From outside the sliding glass doors of an ICU room on the third floor of Bakersfield Memorial Hospital, nurse Jaclyn Moore peered in at a patient.
The woman, a COVID-19 patient connected to a breathing machine, had been shifting her head back and forth moments earlier. Now, she seemed calm.
“It’s the first time all day she doesn’t seem uncomfortable,” Moore said.
It was noon and quiet in the unit, one of two in the hospital that has eight intensive care beds for the sickest COVID-19 patients. Almost every bed was occupied. Two other units in the hospital held about 45 less critical COVID-19 patients.
The hallways are sparse but the hospital is teeming with close to 60 COVID-19 patients, many struggling to breathe and maintain oxygen saturation in their blood. Nurses, nurse assistants and respiratory therapists, wearing yellow paper coats, masked and donning face shields, are busy logging patient updates into computers and entering the rooms of patients, many of whom require constant vigilance.
It’s not like the scenes from New York with patients in hallways and people rushing to tend to them. Not yet, anyway. But every so often, the scattered yellow coats come together at one room in a flurry of activity. A patient struggling to breath, their oxygen level plummeting. Or their blood pressure crashing.
"There's definitely a lot more anxiety," Moore said. "It's easy to see something happening and run into a room and then, crap, I forgot my face shield."
Moore said she's lost weight in recent weeks from the sheer intensity required on her shifts.
As Bakersfield's hospitals fill up, the work of hospital staff, from doctors and nurses to janitors and kitchen workers, has become exhausting and overwhelming. With COVID-19 raging throughout Kern County, these workers arrive to work each day to find more people in beds, who are sicker than typical hospital patients and suffering alone without family by their side.
These front-line workers spend 12 or more hours tending to patients, fielding calls from anxious loved ones wanting updates and holding a hand as a heart stops beating. Then they go home, often still thinking about their patients or mentally preparing to see their families, stripping out of scrubs in the garage and heading straight to the shower, trying to hide from any small children who might run in for a hug or kiss too soon.
"Going into work you never know what you’re going to get into, especially in health care. But with COVID it’s that times 10," said Tyler Phelps, a respiratory therapist at Bakersfield Memorial. "There’s so much pressure and you never know if you’ll have enough staff."
Respiratory therapists play a critical role in treating COVID-19 patients because the illness targets the lungs and so many struggle to adequately breathe.
“It's like a constant panic attack," Phelps said of patients who are short of breath and unable to get enough oxygen.
It's not like you just exercised and feel out of breath. It's not even like having pneumonia, he says.
"It’s a whole different ballgame," said Phelps, a 36-year-old father of four. "You see the patient afraid to move. Just trying to adjust their position on a bed winds them."
Respiratory therapists, among other duties, set up patients on ventilators, a key piece of equipment in treating the most critical COVID-19 patients. That also means shutting down the ventilator when a patient has no hope of recovery. With visitors restricted and no family at the patient’s side, Phelps and his colleagues have also taken on the role of providing support and comfort in those final moments.
One of his first COVID-19 patients who died was a 95-year-old man who developed organ failure.
"I thought, this patient has been living on this planet for 95 years and this is the end, in this room, without their loved ones holding their hand, saying goodbye. It was me and our nurse," Phelps said. "This is what we’re dealing with. People are dying alone."
Phelps, whose wife is an ICU nurse at another local hospital, also has the added worry of being as careful as possible not to contract the virus and spread it to his family. He described a constant fear that comes on at the end of his shift, as he heads home to his kids — ages 2, 4, 6 and 8.
"It’s that drive home, wondering if you were as safe as possible. Did I accidentally breathe something I shouldn't have?" he said. "It’s a gut-wrenching feeling."
Many of the medical workers said this was the most challenging time of their careers.
Dr. Amy Mehta, a pulmonologist who is part of a three-doctor team treating the hospital's COVID-19 patients, described long days and an increased patient load. In addition to that, she and her colleagues are treating a disease about which little is known. There are no known cures for the coronavirus and the few therapies available are in short supply.
“We were doing OK but in the past three or four weeks we have gotten a lot more patients and I think that’s coincided with opening everything up," said Mehta, a Fresno native. On Friday, she was heading into her first weekend off in weeks.
“I have little kids so being at home is my way of decompressing. They’re so innocent and playful. That’s my way of forgetting about everything,” she said.
Anna Leviyeva, a 34-year-old ICU nurse at Bakersfield Memorial, said working in the ICU is known to be hard "but this is different because it’s so drawn out, because it's weeks and weeks and we get so invested in it."
The native of New York City and daughter of two Russian immigrants who were both doctors has been a nurse for close to five years.
She recalled one of her earliest COVID-19 patients, an otherwise healthy Hispanic man in his late 50s or early 60s. He had difficulty breathing and ended up in the ICU, Leviyeva said, but he wasn’t as bad off as some other patients. He could get up, use the bathroom on his own and feed himself, she said.
But Leviyeva returned to the unit one day and the man was on a ventilator. After two weeks, his feet turned black and necrotic, a sign, she said, that a COVID patient is reaching the endpoint. And in his third week there, he died.
ICU nurses care for patients in their most critical point of illness, but watching someone slowly progress through it that way struck her, she said.
One of the hardest parts of the job for Leviyeva has been calling families to deliver the news that a loved one has died.
Normally family is there in the room. There is no need to describe in words how the patient passed. Or that a nurse was holding his hand so he wasn’t alone.
"It’s very difficult to call the family. You don’t have words for it,” said Leviyeva. “It kind of feels like you’re not doing enough."
But she has taken heart in the camaraderie and cohesion she feels with her colleagues, who turn to each other for support both in their work and processing the emotional side effects of it.
"It’s not a one-man sport, nursing, at all. Ever," Leviyeva said. "We’re a lot closer. I feel like we’re in a war, like a little squadron. We’re working so well together and have each other's backs."
On the fourth floor of Bakersfield Memorial on Friday, Pedro Cortez was lying in a hospital bed in a blue and white gown with an oxygen cannula at his nose.
He was in one of two 30-bed units for less critical COVID-19 patients.
He held up a casted left arm, explaining in short bursts that he had broken his wrist. When he came to the hospital, he was tested for the virus. It was positive. He’d said he hadn’t felt well, and then his symptoms got worse and he was struggling to breathe. On Friday, he was feeling better and expressed his appreciation for the care he was receiving as nurse Angela Bilyeu flushed his IV and checked his oxygen levels.
Bilyeu later explained she frequently checks on Cortez’s oxygen level because even with less critical COVID-19 patients, just talking can cause oxygen saturation levels to go down.
"We were told we peaked out in early April," said Terri Church, vice president and chief nursing officer for Memorial Hospital and Dignity Health Central California Division. "Our next peak wasn’t supposed to be until winter."
But then patients began to stream into the hospital. Many said the uptick began after the stay-at-home orders were lifted and the county began reopening in early June.
On June 1, there were 63 patients hospitalized for COVID-19 in Kern County. That number has now quadrupled, reaching a high of 280 early last week. Public health officials announced Thursday that all 10 Kern County hospitals had reached capacity and were starting to roll out surge plans to increase beds. That would also require finding hundreds more health care workers to staff those additional beds.
Memorial Hospital is licensed for 420 beds but typically operates at about 280 staffed beds. Under surge plans, the hospital will start to add 60 more, half of which will be ICU beds, said Michelle Willow, director of external communication.
COVID-19 is an intensive sickness and requires more staff to treat each patient, so even a well-staffed unit gets spread thin quickly, said Dustin Neefus, nurse manager of the ICUs at the hospital.
Some on ventilators require "proning," Neefus explained, where the patient is placed face-down for up to 18 hours in order to get better oxygenation. That process of flipping the patient who is attached to monitors and a ventilator typically requires up to seven staffers to accomplish, Neefus said.
On top of that, nurses who are older, immunocompromised or pregnant can’t work in COVID-19 units, further limiting staffing.
“It was scary at first but I think everyone has risen to the occasion,” said Neefus of his nursing staff.
Many of the health care workers interviewed said it's a huge misconception that only the elderly or those with preexisting conditions get deathly ill from COVID-19. It affects people of all ages — in their 20s and 30s and 80s and 90s, they said.
Nearly everyone expressed frustration at the difficult work they do in the hospital and the distance they’ve kept from their own families only to be driving in their car or scrolling social media and see people who don't take the virus seriously, or refuse to wear a mask, or continue to gather with others.
They wished those people could take a tour through the hospital and see patients hooked to machines, hear their wheezing and labored breathing, or see the fear in their eyes when told they have to go on a ventilator.
"I'm hoping the public will know it's not a hoax, it's real," Church said. "Wearing your mask is very important."