Inside Parkland Memorial Hospital’s COVID-19 unit, the caregivers’ eyes — alternately flashing determination, fatigue and sorrow — provide the only clue to the mental health toll this crisis is taking on even the most resilient staffers.
Encased from head to toe in protective plastic, many of these women and men have been in this firefight for more than three months. As we walked the Tactical Care Unit on Saturday, they acknowledged the weariness and mental strain that I had seen in their only unmasked human feature.
Each wrestled with how to convey this deep distress, but fell back on some version of “people are just so very tired.”
They don’t have the time — or energy — to give it more thought than that.
“No matter how hard you work and how much you do, more people are sicker and more are dying than ever,” nurse Perla Sanchez-Perez said. “It’s been really, really difficult.”
Like all of the 300 staffers who make up this team, Sanchez-Perez volunteered for this job — and she’s intent on pushing forward.
Samantha Rowley, senior vice president of nursing and surgical services, was blunt about what we saw Saturday: “People are exhausted. People are mentally drained. People are going through turmoil and distress.
“But they are managing to come back every day and fight through it because of that resilience and grit and their desire to be here.”
All of the Parkland bosses see the grooves of stress being worn into their staff; a team is already in place to oversee what they know will be a long-term effort to help caregivers deal with the residual trauma.
For now, supervisors work to get people a few days off and encourage the staff to use internal mental health resources such as the weekly wellness webinars and one-on-one counseling. Leaders will attempt the silliest thing — say, a flash mob outside the Tactical Care Unit windows — if they think it will bring even a moment of joy to the caregivers.
But with each week of this unprecedented health nightmare, the caregivers in “the red box,” as the COVID-19 unit is informally known, are mostly leaning on one another for emotional support. They say their best comfort comes from knowing they are working side-by-side with other people who get it in a way that those of us on the outside will never comprehend.
“We were hoping it was dying down but it’s getting worse, unfortunately,” nurse Liyu Daniel told me Saturday, her eyes never wavering from a vital-signs monitor. “But the passion in all of us is still here, and we support each other with that.”
She said with a laugh that “Dr. Leveno was asking me the other day if I was going to take time off, and I said there’s nothing I would do other than think about being back here.”
Daniel was referring to Matt Leveno, the unit’s medical director, who says all the credit goes to the people who make up the red box team. “We sustain each other,” he said as we walked past bed after bed of unconscious COVID victims.
There’s no time for introspection or reflection, Leveno said. ”It’s eat, sleep, take care of yourself as best you can. … You aren’t really processing it. You are just doing your job.”
Dr. Joe Chang, Parkland’s chief medical officer, and Rowley, the Parkland executive responsible for the COVID unit, offered example after example of the sacrifices made by their caregivers:
The nurse who volunteered only to have her roommates kick her out of their shared apartment because of coronavirus fears. Another who sings a lullaby over FaceTime each night to her daughter from the ward. The doctor who was on duty in the unit when his father passed away, then returned just a day or two later.
Some staffers with high-risk family members continue to live in temporary quarters. Mothers and fathers require 45-minute cleaning regimens before they can hug their kids.
And there’s no end in sight.
“At some point in time, we are all going to collapse from pure emotional exhaustion and I have no clue what that tsunami looks like,” Rowley said.
After spending part of Saturday in the Tactical Care Unit, I checked in Tuesday morning with three Parkland nurses who have worked inside since it opened in March.
Sanchez-Perez, Tyler Brookshire and Otto Madrigal had just come off their 12-hour shift, which they described as a much-needed “good” one: It was hectic — organized chaos, they said — but unlike so many recent nights, no one had died.
Sanchez-Perez said she lost two patients back to back last week and couldn’t help but feel defeated.
She monitored those patients as their families — who, like so many, watched over their dying loved one via a remote Zoom screen. “They are saying goodbye and crying for hours,” Sanchez-Perez said. “A patient doesn’t just pass away in an hour. It’s hard to see them suffer through it all so publicly.”
To protect her own loved ones, including her toddler, Sanchez-Perez mostly confines herself to a makeshift living space in her family’s garage. Since the recent surge in COVID cases, she sees her daughter only once a week.
“I still don’t feel comfortable touching her,” Sanchez-Perez said. “I haven’t had any symptoms but there’s always that part of me that questions, ‘what if?' … When I do touch her, I’m wearing an N95 [mask] and gloves.”
While Sanchez-Perez runs to relieve her stress, Madrigal tries to shake off what he described as “this heavy weight on my back” by jogging with his dogs, working out in his garage and learning yoga.
He hasn’t seen his young daughter, who lives in El Paso, for more than three months.
“I’m still calling her every single day via FaceTime and hopefully at the end of July, I’ll get out to see her.” But even that long-awaited visit is uncertain due to the growing COVID cases statewide.
Madrigal avoids looking at the news because hearing that coronavirus naysayers still question the seriousness of this health crisis leaves him frustrated and angry — especially when he considers the mental and emotional toll this long fight is taking on his Parkland team.
“But we’re still holding our heads up high and just giving it our all every single day,” he said.
As a supervising nurse, Brookshire doesn’t develop as close attachments to individual patients as his colleagues, but he still feels the deaths keenly. “A lot of them have been with us for a while — some a couple of months.
“To be rooting for them and then see them not make it is kinda rough.”
Brookshire stays in a local hotel Monday through Friday and FaceTimes twice a day with his family.
Going home on weekends is a big stress reliever, but each Monday, Brookshire’s children hold on to him and beg him not to leave for another week. “It’s frustrating that those people who don’t think it’s real don’t have to go through what we go through,” he said.
Rowley and Leveno understand that, with each day, the situation is getting more difficult. For now, their best response is to create an environment within the Tactical Care Unit that allows the staff to know it’s OK to be more vulnerable and understand “they have permission to suffer together,” Rowley said.
Chief medical officer Chang is confident of Parkland’s ability to deal effectively with the virus at the heart of this pandemic. His big worry is the fatigue and mental strain on a staff that has fought for months while outsiders downplay — or deny — the disease.
What he’d like all of us to do — along with wearing our masks, washing our hands and practicing social distancing — is to go out of our way to thank anyone who works in a hospital.
“Let them know that what they are doing is seen and you know it matters,” Chang said.
“We will eventually win. But we just want to be intact when we get there.”
