The woman with graying hair convulsed on her hospital bed, her arms and legs writhing as her chest rose high and fell in a rapid pump, pump, pump.
She was losing a war to the coronavirus overtaking her body. Aided by an oxygen mask strapped to her face — the woman had declined a ventilator — staff at Memorial Hermann Hospital in the Texas Medical Center aimed to make her more comfortable in her last days.
Two nurses lifted a blanket over the elderly woman’s shoulders after administering the powerful painkiller Fentanyl, her frizzy hair poking out from under the fleece. In minutes, her breathing finally slowed.
Pump… pump… pump.
Registered nurse Ivette Palomeque stepped into the quiet hallway of the hospital’s COVID-19 ICU and shut the sliding glass doors behind her. Around the horseshoed wing, 21 other patients filled every room.
Palomeque had just returned from New York, where she volunteered at the hard-hit Elmhurst Hospital in Queens. When she left Houston three months ago, case counts were low and most residents were ordered to stay at home. After less than a week back, she realized she had departed one disaster zone for what could be another.
“It’s troublesome to watch, because I know what’s coming,” she said. “This is demoralizing.”
While physicians and nurses at Memorial Hermann say they’re still equipped to handle the surge in cases, ICU beds at the hospital are nearly full, and all Texas Medical Center institutions are operating at a “Phase 2” contingency plan to make use of additional beds in overflow areas. With the plan in place, the total number of ICU beds being used across the medical center is 1,367, including 512 for COVID-19.
Another 840 ICU beds are available under surge plans, according to medical center data, and more capacity can be created by converting beds.
Houston isn’t yet in a New York-type situation, physicians agreed, and they were hopeful that the largest medical complex in the country wouldn’t experience a breakdown of the healthcare system.
Models predict the disease will peak in mid-to-late July, almost two months after cases began to surge with the reopening of the Texas economy and a busy Memorial Day weekend. Texas has become one of the worst spots in nation for the spread, and all eyes are on the state and Houston as health and government leaders desperately try to slow the outbreak.
“It’s going to be a couple of rocky weeks, but we’re going to get through this,” said Dr. Luis Ostrosky, infectious disease expert with Memorial Hermann and UT Health.
The risk for medical professionals
Dr. Pratik Doshi walked down the halls of floor 8 at the Sarofim Pavilion, a shining glass building which fortuitously opened in February before the pandemic landed in Houston.
He’s the attending physician of the COVID ICU, which takes up half of the landing. Back in April, only 10 people occupied beds there, but he and his staff watched the numbers rise: 16 in May, then 22 in June – capacity. The influx forced Memorial Hermann to overflow patients to the medical ICU on the other half of the floor, taking up roughly three-fourths of the 16 beds there on Thursday.
Doshi had just completed his rounds, and he again passed each room, separated from the hallway by an all-glass wall.
On one bed, a man made the sign of the cross, kissing his fist and pointing to the sky.
On another, a man hunched over, speaking on the phone.
In surrounding rooms, other patients lay immobile.
Almost every bed was occupied by a patient with some sort of breathing apparatus – at best, oxygen support, at worst, an extracorporeal membrane oxygenation machine. The apparatus, called ECMO, takes over the lung’s function by circulating blood out of and back into the body, said Dr. Bela Patel, exececutive medical director of critical care medicine at Memorial Hermann.
The youngest patient in the unit was a woman who had just delivered a baby, Doshi said. She got diagnosed with COVID-19 and is seriously ill.
The hospital is calm, despite the circumstances. A week’s activity in the unit would fill up maybe one episode of the TV show “ER,” Doshi said. After months of working with the disease, they have found a pattern of operating that works for them, even though more patients keep coming. On Friday, the hospital wasn’t quite at its capacity of 38 ICU beds and 29 floor beds for COVID, according to hospital data.
Registered nurse Robert Luckey said he and his coworkers benefitted from learning to handle the coronavirus before the beds began to fill up, making it feel steadier than the numbers that are being reported.
“I don’t think we feel the hit, with how many cases they’re reporting,” he said after leaving a patient’s pressure-sealed room, which keeps the COVID-tinged air contained inside. “It’s kind like of a way of life at this point.”
That doesn’t diminish the seriousness of the virus, which is approaching a dangerous level in Houston, hospital officials said. But they repeatedly stated that they felt they had enough space to accommodate the growing number of cases at Memorial Hermann. Sixteen more beds will be available in an unused wing on Monday, and another 54 are also available.
Seeing that need for more care in Houston can be frustrating because so much of the coronavirus’ spread is preventable, said nursing floor manager Mechele Jenkins.
“Some people, because they don’t see what we see every single day, they don’t necessarily think that it’s as important to wear a mask because they may be a healthy individual,” she said. “The person next to you might not be so healthy.”
Caring for any COVID patient is still risky for medical professionals, but Doshi and his colleagues on the eighth floor have their new procedures down to a science. They try to limit the frequency of room visits and are able to infuse fluids to patients using pumps that stretch outside the door, in lieu of the usual place at their bedside.
They wear masks at all times and don their gowns and gloves only when they enter the patients’ rooms. They compile to-do lists on the glass and when a nurse or resident is inside, they can communicate by writing on the wall.
That sort of precaution almost amounts to a hesitation that is unfamiliar to the doctors.
“I’ve never, ever thought about myself when I take care of patients,” Doshi said. “It’s against everything we have ever done.”
‘Angels walking among us’
With an intake of COVID patients that has become more and more regular, Doshi said he felt lucky on Thursday when the emergency room had no one waiting for a spot in the ICU. Staff is always looking for openings to move their patients – from the ER to the ICU, from the general floor to an ICU overflow, or from the ICU to the general floor.
Jorge Zambra was one person who was well enough to relinquish his ICU bed Wednesday night after eight days at the hospital. In the medical intermediate care unit on Thursday, he appeared fatigued, his breathing becoming labored with prolonged talking.
His diagnosis started with the worst headache of his life and led to hospitalization after a sudden drop in oxygen levels.
He never lost hope, the 70-year-old said, even though the experience has been a “royal nightmare.”
“One minute you think you feel better then the next couple hours you start going south again,” Zambra said. “They tell me that probably the worst is over, but the recovery is going to be very lengthy. Because I’m exhausted.”
Like every hospitalized person with COVID, Zambra’s stories pointed to the human toll of the disease — how he misses interaction, how the illness has temporarily stripped his personhood.
Time moves slowly in the hospital. Zambra, a semi-retired UT Health department administrator, prays frequently, texts his family and friends and watches a Memorial Hermann channel on his TV that plays soothing music and shows beautiful landscapes.
When he is discharged, Zambra can’t wait to resume his piano lessons and rehearse his Spanish theater group’s next play about obsessive compulsive disorder.
He still has a way to go before that happens, but his chest heaves with emotion just thinking of the gratitude he owes the people at the hospital who saved his life.
“The ‘thank you’ that I feel is bigger than Reliant Stadium,” he said. “I never knew that there were so many angels walking among us.”
