Just before he enters the hospital for a 12-hour shift in the emergency room, Kyle Mullica pauses to narrate the moment.
The 33-year-old state lawmaker struggles for words to describe what it feels like to trade his suit for scrubs and return to his job as an ER nurse amid the outbreak of the novel coronavirus.
As he records an audio diary entry on his phone, an analogy comes to mind: “It’s almost like you can see a tsunami coming — and there’s nothing that you can do about it but stand there.”
The Northglenn representative is one of at least three Colorado lawmakers working on the front lines of the global pandemic since the General Assembly abruptly suspended its session in mid-March.
His wife cried when he returned to the ER at Presbyterian/St. Luke’s Medical Center the day after the session paused. Just before his first shift, the hospital sent home a nurse who began to show potential COVID-19 symptoms. His father-in-law told him not to go home after work and put his two children at risk.
Mullica knows the dangers. A week before the state’s first positive case, he began to sound the alarm at the Capitol about the epidemic. He expressed concern to top state officials about the shortage of protective equipment for health care workers and about Colorado’s overall preparedness level.
Yet he feels a sense of duty to return to the hospital. “I have a skill set that I feel like I needed to use,” he says, recalling what he told his wife. “The whole reason I became a nurse was I wanted to help people — and this was the time to do that.”
His dual role gives him a unique perspective on the public health crisis, seeing first-hand the toll of the disease caused by the novel coronavirus as well as a vision for what the state legislature needs to address when it returns to the Capitol.
To get a sense of how his two jobs intersect, The Colorado Sun asked Mullica to make a series of audio diary entries during a recent shift when he was assigned to treat possible COVID-19 cases.
The recordings — edited for clarity and presented in italics — took place March 21. Along with subsequent interviews, his words reveal the challenges health care workers face, on the job and at home, as well as the anxiety that comes from confronting a pandemic that killed 70 people so far in Colorado. His reflections also offer insights into how his work will inform his policy approach when he returns to the Capitol.
LISTEN: Rep. Kyle Mullica’s audio diaries
A foreboding sense of the challenges ahead
“Just getting into work right now. I’ve never done this before so be patient with me, but I wanted to give you insight on what it’s like to come in. I left for work this morning and this is obviously a difficult time for my family. My wife is a little emotional with it, but my kids don’t really understand it right now.”
The conversation about Mullica’s decision to return to the ER wasn’t easy. His wife, Julie, is an infection preventionist at SCL Health. She knows the dangers, too. And departing for each shift is tough.
“Outside of being a nurse or state representative, you’re a husband and you’re a dad and you’re a son. Those people care about you, and those people don’t want to see you harmed,” Mullica says later.
He records the first diary entry from his car parked outside the hospital just minutes before his shift starts at 10 a.m. On a normal day, the life-and-death consequences of his job inject adrenaline into his veins. “You can never let your guard down because at the end of the day people’s lives are in your hands,” he says.
It’s even more true now, and the rush is evident in his voice as he talks about the day ahead.
“The unique thing about working in the ER is that you never know what you are going to walk into for your shift, and you never know what’s going to walk through that door during your shift. It just keeps you on your toes, and it’s one of the things that attracts me to the ER. You never know what’s going to happen and you always have to be ready for the worst thing that can happen.”
More than once, Mullica talks about how the current public health crisis is unlike anything he’s seen. He participated in training at the hospital for a potential Ebola outbreak a while back, but the invisible way this new disease spreads makes it more challenging to address.
It’s why he compares it to a tsunami. The seismic sea wave starts underwater, invisible but detectable. The warnings come long before the disaster arrives on shore, and yet there’s no way to know how bad it will be.
The numbers of positive COVID-19 cases are easy to project, but projections show the crest of the pandemic in Colorado won’t come until mid-April. Presbyterian/St. Luke’s is one of the state’s largest hospitals in terms of beds and projections show all 300-plus are needed when the disease reaches its peak.
The anxiety about the future is palpable in Mullica’s voice before the shift. In the ER, nurses often see instant gratification. They can make people feel better, they can save lives. The novel coronavirus is different because it’s not curable.
“What’s so scary about this is we have no tools,” he says. “All hospitals are able to do — until they figure out antivirals — is treat those symptoms. And as a provider, for me at least, that’s really scary. That scares the hell out of me.”
“Just to give you an idea on how it operates here. … When you walk in, we have two different waiting rooms. There’s a nurse out there who directs you to a waiting room that is more for isolation patients who have symptoms — shortness of breath, cough, fever and that type of thing. And then a different waiting room for those who are not showing symptoms.
“We also have a section of the ER with one negative pressure room and other rooms — farther away from the nurse’s station and the other patients — to put those patients who are showing (COVID-19) symptoms. I am in that pod today taking care of those patients.”
Mullica’s assignment for the day is the section — known as a pod — where patients with COVID-19 symptoms are treated.
He later says it’s hard to describe what he felt when he learned his lot. “I’d be lying if I didn’t say … your heart drops a little bit,” he says. “But it’s inevitable, too. You know it’s going to come, you know it’s part of what you’re signing up for.”
The balance between helping patients and protecting himself
His first break comes near 6 p.m. He eats a ham sandwich and records another diary entry.
So far the day is not as busy as he expected, and patients without serious symptoms arrive as often as those who do. The normal flow of heart attacks and strokes and lacerations only adds to the workload. He estimates about a third of the patients on this day are exhibiting symptoms consistent with COVID-19.
As he talks, his radio crackles: “I have one pediatric iso.” The alert tells nurses that a young patient with COVID symptoms arrived and waits for them in an isolation room.
In the ER, the nurses and doctors just assume they are exposed to COVID-19. But they can’t self-quarantine like other people because they are needed on the job. Only when they show symptoms do they get tested and self-isolate at home.
“We are trying to make sure that we’re protecting ourselves as health care providers … to make sure we’re not exposing ourselves and potentially causing us not to be able to be here because we’re on quarantine ourselves. …
“We are seeing there’s a lot of anxiety out there. I’m seeing that with the patients we are taking care of. There is obviously anxiety with the health care providers as well, just because this is something that we’ve never seen before.”
Mullica says he’s doing all he can to protect himself and his family. He wears a surgical mask for his entire shift and puts on his assigned goggles and N95 mask if working with a COVID-positive patient.
His wife’s father told him to live in their basement as a precaution if he plans to keep working at the hospital. “He was basically chewing me out for going to the ER and then coming home,” Mullica says.
He considered alternatives, but staying in a hotel room isn’t financially feasible. He also can’t imagine being away from his three children, ages 6, 4 and 1, whom he calls “my Zen.” But he knows he will need to leave home if he becomes symptomatic.
“That’s really what tears me up,” he says. “I’m going to go do this, and potentially make this sacrifice, and that sacrifice is going to be losing precious time with my family.”
“But,” he continues, “I also think about: What am I going to tell them when they are my age? I want them to know that their dad stood up and did something — used the skills he had to try to help people.”
The fatigue mixes with a sense of duty at the end of the shift
“I think I jinxed myself in the last recording because after lunch, and after that last recording, it got pretty busy with a lot of respiratory stuff. …
“You’re just running around. You’re getting a respiratory patient right after a respiratory patient, and you admit them or you discharge them, and you’re getting a patient right again to fill that room.”
The challenge with triaging people in the ER is identifying potential COVID-19 patients. The symptoms are similar to other ailments, particularly the seasonal flu, which is still rampant.
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And some of the symptoms overlap with other serious conditions. For instance, an elderly patient with chest pain may need an electrocardiogram to check the heart. “It’s just that we are treating those symptoms and the presentation a lot differently because of coronavirus,” Mullica explains.
To reach a diagnosis requires a full run of tests. And it’s the same for patient after patient toward the end of the shift. Mullica sounds exhausted as he records a final entry just before 11 p.m. in his car.
Still, he reaches for the positive to put his day in a broader context and summon the pride that led him to return to the ER in the first place. It’s hard to verbalize, but he says it is inspiring to work in the ER right now.
“It’s really, truly, an honor to be working alongside these people, who you know are putting themselves ahead of all these other things that are going on in the world to make sure that they are doing the job they are signing up for. …”
The dedication to the job is being recognized now more than ever. The governor, his legislative colleagues and constituents are sending him kudos on social media. The thank-you’s and hero-talk is appreciated, Mullica says, but it’s so disconnected from the warrior mentality in the ER.
“You get into this job because you care about people and because you want to help people. And when there’s an opportunity to do that, there’s just this weird strong calling that you need to do that. … So it’s tough to put into words, and I feel cheesy sometimes talking about it. But it’s just — it’s a calling, almost it’s this sense of duty.”
From practice to policy, lawmakers learn from experience on front lines
The end of the shift is not the end for Mullica. He doesn’t want the disease doesn’t follow him home. His wife meets him at the door with disinfectant wipes. He cleans his phone, work badge and wallet. He puts his scrubs in a bag that his wife takes straight to the laundry. He heads directly to the shower.
The exhaustion he feels these days is what he heard from fellow nurses in the weeks before the legislative session ended. They were tired, which is why he felt compelled to help.
Mullica started as an ER nurse two years ago but worked for four years prior at the same hospital as an emergency medical technician. Health care is a second career. A finance major, he first worked for a nonprofit that helped the homeless until he burned out.
Once he took his seat in the state House in January 2019, he moved to part time in the ER. He occasionally picks up a weekend shift early in the session but lets it go when the hours at the Capitol become too much.
One Colorado lawmaker has tested positive for COVID-19. Most others are staying at home. The exceptions are those who returned to medicine when the statehouse shut down. Senate President Leroy Garcia is working in Pueblo as a paramedic responding to emergency calls, and state Rep. Yadira Caraveo, the legislature’s only physician, is seeing patients at a pediatric clinic in Thornton.
Between their jobs, all three Democrats are responding to dozens of calls and emails from their constituents about unemployment benefits and how to pay rent. And they are thinking about what comes next when the General Assembly resumes its work.
“The biggest thing we are going to carry away from this as health care workers: How poorly the system is prepared for this,” Caraveo says.
Mullica agrees. The questions paramount in his mind: “How do we protect health care workers and how do we make sure we are in the best position possible if something like this happens again?”
From what he’s seen, he thinks the state needs a larger stockpile of medical supplies, including ventilators, so it’s not reliant on the federal government. He didn’t think the state officials he spoke with in late February, a week before the state’s first positive case, took it seriously enough. The state must plan better to streamline its response in the future.
Moving forward, Mullica says, “I think it makes you want to fight harder because you see it more and you see it first hand.”