"9-1-1 operator. What’s your emergency?”
“Don’t hang up, help is on the way!”
The ambulance swerves past traffic, its lights blind, its siren screaming a loud-ear splitting wail. The clock is ticking. The team has eight minutes to arrive at the destination before it’s too late. The adrenaline rushes through her body. This feeling is nothing new. Nicole Johnson, a 23-year-old paramedic in Rockwall, Texas does this every day on repeat. Every day is something new and unpredictable. To a regular person, this can be scary. But to her, this is just Monday.
They arrive at the house. She steps out of the vehicle, pulls up her dirty blonde hair, pushes up her glasses, and rushes inside.
“Hello, we are here to help you. Can you tell me what the problem is?”
The woman lies there restless and doesn’t respond. There is swelling around her left eye and her shoulder looks out of place. Johnson should keep her distance but has no choice and remains close.
“Have you traveled recently? Have you been exposed to COVID-19?"
She keeps these same questions locked in her head- the same questions she has asked every patient since March 2020, after she had only been on the job for a month. When she started responding to calls, she would wear a blue T-shirt with her name plastered across it with a matching jacket and pants, and no mask to cover her face. Now she must wear a gown, and she doubles masks with N-95s. With every house and every call, the tension is high. She never knows what she would face walking into someone’s home. She has to step in and be careful not to touch anything. She could contract COVID-19.
Her mind races as she helps the woman with the busted shoulder onto the gurney and into the ambulance. The woman cries out in pain and Nicole assures her everything is going to be alright. If only she felt the same way about herself. Every time she answers a call, she puts her life on the line.
Millions of healthcare workers face these same situations. Nurses, doctors, EMTs, and many others. Their risk is higher and their daily challenge is harder. Becoming infected with COVID-19 is more likely due to a higher volume of sick patients. According to a report by Kaiser Health News, more than 2,900 health care workers have already died because of the pandemic. Even with the longer hours, the greater pandemic risk and the emotional toll on their health, they have one common goal in this war zone: to save lives.
Nicole isn't the only one waging this battle. Two other women interviewed who are in the healthcare profession have been forced to manage the unchartered waters of the pandemic as they do their jobs. A paramedic, an internist, and a physical therapy student. This is their story.
From dawn to dusk, Dr. Elena Inglehart handles everything that comes her way. It’s a part of her job. She’s an internist for the past eight years at the Methodist Hospital Specialty and Transplant in San Antonio, Texas.
Inglehart didn’t always know she would work in the hospital. Originally, she liked family medicine. But with her love of the human body, she grew to love working in a hospital.
“People can come in with weird symptoms, and I get to play 'House' and figure out what’s wrong,” Inglehart said.
Before COVID, it seemed as though her life couldn't be more perfect. She and her husband were making good money, which allowed them to have fun and travel, even with her schedule of working 10 days straight and five days off. She was able to see her family and friends when she had time. The couple even had a special surprise at the end of 2019.
“I found out I was pregnant.”
They couldn't be more excited, bringing another life into the world- a beautiful baby girl. Inglehart couldn’t wait to plan her shower and "gender reveal" in the upcoming months. But that world came to a halt in March 2020.
“It’s an influx we have never seen before.”
Patient after patient with COVID symptoms came into the hospital to be treated. Doctors placed COVID patients into three separate COVID units: COVID patients who were feeling OK, patients who were feeling ill, and patients who were placed in COVID ICU. The three wards made up their own hospital wing where patients were locked in their rooms, unable to see family or friends. Inglehart’s confidence in how to handle patients slowly started to dissipate.
“We pride ourselves on finding out what’s wrong with you and then treating it,” she said. "This virus is now something we can diagnose but treat it? There’s no treatment. Every individual is different. We only have three or four things we can give you. We kind of just have to sit there and wait.”
This uncertainty grew fast in only a few months. There was no telling when the hospital would run out of PPE or ventilators. A surge in patients kept everyone on their toes. Inglehart was seeing between 30 to 40 COVID-patients a day. The hospital had to open up more rooms and units for COVID patients and turn away other incoming patients. They were treating people for a deadly virus and had no idea if they might contract it themselves.
“ We are at war with this virus,” Inglehart said. “It’s not just us. It’s nurses, nurse assistants, administration, and everyone else. A war we were not prepared for.”
One of the hardest challenges besides treating the sick and remaining healthy was consoling the families of patients.
“Those patients are lonely,” Inglehart said. “ Their family can’t come to see them, so I talk to them. They are locked in there like prisoners. They are sick, lonely, and scared.”
Inglehart’s responses to families started feeling like a broken record.
“It’s getting better.”
“It’s not getting better.”
“They are slowly dying.”
“Unfortunately, they have died.”
She had bookmarked the website of the Bexar County Medical Examiner’s office, because she was filling out so many death certificates.
At the same time, her uncle was admitted into the hospital--and he wasn't getting any better. She felt overwhelmed, taking care of patients and their families- and now her own family wanted to know how her uncle was doing-- plus she was pregnant. She couldn’t cope, feeling anxious and fearful for the baby she was carrying.
When her uncle passed away, she couldn’t hold in her feelings anymore.
“I had to realize it was a lot,” she said. “ It wasn’t that it was too much, but my emotions are valid. It was a hurt like no other, and that was the hardest moment for me.”
She grew concerned the stress and anxiety she was feeling might affect her unborn daughter. She chose not to attend her uncle’s funeral, and to engage in more self-care.
She saw a therapist twice a week and stepped away from her duties at the hospital, instead practicing telemedicine from her home. She cooked more and took up a few hobbies including photography and calligraphy. She and her husband took daily three-mile walks growing closer with their neighbors.
“ I was that pregnant girl walking the neighborhood. They knew my baby’s name and when she was going to be born. I got gifts from neighbors that I didn’t even know existed.”
Even though the couple knew the gender of the baby in February, they still did their own reveal. Her OB/GYN made a card for the reveal and videotaped it for friends and family. She didn’t just have one Zoom -- she had four.
“Even though I couldn’t see my family in person,” she said. “I still had fun. I was still able to celebrate. It was simply different.”
On Aug. 12, at 40 weeks of pregnancy, her doctor induced labor. The day before, she and her husband got COVID tests. Her husband was the only visitor allowed in the room with her. They both wore masks. Throughout the labor, she grew fearful about COVID and the birth. But her husband made her feel safe.
“I’m not in control of the virus. All I can control is myself and remain calm to make sure I can deliver a healthy baby.”
Around 9:49 p.m., she gave birth to a beautiful baby girl: Daniela Luz Inglehart.
Twenty-three-year-old Ciara Donnelly enters Baylor Scott & White in Dallas for another day of clinical observation as a physical therapy student at Baylor University. To get her license, she must participate in these observation hours, which allows her to watch what a practitioner does. Donnelly wears her N-95 mask covered with a surgical mask leaving a mark down her nose from wearing it all day. This is her first shadow experience at the hospital, and as she walks around the treatment floor, she notices how everyone keeps their social distance.
“I had no idea what I was walking into,” she said.
But, Donnelly didn’t get to actually see any patients. She was forced to watch by peeking into hospital rooms through blinds if patients were suspected of having the virus.
Donnelly didn’t always want to be in physical therapy (PT). Growing up, she literally stumbled on the idea after playing in a high school soccer match.
“My freshman year I nearly tore one of my hamstrings, so I’d go to PT. Even though the process was painful, I really enjoyed it.”
This made undergrad at Mississippi State a little easier with having a clear vision of what to do. Her senior year she started applying to grad school programs and was accepted into Baylor University in Waco, Texas.
She started her classes in January of 2020. They were supposed to be online for six weeks and then move to Waco for hands-on training labs with 100 other students. When they made it to Baylor, the program received unexpected news.
“They brought us together and didn’t know how the program was going to play with COVID,” Donnelly said. “ [They said] we’ll just kind of play it by ear and see how it goes.”
A week later, the pandemic shut down the entire country.
“Everything was thrown into the wind. I was not expecting everything to be shut down --at least not that soon.”
The program again tried to open live in April, and then again in June, but students remained at home participating in virtual labs.
Finally, at the beginning of August, students were permitted to come to campus. It was supposed to be for 12 to 16 days. The students went for nine.
“It got to the point where they said if we can’t physically get you guys here and learn these skills, then we are worried about your progression for the rest of the program.”
The students had been required to travel to Waco together and before arrival were encouraged to stay together in accommodations of four to eight people, and split the cost. They were also required to pass COVID tests, which were mailed to them. On-campus they were instructed to work in groups of 10. Every time students entered or left a building a temperature and symptom check would be waiting for them at the entrance. After Thanksgiving, however, COVID cases began to spike again and classes were canceled.
During the program, the students are placed in clinical rotations. The first rotation requires them to work with patients inside different hospitals. Two weeks before clinicals were supposed to start, she heard her classmates weren't allowed to continue.
“A few of my classmates were getting ready for their sites, but the hospitals backed out because of COVID. It was definitely stressful trying to get ready for it yourself.”
This created different concerns for Donnelly.
“Is my site going to be canceled?”
“What kind of population am I going to be working with?
By the end of September, she was placed into Baylor Scott & White in Dallas.
There was one question that still needed to be answered; Will she be exposed to COVID patients?
“I live with both of my parents and my little sister in Dallas. All three are considered high-risk,” she said. "I needed to know if I was going to be actively exposed to COVID because of these patients, then I need to adjust where I’m living because I don’t feel good about that.”
The hospital answered Donnelly’s questions in its COVID protocols: COVID testing for all students, N-95 masks and safety goggles required-- and no student contact with COVID patients.
Paramedic Nicole Johnson walks into work in Rockwall County, Texas around 6:30 every morning. She greets everybody she passes on her way to her daily routine: check in with ambulances, pick up supplies, find breakfast, wait for a call. Some days can be super busy ranging from 10-15 calls. Some days are slow with only two to three calls. But when the “devil," as she calls her phone, goes off, it’s time to get to work.
“You never know what your day is going to bring,” Johnson said. “It’s unpredictable.”
She decided she wanted to be a paramedic in 2017, her sophomore year in high school. Two years later she graduated from Brookhaven College in Dallas with an associate’s degree in paramedicine. She thought she was prepared when she went to work for Rockwall County EMS in February 2020. But when the pandemic hit one month later, no one was ready.
“It feels like at least one call a day is someone with COVID,” Johnson said. “By now COVID-19 is second nature.”
She puts herself in a defensive mindset even with the other paramedics, even when the patient's injury seems minor.
“They might've only broken their ankle ,but they could have COVID,” Johnson said. “ I could be exposed and I can’t take that risk, especially around my family. I can’t take the risk of someone dying.”
Johnson strives to do her best on every call, but admits she isn't at her best on every call. On the rough ones, she would mentally beat herself up on what she could have done better. “It’s hard sometimes to pick yourself up and push it aside while you go on another call and pretend it didn’t happen,” Johnson said. “Some calls linger with you for a while, but we can’t let it bog us down.”
She started to notice this more during the COVID surge in the fall and summer of 2020. Her mental health started to falter as more patients tested positive.
“Some days it’s mentally draining," Johnson said. “But knowing you helped someone have a better outcome, it’s always rewarding.”
Johnson experienced some of these rewards when she was assigned to be part of the detail driving a woman home from the hospital. It had taken 160 days in the hospital, but the woman had beaten COVID. She even had been read her last rites. Johnson wheeled her outside into fresh July afternoon. The woman hadn’t been outdoors since April. The flashing lights from the media made it feel like she was rolling down the red carpet. Johnson looked at the woman whose smile went from one cheek to the other.
“Days like these make the job so worth it,” recalled Johnson.
While Covid-19 still lingers, cases have significantly decreased. Johnson says she is now in a “COVID-relaxed” phase at her job. She is still cautious and wearing protective gear, but with more people getting vaccinated including everyone in her own family, she feels entitled to breathe a sigh of relief.
Ciara Donnelly is gearing up for a move to Seattle to finish the second and third parts of her physical therapy program. She will be in Seattle for six months and complete her clinical rotations in December. After returning home to Dallas, she will graduate and hopes to be officially licensed in 2022.
Elena Ingleheart’s daughter, Daniela, is now 8 months and counting. Dr. Inglehart stopped going to therapy and feels she’s in a better place. She has returned to the hospital but isn’t seeing as many COVID patients.