Ruby Choate sat in her tiny Manhattan hotel room and felt a pain in her chest, a shallowness in her breathing, and considered for the first time that the temporary job she had signed up for could actually kill her.
Choate, 27, left her nursing job in Delta at the end of March, walking away from the Gunnison River and the Rocky Mountains and her pitbull, Duke, because she wanted to help in New York City.
COVID-19 IN COLORADO
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She hadn’t seen a single coronavirus patient before she left Delta, but she was tossed into the emergency department rotation at Harlem Hospital Center without even an orientation. Patients were two to a room, filling all 25 rooms, and spilling out into the hallways. Back home at Delta County Memorial, the operating unit where Choate worked has just four patient rooms.
Before this, the Olathe native had never seen New York or been anywhere on the East Coast.
Choate was feeling restless in rural Colorado, hearing about the overwhelmed health care workers in New York and New Jersey and thinking it was a waste that she wasn’t using her skills to help. So she asked her boss if she could take a leave, applied for a job through a recruiting company, and left her beloved dog in the care of her mom.
She’s been working in Harlem and living in a hotel on the Lower East Side for seven weeks, long enough to see the thick of it, and then the tapering off of coronavirus patients, and now the frightening after-effects, including patients who had recovered — even a physician — suddenly dying because of blood clots.
Nurses, paramedics and doctors across the country — including an unknown number from Colorado — went to New York and New Jersey to help as the pandemic overran hospitals and led public health officials to put up tents filled with hospital beds in Central Park and order massive refrigerated trucks to hold bodies of the dead.
The virus so far has killed more than 21,000 people in New York and more than 9,000 in New Jersey. One Colorado man, 66-year-old retired paramedic Paul Cary, died of COVID-19 after traveling to New York City to work.
The Colorado Sun interviewed three Colorado health care workers, two in Harlem and one in New Brunswick, New Jersey, to find out what they’ve learned working in those cities and how that could help patients here once they return home.
Choate hasn’t gotten sick — she believes now that the shortness or breath was either anxiety or the result of breathing through an N95 mask for 12 hours a day. Most of her friends working in Harlem have had similar experiences, including headaches, and they chalk it up to the stress of working in coronavirus wards with their faces covered.
New York was tugging at her, Choate said. And, as a single woman with no kids, she felt she could “just drop everything and go.” For days, though, she considered whether she should stick around to help Delta County if and when the hospital filled up with coronavirus patients. The county on the Western Slope has since had one death and 55 positive cases.
“I just had to do something for other people. I could see the suffering, and I could see the need,” she said. “It might be a way of coping for me. I can get straight into it, and I can help people.”
The first few weeks in New York were “on-your-feet, critical thinking,” Choate said, which is what she lives for and why she became a registered nurse. She had to decide which patients needed heart-rate and oxygen monitors, because there weren’t always enough for everyone. The hospital was low on ventilators, too.
That’s not to mention the gunshot wounds, stabbings and other trauma cases common in Harlem and rare in Delta. “We were so busy that you don’t even have time to stop and think about this,” she said. “We were so in over our heads.”
To protect herself, Choate takes off her shoes and scrubs at the door of her hotel room after a shift, then sprays them with a Microban disinfectant. She heads straight for the shower, and afterward, retraces her steps through the hotel room wielding the bottle of Microban. In the morning, she sprays her sheets and puts them in a bag to protect the hotel workers.
This is why the job comes with “disaster pay.”
The staff in Harlem has noticed a “little lull” in coronavirus patients the past two weeks but, along with it, a surprising number of blood clots among patients who had made it through the worst of COVID-19 and were recovering at home, Choate said. They use a test called a D-Dimer to determine whether a patient’s blood is clotting.
“If those are positive, they are usually in the 100s. We have been seeing them in the 1,000s,” she said. “It’s insane. For whatever reason in this disease process, we are seeing that every bit of inflammation is elevated.”
A week ago or so, a man who was diagnosed with COVID-19 in mid-April returned to the hospital with a pulmonary embolism, caused by a blood clot, Choate said. He died.
Choate expects she will return to Delta soon, and she hopes to return to her job at the hospital and care for coronavirus patients in Colorado. She feels exponentially more comfortable about treating the disease than she did before working in Harlem.
“We are seeing progress, and it’s encouraging,” she said. “If my own family got sick, it’s less scary now because I at least know the treatment line. I know the course.”
The time in New York has been life-changing, she said — from riding her bicycle past the refrigerated morgue trucks and down the deserted streets of Manhattan, to the kindness of the nurse from Louisiana who keeps giving her food and the bicycle shop owner who was so grateful that she had come to help that he knocked his rental price from $30 per day to $2.
Most everyone she has met in New York knows someone who has died because of coronavirus.
Choate shows her Harlem coworkers photos of Colorado and looks forward to getting back to the mountains and hiking more 14ers. “To go from my open spaces and beautiful mountains to skyscrapers stacked on top of each other, that was the biggest culture shock,” Choate said.
Erin Miller: New Brunswick, New Jersey. “The staff are the patients now.”
Just before her first shift in a New Jersey hospital overrun by coronavirus patients, Colorado nurse Erin Miller was admonished for standing too close to fellow nurses in the hospital coffee shop.
“We’re sorry. We’re not from here,” Miller and the rest of the Colorado relief crew began to stammer, realizing then that things were different there.
Scarier, though, was when they were led past what until a few weeks earlier had been a waiting area for same-day surgery. Now, it’s a ward for nurses and doctors sick with the new coronavirus.
“That was the first moment that all of us had that moment of panic,” Miller recalled. “The staff are the patients now, and that’s why we are here.”
She is one of 34 registered nurses with Centura Health in Colorado who traveled to sister hospitals in New Jersey to help relieve health care workers there.
Miller, 32, has been working at Saint Peter’s Healthcare System in New Brunswick since April 21. The single mom, who left her 10-year-old son in the care of his grandparents, normally works in the cardiovascular unit at Penrose Hospital in Colorado Springs.
Compared to the manageable caseload of coronavirus patients in Colorado, work in New Jersey is like another world, she said. The hospital has just one “clean” unit left — one unit that does not have patients with COVID-19. That unit is for everything else — from heart attacks to broken bones to psychotic breakdowns.
“Honestly, I wish that we were able to take phones and record what we are seeing,” Miller said last week from her hotel room. “The pictures would speak so much more than anything I could say. There is something about seeing someone who is not that much older than you on Day 28 in the hospital, maxed out on two different sources of oxygen, who can’t sit up. It’s terrifying.
“I better write down some notes because if we turn into New Jersey, we are in so much trouble.”
Miller feels like she’s in the movie E.T. when she enters a patient’s room — “that scene where they are coming in to decontaminate.” Every nurse is in the same baby-blue scrubs, the same blue masks, the same face shield. “They can’t tell anyone apart besides eyebrows and eyes,” she said. “You can’t even tell who is caring for you.”
Most COVID-19 patients are on their stomachs, to help them breathe, Miller said. The negative-air-pressure equipment that keeps air from flowing out of the room is so loud that patients can hardly hear what’s going on around them. “They just hear us moving around the room,” Miller said.
So she speaks loudly. And, if possible, she tries to connect with every patient about at least one thing, so she can bring it up the next time she enters their room.
“Hey, it’s Erin, with the son who plays Fortnite,” she said to one patient who also has a kid who likes video games.
Some of Miller’s patients are going on 40 days without seeing their families. No visitors are allowed. Even phone calls and FaceTime chats are hard because the machines are so loud that patients can’t hear what their loved ones are saying.
It makes her mad to hear people complain that they can’t go out to eat or have coffee with their girlfriends. Remember, she said, “this person hasn’t had a conversation with their child in 40 days.”
Back in April, Miller read a Centura email seeking volunteers for a three- to four-week stint on the East Coast. She said yes within four hours, and was on a plane to New Jersey three days after that.
Miller and two other Colorado nurses are working four 12-hour shifts per week in New Brunswick and staying in a nearby hotel, with meals and accommodations paid for by the health system. They get takeout for every meal and watch a lot of Netflix. “We want to keep a little bit of community so we try to eat our meals together when we can,” she said.
In their time off, the nurses walk around the neighborhood — at first, they were strolling along a little river near the hotel until they were warned that it wasn’t safe because of crime along the path, Miller said.
Miller duct-taped a sheet of plastic to the floor just inside the entrance to her hotel room. It’s where she takes off her shoes after her night shift and wipes them down with bleach wipes. She puts the clothes she wore home from the hospital in a laundry bag, then eats breakfast and goes to bed.
She is planning to return home to Colorado Springs on May 17, when the hospital in New Jersey is expected to get 16 new nurses from a staffing agency. She will get a coronavirus test, and was advised not to see her family until she gets the results — and even if she tests negative, to wear a mask for seven days.
She will look at her son from a distance, and wave, as soon as she returns to Colorado. “I will see him from 6 feet away and tell him how much I love him, and then I will go wait for the results of my test,” she said.
Miller said she appreciates the praise she and other workers have received for helping in New Jersey and New York, but that it’s misplaced. “We are by no stretch the heroes of this story; we were the temporary relief,” she said. “The people who have been here day in and day out are the true heroes. They show up every day. They are doing it exhausted. We get to come home. We had an end date.”
Nate Cameron: New York City. “It’s emotional times.”
Each time a patient comes off a ventilator, Harlem Hospital Center blasts the same Bob Marley lyrics through the intercom system: “Every little thing is gonna be alright.”
It’s a hopeful moment that breaks up the dark hours of Nate Cameron’s new job in New York. The physician assistant, who worked at Littleton Adventist Hospital, took a job through a staffing agency and ended up in Harlem in mid-April.
Cameron’s wife and four kids are home in Littleton while he works six days out of seven for higher pay than he received at home, sleeps in a small Manhattan hotel room and eats a lot of peanut butter and jelly sandwiches. Some of the worst moments have come as Cameron held up iPads to the ears of patients so their loved ones could offer words of encouragement — or say goodbye. Sometimes, the patients can speak. But often they can’t, so it’s on Cameron to describe what is happening in the room.
“It’s emotional times,” he said. “Not only am I missing my family, I’m seeing people who have to dial in because of the very strict no-visitation policy. That is one of the hardest things, knowing that people are dying.”
When the outbreak began, and Cameron was still in Colorado, he thought the virus would end up looking like the flu. “I have been completely humbled and incorrect,” said Cameron, who in past jobs has worked on an ambulance and as a paramedic in the military. “I have never experienced death on this level.”
The daily deaths in New York City are declining now, dropping to about half of the seven to 10 deaths per day that Cameron experienced on most shifts after he arrived at Harlem Hospital.
Cameron’s job is to assess patients who arrive in the emergency department. At first, about 10 of his patients per day were admitted to the hospital with COVID-19 symptoms. That’s since fallen to anywhere from two to six, he said.
The top three symptoms bringing New Yorkers to the ER are cough, shortness of breath and fever. But other cases of COVID-19 aren’t as straightforward, Cameron said. He learned soon into his stint in Harlem that gastrointestinal pain and diarrhea are common with coronavirus — almost one out of five patients who complain of stomach pain or gastro issues end up testing positive.
“If they come in and have gastric pain or vomiting and they’re hypoxic, you can pretty much guarantee that it’s COVID,” he said.
Harlem staff also have learned that coronavirus is affecting multiple organs: not just the lungs but the kidneys and the liver. “Liver enzymes go up. Renal function goes down. They don’t filter urine like they should. Their lungs go kaput,” Cameron said.
Cameron, 45, works for a national company that contracts with various hospitals for emergency department staff. He plans to stay in New York until early July, and then go wherever he is most needed. Detroit is a possibility, he said.
Cameron brought enough N95 masks with him from Colorado that he does not wear the same one again for five days. After a shift, he puts the mask he wore that day into a paper bag, leaving it there long enough — he hopes — that any virus that might have gotten on it has died.
He showers at the end of every shift after returning to his hotel room, where he makes a sandwich with the small stash of groceries he bought or the food his family sends in care packages. He’s become a regular at the deli down the street. Cameron went sightseeing once, taking a ride on the Staten Island Ferry for a view of the Statue of Liberty. The city is vacant, he said. “It’s dead, a ghost town.”
Last week, Cameron came back to Littleton for two days to visit his wife and kids, who range in age from 7 to 17. He’s had no symptoms of the disease, so Cameron decided to hug everyone and act as normal as possible. Now, he’s back to his solitary life in New York, thinking of that visit. “It was glorious.”