t shared with the girls.
“If mommy gets the virus, mommy will be OK because I’m strong, because mommy runs every day and I have no comorbidities. That’s what I want them to believe,” Cervantes said. “That’s maybe one thing I have kept from them.”
She tries to believe it, too.
“We don’t know enough about this virus,” she said. “It has taken the lives of very young people and many of them clinicians. I have been extremely scared.”
Cervantes, who normally spends about 75% of her time on research, isn’t scheduled to work again in the COVID-19 ward until May. She expects though, that she will return much sooner.
“This is emotionally challenging to know that I’m done today,” she said, “but I could be back early next week and we could be knee deep in trying to keep people alive.”