As coronavirus infections surged in Texas this summer, Houston Methodist Hospital opened one intensive care unit after another for the most critically ill.
We had unique access to one of the ICUs, where many patients or their families gave us permission to follow their care. In mid-July, more than 60% of the patients on this 24-bed COVID unit identified as Hispanic, compared with just over 20% among the hospital’s ICU patients without COVID. (Houston’s population is estimated to be 45% Hispanic.) It is a microcosm of the national picture, as the pandemic has disproportionately affected Latinos.
In the COVID medical ICU, machines beep to indicate danger, doctors sweep in to perform procedures, and patients experience alternating waves of improvement and decline. Veteran staff members said they have never seen so much severe illness and death all at once. Still, they maintain hope.
Many of these patients endure cascading tragedies, with multiple relatives struck by the virus. A man recovers and goes home from the hospital but leaves his critically ill wife behind. A patriarch with two dozen ailing family members fights for his life after attending his son’s funeral. A grandmother may die because she celebrated a grandchild’s birthday. A father of three undergoing cancer treatment is thought to have been infected at the hospital.
“It’s hurt me to see so many of my people,” said Lluvialy Faz, a critical care nurse on the unit who is Hispanic. “I feel like it’s really hit our community, and my community, more.” She teared up as she spoke.
“On the news they’re always like, ‘People are partying. People aren’t taking it seriously,'” she said, but the patients she has treated have been “working people, family people.”
“I’m not seeing the person that went out and got drunk and got COVID,” she said. “All I’ve seen is the grandma and the aunt.”
A Last-Chance Treatment
Irving “Ivan” Sanchez, 30 years old, Room 13
Ivan’s mother, Marta Sanchez, who cooks and cleans at other people’s homes, worried that she had infected her son. Ivan’s brother, Javier Sanchez, works part time at Methodist and wanted a chance to apologize for an argument they’d had. The family joined in prayer for Ivan, who has epilepsy and has served in the National Guard and the Army Reserve.
Ivan was admitted to Methodist Hospital on July 6. His coronavirus pneumonia was so severe that he was soon given a breathing tube and a ventilator, but he continued deteriorating. “We are stuck,” his doctor, Daniela Moran, said July 14.
There was one option left that might save his life: extracorporeal membrane oxygenation, or ECMO, treatment that would add oxygen to his blood directly, allowing his lungs to rest. As a cardiovascular surgeon, Erik Eddie Suarez, connected Ivan to the machine, Javier wished for a second chance with his brother.
“Over the years we kind of grew apart,” he said. “I’m just hoping that he recovers. Every day I pray. So does my mom.”
Ivan has slowly improved, and he successfully came off the ECMO machine July 29. He is still on a ventilator. Doctors hope that he will be able to breathe on his own again.
The Delivery Worker
Edwin Garcia, 31 years old, Room 23
Edwin loves his family and Astros baseball. He worked delivering Dr Pepper to grocery stores and stocking their shelves. And even though he wore a mask and carried hand sanitizer, his family believes that he caught the coronavirus on the job.
Edwin was admitted to Methodist on July 9 and was put on a ventilator the next day. Doctors wanted to turn him on his stomach, a technique known as proning, to try to improve his oxygen level, but his weight posed a challenge. A team arrived to help keep all his tubes and intravenous lines in place as they executed a series of movements to rotate him on a twin-size hospital bed.
Family members were distraught that they could not be at the hospital, which had stopped allowing visitors to help prevent the spread of the virus. As Edwin lay in the ICU, his mother, Rosa Garcia, described the son she missed but could not visit.
“He’s a good boy. Studious, very hardworking. He has a big heart,” she said. “He’s a perfect person. And so my heart is fragile right now, having my son in the hospital and my other daughter in the hospital in Dallas.”
The family prayed over Edwin by video whenever a nurse could bring a tablet into the room. Moran gave the family hope that his youth would help him recover. He was on a ventilator for more than a month and slowly improved. As of last weekend, he was off the ventilator and required only a small flow of oxygen from a tube under his nose. His sister who was hospitalized in Dallas has recovered and been discharged.
First a Transplant, Then the Virus
Ana Flores
49 years old, Room 18
Ana and Domingo Flores were high school sweethearts who married and now have three children. They believe Domingo caught the virus from a colleague at the petrochemical plant where he works. Domingo was admitted to Methodist Hospital for COVID pneumonia on June 29, and within a few hours Ana was admitted, too.
Domingo had donated a kidney to Ana in 2018. Now, with the virus, doctors worried that the kidney might fail. And they didn’t know whether the medicines she took to keep her immune system from attacking the transplanted organ would make her more vulnerable to the virus or, in fact, help protect her body from inflammation.
For days, Ana was so sick that any stimulation — even someone entering her room — could cause her oxygen level to drop and her heart rate and blood pressure to skyrocket. Three weeks after she was admitted, Ana’s lungs had improved enough for her to breathe on her own, and the medical team awakened her.
“Slow, deep breaths, OK?” Moran coached her as the breathing tube was removed successfully. “You did so good. You are the star of the day today.”
On Aug. 12, Domingo picked up Ana at the hospital and finally brought her home. “I feel so happy,” he wrote in a text message.
The Indomitable Grandmother
Rosa V. Hernandez, 72 years old, Room 21
Rosa took COVID seriously, but she let down her guard to celebrate her granddaughter’s eighth birthday with a small group of relatives, several of whom contracted the virus. To support her breathing, doctors ran a tube under her nose that supplied a high flow of oxygen. She also received the antiviral medicine remdesivir and an experimental drug, and she seemed to be improving.
But on the Fourth of July, Rosa began working hard to breathe. She refused at first to be put on a ventilator, but after Dr. Mukhtar Al-Saadi said that her oxygen level was dangerously low and that she would be asleep for the procedure, she agreed to it. Inserting the breathing tube was unexpectedly challenging because of bleeding in her airway, and he succeeded just in time to save her life.
For the first two days on the ventilator, Rosa did not improve, and doctors were running out of options. Then slowly, her lungs began to recover. After she came off the ventilator, she described how the experience had changed her.
“I thought, as much as I believe in all this, it can’t happen to me,” she said. “What have I learned? The value of life, the value of family.” She added that it was important for people with COVID not to give up. “None of us are invincible. I guess I thought I was. If I could help one person, I would.”
Rosa reached every milestone the medical team set for her, and then opted to go directly home instead of to a nursing home for rehabilitation. “She’s an example for all of us,” Moran said. “I’m blessed I was part of her care.”
Fighting Two Battles
Hector Rodriguez Montes, 30 years old, Room 19
Hector, a hardworking, sociable father of three, and a lover of dancing, Mexican music and horses, came to Methodist in late June for symptoms related to metastatic cancer. He received high-dose chemotherapy and a bone marrow transplant, which doctors believed had a chance of curing him. But the treatment also hobbled his immune system, lowering his defenses against infection.
Days later, Hector developed a fever, diarrhea, vomiting, cough and difficulty breathing, and he tested positive for the coronavirus. Doctors thought he caught it at the hospital, despite many precautions taken to prevent its spread. He was offered the last spot in a study of experimental plasma treatment, but he was confused and declined it.
His wife, Nancy Bravo, said the coronavirus’s biggest threat was to vulnerable people like her husband. “Society needs to protect the weak and the sick,” she said. “He’s just a really good person with a lot of desire to keep living and fighting for his kids.” From his hospital bed, he urged people to take the virus seriously.
“This is not a game,” he said. “This is real. To all the people who don’t think that coronavirus exists, it does exist. Just look at me.”
On July 22, Hector had an unexplained seizure and doctors inserted a breathing tube to save his life. He remained on a ventilator, with medications keeping him deeply sedated. His condition worsened precipitously in early August, with evidence that his cancer was spreading, too.
“Just don’t disconnect him, because a miracle can happen,” Bravo pleaded, and doctors kept treating him. She asked to visit, but was told it wasn’t possible because of the pandemic. Instead, the family joined in prayer on video calls, with a staff member pointing a camera at Hector.
On Saturday, Aug. 15, Hector died.
c.2020 The New York Times Company
