''For Code Use Only.''.
The patient is 63 years old, someone reads from a chart. She had been hospitalized two weeks earlier and rushed to the ICU that morning. ''Where's her family?'' asks Jen. ''Her son is here,'' says another nurse. Jen nods, then sighs. ''This is how yesterday started.''. Yesterday was the worst day on her ward. Ever. Three COVID-19 patients died -- two before 8 a.m. They were 44, 50 and 64 years old. Jen had to tell their families. A man collapsed on the floor beside her, wailing when his wife passed. A woman begged Jen to save her husband, sobbing, ''How do I tell our 6-year-old daughter, 'Daddy's not coming home?' ''.
Jen is a trauma nurse, mom to two teenagers. She rarely cries. Yesterday, for the first time in forever, she broke down. Her husband told her, ''Whenever you're ready to step away, I'll support you.''. Today, she woke in the dark, pulled on her blue scrubs, tied her hair into a ponytail and came back for a 12-hour shift. She'll try to save the sickest COVID-19 patients, knowing that no matter what she does, most of them won't make it -- and that so many more are waiting for those beds. Jen has been an ICU nurse for 20 years. She grew up in Cleveland, Ohio, and moved to Florida in 1995. She and her husband have a son and a daughter and two dogs, who Jen loves to walk after work. Jen made a career in intensive care because she likes treating a variety of life-threatening conditions, helping the worst patients get better and go home. She's been a nurse on this wing for 20 years and is now a manager.
When the pandemic hit in March 2020, she helped set up the hospital's first COVID-19 ward, implementing new protocols. Everyone was terrified, anxious for their patients and themselves. But by this spring, doctors had figured out new treatments. They had better medicine, new machines. People were getting vaccinated. Nurses began scheduling vacations, wondering when they might be able to stop wearing respirators. Jen's unit has 18 beds. In June, there were only an average of three COVID-19 cases each day. Then, two weeks into July, cases started spiking. In one month, infections increased 10-fold. To make room, BayCare had to suspend elective surgeries in its 14 hospitals across Tampa Bay. About 40 percent of the beds in those facilities now are filled with COVID-19 cases. On this day, near the end of August, BayCare's hospitals have 1,164 cases -- 462 more than during the peak in July 2020, before there was a vaccine. Across the country -- around the world -- the same scenes are playing out. Emergency rooms are overwhelmed. Ambulances are being turned away. More people are dying each day: An average of 250, just in Florida.
The delta variant is spreading faster, striking harder, hitting younger people, even kids. The saddest part, Jen says, is this didn't have to happen. Most of her patients, and the ones suffering the most, haven't been vaccinated. ''How did we get here?'' asks Jen, who got vaccinated as soon as she could. ''What's wrong with people who still don't believe?''. For her and her staff, last summer's fear and anxiety have morphed into frustration and anger. Some patients beg Jen for the vaccine, though it's too late. Others continue to insist COVID-19 is a hoax -- while they're dying. Her job is to try to save them, not judge. But people are suffering so much more, she says, languishing two or three weeks in intensive care before they eventually go on a ventilator. Once that happens, 95 percent die. If everyone could see what she sees, she says, the horror and hopelessness her nurses live with every day, the anguish the patients' families endure, maybe they'd believe.
6:35 a.m. After the woman in Room 84 is sedated and someone sends her son home, after a nurse rolls away the emergency cart, after Jen checks on an 80-year-old man from an assisted living facility, she sinks into a chair at the nurses' station and opens a three-ring binder.
Most of the patients in the COVID-19 intensive care ward are unconscious, sent into medical comas so they can be intubated. Once they're on a ventilator, 95 percent don't survive. When they're taken off the machine, they usually die within 10 minutes...The night nurse manager peers over the pages with her, reports on each patient. ''This one with the belly bleed is unresponsive,'' says the nurse. ''Too fragile to move.'' Jen nods. The nurse turns the page. ''This girl in 93, doctors were trying to hold off for her, but ... ''. Jen doesn't look up.
Now that the patients are staying longer, the nurses get to know them, and their families. Jen knows the 36-year-old woman has two young children, that she's been holding on for two weeks, that yesterday she had respiratory failure and turned blue. ''She's going to need to be intubated,'' the nurse says. The beginning of the end. The ward is shaped like a U, with nine rooms on each side. The front walls are glass, so staff can see into them without opening the doors. The ventilation system has negative pressure, so contaminated air recirculates into the ducts. Most of the patients are motionless, sunken into medical comas. The few who are still conscious sometimes moan. TVs are not on here. There's no music. No visitors, until the end. But nurses constantly call out to each other, phones ring, the halls buzz and beep. And too often, a siren screams throughout the hospital, blue lights spin from the ceiling, signaling someone has coded -- if not already died. Nurses have little time to put things in perspective or process the pain. There's a massage chair in the break room, piles of granola bars and cheese sticks. But they often skip meals. A poster by the medicine room proclaims: Here's to another day of outward smiles and inward screams.
8:00 a.m. The man in Room 89 is deteriorating. His lungs blew out from pumping so much oxygen into them. Doctors put him on steroids, and he's been on a ventilator for two weeks. To relieve pressure on his lungs, he needs to be flipped over, onto his stomach, the respiratory therapist says. The patient is hooked to a tangle of tubes and a half-dozen monitors. He's a big man. Most of the people in this ward are obese. He's 50 years old -- the same age as Jen. ''I'm coming,'' she calls, pulling on blue gloves and her N95 mask. ''Hey, we need another pair of hands.''. Six people work together to roll sheets beneath the patient and thread tubes out of the way. Jen stands by his head as a co-worker pulls out the ventilator, watching the numbers dropping on the monitor. Two more nurses are ''bagging'' the man, manually pumping air into his lungs until they can reconnect the machine. Once he's turned, Jen re-hooks his lines, smooths a clean sheet over his back, checks to see if his vital signs improve. They don't. Ten minutes later, he's worse than when he was on his back. Jen shakes her head and tells the nurse beside her, ''He's not going to make it out of here.''.
8:30 a.m. Rounds are supposed to start at 8 a.m. But with so many emergencies, they often begin late. The team gathers in the hall, a dozen people: Nurses, therapists, doctors. A pharmacist. A chaplain. A social worker. A dietician. A couple of interns. They each push a cart with at least one laptop on it, checking information, typing into charts. Jen carries two phones and a beeper and wears an Apple watch to check email. Sometimes, nurses on other floors need her. Sometimes, she needs help, with X-rays, prescriptions, tests and specialists. Every morning, a team of up to a dozen health care workers makes rounds in the ICU, updating each other on the patients' conditions, medicines, needs, families and prognoses. Jen, center, coordinates care with doctors, nurses, therapists, dieticians and pharmacists...''It's a little crazy in here,'' a nurse tells the primary doctor on duty. ''Not as bad as yesterday,'' he says. Not yet. Outside each room, a nurse reads through a chart, updating the team on the patient's condition. They talk about family members: Who is making medical decisions? If they can't find a relative, they go through the patient's phone. They start rounds at Room 81, where the man's stomach is bleeding. ''He's not doing well,'' the nurse says. They're about to head to the next room when Jen interjects, ''The woman in 84 is really looking bad.''. So the team heads across the hall. ''After you get a PICC line in, try to prone her,'' the doctor says, meaning they should roll her onto her stomach. ''Who is her health care surrogate?'' asks Jen. ''We need someone legally to make some decisions.''. In Room 86: A 46-year-old man got so aggressive he had to be sedated.
Room 91: This man has been in the ICU for a week. ''Very anxious,'' says a nurse. On the way to the next room, Jen's cell rings. ''Yes, we just got a new one. No, we don't have a bed,'' she tells a nurse on another floor.
Room 92: Jen says of this woman, ''There's not much more we can do.''.
Room 95: This woman has pneumonia, almost coded yesterday.
Room 97: The man was hypothermic overnight. On other floors, seven more COVID-19 patients are waiting to get into the ICU. A doctor, who had been on duty the day before, walks up to Jen on his way through the ward. ''Hey, are you okay?'' he asks. ''I was thinking about you last night.''. Jen swallows and nods without meeting his eyes.
10:50 a.m. After hours on her feet, Jen finally gets to sit. At the nurses' station, she reads lab reports, answers calls, talks to families. Someone brings Publix subs to the ward, so she takes a few bites in the break room before her beeper goes off again. A man who had been intubated on a ward upstairs has gone downhill. His family has decided to withdraw care. Instead of coming to the ICU, he will be going to the morgue. ''He was here with us before,'' Jen tells a nurse. ''We transferred him out. But ... ''. By the time most patients come to the ICU, their bodies are exhausted from struggling so hard to breathe. Their hearts are deprived of oxygen, so their blood pressure plummets. They're in pain and panicking. Nurses try to make them comfortable and update their loved ones. When you can't see the patient, you don't know how bad things are. You don't realize, or admit, Jen says, when it's time to let go. The nurses don't want to prolong anyone's suffering, Jen says. ''But we do it until the family is ready to stop.''. When death seems imminent, one visitor is allowed in the room. If there's no relative or friend, a nurse holds the person's hand. ''No one dies alone here,'' Jen says. Some patients have Do Not Resuscitate orders: If they stop breathing, or their heart gives out, they don't want CPR. But those orders don't necessarily include ventilators, Jen says.
Over the last couple of years -- mostly since COVID-19 -- health care officials have required a new classification: Do Not Intubate. Most people don't know they need that, Jen says. Just before noon, she ducks into Room 85. The man from assisted living is doing so much better he can be transferred to another floor. He's the oldest person on her ward, the only one who got the vaccine.
2:35 p.m. Blue lights flash overhead. A siren howls. Jen and her team rush to Room 84. Around the patient, two doctors and five nurses are pumping medications through IVs, trying to keep oxygen circulating to her organs. A machine, the size of a shoebox, is strapped across the woman's chest. The ''Lucas 3'' device is new, a product of the pandemic, and does chest compressions so nurses don't have to. Each time it pushes, the woman's body convulses, arms and legs jerking. ''Everybody knew it was going to come to this,'' a nurse says from the hall. Still, they try. And try again. When the woman came in this morning, she had begged a nurse to do anything. Anything! Her son said the same thing: No matter what, don't let her go. ''You gotta call him again,'' Jen says. Almost 40 percent of the beds in BayCare's 14 hospitals now are filled with COVID-19 cases. No other outbreak ever has accounted for that percentage of patients, according to spokeswoman Lisa Razler.
By mid-August, there were so many infected people, the hospitals had to suspend elective surgeries. Another nurse picks up her phone, dials the number on the whiteboard by the door. ''Your mom has coded again,'' she tells the son. ''It's really not looking good. At this point, we've given her all the medications we can.'' She pauses. ''I don't know if you want us to continue to do this. You can come up to see her.''. The son is a 45-minute drive away. The nurse offers to FaceTime, but he has an Android phone. ''She's failing, actively dying,'' the nurse tells the son. ''I'm sorry to say that to you. We've given her 110 percent. But she's just spiraling back down ... I think at this point, it's time to give her peace.'' Silence. ''Do you want me to put a phone to her ear, so she can hear your voice?''. In the hall, through the glass, everyone hears her son weep. Jen walks away. At the nurses' station, she drops her head into her hands. After listening to a call when a man learned his mother was dying, and hearing that two more patients need to be put on ventilators, Jen pauses. ''These nurses have been working 12-hour days for 18 months straight now,'' says Morton Plant Hospital President Lou Galdieri, who also is a nurse. ''The psychological stressors are affecting everyone.''. She tries not to think about all the patients she's lost, the children they won't see grow up, the grandkids they'll never know.
In Room 83, the family of a woman who has been in the ICU for 25 days has decided to take her off life support. She's 56. A wife and mother. Orderlies roll a new patient onto Jen's ward. This woman is 54. She's been in the hospital for three days. She's wrapped in thick plastic, so she doesn't expose others to the virus. She looks like she's been swaddled in Saran Wrap. She needs to be sedated and put on a ventilator. Now.
When patients are brought into the COVID-19 ICU from other parts of the hospital, they're swathed in thick plastic, so they don't contaminate anyone else. This woman is being rolled in for an emergency intubation and is still conscious when Jen greets her. As Jen hurries to meet her in Room 96, another nurse draws her into the coffee room. ''Here, you need to eat,'' she says, shoving a fork toward Jen's mask. For the first time all day, Jen laughs. ''There's nothing like eating a tamale, then putting on an N95,'' she says. ''Yummy!''.
Even when she tries to take a break, Jen's phone never stops ringing. She seldom gets to escape to the small office she shares at the end of the ward. On this day, when she finally does, she finds a stack of thank-you cards from first-graders who drew smiling, stick-figure nurses.
3:20 p.m. The woman in Room 84 codes again. Lights. Sirens. A dozen people rush to the room. ''We gotta stop. We're not doing anything for her,'' says a nurse. ''Her son says he's on the way,'' says another. ''He wants us to keep her alive until he can say goodbye.''.
In Room 89, the man they had rolled over had his chest tube pop out. Jen sends someone to reinsert it.
In Room 95, a woman's daughters have decided to let her go. Then the woman in Room 84 codes again. Every 20 minutes, the staff brings her back. She has now coded seven times. ''This is something we don't do,'' Jen says. Jen's not religious or spiritual. She doesn't ask why things happen, what they mean. Or what comes after death. She's cemented in the here and now, multi-tasking through every moment. Making life and death decisions. Finally, the woman's son runs in. Two nurses help him put on a gown, gloves, mask and goggles. ''Would you like the chaplain to be here with you?'' asks a nurse. The son looks stunned. He swallows, blinks back tears, nods. He shuffles into the room, freezes and stares. Then he collapses on top of his mother. Through the door, Jen motions for a nurse to unstrap the machine that's keeping her alive. So her son can truly hug her. 5:50 p.m. Near the end of her shift, Jen's back is sore. Her knees ache. She's thirsty. No time to fill her water bottle. She keeps yawning. She can't stop thinking about the man who just lost his mom, and her own mom, who she lost in June to cancer.
A nurse from another COVID-19 ward comes to see Jen. She lost two people today and had heard ICU did, too. The nurses embrace, feeling each other's pain. At the end of her shift, nurse Samantha Bond comes to check on Jen and give her a hug. Workers on other floors hear each time someone codes. They knew two people already had died in the ICU that day. For the next half-hour, Jen works on scheduling, checks on her nurses, walks the ward one more time. When the night nursing supervisor comes, she briefs her on each patient.
Room 83: She's CMO. Comfort Measures Only. Room 84: The woman finally passed. But her son is still with her.
Room 86: This man brought pictures of his family. He told the ER nurse: Don't let me die.
Room 89: He's still prone, still struggling. He's got kids. He's not going to make it. ''But 93 is better, right?'' asks the night nurse, referring to the young mom. Jen drops her eyes and says softly, ''Nooooo.''. Saving sick people used to motivate her to keep doing this hard work. Now, she says, there's no joy to buoy her through the sorrow. ''You wonder: How long can I do this for?'' she says. ''I've definitely thought about what I want to do next. I want to work with dogs.''. She's grateful for her own health, her friends' and families' health. And that she finally convinced her 18-year-old son to get the shot. ''I had to bribe him with $100,'' she says. She's incredulous at co-workers who won't get vaccinated. BayCare doesn't require its employees to, but it asks each patient.
For a while, the community was cheering for health care workers, bringing so many meals they donated some to the food bank. This summer, the love seemed to evaporate. On the ''Heroes Work Here'' sign, someone added the word ''Still.''. ''I don't feel like a hero,'' Jen says. ''I feel helpless.''.
Maria Martinez sanitizes a room in the COVID-19 ICU, readying it for the next patient. The ventilation system in this wing has negative pressure, so contaminated air recirculates into the ducts.
6:10 p.m. Like most of the nurses, Jen will drive home in silence. Some try to process their day, so they don't take it to their families. Others try to block it out, so they don't have to relive it. Jen tries to not think about anything during her commute to Palm Harbor, which, of course, is impossible. When she gets home, she works out or walks her two dogs. Her kids don't ask about her day much. Her husband pours her a Chardonnay and lets her talk -- if she wants. He doesn't understand why she's putting herself through this. But this job is what she does. And who she is. She can't walk away. Not now. About the story. BayCare allowed a Times reporter and photographer to shadow a nursing supervisor through a 12-hour shift, with the condition that the patients not be identified by name. The journalists have both been vaccinated and wore protective gear. Within the next week, five more ICU patients would die.
By the numbers.
July - August 2020 for BayCare's 14 hospitals.
Average age of COVID patients: 75+. July - August 2021 for BayCare's 14 hospitals.
Average age of COVID patients: 45-58. More than 80 percent of them hadn't been fully vaccinated.
Tampa Bay Times coronavirus coverage by Lane DeGregory/Tampa Bay Times/ZUMA
© On this ward at Morton Plant Hospital, nurses are overwhelmed by the number of new, desperate cases. Medical workers in the Intensive Care Unit try to stabilize a patient who has been battling the virus. From mid-July through August, 43 people died of COVID-19 at Morton Plant Hospital in Clearwater.
More than 75 percent of them were unvaccinated. She gets to the hospital 20 minutes before her shift, walks through the lobby carrying a smoothie, hoping -- but not believing -- that today might be better than the day before. When she steps off the elevator on the second floor, she turns left, toward what used to be the Intensive Care Unit. Since mid-July, it's become the COVID-19 ICU.
Jennifer Tellone has started calling it ''The War Zone.''In the small office she shares at Morton Plant Hospital in Clearwater, Jen lifts her mask to sip her drink. She hasn't even put down her purse when another nurse rushes in. The patient in Room 84 can't breathe. She needs to be intubated -- right away. ''Want me to put in for a chest X-ray?'' Jen asks, pulling an N95 mask over her surgical one. ''They're on their way.''. ''Is there anything you need me to do?''. ''Ask for fentanyl.''. Through the glass wall, Jen sees the patient on her back, gasping, arms flailing. Nurses wearing plastic gowns and respirators are struggling to sedate her. Others are pumping air into her mouth with a plastic bulb. Tubes snake from her wrists and chest. Above her head, monitors blink green, red and blue lifelines. Outside the door is a cart labeled: ''For Code Use Only.''.
The patient is 63 years old, someone reads from a chart. She had been hospitalized two weeks earlier and rushed to the ICU that morning. ''Where's her family?'' asks Jen. ''Her son is here,'' says another nurse. Jen nods, then sighs. ''This is how yesterday started.''. Yesterday was the worst day on her ward. Ever. Three COVID-19 patients died -- two before 8 a.m. They were 44, 50 and 64 years old. Jen had to tell their families. A man collapsed on the floor beside her, wailing when his wife passed. A woman begged Jen to save her husband, sobbing, ''How do I tell our 6-year-old daughter, 'Daddy's not coming home?' ''.
Jen is a trauma nurse, mom to two teenagers. She rarely cries. Yesterday, for the first time in forever, she broke down. Her husband told her, ''Whenever you're ready to step away, I'll support you.''. Today, she woke in the dark, pulled on her blue scrubs, tied her hair into a ponytail and came back for a 12-hour shift. She'll try to save the sickest COVID-19 patients, knowing that no matter what she does, most of them won't make it -- and that so many more are waiting for those beds. Jen has been an ICU nurse for 20 years. She grew up in Cleveland, Ohio, and moved to Florida in 1995. She and her husband have a son and a daughter and two dogs, who Jen loves to walk after work. Jen made a career in intensive care because she likes treating a variety of life-threatening conditions, helping the worst patients get better and go home. She's been a nurse on this wing for 20 years and is now a manager.
When the pandemic hit in March 2020, she helped set up the hospital's first COVID-19 ward, implementing new protocols. Everyone was terrified, anxious for their patients and themselves. But by this spring, doctors had figured out new treatments. They had better medicine, new machines. People were getting vaccinated. Nurses began scheduling vacations, wondering when they might be able to stop wearing respirators. Jen's unit has 18 beds. In June, there were only an average of three COVID-19 cases each day. Then, two weeks into July, cases started spiking. In one month, infections increased 10-fold. To make room, BayCare had to suspend elective surgeries in its 14 hospitals across Tampa Bay. About 40 percent of the beds in those facilities now are filled with COVID-19 cases. On this day, near the end of August, BayCare's hospitals have 1,164 cases -- 462 more than during the peak in July 2020, before there was a vaccine. Across the country -- around the world -- the same scenes are playing out. Emergency rooms are overwhelmed. Ambulances are being turned away. More people are dying each day: An average of 250, just in Florida.
The delta variant is spreading faster, striking harder, hitting younger people, even kids. The saddest part, Jen says, is this didn't have to happen. Most of her patients, and the ones suffering the most, haven't been vaccinated. ''How did we get here?'' asks Jen, who got vaccinated as soon as she could. ''What's wrong with people who still don't believe?''. For her and her staff, last summer's fear and anxiety have morphed into frustration and anger. Some patients beg Jen for the vaccine, though it's too late. Others continue to insist COVID-19 is a hoax -- while they're dying. Her job is to try to save them, not judge. But people are suffering so much more, she says, languishing two or three weeks in intensive care before they eventually go on a ventilator. Once that happens, 95 percent die. If everyone could see what she sees, she says, the horror and hopelessness her nurses live with every day, the anguish the patients' families endure, maybe they'd believe.
6:35 a.m. After the woman in Room 84 is sedated and someone sends her son home, after a nurse rolls away the emergency cart, after Jen checks on an 80-year-old man from an assisted living facility, she sinks into a chair at the nurses' station and opens a three-ring binder.
Most of the patients in the COVID-19 intensive care ward are unconscious, sent into medical comas so they can be intubated. Once they're on a ventilator, 95 percent don't survive. When they're taken off the machine, they usually die within 10 minutes...The night nurse manager peers over the pages with her, reports on each patient. ''This one with the belly bleed is unresponsive,'' says the nurse. ''Too fragile to move.'' Jen nods. The nurse turns the page. ''This girl in 93, doctors were trying to hold off for her, but ... ''. Jen doesn't look up.
Now that the patients are staying longer, the nurses get to know them, and their families. Jen knows the 36-year-old woman has two young children, that she's been holding on for two weeks, that yesterday she had respiratory failure and turned blue. ''She's going to need to be intubated,'' the nurse says. The beginning of the end. The ward is shaped like a U, with nine rooms on each side. The front walls are glass, so staff can see into them without opening the doors. The ventilation system has negative pressure, so contaminated air recirculates into the ducts. Most of the patients are motionless, sunken into medical comas. The few who are still conscious sometimes moan. TVs are not on here. There's no music. No visitors, until the end. But nurses constantly call out to each other, phones ring, the halls buzz and beep. And too often, a siren screams throughout the hospital, blue lights spin from the ceiling, signaling someone has coded -- if not already died. Nurses have little time to put things in perspective or process the pain. There's a massage chair in the break room, piles of granola bars and cheese sticks. But they often skip meals. A poster by the medicine room proclaims: Here's to another day of outward smiles and inward screams.
8:00 a.m. The man in Room 89 is deteriorating. His lungs blew out from pumping so much oxygen into them. Doctors put him on steroids, and he's been on a ventilator for two weeks. To relieve pressure on his lungs, he needs to be flipped over, onto his stomach, the respiratory therapist says. The patient is hooked to a tangle of tubes and a half-dozen monitors. He's a big man. Most of the people in this ward are obese. He's 50 years old -- the same age as Jen. ''I'm coming,'' she calls, pulling on blue gloves and her N95 mask. ''Hey, we need another pair of hands.''. Six people work together to roll sheets beneath the patient and thread tubes out of the way. Jen stands by his head as a co-worker pulls out the ventilator, watching the numbers dropping on the monitor. Two more nurses are ''bagging'' the man, manually pumping air into his lungs until they can reconnect the machine. Once he's turned, Jen re-hooks his lines, smooths a clean sheet over his back, checks to see if his vital signs improve. They don't. Ten minutes later, he's worse than when he was on his back. Jen shakes her head and tells the nurse beside her, ''He's not going to make it out of here.''.
8:30 a.m. Rounds are supposed to start at 8 a.m. But with so many emergencies, they often begin late. The team gathers in the hall, a dozen people: Nurses, therapists, doctors. A pharmacist. A chaplain. A social worker. A dietician. A couple of interns. They each push a cart with at least one laptop on it, checking information, typing into charts. Jen carries two phones and a beeper and wears an Apple watch to check email. Sometimes, nurses on other floors need her. Sometimes, she needs help, with X-rays, prescriptions, tests and specialists. Every morning, a team of up to a dozen health care workers makes rounds in the ICU, updating each other on the patients' conditions, medicines, needs, families and prognoses. Jen, center, coordinates care with doctors, nurses, therapists, dieticians and pharmacists...''It's a little crazy in here,'' a nurse tells the primary doctor on duty. ''Not as bad as yesterday,'' he says. Not yet. Outside each room, a nurse reads through a chart, updating the team on the patient's condition. They talk about family members: Who is making medical decisions? If they can't find a relative, they go through the patient's phone. They start rounds at Room 81, where the man's stomach is bleeding. ''He's not doing well,'' the nurse says. They're about to head to the next room when Jen interjects, ''The woman in 84 is really looking bad.''. So the team heads across the hall. ''After you get a PICC line in, try to prone her,'' the doctor says, meaning they should roll her onto her stomach. ''Who is her health care surrogate?'' asks Jen. ''We need someone legally to make some decisions.''. In Room 86: A 46-year-old man got so aggressive he had to be sedated.
Room 91: This man has been in the ICU for a week. ''Very anxious,'' says a nurse. On the way to the next room, Jen's cell rings. ''Yes, we just got a new one. No, we don't have a bed,'' she tells a nurse on another floor.
Room 92: Jen says of this woman, ''There's not much more we can do.''.
Room 95: This woman has pneumonia, almost coded yesterday.
Room 97: The man was hypothermic overnight. On other floors, seven more COVID-19 patients are waiting to get into the ICU. A doctor, who had been on duty the day before, walks up to Jen on his way through the ward. ''Hey, are you okay?'' he asks. ''I was thinking about you last night.''. Jen swallows and nods without meeting his eyes.
10:50 a.m. After hours on her feet, Jen finally gets to sit. At the nurses' station, she reads lab reports, answers calls, talks to families. Someone brings Publix subs to the ward, so she takes a few bites in the break room before her beeper goes off again. A man who had been intubated on a ward upstairs has gone downhill. His family has decided to withdraw care. Instead of coming to the ICU, he will be going to the morgue. ''He was here with us before,'' Jen tells a nurse. ''We transferred him out. But ... ''. By the time most patients come to the ICU, their bodies are exhausted from struggling so hard to breathe. Their hearts are deprived of oxygen, so their blood pressure plummets. They're in pain and panicking. Nurses try to make them comfortable and update their loved ones. When you can't see the patient, you don't know how bad things are. You don't realize, or admit, Jen says, when it's time to let go. The nurses don't want to prolong anyone's suffering, Jen says. ''But we do it until the family is ready to stop.''. When death seems imminent, one visitor is allowed in the room. If there's no relative or friend, a nurse holds the person's hand. ''No one dies alone here,'' Jen says. Some patients have Do Not Resuscitate orders: If they stop breathing, or their heart gives out, they don't want CPR. But those orders don't necessarily include ventilators, Jen says.
Over the last couple of years -- mostly since COVID-19 -- health care officials have required a new classification: Do Not Intubate. Most people don't know they need that, Jen says. Just before noon, she ducks into Room 85. The man from assisted living is doing so much better he can be transferred to another floor. He's the oldest person on her ward, the only one who got the vaccine.
2:35 p.m. Blue lights flash overhead. A siren howls. Jen and her team rush to Room 84. Around the patient, two doctors and five nurses are pumping medications through IVs, trying to keep oxygen circulating to her organs. A machine, the size of a shoebox, is strapped across the woman's chest. The ''Lucas 3'' device is new, a product of the pandemic, and does chest compressions so nurses don't have to. Each time it pushes, the woman's body convulses, arms and legs jerking. ''Everybody knew it was going to come to this,'' a nurse says from the hall. Still, they try. And try again. When the woman came in this morning, she had begged a nurse to do anything. Anything! Her son said the same thing: No matter what, don't let her go. ''You gotta call him again,'' Jen says. Almost 40 percent of the beds in BayCare's 14 hospitals now are filled with COVID-19 cases. No other outbreak ever has accounted for that percentage of patients, according to spokeswoman Lisa Razler.
By mid-August, there were so many infected people, the hospitals had to suspend elective surgeries. Another nurse picks up her phone, dials the number on the whiteboard by the door. ''Your mom has coded again,'' she tells the son. ''It's really not looking good. At this point, we've given her all the medications we can.'' She pauses. ''I don't know if you want us to continue to do this. You can come up to see her.''. The son is a 45-minute drive away. The nurse offers to FaceTime, but he has an Android phone. ''She's failing, actively dying,'' the nurse tells the son. ''I'm sorry to say that to you. We've given her 110 percent. But she's just spiraling back down ... I think at this point, it's time to give her peace.'' Silence. ''Do you want me to put a phone to her ear, so she can hear your voice?''. In the hall, through the glass, everyone hears her son weep. Jen walks away. At the nurses' station, she drops her head into her hands. After listening to a call when a man learned his mother was dying, and hearing that two more patients need to be put on ventilators, Jen pauses. ''These nurses have been working 12-hour days for 18 months straight now,'' says Morton Plant Hospital President Lou Galdieri, who also is a nurse. ''The psychological stressors are affecting everyone.''. She tries not to think about all the patients she's lost, the children they won't see grow up, the grandkids they'll never know.
In Room 83, the family of a woman who has been in the ICU for 25 days has decided to take her off life support. She's 56. A wife and mother. Orderlies roll a new patient onto Jen's ward. This woman is 54. She's been in the hospital for three days. She's wrapped in thick plastic, so she doesn't expose others to the virus. She looks like she's been swaddled in Saran Wrap. She needs to be sedated and put on a ventilator. Now.
When patients are brought into the COVID-19 ICU from other parts of the hospital, they're swathed in thick plastic, so they don't contaminate anyone else. This woman is being rolled in for an emergency intubation and is still conscious when Jen greets her. As Jen hurries to meet her in Room 96, another nurse draws her into the coffee room. ''Here, you need to eat,'' she says, shoving a fork toward Jen's mask. For the first time all day, Jen laughs. ''There's nothing like eating a tamale, then putting on an N95,'' she says. ''Yummy!''.
Even when she tries to take a break, Jen's phone never stops ringing. She seldom gets to escape to the small office she shares at the end of the ward. On this day, when she finally does, she finds a stack of thank-you cards from first-graders who drew smiling, stick-figure nurses.
3:20 p.m. The woman in Room 84 codes again. Lights. Sirens. A dozen people rush to the room. ''We gotta stop. We're not doing anything for her,'' says a nurse. ''Her son says he's on the way,'' says another. ''He wants us to keep her alive until he can say goodbye.''.
In Room 89, the man they had rolled over had his chest tube pop out. Jen sends someone to reinsert it.
In Room 95, a woman's daughters have decided to let her go. Then the woman in Room 84 codes again. Every 20 minutes, the staff brings her back. She has now coded seven times. ''This is something we don't do,'' Jen says. Jen's not religious or spiritual. She doesn't ask why things happen, what they mean. Or what comes after death. She's cemented in the here and now, multi-tasking through every moment. Making life and death decisions. Finally, the woman's son runs in. Two nurses help him put on a gown, gloves, mask and goggles. ''Would you like the chaplain to be here with you?'' asks a nurse. The son looks stunned. He swallows, blinks back tears, nods. He shuffles into the room, freezes and stares. Then he collapses on top of his mother. Through the door, Jen motions for a nurse to unstrap the machine that's keeping her alive. So her son can truly hug her. 5:50 p.m. Near the end of her shift, Jen's back is sore. Her knees ache. She's thirsty. No time to fill her water bottle. She keeps yawning. She can't stop thinking about the man who just lost his mom, and her own mom, who she lost in June to cancer.
A nurse from another COVID-19 ward comes to see Jen. She lost two people today and had heard ICU did, too. The nurses embrace, feeling each other's pain. At the end of her shift, nurse Samantha Bond comes to check on Jen and give her a hug. Workers on other floors hear each time someone codes. They knew two people already had died in the ICU that day. For the next half-hour, Jen works on scheduling, checks on her nurses, walks the ward one more time. When the night nursing supervisor comes, she briefs her on each patient.
Room 83: She's CMO. Comfort Measures Only. Room 84: The woman finally passed. But her son is still with her.
Room 86: This man brought pictures of his family. He told the ER nurse: Don't let me die.
Room 89: He's still prone, still struggling. He's got kids. He's not going to make it. ''But 93 is better, right?'' asks the night nurse, referring to the young mom. Jen drops her eyes and says softly, ''Nooooo.''. Saving sick people used to motivate her to keep doing this hard work. Now, she says, there's no joy to buoy her through the sorrow. ''You wonder: How long can I do this for?'' she says. ''I've definitely thought about what I want to do next. I want to work with dogs.''. She's grateful for her own health, her friends' and families' health. And that she finally convinced her 18-year-old son to get the shot. ''I had to bribe him with $100,'' she says. She's incredulous at co-workers who won't get vaccinated. BayCare doesn't require its employees to, but it asks each patient.
For a while, the community was cheering for health care workers, bringing so many meals they donated some to the food bank. This summer, the love seemed to evaporate. On the ''Heroes Work Here'' sign, someone added the word ''Still.''. ''I don't feel like a hero,'' Jen says. ''I feel helpless.''.
Maria Martinez sanitizes a room in the COVID-19 ICU, readying it for the next patient. The ventilation system in this wing has negative pressure, so contaminated air recirculates into the ducts.
6:10 p.m. Like most of the nurses, Jen will drive home in silence. Some try to process their day, so they don't take it to their families. Others try to block it out, so they don't have to relive it. Jen tries to not think about anything during her commute to Palm Harbor, which, of course, is impossible. When she gets home, she works out or walks her two dogs. Her kids don't ask about her day much. Her husband pours her a Chardonnay and lets her talk -- if she wants. He doesn't understand why she's putting herself through this. But this job is what she does. And who she is. She can't walk away. Not now. About the story. BayCare allowed a Times reporter and photographer to shadow a nursing supervisor through a 12-hour shift, with the condition that the patients not be identified by name. The journalists have both been vaccinated and wore protective gear. Within the next week, five more ICU patients would die.
By the numbers.
July - August 2020 for BayCare's 14 hospitals.
Average age of COVID patients: 75+. July - August 2021 for BayCare's 14 hospitals.
Average age of COVID patients: 45-58. More than 80 percent of them hadn't been fully vaccinated.
Tampa Bay Times coronavirus coverage by Lane DeGregory/Tampa Bay Times/ZUMA
