Photo by Miguel Gutierrez Jr./The Texas Tribune
Editor's Note: This story was originally published July 2. Since then, the number of COVID-19 hospitalizations in the Trauma Service Area (TSA) that includes Cameron, Hidalgo, Starr, and Willacy counties has climbed from 693 to more than 1,500, including more than 400 in ICUs. The Texas Medical Association is reprinting this story as a first step in drawing attention to the crisis in the Rio Grande Valley. The opinions expressed in this story do not necessarily reflect those of TMA.
EDINBURG — At midnight in South Texas, nearly every bed is full in a low-slung building housing some of the sickest COVID-19 patients near the U.S.-Mexico border.
Many patients in this unit, a hospice center at Doctors Hospital at Renaissance remade into a coronavirus ward, are sedated, intubated and attached by a tangle of cords to the whirring and beeping machines keeping them alive. Some are in individual rooms; dozens more are lined up in vacated bay divided into a grid by curtains to separate beds.
“How many more are coming?” a nurse asks around 11 p.m. No one can be sure.
Some of these patients will go home and complete their recoveries. Others will leave to be buried.
The Rio Grande Valley has seen a surge in coronavirus cases, and the patients arrive daily. At least 10 were brought here from the emergency room Wednesday. More than a dozen the day before that. Some nurses tend to three patients each, instead of the usual two, and pick up extra hours. A lead nurse who clocked in at 6:45 a.m. Tuesday was still working past 10:30 p.m. Another, on her fourth 12-hour shift, said she’d seen things she will “never unsee
“We're getting more and more and more, and that's the problem,” said nurse Apryle Pelshaw. The blaring alarm that signals a patient needs to be intubated or is having a medical emergency sounds in her sleep.
Similar scenes are playing out in hospitals across the Rio Grande Valley. The number of people infected in this predominantly Hispanic four-county region — Cameron, Hidalgo, Starr and Willacy — has climbed from 1,391 to 7,600 since the beginning of June, and Republican Gov. Greg Abbott directed some of the region’s medical facilities this week to stop elective procedures to free up hospital beds.
At a press conference this week, officials from a half-dozen of the region’s hospitals said cases were rapidly rising, stretching their staff and filling up beds. Sometimes whole families were coming in. A county health authority who attended the press conference found out he’d tested positive that day.
At Valley Baptist Medical Center in Brownsville, there were so many patients in the hospital’s holding area and emergency room that a space for elective surgeries was emptied a few days ago to make way for another coronavirus unit. That center is filling up now, too, and there are intubated patients there, said Dr. Jamil Madi, who works there and at Valley Baptist in Harlingen, where he’s medical director of the intensive care unit.
“We can handle small surges and clusters; it's not a big deal. But when you get this continuous surge ongoing hour after hour — you see these patients and they are all coming in with the same symptoms huffing and puffing, some of them are gasping for air and some of them are confused because of the lack of oxygen, and they're elderly and they're young and they're distressed and they're agitated, and then there are no family members around,” Madi said. “It is draining.”
The U.S. Centers for Disease Control and Prevention has found that Hispanics are hospitalized for the coronavirus at about four times the rate of white people and cited “long-standing systemic health and social inequities.”
The Rio Grande Valley — which includes South Padre Island, a party destination — has a median household income of around $34,000 and a large number of residents with comorbidities that can make them more susceptible to becoming severely ill with the coronavirus. Officials here have tried for months to stamp out the virus, quickly ordering residents to stay home in March and even setting up checkpoints to enforce compliance.
But infections have shot up in recent weeks after Abbott let businesses reopen and barred local officials from forcing residents to wear masks. (He reversed course Thursday and required people in all counties with 20 or more cases to cover their faces.) There have also been occasions to gather, further driving up the spread: Memorial Day, graduations, Father’s Day and a regional penchant for backyard barbecues.
“When people say it's conspiracy, it doesn't exist or really [exaggerated], my response would be: Come to our emergency department where we have five people on ventilators for three days. Come to the three floors we've had to use to put these people on. Come to all the health care workers that go home every night, every little cough they're sure they have it. We're in tough times,” Dr. Ivan Melendez, Hidalgo County's health authority, said at the press conference.
DHR Health, which has hospitals and dozens of clinics throughout the area, spent $9 million converting its hospice center into a COVID ward in March, when cases first started to spread in Texas. It housed two, four, six patients for weeks. But the numbers began multiplying in late May, and with nearly 80 patients in late June, hospital officials decided to turn a nearby rehabilitation facility into a second ward for COVID-19 patients on the mend. With the volume of patients not abating, they’re adding dozens more beds.
Local officials eye the filling hospitals with trepidation.
Hidalgo County Judge Richard Cortez requested state aid and imposed a nighttime curfew to dissuade people from gathering in groups. Two congressmen asked the governor to help avert an “impending health care crisis” by sending in the National Guard to provide medical support, and to erect field hospitals. They had not heard back by Thursday afternoon.
“We’re very concerned,” Cortez said Monday. “I’m not blaming the governor for anything, but since the governor opened up Texas, the numbers have been escalating, and … they’re at the point where we’re getting close to capping out on our hospital capacity.”
The strain is already evident at DHR Health, where eight physicians are quarantined with the virus.
Doctors and nurses are working extra shifts, with hazard pay, and administrators are setting aside bonuses to reward medical staffers who have worked for weeks with little respite. They’ve been stocking up on personal protective equipment since March, even asking staff to sew face masks.
The system's coronavirus units are apart from the emergency room, where patients with appendicitis, strokes and the like continue to be treated. Patients that come to the ER and have coronavirus symptoms are immediately sent to another site for screening. If they test positive for the virus and need to be hospitalized, they’re sent to one of the new offsite wards, which are staffed 24 hours a day, with shifts starting around 7 a.m. and 7 p.m.
Pelshaw’s night shift Tuesday began in what was the hospice center’s “meditation room,” a curtained dressing room that now teems with nurses snapping on periwinkle gloves and gauzy hair bonnets. Then it’s into the infectious disease unit, where staff members who worked during the day pass patient information on to those who’ll care for them overnight.
Most of the patients Tuesday were elderly, some with underlying health issues common in the Valley, like diabetes. Several members of one patient’s family had already tested positive for the virus. Another woman’s daughter called Pelshaw around 8:30 p.m. asking to say a prayer for her mom.
“Do you have any idea what room she's in, ma'am?” Pelshaw asked over the mechanical whirring and the beeping of the intravenous pumps.
Pelshaw’s wing had the sickest of the sick, 23 patients, 17 on vents, each kept in an individual room with an IV pole outside in the hallway, so nurses can make adjustments with minimal exposure. At the center is the hospice’s break room — once a place where elderly residents visited with family members. It now holds shelf after shelf of supplies — tubes, lubricating jelly — and five ventilators in a corner. There’s a case of refrigerated medications in what was once the “kids room.”
The patients who are slightly less ill are in a cavernous wing on the other side of the building, their beds arranged in rows and separated by high blue and white curtains. Many were prone and unconscious Tuesday night.
Nurses worry about the mental toll the pandemic is taking on their colleagues. About eight patients have died in the last two weeks, leaving hospital staff to break the news to family members who were not allowed to visit the infectious disease wards in person.
There’s the strain of trying to support patients while dressed “like an alien,” as Pelshaw described it, gesturing at the scrubs, gown, face shield and masks she was wearing. There’s the intense workload. And there’s the constant worry about their own families and the possibility they might carry the disease home with them.
The unit has a disinfection section where protective equipment is stripped off and discarded, or set aside to be cleaned and reused, and an area where medical staff members can shower before leaving. No medical staffers have gotten the virus from working in the coronavirus ward, hospital officials said.
“We hold it together, and I think we go out into our vehicles and cry,” said Pelshaw, hovering in a hallway above a monitor with her patient’s charts. Then they collect themselves and come back to work.
The hospitals most urgently need additional staff, not just nurses but the phalanx of respiratory therapists, nursing assistants, specialists and technicians that circulate through the DHR Health ward.
Some help is coming. The state sent medical workers to Hidalgo County, and visiting nurses in black scrubs have already begun checking in to nearby hotels. Chris Van Deusen, a spokesperson for the Department of State Health Services, said the personnel are sourced through BCFS, the agency’s “medical sheltering contractor,” and that the costs are expected to be reimbursed by the federal government.
Another patient on the way
Late Tuesday in the DHR Health coronavirus ward, medical staff members tried to put a needle into the artery of one of nurse Christian Ramirez’s patients. Her blood pressure dropped, and Ramirez rushed to adjust the medications. He watched her blood pressure stabilize, standing amid discarded gloves strewn on the ground in the frenzy.
“She didn’t deserve this,” he said of the patient, who had patches on both cheeks holding her endotracheal tube in place. “My other two patients don’t deserve this.” All three needed critical care, two on ventilators, one on a nasal cannula and “maxed out on oxygen.”
The patient’s blood pressure suddenly shot up, and Ramirez darted to adjust her medications again, the green light of the machine reflecting on his face shield.
The people that wind up in this coronavirus ward are seriously ill and “require a lot of attention, a lot of medications,” said Veronica Gomez, director of the unit. Two or three typically need to be intubated each shift. One doctor said he’d intubated five patients in one morning.
On top of that, nurses have become the patients’ entire support system because family members aren’t allowed in. They’ll help connect patients and family by phone, and “we can hear the anguish on the other side of the phone line,” said Gomez, who’s been a nurse for almost 20 years.
Not long before midnight, word came that a patient would be transferred over in an ambulance. One of the critical patients in the former hospice building had improved enough to move to a bed in the emptied bay. Their old room was being cleaned. A woman traipsed out with bagged-up trash. Ramirez began moving in supplies.
Another patient was on their way. Ramirez would be there to treat them.