Tagged Doctors

‘Please Tell Me My Life Is Worth A LITTLE Of Your Discomfort,’ Nurse Pleads

When an employee told a group of 20-somethings they needed face masks to enter his fast-food restaurant, one woman fired off a stream of expletives. “Isn’t this Orange County?” snapped a man in the group. “We don’t have to wear masks!”

The curses came as a shock, but not really a surprise, to Nilu Patel, a certified registered nurse anesthetist at nearby University of California-Irvine Medical Center, who observed the conflict while waiting for takeout. Health care workers suffer these angry encounters daily as they move between treacherous hospital settings and their communities, where mixed messaging from politicians has muddied common-sense public health precautions.

“Health care workers are scared, but we show up to work every single day,” Patel said. Wearing masks, she said, “is a very small thing to ask.”

Patel administers anesthesia to patients in the operating room, and her husband is also a health care worker. They’ve suffered sleepless nights worrying about how to keep their two young children safe and schooled at home. The small but vocal chorus of people who view face coverings as a violation of their rights makes it all worse, she said.

That resistance to the public health advice didn’t grow in a vacuum. Health care workers blame political leadership at all levels, from President Donald Trump on down, for issuing confusing and contradictory messages.

“Our leaders have not been pushing that this is something really serious,” said Jewell Harris Jordan, a 47-year-old registered nurse at the Kaiser Permanente Oakland Medical Center in Oakland, California. She’s distraught that some Americans see mandates for face coverings as an infringement upon their rights instead of a show of solidarity with health care workers. (Kaiser Health News produces California Healthline, is not affiliated with Kaiser Permanente.)

Jewell Harris Jordan is a registered nurse in the labor and delivery department at Kaiser Permanente Oakland Medical Center. In the midst of a shortage of personal protective equipment for health care workers, she says, the public’s refusal to don a face covering in public feels like a “slap in the face.” (Courtesy of Jewell Harris Jordan)

“If you come into the hospital and you’re sick, I’m going to take care of you,” Jordan said. “But damn, you would think you would want to try to protect the people that are trying to keep you safe.”

In Orange County, where Patel works, mask orders are particularly controversial. The county’s chief health officer, Dr. Nichole Quick, resigned June 8 after being threatened for requiring residents to wear them in public. Three days later, county officials rescinded the requirement. On June 18, a few days after Patel visited the restaurant, Gov. Gavin Newsom issued a statewide mandate.

Meanwhile, cases and hospitalizations continue to rise in Orange County.

The county’s flip-flop illustrates the national conflict over masks. When the coronavirus outbreak emerged in February, officials from the U.S. Centers for Disease Control and Prevention discouraged the public from buying masks, which were needed by health care workers. It wasn’t until April that federal officials began advising most everyone to wear cloth face coverings in public.

One recent study showed that masks can reduce the risk of coronavirus infection, especially in combination with physical distancing. Another study linked policies in 15 states and Washington, D.C., mandating community use of face coverings with a decline in the daily COVID-19 growth rate and estimated that as many as 450,000 cases had been prevented as of May 22.

Dr. Megan Hall went viral on Facebook after publishing photos that showed her oxygen saturation levels remained consistent no matter what type of face mask she wore. The pediatrician hopes that both the public and officials have a “change of heart” about face coverings. (Courtesy of Megan Hall)

But the use of masks has become politicized. Trump’s inconsistency and nonchalance about them sowed doubt in the minds of millions who respect him, said Jordan, the Oakland nurse. That has led to “very disheartening and really disrespectful” rejection of masks.

“They truly should have just made masks mandatory throughout the country, period,” said Jordan, 47. Out of fear of infecting her family with the virus, she hasn’t flown to see her mother or two adult children on the East Coast during the pandemic, Jordan said.

But a mandate doesn’t necessarily mean authorities have the ability or will to enforce it. In California, where the governor left enforcement up to local governments, some sheriff’s departments have said it would be inappropriate to penalize mask violations. This has prompted some health care workers to make personal appeals to the public.

After the Fresno County Sheriff-Coroner’s Office announced it didn’t have the resources to enforce Newsom’s mandate, Amy Arlund, a 45-year-old nurse at the COVID unit at the Kaiser Permanente Fresno Medical Center, took to her Facebook account to plead with friends and family about the need to wear masks.

Amy Arlund is a registered nurse at Kaiser Permanente Fresno Medical Center’s dedicated COVID-19 unit. She lives in a separate zone of her house to protect the rest of her family from potential exposure to the coronavirus, and says that her husband was recently ridiculed for wearing a mask at a hardware store. (Courtesy of Amy Arlund)

“If I’m wrong, you wore a silly mask and you didn’t like it,” she posted on June 23. “If I’m right and you don’t wear a mask, you better pray that all the nurses aren’t already out sick or dead because people chose not to wear a mask. Please tell me my life is worth a LITTLE of your discomfort?”

To protect her family, Arlund lives in a “zone” of her house that no other member may enter. When she must interact with her 9-year-old daughter to help her with school assignments, they each wear masks and sit 3 feet apart.

Every negative interaction about masks stings in the light of her family’s sacrifices, said Arlund. She cites a woman who approached her husband at a local hardware store to say he looked “ridiculous” in the N95 mask he was wearing.

“It’s like mask-shaming, and we’re shaming in the wrong direction,” Arlund said. “He does it to protect you, you cranky hag!”

After seeing a Facebook comment alleging that face masks can cause low oxygen levels, Dr. Megan Hall decided to publish a small experiment. Hall, a pediatrician at the Conway Medical Center in Myrtle Beach, South Carolina, wore different kinds of medical masks for five minutes and then took photos of her oxygen saturation levels, as measured by her pulse oximeter. As she predicted, there was no appreciable difference in oxygen levels. She posted the photo collection on June 22, and it quickly went viral.

Cynthia Butler is a floating registered nurse at the Fawcett Memorial Hospital in Port Charlotte, Florida, who is also a COVID-19 survivor. Despite skyrocketing case numbers, Butler estimates that about 75% of residents in her community do not wear masks in public. She doesn’t feel she has the time or energy to educate people about the risk. (Courtesy of Cynthia Butler)

“Some of our officials and leaders have not taken the best precautions,” said Hall, who hopes for “a change of heart” about masks among local officials and the public. South Carolina Gov. Henry McMaster has urged residents to wear face coverings in public, but he said a statewide mandate was unenforceable.

In Florida, where Gov. Ron DeSantis has resisted calls for a statewide order on masks despite a massive surge of COVID-19 cases and hospitalizations, Cynthia Butler, 62, recently asked a young man at the register of a pet store why he wasn’t wearing a mask.

“His tone was more like, this whole mask thing is ridiculous,” said Butler, a registered nurse at Fawcett Memorial Hospital in Port Charlotte. She didn’t tell him that she had just recovered from a COVID-19 infection contracted at work. The exchange saddened her, but she hasn’t the time to lecture everyone she encounters without a mask — about three-quarters of her community, Butler estimated.

“They may think you’re stepping on their rights,” she said. “It’s not anything I want to get shot over.”

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Lost On The Frontline

America’s health care workers are dying. In some states, medical personnel account for as many as 20% of known coronavirus cases. They tend to patients in hospitals, treating them, serving them food and cleaning their rooms. Others at risk work in nursing homes or are employed as home health aides.

“Lost on the Frontline,” a collaboration between KHN and The Guardian, has identified 765 such workers who likely died of COVID-19 after helping patients during the pandemic.

We have published profiles for 133 workers whose deaths have been confirmed by our reporters.

Some cases are shrouded in secrecy. Our team contacts family members, employers and medical examiners to independently confirm each death. Many hospitals have been overwhelmed and workers sometimes have lacked protective equipment or suffer from underlying health conditions that make them vulnerable to the highly infectious virus. In the chaos, COVID casualties might otherwise get overlooked.

This project aims to document the lives of U.S. health workers who die of COVID-19, and to understand why so many are falling victim to the pandemic.

Michelle Abernathy
John Abruzzo
Debbie Accad
Romeo Agtarap
Felicia Ailende
Quen Agbor Ako
Jerry Alford
Jenniffer Anderson-Davis
Mario Araujo
Bernard Atta
Marsha Bantle
Alex Bass
Don Ryan Batayola
Jeff Baumbach
Nestor Bautista
Barbara Bedonie
Gianmarco Bertolotti
Barbara Birchenough
Billy Birmingham Sr.
Dorothy Boles
Linda Bonaventura
Sean Boynes
Brittany Bruner-Ringo
Araceli Buendia Ilagan
Joshua Bush
Patrick Cain
Luis Caldera-Nieves
John Careccia
Karen Carmello
Rosary Celaya Castro-Olega
Sheila Faye Christian
Susan Cicala
Roy Chester Coleman
Bishop Bruce Davis
Christopher Dean
Leo Dela Cruz
Cassondra Diaz
Karla Dominguez
Daisy Doronila
Maurice Dotson
Monica Echeverri Casarez
Jeremy Emerich
Lisa Ewald
Jessica ‘Jess’ Fajardo
David Ferranti
Mike Field
Barbara Finch
Nina Forbes
Devin Francis
Arthur Friedman
Clair Fuqua
Frank Gabrin
Dulce Garcia
Brian Garrett
Helen Gbodi
Scott Geiger
Denny Gilliam
Michael Giuliano
James Goodrich
Leola Grady
Kevin Graiani
Ali Dennis Guillermo
Krist Guzman
Rose Harrison
James House
Marilyn Howard
Alex Hsu
Pamela Hughes
Curtis Hunt
Gabrail Ismayl
Aleyamma John
Priya Khanna
Kim King-Smith
Kevin Leiva
Roger Liddell
Theresa Lococo
Maria Lopez
Tom Luna
Nancy MacDonald
Frank Mahoney
Michael Marceaux
Celia Marcos
David Martin
Juan Martinez
Kelly Mazzarella
Hazel Mijares
Sheena Miles
Anjanette Miller
Francis Molinari
Edwin Montanano
Adiel Montgomery
Matthew Moore
Paul Odighizuwa
John Robert Oglesbee
Sandra Oldfield
Alfredo Pabatao
Susana Pabatao
Marybeth Papetti
Tomas Pattugalan
David Joel Perea
Steven Perez
Jana Prince
Tina Reeves
Neftali “Neff” Rios
Monemise Romelus
Darrin Santos
John Schoffstall
Gary Sclar
Rosemary Sell
Alvin Simmons
James Simpson
Antonia ‘Tony’ Sisemore
Thomas Soto
Joan Swann
Rose Taldon
Adlin Thompson
Vianna Thompson
Saif Titi
Israel Tolentino Jr.
Louis Torres
J. Ronald Verrier
Jesus Villaluz
Ritchie Villena
Valeria Viveros
Barry Webber
Gerald Welch
Shenetta White-Ballard
Capt. Franklin Williams
David Wolin
Celia Yap-Banago
Ali Yasin
Jesus Manuel Zambrano
Robert Zerman

Nursing Aide Who Kept To Himself ‘Was Just Work, Work, Work’

(Courtesy of Cecilia Bautista)

Nestor Bautista

Age: 62
Occupation: Nursing aide
Place of Work: Clara Maass Medical Center in Belleville, New Jersey
Date of Death: April 15, 2020

Nestor Bautista came from a family of quiet men. He was quiet, too, said Cecilia Bautista, one of his four siblings.

Cecilia and Nestor came to the U.S. from the Philippines in the 1980s. Cecilia became a nurse. Nestor, who had studied engineering, became a nursing aide.

Nestor lived with Cecilia’s family and worked at the same hospital for 24 years, she said. Nestor, who had diabetes, cooked for himself and “preferred to do things alone.”

He picked up extra shifts on his days off and didn’t need to be told what to do, Cecilia said. “He was just work, work, work.”

Eight days after he was hospitalized with COVID-19, Cecilia spoke to Nestor by phone. He said he felt OK. The next day, he was transferred to intensive care, where he died of cardiac arrest.

A nurse with whom Nestor worked died the same day of COVID-19 complications. A hospital spokesperson declined to comment on their deaths, citing privacy.

Cecilia has placed Nestor’s ashes in an urn in his bedroom. She plans to take the ashes to the Philippines, where families visit graveyards every Nov. 1, and put them next to an older brother’s.

Nestor had few friends, she said, but this way, “if someone will visit my other brother, someone will visit Nestor as well.”

Melissa Bailey | Published July 7, 2020

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Haitian Immigrant’s 4 Children Followed Her Into Health Care Field

(Courtesy of Paul da Costa)

Monemise Romelus

Age: 61
Occupation: Nursing aide
Place of Work: New Jersey Veterans Memorial Home at Menlo Park in Edison, New Jersey
Date of Death: May 11, 2020

Each day for lunch, Monemise Romelus and her fellow Haitian co-workers would heat up bowl after bowl of traditional cuisine: fried turkey, rice and peas, griot. They shared with all, said Shirley Lewis, her union president.

Romelus, who worked on a floor with COVID patients, was a quiet woman with many friends, Lewis said. Romelus beamed when talking about her four children, all of whom work in health care.

When the pandemic began, workers initially were told not to wear masks so they wouldn’t scare patients, said Paul da Costa, a lawyer representing Romelus’ family. She worked without adequate protective gear, contracted COVID-19 and died, he said.

More than 100 workers at the veterans home have tested positive for COVID-19; 62 residents have died, state data shows. Facility spokesperson Kryn Westhoven declined to comment on Romelus’ death but said workers “are directed to wear PPE in accordance with CDC guidelines.”

Management never acknowledged Romelus’ death, Lewis said. When the police killing of George Floyd ignited protests nationwide, staffers and supervisors gathered for eight minutes of silence. Lewis said she insisted they hold a moment of silence for Romelus, too.

Melissa Bailey | Published July 7, 2020

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A Nurse From Cameroon Who Liked To Sing And Dance

Quen Agbor Ako

Age: 53
Occupation: Registered nurse
Place of Work: FutureCare Old Court nursing home in Randallstown, Maryland
Date of Death: April 10, 2020

Quen Ako was known to wear stylish, bright clothing and break out in song and dance. Posting to an online memorial, friends, family and co-workers described a lively, compassionate woman.

“My memory of you is that of a warm person, one that will break out in songs of joy,” one friend wrote. Another described laughing at an inside joke with Ako just weeks before her death. “Did I for one second think that I would never hear that resounding, hearty laughter again?”

Born in Cameroon, Ako worked as a guidance counselor and teacher before coming to the U.S., where she earned her nursing degree. She worked for a chain of nursing homes and rehabilitation centers that saw massive COVID-19 outbreaks.

Ako’s family declined to be interviewed for this article but told a local news station that she had died of COVID-19. The Guardian independently verified Ako’s cause of death with one of her former co-workers. Ako’s employer did not respond to requests for comment about her death.

Anna Jean Kaiser, The Guardian | Published June 30, 2020

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Firefighter Who Lit Up Others’ Lives

(Courtesy of Richard Whitehead)

Mario Araujo

Age: 49
Occupation: Firefighter and emergency medical technician
Place of Work: Chicago Fire Department Truck Company 25
Date of Death: April 7, 2020

Despite fighting fires and treating the injured for nearly 20 years, Mario Araujo remained goofy and light.

He had an uncanny ability to pry open roofs and pop open doors, said Richard Whitehead, a fellow firefighter. But he also loved playing virtual slot machines and cracking jokes.

“He was always kidding around. You could never take him serious,” Whitehead said. “But when it came time to go to work, he was just always ready to go.”

He was the first Chicago firefighter to die from the coronavirus, the department confirmed. Chicago Mayor Lori Lightfoot honored him on Twitter: “Mario selflessly dedicated his life to protecting our communities.”

Araujo approached his relationship with his girlfriend, Rosa Castillo, 48, and her son, Leo, 7, with the same zeal. He was attentive, picking up Leo from school and giving him a tablet computer so they could speak when he traveled.

“He taught my son a lot, even if they didn’t share the same blood,” Castillo said.

Castillo told Leo that God took Araujo to ease his suffering. She said her child believes he is an angel: “He hugs me and says, ‘Mom, I can feel Daddy with us.’”

Carmen Heredia Rodriguez, Kaiser Health News | Published June 30, 2020

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Ghanaian Nurse Made ‘A Deep Impact Across The Planet’

(Courtesy of Kojoh Atta)

Bernard Atta

Age: 61
Occupation: Registered nurse
Place of Work: Correctional Reception Center in Orient, Ohio
Date of Death: May 17, 2020

In December 2019, Kojoh Atta returned to his father’s hometown in Offinso, Ghana. Kojoh arrived alone, but everybody knew his father, Bernard Atta.

As a nurse in Ohio’s prison system, Bernard worked overtime so he could afford to ship “drums of clothes” across the Atlantic to the Takoradi port. Inside were sneakers, sandals and Ralph Lauren polos for cousins. “Always with stripes,” Kojoh said, “so the boys knew they were special.”

The regard for his father made Kojoh realize “there are countless unsung heroes making a deep impact across the planet.”

In New York last summer, the two visited the United Nations to pay respects to a portrait of their hero, Kofi Annan, a former U.N. secretary-general from Ghana. They cried. “Look at this man, and look at us,” Bernard told his son. “We came from nothing, but we are here. We are making it.”

As COVID-19 ravaged Ohio, Kojoh urged his father to leave work, worried about inadequate protective gear. Bernard refused, citing “his duty,” Kojoh said. “PPE was, and continues to be available to staff,” a prison spokesperson said.

Bernard showed symptoms and tested positive for COVID-19, but he remained home, fearing the hospital bills. Awakened by a flurry of WhatsApp messages, Kojoh learned his father died, leaving behind his wife, three other children and grandchildren.

“He never could live for himself,” Kojoh said, “but he’s finally on vacation, in eternal paradise.”

Eli Cahan | Published June 30, 2020

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On Eve Of Her Retirement, Nurse Took Ill

(Courtesy of Kristin Carbone)

Barbara Birchenough

Age: 65
Occupation: Registered nurse
Place of Work: Clara Maass Medical Center in Belleville, New Jersey
Date of Death: April 15, 2020

Barbara Birchenough consistently mailed cards to her family and friends, for birthdays, holidays or just as a pleasant surprise. Her youngest son, Matthew Birchenough, said it reflected her personality: quiet, thoughtful and kind.

Birchenough began training as a nurse right after high school and worked for 46 years. Her retirement was planned for April 4, with a big party to follow.

On March 24, she came home from work and told Matthew that four floors of the hospital had been taken over with COVID patients.

The next day, she began to cough. In text messages with her oldest daughter that morning, she conveyed that protective gear was lacking at the hospital. “The ICU nurses were making gowns out of garbage bags,” Barbara texted. “Dad is going to pick up large garbage bags for me just in case.”

When Birchenough returned to the hospital, though, it was as a patient. Her eldest daughter, Kristin Carbone, said she tested positive for COVID shortly before she died.

A Clara Maass spokesperson said the hospital has been compliant with state and CDC guidelines for protective gear.

Christina Jewett, Kaiser Health News | Published June 30, 2020

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First COVID Casualty Among Staff At His Hospital, Nurse ‘Had No Enemies’

Patrick cain and his wife, Kate (Courtesy of Kelly Indish)

Patrick Cain

Age: 52
Occupation: Registered nurse
Place of Work: McLaren Flint Hospital in Flint, Michigan
Date of Death: April 4, 2020

Patrick Cain was a dedicated nurse, always “close to his patients,” said Teresa Ciesielski, a nurse and former colleague. “The guy had no enemies.”

Cain was from Canada — a heritage he was especially proud of, Ciesielski recalled. He met his wife, Kate, in 1994, when they both worked in Texas. They had a son.

“He was an amazing father,” Ciesiekski said. “He was always talking about his kid.”

Cain’s ICU work meant caring for patients awaiting COVID test results. Some days, he worked outside the room where “suspected COVID” patients were being treated. The hospital hadn’t provided protective gear, despite his requests, according to Kelly Indish, president of the American Federation of State, County and Municipal Employees Local 875, his union.

On March 26, he texted Indish. He was worried he had been exposed to the virus the week before, and he hadn’t had a mask. “McLaren screwed us,” he wrote.

A hospital spokesperson said employees received appropriate gear based on government guidelines. But those rules didn’t mandate N95s — known to block viruses — for workers who, like Cain, were providing care but weren’t performing aerosolizing treatments, which can release virus particles into the air.

COVID-19 came with a fever, loss of appetite, dry cough, nausea. Cain was the hospital’s first employee known to die of the illness.

Shefali Luthra, Kaiser Health News | Published June 30, 2020

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Grateful Immigrant Who Loved Thanksgiving Catered To Chinese Community

(Courtesy of the Hsu family)

Alex Hsu

Age: 67
Occupation: Internal medicine physician
Place of Work: Hsu & Loy Medical Group in Margate, Florida
Date of Death: March 24, 2020

Alex Hsu loved Thanksgiving.

Sitting down with his family for the holiday feast, Hsu always spoke for at least 10 minutes about how grateful he was to be in America. Hsu “didn’t really come from much,” said Zach Hsu, his son.

Hsu fled Communist China, first immigrating to Hong Kong and then to Hawaii, where he attended medical school. He served his residency in Kentucky and, eventually, landed in Broward County, Florida, where he practiced for decades.

As one of the few Chinese-speaking internal medicine doctors in the area, Hsu would see “a crazy amount of patients, and he never complained about it,” Zach said. As Hsu aged, he turned to Buddhism and meditation and wrote loving notes to his children as they left for college.

It is not clear how Hsu contracted COVID-19. He had traveled to New York weeks before falling ill but also was seeing patients who could have been carrying the virus.

Hsu worked in a private practice with privileges at Northwest Medical Center. His staff did not return requests for comment. Hsu died at the same hospital where he had cared for patients.

Sarah Jane Tribble, Kaiser Health News | Published June 30, 2020

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Hospital Supply Manager Lacked Protective Gear For Himself

(Courtesy of Bill Sohmer)

Roger Liddell

Age: 64
Occupation: Supply manager
Place of Work: McLaren Flint hospital in Flint, Michigan
Date of Death: April 10, 2020

Roger Liddell was a family man. One of nine siblings, he frequently visited his extended family back in Mississippi. He was involved in his church and loved cooking, Westerns and the Chicago Bears.

After high school, Liddell joined the Marine Corps. Upon finishing his service, he moved to Chicago, working for the U.S. Postal Service. Finally, he settled down in Michigan, working at McLaren Flint for almost 20 years.

His job took him all over the hospital. And as COVID cases climbed, he was worried.

Liddell requested protective gear from his hospital, said Bill Sohmer, president of AFSCME Local 2650, which represents non-technical employees at the hospital. Since he didn’t treat patients, he was denied — even though his work took him to floors with COVID-positive patients.

In an email, a hospital spokesperson said McLaren Flint had followed government guidelines to ensure employees received sufficient protective gear.

On March 30, Liddell posted to Facebook: He had worked the previous week in the ICU and critical care unit, without PPE. “Pray for me God is still in control,” he wrote.

Liddell tested positive for COVID-19. He was put on a ventilator but died, leaving behind his wife, four children, two stepchildren and 11 grandchildren.

Shefali Luthra, Kaiser Health News | Published June 30, 2020

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A Doctor And A Poet Who ‘Wasn’t Done’

(Courtesy of Adam Oglesbee)

John Robert Oglesbee

Age: 80
Occupation: Family physician
Place of Work: CCOM Medical Group Cardiology Clinic in Muskogee, Oklahoma
Date of Death: April 26, 2020

A bushel of corn or meat from the family cow was how some of John Oglesbee’s clients paid him. No matter, he always put his clients first.

“He loved small-town Oklahoma,” said grandson Adam Oglesbee.

For nearly 30 years, John Oglesbee had his clinic outside of Ada until the mid-90s, when he began fill-in work at rural emergency rooms for a time before ending up in his hometown.

An avid reader of books on every topic, he would always return to the Bible. He was a churchgoer and deacon for many years, often guest-preaching.

Wherever he went, Oglesbee wrote poems, whether on a napkin or the back of an envelope, stuffing them in books within his vast home library.

He saw patients until he contracted COVID-19. On March 19, he went into home isolation. He tested positive March 23.

“He told me when I last saw him at his home through the window, ‘Dammit, I wasn’t done,’” Adam said. “He was a doctor until the day he died.”

Multiple attempts to reach CCOM Medical Group for comment went unanswered.

— Eriech Tapia, University of Oklahoma | Published June 30, 2020

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Big-Hearted Nurse Feared For The Safety Of Those Who Cared For Her

(Courtesy of Lori Rodriguez)

Sandra Oldfield

Age: 53
Occupation: Registered nurse
Place of Work: Kaiser Permanente Fresno Medical Center in Fresno, California
Date of Death: May 25, 2020

Sandra Oldfield had a big heart and couldn’t say no to anyone, her sister Lori Rodriguez said. She had no children of her own but loved to spoil and care for her nieces and nephews.

She was a nurse who would listen to others’ problems. And she could amplify those concerns for management without losing her composure, Rodriguez said.

Oldfield had concerns of her own in mid-March while caring for critically ill patients in the telemetry unit. She was upset that she was given a surgical mask — not nearly as protective as an N95 respirator — to treat patients as COVID-19 was spreading.

Her concern was on point: She cared for a patient whose initial symptoms didn’t meet the well-known COVID profile, but who tested positive for the virus.

“I feel if she had an N95, she would be here today,” Rodriguez said. “I don’t want to see anyone else lose their life like my sister did.”

Kaiser Fresno said it has followed state and federal guidelines on protective gear. (KHN is not affiliated with Kaiser Permanente.)

Rodriguez said her sister resisted going to the hospital as her symptoms worsened, reluctant to expose paramedics or hospital staffers to the virus. When Oldfield agreed that an ambulance should be called, she wanted the paramedics to be advised to take every precaution.

Christina Jewett, Kaiser Health News | Published June 30, 2020

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The ‘Life Of The Party’ Who Bonded With Patients

(Courtesy of Christina Ravanes)

John Abruzzo

Age: 62
Occupation: Registered nurse
Place of Work: Huntington Hospital in Huntington, New York
Date of Death: April 2, 2020

Long Island is where John Abruzzo was born, raised, worked and died. The second of 14 children, he was the “life of the party,” said his daughter, Christina Ravanes. He loved poker and fishing. He had a son as well, and three grandchildren.

Abruzzo developed strong friendships with patients, said Susan Knoepffler, the hospital’s chief nursing officer. “He had a winning smile. He was kind of a teddy bear,” she said.

He tested positive for COVID-19 in late March and died five days later. “I went from seeing my dad at a wedding,” Ravanes said, “to the next time I see him, it’s ashes.”

John’s wife, Mary Abruzzo, died eight days later, on her birthday, Ravanes said, likely from complications related to Type 1 diabetes (she had not been exposed to John when he was infected).

As of June 18, no other nurses at Huntington hospital had died of COVID-19, Knoepffler said, adding that the facility was well prepared and never ran out of supplies. What’s missing, she said, is Abruzzo.

— James Faris, James Madison University | Published June 26, 2020

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A Nurse And Pastor Who Tended To Bodies And Souls

(Courtesy of the Boles family)

Dorothy Boles

Age: 65
Occupation: Licensed practical nurse
Place of Work: Greenwood Leflore Hospital in Greenwood, Mississippi
Date of Death: April 3, 2020

Dorothy Boles had two callings: one as a healer and the other as an ordained minister.

“Mama Boles,” as she was known, was a counselor and caretaker, said longtime friend and colleague Glory Boyd. Boles mentored aspiring ministers at First Chosen Tabernacle Church and welcomed recovering patients into her home.

“She went over, above and beyond,” said Boyd, the hospital’s chief nursing officer. “She cared for other people before she cared for herself.”

When patients leaving the hospital didn’t have the means to recover on their own, Boles opened her home to them, her son Marcus Banks told a local newspaper. Most stayed a few days. One young man stayed five years.

“Once she nursed him back to health, he just hung around,” Banks told the paper. “She just felt that nobody could take care of him like she could.”

Boles was admitted March 22 to the hospital where she had worked for 42 years. She was among the first four people to die of COVID-19 in Leflore County.

The hospital renamed the nurses’ station in her memory.

Michaela Gibson Morris | Published June 26, 2020

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Pediatric Nurse Wore ‘Minions’ Scrubs And Connected With Children

(Courtesy of Carlos Dominguez)

Karla Dominguez

Age: 33
Occupation: Registered nurse
Place of Work: Providence Children’s Hospital in El Paso, Texas
Date of Death: April 19, 2020

Karla Dominguez’s medical “practicing” began at a young age, with a doctor’s bag she got one Christmas. “Every time I came home, she’d say, ‘Let me listen to your heart; let me see how you’re doing,’” recalled her father, Carlos Dominguez.

She dreamed of becoming a pediatric neurosurgeon. Hurdles getting into medical school dampened her spirits. Then she pursued nursing, a field in which she blossomed.

“She was so full of joy, so happy with her work,” said Dominguez, a doctor. She wore scrubs with cartoon Minions and managed to connect with even the most challenging patients, her father said. A few years into her nursing career, she considered reapplying to medical school, but ultimately decided to stick with nursing because it allowed for more interaction with patients.

In early April, she began experiencing excruciating headaches — symptoms that have since been associated with COVID-19. She visited urgent care and the emergency room and was twice denied a coronavirus test. She was eventually hospitalized. Tests revealed she had the virus and CT scans showed brain hemorrhaging.

Dominguez doesn’t know how his daughter contracted the virus but suspects she may have contracted it at work. Providence did not respond to a request for comment.

— Maureen O’Hagan | Published June 26, 2020

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Passionate EMT And Volunteer Firefighter Was ‘Constantly On Call’

(Courtesy of Shana Konek)

Jeremy Emerich

Age: 40
Occupation: Emergency medical technician
Place of Work: Lehigh Valley Health Network MedEvac in Center Valley, Pennsylvania
Date of Death: May 21, 2020

Jeremy Emerich and his girlfriend, Shana Konek, made a pact: Home is home. Work is work.

They set aside time to do things they loved, like watching “The Big Bang Theory” or walking their two beagle-mix puppies. “Unless we scheduled it in, it wasn’t happening,” Konek said.

An Army veteran who served in Iraq, Emerich “was passionate and loved a challenge,” Konek said. When he wasn’t taking emergency shifts, he volunteered for the Exeter Township Fire Department. “He was constantly on call, always lending a helping hand,” said Konek, an emergency medical services dispatcher.

If families of patients were in shock, he’d comfort them — sometimes in Spanish, to his colleagues’ surprise. Emerich worked long shifts caring for COVID-19 patients across the Lehigh Valley, for which he was equipped with adequate protective gear, Konek said. His employer could not be reached for comment.

On April 25, Emerich’s appetite began to wane and he complained of “a little fever.” Konek took his temperature: 104 degrees. A week later, he was in the ICU.

On May 8, Emerich told Konek he was signing some paperwork and would call her back.

“I never got that call,” Konek said.

Eli Cahan | Published June 26, 2020

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He Bridged Cultures With Cooking And Camaraderie

(Courtesy of Diana Ese Odighizuwa)

Paul Odighizuwa

Age: 61
Occupation: Food services coordinator
Place of Work: Oregon Health & Science University (OHSU) in Portland, Oregon
Date of Death: May 12, 2020

When Paul Odighizuwa left Nigeria in 1987, he enrolled at Portland State University to study visual arts and began a decades-long career at OHSU, a large teaching hospital. He became a pillar of the area’s close-knit Nigerian community.

“Paul was such a go-to guy,” said Ezekiel Ette, a friend. “If you needed something done, Paul would do it, and do it graciously.”

As a student, he helped paint a prominent mural depicting African and African American heroes — it stood for decades in Portland’s King neighborhood.

Odighizuwa, who worked in the hospital’s food services department, cooked traditional Nigerian dishes at home — as well as American-style pancakes with “crispy edges,” his daughter, Diana, said.

In mid-March, his union complained that management in Odighizuwa’s department was not allowing proper social distancing. Eleven people in the department became ill, and Odighizuwa died.

OHSU did not respond to a request for comment.

— Maureen O’Hagan | Published June 26, 2020

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She Answered A Calling And Helped Fellow Native Americans

(Courtesy of Charmayne Bedonie)

Barbara Bedonie

Age: 56
Occupation: Certified medication aide
Place of Work: Cedar Ridge Inn in Farmington, New Mexico
Date of Death: May 16, 2020

Barbara Bedonie was happily raising three children when she realized she wanted to do more. She enrolled to become a certified nursing assistant, which turned out to be a calling.

“She was truly happy working,” her daughter Charmayne Bedonie said. “I’ve been hearing so many stories from families she’s helped.”

For 17 years, Barbara worked at a nursing home and received awards for perfect attendance. Management admired her work ethic enough to pay for her to become a certified medication aide. She was Navajo and could speak to residents at the home in their Indigenous tongue.

“I know she helped a lot of people just by speaking the language,” Charmayne said.

The home had reported a number of COVID cases. Bedonie tested negative for the virus repeatedly, but, overwhelmed by fatigue, she knew something was wrong. She was hospitalized and finally a test confirmed she had the coronavirus, Charmayne said.

Charmayne expressed praise for the hospital and the nursing home. Her employer did not respond to questions about protective gear and said only, “Cedar Ridge Inn misses our beloved colleague very much.”

Charmayne said families have been sharing stories about her mother. “They say she was a beautiful soul, inside and out,” she said.

Maureen O’Hagan | Published June 23, 2020

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Travel Nurse Was ‘A Country Boy At Heart’

Denny Gilliam and his wife, Amanda Marr Gilliam (Courtesy of Amanda Marr Gilliam)

Denny Gilliam

Age: 53
Occupation: Travel nurse
Place of Work: NewYork-Presbyterian Brooklyn Methodist Hospital in Brooklyn, New York, via Trustaff
Date of Death: May 7, 2020

Amanda Marr Gilliam was on a cigarette break when Denny Gilliam threw that first glance. “Those blue eyes caught me,” she said. “The very next day, we started dating.”

Gilliam treasured family time, like movie nights, when the kids would pile into the couple’s king-size bed with chips and French onion dip.

“A country boy at heart,” Gilliam loved the outdoors, Amanda said. He took the family hunting for ginseng, digging for frogs and camping throughout the Appalachian Mountains near their home in Pelham, Tennessee. He and Amanda liked to fish in Lake Chickamauga for crappie and bluegill.

Gilliam was a committed nurse — it was his second career, after serving in the military. In April, when he learned New York hospitals were short-staffed in the pandemic, he felt obliged to serve.

In early May, when Amanda didn’t hear from him for “what felt like eternity,” she called 35 hotels near the hospital before finding where he’d checked in. A private investigator confirmed: He had died days earlier of COVID-19.

“My worst fear came true,” Amanda said.

Eli Cahan | Published June 23, 2020

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‘He Explored Life Without Restrictions’

(Courtesy of Monique Bertolotti)

Gianmarco Bertolotti

Age: 42
Occupation: Mason
Place of Work: Lenox Hill Hospital in New York City
Date of Death: April 22, 2020

Decades ago, two girls asked Gianmarco Bertolotti to the senior prom. Even as a teenager, Bertolotti was “such a sweet soul,” said Monique Bertolotti, his sister. Instead of rejecting either one, he skipped prom.

As a child visiting grandparents in Rapallo, Italy, Bertolotti would invariably return from town with “focaccia, espresso and stories of the friends he’d made.” As an adult, the man known as “G-Funk” had “a special way about him,” Monique said, “forg[ing] a lasting bond with everyone he met.”

An avid traveler, he’d visited New Orleans and Japan in recent years. “He explored life without restrictions,” Monique said.

A mason, Bertolotti took the subway from his home in Queens every morning to help repair the hospital’s ceilings, floors, soap dispensers and sharps collectors. But on April 13, he called his sister because he was coughing up blood after carrying a case of seltzer up three flights of stairs.

The next morning, he went to the emergency room. A week later, he was dead.
“Protecting our employees … has been our priority from day one,” the hospital said in a statement.

Eli Cahan | Published June 19, 2020

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An Unflappable Nurse Who Loved Playing Tour Guide

(Courtesy of Michelle Helminski)

Edwin Montanano

Age: 73
Occupation: Registered nurse
Place of Work: Wellpath at Hudson County Correctional Center in Kearny, New Jersey
Date of Death: April 5, 2020

Edwin Montanano went to the U.S. Open every year. He loved Broadway shows, especially “Miss Saigon,” but also “Les Misérables,” “The Phantom of the Opera” and “Cats.” He liked candy — Symphony bars and M&M’s. And he and his wife, Annabella, relished hosting guests.

“My parents always had an open-door policy, and [growing up] it was always a very busy house,” said Michelle Helminski, his daughter. “When relatives or friends would come to visit, my dad would take them to New York — he was an expert tour guide.”

In more recent years, his four young grandchildren became a focal point in his life.

Montanano, who studied nursing in his native Philippines, worked at St. Michael’s Medical Center in New Jersey for 30 years alongside Annabella; Michelle and her brother, Matthew, were born at the hospital. After retiring, Edwin returned to work as a nurse at a nearby prison.

Helminski said she does not know whether her father contracted the virus at work, but as of May, at least three other workers at the prison had died of COVID-19. A representative from Wellpath, Montanano’s employer, wrote that, “Our clinical personnel have ongoing access to masks, gowns, and other PPE, as well as the training to use it effectively.”

Montanano developed COVID-19 symptoms in late March and died at St. Michael’s.

Danielle Renwick, The Guardian | Published June 19, 2020

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A Former Marine Whose Altruism Shined In The Operating Room

(Courtesy of Valerie Alford)

Jerry Alford

Age: 60
Occupation: Licensed practical nurse
Place of Work: DCH Regional Medical Center in Tuscaloosa, Alabama
Date of Death: April 22, 2020

Jerry Alford brought the same meticulous care to nursing he’d learned as a reconnaissance Marine. He was a stickler for maintaining a sterile workspace and never passed on the chance to lighten a co-worker’s load.

Jerry dedicated 32 years to nursing and spent 27 of them married to Valerie, a trauma ICU nurse. Together they raised three sons and had three grandchildren.

When the pandemic hit, Jerry transferred to the emergency room, where Valerie believes he contracted COVID-19, despite access to personal protective equipment. Jerry’s employer did not respond to questions about whether he may have contracted the virus at work.

Jerry had celebrated his 60th birthday in January with a blowout surprise party. His wife and sons invited family he hadn’t seen in years. “Not knowing that was going to be his last birthday,” said Valerie, “that’s the best thing I could have done for him.”

— Suzannah Cavanaugh, City University of New York | Published June 17, 2020

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An Urgent Care Physician Beloved By His Patients

(Courtesy of Nikki Friedman)

Arthur Friedman

Age: 62
Occupation: Urgent care physician
Place of Work: Independent Physician Association of Nassau/Suffolk counties in Smithtown, New York
Date of Death: April 30, 2020

When Arthur Friedman did not get into medical school in the United States, he enrolled in a school in Tampico, Mexico, teaching himself Spanish. “He was willing to do whatever it took,” said Eric Friedman, his son.

Arthur went on to open his own urgent care facility in Commack, New York. Though he was best known for his decades of work there, he was working at a clinic in Smithtown over the past year.

Arthur loved boating, the outdoors and hoped to retire soon in Florida, to be near his children. When COVID-19 hit, he put those plans aside.

“He seemed like a superhero to us. Nothing fazed him,” said Nikki Friedman, his daughter. Arthur began to experience symptoms on April 10 and tested positive shortly after. (His employer did not respond to requests for comment.)

He died on April 30 and was buried next to his youngest son, Greg, who died in 2014.

Scores of Arthur’s former patients reached out to his children after his death to express their love and gratitude for him.

— Madeleine Kornfeld, City University of New York | Published June 17, 2020

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A Former Foster Child Who Was Charting Her Own Path

(Courtesy of the Fuqua family)

Clair Fuqua

Age: 28
Occupation: Receptionist
Place of Work: Pineville Children’s Clinic in Pineville, Louisiana
Date of Death: April 2, 2020

Clair Fuqua was figuring out her path in life.

On her phone, she saved pictures of wedding dresses and venues, anticipating a proposal from her boyfriend of over two years, according to her parents, Curt and Claudia Fuqua. With an infectious smile, Clair welcomed young patients to the clinic, but she was looking forward to other roles in life.

“She was finally going to decide what she was going to do,” Curt said.

Her parents, who adopted Clair and two of her younger siblings when she was 10, hoped she would follow her passion for adoption and foster care into a career. Clair valued the love and stability of her forever family; before their adoption, Clair and her siblings had lived in six different foster homes.

When the coronavirus surfaced in Louisiana, Clair was already fighting bronchitis. At work, she wore a mask to keep her cough to herself. Days after a colleague was diagnosed with COVID-19, Clair developed a fever.

Clair’s employer declined to confirm how many staff members had become sick with COVID-19 or to comment for this story.

Clair was hospitalized on March 22.

“Everyone thought she would pull through,” Curt said.

In Clair’s honor, friends have donated Bibles and more than $2,100 to a local charity that supports children in the foster care system.

Michaela Gibson Morris | Published June 17, 2020

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A Loving Mother And Nurse Who ‘Always Looked Tremendous’

(Courtesy of Scott Papetti)

Marybeth Papetti

Age: 65
Occupation: Registered nurse
Place of Work: CareOne at Livingston Assisted Living in Livingston, New Jersey
Date of Death: March 24, 2020

Marybeth Papetti cared for beautiful things. She planted a garden filled with “a thousand different colors” of flowers, according to her son, Scott Papetti. Her nails, hair and makeup were always done, whether hanging out with girlfriends or dining out with her husband. “She always looked tremendous,” said Scott.

“You wouldn’t have thought she had any health issues,” said Scott, referring to her pulmonary fibrosis, a condition where lung tissue is scarred and blocks oxygen from passing through freely.

Scott does not know where his mother contracted the novel coronavirus, or whether she had adequate PPE at work. Marybeth worked as the director of nurses at an assisted living facility in New Jersey, which, as of June 11, had reported 39 cases of COVID-19 among residents and staff and 15 deaths. But she also attended parties and continued regular appointments with a pulmonologist.

Papetti went to the hospital on March 12 with a fever and shortness of breath. She stayed there for two weeks before she died.

Almost everyone who sent messages after Marybeth passed talked about how well put together she was, according to Scott. “She would have been a wreck with not getting her hair done,” he joked.

— Lila Hassan | Published June 17, 2020

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Pitching In After Retirement, Traveling Nurse Was An Adventurer

(Courtesy of Tiffany Olega)

Rosary Celaya Castro-Olega

Age: 63
Occupation: Traveling registered nurse
Place of Work: Various hospitals in Los Angeles County
Date of Death: March 29, 2020

Rosary Celaya Castro-Olega wasn’t what you’d call shy. At her daughter’s basketball games, she was the loudest voice in the bleachers. She dressed head-to-toe in purple: purse, glasses, phone, scrubs. She was Kobe Bryant’s No. 1 fan. And she loved sharing stories with patients.

Her oldest daughter, Tiffany Olega, recalled meeting her mother’s patients.

“They’d say, ‘Your mom has told me all about you!’” she recounted. “She didn’t just do her rounds and disappear.”

Even after retiring in 2017 from Cedars-Sinai Medical Center, she couldn’t stay away. She filled in at hospitals that were shorthanded. In between, she traveled the globe. In 2019, she visited Germany, Japan and China.

She had a cruise planned in March. When it was canceled because of the coronavirus, she took shifts at various hospitals in Los Angeles County, hoping to help out. Olega doesn’t know if her mom cared for COVID patients. But Castro-Olega and her twin daughters — Olega’s younger sisters — developed symptoms in mid-March. All three wound up hospitalized. Castro-Olega never came home.

Los Angeles Mayor Eric Garcetti honored her as the first health care worker to die of COVID-19 in L.A. County.

Maureen O’Hagan | Published June 12, 2020

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Phlebotomist Often Struck Patients’ Funny Bones

Jess Fajardo (Left) and her friend Maria Hernandez (Courtesy of Maria Hernandez)

Jessica ‘Jess’ Fajardo

Age: 30
Occupation: Phlebotomist
Place of Work: Center for Hypertension and Internal Medicine in Odessa, Texas
Date of Death: April 12, 2020

Jessica “Jess” Fajardo had the same best friend for 28 of her 30 years: Maria Hernandez. They hung out in school and after school. They got jobs at a restaurant and, later, a video arcade. They rented an apartment.

Even when Hernandez married, moved away and had children, they talked or texted daily. “She would take care of anybody she could,” Hernandez said.

In phlebotomy, Fajardo found a career she loved. Patients loved her, too — even though her job was sticking them with needles. More than one commented on her sense of humor, her skill, her bubbly cheer.

In late March, Fajardo started coughing, but with no identified coronavirus cases in the county, she was diagnosed with asthmatic bronchitis. It got worse. When a colleague was hospitalized with COVID-19, Fajardo went for a test. Days later, she sought emergency care.

Dr. Madhu Pamganamamula, who runs the clinic where Fajardo worked, said precautions had been in place since mid-March. Ultimately, six employees tested positive for the virus; four others tested positive for the antibodies.

Hospitalized and intubated, Fajardo’s condition appeared to be improving. But she died after doctors removed her ventilator. Said Hernandez, “she was an amazing friend.”

Maureen O’Hagan | Published June 12, 2020

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A ‘Protective’ Presence, He Drove Seniors To Medical Appointments

(Courtesy of Rebecca Garrett)

Brian Garrett

Age: 45
Occupation: Van driver for patients
Place of Work: Columbine Health Systems in Fort Collins, Colorado
Date of Death: March 31, 2020

Brian Garrett had classic COVID-19 symptoms: cough, fatigue, fever, nausea, vomiting, breathing difficulty and loss of taste. But he fell ill early in the pandemic’s U.S. spread, his wife, Rebecca, said, and the health clinic he visited said it was probably the flu.

By March 23, the otherwise vigorous, nearly 6-foot-5 father of four (ages three to 20) told Rebecca, “Something’s just not right inside.” He was admitted to the hospital that day. County health officials registered his as a COVID-19 death.

Garrett, who transported senior residents to medical appointments, became ill before the use of protective gear became widespread. “We had that conversation that all these people would be so vulnerable,” Rebecca said. “He became ill so early on that no one was [wearing] masks.”

A spokesperson for his employer did not respond to requests for comment about whether Garrett was exposed to COVID-19 at work.

On Facebook, Garrett’s nephew, Brandon Guthrie, posted that Brian was a protective figure. “He was our tall older brother,” Guthrie wrote. Despite his imposing stature, it was his kindness that stood out. In an interview, Guthrie said, “He genuinely cared about everybody.”

Sharon Jayson | Published June 12, 2020

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From A Traumatic Childhood To A Life ‘Bigger Than Himself’

(Courtesy of the Simpson family)

James Simpson

Age: 28
Occupation: Mental health technician
Place of Work: Sunstone Youth Treatment Center in Burien, Washington
Date of Death: April 10, 2020

James Simpson’s difficult childhood in the foster care system led him to a career at a youth mental health center — where he worked with kids who reminded him of himself. “He had been through so much trauma and abandonment as a child,” said Chezere Braley, his cousin. “And he did not become a product of his environment.”

James’ sister Kamaria Simpson described him as the life of the party. “He was always smiling, even if he was having a bad day,” she said.

James’s family believes he contracted COVID-19 during an outbreak at work, where eight of the center’s 15 residents were infected. Sunstone waited over a week before telling James he may have been exposed to the virus, Kamaria said. She said the center also delayed in providing employees with adequate protective gear and that when her brother became sick, he was told to come in anyway. On April 6, he was sent home with a fever; he died in his apartment four days later.

In a written statement, Sunstone’s parent company, Multicare, said the organization “took early and aggressive steps to prevent the spread of the virus” at work, including “early access to PPE, sanitizer, training for staff and testing.” It added that the company’s policy was always to direct staff to stay home when sick.

Braley and Kamaria said they’re grieving, but they’re also angry. “He risked his life,” said Braley. “He deserved so much better.”

— Holly DeMuth, City University of New York | Published June 12, 2020

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A Physician Assistant Who Mentored Residents At His Hospital

(Courtesy of Alexander Beylinson)

Alex Bass

Age: 52
Occupation: Physician assistant
Place of Work: NYC Health + Hospitals/Coney Island in Brooklyn, New York
Date of Death: April 10, 2020

Alex Bass was technically a physician assistant, but his patients all called him “Dr. Bass,” a title his boss said was well-deserved.

“His patients often sent us letters, thanking us for the services that he provided and saying how great he was,” said Dr. Abdo Kabarriti, chief of urology at Coney Island Hospital.

Bass moved to the U.S. from Ukraine in his mid-20s. Rather than redoing medical school, he decided to become a PA. His extensive knowledge led him to mentor numerous urology residents.

“He helped a lot of people really become who they are today,” Kabarriti said.

When Bass noticed a fever spike in mid-March, he stopped going to work and made an appointment with Dr. Alexander Beylinson, his primary physician and friend of 26 years.

He arrived at his office on March 20 looking “very sick,” so Beylinson tested him for COVID-19 and sent him to the hospital.

A few days later, the test came back positive. At that point, it was too difficult for Bass to talk. Soon after, he was put on a ventilator, until he died.

The hospital did not comment on whether Bass had worked with COVID-19 patients.

Beylinson was one of the 10 people at Bass’ funeral. He doesn’t feel he achieved closure, he said, and still considers Bass his “hero.”

— Shoshana Dubnow | Published June 10, 2020

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‘There Were So Many Things She Had Unfinished’

(Courtesy of Brittany Mathis)

Dulce Garcia

Age: 29
Occupation: Clinical interpreter
Place of Work: University of North Carolina Hospitals in Chapel Hill, North Carolina
Date of Death: May 26, 2020

Dulce Garcia loved to dance. On weekends, she would escape with friends to the Luna Nightclub in Durham, where they would romp to bachata, merengue and reggaetón. “It was our ritual,” said Brittany Mathis, one of her close friends.

At dawn, those unable to safely drive would sleep over at Garcia’s. “She was the group mom,” Mathis said. “She’d tell us, ‘We don’t want to lose anyone.’”

Garcia was “the rock and foundation” for her family, Mathis said. As a teen, Garcia cared for siblings while her parents worked. She also volunteered at the neighborhood Boys & Girls Club.

When Garcia learned about the health care gaps faced by Spanish speakers, she joined the hospital. There, she was “surprised at how much she could help,” Mathis said, “and how many needed her.”

The week after she picked up a Sunday shift, she developed a fever. Mathis was not sure whether she received personal protective equipment (PPE). “Our PPE policies have always followed CDC guidance,” the hospital said through a spokesperson.

The symptoms “wouldn’t go away,” Mathis said. “It just doesn’t feel real. There were so many things she had unfinished.”

Eli Cahan | Published June 10, 2020

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A Friendly Nursing Assistant Who Worked Into Her 70s

Antonia ‘Tony’ Sisemore

Age: 72
Occupation: Certified nursing assistant
Place of Work: Stollwood Convalescent Hospital at St. John’s Retirement Village in Woodland, California
Date of Death: April 30, 2020

Antonia Sisemore always wore a smile — around her family, at church and at her job at a retirement home, where she worked through the coronavirus pandemic.

In a Facebook post, her colleagues called her “one of our most talented and dedicated CNAs.” She worked “tirelessly and unfailingly to deliver care, compassion, and love to those more vulnerable than herself,” it said. (Her family declined to be interviewed for this article.)

Comments remarking on her kindness and work ethic poured in from patients and their families. “She went the extra mile to [make] sure I had what I needed and was comfortable,” wrote a former patient. “Tony was one of my mother’s caregivers,” wrote another Facebook user. “She was selfless … it breaks my heart that the residents will no longer have her.” Some mentioned that Sisemore cheered people up with her sense of humor. “I remembered you [danced] in front of me,” another former patient wrote.

Sisemore’s obituary says she battled COVID-19 for four weeks after passing away from complications from the virus. The nursing home where Sisemore worked reported 66 confirmed cases and 17 deaths according to county data. Over half of the infections were among staff members. The facility did not respond to requests for comment.

Anna Jean Kaiser, The Guardian | Published June 10, 2020

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A Nurse, Family Linchpin And Generous Aunt

(Courtesy of Mario Thompson)

Adlin Thompson

Age: 56
Occupations: Certified nursing assistant and endoscopy technician
Places of Work: NewYork-Presbyterian Hospital and Isabella Center for Nursing and Rehabilitation in New York City
Date of Death: April 24, 2020

Adlin Thompson had 20 siblings and more than 30 nieces and nephews. Like her, many of them immigrated to New York City from St. Kitts and Nevis in the early 1980s. With such a large family, it was difficult to keep track of everyone, said Adlin’s son, Mario Thompson. But Adlin did — she was the glue who kept the family together.

Adlin worked long hours between her two jobs. When she wasn’t at the nursing home or the hospital, she visited family, and “never came home empty-handed,” often toting gifts of socks or perfume, Mario said.

Adlin cared for patients who had been diagnosed with COVID-19 at both her jobs. She was always covered in protective gear, said Mario. Still, he worried that her asthma made her particularly vulnerable to the coronavirus. Mario believes she contracted the virus at the nursing home, where he said she had more direct contact with patients.

A spokesperson for the facility said it “followed state guidelines as it relates to infection prevention and control procedures.”

Adlin died four days after testing positive for COVID-19. She was alone in her home, preparing to go to the hospital.

— Lila Hassan | Published June 10, 2020

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Housing Supervisor Committed Herself To Helping The Vulnerable

(Courtesy of Barbara Abernathy)

Michelle Abernathy

Age: 52
Occupation: Residential services supervisor
Place of Work: Elisabeth Ludeman Developmental Center in Park Forest, Illinois
Date of Death: April 13, 2020

Barbara Abernathy said she is trying to figure out what to do with six bins of toys her daughter bought for neighborhood children.

Growing up in Chatham, a middle-class neighborhood on the South Side of Chicago, Michelle Abernathy “was always trying to help somebody,” Barbara said.

Michelle spent decades investigating child abuse and neglect while holding night jobs mentoring children.

A supervisor at a state-run facility for developmentally disabled adults, she bought clothes, games and snacks for residents. A staff memo lauded her “big heart and nurturing personality.”

She fell ill March 28 and was hospitalized April 6, too weak to walk.

Three other workers at the facility died of COVID-19. A spokesperson for the American Federation of State, County and Municipal Employees, which represents workers at Ludeman, said that early in the pandemic the staff had a “huge struggle” to get personal protective equipment (PPE).

The Illinois Department of Human Services said it “can’t say precisely” how workers caught the virus and was working to provide sufficient PPE.

After long professing that she was too busy for marriage, Abernathy recently had become engaged to Torrence Jones, a colleague. She had planned to surprise her mother with the news but never had the chance.

Mary Chris Jaklevic | Published June 5, 2020

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A Loving Bookkeeper Who ‘Had The Most Awesome Laugh’

(Courtesy of Sean Diaz)

Cassondra Grant Diaz

Age: 31
Occupation: Nursing home bookkeeper
Place of Work: Chelsea Place Care Center in Hartford, Connecticut
Date of Death: April 29, 2020

Cassondra Diaz was a receptionist-turned-bookkeeper at a nursing home in her hometown.

“She was my therapist, my fashion consultant, my hair designer,” said her older sister, Takara Chenice. “I called her my ‘big little sister.’”

Loved ones described her as “an old soul,” loyal to her family, including her husband, Sean Diaz. In their free time, the couple would hit the highway for a long drive, venturing to parks, lakes and the beach.

Her family believes she contracted the coronavirus at work. A spokesperson for Chelsea Place confirmed that the nursing home had COVID cases among staff and patients. It said staffers were provided with personal protective equipment. Despite wearing protective gear, removing her work clothes at the door and showering after work, Cassondra developed symptoms in mid-April.

On April 29, she woke up having difficulty breathing and pain in her leg, said Sean, who called an ambulance. She died that day.

Sean keeps a photo of her in their car. “My six years with her were better than any lifetime I had before her,” he said.

— Madeleine Kornfeld, City University of New York | Published June 5, 2020

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A Doting Family Man, He Was A Long-Standing Fixture At His Hospital

(Courtesy of Susan Ferranti and family)

David Ferranti

Age: 60
Occupation: Hospital equipment coordinator
Place of Work: St. Elizabeth‘s Medical Center in Brighton, Massachusetts
Date of Death: May 2, 2020

David Ferranti was committed to his two families — both at home and at work. In his job on the engineering unit, he was really part of every team in the hospital, wrote St. Elizabeth’s president, Harry Bane, in a note to employees. “He was always worried about ‘his nurses’ and ‘his departments’ having what they needed to best care for our patients.”

Ferranti worked at the hospital for almost 42 years “and he loved every day of it,” said his father, Savino Ferranti. St. Elizabeth’s was treating many COVID-19 patients when David became infected with the virus, his father said, but it was impossible to say where he caught it. St. Elizabeth’s had no further comment about his case.

Ferranti was a family man “and the greatest son you can imagine,” his father said. He had a wife, Susan, and a son, John.

Ferranti worked in his garden and enjoyed walks in nature. A history buff, he was born in Wiesbaden, Germany. His father, a descendant of Italian immigrants, served in the military there, where he met David’s mother, Renate.

For his family, tragedy hit twice within weeks. David’s aunt Ann Ferranti died of the disease a few weeks before David. The advice David would have given to anyone, said his father, “is to stay safe, whatever it takes.”

Katja Ridderbusch | Published June 5, 2020

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A Nurse For Whom Family Was Everything — And Patients Were Like Family

(Courtesy of the Mazzarella family)

Kelly Mazzarella

Age: 43
Occupation: Clinical nurse manager
Place of Work: Montefiore Mount Vernon Hospital in Mount Vernon, New York
Date of Death: May 8, 2020

Even as a girl, Kelly Mazzarella had her sights set on helping others. She turned this innate altruism into a 16-year career at a community-based teaching hospital.

Karen Jedlicka was blown away by the care her big sister showed every patient. “People would be going through the worst things in their lives and she was just there for them,” Jedlicka said.

Mazzarella showed that same compassion with her husband, Ronnie Mazzarella, and daughters, Hailey and Kristina. She never missed an opportunity to tell her daughters how proud they made her, Jedlicka said.

In July 2019, Mazzarella was diagnosed with lupus, an autoimmune disease that brought on painful bouts of swelling. She worked on and off through March, helping with the influx of COVID patients. She was diagnosed on April 2 and died five weeks later. Her employer did not respond to requests for comment.

Nicol Maursky, a lifelong friend, organized a GoFundMe for the family. A staggering outpouring has brought in close to $75,000.

“She just had such a love and a light that emanated from her,” Jedlicka said. It’s “very comforting to know everybody felt the same way that we did.”

— Suzannah Cavanaugh, City University of New York | Published June 5, 2020

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A Proud New Orleanian And Community Caretaker

(Courtesy of Talisa Pace)

Jana Prince

Age: 43
Occupation: Case manager
Place of Work: Salvation Army in New Orleans, Louisiana
Date of Death: April 6, 2020

A “natural New Orleanian,” Jana Prince was bubbly and loving, her brother Paul Prince said.

Since high school, Jana knew she wanted to be a social worker. She grew up with cerebral palsy, wearing a leg brace and diligently practicing physical therapy so she could walk. Kids bullied her about her disability, but nothing would stop Jana from connecting with her community.

“She was trying to share her strength with other people, because she just didn’t want to see people suffer,” cousin Talisa Pace said. “She really wanted to help the Black community.”

One day in mid-March, Jana had trouble breathing, Paul said. She was hospitalized for more than a week before she was intubated, and died the next day. The family said they did not know whether she was infected at work, especially given how early she became infected; the Salvation Army declined to comment.

Her mother, Barbara Prince, died of the virus three days later.

The duo lived together and got on like Laverne and Shirley. They often took care of Paul’s twin 6-year-old boys. “I don’t know how one would have survived without the other,” Paul said.

Jana and Pace had dreamed of opening a coffee shop and counseling center. “She would have been the highlight of the whole place,” Pace said.

— Theresa Gaffney, City University of New York | Published June 5, 2020

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‘She Always Listened And Never Judged’

(Courtesy of Tiana Mohabir)

Tina Reeves

Age: 58
Occupation: Licensed practical nurse
Place of Work: Pickaway Correctional Institution in Orient, Ohio
Date of Death: April 27, 2020

When Tina Reeves visited her grandchildren, music would blast from the car. Wale’s “On Chill” rang out: “Trying to hear all your problems, so I can lighten the load.”

“She loved her music,” said daughter Tiana Mohabir, “even though she had no rhythm for squat.”

Reeves had an ear for the rhythm in other people’s lives, though. Younger co-workers called her “Mother Advice,” Mohabir said. In interactions with prisoners and officers alike “she always listened,” Mohabir said, “and never judged.”

She called her three daughters daily, “checking in on all of us.”

When Reeves started coughing in early April, Pickaway Correctional had already reported more than 1,500 cases of COVID-19.

“PPE [personal protective equipment] was, and continues to be, available to staff,” a prison spokesperson said. The family said their mother did not have access to adequate PPE.

By April 13, Reeves was hospitalized with COVID-19. She called her daughter to ask her to take care of paying her utility, insurance and cable bills. “I didn’t think twice,” Mohabir said, “because I didn’t want them shut off when she got home.”

Within 24 hours, Reeves was intubated. On the bedside table, her phone kept ringing.

Eli Cahan | Published June 5, 2020

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An ‘Icon,’ Hospital Secretary ‘Brightened Every Situation’

(Courtesy of Glenna Swann)

Joan Swann

Age: 70
Occupation: Intensive care unit secretary
Place of Work: Kent Hospital in Warwick, Rhode Island
Date of Death: April 29, 2020

When things were slow at the hospital, Joan Swann would head down to the gift shop.

If someone was having a hard day — the security guard, the patient transporter, the barista — she might buy them a candle. Or charm bracelet. Or a Vera Bradley handbag.

“She brightened every situation,” said Glenna Swann, her daughter. A former nurse, Joan coached trainees from behind the administrative desk. They called her an “icon” who was the reason many stayed working in the intensive care unit.

When Joan was admitted to the hospital, those she had long cared for returned the favor. Her isolation room was adorned with blue hearts, and following her intubation, the nurses would FaceTime the family in. During quiet hours, they sat at her bedside.

The hospital did not respond to requests for comment.

After Joan died, the family found “thousands upon thousands” of unused greeting cards, sorted by occasion (weddings or Christmas) and emotion (sympathy or humor).

In the coming weeks, Joan’s cherished grandson, Adam, will complete high school. Glenna is still choosing from among Joan’s graduation cards for him.

Eli Cahan | Published June 5, 2020

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In A Family Who Lost Both Mother And Son, Food Was Love

(Courtesy of Lloyd Torres)

Louis Torres

Age: 47
Occupation: Food service director
Place of Work: Queens Boulevard Extended Care Facility in Woodside, New York
Date of Death: April 8, 2020

Louis Torres went into the family business. He grew up adoring his mother’s Philippine home cooking, so it was natural to channel his passion for food into comforting others. As a food service director at a nursing home in his native Queens, he could cook and work in health care as his mother did.

Feeling terrible on March 30, Louis called his older brother, Lloyd, after work. “He was struggling to make it from the subway station,” Lloyd said.

Louis lived with his mother, Lolita, 73, a retired hospital clerk. She also had severe COVID-19 symptoms.

By the next day, mother and son had been taken by ambulance to separate hospitals. In the chaos, Lloyd said, it took an entire day of panicked calls to find their mother, who was still in the emergency room.

A few days later, Lloyd was able to pray the rosary with Lolita over the phone, and it seemed to calm her. Before they hung up, she asked that Lloyd take care of his brother. Louis made the same request about his mother before going on a ventilator.

“Their last words to me [were to] take care of each other, my God,” Lloyd said, his voice cracking.

On April 7, Lolita died. Louis died the next day.

In the weeks since then, Lloyd was comforted by a powerful dream.

“I woke up and smelled the frying of food,” he said, invoking his mother’s cooking. “That’s how she showed her love.”

— Kathleen Horan | Published June 5, 2020

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Theater Brought Them Together, Then Life Imitated Art

(Courtesy of Harriet Clark Webber)

Barry Webber

Age: 67
Occupation: General surgeon
Place of Work: Mount Sinai Queens in New York City
Date of Death: April 18, 2020

Barry Webber wanted to understand how things worked. That curiosity and drive motivated him to reconstruct an old Jeep, build a computer, take up rock climbing and, of course, become a surgeon.

He pursued medicine when he realized he wasn’t going to become a concert pianist, said his wife, Harriet Clark Webber.

They met when Harriet was a dancer with the American Ballet Theatre and Barry moonlit as a supernumerary — a non-dancing extra on stage — for the company. “He just wanted to be around the theater,” she said.

Barry honed his surgery skills in a Brooklyn emergency room in the 1980s. “It was a rough time to be in an ER in Brooklyn,” Harriet said. “He was treating a lot of gunshot wounds and trauma.”

They married in 1996 and had two sons, now 22 and 20.

Like so many Americans, when COVID-19 struck, the couple watched “Contagion,” a 2011 film about a pandemic. Barry said it gave him a bad feeling.

On March 27, his fears were realized. He texted his wife: “I’m sick.”

Harriet believes he contracted the virus at work before the hospital ordered the universal use of protective gear.

Danielle Renwick, The Guardian | Published June 5, 2020

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Brooklyn Radiologist Was ‘Kind, Simple, Loving And Devoted’

David Wolin and his daughter, Helena Cawley (Courtesy of Helena Cawley)

David Wolin

Age: 74
Occupation: Radiologist
Place of Work: The Brooklyn Hospital Center in New York City
Date of Death: March 30, 2020

By 10 a.m. on Sundays, David Wolin and his wife, Susan, would have completed one-quarter of the New York Times crossword.

When the grandchildren arrived, Wolin greeted them with bagels, lox, whitefish “and the best scrambled eggs in the entire world,” said Helena Cawley, his daughter.

Wolin was “kind, simple, loving and devoted.” A radiologist specializing in mammography, he was “committed to learning everything he could,” Cawley said. “The latest medical journal was always on his nightstand.”

He and Susan would skip off to their home upstate on Wolf Lake, where they might take out a rowboat, a bottle of chardonnay and a brick of Roquefort cheese under the stars. “All they needed was each other,” Cawley said.

In late March, Wolin complained of “bad colds” but deferred testing. Brooklyn Hospital was overwhelmed with COVID-19. A hospital spokesperson could not be reached for comment.

On March 30, when Cawley couldn’t reach her father, she called the doorman of his building. He reluctantly shared the news: Wolin had died overnight.

Susan was hospitalized that day and died weeks later. “We’re grateful in a way,” Cawley said, “because we don’t know how they could have lived without each other.”

Eli Cahan | Published June 5, 2020

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‘Working There Was The Proudest Accomplishment Of His Life’

(Courtesy of Maria Joy Agtarap)

Romeo Agtarap

Age: 63
Occupation: Emergency room nurse
Place of Work: NewYork-Presbyterian/Columbia University Irving Medical Center in New York City
Date of Death: April 24, 2020

Joy and Romeo Agtarap met in Queens in the 1980s, when they were both young nurses, newly arrived from the Philippines. Joy Agtarap said her husband was a jokester who had a vibrant personality that often made him the life of the party. At gatherings, he liked to get people onto the dance floor.

“He’s a very good dancer ― sometimes he made the line dances too hard and people would get lost!” she remembered.

He was also a dedicated emergency room nurse. Agtarap had spent 20 years at what his wife said was his “dream job” at the NewYork-Presbyterian/Columbia University Irving Medical Center.

“Working there was the proudest accomplishment of his life,” she said. He was still seeing patients when the pandemic hit. (The hospital did not respond to requests to comment on whether he had adequate personal protective equipment).

Romeo was diagnosed with COVID-19 in late March. Joy, who had left nursing due to an injury, became sick a week later. They were both hospitalized ― he at NewYork-Presbyterian and she at a facility on Long Island. As Joy recovered, she anxiously awaited updates on her husband’s condition.

“It was the most devastating thing that’s ever happened to me. I was going crazy in there waiting for calls about him,” she said. He died on April 24. “I believe he took the worst of the virus for me, that’s why I’m still here,” she said.

Anna Jean Kaiser, The Guardian | Published June 2, 2020

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As Nurse And Minister, She Tended To Her Patients, Flock ― And Garden

(Courtesy of Elijah Ailende)

Felicia Ailende

Age: 67
Occupation: Registered nurse
Place of Work: Bria of Forest Edge in Chicago
Date of Death: April 20, 2020

Felicia Ailende was a beacon of unity to her family and members of Maranatha Chapel in Evergreen Park, Illinois, where she was a minister. She counseled many, helping keep marriages intact and lives on track, her son Elijah Ailende said. Though her six children were very different from one another, she saw the best in each.

An immigrant from Nigeria, she planted a garden each year and used the produce to cook West African dishes. When there were too many cucumbers, hot peppers or greens, she shared with neighbors.

At Bria of Forest Edge, a nursing home, Felicia cooked for residents at times or prayed for them, Elijah said.

Administrator Julie Kosman said in a statement that Ailende was a hardworking nurse who was pleasant and funny and had a great rapport with residents.

She is one of three workers at the facility who have died of COVID-19; two residents also died. The facility reported 132 infections.

Elijah said staffers had to reuse surgical masks provided by the facility. Administrators did not tell them when residents and other staff members got the virus “so they could take precautions and safeguard their lives,” he said.

Kosman’s statement says “full PPE” — personal protective equipment — was available to staffers and there is no reason to believe Ailende was exposed to COVID-19 “within our facility.” She “had no known contact with any resident or staff member who showed symptoms or had tested positive for COVID-19.”

Christina Jewett, Kaiser Health News | Published June 2, 2020

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He Practiced What He Preached, Caring For Inmates With Mental Illness

(Courtesy of Gwendolyn Davis)

Bishop Bruce Edward Davis

Age: 57
Occupation: Shift leader for forensic service technicians
Place of Work: Central State Hospital in Milledgeville, Georgia
Date of Death: April 11, 2020

In sermons at his Pentecostal church, Bishop Bruce Davis preached love. On weekdays, he practiced it by feeding, bathing and caring for patients at a maximum-security psychiatric hospital. Davis worked for 27 years at the state facility, said his wife, Gwendolyn Davis.

As a boy, Davis would break his pencils in half to share with his twin sister. At church, he hosted youth parades and gave away computers, bicycles and groceries. He distilled the Bible into simple lessons, she said, once winning over a parishioner with a sermon based on “The Wizard of Oz.”

When COVID-19 emerged, Davis and his co-workers at the psychiatric facility were told they couldn’t wear masks or gloves because it wasn’t part of their uniform, she said. Five days after a close co-worker tested positive for COVID-19, Davis was hospitalized, she said.

More than 70 workers at the hospital have tested positive for COVID-19, according to state data; Davis is one of two who have died. A hospital spokesperson declined to comment on Davis’ case.

After Davis’ illness, his entire household – Gwendolyn, three children and a grandchild – got sick with COVID-19, Gwendolyn said. Their adult son, who has autism, was hospitalized, Gwendolyn said. Their daughter, 22, recovered and returned to work at the same hospital.

“It is extremely hard for her to go back to work there,” Gwendolyn said.

Melissa Bailey | Published June 2, 2020

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Dedicated Dad And Technologist ‘Was As Smart As They Come’

(Courtesy of Junette Francis)

Devin Francis

Age: 44
Occupation: Radiologic technologist
Place of Work: Jackson Memorial Hospital in Miami
Date of Death: April 8, 2020

Devin Francis was due to get married June 27 to his longtime love, Micela Scott, mother of their 11-year-old daughter, Dekayla.

Scott said her fiancé was a devoted father.

“He’d take [Dekayla] to school every morning. He’d help her with her homework,” she said. “He just wanted peace to his life and us to have a good life.”

“He had a very jovial spirit,” said his youngest sister, Junette Francis.

Devin took a COVID test at Jackson Memorial after his shift on April 6 — it came back positive. His breathing became labored and he died at home early on April 8.

His family and a hospital representative said it was unclear whether he came into contact with patients with COVID-19. Devin also worked in fleet services for American Airlines.

Colleagues admired his work ethic.

“No matter where we were in life, he never had less than two jobs,” said Milton Gonzalez, a hospital co-worker. “He was as smart as they come.”

Sharon Jayson | Published June 2, 2020

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A Pediatric Neurosurgeon Who Separated Conjoined Twins

(Courtesy of Judy Goodrich)

James Goodrich

Age: 73
Occupation: Pediatric neurosurgeon
Place of Work: Montefiore Medical Center in the Bronx, New York City
Date of Death: March 30, 2020

James Goodrich was a renowned pediatric neurosurgeon, best known for separating conjoined twins ― a rare and risky procedure. Over the course of his career, he was directly involved in about 10 cases, advising on dozens more.

A late bloomer academically, Goodrich began his undergraduate studies at age 24, after returning from Vietnam, where he served in the Marines.

“He had seen a neurosurgeon when he was in Vietnam, and he just was fascinated at what they were able to do,” said Judy Goodrich, his wife of 50 years. “I thought, just try to become a doctor first.”

He was also known for innovations regarding conditions affecting the skull. He helped develop standards for treating craniosynostosis, in which the bones of a child’s skull fuse too soon, preventing the brain from growing properly.

Goodrich was an avid collector ― of antique medical books, pre-Columbian medical artifacts, rare watches and fine wines, among other things. He surfed, cultivated bonsai trees and played the didgeridoo.

He had seen patients in the clinic in early March, just before flying to Mexico for a family vacation. He soon began to feel ill, and when he returned to New York, he was diagnosed with COVID-19. He was hospitalized on March 25 and died five days later.

Read more here.

Danielle Renwick, The Guardian | Published June 2, 2020

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She Brought ‘Calming Presence’ And Fun To Nursing Home

(Courtesy of Howard Fox Jr.)

Leola Grady

Age: 59
Occupation: Recreational aide
Place of Work: Bria of Forest Edge in Chicago
Date of Death: April 10, 2020

Leola Grady had planned to be with her son and granddaughter in Mississippi for Mother’s Day but did not live to make the trip.

At the Bria of Forest Edge nursing home, she entertained residents, including with a “good game of cards,” administrator Julie Kosman said. “She had a calming presence about her.”

When Grady fell ill, a nurse at the facility was already sick with the coronavirus. A nursing aide whose name has not been released also died of COVID-19. Staff at the facility, with SEIU union leaders, spoke out saying they were unaware their co-workers were dying until they saw it on the news.

Howard Fox Jr., Grady’s son, said his mother was his best friend. An honest, straightforward and loving person, she enjoyed listening to the blues. “I’m not going to sit here and sugarcoat it,” he said. “It hurts. … I look at our picture. I cry.”

Fox said his mother went to a Chicago hospital with COVID symptoms but was sent home. She was found dead several days later. A Cook County spokesperson confirmed she died of pneumonia due to COVID-19.

Kosman said the facility does not believe Grady or the nurse, Felicia Ailende, “were exposed to COVID-19 within our facility. They had no known contact with any resident or staff member who showed symptoms or had tested positive for COVID-19.”

As of May 27, Bria of Forest Edge has reported 132 coronavirus cases and two deaths to Illinois officials. In the statement, Kosman said it reported worker deaths to the Occupational Safety and Health Administration, which shows three pending death investigations at the facility.

Christina Jewett, Kaiser Health News | Published June 2, 2020

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Young Nurse Lived A Life Of ‘No Regrets’

(Courtesy of the Guzman family)

Krist Angielen Castro Guzman

Age: 35
Occupation: Licensed practical nurse
Place of Work: Meadowbrook Manor in Bolingbrook, Illinois
Date of Death: May 2, 2020

Krist Guzman packed a lot into her short life. She worked full time while studying to become a registered nurse. She had three children, one a newborn.

Smart, funny and outgoing, she nurtured relationships.

“Hers was a life of no regrets,” said a cousin, Jeschelyn Pilar.

In a Navy family that moved often, she was close with her brother, Anjo Castro.

“She was my role model,” said Castro, who also pursued a medical career as an independent duty corpsman in the Navy.

The pandemic hit home when their uncle, pediatric surgeon Dr. Leandro Resurreccion III, died March 31.

Guzman told family she had seen COVID patients. Worried she didn’t have adequate protective gear, she scrambled to find some online.

Meadowbrook has registered the worst COVID outbreak in Illinois, with more than three dozen deaths. Nursing home spokesperson Marissa Kaplan said in a statement: “Meadowbrook puts the safety and welfare of its residents and staff at the forefront of everything we do.” She did not address whether there was sufficient protective gear.

Mary Chris Jaklevic | Published June 2, 2020

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Selfless Nephrologist Fought For Her Life While Treating Others

(Courtesy of the Khanna family)

Priya Khanna

Age: 43
Occupation: Nephrologist
Place of Work: Khanna Nephrology in Glen Ridge, New Jersey
Date of Death: April 13, 2020

Priya Khanna came from a family of doctors, and she knew the risks of contracting the deadly coronavirus. She was immunocompromised and actively seeing patients days before she became ill with COVID-19.

On April 1, Priya was hospitalized in the same facility where her father, Satyender Dev Khanna, had been brought days earlier. He was also being treated for COVID-19.

From her hospital bed, Priya checked in on friends, reviewed patient files and communicated with the physician who was seeing patients in her stead. She continued to do so until she was put on the ventilator.

“She literally worked for others until she could no longer breathe for herself. That was Priya,” said childhood friend Justin Vandergaag. “Always putting others first with a smile.”

“She was a devoted daughter, sister and aunt,” said childhood friend Laura Stanfill. “Her healing gifts extended not only to her patients but, in the many ways, she made everyone in her life feel important and loved.”

Read more here.

— Natalia Megas | Published June 2, 2020

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‘He’s One Of Our Legends’

(Courtesy Stephanie Mahoney)

James ‘Charlie’ Mahoney

Age: 62
Occupation: Pulmonologist
Place of Work: SUNY Downstate Medical Center in Brooklyn, New York City
Date of Death: April 27, 2020

James “Charlie” Mahoney eschewed hospital hierarchies.

“He didn’t treat people like underlings,” said his sister, Saundra Chisholm. “He would talk to housekeeping like he would talk to the chief of the hospital. That’s why he was so well respected.”

Growing up on Long Island, Mahoney was an ace student and athlete. He was one of only a handful of Black students at his medical school and throughout his training. He and his brother, Melvin Mahoney, worked side by side at SUNY Downstate for many years, a public hospital that treats a mostly minority and low-income patient population.

When the pandemic hit New York in March, Mahoney, who specialized in respiratory care, “ran into the fire,” Melvin said. But his hospital, like other underfunded public institutions in the city, was short of protective equipment and staff.

Mahoney started experiencing symptoms in early April, and was hospitalized soon after. He died on April 27.

“He’s one of our legends ― he’s one of our giants,” said Julien Cavanaugh, a neurology fellow at SUNY Downstate who trained under Mahoney.

Read more here.

Ankita Rao, The Guardian | Published June 2, 2020

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Psychiatric Nurse Knew Her Patients’ Hometowns And Hobbies

(Courtesy of Eddie Ballard)

Shenetta White-Ballard

Age: 44
Occupation: Licensed practical nurse
Place of Work: Legacy Nursing and Rehabilitation of Port Allen, Louisiana
Date of Death: May 1, 2020

Eddie Ballard was baking “Pecan Delight” pie at the Piccadilly Cafeteria in Baton Rouge, Louisiana, when Shenetta White, accompanying her auntie and grandmother, leaned over the buffet counter to grab a Jell-O.

“She gave me this look,” Ballard said, and he gathered the confidence to ask for her number. On their first date he quickly realized “not only was she beautiful, but she was mature beyond her years.”

That maturity manifested across her life.

As a nurse to psychiatric patients, she was adored by those she “saw as people more than just patients,” Ballard said. She knew their parents’ names, their hometowns and hobbies. At home, White-Ballard was “queen of the house,” Ballard said. She handled the errands and the finances, while “her two boys [Ballard and his son, Warren] hung on whatever she asked.”

With a preexisting condition, White-Ballard depended on supplemental oxygen. She died May 1, just three days after developing COVID-19 symptoms.

In an email, a Legacy spokesperson wrote that the facility had followed all guidelines and “had more than enough PPE.”

The first piece of jewelry Ballard bought his wife was a bracelet that read: “Love is patient, love is kind, love never ends.”

“I hadn’t read that in 11 years,” he said, “but boy, it’s still true.”

Eli Cahan | Published June 2, 2020

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From His ICU Bed, Nurse Planned To Help Fight COVID After Recovery

Christopher Dean with his wife, Natalya Kubaevskaya (Photo by Donna Dean/Courtesy of Natalya Kubaevskaya)

Christopher Dean

Age: 37
Occupation: Licensed practical nurse
Place of Work: Northport VA Medical Center’s Valley Stream Clinic in Valley Stream, New York
Date of Death: April 15, 2020

When Christopher Dean went to the emergency room, he was “absolutely positive” he would be in the hospital a few days, get some fluids and oxygen and then go home.

“He was always optimistic, full of life,” said Natalya Kubaevskaya, his wife of 10 years. “And he had a big heart.”

When tests came back positive for COVID-19, he planned to recover and then help fight the disease by donating blood and plasma. Three weeks later, he was dead.

He had mild asthma, his wife said, but was a healthy man who loved snowboarding, swimming and racquetball.

His father, Alvin Dean, shared on a GoFundMe page that Christopher Dean caught the coronavirus at work. Northport said by email that it provided “PPE in accordance with CDC guidelines.”

Kubaevskaya, who recently finished treatment for breast cancer, said Dean pushed her to keep going.

Daughter Donna, 15, struggles with her adoptive father’s death. “There are moments,” Kubaevskaya said, “when she tries to convince herself that he’s still in the hospital and will come home soon.”

Katja Ridderbusch | Published May 29, 2020

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A Robotic Surgery Expert Who ‘Just Made Everything Fun’

(Courtesy of the Lopez family)

Maria Lopez

Age: 63
Occupation: Registered nurse
Place of Work: University of Illinois Hospital in Chicago
Date of Death: May 4, 2020

“What lady? I don’t see a lady here.”

That was the sort of self-deprecating comment Maria Lopez would fire back when teased by a co-worker about an etiquette faux pas in the operating room.

Lopez knew how to break the tension, said chief nurse anesthetist Mary Ann Zervakis Brent, a colleague since 2005. Lopez called everyone “amigo” or “amiga,” regardless of rank.

“She just made everything fun,” Zervakis Brent said.

Lopez was an expert in robotic surgery and trained others to use the equipment.

She taught her two daughters to be independent. The oldest of nine kids, Lopez fought her father’s expectation that she forgo college, said her daughter Maria, who was named for her.

Lopez’s symptoms appeared days after she returned to work from leave for knee surgery. She planned to retire April 30.

In the hospital, Lopez tried to stay positive. Yet during one FaceTime call, daughter Maria said, “she just broke down. She said, ‘I wouldn’t want anyone I love going through what I’m going through right now.’”

A hospital official confirmed in a statement that Lopez died of complications of COVID-19.

Mary Chris Jaklevic | Published May 29, 2020

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With Retirement In Sight, She Died Awaiting COVID Test Results

(Courtesy of Hannilette Huelgas)

Hazel Mijares

Age: 66
Occupation: Licensed practical nurse
Place of Work: Amsterdam Nursing Home in New York City
Date of Death: March 30, 2020

Faith was central to Hazel Mijares’ life. She was a lay leader at Trinity United Methodist Church in Jersey City, New Jersey.

She was drawn to church as a child in the Philippines, sister Hannilette Huelgas said. Theirs was a big family with nine children. At get-togethers, Mijares always led the prayers.

After a long career, Mijares was finally ready to retire in late March.

She worked through March 13, burned up accrued paid time off, then stopped back a week later for her last day. As she said her goodbyes, she noticed a little cough.

Learning that one of her patients had died of COVID-19, Mijares tried several times to get tested. Her results were expected March 30. When Huelgas called that day, Mijares didn’t answer. She had died waiting for the results, which the family learned were positive.

As of May 24, the nursing home had recorded 45 presumed-COVID deaths. Officials there did not respond to requests for comment, but a phone recording updated May 21 said they had “completed COVID-19 testing of residents” and had “begun testing of all staff.”

“Our dedicated and caring staff are continuing the Amsterdam tradition of providing exceptional care,” the recording noted.

Mijares “had wanted to go to Jerusalem, to the Philippines,” Huelgas said. “And she didn’t even get to enjoy retirement.”

Maureen O’Hagan | Published May 29, 2020

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You Could Count On Him ‘For Anything’

(Courtesy of Griselda Bubb-Johnson)

Adiel Montgomery

Age: 39
Occupation: Security guard
Place of Work: Kingsbrook Jewish Medical Center in Brooklyn, New York
Date of Death: April 5, 2020

When Griselda Bubb-Johnson couldn’t reach her friend Marva — hospitalized with COVID-19 — Bubb-Johnson called her son, Adiel Montgomery.

Montgomery, a security guard in the hospital’s emergency department, found Marva in the ICU. He then did “everything for her,” Bubb-Johnson said. When Marva was cold, he got a blanket. When she was hungry, he got food. When her phone died, he found a charger.

“Some people boast about their children, but I didn’t have to,” Bubb-Johnson said, “because everybody knew you could count on Adiel for anything.”

Montgomery doted on residents as a part-time supervisor at the Urban Resource Institute, a domestic violence shelter. He invited his godbrothers for Golden State Warriors games, Thanksgiving and sometimes for his mom’s renowned oxtail dish.

Two weeks after Montgomery noted he couldn’t taste his lunch, he experienced acute chest pain. When, after 12 hours in the ER, his heart stopped “nobody could believe it,” Bubb-Johnson said.

Montgomery was vocal about a lack of personal protective equipment for hospital security guards, according to a New York Times report. The hospital did not respond to requests for comment.

Montgomery’s 14-year-old daughter, Aaliyah, never got to say goodbye. She wrote a poem to put in the coffin.

“Don’t worry,” Bubb-Johnson told her. “He’ll read it. I promise.”

Eli Cahan | Published May 29, 2020

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Traveling Nurse ‘Wanted To Be Somebody’

(Courtesy of Daniel Perea)

David Joel Perea

Age: 35
Occupation: Traveling registered nurse
Place of Work: Lakeside Health & Wellness Suites in Reno, Nevada, via MAS Medical Staffing
Date of Death: April 19, 2020

David Joel Perea would call in from Maine, Vermont, Minnesota and, ultimately, Nevada, with the same request: “Mom, can you send tamales?” Dominga Perea would ship them overnight. This is how she always knew where her son was.

A traveling nurse routinely pulling 80-hour weeks, David “had a tremendous work ethic,” said his brother, Daniel. A young David, returning from his father’s mechanic shop, said, “I don’t want to spend life sweating under a car,” Dominga recalled. “I want to be somebody.”

Dominga was proud of him, “for doing God’s work.”

When “mijito” didn’t respond to her text April 6, Dominga knew something was wrong: “I could always tell how David was. If he said ‘Hi, Mama,’ he was happy. If he said ‘I’m fine, Mom,’ he was tired.”

This time he said neither. “Don’t panic, Mama,” David wrote, “just pray for me. I have the COVID.”

His workplace did not respond to requests for comment.

David FaceTimed with his mother on Easter Sunday. “He was starving, but he struggled even eating mashed potatoes,” Dominga said, “because he couldn’t breathe.” The next morning, he was on a ventilator and never woke up.

Eli Cahan | Published May 29, 2020

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His Church Became His Second Home

(Courtesy of Lean Carlo Romualdo)

Ritchie Villena

Age: 44
Occupation: Physical therapist
Place of Work: SportsMed Physical Therapy clinic in Glen Rock, New Jersey, placed by AHVIA Staffing Solutions in Jersey City
Date of Death: April 15, 2020

When Ritchie Villena emigrated from the Philippines in 2011 after studying physical therapy, he struggled. Then he got in touch with Lean Carlo Romualdo, a fellow Filipino physical therapist in New York state. Villena moved in with him and secured a good job at a sports medicine clinic.

He became devoted to his church, Iglesia Ni Cristo, where he spent hours singing with the choir and practicing the organ. “He’s not an outgoing person,” Romualdo said. “But if you ask people in his religious group here in Rockland County, everyone will know him.”

Romualdo’s 7-year-old still plays the “Baby Shark” song Villena taught him on the piano, asking, “Is Uncle Ritchie coming back home?”

It’s unclear how Villena contracted the coronavirus. According to the staffing agency, he worked until March 13 and took ill the following week. On March 26, he called 911 with difficulty breathing; he was hospitalized until his death.

Villena, who only recently gained permanent residency status, hadn’t seen his family in nine years. “Every time his mom calls me, she wants to see Ritchie’s stuff,” Romualdo said. As he gives a video tour of Villena’s room, she can’t stop crying. He promised to pack everything and send it home.

Maureen O’Hagan | Published May 29, 2020

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Nurse With ‘Heartwarming’ Smile Did Her Best For Her Children

(Courtesy of Anderson Family)

Jenniffer Anderson-Davis

Age: 44
Occupation: Licensed practical nurse
Place of Work: Meramec Bluffs Life Plan Community in Ballwin, Missouri
Date of Death: April 14, 2020

As a single mother, Jenniffer Anderson-Davis was determined to give her three children everything they needed, so she pursued her nursing degree while delivering pizza to make ends meet.

“She always did the best that she could to give them the best life,” her brother Earl Anderson said.

Most recently, Anderson-Davis worked as an admission and discharge nurse at a senior living community. Her mother, Edna Anderson, said that Anderson-Davis was concerned about residents who returned to the facility after visiting Florida (it has since banned reentry for residents who spent time away).

Anderson-Davis tested positive for COVID-19 on April 9 and died at home five days later. The Occupational Safety and Health Administration opened a fatality investigation at Meramec Bluffs on April 16.

Lutheran Senior Services, the nonprofit that operates Meramec Bluffs, acknowledged Anderson-Davis’ death but did not respond to specific questions about her case. In a statement, a spokesperson said: “Jenniffer’s coworkers remember her as a thorough and well-respected nurse who had a smile that could warm any heart.”

Cara Anthony, Kaiser Health News | Published May 26, 2020

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A Tireless Nurse, She Loved Her Children And Travel

(Courtesy Stefaney Cicala)

Susan Cicala

Age: 60
Occupation: Registered nurse
Places of Work: Northern State Prison in Newark, New Jersey; Clara Maass Medical Center in Belleville, New Jersey
Date of Death: April 4, 2020

Susan Cicala worked long hours. A typical workday began at the hospital surgery department at 5:30 a.m. She’d work there until 2 p.m., and an hour later would start her next eight-hour shift at a nearby state prison. She worked weekends, too.

As for sleep? “She must have slept somewhere, but I don’t know,” her son, Steven Cicala, said with a laugh. “She was the hardest worker I ever met.”

Reminiscing on Facebook, colleagues said she talked about her two children constantly. She started wrapping Christmas presents in May. She loved to travel, to Disney World and national parks, and saw vacations as opportunities to learn about the world beyond New Jersey — on a trip to Hawaii, she delved into the attack on Pearl Harbor.

Cicala became sick in late March and died in early April; her family said they presume she contracted the virus at one of her jobs.

“She didn’t go anywhere else,” Steven said.

As of May 21, the New Jersey Department of Corrections had tallied 152 COVID-19 cases at the prison where Cicala worked; 134 of those diagnoses were among staffers. In early May, the union representing Cicala and other workers filed a safety complaint saying precautions have been inadequate and may have led to Cicala’s death. A spokesperson for the prison health care agency that employed Cicala said that it had followed all state and federal guidelines, and that the staff was provided with personal protective equipment.

Maureen O’Hagan | Published May 26, 2020

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The Single Mother Dreamed Of Opening A Nursing Home

(Courtesy of Rebecca Gbodi)

Helen Gbodi

Age: 54
Occupation: Registered nurse
Place of Work: MedStar Washington Hospital Center in Washington, D.C.
Date of Death: April 19, 2020

Helen Gbodi was known for helping elderly neighbors and fellow churchgoers — picking up their medications and groceries and accompanying them on walks. She even dispatched her daughter, Rebecca Gbodi, to shovel snow in neighbors’ driveways.

“Even when she didn’t have a lot, she would always give,” Rebecca said of her mother, who worked long hours to put her children through college and helped pay school fees for other relatives. This year, she embarked on her own dream: crafting plans to open her own nursing home, her daughter said.

Gbodi understood the severity of COVID-19 early on. In March, she called every person in her contacts list, including people she hadn’t talked to in years, to make sure they were aware and taking precautions, her daughter said. Though she did not actively care for patients who had been diagnosed with COVID-19, such patients were being treated on her floor, her daughter said.

Days later, she was fighting for her life. By the time she was hospitalized with COVID-19, she was too weak to lift her arm for a virtual handshake with her daughter on FaceTime.

“At the end of the day, she was willing to put her life in danger for others,” Rebecca said.

Anna Jean Kaiser, The Guardian | Published May 26, 2020

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Always Upbeat, Patient Transporter Was A Sewing Wiz

(Courtesy of the Ismayl family)

Gabrail ‘Gabe’ Ismayl

Age: 62
Occupation: Patient transport worker
Place of Work: Swedish Hospital in Chicago
Date of Death: May 6, 2020

Caring, upbeat, always first to arrive at a party. Gabrail Ismayl loved an excuse to don a suit and splash on cologne.

That’s how Fidelline Youhanna remembers her uncle. “Everybody loved Gaby,” she said.

After migrating from Syria in the 1980s, Ismayl ran wholesale clothing shops on Chicago’s North Side. He was a wiz with the sewing machine and enjoyed altering dresses, making curtains and doing creative projects for family and friends.

Later, his people skills were an asset as he wheeled patients where they needed to go.

As the pandemic took hold, Ismayl worked despite health conditions that elevated his risk, Youhanna said.

“I think he just liked his job,” she said. “He made a lot of friends there.”

On May 6, Ismayl was self-isolating in the basement of the house he shared with two sisters. He was short of breath, Youhanna said. By evening, he was dead.

Ismayl was employed by management services company Sodexo. The CEO of its health care division in North America, Catherine Tabaka, said in a statement that his passing “is a tragic loss for Sodexo and we mourn an incredible friend and presence.”

Mary Chris Jaklevic | Published May 26, 2020

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Charismatic Surgical Technician Taught His Kids To Be ‘Faithful To Your Job’

(Courtesy of the Martinez family)

Juan Martinez

Age: 60
Occupation: Surgical technician
Place of Work: University of Illinois Hospital in Chicago
Date of Death: April 27, 2020

It was easy to befriend Juan Martinez.

The surgical technician “could start a conversation up with anyone about anything,” said Jose Moreno, an operating room nurse and co-worker.

He went out of his way to teach others what he learned from 34 years in the field, said his son, Juan Martinez Jr., who followed his dad’s career path at the same hospital.

The military veteran and former church pastor set an example “to be faithful to your job,” his son said.

Due to retire April 30, Martinez anticipated spending time with his grandchildren, traveling and opening Bible education centers in Mexico, his family said.

After feeling tired and feverish, he went to be tested for COVID-19 on April 17. His symptoms were so severe that he was taken by ambulance to the hospital where he worked.

Family members said Martinez did not engage in direct patient care but came in contact with staffers who did.

Juan Jr. said that losing his dad has been like a nightmare, and that he and his siblings are “leaning on the Lord and praying a lot, just like how our father taught us.”

Mary Chris Jaklevic | Published May 26, 2020

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Memory Care Nurse Set Fear Aside

(Courtesy of Jessica Forbes)

Nina Forbes

Age: 56
Occupation: Licensed practical nurse
Place of Work: Silverado memory care facility in Alexandria, Virginia
Date of Death: April 25, 2020

Nina Forbes refused to let fear stop her from living.

She was terrified of flying. But a few years ago, Forbes got on a plane for the first time to watch her younger daughter Jennifer play volleyball.

COVID-19 also scared Forbes, and as a nurse at an assisted living facility, she knew the virus posed a serious risk. Still, she continued showing up to work.

Forbes tested COVID-positive just after Easter. Chills, body aches and a fever kept her from attending family dinner that Sunday. By the following weekend, she struggled to breathe and couldn’t walk on her own. An ambulance took her to the hospital.

Her older daughter, Jessica, said her mother didn’t have the necessary protection at work. Forbes sometimes wore trash bags to protect herself, she said.

In a statement, a representative for the facility said it met the Centers for Disease Control and Prevention guidelines for personal protective equipment. Employees sometimes used trash bags as an added layer of protection, worn over a disposable gown, according to the representative.

Forbes appeared to do what she wanted even in her final moments. Jennifer was able to visit her mother in the hospital, and Forbes died shortly after she left, Jessica said. “It was like she waited for her to leave.”

Carmen Heredia Rodriguez, Kaiser Health News | Published May 19, 2020

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A Family Man Who Loved Disney, Took Risks To Help Others

(Courtesy of AMR Southwest Mississippi)

David Martin

Age: 52
Occupation: Paramedic
Place of Work: AMR Southwest Mississippi, covering Amite and Wilkinson counties
Date of Death: April 22, 2020

On March 22, David Martin changed his Facebook profile picture. Around his smiling face, the frame read, “I can’t stay home … I’m a healthcare worker.”

Outside of work, he was a dedicated family man with two children, known for his love of Disney.

Martin, who covered 1,420 square miles across two rural counties, had cared for people with suspected COVID-19 in the weeks leading up to his death, said Tim Houghton, chief of operations for AMR Southwest Mississippi.

“We do what we do knowing the risks,” Houghton said. But Martin’s death was “a hard hit.”

On March 23, at the end of a shift, Martin told a supervisor he had mild flu symptoms. A month later, he died at a hospital in Baton Rouge, Louisiana.

AMR paramedics had N95 masks and protective gear and followed Centers for Disease Control and Prevention guidelines, Houghton said. “We have not yet had a shortage.”

In Facebook posts honoring Martin, colleagues described his excitement before trips to Disney World. In his memory, his fiancee, Jeanne Boudreaux, shared a photo of a hot air balloon ride at Disney Springs.

Michaela Gibson Morris | Published May 19, 2020

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For a 9/11 First Responder, ‘Sitting on the Sidelines Was Never in His DNA’

(Courtesy of Erin Esposito)

Matthew ‘Matty’ Moore

Age: 52
Occupation: Radiologic technologist
Place of Work: Northwell Health’s GoHealth Urgent Care in Eltingville, Staten Island, New York City
Date of Death: April 17, 2020

Matthew Moore “would give the shirt off his back to help others,” said his sister, Erin Esposito.

A former firefighter and Staten Island native, “Matty” Moore volunteered as a first responder for weeks after 9/11, “even when everyone else stopped going,” Esposito said.

Moore was known as “a gentle giant” in Prince’s Bay, his brother-in-law Adam Esposito said. He was a devoted churchgoer and a beloved member of “The Beach Boys Firehouse” (as Engine 161/81 was nicknamed).

He even came through as Santa Claus, delivering gifts on Christmas morning to the children of two firefighters who died on 9/11.

Moore became an X-ray technologist, cherishing the ability to help those seeking urgent care. When COVID-19 emerged, he continued showing up to work. “Sitting on the sidelines was never in his DNA,” Erin Esposito said.

At the time, the family was reassured that he was receiving the personal protective equipment he needed. Despite his precautions, when Matty contracted COVID-19, it tore through his lungs, which had been damaged at ground zero.

As Matty lay dying, Esposito sought to reassure her brother. “You’ve done enough for us,” she told him, over the phone. Moments later, Matty’s heart stopped beating.

Eli Cahan | Published May 19, 2020

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‘Gentle Soul’ Had A Brilliant Mind And A Big Heart

Neftali “Neff” Rios

Age: 37
Occupation: Registered nurse
Place of Work: St. Francis Hospital’s intensive care unit in Memphis, Tennessee
Date of Death: April 26, 2020

Hospital colleagues loved working with Neftali “Neff” Rios. He was humble, kind and capable, a “gentle soul” who always strived to learn something new. Not just smart — “I’m talking extremely intelligent,” his brother Josue Rios said. And he simply loved people. Nursing was a perfect fit.

Neff worked at a small hospital in Clarksdale, Mississippi, then earned his master’s in business administration with an emphasis on health care, and moved to St. Francis, hoping to enter management.

In mid-April, he came down with fever, body aches and a terrible cough and tested positive for the coronavirus. Several family members got sick, too. His parents were hospitalized.

On April 26, Neff collapsed at home, unable to catch his breath. His wife, Kristina, called 911, started CPR and waited for the EMTs. When they arrived, he had already died.

The family believes he was exposed at work. A spokesperson for the hospital declined to comment, citing family privacy.

“Neff was never scared” of catching the virus at work, Rios said. “You take an oath to take care of people, no matter what.”

Maureen O’Hagan | Published May 19, 2020

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His Warmth And Generosity Brought Diverse Clients To His Pharmacy

(Courtesy of the Titi family)

Saif Titi

Age: 72
Occupation: Pharmacist
Place of Work: Noble Pharmacy in Jersey City, New Jersey
Date of Death: April 7, 2020

When the pandemic hit, Saif Titi was working six days a week at his Jersey City pharmacy and had no interest in slowing down. As was his way, he wanted to be helpful.

“He didn’t really run it as a business,” said Titi’s son, Justin. “He wasn’t trying to make profit. He was really just trying to help people.”

Titi was born in Jaffa in the last days of British rule in Palestine and grew up a refugee in the Gaza Strip. After studying in Egypt, Austria and Spain, he immigrated to New Jersey in 1972 and bought Noble Pharmacy a decade later.

The pharmacy became a fixture in the community, known as a place immigrants could go for help and advice, often in their native language. If they couldn’t afford medication, Titi would give it to them for free. “All different types of people from different cultures would come and they would instantly fall in love with him,” Justin said.

Active in the local Arab American community, Titi gave to charity and sent money home regularly. A Facebook tribute included dozens of stories of his generosity and mentorship. “We all lost the sweetest and the most noble man on earth,” wrote one relative.

Titi, a father of three adult children, developed symptoms of COVID-19 in late March. He died in the hospital on April 7. His wife, Rachelle, also became infected and has taken some six weeks to recover. In quarantine, the family has been unable to grieve together.

Noa Yachot, The Guardian | Published May 19, 2020

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Social Worker Was A ‘Big Voice’ In His Community

(Courtesy of Donna Welch)

Gerald Welch

Age: 56
Occupation: Social worker and behavioral specialist
Place of Work: Opportunity Behavioral Health in Reading, Pennsylvania
Date of Death: April 15, 2020

Donna Welch had sworn she would “never, ever, ever get married again.” Then Gerald appeared.

They met on MySpace, and she quickly realized that “our spirits connected.” On their first date, at Donna’s house in Harrisburg, Pennsylvania, Gerald proposed — and Donna said yes. “It was like he came down on a bolt of lightning from heaven,” she said.

Gerald’s fiery passion and courage to speak out served him as a boardroom advocate for underperforming students in the school district, and at the St. Paul Missionary Baptist Church, where he resurrected a scholarship now named in his honor.

“He had a big voice,” Donna said, “and he was not afraid to use it.” His “Families, Organizations and Communities United in Service” podcast combined Gerald’s lived experience overcoming drugs and his spirituality to support others struggling with addiction.

So even as the state’s COVID cases mounted, Gerald was a dutiful companion for his clients with severe autism — he took them to the supermarket in Lancaster and the laundromat in Lebanon. “Wherever they needed to go, he went,” Donna said. “He cared so much for them, and they loved him dearly.”

“We all did,” she added.

Eli Cahan | Published May 19, 2020

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Hardworking Immigrant Realized His Dream To Practice Medicine In US

Jesus Manuel Zambrano and his son, Jesus Manuel Jr.
(Courtesy of the Zambrano family)

Jesus Manuel Zambrano

Age: 54
Occupation: Pediatrician
Place of Work: Private practice in Freeport, New York; attending physician at Mount Sinai South Nassau hospital
Date of Death: March 30, 2020

Jesus Manuel Zambrano studied medicine in the Dominican Republic and immigrated to New York in the 1990s.

He hustled, working in fast food and as a school bus driver between studies, his wife, Sandra, said. He completed his residency in 2010.

In the meantime, they had two children: Jesus Manuel Jr., 22, and Angelyne Ofelia, 18. Jesus Manuel Jr., who uses a wheelchair, never veered far from his father during family outings to restaurants and parks, and Holy Week vacations.

Zambrano’s bond with his son informed his care for his patients. “There was not a single day we met and talked when we didn’t talk about his son,” said Dr. Magda Mendez, a former colleague.

Zambrano spent days in private practice, Sandra said, and in the evenings treated others at the hospital, which saw COVID cases.

In early March, he felt ill. He took the next day off — a rare occurrence, Sandra said. He was taken to the hospital where he worked, where he died after a week and a half of care.

In becoming a physician in the United States, Zambrano had realized his lifelong dream. He wished the same for his family.

“He had a lot of plans for his children, a lot of dreams,” Sandra said. “He took them with him.”

Carmen Heredia Rodriguez, Kaiser Health News | Published May 15, 2020

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Quick-Witted And Quick To Serve, Firefighter ‘Always Had Your Back’

(Courtesy of the Zerman family)

Robert Zerman

Age: 49
Occupation: Volunteer firefighter
Place of Work: Pioneer Hose Company No. 1 in Robesonia, Pennsylvania
Date of Death: April 16, 2020

Anyone who met Robert Zerman would see two things: He was devoted to firefighting and emergency medical services, and he had a quick sense of humor.

“He probably went on tens of thousands of calls,” said Anthony Tucci, CEO of the Western Berks Ambulance Association. Tucci, who knew Zerman for over three decades, added, “he always had your back, always knew his stuff.”

Most recently, Zerman was a volunteer assistant fire chief. He responded to an emergency in March in which the patient had COVID-19 symptoms.

“That was before there was really any guidance to wear PPE,” Tucci said.

Soon Zerman got sick, leading the family to suspect that he’d contracted the coronavirus on that call, Tucci said. Zerman tested positive and was hospitalized. He seemed to be improving before taking a bad turn.

Berks County, in eastern Pennsylvania, is among the state’s hardest hit, recording around 3,500 total cases and nearly 200 deaths by mid-May.

Representatives from two dozen first responder agencies lined the streets for Zerman’s funeral procession.

Maureen O’Hagan | Published May 19, 2020

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Lighthearted Nurse ‘Lit Up the Room’

(Courtesy of Alisa Bowens)

Linda Bonaventura

Age: 45
Occupation: Licensed practical nurse
Place of Work: Wildwood Healthcare Center in Indianapolis
Date of Death: April 13, 2020

Even on bad days, Linda Bonaventura’s lighthearted sense of humor made people feel better, her sister Alisa Bowens said.

Bonaventura dedicated her career to children with special needs and seniors. She did her best to keep her spirits up while working 16-hour days.

“We like to say she was laughter,” Bowens said. “She lit up the room.”

In a statement, Ethan Peak, executive director of Wildwood, called Bonaventura a dedicated nurse who “would do anything for her residents and co-workers.”

As the list of patients and employees with COVID-19 grew longer at Wildwood, Bonaventura refused to live in fear, Bowens said.

Bowens recalled the day her sister confessed she was spraying herself with Lysol to kill the germs on her clothes. She did the same for a co-worker. A Wildwood spokesperson said the nursing home had sufficient personal protective equipment for employees.

The sisters, in one of their last conversations, told each other they would be at peace if death came during the pandemic. A short time later, Bonaventura tested positive for COVID-19. Just a week after coming down with a sore throat and fever, she died.

“She believed in fate,” Bowens said. “We shared that belief. But it was still a shock.”

Cara Anthony, Kaiser Health News | Published May 15, 2020

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Nurse’s Death Ripples Through The Heart Of An Extended Community

(Courtesy of Courtney Christian)

Sheila Faye Christian

Age: 66
Occupation: Registered nurse
Place of Work: Care Pavilion Nursing and Rehabilitation Center in Philadelphia
Date of Death: April 19, 2020

So many people are mourning the death of Sheila Christian, her daughter set up a website to comfort them all.

Christian was a longtime friend of Tina Knowles-Lawson ― the mother of Beyoncé — who posted about the loss on Instagram.

But Christian was also a superstar at the center where she worked for 26 years and among those who knew her. She was the kind of person who brought lunch to a new co-worker and hosted a baby shower for someone without close family, according to her daughter and a memorial board.

At the outset of the COVID crisis, Christian was not given personal protective equipment, her daughter, Courtney Christian, 30. She said her mother received a mask only in late March. A lawyer for the center acknowledged Christian’s death and said federal guidelines were followed but didn’t respond to specific questions about protective gear.

Christian was diagnosed April 2. She endured more than a week of fever, chills and coughing, but seemed to be on the mend. She had been cleared to return to work when she collapsed at home. An outpouring of grief followed, her daughter said.

“She just helped and cared for so many people,” she said. “People I had never met.”

JoNel Aleccia, Kaiser Health News | Published May 15, 2020

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At Work, Church And Home, Army Veteran Gave It His All

(Courtesy of Shlonda Clark)

Roy Chester Coleman

Age: 64
Occupation: Emergency medical technician
Place of Work: Overton Brooks VA Medical Center in Shreveport, Louisiana
Date of Death: April 6, 2020

Shlonda Clark calls her father her “favorite superhero.”

It was one of Roy Coleman’s many roles. For the past 11 years, the Army veteran and EMT worked as a housekeeper at the VA hospital in his hometown. He was a church deacon, Sunday school teacher and usher. He also volunteered with special-needs adults.

Roy had a big family, with three children, eight grandchildren and two great-grandchildren.

“He was funny, he was kind, he was giving,” said Mabel Coleman, his wife of 40 years.

“If he didn’t like you, something was wrong with you,” added Clark.

Coleman fell ill March 23. After three trips to the emergency room, he was admitted March 27, with a fever and labored breathing.

“It was the last time I saw him,” Mabel said.

He tested positive for COVID-19 and died at the hospital where he had worked.

His family said he was concerned about the lack of personal protective equipment. The VA medical center said by email it “has and continues to use PPE in accordance with CDC guidelines.”

Katja Ridderbusch | Published May 15, 2020

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Beloved Doctor Made House Calls, Treated Patients Like Family

(Courtesy of the Giuliano family)

Michael Giuliano

Age: 64
Occupation: Family practice physician
Place of Work: Mountainside Medical Group in Nutley, New Jersey
Date of Death: April 18, 2020

For 39 years, Michael Giuliano practiced old-fashioned family medicine.

He made house calls. He visited his patients in the hospital rather than asking another physician to check in on them. He saw generations of the same family.

“Some patients would show up here at the house,’” said Giuliano’s wife, Marylu, a nurse and the office manager of his solo practice. “Patients would call and he’d say, ‘Come on over, I’ll check you out.’ He always went above and beyond.”

A father of five and a grandfather of four, Giuliano was jovial, with a quirky sense of humor and love of Peanuts characters, especially Charlie Brown. He liked to tell patients, “I’ll fix you up.”

“He treated all of his patients like family,” said Nutley Mayor Joseph Scarpelli.

When COVID-19 hit the U.S., Giuliano ordered N95 masks, his family said, but suppliers were out and sent surgical masks instead. Giuliano wore two at a time.

The week of March 16, Giuliano saw four patients with respiratory symptoms who later tested positive for COVID-19. About two weeks later, he tested positive.

Giuliano continued to see patients from home using telemedicine until he was hospitalized. He died 11 days later.

— Michelle Crouch | Published May 15, 2020

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He Tried To Reassure His Family Until The End

(Courtesy of Sheryl Pabatao)

Alfredo Pabatao

Age: 68
Occupation: Orderly
Place of Work: Hackensack Meridian Health Palisades Medical Center in North Bergen, New Jersey
Date of Death: March 26, 2020

After 44 years of marriage, Alfredo Pabatao still bought his wife, Susana, flowers.

“They were that type of couple that you rarely see nowadays,” their youngest daughter, Sheryl Pabatao, 30, said. “They set such a high standard for us, their kids — that may be the reason why I’m still single.” She said her father was a patient man who could fix just about anything.

The Pabataos came from Quezon City, just outside Manila, in the Philippines. Alfredo worked at a car dealership, and Sheryl said she and her siblings grew up comfortably.

But the couple wanted more for their five children, and immigrated to the United States in October 2011. “The first year that we were here, was really, really tough,” Sheryl remembered. Her oldest two siblings, already adults by the time the Pabataos’ immigration application cleared, had to stay behind.

Alfredo found a job as an orderly at a hospital in New Jersey, where he worked for nearly two decades. In mid-March, he told his family he had transported a patient with signs of COVID-19; he fell ill days later. In a statement, his employer wrote: “We have policies and procedures in place to protect our team members and patients that are all in accordance with CDC guidelines.”

Sheryl said the family’s last conversation with her father was via FaceTime, with him on his hospital bed. Connected to oxygen, he insisted he wasn’t gravely ill. He made jokes and even demonstrated yoga poses to reassure his wife and children. He died soon after.

Danielle Renwick, The Guardian | Published May 15, 2020

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A ‘Selfless’ Mother Who ‘Always Had The Right Words’

(Courtesy of Sheryl Pabatao)

Susana Pabatao

Age: 64
Occupation: Assistant nurse
Place of Work: Bergen New Bridge Medical Center in Paramus, New Jersey
Date of Death: March 30, 2020

Susana Pabatao became a nurse in her late 40s, after her family immigrated to the United States.

It eased some of her longing for her own mother, whom she had left behind in the Philippines, her daughter, Sheryl Pabatao said. “It helped her to know that she was helping other people — something that she couldn’t do for my grandmother,” Sheryl said. Susana treated her older patients as if they were her own parents, she added.

Susana was warm, selfless and a constant source of comfort. Sheryl said, “My mom always had the right words.”

Susana’s husband, Alfredo Pabatao, began showing symptoms of COVID-19 in mid-March, and Susana became ill soon after. Sheryl, who described the two as “inseparable,” said: “When my dad got sick, it’s like part of her was not there anymore.”

Alfredo was hospitalized, and Susana spent her last days at home resting and speaking with him on FaceTime. Sheryl, who lived with her parents, said she overheard the two console each other one morning. “My mom was telling my dad, ‘We’ve gone through so many things, we’re going to get through this.”

Alfredo died on March 26. Susana died four days later.

Danielle Renwick, The Guardian | Published May 15, 2020

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Air Force Doctor Had Served In The White House

(Courtesy of the Medical Center of Annandale)

Steven Perez

Age: 68
Occupation: Internal medicine physician
Place of Work: Medical Center of Annandale in Annandale, Virginia
Date of Death: May 7, 2020

When George H.W. Bush announced his 1988 run for the presidency, Steven Perez was one of the doctors who gave him a clean bill of health.

An “Air Force brat” who was born in the United Kingdom, Perez served as a flight surgeon and medical director in the Air Force Medical Service Corps before practicing as a physician in the White House from 1986 to 1990, according to a statement from his family.

“It was the honor of his life,” his son, Benjamin Perez, said.

Perez went into private practice in San Antonio in the early ’90s before opening his own clinic in Northern Virginia. He also taught at the University of Virginia.

According to his family, he made a promise to God and “never refused medical aid to the poor who came to his office, even accepting yams as payment on occasion.”

Perez’s family describes him as a proud grandfather to his three grandchildren (with two more on the way); he loved the University of Southern California Trojan football, the Dallas Cowboys and the Nationals.

“He could make anyone laugh, knew just what to say, and showed profound love for his friends and family,” his family wrote in an obituary. “Every person he met felt like they were the reason he was there.”

Danielle Renwick, The Guardian | Published May 15, 2020

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She Jumped At Chance To Lend Her Nursing Skills To Her Beloved New York

(Courtesy of the Sell family)

Rosemary Sell

Age: 80
Occupation: Pediatric nurse practitioner
Place of Work: New York City public schools
Date of Death: April 17, 2020

Rosemary Sell was a New Yorker through and through. Born in Washington Heights in northern Manhattan, she went to nursing school in Greenwich Village and raised her five boys on the Lower East Side.

In the 1960s, she traveled to Berlin, where she worked as a nurse for the British army and met her future husband, Peter. A lifelong love of travel was born. Gregarious and high-energy by nature, she loved meeting new people. “Wherever she’d go, she’d make a new friend,” said her son, also named Peter.

In later years, Sell spent much of her time in Florida. But she jumped at opportunities to lend her nursing skills to her home city and see her grandchildren and friends.

In February, she was contacted by a firm that places nurses on temporary assignments. Her children were concerned about the encroaching pandemic, especially given her age. “But they need a nurse,” she responded. She traveled to New York to fill in as a nurse at several schools citywide just as the pandemic took hold. The firm, Comprehensive Resources, did not respond to questions on protections for its contractors.

Sell began developing symptoms in mid-March, just before the citywide school closure went into effect. She returned home to Florida, where she died from pneumonia caused by COVID-19.

Before Rosemary died, she had been hatching her next adventure with a friend: to travel to India. She wanted to see the Taj Mahal.

Noa Yachot, The Guardian | Published May 15, 2020

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A Hands-On Pharmacist Who Made The Big City Feel Smaller

(Courtesy of Zair Yasin)

Ali Yasin

Age: 67
Occupation: Pharmacist
Place of Work: New York City Pharmacy in East Village, Manhattan
Date of Death: May 4, 2020

Ali Yasin was a small-town druggist in a big city filled with impersonal, chain-store pharmacies. He found a way to operate a robust business and still be on a first-name basis with his customers. Over the years, he became their medical consultant, insurance whisperer and friend.

Jen Masser said she stumbled into Yasin’s pharmacy the first time, covered from hands to elbows in hives. “Something is happening, see someone right away,” Yasin advised. “This could be a serious disease.” He turned out to be right, encouraging her to keep seeing doctors until she finally got the proper autoimmune diagnosis.

Born in Pakistan, Yasin moved to the United States in 1979 and worked in various pharmacies before opening his own in 2001. He ran it with the help of his four sons.

In March, after serving customers in hard-hit Manhattan in his typical hands-on manner, Yasin contracted a cough and tested positive for COVID-19. By month’s end, he was in the hospital on a ventilator. He died May 4.

The storefront window of the Yasin family pharmacy is pasted with condolence cards. Son Zair Yasin said the outpouring has been immense: “I didn’t realize until he was gone how many people he touched.”

— Kathleen Horan | Published May 15, 2020

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Nurse Wouldn’t Abandon Her Patients Or Let Family Worry

(Courtesy of the Isaacs family)

Marsha Bantle

Age: 65
Occupation: Registered nurse
Place of Work: Signature Healthcare in Newburgh, Indiana
Date of Death: May 1, 2020

Marsha Bantle’s family begged her to quit after a resident in the nursing home where she worked was diagnosed with COVID-19.

But Bantle wouldn’t leave. “My patients can’t leave their rooms, they can’t see their families. They really need me right now,’” she told her cousin Carol Isaacs.

Bantle tried to reassure relatives she would limit her exposure, but, on April 17, her temperature spiked. Bantle, who lived alone, holed up at home. She finally called her family when it was clear she needed to be hospitalized.

“That’s Marsha for you,” her cousin John Isaacs said. “She didn’t want us to worry.”

Even while hospitalized, Bantle was selfless, said Shay Gould, the ICU nurse who cared for her. She offered to turn off her medication pump to save the nurse a trip. She asked for other patients’ names to pray for them.

After about a week, Bantle had a stroke, likely brought on by the COVID-19 infection. Within days, she died.

Since April, the nursing home has had 52 positive cases and 13 COVID-19 deaths, including Bantle’s. In a statement, Signature Healthcare said: “The loss of any of our residents or staff, for any reason, is devastating.”

— Michelle Crouch | Published May 12, 2020

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Pharmacist, Feeling Sick, Didn’t Want To Let Patients Down

(Courtesy of the Boynes family)

Sean Boynes

Age: 46
Occupation: Pharmacist
Place of Work: AbsoluteCare Medical Center & Pharmacy in Greenbelt, Maryland
Date of Death: April 2, 2020

When the coronavirus began circulating in the Washington metropolitan region, Sean Boynes went to work.

“Patients need their medicine,” he told his wife, Nicole.

The medical center where he worked bills itself as “a medical home for the sickest of the sick”; many of its patients struggle with chronic illness and poverty. Boynes was the Greenbelt branch’s first pharmacist.

He was an “incredible, loving guy,” said Dr. Gregory Foti, chief of innovative operations at AbsoluteCare.

Boynes was a proud Howard University alumnus and had three degrees — a bachelor’s of science in biology, a master’s in exercise physiology and a doctorate in pharmacy — from the institution.

In early March, Boynes and his wife began feeling sick. Boynes didn’t want to stop working but thought “taking a sick day might be OK,” Nicole said. He also took a break from being a jungle gym to his eight- and 11-year-old girls. Nicole called him “Super Dad.”

Nicole got better, but Sean, who had asthma, saw his breathing deteriorate.

On March 25, Nicole dropped him at the hospital doors. The medical staff confirmed COVID-19. The family never saw him again.

Foti said AbsoluteCare follows CDC recommendations, such as providing staff with face masks, and declined to comment on where Boynes became infected. He said “it was literally impossible to tell” where Boynes had contracted the virus.

To honor him, AbsoluteCare is naming the Greenbelt pharmacy after Boynes.

Sarah Jane Tribble, Kaiser Health News | Published May 12, 2020

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A Spry EMT, He Made ‘The Ultimate Sacrifice’

(Courtesy of Toni Lorenc)

John Careccia

Age: 74
Occupation: Emergency medical technician and rescue squad chief
Place of Work: Woodbridge Township Ambulance and Rescue Squad in Iselin, New Jersey
Date of Death: April 17, 2020

“That’s not the way you throw a curveball!” John Careccia famously declared to his grandson at a family picnic, according to his daughter, Toni Lorenc. Careccia then threw the ball so wide that it broke a window in her shed.

“That’s how you throw the batter off,” he said, brushing off the mishap.

“Typical Pop-Pop,” Lorenc said. “He had so much confidence in himself.”

Careccia, who worked for the Port Authority of New York and New Jersey for 30 years, harnessed his self-confidence into a second career. Inspired by two EMTs who saved his son’s life, he became a volunteer EMT in 1993. A consummate educator, he taught CPR, mentored young EMTs and gave catechism classes at his church, Lorenc said.

A spry 74, Careccia responded to 911 calls as chief of his rescue squad, a volunteer position. On a March 25 call, he evaluated a coronavirus patient, said Ed Barrett, squad president. Careccia died of COVID-19 several weeks later.

At his firehouse memorial service, Careccia was summoned over a loudspeaker for his “last call.”

“Having heard no response from Chief Careccia, we know that John has made the ultimate sacrifice,” said Steve Packer, a previous squad president. “His leadership, dedication, compassion and friendship will be greatly missed.”

Melissa Bailey | Published May 12, 2020

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Police Officer Turned Nurse Practitioner Was Pursuing A Doctorate

(Courtesy of Dennis Graiani)

Kevin Graiani

Age: 56
Occupation: Family nurse practitioner
Place of Work: Rockland Medical Group in Garnerville, New York
Date of Death: March 30, 2020

Kevin Graiani always wanted to work in health care, according to Dennis Graiani, one of his three sons. But his mother told him he needed a pension, so he became a cop.

Kevin, who grew up in the Bronx, served five years on the New York City Housing Authority police force, then 15 on a suburban police force in Spring Valley, New York. He was a “brilliant officer,” said Lt. Jack Bosworth of Spring Valley.

Known for his dry sense of humor, Kevin often rattled off quotes from movies. He played bagpipes for the Rockland County Police Emerald Society, a law enforcement group. When he retired from police work, he began nursing school and became a nurse practitioner in 2018.

Kevin, who worked at a private practice, became sick on March 10 and was later diagnosed with COVID-19, Dennis said.

He loved learning and was set to finish classes this summer for his doctorate of nursing practice, said Lynne Weissman, his professor and program director at Dominican College.

He was an “extremely bright student” with a 3.7 GPA, Weissman said.

She has nominated him for a posthumous degree.

Melissa Bailey | Published May 12, 2020

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School Nurse ‘Was A Mother To Many’

(Courtesy of the Howard family)

Marilyn Howard

Age: 53
Occupation: School nurse
Place of Work: Spring Creek Community School in Brooklyn, New York
Date of Death: April 4, 2020

Marilyn Howard was known for her generosity and never missing a party. Born in Guyana, she came to the U.S. as a teenager. She helped raise her five brothers, putting her ambitions on hold. “She was a mother to many,” her brother Haslyn said.

In her mid-30s, she turned to her own career goals. She steadily racked up four nursing degrees and recently had begun studying to become a nurse practitioner.

Howard, who lived in Queens, New York, was a school nurse in Brooklyn, where she regularly treated children with chronic illnesses associated with poverty. The week before the pandemic shuttered schools, a fellow nurse had a fever and cough.

Days later, Howard developed the same symptoms. After initially improving, she took a sudden turn for the worse April 4. As her brother drove her to the hospital, her heart stopped. She was declared dead at the hospital.

In tribute, hundreds turned out on Zoom to mark Nine-Night — a days-long wake tradition in the Caribbean — where loved ones shared photos, sang songs and recounted Howard’s effect on their lives.

The pandemic has since ripped through Howard’s extended family, infecting at least a dozen relatives. (One cousin was hospitalized but was released and is recovering.) The family has evolved into a sprawling triage team, monitoring one another’s temperatures, delivering food, charting emergency contacts and nearby hospitals.

Howard’s brothers hope to start a foundation in her name to help aspiring nurses in the U.S. and West Indies. “The best way to honor her spirit and her memory is to bring more nurses into this world,” said her brother Rawle. “We need more Marilyns around.”

Noa Yachot, The Guardian | Published May 12, 2020

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Post-Retirement, She Tirelessly Rejoined Workforce

(Courtesy Bethany MacDonald)

Nancy MacDonald

Age: 74
Occupation: Receptionist
Place of Work: Orchard View Manor, a nursing home and rehabilitation center in East Providence, Rhode Island
Date of Death: April 25, 2020

Nancy MacDonald tried retiring, but couldn’t make it stick.

For 20 years, she was a middle school teaching assistant and cheerleading coach. At home, she loved painting rocks and watching “Blue Bloods” and “American Idol.” She was married with two adult children.

A lifelong Rhode Islander, Nancy was a people person, her daughter, Bethany MacDonald, said. “She always wanted to help others.”

So, in 2017, it was natural that she’d go back to work, this time at a nursing home.

As Orchard View’s COVID case count escalated, MacDonald worried. Still, she kept coming in — washing and reusing her N95 respirator and having her temperature taken daily.

Tim Brown, an Orchard View spokesperson, said the facility has “extensive infection control,” satisfying government guidelines. He would not say how often employees receive new N95s.

On April 13, MacDonald began coughing. By April 16, she was hospitalized. Her COVID test came back positive. She died 10 days later ― almost a week after her last conversation with her daughter.

“I said, ‘Mama, we love you,’” Bethany said. “The last words she said to me were, ‘I love you, too.’”

Shefali Luthra, Kaiser Health News | Published May 12, 2020

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Despite Danger, Semi-Retired Nurse Kept Caring For ER Patients

(Courtesy of the Miles family)

Sheena Miles

Age: 60
Occupation: Registered nurse
Place of Work: Scott Regional Hospital in Morton, Mississippi
Date of Death: May 1, 2020

At age 60, Sheena Miles was semi-retired. She usually worked every other weekend, but as COVID-19 emerged in Mississippi, she worked four weekends in a row from mid-March to mid-April.

“I’ve got a duty,” she told her son, Tom Miles.

The economy where she lived is dominated by poultry plants, and the county has been a coronavirus hot spot. Sheena was diligent with protective gear, wearing her mask and doubling up on gloves, Tom said. She stayed home when she wasn’t working.

“Losing Sheena has been a tragic loss, as she had been a part of our hospital for 25 years,” said Heather Davis, a hospital administrator.

Sheena took ill on Easter Sunday. By Thursday, Tommy Miles, her husband of 43 years, drove her to the University of Mississippi Medical Center in Jackson.

Two long weeks passed. The family was allowed to say goodbye in person, and on their way into her room, an ICU nurse told them that years ago Sheena had cared for his infant daughter. “‘Your mom saved her life,’” the nurse said.

“That was a little comfort in the storm,” Sheena’s son said.

Michaela Gibson Morris | Published May 12, 2020

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A Nurse Who Was Living Her Dream Of Working In The U.S.

(Courtesy of Venus Donasco-Delfin)

Anjanette Miller

Age: 38
Occupation: Registered nurse
Place of Work: Community First Medical Center and Kindred Chicago Lakeshore in Chicago, and Bridgeway Senior Living in Bensenville, Illinois
Date of Death: April 14, 2020

As a child, Anjanette Miller dreamed of becoming a nurse in the U.S. She studied in her native Philippines and worked briefly in Saudi Arabia before fulfilling her wish in 2001.

Miller settled in Chicago and worked as a supervising nurse at three facilities. Her sister, Venus Donasco-Delfin, said Miller got along well with co-workers who shared her work ethic.

“At work, I think, she was strict, but beyond work, she’s a great friend,” Donasco-Delfin said. One of five siblings, she was the “pillar of the family” and supported relatives back home.

“I studied psychology for two years,” Donasco-Delfin said, “but she kept calling me [in the Philippines] and said, ‘No, Venus. … You have to pursue nursing. You will make a difference.’” Donasco-Delfin, now in Canada, became a nurse.

Miller started feeling sick in mid-March and was diagnosed with COVID-19 in early April. She self-isolated, chronicling her illness on YouTube and Facebook. She was hospitalized April 5 and died nine days later.

Miller had hoped to retire to the Philippines and pursue her other passion, filmmaking. Last year she traveled back home to shoot scenes for a project. “The movie she was making is about her life story,” Donasco-Delfin said. “But it’s not finished yet.”

Danielle Renwick, The Guardian | Published May 12, 2020

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He Took The Time To Put Patients At Ease

(Courtesy of Holy Name Medical Center)

Jesus Villaluz

Age: 75
Occupation: Patient transport worker
Place of Work: Holy Name Medical Center in Teaneck, New Jersey
Date of Death: April 3, 2020

After Jesus Villaluz died from COVID-19 complications, colleagues lined the hallway at Holy Name Medical Center in Teaneck, New Jersey, to say goodbye. They’d never done that for anyone else.

“Jesus knew many and meant a lot to all of us, so this gesture felt like the right thing to do,” said hospital spokesperson Nicole Urena.

The hospital, and surrounding Bergen County, have been hit hard by the pandemic. By May 8, Holy Name had treated more than 6,000 COVID patients, 181 of whom died.

Villaluz worked at Holy Name for 27 years. In a Facebook post, the hospital memorialized Villaluz’s generosity: He once won a raffle and shared the winnings with colleagues, an anecdote New Jersey Gov. Phil Murphy repeated at a news conference. Family members declined requests for an interview.

Co-worker Hossien Dahdouli said Villaluz’s compassion for patients was exemplary. He never rushed anyone, took the time to chat with patients and was always concerned for their privacy and safety, Dahdouli said.

Years ago, after Dahdouli had a sad day caring for deteriorating ICU patients, he asked Villaluz why he always appeared so happy.

“He said, ‘My worst day at work is better than someone’s best day as a patient.’”

Anna Almendrala, Kaiser Health News | Published May 12, 2020

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Family Vacations And Reggae Gave Rhythm To His Life

(Courtesy of Nina Batayola)

Don Ryan Batayola

Age: 40
Occupation: Occupational therapist
Place of Work: South Mountain Healthcare and Rehabilitation Center in Vauxhall, New Jersey
Date of Death: April 4, 2020

April 4 was the day Don and Nina Batayola had planned to leave for London on a 10-day European vacation. Instead, that was the day Don died of COVID-19.

The Springfield, New Jersey, couple loved to travel ― on their own or with their children, Zoie, 10, and Zeth, 8. Disney World. Road trips to Canada. Every year for a week they would savor the beach on North Carolina’s Outer Banks.

Don’s love of reggae music prompted a trip to Jamaica to visit Bob Marley’s birthplace.

The Batayolas, both occupational therapists, moved to New Jersey from the Philippines 13 years ago to pursue their careers.

“He loved to help,” Nina said. “He had such the ability to make everybody smile or laugh.”

Don worked with at least one patient and a handful of colleagues who subsequently tested positive for COVID-19, and in late March, he developed symptoms. Nina came home from work for lunch on March 31 to find him struggling to breathe. She dialed 911.

He was hospitalized, then she also developed COVID symptoms. Self-isolating at home, Nina talked with Don once a day. She thought he seemed stronger but, on the fourth day, his heart suddenly stopped.

Michelle Andrews | Published May 8, 2020

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Even On ‘The Saddest Day … She Could Make You Laugh’

(Courtesy of Kim Bruner)

Brittany Bruner-Ringo

Age: 32
Occupation: Licensed vocational nurse
Place of Work: Silverado Beverly Place in Los Angeles
Date of Death: April 20, 2020

When it was Brittany Bruner-Ringo’s turn to pick the family vacation, it was always New Orleans. A city so full of life.

And that is how family described the 32-year-old who left the Oklahoma plains for the excitement of Southern California.

“She always made the best of things,” her mother, Kim Bruner, said. “It could be the saddest day, and she could make you laugh.”

Bruner-Ringo worked at a dementia care center. On March 19, she admitted a patient flown in from New York. She suspected he might have COVID-19, and she was nervous. For fear of frightening the patients, she hadn’t been allowed to wear a mask or gloves, she told her mom by phone that night. (A spokesperson from her employer said, “We have no issues in our environment using appropriate masking and gloves and have followed CDC guidelines throughout this pandemic. We have always had adequate PPE to protect our residents and associates.”)

The following day, the patient grew worse. Bruner-Ringo checked into a hotel to isolate from her roommate. She later tested positive for COVID-19, but when she developed symptoms did not complain ― even to her mom: “She would say, ‘I’m fine. I’m going to beat this. Don’t worry about me.’”

Bruner, a veteran nurse herself, called the hotel front desk for help getting an ambulance to her daughter. She had just hung up with her daughter, who insisted she was fine, while struggling to breathe.

Samantha Young, Kaiser Health News | Published May 8, 2020

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He And His Wife Shared A Lust For Travel ― And A COVID Diagnosis

(Courtesy of LaKita Bush)

Joshua Bush

Age: 30
Occupation: Nurse and nursing student
Place of Work: Benton House of Aiken in Aiken, South Carolina
Date of Death: April 17, 2020

Joshua Bush never let his wife, LaKita, forget that she was five hours late for their first date.

“He never held back telling the truth,” LaKita said, with a doleful laugh.

They met online in 2011, each attracted to the other’s lust for travel. For Joshua’s 30th birthday, they took a cruise to Bermuda. He yearned to go farther afield to Tokyo to revel over anime.

Joshua began his nursing career after high school, eventually ending up at Benton House of Aiken, an assisted living facility. Joshua and LaKita, who works in human resources for a hospital, thought it was allergy-related when they both fell ill in late March. Benton House had no confirmed COVID cases at the time, LaKita said. Even still, the staff was taking precautions.

A doctor prescribed Joshua flu medication, but his symptoms — fever and aches but no cough — worsened, and he was admitted to a hospital in Augusta, Georgia, on April 4.

“That was the last time I saw him alive,” LaKita said.

Over the next few days, both tested positive for the coronavirus. Joshua was sedated in the hospital for two weeks and died on April 17. LaKita recovered at home.

Joshua was earning a bachelor’s degree in nursing at the University of South Carolina-Aiken. May would have marked the couple’s fifth anniversary.

Sarah Varney, Kaiser Health News | Published May 8, 2020

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Her Sudden Death Blindsided Husband And Autistic Son

(Courtesy of Vincent Carmello)

Karen Carmello

Age: 57
Occupation: Licensed practical nurse
Place of Work: Maryhaven Center of Hope in Port Jefferson Station, New York
Date of Death: April 16, 2020

Karen Carmello had an intimate understanding of working with intellectually disabled patients.

Her 26-year-old son, Steven, has autism. According to her husband, Vincent, the two spoke by phone every day. Steven would recall exactly what he did, and Karen listened intently.

“She could do no wrong in his eyes, ever,” Vincent said. “It’s a very special bond, but it’s one that she earned.”

Sharing the news of her death was shattering: “It was the hardest thing I’ve ever had to do — letting him know.”

When Karen took ill, she discovered that a patient in her ward had tested positive for COVID-19. She was hospitalized March 23. Eight days later, she sent Vincent her last text, at 2:17 a.m., before going to the ICU.

On April 16, hospital staff called and asked whether Vincent would be comfortable signing a do-not-resuscitate order. He hadn’t been able to see his wife, so he didn’t completely grasp how grave her condition was.

“I thought, ‘OK, this must be a formality,’” he said. “I authorized it. And I got a call within two hours that she passed. I was stunned.”

— Shoshana Dubnow, Kaiser Health News | Published May 8, 2020

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His Facebook Posts Left Clues Of A Tragic Timeline

(Courtesy of Felicia Dodson-Hill)

Maurice Dotson

Age: 51
Occupation: Certified nursing assistant
Place of Work: West Oaks Nursing and Rehabilitation Center in Austin, Texas
Date of Death: April 17, 2020

Maurice Dotson’s sister knew something was wrong when her older brother didn’t post his daily Facebook update.

“We knew he was good as long as he posted every morning,” Felicia Dodson-Hill, of Jacksonville, Arkansas, said.

Dotson, 51 ― a certified nursing assistant for 25 years at the West Oaks Nursing and Rehabilitation Center in Austin — had begun caring for COVID-19 patients.

He sounded positive on Facebook, posting on March 30: “We are going through scary, difficult times, but better days are coming.”

Days later, family in Arkansas couldn’t reach him.

“We had been trying to get in contact with him since April 1st,” his sister said. “On April 3rd, he posted that he had to go to the hospital ― that he was not feeling good.”

Dodson-Hill said the hospital sent him home. Her mother finally reached him on April 6 or 7.

“He told my mom he didn’t have the energy to barely talk,” Dodson-Hill said.

Dawunna Wilson, a cousin from Hazen, Arkansas, said Maurice called an ambulance on April 8. Results from his coronavirus test done at the hospital came back positive the next day. “From there, it was pretty much downhill,” Wilson said.

Sharon Jayson | Published May 5, 2020

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Community Salutes Nurse Who Loved Baseball

(Courtesy of Leigh Ann Lewis)

Barbara Finch

Age: 63
Occupation: Licensed practical nurse
Place of Work: Southern Virginia Regional Medical Center in Emporia, Virginia
Date of Death: March 29, 2020

When Barbara Finch got excited, she’d scrunch her hands into fists and wave them around like a kid at Christmas. She did it when the Atlanta Braves scored, or while watching her grandkids play baseball, her No. 1 passion outside work.

Finch spent her 37-year nursing career in the emergency department of the hospital in Emporia, Virginia (population of about 5,000), where one of her four children, Leigh Ann Lewis, worked as an EMT.

Lewis knew her mother was well liked: Patients she transported from the hospital would rave that Finch had been sweet and compassionate.

Finch fell ill on March 17 and died in an ICU 12 days later. As a hearse carried her casket to the graveyard, Lewis said, people lined the way at driveway mailboxes, churches and stores, holding signs that read, “We love you,” “Praying for you,” “Hugs.” At her hospital, employees released balloons to the sky.

“It seemed like, in our area, she knew everybody — either she worked with them, or they were a patient of hers at some point,” Lewis said. “It was a very, very large outpour of love and comfort and solidarity.”

Melissa Bailey | Published May 8, 2020

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‘He Loved To Work,’ With No Plans To Retire

(Courtesy Giancarlo Pattugalan)

Tomas Pattugalan

Age: 70
Occupation: Internal medicine physician
Place of Work: Private practice in Jamaica, Queens, New York
Date of Death: March 29, 2020

Tomas Pattugalan’s kids had been encouraging him to retire. Even after 45 years of medicine, Pattugalan wasn’t ready to slow down.

“He loved his patients. He loved to work. He loved to help others,” said Giancarlo, his son. “He had an enormous capacity to give of himself.”

A father of three, Pattugalan grew up in the Philippines, immigrating to the U.S. in the 1970s. He was a devout Catholic — attending Mass weekly ― and “karaoke master,” Giancarlo said.

In early March, Pattugalan began testing patients for COVID-19. His medical history, including a family history of strokes and high blood pressure, heightened his own risk. So after tests of two patients returned positive, he got tested himself. On March 24, he learned he had the coronavirus.

“He made a joke and said Prince Charles had tested [positive] too, and he was sharing royalty,” Giancarlo said. “He was making light of it, not trying to get any of us worried.”

Pattugalan had a cough. Then came wheezing. His oxygen levels dropped. He tried hydroxychloroquine, an experimental treatment touted by President Donald Trump that has yielded mixed results. Nothing helped.

On March 29, Pattugalan agreed to seek hospital care. He died that day.

Shefali Luthra, Kaiser Health News | Published May 8, 2020

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Says Widow Battling Cancer: ‘He Was My Backbone’

(Courtesy of Melissa Castro Santos)

Darrin Santos

Age: 50
Occupation: Transportation supervisor
Place of Work: NewYork-Presbyterian Westchester Behavioral Health Center in White Plains, New York
Date of Death: April 4, 2020

Melissa Castro Santos had just started a new treatment for multiple myeloma when her husband, Darrin, got sick.

For nearly two weeks, he isolated in their bedroom, but after he began gasping for air, he went to the hospital. He died of COVID-19 days later.

“It’s just unbelievable,” Castro Santos said.

As a transportation supervisor, Santos delivered health care workers and equipment between hospitals in the New York metropolitan area. He loved his job, Castro Santos said, and was known to drive doctors wherever and whenever they were needed, through heavy traffic and snowstorms.

Castro Santos, who has been battling cancer since 2012, said her husband doted on their three teenagers, all avid athletes. He arranged his work schedule to attend as many of their games as possible. When he couldn’t make it, she would call him on FaceTime so he could catch glimpses of the action.

Unable to hold a funeral, they arranged for burial five days after Santos died. Friends lined the streets in cars in a show of support as the family drove to and from the cemetery.

Now Castro Santos is confronting cancer without her husband. “He was my backbone. He was the one who took me to chemotherapy and appointments.”

Anna Jean Kaiser, The Guardian | Published May 8, 2020

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An Animal Lover Who Loved Aerospace, She Died Alone At Home

(Courtesy of Aubree Farmer)

Lisa Ewald

Age: 53
Occupation: Registered nurse
Place of Work: Henry Ford Hospital in Detroit
Date of Death: April 1, 2020

Lisa Ewald was a nurse to many living things, human and otherwise.

When her neighbor Alexis Fernandez’s border collie had a stomach blockage, Ewald hooked the dog up to an IV four times a day. “She was this dedicated nurse who nursed my dog back to health,” Fernandez said.

Ewald also loved gardening, aerospace and comic book conventions.

Ewald told Fernandez that a patient she had treated later tested positive for COVID-19, and that she was not wearing a mask at the time. Two days later, after seeing the patient, she got sick. After delays in accessing a test, she learned on March 30 that she was infected with the coronavirus.

A hospital spokesperson acknowledged that staff who treat coronavirus patients have a higher risk of exposure, but said there was “no way to confirm” how a staff member contracted the virus.

On March 31, Ewald didn’t answer when Fernandez texted her. The next day, Fernandez and a hospital nurse went to Ewald’s home to check on her and found her unresponsive on the couch.

“I said, ‘Aren’t you going to go take her pulse or anything?’” Fernandez said. “The nurse just said, ‘She’s gone.’”

Melissa Bailey | Published May 5, 2020

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An Ardent EMT Who Seemed To Have Nine Lives

(Courtesy of Ben Geiger)

Scott Geiger

Age: 47
Occupation: Emergency medical technician
Place of Work: Atlantic Health System in Mountainside and Warren, New Jersey
Date of Death: April 13, 2020

Scott Geiger wasn’t always enthusiastic about school, but at age 16 he brought home a tome the size of two phone books. It was a manual for emergency medical technicians, and he devoured it, said his younger brother, Ben Geiger.

Scott was certified as an EMT at 17. He never married or had kids, but did not seem to miss those things.

“He was so focused on being an EMT and helping people in their most vulnerable and desperate moments,” Ben said. “That’s really what made him feel good.”

Scott loved playing pool each week with friends. He was a loyal New York Jets football fan, content to joke about their follies and watch them lose. He was quiet. And he seemed to have nine lives, his brother said, surviving hospitalizations for epilepsy as a kid and blood cancer around age 40.

When the coronavirus began to tear a path through northern New Jersey, he faced his EMT work with resolve. He downplayed his symptoms when he first fell ill in late March, but wound up spending 17 days on a ventilator before he died. The family has had to mourn separately, with the brothers’ father, who lived with Scott, in quarantine, and their mother confined to her room in a nursing home that has COVID-19 cases.

Christina Jewett, Kaiser Health News | Published May 5, 2020

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Caring Nurse ‘Always Put Herself Last’

(Courtesy of Lisa Lococo)

Theresa Lococo

Age: 68
Occupation: Pediatric nurse
Place of Work: Kings County Hospital in Brooklyn, New York
Date of Death: March 27, 2020

Theresa Lococo spent most of her life at the hospital, working as a pediatric nurse for almost 48 years.

“There wasn’t a day that goes by she wouldn’t come home and tell me about her patients,” said her daughter, Lisa Lococo. “She had to be forced to take her vacation days.”

New York City Mayor Bill de Blasio publicly saluted her lifelong service to New Yorkers, saying, “She gave her life helping others.”

Theresa had dogs — “sometimes too many,” Lisa said — and lived with her son, Anthony, in the home she owned for decades. She loved cooking and watching cooking shows, reading and following soap operas.

Theresa wasn’t tested for COVID-19. But Kings County Hospital, in Brooklyn, was hit hard by the coronavirus.

Days before dying, she described nausea. Friends recalled a cough. Her supervisor encouraged her to stay home, her daughter said.

Lisa called her mother on March 27, just as Anthony was dialing 911 for help.

“She always put others first,” Lisa said. “She always put herself last.”

Shefali Luthra, Kaiser Health News | Published May 5, 2020

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He Was Full Of Life And Planning For The Future

(Courtesy of the Luna family)

Felicisimo “Tom” Luna

Age: 62
Occupation: Emergency room nurse
Place of Work: Trinitas Regional Medical Center in Elizabeth, New Jersey
Date of Death: April 9, 2020

Tom Luna was a joker, a lively and outgoing man who thrived on the fast-paced and varied action of the emergency room. He also adored his three daughters, something clear to all who knew him.

“Tom was a fantastic emergency nurse. He was well liked and loved by his peers,” Gerard Muench, administrative director of the Trinitas emergency department, said in a statement. “His greatest love was for his wife and daughters, who he was very proud of.”

His oldest daughter, Gabrielle, 25, followed his path to become an ER nurse. When Tom fell ill with the coronavirus, he was admitted to the hospital where she works. At the end of her 12-hour night shifts, she made sure he had breakfast and helped him change his clothes. She propped a family photo next to his bed.

Tom’s wife, Kit, also a nurse, said that when some of his symptoms appeared to let up, they talked about him recovering at home. He was a planner, she said, and was already talking about their next family vacation, maybe to Spain.

Christina Jewett, Kaiser Health News | Published May 5, 2020

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Air Force Veteran Went ‘Above And Beyond For Patients’

Michael Marceaux and his wife, Dunia, when he graduated from nursing school in 2018 (Courtesy of Drake Marceaux)

Michael Marceaux

Age: 49
Occupation: Registered nurse
Place of Work: Christus Highland Medical Center and Brentwood Hospital in Shreveport, Louisiana
Date of Death: April 16, 2020

After Michael Marceaux retired from the Air Force, he went back to school. In 2018 he launched a new career as an emergency room nurse.

“Everyone who worked with him said he was so happy,” said Drake Marceaux, one of his four sons. “He was willing to go above and beyond for patients.”

As the coronavirus spread throughout Louisiana, Michael developed a cough and fever. Soon afterward, he tested positive for COVID-19.

“He didn’t seem too worried,” Drake said. “He just wanted to make sure not to give it to other people.”

A spokesperson with Christus Health said Michael would be missed for “how he always had a positive attitude, even after a hard shift. His laughter brought joy to others.” The spokesperson declined to answer questions about workplace safety conditions.

Drake said he wanted his father to be remembered for how much he was loved.

His funeral was livestreamed on Facebook. “At one point, there were 2,000 viewers watching his service,” Drake said. “As much as he didn’t want attention, it gravitated toward him.”

Victoria Knight, Kaiser Health News | Published May 5, 2020

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She Loved To Give Gifts And Never Forgot Her Hometown

(Courtesy of Courtesy of Donald Jay Marcos)

Celia Lardizabal Marcos

Age: 61
Occupation: Telemetry charge nurse
Place of Work: CHA Hollywood Presbyterian Medical Center in Los Angeles
Date of Death: April 17, 2020

Whenever she traveled to her hometown of Tagudin in the Philippines, Celia Lardizabal Marcos showered family with gifts and delighted in planning weekend outings for everyone, said her eldest son, Donald.

And when she returned home to California, she brought presents for her sons. “She always thought of how her family could be happy,” he said.

Trained as a nurse in her home country, Marcos immigrated to the United States in 2001 and settled in Los Angeles. Three years later, she became a telemetry charge nurse, a specialist who tracks patients’ vital signs using high-tech equipment.

On April 3, she was one of three nurses who responded after a suspected COVID patient went into cardiac arrest. Wearing a surgical mask, she intubated the patient. Three days later, she had a headache, body aches and difficulty breathing.

Her symptoms worsened, and she was admitted April 15 to the hospital where she had worked for 16 years. That was the last time Donald spoke to his mother. Two days later, she went into cardiac arrest and died that night.

Her sons plan to honor her wishes to be cremated and buried in Tagudin, alongside her parents.

Christina M. Oriel, Asian Journal | Published May 5, 2020

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‘Hero Among Heroes,’ Doctor Cared For Generations Of Patients

Francis Molinari (right) with his siblings (from left) Janice, Albert and Lisa (Courtesy of Lisa Molinari)

Francis Molinari

Age: 70
Occupation: Physician
Place of Work: Private practice in Belleville, New Jersey; privileges at Clara Maass Medical Center
Date of Death: April 9, 2020

In late March, Dr. Francis “Frankie” Molinari told his sister Lisa he was “down for the count,” with chills, fever and trouble breathing.

“Frankie, you know what you have,” she recalled telling him.

“Yes.”

Two days later, he collapsed at home and was rushed to Clara Maass Medical Center. Colleagues stayed by his side as he succumbed to COVID-19.

“We take solace in the fact that he was cared for by colleagues and friends who deeply loved and respected him,” his sister Janice wrote in a blog. “He died a hero among heroes.”

Molinari, a New Jersey native who was married with an adult daughter, was the oldest of four siblings. His sisters describe him as a positive guy who loved music, fishing and teasing people with tall tales: He went to medical school in Bologna, Italy, and he liked to say he had played pinochle with the pope.

Molinari practiced medicine for over four decades, caring for generations of patients in the same family. His family suspects he contracted the coronavirus at his private practice.

“A friend had once described us as four different legs of the same table,” Janice wrote. “Now I’m stuck on the fact that we are only a three-legged table. Less beautiful, less sturdy. Broken.”

Laura Ungar, Kaiser Health News | Published May 5, 2020

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5-Foot-Tall ‘Fireball’ Was A Prankster To Her Sons

(Courtesy Josh Banago)

Celia Yap-Banago

Age: 69
Occupation: Registered nurse
Place of Work: Research Medical Center in Kansas City, Missouri
Date of Death: April 21, 2020

Celia Yap-Banago was a 5-foot-tall “fireball,” said one co-worker. She had moved to the U.S. from the Philippines in 1970 and worked for nearly 40 years for the HCA Midwest Health system. Her family said she was planning for retirement.

Her son Josh said she showed her love through practical jokes: “You knew she loved you if she was yelling at you or if she was pranking you.”

“She was very outspoken,” said Charlene Carter, a fellow nurse. “But I later learned that’s a really good quality to have, as a nurse, so you can advocate for your patients and advocate for yourself.”

In March, Yap-Banago treated a patient who later tested positive for COVID-19. Carter said Yap-Banago was not given personal protective equipment because she was not working in an area designed for COVID patients. She spent her final days in isolation to protect others.

A spokesperson for HCA Midwest Health said that medical staff received adequate personal protective equipment in line with CDC guidelines.

Josh said she spoke with reverence of her patients and their families. “She was always focused on the family as a whole, and that the family was taken care of, not just the patient in the bed,” he said.

Alex Smith, KCUR | Published May 5, 2020

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In Ministry And Rescue Missions, ‘He Put His All Into It’

(Courtesy of the Birmingham Family)

Billy Birmingham Sr.

Age: 69
Occupation: Emergency medical technician
Place of Work: Kansas City Missouri Fire Department
Date of Death: April 13, 2020

Bill Birmingham Jr. fondly remembers the year his father took on a new career. The whole family studied, even acting out scenes to ensure Billy Birmingham Sr., a minister, was ready for his emergency medical technician exam.

“He put his all into it,” the son recalled.

Billy Birmingham passed the test. And from the late 1990s on, he served as an EMT and a minister.

His family rallied again for his doctorate in pastoral theology. During nearly four decades as a minister, he founded two churches.

“He had a heart for other people,” his son said. “Whatever he could do for other people, he would do it.”

As an EMT with the Kansas City Fire Missouri Department, he was exposed to the novel coronavirus. The cough came in March.

“‘I’m just tired.’ That’s what he kept saying,” his son said. His dad went to the hospital twice. The first time he told the staff about his symptoms and underlying health conditions, then they sent him home.

The second time he arrived in an ambulance. Just over two weeks later, his final hours arrived.

Hospital staff set up a video chat so his family could see him one last time.

Cara Anthony, Kaiser Health News | Published May 1, 2020

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Jovial Man Trained Scores Of Doctors In Obstetrics, Gynecology And Kindness

(Courtesy of Ashley Ulker)

Luis Caldera-Nieves

Age: 63
Occupation: OB-GYN doctor
Place of Work: University of Miami and Jackson health systems in Miami
Date of Death: April 8, 2020

“Somos felices.” That was Dr. Luis Caldera-Nieves’ signature signoff after a cesarean section or patient visit or at the end of a difficult shift. “We’re happy,” he meant, and often, when he was around, it was true.

Caldera-Nieves, a popular OB-GYN, trained scores of doctors and helped bring thousands of babies into the world in his 25 years at the University of Miami and Jackson health systems.

Born in Bayamón, Puerto Rico, he worked as an Air Force doctor before joining UM, said longtime co-worker Dr. Jaime Santiago. Caldera-Nieves was so devoted to his patients that he often gave them his private phone number — and his wife’s, Santiago said.

Because he was so jovial, he earned the nickname “the Puerto Rican Santa Claus,” Santiago said.

“He was truly loved and admired by everyone who worked with him, and will be remembered for his humor and never-ending positive energy,” said Dr. Jean-Marie Stephan, who trained under Caldera-Nieves.

In a statement, UM and Jackson confirmed Caldera-Nieves died from complications of COVID-19 and said they “grieve the loss of our esteemed and beloved colleague.” He is survived by his wife and six adult children.

Melissa Bailey | Published May 1, 2020

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A Cluster Of Illness Robs Community Of Another Fearless EMT

(Courtesy of Vito Cicchetti)

Kevin Leiva

Age: 24
Occupation: Emergency medical technician
Place of Work: Saint Clare’s Health in Passaic, New Jersey
Date of Death: April 7, 2020

When Kevin Leiva died of COVID-19 in early April, it was a second crushing loss to his close-knit team of EMT workers. Their colleague, Israel Tolentino Jr., had died one week before.

“People were scared that everyone was going to die from it,” said Vito Cicchetti, a director at Saint Clare’s Health, where the men worked. “After Izzy died, we all started getting scared for Kevin.”

Leiva, according to an obituary, “was always worried about his crew.” He was “very proud” of his work and was recalled to have said “becoming an EMT was an act of God.”

He met his wife, Marina, online while they were in high school. She moved a thousand miles to build a life with him. He loved spending time at their home, playing guitar and tending to his tegu lizards, AJ and Blue.

As COVID-19 ramped up, the station’s three ambulances each handled up to 15 dispatches a shift, roughly double the usual number. In a busy 12-hour shift, EMTs often responded to calls continuously, stopping only to decontaminate themselves and the truck.

Leiva “always had a joke” that helped to defuse stressful situations and bring his co-workers together, Cicchetti said.

Michelle Andrews | Published May 1, 2020

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Firefighting And ‘Helping People’ Were In His Blood

(Courtesy of the Terre Haute Fire Department)

John Schoffstall

Age: 41
Occupation: Paramedic and firefighter
Place of Work: Terre Haute Fire Department in Terre Haute, Indiana
Date of Death: April 12, 2020

John Schoffstall grew up around firehouses, and it was at his own firehouse in Terre Haute, Indiana, that he was exposed to the coronavirus.

A paramedic and firefighter with the Terre Haute Fire Department for almost 12 years, Schoffstall died April 12 at age 41. Deputy Chief Glen Hall said investigations by the county health department and his own department “determined John contracted the virus from another firefighter in the firehouse.” Four other firefighters “had symptoms but none progressed.”

“We respond every day to potential COVID patients,” Hall said.

Jennifer Schoffstall, his wife of 18 years, said her husband went to the hospital March 28.

“His breathing was so bad in the ER, they just decided to keep him,” she said. “He regressed from there.”

Hall said Schoffstall’s “biggest hobby was his family,” with a son, 17, and a daughter, 13.

Schoffstall’s father had been a volunteer firefighter, Jennifer said, and her husband signed up for the New Goshen Volunteer Fire Department when he turned 18.

“He loved the fire service and everything about it,” she said. “He loved helping people.”

Sharon Jayson | Published May 1, 2020

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Boston Nurse, A Former Bus Driver, Was A Champion For Education

(Courtesy of Teadris Pope)

Rose Taldon

Age: 63
Occupation: Nurse
Place of Work: New England Baptist Hospital in Boston
Date of Death: April 12, 2020

Rose Taldon was just 5 feet tall. But when she bellowed out the window, her kids ran right home.

“She didn’t take any crap,” said her daughter, Teadris Pope.

Taldon raised three children with her husband on the street where she grew up in Dorchester, Boston. She was respected as a strong Black woman, earning a nursing degree while working in public transit for 23 years. Described as stern, she still was quick to tickle her eight grandkids.

Taldon was generous: Even as she lay in a hospital in April, exhausted from the coronavirus, she arranged to pay bills for an out-of-work friend, her daughter said.

It’s unclear whether Taldon caught the virus at her hospital, designated for non-COVID patients. Hospital officials said three patients and 22 staff have tested positive.

Once her mother was hospitalized, Pope couldn’t visit. On Easter morning, a doctor called at 2 a.m., offering to put Taldon on a video call.

“I just talked until I had no words,” Pope said. “I was just telling her, ‘We’re so proud of you. You worked so hard raising us. … You’ve gone through a hell of a fight.’”

An hour later, her mother was gone.

Melissa Bailey | Published May 1, 2020

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Unflappable First Responder With An Ever-Ready Smile

(Courtesy of Vito Cicchetti)

Israel Tolentino Jr.

Age: 33
Occupation: Emergency medical technician and firefighter
Place of Work: Saint Clare’s Health and the Passaic Fire Department, both in Passaic, New Jersey
Date of Death: March 31, 2020

When Israel Tolentino Jr. arrived for his EMT shift one morning in March, he seemed fine. Then he got a headache. Then a fever came on, and he was sent home, said Vito Cicchetti, a director at Saint Clare’s Health.

Izzy, as he was called, was an EMT who fulfilled his dream to become a firefighter. In 2018, the former Marine took a job with the Passaic Fire Department but kept up shifts at Saint Clare’s.

He was husband to Maria Vazquez, whom he’d met at church, according to nj.com. They had two young children.

The work pace could be brutal during the pandemic. In a 12-hour shift, Tolentino and his partner were dispatched to one emergency after another, each typically lasting under an hour but requiring nearly that long to decontaminate their gear and truck.

Izzy died in hospital care. The coronavirus tore through his EMT team. Most eventually recovered. But his friend and co-worker Kevin Leiva also died.

Izzy’s unflappable, cheerful presence is missed, Cicchetti said: “No matter how mad you were, he’d come up with a smile and you’d be chuckling to yourself.”

Cicchetti hasn’t replaced either man: “I don’t know if I’m ready for that yet.”

Michelle Andrews | Published May 1, 2020

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Their Decade-Long Dream Marriage Ends In Nightmare

(Courtesy of the Detroit Fire Department)

Capt. Franklin Williams

Age: 57
Occupation: Firefighter and medical first responder
Place of Work: Detroit Fire Department in Detroit
Date of Death: April 8, 2020

Capt. Franklin Williams stood at the altar on his wedding day and pretended to hunt for the ring. He patted his chest, then his pants legs and looked up at his soon-to-be wife with a million-dollar smile.

He was always clowning and “so silly,” said Shanita Williams, his wife, recalling how he wanted to make her laugh. Williams, 57, died from complications of the novel coronavirus on April 8 — one month before the couple’s 10-year wedding anniversary.

Williams had been on an emergency call with a verified COVID patient before falling ill, according to Detroit Fire Department Chief Robert Distelrath. He died in the line of duty.

Crews are equipped with personal protective equipment including a gown, N95 mask and gloves. But it’s easy for a mask to slip ― “when you’re giving [chest] compressions, your mask isn’t staying in place all the time,” said Thomas Gehart, president of the Detroit Fire Fighters Association.

When Williams fell sick on March 24, he moved to the guest bedroom and never returned to work.

“I’m thankful and thank God for having him in my life,” Shanita said, adding that she keeps hoping this is a nightmare and she’ll soon wake up.

Sarah Jane Tribble, Kaiser Health News | Published May 1, 2020

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A 9/11 First Responder, He Answered The Call During The Pandemic

(Courtesy of the Valley Stream Fire Department)

Mike Field

Age: 59
Occupation: Volunteer emergency medical technician
Place of Work: Village of Valley Stream on New York’s Long Island
Date of Death: April 8, 2020

Mike Field had a strong sense of civic duty. An emergency medical technician, he was a first responder with the New York Fire Department (FDNY) on 9/11. He was also a member of his community’s all-volunteer fire department since 1987.

After he retired from FDNY in 2002, he took a job making and posting street signs with his local public works department. He continued to volunteer with Valley Stream’s fire department and mentoring the junior fire department. When he wasn’t responding to emergencies or training future emergency technicians, he led a Boy Scout troop and volunteered for animal causes.

“Here’s somebody who cares about the community and cares about its people,” said Valley Stream’s mayor, Ed Fare, who had known Mike since the seventh grade.

Stacey Field, Mike’s wife, said he found his calling early, after his own father experienced a heart attack. “When the fire department EMTs came and helped his dad, he decided that’s what he wanted to do,” she said.

Their three sons ― Steven, 26; Richie, 22; and Jason, 19 — have followed in their father’s footsteps. Steven and Richie are EMTs in New York; Jason plans on training to become one as well. All three volunteer at the same fire station their father did.

In late March, Mike and fellow volunteer responders were called to an emergency involving a patient showing symptoms of COVID-19. Field died on April 8.

Sharon Jayson | Published April 29, 2020

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Nurse Fought For His Life In Same ICU Where He Cared For Patients

(Courtesy of Romielyn Guillermo)

Ali Dennis Guillermo

Age: 44
Occupation: Nurse
Place of Work: Long Island Community Hospital in East Patchogue, New York
Date of Death: April 7, 2020

In 2004, Ali Dennis Guillermo, his wife, Romielyn, and their daughter came to New York from the Philippines to find a better life.

Everything fell into place. The former nursing instructor landed a job at Long Island Community Hospital, often working in intensive care or the emergency room. He enjoyed the intensity of ER work, his wife said. As years passed, the couple had two sons and settled into a close-knit Philippine community.

As COVID-19 emerged, Guillermo was posted to the step-down floor, working with patients transitioning out of intensive care.

A lot of the nurses on his floor had gotten sick with the virus, his wife said, and “everybody was scared.”

And then, Guillermo felt achy, with a fever that soared to 102. He went to the hospital and X-rays were taken, but he was sent home. Within days, his blood oxygen level plummeted.

“My nails are turning blue,” he told his wife. “You should take me to the ER.”

He was admitted that night in late March, and they never spoke again.

In the ICU unit where he’d often worked, Guillermo was intubated and treated. Nearly two weeks later, he died.

Michelle Andrews | Published April 29, 2020

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An Eager Student, He Aimed To Become A Physician Assistant

(Courtesy of Catrisha House-Phelps)

James House

Age: 40
Occupation: Registered nurse
Place of Work: Omni Continuing Care nursing home in Detroit
Date of Death: March 31, 2020

James House had a voracious appetite for learning about and a fascination with the human body.

His sister, Catrisha House-Phelps, traces it back to childhood visits to a dialysis center where their father received treatments. “That was what tugged at his heart,” she said. “He just always wanted to know ‘why.’”

House-Phelps said her brother adored his five children, treasured his anatomy and physiology books and got a kick out of the residents he cared for at Omni Continuing Care. “He thought they were family; he just said they were funny people,” she said. He had hoped to go back to school to become a physician assistant.

House came down with what he thought was the flu in mid-March. His sister said he tried to get tested for COVID-19 but was turned away because he was not showing textbook symptoms and had no underlying health issues. On March 31, after resting at home for over a week, House returned to work. Hours later, he collapsed and was rushed to the hospital.

He texted his sister with updates on his condition. “I’m about to be intubated now,” he wrote. It was the last message he sent her.

Danielle Renwick, The Guardian | Published April 29, 2020

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She Loved A Parade And Catering To Patients

Pamela Hughes and her daughter, Brie
(Courtesy of Angie McAllister)

Pamela Hughes

Age: 50
Occupation: Nursing home medication aide
Place of Work: Signature HealthCARE at Summit Manor in Columbia, Kentucky
Date of Death: April 13, 2020

Pamela Hughes lived her entire life in rural Columbia, Kentucky, but longed for wide, sandy beaches. For vacation, Hughes and her daughter, Brie, 26, eagerly drove 14 hours to Daytona Beach, Florida, or Myrtle Beach, South Carolina.

After high school, Hughes worked at Summit Manor, a nursing home in Columbia, for 32 years. She knew which residents preferred chocolate milk or applesauce with their medication; she remembered their favorite outfits and colors. Hughes’ shy demeanor vanished each December when she and co-worker Angie McAllister built a float for the town’s Christmas parade competition.

“We built 10 floats over 10 years,” McAllister said. “We got second place every year.”

Even after several residents tested positive for the coronavirus, Hughes dismissed her worsening cough as allergies or bronchitis. The nursing home was short on help and she wanted to serve her patients, Brie said.

Days later, the public health department suggested her mother get tested. She tested positive, and her health worsened — food tasted bitter, her fever soared, her hearing dulled. On April 10, Hughes was taken by ambulance to a hospital, then by helicopter to Jewish Hospital in Louisville. Barred from visiting, Brie said goodbye over FaceTime.

Sarah Varney, Kaiser Health News | Published April 29, 2020

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The Family Matriarch And ‘We’re Failing Miserably Without Her’

(Courtesy of Ginu John)

Aleyamma John

Age: 65
Occupation: Registered nurse
Place of Work: Queens Hospital Center in New York City
Date of Death: April 5, 2020

Aleyamma John’s family wanted her to retire. Her husband, Johnny, an MTA transit worker, had stopped working a few years earlier. He and their son Ginu urged her to follow suit. “We told her, ‘I’m sure Dad wants to see the world with you — you need to give him that opportunity,’” Ginu said.

She demurred. “I think she found fulfillment in being able to serve,” Ginu said. “She was able to hold people’s hands, you know, even when they were deteriorating and be there for them.” She began her career as a nurse in India 45 years ago; she and her husband immigrated to the United Arab Emirates, where their two sons were born, and moved to New York in 2002.

Ginu said his mother, a devout Christian, found joy in tending to her vegetable garden and doting on her two grandchildren. She cooked dishes from her native India and filled the Long Island home she shared with Johnny, Ginu and Ginu’s family with flowers.

In March, as Queens Hospital Center began to swell with COVID-19 patients, John sent her family a photo of herself and colleagues wearing surgical hats and masks but not enough personal protective equipment. Days later, she developed a fever and tested positive for the virus. Johnny, Ginu and Ginu’s wife, Elsa, a nurse practitioner, also became ill.

When John’s breathing became labored, her family made the difficult decision to call 911. It would be the last time they saw her. “We’re 17 days in, and I feel like we’re failing miserably without her,” Ginu said.

Danielle Renwick, The Guardian | Published April 29, 2020

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‘A Kind Man’ Looking Forward To Retirement

(Courtesy of Jesse Soto)

Thomas Soto

Age: 59
Occupation: Radiology clerk
Place of Work: Woodhull Medical Center, a public hospital in Brooklyn, New York
Date of Death: April 7, 2020

After more than 30 years at one of New York City’s busy public hospitals, Thomas Soto loved his job but was looking forward to retiring, said his son, Jesse Soto, who lived with him.

At Soto’s busy station near the emergency room, he greeted patients and took down their information.

“Everybody saw him before their X-rays,” Soto, 29, said. “He smiled all day, made jokes. He was a kind man.”

As COVID patients began to overwhelm Woodhull and other emergency rooms across the city, Soto said that at first his father didn’t have any protective gear.

He eventually got a mask. But he still grew very sick, developing a high fever, body aches and a wracking cough. After a week, Soto said, “he couldn’t take it anymore.”

He went to Woodhull, where he was admitted. When they tried to put him on a ventilator two days later, he died. The hospital did not respond to requests for comment.

Michelle Andrews | Published April 29, 2020

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‘Blooming’ In Her First Job On Path To Becoming A Nurse

(Courtesy of the Viveros family via GoFundMe)

Valeria Viveros

Age: 20
Occupation: Nursing assistant
Place of Work: Extended Care Hospital of Riverside, California
Date of Death: April 5, 2020

At 20 years old, Valeria Viveros was “barely blooming,” developing the skills and ambition to pursue a nursing career, said Gustavo Urrea, her uncle. Working at Extended Care Hospital of Riverside was her first job.

Viveros, born in California to Mexican immigrants, grew attached to her patients at the nursing home, bringing them homemade ceviche, Urrea said. About a month ago, as he watched her cook, play and joke with her grandmother, he noticed how much her social skills had grown.

When she would say “Hi, Tío,” in her playful, sweet, high-pitched voice, “it was like the best therapy you could have,” Urrea recalled. Viveros, who lived with her parents and two siblings, was enrolled in classes at a community college.

Viveros felt sick on March 30, went to a nearby hospital and was sent home with Tylenol, Urrea said. By April 4, she couldn’t get out of bed on her own. She left in an ambulance and never came back.

“We’re all destroyed,” he said. “I can’t even believe it.”

On April 5, county health officials reported a coronavirus outbreak had sickened 30 patients and some staff at her nursing home. Trent Evans, general counsel for Extended Care, said staffers are heartbroken by her death.

Viveros was “head over heels in love with the residents that she served,” he said. “She was always there for them.”

Melissa Bailey | Published April 29, 2020

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Surgical Technician Made Friends Everywhere She Went

Monica Echeverri Casarez (Courtesy of Jorge Casarez)

Monica Echeverri Casarez

Age: 49
Occupation: Surgical technician
Place of Work: Detroit Medical Center Harper University Hospital in Detroit
Date of Death: April 11, 2020

Monica Echeverri Casarez was in constant motion, said her husband, Jorge Casarez. The daughter of Colombian immigrants, she worked as a Spanish-English interpreter in clinical settings. She was the kind of person whose arrival at a mom and pop restaurant would elicit hugs from the owners. She also co-founded Southwest Detroit Restaurant Week, a nonprofit that supports local businesses.

Twice a month, she scrubbed in as a surgical technician at Harper University Hospital. “She liked discovering the beauty of how the body works and how science is clear and orderly,” Casarez said. She was organized and intuitive, qualities that are assets in the operating room. On March 21, she posted a photo of herself in protective gear with the caption: “I’d be lying if I said I wan’t at least a bit nervous to be there now.” Since many elective surgeries had been canceled, Echeverri Casarez was tasked with taking the temperatures of people who walked into the hospital and making sure their hands were sterilized.

Soon after, Echeverri Casarez and Casarez began feeling ill. Quarantined together, Echeverri Casarez tried to make the best of the situation. She baked her husband a cake — chocolate with white frosting. She died a few days later.

Danielle Renwick, The Guardian | Published April 24, 2020

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A Whip-Smart Neurologist Endlessly Fascinated With The Brain

Gary Sclar (Courtesy of Jennifer Sclar)

Gary Sclar

Age: 66
Occupation: Neurologist
Place of Work: Mount Sinai Queens in New York City
Date of Death: April 12, 2020

Gary Sclar was a whip-smart neurologist who loved comic books, “Game of Thrones” and “Star Wars,” said his daughter, Jennifer Sclar. He was deeply compassionate with a blunt bedside manner.

“My dad was fascinated with the brain and with science,” Jennifer Sclar said. “His work was his passion, and it’s what made him the happiest, besides my brother and me.” Set to retire in June, he was looking forward to writing about politics and neurology.

Gary Sclar saw patients who were showing COVID-19 symptoms and knew his age and underlying health conditions ― he had diabetes — put him at risk for developing complications from the illness. His daughter pleaded with him to stop going to the hospital.

In early April, he mentioned having lost his sense of smell, and on April 8 he collapsed in his home. He was hospitalized a few days later and agreed to be intubated. “I don’t think he realized, like, that this was the end,” Jennifer Sclar said. “He brought his keys. He brought his wallet.”

Danielle Renwick, The Guardian | Published April 24, 2020

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An Exacting But Loving Aunt, She Was A Mentor Until The End

Araceli Buendia Ilagan (Courtesy of Jhoanna Mariel Buendia)

Araceli Buendia Ilagan

Age: 63
Occupation: Intensive care unit nurse
Place of Work: Jackson Memorial Hospital in Miami
Date of Death: March 27, 2020

For Jhoanna Mariel Buendia, her aunt was a constant ― if distant — presence. Araceli Buendia Ilagan emigrated from their hometown Baguio, in the Philippines, to the U.S. before Buendia was born, but she remained close to her family and communicated with them nearly every day.

“She was one of the smartest people I ever knew,” Buendia, 27, said. Buendia Ilagan, who at one point looked into adopting her niece so she could join her and her husband the United States, encouraged Buendia to become a nurse, and talked her through grueling coursework in anatomy and physiology. Buendia is now a nurse in London.

Buendia Ilagan was also demanding. “Whenever she visited the Philippines, she wanted everything to be organized and squeaky-clean,” Buendia said.

The last time the two spoke, in late March, Buendia Ilagan didn’t mention anything about feeling ill. Instead, the two commiserated over their experiences of treating patients with COVID-19; as always, her aunt offered her advice on staying safe while giving the best possible care. She died four days later.

Danielle Renwick, The Guardian | Published April 22, 2020

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A Beloved Geriatric Psychiatrist And Church Musician Remembered For His Cooking Skills

(Courtesy of Nida Gonzales)

Leo Dela Cruz

Age: 57
Occupation: Geriatric psychiatrist
Place of Work: Christ Hospital and CarePoint Health in Jersey City, New Jersey
Date of Death: April 8, 2020

Dr. Leo Dela Cruz was nervous about going to work in the weeks before he died, his friends said. Like many in the region, Christ Hospital had an influx of COVID-19 patients and faced a shortage of ventilators and masks.

Dela Cruz was a geriatric psychiatrist and didn’t work in coronavirus wards. But he continued to see patients in person. In early April, Dela Cruz, who lived alone, complained only of migraines, his friends said. Within a week, his condition worsened, and he was put on a ventilator at a nearby hospital. He died soon after.

Friends said he may have been exposed at the hospital. (In a statement, hospital representatives said he didn’t treat COVID-19 patients.)

Dela Cruz, the oldest of 10 siblings, came from a family of health care professionals. His friends and family — from Cebu, Philippines, to Teaneck, New Jersey — remembered his jovial personality on Facebook. He won “best doctor of the year” awards, played tennis and cooked traditional Cebu dishes.

Nida Gonzales, a colleague, said he always supported people, whether funding a student’s education or running a church mental health program. “I feel like I lost a brother,” she said.

Ankita Rao, The Guardian | Published April 22, 2020

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Alabama Nurse Remembered As Selfless But Sassy

Rose Harrison (Courtesy of Amanda Williams)

Rose Harrison

Age: 60
Occupation: Nurse
Place of Work: Marion Regional Nursing Home in Hamilton, Alabama
Date of Death: April 6, 2020

Rose Harrison, 60, lived to serve others ― her husband, three daughters, grandchildren and the residents of the nursing home where she worked. Though the Alabama nurse was selfless, she also had a sassy edge to her personality and a penchant for road rage, her daughter, Amanda Williams said.

“Her personality was so funny, you automatically loved her,” Williams said. “She was so outspoken. If she didn’t agree with you, she’d tell you in a respectful way.”

Harrison was not wearing a mask when she cared for a patient who later tested positive for COVID-19 at Marion Regional Nursing Home in Hamilton, Alabama, her daughter said. She later developed a cough, fatigue and a low-grade fever, but kept reporting to duty all week. Officials from the nursing home did not return calls for comment.

On April 3, Williams drove her mother to a hospital. The following evening, Harrison discussed the option of going on a ventilator with loved ones on a video call, agreeing it was the best course. Williams believed that her mother fully expected to recover. She died April 6.

Christina Jewett, Kaiser Health News | Published April 22, 2020

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Connecticut Social Worker Had Angelic Singing Voice And A Zest For Life

(Courtesy of the Hunt family)

Curtis Hunt

Age: 57
Occupation: Social worker
Places of Work: Cornell Scott-Hill Health Center and New Reach, both in New Haven, Connecticut
Date of Death: March 23, 2020

At a shelter for adults recovering from addiction, residents looked forward to the days when Marion “Curtis” Hunt would take the stage, emceeing talent shows and belting out Broadway and gospel tunes.

It wasn’t part of his job description as a social worker. It was just one of the ways he went “above and beyond,” said his supervisor at Cornell Scott-Hill Health Center, Daena Murphy. “He had a beautiful voice,” she said. “He was just a wonderful person — funny, engaging, always a huge smile on his face.”

Hunt, the youngest of four brothers, earned his master’s in social work from Fordham University at 52, and was baptized at his brother’s Pentecostal church at 54. He was a devoted uncle who doted on his dog and cat, Mya and Milo.

It’s unclear how Hunt got infected, but one patient he worked with had tested positive for COVID-19, as did two co-workers, according to Dr. Ece Tek, another supervisor at Cornell Scott-Hill Health Center. Hunt died on March 23, one week after developing flu-like symptoms, said his brother John Mann Jr.

Melissa Bailey | Published April 22, 2020

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To The End, King-Smith Was Driven By A Desire To Help Others

Kim King-Smith (Courtesy of Hassana Salaam-Rivers)

Kim King-Smith

Age: 53
Occupation: Electrocardiogram technician
Place of Work: University Hospital in Newark, New Jersey
Date of Death: March 31, 2020

Kim King-Smith was a natural caregiver. An only child, she grew up close to her extended family, including her cousins Hassana Salaam-Rivers and Sharonda Salaam. After Salaam developed multiple sclerosis, King-Smith visited her every day.

“She’d bring her sweets that she wasn’t supposed to have and share them with her,” Salaam-Rivers said. King-Smith’s desire to care for others was the reason she became an electrocardiogram technician, her cousin added. “If a friend of a friend or family member went to the hospital, she would always go and visit them as soon as her shift was over,” she said.

In March, King-Smith cared for a patient she said had symptoms of COVID-19; she soon fell ill herself and tested positive for the virus. It seemed like a mild case at first, and she stayed in touch with family via FaceTime while trying to isolate from her husband, Lenny.

On March 29, Salaam-Rivers checked in on her cousin and noticed she was struggling to breathe. She urged her to call an ambulance. After King-Smith was hospitalized, she exchanged text messages with her mother and cousin. As the day progressed, her messages carried increasingly grave news, Salaam-Rivers said. Then she stopped responding.

Danielle Renwick, The Guardian | Published April 22, 2020

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On The Eve Of Retirement, VA Nurse Succumbs To COVID-19

(Courtesy of Mark Accad)

Debbie Accad

Age: 72
Occupation: Clinical nursing coordinator
Place of Work: Detroit VA Medical Center in Detroit, Michigan
Date of Death: March 30, 2020

Nurse Divina “Debbie” Accad had cared for veterans for over 25 years and was set to retire in April. But after contracting the novel coronavirus, she spent her final 11 days on a ventilator — and didn’t survive past March.

She joined a growing list of health care professionals working on the front lines of the pandemic who have died from COVID-19.

Accad, 72, a clinical nursing coordinator at the Detroit VA Medical Center, dedicated her life to nursing, according to her son Mark Accad.

“She died doing what she loved most,” he said. “That was caring for people.”

Read more here.

Melissa Bailey | Published April 15, 2020

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California Nurse Thrived In ER and ICU, But Couldn’t Survive COVID-19

Jeff Baumbach and his wife, Karen
(Courtesy of the Baumbach family)

Jeff Baumbach

Age: 57
Occupation: Registered nurse
Place of Work: St. Joseph’s Medical Center in Stockton, California
Date of Death: March 31, 2020

Jeff Baumbach, 57, was a seasoned nurse of 28 years when the novel coronavirus began to circulate in California. He’d worked in the ER, the ICU and on a cardiac floor. Hepatitis and tuberculosis had been around over the years but never posed a major concern. He’d cared for patients who had tuberculosis.

Jeff and his wife, Karen Baumbach, also a nurse, initially didn’t consider it significantly riskier than challenges they’d faced for years.

“He’d worked in the ICU. He was exposed to so many things, and we never got anything,” she said. “This was just ramping up.”

One day during work, Jeff sent a sarcastic text to his wife: “I love wearing a mask every day.”

Within weeks, he would wage a difficult and steady fight against the virus that ended with a sudden collapse.

Read more here.

Christina Jewett, Kaiser Health News | Published April 15, 2020

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Nurse’s Faith Led Her To Care For Prisoners At A New Jersey Jail

(Courtesy of Denise Rendor)

Daisy Doronila

Age: 60
Occupation: Registered nurse
Place of Work: Hudson County Correctional Facility in Kearny, New Jersey
Date of Death: April 5, 2020

Daisy Doronila had a different perspective than most who worked at the Hudson County Correctional Facility, a New Jersey lockup 11 miles from Manhattan. It was a place where the veteran nurse could put her Catholic faith into action, showing kindness to marginalized people.

“There would be people there for the most heinous crimes,” said her daughter, Denise Rendor, 28, “but they would just melt towards my mother because she really was there to give them care with no judgment.”

Doronila, 60, died April 5, two weeks after testing positive for the coronavirus that causes COVID-19. The jail has been hit hard by the virus, with 27 inmates and 68 staff members having tested positive. Among those, another nurse, a correctional officer and a clerk also died, according to Ron Edwards, Hudson County’s director of corrections.

Doronila fell ill before the scope of the jail infections were known. She was picking up extra shifts in the weeks before, her daughter said, and planning on a trip to Israel soon with friends from church.

That plan began to fall apart March 14, when someone at the jail noticed her coughing and asked her to go home and visit a doctor.

Read more here.

Christina Jewett, Kaiser Health News | Published April 15, 2020

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An Army Veteran, Hospital Custodian ‘Loved Helping People’

(Courtesy of Michelle Wilcox)

Alvin Simmons

Age: 54
Occupation: Environmental service assistant
Place of Work: Rochester General Hospital in Rochester, New York
Death: March 17, 2020

Alvin Simmons started working as a custodian at Rochester General Hospital, in New York state, weeks before he fell ill. “He loved helping people and he figured the best place to do that would be in a hospital,” his sister, Michelle Wilcox said.

An Army veteran who had served in the first Gulf War, Simmons loved karaoke and doted on his three grandchildren, Wilcox said. “He was a dedicated, hardworking individual who had just changed his life around” since a prison stint, she said.

According to Wilcox, Simmons began developing symptoms shortly after cleaning the room of a woman he believed was infected with the novel coronavirus. “Other hospital employees did not want to clean the room because they said they weren’t properly trained” to clean the room of someone potentially infected, she said. “They got my brother from a different floor, because he had just started there,” she said. (In an email, a hospital spokesperson said they had “no evidence to suggest that Mr. Simmons was at a heightened risk of exposure to COVID-19 by virtue of his training or employment duties at RGH.”)

On March 11, he visited the emergency room at Rochester General, where he was tested for COVID-19, Wilcox said. Over the next few days, as he rested at his girlfriend’s home, his breathing became more labored and he began to cough up blood. He was rushed to the hospital on March 13, where he was later declared brain-dead. Subsequently, he received a COVID-19 diagnosis. Simmons died on March 17.

Danielle Renwick, The Guardian | Published April 15, 2020

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Nurse At Nevada VA Dies After Caring For Infected Colleague

(Courtesy of Bob Thompson)

Vianna Thompson

Age: 52
Occupation: Nurse
Places of Work: VA Sierra Nevada Health Care System and Northern Nevada Medical Center in Reno, Nevada
Date of Death: April 7, 2020

Nurse Vianna Thompson, 52, spent two night shifts caring for a fellow Veterans Affairs health care worker who was dying from COVID-19.

Two weeks later, she too was lying in a hospital intensive care unit, with a co-worker holding her hand as she died.

Thompson and the man she treated were among three VA health care workers in Reno, Nevada, to die in two weeks from complications of the novel coronavirus.

“It’s pretty devastating. It’s surreal. Reno’s not that big of a city,” said Robyn Underhill, a night nurse who worked with Thompson in the ER at Reno’s VA hospital the past two years.

Thompson, who dreamed of teaching nursing one day, died April 7, joining a growing list of health care professionals killed in the pandemic.

Read more here.

Melissa Bailey | Published April 15, 2020

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Dr. J. Ronald Verrier Was Busy Saving Lives Before The Pandemic

(Courtesy of Christina Pardo)

J. Ronald Verrier

Age: 59
Occupation: Surgeon
Place of Work: St. Barnabas Hospital in the Bronx, New York
Date of Death: April 8, 2020

Dr. J. Ronald Verrier, a surgeon at St. Barnabas Hospital in the Bronx, spent the final weeks of his audacious, unfinished life tending to a torrent of patients inflicted with COVID-19. He died April 8 at Mount Sinai South Nassau Hospital in Oceanside, New York, at age 59, after falling ill from the novel coronavirus.

Verrier led the charge even as the financially strapped St. Barnabas Hospital struggled to find masks and gowns to protect its workers — many nurses continue to make cloth masks — and makeshift morgues in the parking lot held patients who had died.

“He did a good work,” said Jeannine Sherwood, a nurse manager at St. Barnabas Hospital who worked closely with Verrier.

“He can rest.”

Read more here.

Sarah Varney, Kaiser Health News | Published April 15, 2020

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America’s First ER Doctor To Die In The Heat Of COVID-19 Battle

(Courtesy of Debra Vasalech Lyons)

Frank Gabrin

Age: 60
Occupation: Doctor
Places of Work: St. John’s Episcopal in Queens, New York, and East Orange General in New Jersey
Date of Death: March 26, 2020

At about 5 a.m. on March 19, a New York City ER physician named Frank Gabrin texted a friend about his concerns over the lack of medical supplies at hospitals.

“It’s busy ― everyone wants a COVID test that I do not have to give them,” he wrote in the message to Eddy Soffer. “So they are angry and disappointed.”

Worse, though, was the limited availability of personal protective equipment (PPE) — the masks and gloves that help keep health care workers from getting sick and spreading the virus to others. Gabrin said he had no choice but to don the same mask for several shifts, against Food and Drug Administration guidelines.

“Don’t have any PPE that has not been used,” he wrote. “No N95 masks ― my own goggles — my own face shield,” he added, referring to the N95 respirators considered among the best lines of defense.

Less than two weeks later, Gabrin became the first ER doctor in the U.S. known to have died as a result of the COVID-19 pandemic, according to the American College of Emergency Physicians.

Read more here.

Alastair Gee, The Guardian | Published April 10, 2020

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This story is part of “Lost on the Frontline,” an ongoing project from The Guardian and Kaiser Health News that aims to document the lives of health care workers in the U.S. who die from COVID-19, and to investigate why so many are victims of the disease. If you have a colleague or loved one we should include, please share their story.

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Think Like a Doctor: The Boy With Nighttime Fevers Solved!

Photo

Credit Andreas Samuelsson

On Thursday we asked Well readers to take on the case of a 7-year-old boy who’d been having fevers and drenching sweats nightly for over a month. More than 300 of you wrote in, and although 20 of you came up with the right diagnosis, only three of you figured out both the diagnosis and the test needed to confirm it.

The correct diagnosis is…

Coccidioidomycosis, or valley fever.

The diagnosis was made based on a lymph node biopsy.

The first reader to suggest this diagnosis and the test was Dr. Malkhaz Jalagonia, an internist from Zugdidi, in the Republic of Georgia. He says he’s never seen a case like this, but he’s fascinated by zebras and so recognized the disease immediately. Well done, Dr. Jalagonia!

One of the reasons I chose this case was that, although this diagnosis is rare in life, it was the most frequently suggested diagnosis in my last column – the one about the middle-aged man with a cough for over a year. I thought it would be fun to show what valley fever really looks like. Hope you did too.

The Diagnosis

Coccidioidomycosis is a lung infection usually caused by inhaling the spores of a tiny fungus called coccidioides. This organism grows as a mold, a few inches below the surface of the soil in deserts in parts of the southwestern United States, Mexico and other countries of Central America.

In dry conditions, the fungus becomes fragile and is easily broken up into tiny single-celled spores that can be sent airborne with even the slightest disturbance. And once these single cells are aloft they can remain suspended there for prolonged periods of time.

Infection is usually acquired by inhaling the spores. Once lodged in the lung, the organism begins to reproduce almost immediately. The time course between exposure and disease depends on the inhaled dose and the patient’s immune system.

Symptoms, or No Symptoms

Disease severity varies considerably. Nearly half of those who breathe in these spores have no symptoms, or symptoms are so mild they never visit the doctor’s office.

More severe infection usually takes the form of a slowly progressive pneumonia known as coccidioidomycosis, or valley fever. This illness is characterized by a cough, fevers, chest pain, fatigue and sometimes joint pain. Indeed, because of the prominent joint pain, in some cases — though not this one — the disease is also known as desert rheumatism.

Rashes are also seen in many patients. Those who get a rash seem to have a more benign course of illness. The thinking is that the skin symptoms are the result of an aggressive immune response in the host to the pathogen.

Symptoms can last for months, and in many cases they resolve without treatment. But in some cases they get worse.

Hard to Diagnose

Those who seek medical attention are often not diagnosed — or not diagnosed quickly — because the symptoms of valley fever are not very specific, and few of the tests that doctors usually order have features that are unusual enough to suggest the diagnosis.

Chest X-rays are often normal. Blood tests may be normal as well, though some patients, like this child, have an unusually high number of a type of white blood cell known as eosinophils. These cells are usually seen in allergic responses or with infections due to parasites.

The most important clue to the possibility of this infection is travel to one of the areas where the fungus lives. In the United States, valley fever is endemic primarily in Arizona and southern California, as well as parts of southern New Mexico and West Texas. Indeed, the name valley fever is a shorter and more general term for an earlier name, San Joaquin Valley fever, because it was so common in that part of California.

A Dramatic Rise

There has been a significant increase in the number of cases of coccidioidomycosis in the past 15 years, with nearly 10 times as many in areas where the fungus is found. Development in areas where the fungus is endemic is thought to be the primary cause. Better diagnostic testing may also play a role.

While this infection may cause only a minor illness in many, there are some – like this child – for whom the disease can spread beyond the lungs into the rest of the body. Disseminated coccidioidomycosis is usually seen in those with some problem with the immune system – an underlying disorder such as H.I.V., for example, or because someone is taking immune suppressing medications such as prednisone.

Once out of the lungs, the bugs can go anywhere in the body, though they seem to prefer joints, skin or bones. Those with disseminated disease have to be treated for a long time – often up to a year, or occasionally for life.

How the Diagnosis Was Made

The little boy had been sick for nearly a month, and his parents were getting quite worried. He was pale, thin and really, really tired.

With their pediatrician’s encouragement, they had gone on a long planned, much anticipated vacation to the mountains of Colorado. But the child wasn’t getting better, and so his mother took him to yet another doctor – this one in a walk-in clinic.

The results of some simple blood tests done at that visit worried the doctor, who suggested that the boy be taken to a hematologist, a specialist in diseases and cancers of the blood.

Now the parents were terrified. The mother faxed copies of the lab results to her brother, a researcher in immunology. He wasn’t a physician but showed the results to friends who were. They agreed with the doctor at the walk-in clinic: The boy needed to be seen by a hematologist.

A Series of Specialists

The next morning the family headed home to Minneapolis. They took the boy to his regular pediatrician, who sent them to a hematologist. It wasn’t cancer, that specialist told them. Maybe some kind of severe food allergy, he suggested, and referred them to a gastroenterologist.

Not a GI thing, that specialist told them, and he referred the now nearly frantic family to an infectious disease specialist and a rheumatologist.

Nearly 10 days after getting the alarming blood test results, the couple and their child found themselves in the office of Dr. Bazak Sharon, a specialist in infectious diseases in adults and children at the University of Minnesota Masonic Children’s Hospital. After introducing himself, Dr. Sharon settled down to get a detailed history of the boy and the family.

A Desert Visit, but Other Possibilities

When Dr. Sharon heard that the family had spent a week at a ranch in the desert of Arizona, he immediately thought of coccidioidomycosis. The fungus isn’t found in Minnesota or Colorado – which is probably why other doctors hadn’t considered it. But it is all over the part of Arizona where they’d visited.

Still, there were other possibilities that had to be ruled out, including some types of cancer. After Dr. Sharon examined the boy, he sent the family to the lab for a chest X-ray and some blood tests.

The results of those tests were concerning. The child was getting worse. Dr. Sharon wasn’t going to be back in clinic for a week, and he was certain the child needed to be seen and diagnosed well before then. He called a friend and colleague who was taking care of patients in the hospital, Dr. Abraham Jacob, and asked if he would admit the child and coordinate the needed diagnostic workup for the boy.

First Some Answers, Then More Questions

Once in the hospital, the child had a chest CT scan. The results were frightening. The lymph nodes that surround the trachea, the tube that carries inspired air to the lungs, were hugely enlarged. They were so big that the trachea was almost completely blocked. The opening at one point was just two millimeters wide – basically the dimensions of a cocktail straw. Any worsening of his disease might cause the tube to close completely, making breathing impossible.

A pediatric surgeon was brought in immediately. The enlarged lymph nodes had to be removed. First in order to protect the child’s airways. And second because those nodes would reveal what the little boy had.

But trying to do surgery on a 7-year-old boy’s neck was complicated. Although the surgeon could easily feel the enlarged gland in his neck, it was close to many vital blood vessels, nerves and organs. The child had to lie perfectly still, and with most children that could only be guaranteed if they were under anesthesia.

Risky Surgery

When the anesthesiologist saw the CT scan, the doctors’ concern grew. They could put the child to sleep, but if anything went wrong during surgery and they had to put a tube down his throat into his lungs, they weren’t sure it would be able to fit.

The trachea was so small, there was no guarantee they could get the tube into place. In order to do this safely, they said they needed to use a technique known as ECMO, or extracorporeal membrane oxygenation – basically a machine that allows them to oxygenate blood without sending it to the lungs.

Rather than subject the child to this risky procedure, Dr. Jacob and the surgeon decided to just take a piece of the lymph node out in order to make the diagnosis. Treatment of whatever the boy had would bring the size of the lymph node down.

Don’t Make a Move

When the boy was brought to the procedure room, the surgeon explained that he was going to put numbing medicine all around the bump in the boy’s neck and take out a piece of it. The child listened calmly and agreed.

He wasn’t to move at all, the surgeon explained. The child nodded solemnly. He understood. The boy was remarkably mature and so brave throughout the entire process of anesthetizing the region that the surgeon thought he might be able to continue and get the entire node out.

He paused in his surgery and consulted the parents. Would they allow him to try this? Their son was doing so well he was sure he could get it. They agreed, and the surgeon returned to his task. The lymph node came out without difficulty.

Photo

Credit

It was sent to the lab and the answer came back almost immediately. The swollen tissue was filled with the tiny coccidioides. You can see a picture of these little critters here.

A Year of Medicine

The boy was started on an intravenous medicine for fungal infections. Then after a week it was changed to one he could take by mouth.

Because the infection had spread beyond the lungs, the child will have to take this medication for a year. After starting the medication, the child began to look a little better. Slowly he was less tired. Slowly he started to eat the way he used to.

It was a long road to the diagnosis, and an even longer road to cure, but at least they were on the right one.

A Perfect Storm?

The mother called the ranch in Arizona where they stayed to let them know what had happened.
The owner told them that their son was not the only person visiting then who got sick. At least one other guest, there at the same time, had come down with the disease.

Apparently the conditions for spread were perfect. Their stay had started off with some rain, followed by heat and some brisk wind. The moisture helped the fungus grow; the heat dried it out so that it could become easily airborne and inhaled when lifted by the wind.

Although the family has loved their visits to this ranch – this was their second year – the child’s mother tells me that she’s not sure she’ll be going back, at least for a couple of years. Most people exposed to valley fever become immune forever, but because her little boy was so very sick, she’s planning to wait a while before they return.

Think Like a Doctor: The Boy With Nighttime Fevers

Photo

Credit

The challenge: A healthy 7-year-old boy suddenly starts having fevers and night sweats. Can you figure out why?

Every month, the Diagnosis column of The New York Times Magazine asks Well readers to sift through a difficult medical case and solve a diagnostic riddle. This month we present the case of a boy who has fevers topping 102 degrees every night for over a month. His parents sought help from nearly a dozen doctors in two states before a diagnosis was made.

Below I’ve given you the information that was available to the doctors who figured out the cause of the boy’s fevers. It’s up to you to use this information to put his story together for yourself.

As usual, the first person to crack the case gets a copy of my book, “Every Patient Tells a Story,” and, of course, that fabulous feeling you get when you solve a really tough puzzle.

The Patient’s Story

“I think you need to take him back home.” Her brother’s voice was calm, but she could hear an undertone of anxiety even over the poor cellphone reception that was all she could get from rural Colorado. “He needs to see a hematologist. It could be a virus, but it could also be something else.” He didn’t say it, but she knew what he was thinking: cancer.

Her son, just 7 years old and always a little delicate, had been sick for nearly a month. He was fine during the day, but every night he’d spike a fever of 102 or 103.

Even before they’d come to the mountains for a much needed vacation, she’d taken him to see his pediatrician at home in Minneapolis several times. At each visit, the doctor or one of his partners had looked the boy over closely, and each time he’d seemed fine.

It was probably viral, she was told, time after time. But he seemed to be having one viral infection after another.

A Vacation Cut Short

The day before they left for Colorado, the boy’s father took him to the doctor’s office one more time.

Maybe it wasn’t viral, the pediatrician acknowledged, and prescribed a “Z-pak” — a five-day course of azithromycin. Don’t cancel the trip, the doctor reassured him. He’ll get better.

But he hadn’t. While on vacation, his mother took him to a walk-in clinic, where they’d checked his blood. A worried looking doctor told her that he didn’t know what was wrong with her boy. He should probably see a cancer specialist.

Now she was really worried. There weren’t any specialists anywhere near the bucolic town where they were staying. That’s when she’d sent the test results to her brother, a researcher in immunology. He wasn’t a doctor, but he passed the results to friends who were, and they were worried, too.

Thin and Pale

The family headed home right away, but the 4th of July was coming. They couldn’t get in to see a hematologist until Tuesday.

By now the boy was starting to look sick. He was pale and had dark circles under his eyes. Small for his age — consistently in the fifth percentile for height and weight — he now looked even smaller, thinner. He was a quiet child, always had been. Thoughtful and comfortable in the company of adults, as so many only children are. Even now he never complained.

Nothing hurt. He was simply tired. His fevers started coming a little earlier, peaking a little higher. His mother noticed a cough and wheezing sometimes. Always a picky eater, with these intermittent fevers, very few foods seemed appealing. She tried to hide the terror she felt when he seemed to be fading as she watched.

A Long Line of Specialists

The hematologist examined the boy and sent off more blood. Definitely not cancer, he said. He suggested seeing a gastroenterologist.

The gastroenterologist got an M.R.I. of the child’s digestive system. Nothing there. He noticed the boy’s wheezing and gave him an inhaler, then referred mother and child to a rheumatologist and an infectious disease specialist.

It seemed to the parents that this had to be an infection, but the earliest they could get in to see the infectious disease doctor was the following week. For the boy’s mother, the delay now seemed intolerable.

It had been five weeks since the fevers first started. In that time, the boy had lost nearly 10 pounds. They’d seen eight doctors in two states. They’d all been very nice, thorough, thoughtful, but had no answers.

By the weekend she was desperate. The boy needed to be in the hospital. Couldn’t they see how sick he was? She couldn’t wait for the specialist. She took him to the emergency room of the big university hospital.

The E.R. doctors, like all the doctors they’d seen so far, were kind and thoughtful, and so gentle with her delicate son. But like all the other doctors, they had no answers. They prescribed another inhaler for the boy’s wheezing, since the first hadn’t helped. They also urged her to see the infectious disease specialist. His appointment was just a couple of days away.

TB or not TB?

The boy was sitting quietly between his parents watching a video on his tablet when Dr. Bazak Sharon and the infectious disease fellow he was training entered the exam room. Dr. Sharon’s first thought was that the child looked as if he had tuberculosis.

He’d seen a lot of TB in this clinic, but it was usually among immigrant families who had traveled to Minneapolis from countries where the disease was common. Like this boy, kids with TB were usually thin, sickly looking, pale and quiet. But based on what his fellow told him, the child had no exposures that would put him at risk for this disease. He’d only been out of the country once – to Canada. He’d visited the beaches of South Carolina and the deserts of Arizona, and most recently the mountains of Colorado. But TB was rare in all these locales.

Dr. Sharon introduced himself to the child, who looked up immediately and smiled. How do you feel, he asked the boy? His temperature had been recorded at 103 degrees. I feel good, he’d answered pleasantly. Does anything hurt? No.

His heart was beating rapidly – nearly 140 beats per minute, but that was probably due to the fever. There were several enlarged lymph nodes in the child’s neck and his groin, though none under his arms. Otherwise his exam was unremarkable.

Getting Worse

Dr. Sharon had reviewed the blood tests that had already been done but wanted to see if anything had changed. And given that the only localized complaint was cough and wheezing, he wanted to get another chest X-ray.

Reviewing those studies that night, Dr. Sharon saw that the boy was slowly getting worse. He saw patients at that clinic only once a week and was reluctant to wait that long before having him seen again. He thought they needed an answer much sooner than that.

You can see the note from Dr. Sharon and his fellow here.

Dr. Sharon’s Note

The note from the patient’s visit to the hospital.

To the Hospital

Dr. Sharon called the family the next morning. He’d reached out to one of his friends and colleagues, Dr. Abraham Jacob, who could see them. They should go to the University of Minnesota Medical Center Fairview, where Dr. Jacob would orchestrate a thorough workup. That would be the fastest way to get an answer.

Based on the assessment by Dr. Jacob and his resident and the recommendations from Dr. Sharon, the team reached out to specialists in hematology-oncology and in rheumatology. And since his chest X-ray was abnormal and he had enlarged lymph nodes, they wanted to get a CT scan as well.

You can see the note from Dr. Jacob and his resident here.

Dr. Jacob’s Notes

Here are the notes from the pediatrics department.

Breathing Through a Straw

It was the results of the CT scan that really got things moving. It was the middle of the day when the resident was paged by the radiologist. The pictures showed that the lymph nodes in the boy’s chest were so swollen that they were pressing on the trachea – the breathing tube – so that it was almost completely cut off. Essentially he was breathing through the equivalent of a cocktail straw.

Any additional swelling could cut off the boy’s breath completely. You can see an image from the CT scan here.

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This CT scan shows the patient’s chest. In a child of this age, the trachea is normally eight to 12 millimeters wide. Much of the gray tissue surrounding the trachea and esophagus is swollen lymph nodes.

This CT scan shows the patient’s chest. In a child of this age, the trachea is normally eight to 12 millimeters wide. Much of the gray tissue surrounding the trachea and esophagus is swollen lymph nodes.Credit

A normal trachea in a child this age is four to six times the size seen in the scan. The image added even more pressure to make a diagnosis and treat the child before he got sicker.

Solving the Mystery

A diagnosis was made within the next 24 hours. Can you figure out what the boy had, and how the diagnosis was made?

The first person to offer the correct answers to these two questions will get a copy of my book and that sense of triumph that comes from nailing the right diagnosis when it really matters.

Rules and Regulations: Post your questions and diagnosis in the comments section below. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.

Just a Regular Doctor

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Credit iStock

“What’s your specialty?” That’s the question people always ask, as soon as they learn that you are a doctor.

My specialty? This question continually flummoxes me. This is the moment that I experience a brief surge of envy toward my cardiology and dermatology colleagues who have simple one-word answers to this question that any lay person can understand.

But what do internists say? What is our specialty?

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Danielle Ofri, M.D.

Danielle Ofri, M.D.Credit Joon Park

I sometimes say, “general internal medicine.” But that’s a mouthful. Plus many people have no idea what general internal medicine actually means.

I usually end up saying that I’m just a regular doctor, but it always feels deflating to have to add that “just.”

The American College of Physicians, the professional group for internal medicine, started an ad campaign several years ago to address the confusion. They came up with the slogan of internists as “doctors for adults,” wanting us to credibly sound like specialists, people with more training than the old-fashioned G.P.s. But it just didn’t catch on. I don’t fault the A.C.P. or its Madison Avenue colleagues who came up with this lusterless campaign; there’s just not a lot of pithy material to work with.

Internists, along with the others in the primary care field — family physicians, pediatricians, gynecologists — make up the bulwark of the medical system, though nothing we do or say or represent is especially snappy. No one is rushing to make an edgy cable TV series about adjusting blood pressure medications or treating constipation.

But the need is surely there. Anyone who’s tried to get an appointment with his or her doctor already knows about the primary-care crunch. The Affordable Care Act has highlighted the need for more primary care doctors, with the shortage only likely to grow more acute with a growing and aging population.

In most other countries, the vast majority of physicians are primary care doctors, in recognition that they deliver the vast majority of health care. It is only in the United States that the free market for higher-paid fields results in the number of specialists actually surpassing that of primary care doctors.

We all know the stats — primary care doctors get paid less than specialists, have more administrative headaches, more paperwork, and are generally viewed as lower on the totem pole. Reputation always has it that the smartest medical students go into the specialties; the generalist fields get everyone else who couldn’t make up their mind or who didn’t want to compete in the big leagues.

Dr. Wayne Riley, the president of the American College of Physicians, strongly disputes this characterization. He notes the wisdom acquired by physicians who are required to take both the long view and the wider view of medicine. “I proudly tell people that my specialty is internal medicine.” And if people are still confused, he humorously describes an internist as, “Like television’s Dr. House, but without the bad manners or ethical issues.”

The stereotype of specialists handling the more complex and intellectually challenging cases makes many generalists fume. Generalists observe that specialists get the “simplicity” of handling very narrow slivers of medicine. It’s much easier to be an expert when you only have a handful of diseases to worry about. And any issue that a specialist doesn’t want to deal with can be permissibly kicked back to the generalist.

The generalist, however, gets no dispensation. Every issue that the patient raises must be addressed. Every symptom from any organ has to be acknowledged. Plus, every medication prescribed by every specialist must be accounted for. Every competing interest between the many medical cooks in today’s fragmented health care environment must be integrated.

A recent study regarding patients with diabetes illustrates this reality. In a review of more than 4,500 patients with diabetes, 80 percent of visits to specialists involved only one diagnosis. However, only 45 percent of visits to generalists involved a single diagnosis. Of patients with four or more diagnoses, 90 percent fell to the generalists.

Specialists also get the added ease of pre-screening. A patient referred to a gastroenterologist is generally known to have a GI issue. A patient sent to a cardiologist has some type of heart condition. But the patient who walks into a generalist’s office will often just report pain somewhere in the middle of the body. The generalist has to figure out if the source of the pain is cardiac or pulmonary or gastric or muscular or inflammatory or infectious or hematologic or autoimmune or psychosomatic — a tall order that is somehow considered less intellectually rigorous, and less worthy of reimbursement, than specialty care.

To me, primary care and specialty care are equally demanding. They perhaps represent different types of intellectual challenges, but there’s no reason for one to be thought of as more worthy of respect (or pay).

Primary care doctors, the generalists, won’t be likely to achieve parity in pay or respect until the economics of American medicine changes drastically to reflect more realistically the needs of our patients. Right now, the system values procedures far more than talking to the patient, and so generalists — who do far fewer procedures — continue to rank at the bottom.

But generalists can take heart in the fact that they are what people usually have in mind when they say that they need a doctor. So now when people ask what my specialty is, I say that I’m just a regular doctor. Though I try to remember to leave out the “just.”


Danielle Ofri’s newest book is What Doctors Feel: How Emotions Affect the Practice of Medicine. She is a physician at Bellevue Hospital and an associate professor of medicine at the New York University School of Medicine, as well as editor in chief of the Bellevue Literary Review. She spoke on Deconstructing Our Perception of Perfection at TEDMED.

Food, a Place to Sleep and Other Basic Patient Needs

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Credit Earl Wilson/The New York Times

“Doc,” my patient said, his voice a mix of amusement and irritation. “I ain’t got food to eat or a place to sleep. Took me two hours and three buses to get here. And you’re tellin’ me about some numbers?”

He had a point. Though, in my defense, these numbers — his cholesterol and blood pressure — were important ones.

As I tried to persuade him of their relevance, I thought of another number, his ZIP code — or lack of one, since he lived on the street — and how that was a far more important factor for how long he might live than his cholesterol.

What’s remarkable about our conversation isn’t that it happened, but that it doesn’t happen enough. Many of my patients are not forthcoming about their challenges, and when I probe, I’m often surprised by how many struggle with basic needs like housing, food and transportation.

I recently discussed starting insulin with a patient to control his diabetes. He hesitated — his concern not the syringes needed to inject it, but rather not having a refrigerator to store it. Another patient recently called to cancel her appointment. She was moving into a new apartment — again. Her son’s asthma had flared up, and she thought the mold and cockroaches in their current home were making it worse.

These situations highlight what we’ve known for decades: that patients’ social and economic circumstances powerfully influence their health and well-being. But until recently there’s been relatively little effort to systematically address these factors.

The Center for Medicare and Medicaid Innovation, a government organization established by the Affordable Care Act to test new ways to deliver and pay for health care, is trying to change that. It recently announced a pilot program to help health systems close gaps between medical care and social services in their communities. The program, known as Accountable Health Communities, will invest $157 million over five years to study whether helping patients with social needs in five key areas — housing, food, utilities, transportation and interpersonal safety — can improve health and reduce medical costs.

“Clearly we’re not the first to understand that social factors are important,” said Dr. Darshak Sanghavi, the innovation center’s director of preventive and population health care models. “But these efforts have been fragmented. They haven’t been studied in a way that can be nationally scaled.” As the world’s largest purchaser of health care services, the Centers for Medicare and Medicaid Services can help address that, he said.

The Accountable Health Communities program will award grants to 44 organizations around the country to build partnerships among state Medicaid agencies, health systems and community service providers to identify which strategies are most effective for linking patients to the services they need.

There’s good evidence that dedicated attention to social support can improve health and cut costs. Research suggests nutrition assistance for low-income women and children reduces the risk of low birth weight, infant mortality and developmental problems — at a cost that’s more than fully offset by lower Medicaid spending. Other work suggests providing elderly patients with home-delivered meals can help them live independently and prevent expensive nursing home stays. Research also shows that providing housing for low-income and homeless people can substantially reduce medical costs. A housing initiative in Oregon, for example, decreased Medicaid spending by 55 percent for the newly housed; a study of a similar program in Los Angeles found that every $1 spent on housing led to $6 saved on medical costs.

And local efforts around the country can serve as models for change.

Hennepin Health in Minnesota, for example, is an organization that serves low-income patients, and emerged as a partnership between local social service, public health and medical leaders. These groups share data and funding to ensure patients have access to services like housing, utilities, job training and behavioral and substance abuse counseling. The program’s efforts have lowered emergency department use, reduced the need for hospitalizations, improved chronic disease care — and saved money. Other innovative organizations, like the Camden Coalition in New Jersey and Health Leads in several metropolitan areas, have likewise recognized the challenges vulnerable patients face outside the hospital, and tackled them in inspiring ways.

But we haven’t yet done enough to collect, examine and scale these insights. There’s been no concerted national effort to ease the social problems that drive poor health, and consequently, little financial incentive for medical practitioners to collaborate with social service providers. Until now.

“I think what’s most important is the signal we’re sending,” Dr. Sanghavi said of the Accountable Health Communities initiative. “We recognize that hundreds, potentially thousands, of communities have these needs. We can’t meet them all right now. But this sends a broader signal to other innovators out there — be they private, public or philanthropic: Social determinants are important. We want to learn from their efforts. We want to spark that flame.”

Dhruv Khullar, M.D., M.P.P., is a resident physician at Massachusetts General Hospital and Harvard Medical School. Follow him on Twitter: @DhruvKhullar.

Doctors Should Listen to Patient Instincts

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When a patient complains that he or she doesn’t feel well, doctors should pay attention.

That’s the finding of a new study that suggests that how patients say they feel may be a better predictor of health than objective measures like a blood test. The study, published in Psychoneuroendocrinology, used data from 1,500 people who took part in the Texas City Stress and Health Study, which tracked the stress and health levels of people living near Houston.

The survey included self-assessments from a 36-item questionnaire as well as blood samples, which were analyzed for markers of inflammation and the activity of latent herpes viruses. (The viruses were benign and not the type associated with sexually transmitted disease or cold sores.) Inflammation and viral activity are general markers of immune system health, but they don’t typically cause any obvious symptoms or show up in traditional blood tests.

The study found that when people said they felt poorly, they had high virus and inflammation levels. People who reported feeling well had low virus and inflammation levels.

“I think the take-home message is that self-reported health matters,” said Christopher P. Fagundes, an assistant psychology professor at Rice University and a co-author of the study. “Physicians should pay close to attention to their patients. There are likely biological mechanisms underlying why they feel their health is poor.”

The Doctor-Patient Relationship Is Alive and Well

It’s 2:20 p.m. and Ms. M. is precisely on time for her appointment. She’s brought her hand-printed list of questions, her sack of medications that need renewal, her mordant observations about her newest home attendant, and a box of chocolates that she will press upon me no matter how hard I protest. At 89, her medical conditions don’t have easy cures and the setbacks from aging are often implacable. Yet we always manage to find something optimistic to work on, even if modest in scope.

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Danielle Ofri, M.D.

Danielle Ofri, M.D.Credit Joon Park

Ms. M. requires the assistance of her daughter to make the hour-plus trip by public transportation. Over the 10 years we’ve worked together, I’ve periodically suggested she might consider a clinic closer to home to avoid the arduous travel. She sniffs sharply at the affront and then barrels into the meat of our visit.

It’s been a rocky decade for medicine — the Affordable Care Act, the migration to electronic medical records, record-breaking medication prices, and the shift from traditional doctor-run practices to mammoth corporate-run organizations have left us all reeling. Physician anger at overwhelming administrative demands and patient frustration at the impossibility of navigating the system have frayed the fortitude of everyone.

Medicine is unquestionably harder than it was 10 years ago. Many more doctors I know talk about quitting (an option that is not equally available to patients). However, there’s been no mass exodus of doctors. We doctors grumble loudly — often with good cause — but we aren’t quitting in droves, mainly because of patients like Ms. M.

A new study by the Physicians Foundation of more than 1,500 patients found that more than 90 percent of patients were satisfied with their relationship with their primary care doctor. They felt that their doctors were respectful of them, listened well, explained well, and had a good understanding of their medical history.

On the surface, this seems to contradict the dyspeptic view of medicine we hear about in the media. But it actually reflects the larger truth that most patient rancor is directed not toward the doctor but to the bureaucratic aspects of medicine — the cost, the hassle, the opaqueness. On the whole, patients are happy with the medical care they receive from their primary care doctors — once they’ve slogged through the seven circles of pre-authorization purgatory to get there.

The same is true for doctors. What doctors hate most is everything that surrounds medicine, but not medicine itself. Peel away the administrative migraines and most doctors relish the practice of medicine.

It’s heartening to see that the doctor-patient relationship is surviving this latest round of upheaval. For primary care doctors in particular, whose daily work life has been pummeled with exceptional relentlessness, this latest survey is immensely validating.

So maybe it’s not surprising that it can feel as if morale is both exceptionally high and exceptionally low at the same time. Just this month, a new set of requirements was piled on to our clinic’s electronic medical record system, and a dreary sigh of resignation echoed from one doctor to the next. With all the computerized busywork that a medical visit requires these days, there’s hardly time to call in our patients from the waiting room.

On the other hand, when we welcome our new students and interns — July is the starting month of the medical calendar — the enthusiasm for primary care is fervent. We all have patients, like Ms. M., who bring joy and fulfillment no matter how much inanity we have to lumber though in the electronic medical records system.

Nothing comes close to the experience of making another human being feel better, even a tiny bit. After months of trial and error, Ms. M. and I finally worked out a schedule of her diuretic pill such that she could go for a midday stroll without having to scramble for a nonexistent public bathroom. This isn’t the sort of high-tech medical wizardry that grabs headlines or stock prices, but it allows a formerly housebound patient to now keep tabs on her Brooklyn neighborhood.

The awe of discovering the human body, the honor of being trusted to give advice, the gratification of helping someone through a difficult illness, the intellectual stimulation of continually learning — these things never grow old.

And word seems to be getting out — applications to medical school are at an all-time high, and new medical schools are opening to meet the demand. (By comparison, law school applications continue to decline and business school applications remain flat.)

When I close the door to the exam room and it’s just the patient and me, with all the bureaucracy safely barricaded outside, the power of human connection becomes palpable. I can’t always solve my patients’ issues, but the opportunity to try cannot be underestimated.

We doctors shouldn’t be afraid to speak up about what’s wrong with medicine — and there is plenty that is wrong. But we also shouldn’t be afraid to speak up about what’s right. While the logistics of practicing medicine may feel like an ever-tightening thumbscrew, the doctor-patient relationship is alive and well, and the prognosis is excellent.

Danielle Ofri’s newest book is “What Doctors Feel: How Emotions Affect the Practice of Medicine.” She is a physician at Bellevue Hospital and an associate professor of medicine at N.Y.U. School of Medicine, as well as editor in chief of the Bellevue Literary Review. She spoke on Deconstructing Perfection at TEDMED.

Think Like a Doctor: A Cough That Won’t Stop

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Credit Andreas Samuelsson

The Challenge: A 43-year-old man starts to cough every time he takes a deep breath. Can you help him figure out why?

Every month, the Diagnosis column of The New York Times Magazine asks Well readers to try their hand at solving a medical mystery. Below you will find the story of a healthy middle-aged man who starts coughing and just can’t stop. He can’t exercise. He can’t laugh. Sometimes he can’t even talk without interrupting himself with deep, awful-sounding hacks.

Below I provide much of the information available to the doctors who examined him. It took 18 months before a doctor figured out what was wrong. Can you do it any faster? The first reader to offer the correct diagnosis will receive a signed copy of my book, “Every Patient Tells a Story,” and the satisfaction of solving a real-life case.

An Emergency 18 Months in the Making

“You should probably have that checked out in the E.R.,” the nurse suggested to the middle-aged man on the other end of the phone. “And sooner rather than later.” In the next few days? he asked. In the next few hours, the nurse replied.

The 43-year-old man hung up the phone more surprised than worried. He had been dealing with an annoying and persistent cough for a year and a half and none of the doctors or nurses he’d seen in that time seemed to think it was a big deal. Until now – since he started coughing up blood.

He called his wife to tell her what the nurse suggested. After work he was going to drive himself to the emergency room at the veterans’ hospital in downtown Denver. He could hear the relief in her voice when she asked if he wanted her to come with him. No, she had enough on her hands looking after their four children. He’d let her know what they said.

An Abnormal X-ray

In the E.R., the man’s complaint got him seen right away. His chest X-ray was normal, they told him. (The X-ray is shown here)

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Credit

But when they came back into his cubby wearing masks over their noses and mouths he suspected that the CT scan was not. The scan had shown some kind of hole in his lungs, the E.R. doctor told him. That’s why he was coughing up blood. One of the diseases that can cause those kinds of cavities was tuberculosis. Had he ever been exposed to TB? Not that he knew of. (The CT scan images are shown here.)

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Credit

Because TB was such a dangerous disease – and extremely contagious — they would have to find out if he had it. If he did, he would certainly need to be treated. And to make sure he didn’t infect anyone while he was being tested, he needed to be in a specialized room – a room where the air he breathed wouldn’t be breathed by anyone else. None of the hospital’s negative pressure rooms were available so they were going to transfer him to Presbyterian/St. Luke’s Medical Center, the big regional hospital just a couple of miles away. They had an available room and would be able to care for him.

You can read the patient’s history and physical from the E.R. here:

Admission Notes

The patient’s notes from the hospital.

The Patient’s Long Story

Dr. Karen Schmitz was the second-year resident assigned to care for the new guy sent over to be tested for TB. She could see the patient sitting up in bed talking on the phone as she secured the mask over her nose and mouth and entered the double-door room that would prevent any air-borne infectives from spreading. As she entered, the patient looked at her, smiled a warm smile, and held up a finger as if to say, “I’ll be with you in a minute.” As he finished up his phone call, the doctor looked at him carefully. He was a robust guy – youthful and healthy looking. He certainly didn’t look like any of the people she’d cared for with active TB. When he hung up, he apologized and the doctor introduced herself. She pulled up a chair and settled in. She knew from what she’d read in the chart that it was going to be a long story.

The bloody cough was pretty new, he told her. It started two weeks earlier. But the cough itself had been around for 18 months. He’d caught it a couple of summers ago, and it just never went away. At first he thought it was bronchitis – he’d had that a lot when he was a kid — but when it lasted for more than a couple of weeks, he went to see his primary care doctor. He’d never had a fever or any other sign of being sick. He had some runny nose and itchy eye symptoms that started weeks before the cough and so he and his doctors thought it was allergies. Or asthma. His doctor prescribed an antihistamine and later an inhaler. They fixed his runny nose, and eased up the chest tightness, but the hacking never slowed down.

He went to an ear, nose and throat specialist who scoped his nose and throat. Completely normal. He had a chest X-ray – also normal.

He saw a pulmonologist who, hearing that he had a little heartburn, started him on a powerful antacid medication. That pill completely fixed the heartburn but didn’t touch the cough.

That first year he’d seen three doctors in a half-dozen appointments, and had a scope, a chest X-ray and a slew of blood tests and still no one could tell him why he was coughing or how to make it stop. So he figured he’d just have to learn to live with it.

Not that he wanted that. Every time he took a deep breath he would cough. In the middle of telling a good story he’d have to stop to cough. Whenever he laughed, he coughed. Dozens of times a day, he coughed. He even had to give up exercising. Any time he exerted himself, even just a little, the cough would kick in with a shocking fierceness. Recently he’d tried riding his bike and just 15 minutes in he had to stop. Even though he was taking it easy, as soon as he started to breathe just a little harder than usual, he nearly keeled over. He had to get off his bike. He was doubled over with the ferocious hacking. Sweat and tears poured down his cheeks. He could hear the rasping sound of his breath between the deep jagged coughs. He wondered if he could even make it home. That was the last time he tried to exert himself. And that had been weeks earlier.

You can see the pulmonologist’s notes here:

Pulmonary Consult Note

The notes from the lung specialist.

The Doctor’s Visit

But eventually, he started to cough up blood. That happened the morning after he’d had another terrible blast of coughing. He’d gone with his wife and four children to Vail for Thanksgiving. As he was packing the car to come home he started coughing and felt as if it would never stop, as if he’d never be able to breathe again. But he recovered, until the next morning when he started to cough up blood. It scared him. And terrified his wife. When it didn’t get better after a couple of weeks, he’d decided to call the hospital, and the nurse on the phone sent him to the E.R.

Now, talking to Dr. Schmitz, he told her he never smoked and rarely drank. And even though it was legal, he never smoked pot either. He had been an officer in the Air Force and now was a real estate agent. He had spent a few months in Kuwait and another few in Saudi Arabia, but that was in the 1990s. He’d traveled a bit – mostly out west, but nothing recent. He took medicine for high cholesterol, the antihistamine and the antacid medicine, but that was it. His exam was unremarkable. Dr. Schmitz listened hard through her stethoscope as she placed it on his chest where she knew the hole in his lung was, but heard nothing abnormal.

She didn’t start him on antibiotics, because she didn’t yet know what she was treating, she told him. Tuberculosis seemed unlikely so she was going to test him for other infections as well. To make sure the team didn’t miss anything, they consulted an infectious diseases specialist and a pulmonologist.

You can see their notes here.

Infectious Disease Consult

Notes from the infectious disease specialist.

Dr. Schmitz checked on her patient throughout the day. He was always on the phone, his computer open, hard at work. So far they were doing nothing for the guy – just watching and waiting for answers. When the TB test came back negative, Dr. Schmitz thought he might very well be the healthiest patient in the entire hospital. Was she right? The patient got his diagnosis the very next day.

Solve the Mystery

What do you think is making this patient cough?

Post your answers in the comment section. I’ll tell you the answer tomorrow.

At the End of Life, What Would Doctors Do?

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Credit Stuart Bradford

Americans have long been chided as the only people on earth who believe death is optional. But the quip is losing its premise. A recent profusion of personal narratives, best-selling books and social entrepreneurs’ projects suggest that, as a culture, we are finally starting to come to terms with our mortality. Nationally, the Conversation Project is engaging people to discuss their wishes for end-of-life care. Death Cafes and Death Over Dinner events are popping up across the country, reflecting an appetite for exploring these matters. So too, the Dinner Party and the Kitchen Widow are using meals as a communal space to explore life after loss.

Admittedly, contemplating mortality is not (yet) a national strong suit. That’s why these cultural stirrings are so significant. At a minimum, our heightened awareness and willingness to talk about illness, dying, caregiving and grieving will lead to much better end-of-life care. However, the impact on American culture needn’t stop there. Like individuals who grow wiser with age, collectively, in turning toward death, we stand to learn a lot about living.

Doctors can be valuable guides in this process. In matters of illness, people are fascinated by the question, what would doctors do? Consider the social phenomenon of Dr. Ken Murray’s online essay, “How Doctors Die.” Dr. Murray wrote that doctors he knew tended to die differently than most people, often eschewing the same late-stage treatments they prescribed for patients. The article went viral, being read by millions, and reprinted in multiple languages in magazines, newspapers and websites across the globe.

Dr. Murray’s observation even engendered studies of doctors’ preferences for care near the end of life. So far, results are mixed. In a Stanford study, 88 percent of responding physicians said they would avoid invasive procedures and life-prolonging machines. But a newly released comparative study of Medicare recipients, as well as a longitudinal study and separate analysis of Medicare data published in January, suggest that the actual differences between end-of-life treatments that doctors and nondoctors receive are slight. Perhaps like nearly everyone else, when life is fleeting, physicians find it difficult to follow their previous wishes to avoid aggressive life-prolonging treatments.

For what it’s worth, the terminally ill colleagues I’ve known, including those I’ve been privileged to care for, have usually been willing to use medical treatments aplenty as long as life was worth living, and took great pains to avoid medicalizing their waning days. In any event, the public’s interest in the medical treatments that doctors choose must not be allowed to reinforce our culture’s tendency to see dying solely through medical lenses. More to the point is the question, how do dying doctors live?

What dying doctors do with their time and limited energy, and what they say, are deeply personal, sometimes raw and often tender. Like everyone else, doctors experience pain and suffering – yet many speak of a deepening moment-to-moment sense of life and connection to the people who matter most.

Listen to a few.

Dr. Jane Poulson lost her sight to diabetes while still in medical school. After years of successful internal medicine practice, Dr. Poulson developed inflammatory breast cancer and knew it would claim her life. Writing in the Canadian Medical Journal she said:

In a paradoxical way, I think I can say that I feel more alive now than ever before in my life … When you presume to have infinity before you the value of each person, each relationship, all knowledge you possess is diluted.

I have found my Holy Grail: it is surrounding myself with my dear friends and family and enjoying sharing my fragile and precious time with them as I have never done before. I wonder wistfully why it took a disaster of such proportions before I could see so clearly what was truly important and uniquely mine.

About a year after being given a diagnosis of incurable esophageal cancer, Dr. Bill Bartholome, a pediatrician and ethicist at the University of Kansas, wrote:

I like the person I am now more than I have ever liked myself before. There is a kind of spontaneity and joyfulness in my life that I had rarely known before. I am free of the tyranny of all the things that need to get done. I realize now more than ever before that I exist in a ‘web’ of relationships that support and nourish me, that clinging to each other here ‘against the dark beyond’ is what makes us human … I have come to know more about what it means to receive and give love unconditionally.

Dr. Bartholome referred to this period before his death as “a gift.”

It has given me the opportunity of tying up the ‘loose ends’ that all our lives have. I have been provided the opportunity of reconnecting with those who have taught me, who have shared their lives with me, who have ‘touched’ my life. I have been able … to apologize for past wrongs, to seek forgiveness for past failings.

A healthy defiance is often palpable within the personal decisions of doctors who are living in the growing shadow of death. My friends Herbert Mauer and Lisa Mills, long-married oncologists, boldly renewed their vows before a crowd of family and friends during the months Herb was dying of cancer. In “When Breath Becomes Air,” the neurosurgeon Dr. Paul Kalanithi relates the decision he and his wife, the internist Dr. Lucy Kalanithi, made to have a child, while knowing full well that he was unlikely to see their daughter grow up. Such affirmations of couplehood in the face of death are not denial; but rather insubordination, eyes-wide-open commitments to living fully despite the force majeure.

Gratitude also commonly emerges in the experiences of dying clinicians. In one of our last email exchanges, my friend, the clinical psychologist Peter Rodis, wrote:

The shock of knowing I’ll die has passed. And the sorrow of it comes only at moments. Mostly, deep underneath, there is quiet, joyous anticipation and curiosity; gratitude for the days that remain; love all around. I am fortunate.

The neurologist Dr. Oliver Sacks concluded his essay “My Own Life” in exaltation.

Above all, I have been a sentient being, a thinking animal, on this beautiful planet, and that in itself has been an enormous privilege and adventure.

These experiences are like dabs of paint on an Impressionist’s canvas. Taking in this contemporary ars morendi we can appreciate how dying and well-being can coexist. For all the sadness and suffering that dying entails, our human potential for love, gratitude and joy persists.

How fitting would it be for a corrective to the medicalization of dying to come from the medical profession itself? The general public’s interest in what doctors do can teach all of us about living fully for whatever time we each have.

Ira Byock, a palliative care physician, is founder and chief medical officer of the Providence Institute for Human Caring in Torrance, Calif. His books include “Dying Well” and “The Best Care Possible.”

When Doctors Have Conflicts of Interest

My mother-in-law is an impressive woman.

At the age of 77, she still maintains a garden the size of my entire backyard, on the three acres of land she and my father-in-law, now 81, share in rural western Pennsylvania.

She does not tolerate stasis, and anytime my father-in-law collapses into his plaid armchair in front of the television, she appears on the scene within a minute or two, barks at him that there will be plenty of time to rest when they’re in the old age home, grabs the remote control, and turns the television off while simultaneously giving him another task to perform.

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Mikkael Sekeres, M.D.

Mikkael Sekeres, M.D.Credit

She has kept old age at bay through constant activity, sheer strength of will, and a splash of denial.

Her hip must have been bothering her for some time, then, before she let me and my wife in on her problem. At our insistence, she told one of her doctors, who sent her for X-rays and reviewed them with her, in his office, with my wife at her side.

“Ouch,” her doctor said, pointing at the image of her hip where her femur was scraping against the acetabulum of her pelvis, bone-on-bone. “That looks like it hurts.”

“Well, I do a few chores around the house in the morning and rest on the couch with a heating pad, and then I’m all right,” she told him.

My wife interjected. “Just so you understand, by ‘a few chores,’ she means that she plants five flats of flowers.”

Her doctor’s eyes widened. Recognizing that she is the type of person who would have to decide for herself when she was ready for surgery, he recommended she let the rest of us know when that time occurred. Earlier this summer, she decided it was time.

She met with the orthopedist who would perform her surgery, and the two quickly bonded. As it turned out, his wife is also a gardener, and like my father-in-law, he collects classic cars. He discussed the surgery he intended to perform, her likely recovery period, and then paused.

“Now, I have to tell you that the artificial hip I’m going to use is one that I had a hand in inventing, and although I will receive no royalties for implanting this hip in you, I do have a conflict of interest, and want to make sure you’re O.K. with that.”

I sit on our institution’s conflict of interest committee and this scenario, while not falling into the majority of doctor-patient interactions, is becoming increasingly common.

There are a number of different types of potential conflicts that can arise.

Like my mother-in-law’s surgeon, a doctor may invent a technology, or develop a drug, and receive payments every time that technology or drug is used – though, as my mother-in-law’s doctor told her, no royalties are received if the device is used at our institution. Still, you might wonder if his using that artificial hip influences other doctors who want to emulate him to use the same device, from which he would receive royalties.

Or, a doctor may provide advice to a company, for which she receives an honorarium, and conducts research (such as being an investigator on a clinical trial) using that company’s product. Will the payment she received influence her interpretation of the clinical trial results, in favor of the investigational drug? Or did she make the trial better because of the advice she provided?

What if, instead, the drug for which she provided advice is already commercially available. How much is her likelihood of prescribing this medication – what we call a conflict of commitment – influenced by her having been given an honorarium by the manufacturer for her advice about this or another drug made by the same company?

We know already that doctors are influenced in their prescribing patterns even by tchotchkes like pens or free lunches. One recent study of almost 280,000 physicians who received over 63,000 payments, most of which were in the form of free meals worth under $20, showed that these doctors were more likely to prescribe the blood pressure, cholesterol or antidepressant medication promoted as part of that meal than other medications in the same class of drugs. Are these incentives really enough to encroach on our sworn obligation to do what’s best for our patients, irrespective of outside influences? Perhaps, and that’s the reason many hospitals ban them.

In both scenarios the doctor should, at the very least, have to disclose the conflict to patients, either on a website, where patients could easily view it, or by informing them directly, as my mother-in-law’s doctor did to her.

More importantly, what do patients think of these conflicts? Back in the comfort of our family room, following her appointment, I asked my mother-in-law that very question.

“Oh, I was glad he told me.” I prodded her to go on, as she shifted in her chair, trying to get comfortable. “It made me trust him more. He must be an expert if he helped invent the hip. And of course I want him using the one he invented, he knows it better than anyone!”

It turns out, she’s not alone. In a study of over 600 surgical patients, about 80 percent felt it was both ethical and either did not influence, or actually benefited their health care, if their surgeons were consultants for surgical device companies.

It’s complicated. Certainly, the relationships doctors have with drug or device manufacturers drive innovation, and help make those products better for patients. But can we ever be sure these relationships aren’t influencing the purity of our practice of medicine, even a little?

Dr. Mikkael Sekeres is director of the leukemia program at the Cleveland Clinic. Follow him on Twitter @MikkaelSekeres.

Pelvic Exams May Not Prolong Life, a Task Force Says

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Credit Stuart Bradford

Many women dread the indignity of the annual pelvic exam, in which they are poked and prodded with their feet in stirrups.

Now an influential government task force says there isn’t evidence that routine pelvic exams are necessary or prolong a woman’s life. Some experts think they may even do more harm than good.

And although some 60 million pelvic exams are done each year, the practice hasn’t been studied much. The United States Preventive Services Task Force, a panel of experts in preventative and primary care, declared today that the current evidence is “insufficient” to assess the balance of benefits and harms of the pelvic exam. The task force performed an exhaustive search of the medical literature published over the past 60 years and located only eight studies looking at the diagnostic accuracy of pelvic exams for just four medical conditions.

“We can’t make a recommendation one way or the other at this time,” said Dr. Maureen Phipps, the chairwoman of obstetrics and gynecology at Brown University’s Warren Alpert Medical School and a member of the task force. “We need more evidence.”

The finding refers only to the practice of routine pelvic exams for healthy women, and does not apply to women who are pregnant or those with existing conditions or symptoms that need to be evaluated.

“This is not a recommendation against doing the exam,” Dr. Phipps emphasized. “This is a recommendation to call for more research to figure out the benefits and harms associated with screening pelvic exams. That’s the big message here.”

This is the first time the Preventive Services Task Force has turned its attention to pelvic examinations, which can include a visual exam of external genitalia, an internal exam using a speculum, manual palpation to check the shape and size of the uterus, ovaries and fallopian tubes, and the simultaneous palpation of the rectum and vagina using lubricated gloves.

The recommendations about pelvic exams do not change current guidelines for cervical cancer screening, in which cells are collected from the surface of the cervix and vagina. The screening test is recommended every three years for women ages 21 to 29 and every five years for ages 30 to 65.

Pelvic exams have been subjected to quite a bit of scrutiny in recent years, possibly because of turf battles between physicians and reimbursement battles with insurers. The exams can be both time-consuming and expensive, in part because doctors are advised to have a chaperone present during the exam.

In 2014, the American College of Physicians told doctors to stop performing routine pelvic exams as part of a physical, saying there is no evidence they are useful and much evidence to suggest they can provoke fear, anxiety and pain in women, especially those who have suffered sexual abuse or other trauma.

The American Academy of Family Physicians endorsed that recommendation. But the American College of Obstetricians and Gynecologists (ACOG) continues to recommend an annual pelvic examination for women 21 and older, while acknowledging a dearth of data. Its Well-Woman Task Force, which was convened in 2015, recommended annual external exams but said internal speculum and bimanual exams for women without specific complaints or symptoms should be “a shared, informed decision between the patient and provider.”

“No woman should ever be coerced into having an exam, and that discussion should take place in a nonexam room environment, while the woman is fully dressed and sitting at equal level with the provider at a round table, without a desk between them,” said Dr. Barbara S. Levy, vice president for health policy at ACOG.

But Dr. Levy says that the exams should not be scrapped because trials – which would be difficult to design and fund — have not been carried out.

“I think there’s tremendous value in the laying on of hands,” Dr. Levy said. “Touch has a lot to do with establishing trust, and there are many things I can pick up on during a pelvic exam because I’m skilled and trained.”

She may pick up on the fact that a woman is experiencing abuse or domestic violence, or discover that a woman may benefit from interventions to strengthen muscles to prevent urinary incontinence down the line, she said, adding, “This is the art of medicine.”

Most obstetrician-gynecologists do routine pelvic exams, as do many other physicians, and the majority of preventive care visits between 2008 and 2010 included one, according to the task force’s report.

Health care providers say they can pick up on myriad gynecologic conditions during a pelvic exam, including cancers of the cervix, vagina, vulva, ovaries and endometrium, sexually transmitted diseases, genital warts and genital herpes, uterine fibroids, ovarian cysts and more.

But the task force found no studies that assessed how effective the exams are for reducing death and disease. So for example, although a pelvic exam might be useful in detecting ovarian cancer, the disease is relatively rare, so exams often result in false-positives that can lead to unnecessary surgery, the report said.

In four ovarian cancer screening studies with over 26,000 screened patients, more than 96 percent of the positive test results were false positives, meaning there was no real disease and many patients had unnecessary follow-up procedures.

But Dr. Levy said the call for more research is impractical. Exams are part of preventive care that is tricky to evaluate or assess, she said, and such studies are unlikely to get funded. “Looking for evidence-based answers to centuries-old processes and procedures doesn’t always make sense,” she said.

Reading Novels at Medical School

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Credit Getty Images

Sitting in a classroom at Georgetown Medical School usually reserved for committee meetings, we begin by reading an Emily Dickinson poem about the isolating power of sadness:

I measure every Grief I meet
With narrow, probing, eyes –
I wonder if It weighs like Mine –
Or has an Easier size.

It’s a strange sight: me, a surgical resident, reading poetry to 30 medical students late on a Tuesday night. Some of us are in scrubs, others in jeans; there are no white coats. Over the past four years, as the leader of the group, this has become my routine.

The students are here after long days in class and on the wards because they have discovered that medical education is changing them in ways that are unsettling. I remember that uneasiness well. My own medical education began with anatomy lab. The first day with the cadaver was unnerving, but after the first week the radio was blaring as we methodically dissected the anonymous body before us.

Two years later, on my first clinical rotation, I discovered that it does not take long to acclimate to the cries of patients as I hurried past their rooms, eager not to fall behind in a setting where work must be done quickly and efficiently. This practiced detachment feels necessary, a form of emotional and physical self-preservation. But with little time to slow down, ignoring our own thoughts and feelings quickly hardens into a habit.

During my first year in medical school, I found myself gravitating toward my old comfort zone — literature. As an English major, I had grown accustomed to the company of books and was feeling their absence now that “Don Quixote” had been displaced by Netter’s “Atlas of Human Anatomy.” I could look to Netter for concrete answers, but I needed Cervantes to help me formulate questions I had trouble pinning down, like why it was so easy to ignore the dead (and later, living) bodies around me? Illustrated cross-sections of the brain did little to illuminate the workings of my own mind. I needed time and space for introspection. The solution came in the form of a book club that later became an official course.

At Georgetown, the goal of our new literature and medicine track is to foster habits of reflection over four years of medical school. On the surface, the assigned books have nothing to do with medicine. We read no patient narratives, doctors’ memoirs or stories about disease.

Today’s topic is Haruki Murakami’s novel “Colorless Tsukuru Tazaki and His Years of Pilgrimage,” which tells the story of a depressed middle-aged Tokyoite’s attempt to retrace his past in order to understand how his life became so empty. We talk about the main character’s colorless perception of the world, and why his mind feels so inaccessible to us.

I receive an email from a student later that evening. He, an aspiring psychiatrist, tells me the story of a much-admired college mentor. “I heard last week that he committed suicide. I am still crushed,” he writes. “He was diagnosed with depression but seemed to be doing great.” If he so misjudged his teacher’s state of mind, he worries, how will he make it as a psychiatrist?

Earlier this year, we placed the ethics of animal testing under the magnifying glass of Karen Joy Fowler’s “We Are All Completely Beside Ourselves.” The novel is narrated by a woman whose “sibling,” we later discover, is a chimpanzee who was raised with her as part of a human-chimp experiment. We used the book to think through real-life examples like the Silver Spring Monkeys — a series of gruesome primate experiments that both galvanized American animal-rights groups and led to breakthrough scientific discoveries.

A third-year student talked about the three years he spent working with rhesus macaques. Research from his lab led to breakthrough discoveries about memory and behavior and contributed to therapies such as deep brain stimulation. “Doesn’t that answer the ethical questions?” he asked.

Another student talked about studies that she worked on for several years before starting medical school. “Have you heard of professional testers?” she asked the room. “People whose only source of income is volunteering for different studies, mostly college kids and immigrants? Shouldn’t we be talking about human research also?” For me, the discussion proved transformative. I walked into that class firmly supporting animal research and walked away still supporting research but no longer eating meat.

Our busy jobs on the hospital wards require precision and efficiency, but in literature class we can slow down and explore human lives and thoughts in a different, more complex way. The class is an anatomy lab of the mind. We examine cultural conventions and conflicting perspectives, and reflect on our own preconceived notions about life and work. Reading attentively and well, we hope, will become a sustaining part of our daily lives and practice.

As I’m walking out of the classroom at the end of the evening, a third-year student approaches me to tell me he’s been thinking more deeply about his experience of being an unrelated organ donor to his step-uncle, a man he barely knew. “It’s been on my mind since we read Ishiguro’s ‘Never Let Me Go’ last month,” he says. “I want to write about it. I don’t even know how I feel about it, and I need to figure it out.”

Daniel Marchalik, M.D., is a urologist in Washington and heads the literature and medicine track at the Georgetown University School of Medicine.

Leaving the Pediatrician? Not at 26

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Lule Rault, 26, talks with her doctor, pediatrician Ramon Murphy, who she’s visited since childhood at Uptown Pediatrics in Manhattan.

Lule Rault, 26, talks with her doctor, pediatrician Ramon Murphy, who she’s visited since childhood at Uptown Pediatrics in Manhattan.Credit Yana Paskova for The New York Times

Lule Rault took a seat in the waiting room of Uptown Pediatrics on Park Avenue, across from several young mothers with babies in tow. A toddler played with the toys on the waiting-room floor.

“I felt like they might think I’m just another young mom or something,” she said, “since I am so close to their age.” But Ms. Rault, a 26-year-old medical student, was there this month for her own annual checkup. She has been a patient at Uptown Pediatrics since her own infancy. And she plans to remain so until she finishes her M.D. at Tulane University. At that point she will be 29.

She is not looking forward to the transition.

“I don’t have to leave Dr. Murphy, do I?” she said in an interview by email. “I’m only 26!” And she is not Dr. Ramon Murphy’s only patient long out of high school. “The last time I was there, he told me there was one patient older than me — a boy.”

A poll from the Pew Research Center last month found that for the first time in more than a century, young adults are more likely to live with their parents than with a partner or a spouse. So it should come as no surprise that many are perfectly happy to remain with their childhood physicians. The age at which patients leave the pediatric nest varies, depending on whether their doctors are trained to treat adolescents and young adult patients. Historically, that age has been 18 to 22. It seems to be moving up.

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Lule Rault, 26, left, emerges from an appointment at Uptown Pediatrics in Manhattan. The waiting room there caters both to young children and to patients in their twenties.

Lule Rault, 26, left, emerges from an appointment at Uptown Pediatrics in Manhattan. The waiting room there caters both to young children and to patients in their twenties.Credit Yana Paskova for The New York Times

Under the Affordable Care Act, children can remain under their parents’ insurance plan until they are 26, which since 2010 has added three million young people to the insurance rolls, according to the Department of Health and Human Services. But that doesn’t mean healthy young adults are regularly visiting any doctors.

“Young adults on the whole are not very connected to the health care system,” said Dr. Patience White, a director at the Center for Health Care Transition Improvement, a group that studies the transition from pediatric to adult health care. “They often turn to the emergency room when they get sick.”

In New York City, many pediatricians are willing to keep their older patients so that they won’t stray from the system. Dr. Murphy and other pediatricians also said many young adults have found it impossible to find an internist who will accept insurance from new patients. Some require an initial concierge fee that runs as much as $3,000; those who do take insurance often don’t have appointments available for four to six months.

“The patient, or parent, reasons that it makes more sense to just stay with the pediatrician,” Dr. Murphy said.

Furthermore, a growing number of pediatricians are trained to treat adolescents and young adults. Dr. Murphy’s practice reflects his 19 years at the Adolescent Health Center at Mount Sinai Hospital in Manhattan. It’s a different kind of rapport from the one he has with his grade-school patients.

“I ask them about friends, school, career choices,” he said. “I wasn’t cut out to wear clown noses and funny ties.”

His waiting room at Uptown Pediatrics even has two sides — one furnished with the familiar trappings of the Sesame-Street-and-K.C.- Undercover set, the other with seating and reading material for adult-size patients.

“I think it’s a New York City phenomenon,” said Dr. Ralph Lopez, whose Upper East Side practice focuses primarily on teenage boys and young men. “Your mom and dad may pick out an internist for you, but you don’t like the doctor, so you stay with someone like me.” He added, “I’m seeing two 25-year-olds later today.”

Andrew Ruvkun, 20, who runs varsity track at Carleton College in Minnesota, plans to stay with his Manhattan pediatrician, Dr. Sol Zimmerman, at least until he finishes college.

“He’s a nice guy, so for now this is it for me,” Mr. Ruvkun said. “He signs off on my N.C.A.A. forms, and he’s the only doctor I’ve ever known.”

Suzy Storr, 25, an artist who a year ago moved back to her Park Slope home after finishing her studies in England, would have liked to keep her old pediatrician, Dr. Sylvain Weinberger, but was told she had aged out of his practice.

“It was kind of sad to me,” she said. “I’d always had a fear of needles, and while I’m better about it now, he always knew how to comfort me.”

Dr. Weinberger suggests his patients find another physician when they leave for college. Up to age 19, “they can always call me,” he said.

As a practical matter, he noted, any patient 18 or older who needs to be hospitalized will go on an adult floor, where a pediatrician may not have admitting privileges.

Ms. Storr tried an internist, but she felt that she was“kind of rushed” and that the visit was about “doing a checkup and kicking you out.”

In New York City, several private practices devoted to adolescent medicine have sprung up to fill the gap for young adults whose needs have outgrown the so-called baby doctor.

“Many pediatricians are uncomfortable with talking about birth control, condom use,” said Dr. Karen Soren, director of adolescent health care at the NewYork-Presbyterian Morgan Stanley Children’s Hospital. “This is part of why adolescent medicine came into being.”

“Traditionally,” she added, “adolescent medicine was intended to deal with kids 12 to 18 years old. It became pretty clear kids didn’t suddenly change into adults at 18, so a lot of us kept them until 21 and beyond.”

Dr. Cynthia Pegler, whose private patients on the Upper East Side primarily are young women, will continue to treat patients until they are ready to be parents themselves.

“My official rule is it is really time to go when you yourself are ready to have a baby,” Dr. Pegler said.

Dr. Soren recalled one patient who returned to her adolescent clinic after a year at an adult internist.

“I tried to prepare her as best I could,” Dr. Soren said. “I printed out her vaccines, her medical records. I made an appointment for her with the new doctor. She went once, but said she went into the waiting room and there were all these ‘old people.’ A year later she came back to refill her birth control pills, so I began seeing her again.”

Dr. David Bell, medical director of the Young Men’s Clinic and the Family Planning program at NewYork-Presbyterian, said that when he started at the clinic 16 years ago, the age cutoff was 24. Now it’s 35.

“I pushed it up to 27, then 30, and now 35,” Dr. Bell said. “I’m kind of sticking to 35.”

Drug Company Lunches Have Big Payoffs

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A free lunch may be all it takes to persuade a doctor to prescribe a brand-name drug instead of a cheaper generic, a new study suggests.

Using Medicare’s Open Payments data, researchers collected information on 279,669 doctors who received 63,524 payments reported by drug companies. They concentrated on specific drugs in four categories: cholesterol lowering statins, two types of blood pressure drugs and antidepressants.

The study, in JAMA Internal Medicine, found that 95 percent of the payments were for meals sponsored by drug companies, worth about $12 to $18 each.

Doctors who were treated to a single meal, where drug companies present information about their medications, were 18 percent more likely to prescribe Crestor, a brand-name cholesterol-lowering medicine. They were 70 percent more likely to prescribe Bystolic, a brand-name beta blocker for high blood pressure, and 52 percent more likely to prescribe Benicar, also for hypertension.

The more meals doctors had, the more likely they were to prescribe the promoted drug.

The Doctor’s Ties

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Credit Getty Images

I carefully unwrapped the lilac-colored tissue paper as my patient watched, expectantly. Given its size and shape, I was pretty sure I knew what was in this package.

He was in his late 60s and had been coming to our cancer center for years – first for chemotherapy to treat his lymphoma, then for a bone marrow transplant when the chemotherapy didn’t work. Now, cured of his lymphoma, he was in our clinic for the myelodysplastic syndrome that our treatments had caused. His bruised fingers, a consequence of the low platelets resulting from his failed bone marrow, tapped his knees impatiently until I uncovered his present.

“A tie! I love it! What a beautiful pattern!” I exclaimed, holding it up against my shirt.

He beamed at me. “See? I know you, I know what you like!” he almost shouted.

“I’m touched. Thank you,” I told him. He was still grinning. He had just retired as a tailor, and this was his business – knowing men’s styles, and making them feel comfortable in their clothes. He had done well and it gave him pleasure, I suspect, to be able to help me.

Perhaps I’m in the minority of men, but I appreciate being given ties.

My kids get me ties for Father’s Day, clichéd as that may be. Their taste tends toward bright colors and animals, and I dutifully wear them to work, proudly displaying them to colleagues and patients alike, despite my wife’s entreaties to keep an extra, more subdued tie at the office that I could change into.

My dad, on the other hand, hated ties. He even declared, on the few occasions I ever actually saw him wear one, that he hoped the man who invented these objects of asphyxiation suffered mightily during his own lifetime.

Yet, when my dad died, it was his ties I turned to. After his funeral, I sat on the floor of his closet and sorted through his collection, some decades old, of varied patterns and widths, some still bearing the stains from hurried pasta dinners or cups of coffee. And during the weeks that followed, when I felt as if I roamed the earth unmoored in his absence, I wore his ties to give me strength, and bring me peace.

I still do.

My patients often comment on my ties. I have one, I think intended for a lawyer, subtly patterned with tiny wolves in sheep’s clothing. When a patient notices the gag, I joke that it’s probably not what they were hoping for in an oncologist, and they laugh, breaking the tension in the room.

Ties can be conversation starters, allowing me and my patients to talk about mundanities, before we launch into the seriousness of cancer. Most patients compliment me on my ties. A few of my patients, all older and more formal in how they approach their doctors’ appointments, come dressed to the nines to my clinic, and I make sure to compliment them, too, as they clearly value appearances. But occasionally, someone will make a comment that is vituperative. One patient blurted, as soon as I walked into the clinic room:

“Whoa, doc, that tie is awful! Did you get dressed this morning with the lights off in your bedroom?”

I didn’t get upset. I’m not exactly considered a fashion maven, and style is subjective. I also knew, as did he, that his leukemia had returned, and suspected he was taking out his anger about the return of his cancer on the fabric of my tie.

Ties in medicine can be controversial. There is even a growing movement to ban ties, as they may be vehicles for transmission of germs in their casual draping across hospital beds and exam tables as we move from one patient to the next. Many pediatricians eschew ties for this reason – as well as to prevent themselves from choking, as infants and toddlers are prone to grab them during a clinic visit. This is less likely to occur with adult patients, although it did to me recently.

I was examining a woman in her 30s with leukemia who had suffered mightily at the hands of our chemotherapy, but had emerged in a remission and was feeling better. As I stood before her and reached to feel for lymph nodes in her neck, she similarly reached up to straighten my tie and tighten the knot. Our eyes met, and we both laughed, embarrassed.

“I’m sorry,” she said. “Your tie was off to the side. I need you looking right for me.”

Many patients have expectations of how professional their doctors should appear. If a tie helps build confidence as they face the uncertainty of cancer treatment, as wearing my dad’s ties helped me build confidence as I faced life without a father, then I’m happy to wear one.

Dr. Mikkael Sekeres is director of the leukemia program at the Cleveland Clinic. Follow him on Twitter @MikkaelSekeres.

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Finding Ways to Keep Patients at Home

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Credit Getty Images

My patient was a proudly elegant woman in her 70s who lived alone. Her Parkinson’s disease had so severely restricted her ability to move that it would take her hours to get dressed in the morning. And leaving the house was virtually impossible, so she had to rely on neighbors and friends from her church community for help with shopping.

She was adamant that she wouldn’t want aggressive treatment to keep her alive. She’d been hospitalized many times, and she told me she wouldn’t want to take a hospital bed that would be better used for someone else. So she dutifully completed an advance directive that made her wishes clear. It said that she would not want to be kept alive on a breathing machine, and that she wouldn’t want cardiopulmonary resuscitation if her heart stopped. She also wouldn’t want to be fed through a tube if she was no longer able to eat. What was most important to her, though, was staying at home and avoiding a nursing home.

As a palliative care physician, I always urge my patients to complete advance directives. These are legal documents that tell doctors and family members what treatment they do and don’t want if they’re ever unable to make decisions for themselves. That’s important, because if I don’t know what my patients want, the default is to do everything to keep them alive, which typically results in unnecessary and costly treatment. Indeed, one of the most often-cited arguments for advance directives is the fact that 25 percent of Medicare spending is for people in the last year of life.

When my patient developed a cough and a fever, likely a result of pneumonia, she became too confused to make decisions for herself. Thanks to her advance directive, her family knew that she didn’t want aggressive treatment, and we knew that she wanted to stay home. So we arranged for short-term daily nursing visits and enough support so that, with additional help from her family, she was able to remain at home as she wanted.

I thought that she would get worse without aggressive treatment in the hospital, and that we would enroll her in hospice, so I was surprised when she began to improve. Soon she was able to make decisions for herself and even returned to the same level of independence that she’d had before she became sick. That’s when it became obvious to me that advance directives have their limits.

My patient lived, as many people with chronic, serious illnesses do, on a thin ledge of independence. The smallest nudge — a few missed medication doses, the loss of just a little support — left her entirely vulnerable. In my patient’s case, that nudge came two months later, when her neighbors ran into financial problems and their daughter, who had been doing the grocery shopping for my patient, had to take an after-school job. My patient valued her independence more than anything, so whenever her neighbors and her out-of-state family checked on her, or when we called her, she told us all that she was fine.

For three weeks, my patient subsisted on nothing but white rice, because that was all she had in the house. When her grand niece called us and asked us to check on her, we sent a social worker and a nurse to visit her. We found her housebound, surrounded by garbage, with no clean laundry and no toilet paper.

Despite our best efforts, we couldn’t do enough to keep her safe at home, so she went to live in a nursing home, where she spent the last two months of her life. An advance directive had helped her stay out of the hospital, as she had wanted. And perhaps it even made a bed available for someone who needed it more, as she’d hoped. But that piece of paper didn’t help her to live out her final months with the sort of comfort and dignity that she deserved.

When we talk about advance directives and reducing costly and unnecessary treatment at the end of life, we should also be talking about ways we can provide more support. We need to make sure that people like my patient have access to the kinds of care that can help them remain safely and comfortably at home.

Now when I help my patients complete an advance directive that defines the treatment they don’t want, we also discuss what support they’ll need in the future. I talk with my patients and their families about what’s going to be necessary to keep them safe and comfortable in their homes today, and next month and — if they’re lucky — for the next few years.

Those sorts of discussions are essential, but they’re not enough. We also need to revise the way we think about advance directives. Advance directives help reduce health care costs at the end of life by avoiding aggressive treatment, but that’s not the most compelling argument for them. It’s not enough to reduce what we spend on aggressive treatment at the end of life; we also need to spend those resources in better ways.

For someone around my patient’s age, the average cost of a hospitalization is about $13,000. So Medicare should have been willing to spend $13,000 to keep her safe and comfortable at home. That sum would have been more than enough to pay for a visiting nurse to continue to check on her after she recovered from pneumonia and a home health aide to help her with bathing and dressing. And it could have paid the girl next door to do her grocery shopping so a frail elderly woman didn’t need to subsist on white rice because it was the only food she had.

We should have been able to provide all of that help. My patient was adamant that she didn’t want to spend her last days of life in a hospital, taking up a bed that someone else could use. Let’s make sure that when people like her forgo costly treatment at the end of life, they get something in return.

Dr. David Casarett is a professor at the University of Pennsylvania Perelman School of Medicine and the author of “Stoned: A Doctor’s Case for Medical Marijuana.”

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A Doctor on Schedule, Rarely on Time

Photo

Credit James Yang

The minute I got on that bus, I knew I was in trouble. The driver sat at the stop just long enough to miss the green light. Then he inched along till he missed the next light and the one after that. He stopped at every stop even though not a soul was waiting.

The 20-minute trip to work stretched to a half-hour, then longer. I was late, late, late.

But this was a driver with a mission, clearly way ahead of schedule and trying to get back on track. He was very early; now I was very late. We were two people with competing, mutually exclusive agendas, and the one in the driver’s seat was bound to win.

A half-hour later, still sweating from racing the last five blocks on foot, with patients piling up in the waiting room, I became the one in the driver’s seat, with the mission and overriding agenda. Woe betide those with competing plans.

Just like that driver, I work under two mandates. One is professional: getting my passengers from point A to point B without breaking the law or killing anyone. The other one is less exalted but generally far more visible: I run according to a schedule that I ignore at my peril.

“She’s running late,” they mutter out in the waiting room. And indeed, she runs late for exactly the same reasons your bus runs late: too many slow-moving passengers lined up to board. Not enough buses or drivers. A person in a wheelchair requiring extra attention. Horrible traffic.

Not only does she often run late, but your poor driver — er, doctor — can run only so late before disaster ensues. She has obligations not only to you and your fellow passengers twitching in annoyance, but to a host of others, including the nursing and secretarial staffs and the cleaning crew at the end of the line. She can’t pull that bus in at midnight if everyone is supposed to leave by 7 p.m.

So when there is enough work to last till midnight, my agenda shifts, and not so subtly. Everyone can tell when I begin to speed. Every visit is pared down to the essentials. All optional and cosmetic issues are postponed, including most toenail problems and all paperwork. Chatting is minimized.

As a bus driver once said to me when I was foolish enough to start a conversation about his speed: “Lady, just get behind the white line and let me drive.”

Medicine is full of competing agendas. Even at the best of times, the match between the doctor’s and the patient’s is less than perfect, sometimes egregiously so. Some residents are now trained specifically in “agenda setting,” the art of successfully amalgamating all concerns.

But when it’s all about speed, an advanced skill set is required.

A patient has been waiting weeks for his appointment, anxiously rehearsing his lines. Bad luck that he showed up on a day I need him in and out in 19 minutes. He spends his first 18 unwisely, pretending everything is fine, making small talk, not quite mustering the courage to say what’s on his mind.

Then just as he is being ushered gently to the door, he pauses. “Oh, by the way …”

“Oh, by the way” is an infamous schedule buster. It means something bad: a suspicious lump, a sexually transmitted disease. Further, it is so common that an entire literature now addresses the “oh, by the way” phenomenon and how to tame it.

One favored tool is: “What else?” That question, asked by the doctor early in the visit, is intended to probe the patient’s agenda before it trumps the doctor’s.

As one set of researchers wrote: “The ‘what else?’ technique uncovers pertinent fears and anxieties up front and prevents an ‘oh, by the way, I have been having some chest pain’ from surfacing at the end of a visit.”

In other words: My agenda is to adopt your agenda, and then rework it so that I can drive on. Brutal, perhaps, but effective.

Very rarely do things work out for me the way they did for that driver who made me so late to work. Occasionally I have so much time that I can dawdle along the route.

I remember clearly the last time that happened. “How’s work?” I began. “What are you doing for exercise?” “Any hobbies?” “Your family, are they well?” I progressed rapidly through seatbelts, bike helmets, family medical history, end-of-life preferences — every single stop my bus typically has no time to make.

Every answer was “fine,” “yes,” or “I dunno.” Then the patient stood up: “Look, I have places to be. Are we done?”

We were two people with competing, mutually exclusive agendas. But that time the one in the driver’s seat lost.

Related:

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Think Like a Doctor: The Tired Gardener Solved!

On Thursday, we challenged Well readers to solve the case of a previously healthy 67-year-old gardener who abandoned his garden one summer, alarming his wife and adult children. For weeks this vibrant and energetic man had been the last one out of bed — something his family had never seen before. And his days were interrupted each afternoon with a fever that left him shaking and pale. More than 300 readers suggested diagnoses for this classic presentation of an unusual disease, and a couple dozen of you nailed it.

The correct diagnosis is…

Babesiosis

The first person to identify this unusual infection was Dr. Paige Szymanowski, a resident in her second year of training in internal medicine at the Beth Israel Deaconess Medical Center in Boston. She said she recognized the pattern of a fever with a low blood count, low platelet count and evidence of liver injury. Dr. Szymanowski hasn’t made up her mind what kind of doctor she’s going to be, but she is thinking of subspecializing in infectious diseases. I think she shows real promise in this area. Well done!

The Diagnosis

Babesiosis is caused by the parasite Babesia microti, a protozoa. It is usually transmitted by Ixodes scapularis, better known as the deer tick, the same small arthropod that transmits Lyme disease. Sometimes the two diseases occur together, passed on in the same bite. The disease can also be spread through blood transfusions from an infected donor.

Babesiosis is rare and occurs primarily in the Northeast and Upper Midwest — Minnesota and Wisconsin — regions of the United States. In healthy people it often causes no symptoms. However, those who are over 65 or who have some type of immune suppression – because of a chronic disease or medication – or those who don’t have a spleen are more likely to develop symptoms and can become quite ill or even die from this infection.

Easy to Miss

Babesiosis is difficult to diagnose, and the diagnosis is often overlooked, even in areas where infection is most common. Patients with babesiosis have few, if any, localizing signs to suggest the disease. Fever — which can be constant or, as was the case with this patient, intermittent — is common. So are shaking, chills, fatigue, loss of appetite, abdominal pain and headache. These symptoms, however, are seen in many infections. And indeed, our patient had all of these symptoms, but it took many weeks for him to get a diagnosis.

The diagnosis is confirmed when the ring form of the protozoa is seen on a blood smear, or when the Babesia DNA is detected in the blood. Doxycycline, which is used to treat other tick-borne diseases, is ineffective against this organism. An antimalarial medication (atovaquone) plus an antibiotic (azithromycin) are first-line treatments against this infection. Improvement is usually seen within 48 hours of starting the drugs.

Although the infection will often resolve without treatment, all who are diagnosed with the disease should be treated since, in rare cases, the bug will persist and become symptomatic if a patient later develops some immune system problem or has his spleen removed.

How the Diagnosis Was Made

Dr. Neil Gupta was leading the daytime on-call team at Saint Raphael’s hospital in New Haven, Conn., where the patient’s daughter had taken him. Dr. Gupta heard about this patient when the night team handed off the patients they had admitted on their shift and met him that morning. Seeing how well the patient looked, and hearing that he’d been given the usually benign diagnosis of hepatitis A, he turned his attention to patients who seemed sicker and more in need of thought and care. Until the patient spiked his usual afternoon fever.

One of the ways the doctor’s mind works is to put together pictures of what a disease looks like in a patient. We put these so-called illness scripts together based on our knowledge of the disease plus the patients we have seen who have had it.

When Dr. Gupta heard that the patient had spiked a temperature, he went back to see how he was doing. The patient was pleasant but didn’t say much. Perhaps there was a language barrier — he spoke with a thick Italian accent. Or perhaps he was one of those patients who just don’t focus on what ails them.

Hearing From the Patient’s Family

The patient’s wife and daughter, however, had been much more attuned to the changes in his health and behavior, and what they reported didn’t really sound like hepatitis. Was this the right diagnosis, Dr. Gupta wondered?

He sat down with the family in the nursing lounge and let them tell the whole story as they recalled it. The man had actually been sick for several weeks. He’d had a fever every day. And he was tired. Normally he never sat down, was never idle. These days it seemed he never left the house anymore. Never went into the garden. He just sat on the sofa. For hours.

Sometimes he had pain in his upper abdomen, but never any nausea; he had never vomited. But he did have a cough. This was not the man they knew, the women told him.

Reviewing the Symptoms

Dr. Gupta returned to the patient and examined him, this time quite carefully, looking for the signs common in hep A. The man’s skin was dark but not yellow; and his eyes, while appearing tired, showed no hint of yellow either. His liver was not enlarged or tender. He didn’t look to Dr. Gupta like a patient who had hepatitis A.

The patient did have tests that were positive for hepatitis A, however. Could these tests be wrong? Dr. Gupta suspected that was the case. O.K., if not hepatitis A, what did he have?

The young internist made a list of the key components of the case: He had recurring fevers every afternoon. He had a cough and some upper abdominal pain. Not very specific — except for the repeating fevers.

The labs were a little more helpful. His liver showed signs of very mild injury — again, not consistent with hepatitis A, which usually causes significant liver insult.

However, he did have a mild anemia that had gotten worse over the past three days. He’d had his blood count drawn two days earlier, when he went to the emergency room at Yale–New Haven Hospital. That showed a very mild anemia – slightly fewer red blood cells than normal. The evening before, the patient’s red blood cell count had dropped further. And today, even further. So his red blood cells were being destroyed somehow. To Dr. Gupta, that seemed to be a second important clue. In addition, his platelets were quite low.

Many Possiblities

So, the patient had cyclic fevers, a worsening anemia and a mild liver injury. That suggested a very different set of diseases.

The patient was a gardener and had been treated for Lyme disease. Could he have a different tick-borne illness?

Certainly a number of illnesses could present this way. The cyclic fevers were suggestive of malaria — rare in this country, but still worth thinking about.

Could this be mononucleosis? Or even H.I.V.? Those diseases can affect red blood cells and the liver. And they can last weeks or months. If those tests were negative, he would need to start looking for autoimmune diseases or cancers.

Finally, he would need to review the blood smear with the pathologist. Several of these diseases can provide clues when you look at the blood itself.

An Answer in the Blood

A call came to Dr. Gupta late the next day. The pathologist had tested the patient’s blood for the presence of the Babesia gene, and found it. The patient had babesiosis.

Dr. Gupta went down to look at the blood smear with the pathologist. There, in the middle of a sea of normal looking red blood cells, was a tiny pear-shaped object. It was one of the protozoa.

Dr. Gupta was excited. He pulled up a picture of the tick that spreads the disease and the tiny bug that causes it to show to the family. This was what was making the patient so very sick.

How the Patient Fared

The patient was started on the two medications to treat babesiosis the same day. Twenty-four hours later he spent his first day completely fever-free —the first in several weeks.

After a couple more days, the patient was up and walking around, asking to go home. He went home the following day, with instructions to take his two medications twice a day for a total of 10 days.

That was last summer. This summer, the patient is back in his garden. He is a little more careful to avoid getting tick bites. He wears his long pants tucked into his socks and his wife looks him over every night — just to be sure.

Think Like a Doctor: The Tired Gardener

The Challenge: Can you figure out what is wrong with a lively 67-year-old gardener who develops a daily fever and shaking chills along with chest pain and a dry cough?

Every month, the Diagnosis column of The New York Times Magazine asks Well readers to solve a real-life diagnostic mystery. Below you will find the details of a case involving a retired maker of surgical supplies who starts having daily fevers along with chills, chest pain and a dry cough.

I’ll give you the same information the doctor was given before he made this diagnosis. Will you be able to figure out what’s wrong?

As usual, the first reader to submit the correct diagnosis gets a signed copy of my book, “Every Patient Tells a Story,” and the pleasure of puzzling out a tough but fascinating case.

The Patient’s Story

“NoNo says he doesn’t feel good,” the 9-year-old girl said of her grandfather, handing her mother the thermometer. The woman dried her hands on her apron and took the device. She squinted at the little electronic numbers. Just under 102 degrees.

Her father had been sick for weeks. Feverish, weak, not eating. It was late summer and the tomatoes and eggplants in the garden were ripe, but he hadn’t even walked through his garden for days, so she knew he wasn’t feeling well. But this was the first time he’d admitted that something more serious might be going on.

It was about time. She’d taken her 67-year-old father to several doctors over the past two months. They’d looked him over and given him antibiotics, but it hadn’t helped.

“Tell NoNo that if he’s feeling sick he’s got to go to the hospital,” she told the little girl. She darted back to her grandfather’s room then quickly returned. “He says he’s ready to go.”

The woman wasn’t sure exactly when her father had started to get sick, but six or seven weeks earlier she had noticed that he was no longer the first one out of bed. Instead of being up and out before 7 a.m., he wouldn’t get up until late morning. And he started to have strange shaking chills each afternoon and evening, followed by a fever — regular as clockwork.

He looked sweaty and pale. She asked him what was wrong, but he said he was fine. Or sometimes he’d say he felt a little tired. After an hour or two the fever would pass and he’d just look tired, but the next day, or sometimes the day after, the fever would be back.

The First Diagnosis

The woman first took her father to his regular doctor. Knowing how much he loved to work in his garden, the doctor figured he probably had Lyme disease. It was summertime, and Lyme was common in the area of Connecticut where they lived. Plus, he practically took root in the half-acre garden back behind the house where he lived with his wife and their children and grandchildren.

This was the first summer the woman could remember where her father wasn’t out in his garden every single day. This year it seemed that whole weeks would go by when he did nothing but look out the window at his beautiful handiwork.

Her father took antibiotics for the presumed Lyme. It didn’t help.

A Second Diagnosis

When the patient went for a follow-up visit, he told his doctor that his stomach was bothering him a bit. So he was referred to a gastroenterologist. That doctor diagnosed Helicobacter pylori – a bacterium tough enough to survive the acid environment of the stomach that can cause pain and ulcers.

He took two weeks of treatment for that — three medications to kill the bug, and one to neutralize the acid they thrive in. That didn’t stop the daily fevers, either.

Recently the man’s wife noticed that he’d developed a dry cough. Was this a pneumonia? His doctor gave him yet another antibiotic. And he was still taking that pill when he agreed to go to the emergency room.

Pneumonia?

So three generations — wife, daughter and granddaughter — got in the car with the man they loved and drove to the hospital where the daughter worked.

The emergency room was quiet when they arrived, and after explaining that the patient had been having fevers for weeks, the patient and his entourage were taken into the back so he could be seen right away.

He did have a fever but otherwise looked pretty healthy. The doctors there seemed to focus on the cough and fever. They figured he had a pneumonia that wasn’t responding to the antibiotics he was taking. And when a chest X-ray failed to show any sign of pneumonia at all, the doctors sent him home.

You can see the note from that first visit to the Emergency Department here.

First ER Visit

If Not Pneumonia, Then What?

The next day, the man felt no better. His daughter was distressed. Her father was sick. Antibiotics weren’t working. And he was getting worse.

She called his primary care doctor again. He was also worried, he told her. But he didn’t know what to suggest.

What if she tried a different emergency room?, she suggested. They had gone to Yale-New Haven Hospital initially because that’s where she worked, but what if they went to the smaller branch of the hospital, St. Raphael’s Hospital, less than a mile away. They had different doctors there, and the hospital had a different feel — local and friendly rather than big and academic. Maybe they would find a doctor there who could help them figure out what was going wrong. It was unorthodox, the doctor told her, to shop around emergency rooms. And it wasn’t clear what another E.R. visit might do. But he was also worried about the patient, and it was certainly worth a try.

Another E.R. Visit

So early that evening they all got back into the car and drove to the St. Raphael campus. The E.R. was bustling when the family came in. Once again he had a fever – 101.6 degrees. His family explained how sick he’d been, how tired. And yet when the doctor examined him, he seemed well enough. He couldn’t find anything abnormal beyond the fever.

The labs told a slightly different story. His red blood cell count was low. So were his platelets – a type of blood cell that helps blood to clot. What was particularly strange was that these two findings had been checked the day before at the other E.R. and had been fine. And there was some evidence that he had some liver damage.

And when tested for viral hepatitis — a common causes of abnormal liver tests — he tested positive for hepatitis A and possibly hepatitis B as well.

He was admitted to St. Raphael’s Hospital because of his worsening anemia and viral hepatitis.

You can see the note from this second emergency room visit, and the admission note from the night team here.

The Second ER Note

Admission Note

Fitting the Pattern

The next morning, Dr. Neil Gupta saw the patient. Hearing the patient’s story, and the diagnosis of hepatitis A infection, was a little puzzling. Patients with hepatitis usually have mild flu-like symptoms, with a loss of appetite, nausea and vomiting, plus fatigue, low-grade fever and a generalized sense of being unwell. Certainly this patient didn’t feel well, but he had no nausea, no vomiting. And his fever came in spikes. The pattern didn’t really match.

Dr. Gupta sat down with the patient’s family and reviewed all the symptoms and the timeline. Then he reviewed all the labs. He sent off a bunch of tests.

You can see Dr. Gupta’s note here.

The Doctor’s Note

Solving the Mystery

Dr. Gupta was finally able to figure out what was wrong with this man. Can you?

The first person to figure out what is really going on with this 67-year-old gardener gets a copy of my book and that lovely sense of satisfaction that comes from making a tough diagnosis.

Rules and Regulations: Post your questions and diagnosis in the comments section below. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.

How Much Do You Want to Know About Your Cancer?

Photo

Credit Stuart Bradford

Your appointment is at 2:00 on a Tuesday afternoon. It’s your first visit to the cancer center. You’re probably wondering what we are going to say to you. A tumor was recently detected in your left lung and has spread to your bones and liver. A biopsy was performed.

We’re meeting you for the first time, soon after your primary care doctor, or surgeon, has sat down with you, or called, to tell you some terrible news: You have cancer.

We are the oncologists, and we want to help. We want to discuss your diagnosis, what it means and what the options are for treatment. We’d like to give you a clear map of what your life might look like over the next few months as we fight along with you to minimize the amount of this awfulness, even if temporarily, from your body. We want to answer all of your questions.

But one of the biggest problems we face is that we often can’t figure out what our patients would like to know about their prognosis.

Even when we ask.

Spoiler alert: Despite all the exciting stories about progress against cancer that you’ve heard about in the news, there is no cure for most types of cancer once they have spread to other organs. On average, people with lung cancer like yours that has metastasized live another 18 months.

How much of this do you want to know?

It’s a lot to take in. Two months ago you felt fine, and now you have a life expectancy of one to two years. It’s probably the worst news you’ve ever been told. Next year is your 20th wedding anniversary, and your two teenage children don’t even know yet that you are sick. So in many ways, our lament is completely unfair – it’s on us to determine the right time to discuss prognosis.

What can we do to help?

We have all the facts at our fingertips: average survival; likelihood of being alive in five or 10 years; likelihood that chemotherapy will work; and even how long it might work. We will try to put the information in context, adjusting it for your particular situation, and be sure to emphasize that the data were developed in a specific population of patients and may not apply to you as an individual.

Oh, did you not want to hear numbers?

We can roll with that.

We can speak in generalities. We can use phrases such as “likely to be effective” or “most of the time.” We can say, “some people” or “live for years.” Or months.

If that’s what you’d like. But what we don’t want is to be one of “those” doctors.

You know what we mean. The doctors who never talk to their patients about likely outcomes, or life expectancy, and who don’t prepare them for the inevitable. One of us conducted a study in 348 patients with bone marrow cancers in which 35 percent of those patients reported never having discussed prognosis with their doctors. In another study, 74 percent of a similar group of patients estimated their chance for cure to be greater than 50 percent, while their doctors estimated the chance for cure in that same set of patients to be less than 10 percent.

We will do anything to avoid your returning to us with the regret, “I didn’t have time to plan.” Or your widow writing a letter to castigate us with “You never warned me.”

We want to give you time. We want to warn you. Sometimes we advise you to talk to your children’s teachers so that they know there is a crisis at home. Or to put your affairs in order. But often, we just can’t figure out what you want to hear.

And we get it. We would be just as blown away at a cancer diagnosis, and would have just as much difficulty processing all of the information. When we look into your face and really try to connect with you, to read your emotions, we often see fear. And sadness. And regret. And disbelief. And sometimes hopelessness.

We want to give you hope.

At the very least, we don’t want to dash your hopes. We’ll focus on the positives, the best-case scenarios. We’ll tell stories about some of our superstar patients, the poster children for cancer survival, the ones who ignored the statistics and have lived to brag about it.

But we need to place that hope in the staid court of likelihoods. After all, we aren’t hucksters. This balance, between hope and honesty, remains an uneasy truce in medicine. We want you to believe us, to trust us. We recognize that, in some ways, you are placing that most precious of possessions, your own life, in our hands. And we view this as a sacred bond: We will earn your trust by always speaking the truth, though not necessarily all of it.

The inescapable fact is that a tragedy is unfolding and we’re the bearer of the news. A life will be cut down prematurely, young children will be left without one of their parents, a spouse will be left on his or her own. It’s unfair and we can’t stop it. We wish we had more to offer and believe us, the enormity of the tragedy often makes us weep. And yet, our sadness probably doesn’t help you.

So please tell us. How much would you like to know?

Dr. Mikkael Sekeres is director of the leukemia program at the Cleveland Clinic. Follow him on Twitter @MikkaelSekeres.

Dr. Timothy Gilligan is the director of coaching, Center for Excellence in Healthcare Communication, at the Cleveland Clinic.

Doctors Getting ‘Pimped’

Photo

Credit Earl Wilson/The New York Times

“Name the five brachial plexus roots,” a senior doctor commanded.

I’d spent hours memorizing the anatomy of the arm and shoulder that week. But now — in front of a small audience of patients, nurses and medical students — I squeaked out just four.

“What trunks do they give rise to?” he continued.

Oh boy. It wasn’t going to stop. Whatever the nerves’ configuration was, currently their main function was helping me knead my sweaty palms together. Mercifully, he shifted to another student to solicit what divisions the trunks split into.

My teacher was “pimping,” a core aspect of teaching on the hospital floors. The term, said to be derived from the German coinage pumpfrage, for “pump question,” refers to asking students a rapid series of questions, from thought-provoking and relevant to esoteric and unanswerable. It continues until teachers run out of questions, or doctors in training run out of answers. I’ll let you guess which usually comes first.

As a medical student, I was a frequent pimping recipient. Now, as a second-year resident, someone who both supervises and is still supervised, my relationship with it is more complicated: I find myself both dispensing and dodging questions. (When I do “pimp” others, I try to be gentle.)

Pimping has spawned many creative defense mechanisms, ranging from avoiding eye contact to pretending to choke. Some students use the “politician’s approach”: answer the question you want, not the one you’re asked. My favorite strategy is the “muffin technique,” whereby you hold a muffin close to your mouth so the questioner thinks you’re about to take a bite. If you’re pimped anyway, then, obviously, pretend to choke.

But medical training’s emphasis on demonstrating how many facts we know — typically in front of colleagues, nurses, patients and families — is problematic. It encourages us to learn to show, not grow — to project confidence, and dismiss uncertainty.

In her research on educational development, the psychologist Carol Dweck outlines two models for intellectual growth. Students who view intelligence as a fixed entity want to prove themselves and avoid looking unintelligent. Because they see intelligence as a stable trait, they avoid difficult tasks and treat failure as a threat. By contrast, students with a growth mind-set view intelligence as malleable. They’re more concerned with process than outcome and treat failure as an opportunity. Importantly, these mind-sets are not immutable. Educators can substantially influence the approach students adopt.

Consider the following example. Let’s say I leave medical school and begin my residency thinking: I’m slightly weaker in rheumatology than other specialties. I can’t remember which antibodies predict which disease. On rounds, I don’t speak up or ask clarifying questions. When accepting new patients into my clinic, I shy away from those with diseases like rheumatoid arthritis and lupus. At the end of training, I think: I’m just not that good at rheumatology.

Consider an alternative scenario. I’m subpar at inserting central lines — threading a catheter into a large neck vein. On my first few attempts, I fail. My supervisor takes over and easily passes the catheter. But I don’t fear looking incompetent or accept my lack of skill as an innate deficiency. I study anatomy. I watch videos. I ask supervisors to page me before placing lines. When E.R. doctors ask if they should place one before transferring a patient, I say I’ll do it. At the end of training, colleagues ask for my help inserting difficult central lines.

The most important medical learning comes not from memorization and recitation, but by thrusting yourself into situations just beyond your comfort zone. This controlled stretching makes us better, but is anathema in a performance mind-set. Trainees in a growth mind-set, however, gravitate toward — not away from — challenging clinical experiences.

Research suggests senior physicians’ teaching styles influence whether trainees embrace growth or performance mind-sets. Residents with supportive supervisors are more likely to seek and incorporate feedback. And our training environment affects how we practice throughout our careers.

Our approach to medical knowledge and learning has important consequences for the education of new doctors — and profound implications for patient care. We wear factual knowledge as a badge of honor. We disguise and avoid uncertainty. But if we can’t embrace uncertainty with our peers, can we do so with our patients?

Being unsure about a patient’s diagnosis or how a disease might progress is inherently uncomfortable for doctors. Studies find that patients are less satisfied when physicians communicate uncertainty, but also that how doctors communicate uncertainty matters, and that in general we’re not very good at it.

But uncertainty remains an integral part of medicine. Even the most rigorous trials rarely answer the questions most important to doctors and patients: how to weigh risks and benefits; how a patient will respond to treatment; how long he or she has to live.

Research on communicating uncertainty is fledgling, but it does suggest that, at the very least, we need to recognize it exists, clarify its sources, and acknowledge its challenges for patients and families. Research also suggests that younger physicians are less comfortable disclosing uncertainty to patients, but that our attitudes can evolve over time.

We’re educated in a model that demands certitude, confidence and rightness. But we work in a profession imbued with uncertainty. Ultimately, training doctors to grow — instead of show — may lead to more curious physicians, and more honest patient interactions.

 

Dhruv Khullar, M.D., M.P.P., is a resident physician at Massachusetts General Hospital and Harvard Medical School. Follow him on Twitter: @DhruvKhullar.

Bad News Delivered Badly

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Susan Gubar

Susan GubarCredit Vivienne Flesher

My friend Dana had become alarmed at a canker sore under her tongue: “a white patch, the size of my pinkie fingernail.” Canker might be cancer, she immediately suspected, possibly signaling a recurrence of her endometrial disease. She called an ear, nose and throat practice and made an appointment for what turned out to be a biopsy.

A week later, a nurse phoned to read the pathology report: “Superficial fragment of moderate to severe dysplastic squamous epithelium, cannot rule out invasive squamous cell carcinoma.” Although Dana urged her to define these terms or explain their significance in this particular case, the nurse resisted, stating that the doctor would explain them in a follow-up appointment the next week.

Needless to say, Dana immediately went online where the definitions did not comfort her. At bedtime, she wept herself to sleep, worrying that she would again lose 15 pounds in radiation, imagining her tongue cut out, brooding over a recurrence and her father’s earlier vocal cord cancer, grieving over putting her children and husband through yet another round of treatment. Finally at the appointed consultation, the doctor said the patch was “probably not cancer.” The pathologists were just “covering themselves” by saying they could not it rule out. She was incensed at having been put through unnecessary distress.

As any medical practitioner knows, uttering the words “severe,” “invasive” and “carcinoma” to a patient in remission cannot but escalate terror. Why couldn’t the nurse or the doctor find the ways and means immediately — in a brief phone call or email — to put those fears in perspective?

Given the paperwork, the patient load, and the long hours of medical professionals, we all understand the constraints within which physicians and nurses operate. Surely neither the nurse nor the doctor was willfully unfeeling. However, their tardy and cryptic announcements resulted in callous care. Whether a medical judgment is optimistic or pessimistic, its inept conveyance can upset or infuriate already anxious patients.

Some of the women in my support group were alone, groggy from anesthesia, and in pain when a poorly articulated diagnosis of gynecological cancer unhinged them. After a debulking operation, Julia recalls, a resident involved in the surgery stood near the door, avoided eye contact, and declared, “Stage 3 — we’re not talking cure now, we’re talking treatment.” When I heard similar words, I was in a crowded emergency room with only a privacy curtain between me and other patients.

Julia, a practicing therapist, believes that “these events are so traumatic that medical professionals need to look out for our emotional welfare . . . to reduce the possibility of PTSD. The person in a life-threatening emergency needs specialized mental health care.” Upon hearing a diagnosis of cancer, patients can plummet into the depressing supposition that their life is effectively over and their rapidly impending death will be painful.

Another very private member of our group — I will use her initials, I.M. — suffered through a delay between intimations of bad news and a diagnosis. After a CT scan, a hospital technician warned I.M. that she might have cancer, but he did not have the authority to discuss the matter with her. She would have to wait until her gynecologist could meet with her — the longest and most harrowing period in her life, she said with a shiver.

None of us were eased by communication strategies that have evolved since 2000 when Dr. Walter F. Baile and his associates published their paradigm for delivering bad news in The Oncologist. This article advocates a program called Spikes: S stands for finding the appropriate setting; P for gauging the perceptions of the patient; I for obtaining the patient’s invitation to hear bad news; K for providing the knowledge that the patient needs to receive; E for dealing with the emotional reactions of the patient with empathy; S for concluding with a needed summary.

Despite such a thoughtful template, miscommunication does not taint only diagnosis, as I.M. realized when she went on to confide about a more recent exchange. At her last meeting with her oncologist, they had discussed the sorry fact that the current cycle of chemotherapy had not inhibited tumor growth. The doctor gave her three choices: returning to the drug used in her first cycle, trying a clinical trial or “opting to do nothing.” Alarmed and shaken by this last proposal, she felt as if he were throwing up his hands or she had somehow been fired.

Because the members of our group had visited a hospice facility, we could assure her that she need never choose “opting to do nothing.” Even when patients decide that the struggle to combat cancer will be ineffective, they can gain access to palliative specialists who will alleviate pain and anxiety while rescuing them from pointlessly aggressive, time-consuming, expensive and debilitating treatments.

It cannot be easy for oncologists to deliver bad news so frequently, but it must be worse for them when they deliver bad news badly. The manners of patients erode as we become maddened by confusion and dread. Injurious words should never add insult to the injuries medical professionals witness and patients suffer daily.

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Why Does the Physical Exam Stop at the Navel?

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Credit Getty Images

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Danielle Ofri, M.D.

Danielle Ofri, M.D.Credit Joon Park

Recently a young woman came to my office. She hadn’t seen a doctor in several years and requested a checkup. The bulk of the annual physical isn’t the physical at all — it’s the talking, and we discussed diet, exercise, sleep, mood, alcohol, drugs, smoking, sunscreen, vaccinations, contraception, safe sex. In the last few minutes, however, I did turn to the physical exam.

I proceeded the way I do all my physical exams: I start with the eyes, ears and mouth and methodically work my way south — checking the lymph nodes and thyroid of the neck, listening to the heart and the lungs, percussing the abdomen, all the way down to feeling the pulses near the big toe.

Except that there’s one gaping divide in that north-south trajectory. Like most internists, when I get to the navel I skip down to the knees.

There is something faintly preposterous about doing a “complete physical” and then proceeding to hopscotch past a few key organ systems – especially for those of us in the primary care fields, who pride ourselves in taking care of the “whole patient.” We refer our female patients to the gynecologist for their regular preventive care, while our male patients might get sent to the urologist. It’s like our patients are Humpty Dumpty, and the pieces are divvied out between different medical fields.

When I started out in my medical practice, I vowed not to be the kind of doctor whose physical exam ends at the navel. Why should my patients have to see two separate doctors to get a complete exam? In my first years of practice, I did pelvic and breast exams for all of my female patients as part of their regular medical care. In the days before electronic medical records, I kept one of those heavy green laboratory notebooks in my desk to note of all the Pap tests I had done so that I could follow up with the patients when the results became available.

My patients were thrilled with this arrangement. Although I always offered a referral to gynecology, not a single one chose it. To a one, they preferred that their care be completed in one visit instead of two. I felt good too — I was offering comprehensive primary care for my patients and not overloading my swamped gynecology colleagues with these routine exams.

But while the pelvic exam doesn’t take that long, it does take time, and equipment, and a chaperone. My practice grew busier and it became harder to fit in all the moving parts. Unlike the gynecology clinic that was set up for these exams and the record-keeping, the medical clinic was not, so I was always scrambling on my own.

And after a few years, I simply could no longer manage it all. I regretfully retired my green lab book and speculums, and began referring my patients to gynecology, just like all the other internists. I was disappointed and so were my patients. We’d taken a step backward in comprehensive care.

Over the years, my guilt has been assuaged somewhat by guidelines that now recommend less frequent Pap tests and pelvic exams. Many of my patients for whom I performed an “annual Pap” no longer needed it, though I still feel a pang of guilt about shirking these parts of the body.

The young woman I was seeing that day was actually due for a Pap test — it had been more than three years since her last one. But with three more patients already checked in and waiting to be seen, I simply didn’t have the time.

I’d just read a recent study in the Annals of Family Medicine showing that comprehensive medical care is associated with lower costs and fewer hospitalizations. The study had some limitations, but it reinforced what most doctors and patients intuitively understand: fragmented care is worse for everyone and costs much more. I felt terrible that I was about to contribute to the fragmenting of care for this patient.

But our system is set up to favor fragmentation. It’s so much easier to write a referral to a gynecologist than to do a pelvic exam myself. It’s far quicker to refer to a rheumatologist than to figure out which complex tests to order, and then have to follow up on the results and figure out what they mean. It’s much simpler to refer to a neurologist than to take the time to figure out if a patient’s dizziness is serious or not.

In our current environment, being “comprehensive” just means more work for the primary care doctor. No one is allotting more time for this work or reimbursing for these extra efforts, so it’s no wonder that most patients leave their doctors’ offices with a fistful of referrals.

Regretfully I handed my patient a referral to gynecology, and I apologized for not being able to do the exam in my office. But she was entirely sanguine about it. She was used to going to separate places to care for her different organ systems, so this didn’t strike her as odd at all.

To me, that was perhaps the saddest part of all, that our patients are so accustomed to fragmented care that they no longer think of it as a problem. Fragmented care has become the norm.

There are efforts under way to change the way we deliver care, particularly with the concept of the patient-centered medical home. The goal of a medical home is that all of a patient’s medical services would be located in a single place with a coordinated team. Rather than have the patient run from one place to another, the care would come to the patient, and there are financial incentives to keep care centralized and comprehensive.

But we’re trying to build these medical homes on top of a deeply rooted and deeply fragmented infrastructure, so progress right now is measured in baby steps. We’re a long way off from putting Humpty Dumpty back together again, but I’m staying hopeful.


Danielle Ofri’s newest book is 
What Doctors Feel: How Emotions Affect the Practice of Medicine. She is a physician at Bellevue Hospital and an associate professor of medicine at N.Y.U. School of Medicine, as well as editor in chief of the Bellevue Literary Review. She spoke on Deconstructing Perfection at TEDMED.

Giving New Doctors the Tools They Need

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Credit Early Wilson

They say if all you have is a hammer, everything looks like a nail. I wonder, then, why my toolbox often seems so inadequate for fixing my patients.

I open one recent afternoon in clinic with a middle-aged man I’ve come to know well. He’s drunk. His breath smells of alcohol and he slurs his words. He tells me his brother’s in jail, his mother died, and he punched a neighbor who tried to steal his wallet. In the past year, he’s been admitted to the hospital countless times for everything from falling to getting injured in a fight to failing to take his medications.

“High risk for readmission,” an automated email plops into my inbox each time he’s admitted. Thanks, I’m on it.

I search for mental health and substance use resources we haven’t yet exhausted. I speak briefly with a psychiatrist and case manager and a social worker who is arranging transportation back to the housing he’s in danger of being thrown out of.

“Maybe we increase his mood-stabilizer?” I offer, mostly just to say something. When all you have is a hammer…

The afternoon doesn’t get easier. I see a patient whose heart failure had been in good control with a telemedicine service that had checked his weight at home and adjusted his medications accordingly. But the service has been cancelled, and now he’s in our clinic, gasping for air as fluid fills his lungs.

He’s followed by an older man who’s been on opioid painkillers for a decade — and who I now suspect is selling extra pills on the street. I’m running 45 minutes late by the time I greet an understandably frustrated woman who, a computer alert informs me, is overdue for her first colonoscopy. She balks when I bring it up, and I don’t have the words or the time to convince her otherwise.

The afternoon was not unusual. At the end of most days, I find myself searching for nails that I can hammer.

Part of the problem is the tool kit we assemble during medical training. We’re educated largely in a biomedical framework. We diagnose disease with textbook knowledge and prescribe medications because those are the hammers we have.

But consider the skills I would need to be more effective in just this one clinic session: understanding social issues that contribute to health; marshaling support resources like case management, social work and rehabilitation centers; exploring my patients’ values and goals and encouraging behavior change; leading interdisciplinary care teams; employing new technologies and methods of patient engagement like telemedicine; and appreciating how health systems fit together to influence an individual patient’s care — from home care and community centers to clinics and hospitals. None have traditionally been emphasized in medical education — and, unsurprisingly, doctors in training like myself are often ill-equipped to practice in today’s health care environment.

Medicine has long been a discipline predicated on memorization, which made sense in a world of textbooks, microscopes and information monopoly. But rooting medical training primarily in knowledge acquisition is increasingly insufficient and inefficient. In an era of big data, Google and iPhones, doctors don’t so much need to know as they need to access, synthesize and apply. We’re increasingly asked to consider not just patients, but communities. We’re expected to practice not as individuals, but as team members. And now — liberated from carrying every diagnostic and treatment detail around in our heads — we have both the responsibility and the luxury of deciding what a doctor should be in the 21st century.

Some medical educators are trying to figure it out, with a greater emphasis on new technologies, collaborative care, wellness and community health.

The new Dell Medical School at the University of Texas, Austin, which enrolls its first class in June, is hoping to revolutionize medical education. The school plans to focus on helping students understand how health systems, communities and social issues contribute to individual health through a variety of innovative methods.

Instead of traditional lecture halls, Dell’s students will learn in collaborative workspaces with a curriculum that emphasizes team-based management of patients. They’ll take weekly classes with pharmacy, nursing, social work and engineering students. Dell’s “Innovation, Leadership and Discovery” program affords students an entire year to pursue projects related to population health and delivery system redesign.

Dell also features a unique collaboration with the university’s College of Fine Arts — known as the Design Institute for Health — to bring design thinking to health care. Here students will learn to think about everything from better hospital gowns and more hospitable hospital rooms to how patients access services online and how to make waiting rooms obsolete.

“It’s an incredible gift to start from scratch,” said Dr. Clay Johnston, the school’s first dean. “We can start by looking at where the biggest gaps and problems are. Then say, O.K., given those needs, what should doctors and the medical system look like in the future?”

The health system Kaiser Permanente recently announced its own plans to open a medical school in 2019, in Pasadena, Calif. The medical school, like the health system, will emphasize integrated care, the latest medical evidence and new technologies like online doctor visits.

“We recognize the importance of providing care in alternate settings,” says Dr. Edward Ellison, who is helping to oversee the creation of the school. “We’ll take care of you when you’re sick. But we’ll also help you stay healthy when you’re home.”

While most medical schools are trying to get students out of lecture halls and into hospitals, Kaiser Permanente hopes to get students out of hospitals and into communities. Students will visit patients in their homes to see how they live and what behavior change looks like in living rooms instead of hospital rooms. They’ll also be trained as emergency medical technicians — riding in ambulances alongside other medical professionals, responding to accidents, violence and trauma in their communities.

The American Medical Association, for its part, has provided over $11 million to established medical schools to reimagine their curricula and better prepare students for a rapidly evolving health care environment.

Older physicians, medical educators, policy makers and patients will continue to debate what doctors should be taught and what they should know. But the deeper question is how doctors can learn to think — to solve problems that can’t be solved with the tools we currently have. Because ultimately, there’s no better hammer than that.

Dhruv Khullar, M.D., M.P.P. is a resident physician at Massachusetts General Hospital and Harvard Medical School. Follow him on Twitter: @DhruvKhullar.