Tagged Hospitals

Next Showdown in Congress: Protecting Workers vs. Protecting Employers in the Pandemic

Congressional leaders are squaring off over the next pandemic relief bill in a debate over whom Congress should step up to protect: front-line workers seeking more safeguards from the ravages of COVID-19 or beleaguered employers seeking relief from lawsuits.

Democrats want to enact an emergency standard meant to bolster access to protective gear for health care and other workers and to bar employers from retaliating against them for airing safety concerns.

Republicans seek immunity for employers from lawsuits related to the pandemic, an effort they say would give businesses the confidence to return to normal. The Senate is scheduled to reconvene later this month.

The debate reflects a deepening schism between the major political parties, with Democrats focused on protecting lives and Republicans focused on protecting livelihoods.

Democratic House Speaker Nancy Pelosi expressed frustration over efforts to pass an emergency worker-protection standard, which keeps running into GOP resistance.

“They’re saying ‘Let’s give immunity — no liability — for employers,’” Pelosi said. “We’re saying the best protection for the employer is to protect the workers.”

Nearly 98,000 health care workers have contracted the novel coronavirus, according to Centers for Disease Control and Prevention data that the agency acknowledges is an undercount. KHN and The Guardian have identified more than 780 who have died and have told the personal stories of 139 of them.

In May, the House passed a $3 trillion relief bill that would require the Occupational Safety and Health Administration to put in place an emergency standard that would call on employers to create a plan based, in part, on CDC or OSHA guidance to protect workers from COVID-19.

It would cover health care workers and also those “at occupational risk of exposure to COVID19.” The measure would allow workers to bring protective gear “if not provided by the employer.” Similar rules in place in California health care workers have come under fire for offering little added protection.

In action, the new measure would allow OSHA inspectors to request to review an employers’ plan and hold them accountable for following it, said David Michaels, former U.S. assistant secretary of Labor and OSHA administrator, who has called for such a standard. Federal guidance is currently optional, not required.

“Many employers want to be law-abiding,” Michaels said, “and they know they risk enforcement and possibly a monetary fine if they don’t attempt to do this.”

Top Democrats, including presumptive presidential nominee Joe Biden, have called for better worker protections, while GOP leaders have called for stronger employer protections.

Senate Majority Leader Mitch McConnell has insisted that the next pandemic relief bill include immunity for employers against coronavirus-related lawsuits.

“If we do another bill, it will have liability protections in it for doctors, for hospitals, for nurses, for businesses, for universities, for colleges,” McConnell said July 1. “Nobody knew how to deal with the coronavirus,” he said, and unless they’ve committed gross negligence or intentional harm, those parties should be protected from an “epidemic of lawsuits.”

He has proposed a five-year period of immunity from December 2019 through 2024. (McConnell’s office declined to comment for this story.)

Such a measure could derail lawsuits already filed by grieving family members such as Florence Dotson, the mother of 51-year-old certified nursing assistant Maurice Dotson, who died in April. Her son cared for nursing home residents with COVID-19 in Austin, Texas, and did not have proper personal protective equipment (PPE), her suit alleges. He later died of complications from the virus.

Another lawsuit alleges that an anonymous New York nurse requested but was denied proper PPE when she was assigned to care for a patient in intensive care with COVID-19 symptoms but who was tested for the virus only after death. The nurse, who contracted COVID-19 shortly after, is seeking $1 million in damages.

U.S. workers in every industry have filed more than 13,300 COVID-related complaints with OSHA, records show, demonstrating widespread concern over their lack of protection at work. Twenty-three complaints reference a fear of retaliation, including among hospital workers who say they were pressured to work while sick.

The agency has closed investigations into those complaints but is investigating 6,600 more open complaints. OSHA has so far issued one citation against an employer, a spokesperson confirmed.

Employers are also struggling, evidenced by layoffs and an 11% unemployment rate, which the Congressional Budget Office projects will hit 16% in the coming weeks.

States have taken some matters in their own hands during months of federal inaction. At least 25 states have created some degree of legal immunity for doctors or facilities, through new laws or executive orders, according to the National Conference of State Legislatures.

Officials in Virginia and Oregon have taken steps to enact their own heightened worker-protection rules related to the virus.

The effort to pass an OSHA rule to protect workers from infectious diseases dates to 2010, when regulators saw the need to better protect health care workers after the H1N1 flu pandemic.

Michaels, the former OSHA director under President Barack Obama, said the effort has stalled out under the Trump administration. Trump administration OSHA officials have defended their track record, saying adequate rules are in place to protect workers.

But a similar push succeeded in California in 2009. State officials passed a plan requiring health care employers to create a plan to protect health care workers from airborne viruses.

The California measure went further, requiring hospitals and nursing homes to stockpile or be prepared to supply workers with an N95 respirator — or an even more protective device — if treating patients with a virus like COVID-19.

Workplace safety experts in California, though, said it hasn’t worked as intended.

As more than 17,600 health care workers have become sick and 99 have died in the state, it’s become apparent that health care employers did not have plans in place, said Stephen Knight, executive director of Worksafe, a nonprofit focused on workplace safety.

“This was just a massive missed opportunity and one that cost people their lives,” Knight said. “People are just dying … with frightening regularity.”

California nurses who died after caring for COVID patients without an N95 respirator include Sandra Oldfield, 52, who wore a less-protective surgical mask while caring for a patient who wasn’t initially thought to have the virus.

A complaint to OSHA about a lack of N95 respirators that preceded her death put her hospital, Kaiser Permanente Fresno Medical Center, in violation of the state’s standard, the state labor department confirmed.

However, alternative guidance is now in place because of global PPE shortages, according to the California Department of Industrial Relations. Kaiser Permanente, which is not affiliated with KHN, confirmed that the patient was not initially thought to have COVID-19 and that the company has followed state, local and CDC guidance on patient screening and use of PPE.

Hospital officials, who have come out against a national OSHA standard, said the plans that were in place did not account for the scope of the current pandemic and global supply chain breakdown.

“It is not for a lack of caring or trying to keep our workers safe,” said Gail Blanchard-Saiger, vice president for labor and employment with the California Hospital Association.

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Courts COVID Public Health

Adding To COVID Stress, Families Of Health Workers Fight For Denied Workers’ Comp Benefits

James “Mike” Anderson was a hospital employee in suburban Philadelphia with a low-profile though critical job: changing air filters in COVID patients’ rooms.

By late March, new COVID cases in Bucks County, Pennsylvania, had ramped up to as many as 90 per day. At the hospital, Anderson handled air filters and other surfaces that might have been contaminated with the deadly virus, also known to hang in the air.

In early April, Anderson, 51, came down with what he thought was a cold, according to his family’s lawyer, David Stern. On April 13 Anderson was rushed to the hospital, where he died of acute respiratory distress syndrome from COVID-19, according to the county coroner. He left behind a wife and two children, ages 5 and 9.

James “Mike” Anderson, a maintenance mechanic at St. Mary’s Medical Center outside of Philadelphia, died of COVID-19 complications on April 13.(Courtesy of Stephanie Anderson)

Anderson was exposed to the virus at work, the lawyer contends, making his family eligible for workers’ compensation death benefits paid by his employer’s insurer.

“His family deserves to have that income replaced,” Stern said. “Their husband and father certainly can’t be.”

But in a June 16 response to Stern’s death benefits claim, St. Mary Medical Center denied all allegations.

As the COVID toll climbs, sick workers and families of the dead face another daunting burden: fighting for benefits from workers’ compensation systems that, in some states, are stacked against them.

In interviews with lawyers and families across the nation, KHN found that health care workers ― including nurses’ aides, physician assistants and maintenance workers ― have faced denials or long-shot odds of getting benefits paid. In some cases, those benefits amount to an ambulance bill. In others, they would provide lifetime salary replacement for a spouse.

Legal experts say that in some states COVID-19 falls into a long-standing category of diseases like a cold or the flu — conditions not covered by workers’ compensation — with no plans to change that. Other states force workers to prove they caught the virus at work, rather than from a family member or in the community.

“We are asking people to risk their lives every single day — not just doctors, nurses and first responders, but also nurses’ aides and grocery store clerks,” said Laurie Pohutsky, a Democratic Michigan lawmaker who proposed a bill to help essential workers get coverage more easily. “These people are heroes, but we have to actually back those words up with actions.”

In at least 16 states and Puerto Rico, officials have passed measures to make it easier for workers infected with the coronavirus to qualify for benefits for lost wages, hospital bills or death. Similar bills are pending in other states, but some face opposition from business groups over costs.

Many of the proposed actions would turn the tables on the status quo, forcing employers to prove workers did not catch the virus at work. Bills vary in the scope of workers they cover. Some protect all who left home to work during stay-at-home orders. Others are limited to first responders and health care workers. Some would cover only workers who get sick during states of emergency, while others would cover a longer period.

An early glimpse of data shows that health care workers and first responders, two groups hit hard by the virus, make up the majority of those seeking benefits. Data from the Centers for Disease Control and Prevention shows that more than 95,000 health care workers have been infected, a figure the agency acknowledges is an undercount. KHN and The Guardian U.S. have identified more than 700 who have died and told the story of 139 of them. For these workers’ families, the stakes of the pending laws are enormous.

In Virginia, attorney Michele Lewane is representing a nurse and a physician assistant who contracted the coronavirus while working at the same urgent care center. The physician assistant, who administered COVID tests, was hospitalized with COVID-19 and pneumonia for about a week. He missed five weeks of work.

When the physician assistant asked the urgent care center for paperwork to file a workers’ compensation claim to cover his hospital bill, an administrator refused to hand it over, saying coronavirus treatment wouldn’t be covered, Lewane said. He was laid off days later and left with a $60,000 hospital bill.

Lewane said the law in Virginia will likely consider COVID-19 an “ordinary disease of life,” akin to a cold or the flu. She said she’d have to prove by “clear and convincing evidence” that he caught the coronavirus at work.

The bar is so high, she said, that she’s waiting to file a claim in hopes that Virginia joins many other states passing laws that make it easier for health workers to prove their cases.

Craig Davis, president-elect of the Virginia Trial Lawyers Association, said he took on a test case and received a quick denial of workers’ compensation benefits for a COVID-positive physician assistant.

“We think there’s an infinitesimal possibility of prevailing under our laws as currently written,” he said. His group is pushing for a legislative change.

In Montana, which has largely been spared by the pandemic, workers face even longer odds. A 64-year-old nurse at a small hospital there was hospitalized for eight days with COVID-19 in April, according to her Great Falls lawyer, Thomas Murphy. She remains at home on oxygen, unable to work.

The woman filed a workers’ compensation claim, which could qualify her for up to $800 a week in lost wages plus lifetime coverage of medical bills related to her condition. Instead of agreeing to those benefits, Murphy said, the insurer offered to settle for $17,000, which she declined because it would not cover her medical bills.

Murphy said the employer, which he did not name to protect his client from retaliation, is arguing that she was the first person at the hospital to contract the virus, so she likely didn’t get it at work. However, he noted that two other hospital employees and six patients tested positive within the next two weeks and his client went few places other than work.

In Montana law, the burden of proof lies on the employee to show an illness was work-related.

“We’re going to have to try to piece together all of the sources” that might have infected her — “and prove that it’s more probable than not that she got it at work,” Murphy said. “Women like this woman are going to have a hard road ahead of them.”

The Montana Legislature isn’t set to meet until January, and an executive order appears unlikely.

In New Jersey, attorney Rick Rubenstein is representing the widow of a man who worked as a housekeeper at a nursing home, doing laundry and occasional patient care. Not given protective gear by his employer, the man caught COVID-19 and had a lengthy stay in the intensive care unit before he died.

His wife has the virus now and was faced with a default — no answer in 35 days — after seeking benefits in New Jersey’s workers’ compensation system. They would cover her husband’s $188,000 hospital bill and survivor’s pay of $308 per week.

“She’s isolated, doesn’t know what her own health future holds and doesn’t have an explanation of why this stuff is happening,” Rubenstein said. “It’s terrible.”

A bill proposed in New Jersey would make it easier for essential workers who got COVID-19 during the state of emergency to prove that they got it on the job. The bill was passed by the state Senate and is pending before the General Assembly.

The New Jersey Business & Industry Association has opposed the bill, saying it would push higher workers’ compensation insurance rates onto businesses that are “struggling to survive.”

“Our concerns are primarily that the cost of these claims can overwhelm the system, which was not designed to handle claims during a worldwide pandemic,” NJBIA Chief Government Affairs Officer Chrissy Buteas said in a statement.

While there are no national estimates of how many are filing claims for workers’ compensation ― or getting approvals ― Massachusetts provided KHN with a summary of its coronavirus reports from March, April and May.

During those months, employers filed 3,482 “first reports of injury” regarding a worker with COVID-19 ― 2,915 were for health care workers. Insurers denied benefits to 216 health care workers, according to Massachusetts records.

Florida posted similar data, showing a higher rate of denied claims for health care workers. While 1,740 health care workers sought benefits related to COVID-19, about 30%, or 521 claims, were fully denied. Among the 1,200 who were paid benefits, the amount paid added up to $1.3 million.

The cost of covering 9.6 million first responders and health workers nationally could range from $1 billion to $16 billion, according to the National Council on Compensation Insurance, which provides insurance rate recommendations for 38 states. The bill is paid by employers who buy workers’ compensation insurance, employers that self-insure and taxpayers, who support government agencies.

Those estimates do not include New York or California, where Gov. Gavin Newsom’s executive order broadening coverage through July 5 is projected to add about $1.2 billion to California’s costs.

In many states, business associations consider proposals to expand workers’ compensation too costly and too broad.

A proposed California bill would extend Newsom’s executive order and put the burden on employers to prove that “critical workers,” including those in retail, warehousing and delivery, who got the coronavirus did not get it at work. The bill has critics.

“California employers have been significantly impacted by this crisis and simply cannot be the safety net for this pandemic by providing workers’ compensation benefits for all employees, even when they are not injured at work,” according to a letter of concern signed by the California Chamber of Commerce, California Hospital Association and others.

A federal backstop may become available. Sen. Tammy Duckworth (D-Ill.) and a bipartisan group of lawmakers introduced a bill that would create a federal fund for essential workers, including health care personnel, who get sick or die from the coronavirus. The Pandemic Heroes Compensation Act would be modeled after the September 11th Victim Compensation Fund.

In Pennsylvania, there is no presumption that COVID-19 is acquired on the job.

Stern, the lawyer for Anderson’s family, filed a “fatal claim” in May with the state workers’ compensation board, which passed it on to the employer.

A St. Mary Medical Center spokesperson confirmed in an email that Anderson worked there for 23 years and was a maintenance mechanic. She would not discuss his case. “We are extremely saddened by his death,” she wrote. “We are not able to provide additional information out of respect for his and his family’s privacy.”

Mark Banchi volunteers with hospital chaplains and knew Anderson for over 30 years. He said co-workers are reeling from the death of a man who “was enthusiastic, gregarious, friendly.”

“His loss to the hospital is real,” Banchi said. “Some people lift spirits, some people make you glad you came that day, and Mike was one of those people.”

In addition to working at St. Mary for $22 an hour, Anderson had a cleaning job at a car dealership. Stern said Anderson was unlikely to be exposed to the virus there. If Stern prevails, the family would receive two-thirds of Anderson’s combined pay, capped at $1,081 a week.

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Public Health States

Amid Surge, Hospitals Hesitate To Cancel Nonemergency Surgeries

Three months ago, the nation watched as COVID-19 patients overwhelmed New York City’s intensive care units, forcing some of its hospitals to convert cafeterias into wards and pitch tents in parking lots.

Hospitals elsewhere prepped for a similar surge: They cleared beds, stockpiled scarce protective equipment, and — voluntarily or under government orders — temporarily canceled nonemergency surgeries to save space and supplies for coronavirus patients.

In most places, that surge in patients never materialized.

Now, coronavirus cases are skyrocketing nationally and hospitalizations are climbing at an alarming rate. But the response from hospitals is markedly different.

Most hospitals around the country are not canceling elective surgeries — nor are government officials asking them to.

Instead, hospitals say they are more prepared to handle the crush of patients because they have enough protective gear for their workers and know how to better treat coronavirus patients. They say they will shut down nonessential procedures at hospitals based on local assessments of risk, but not across whole systems or states.

Some hospitals have already done so, including facilities in South Florida, Phoenix and California’s Central Valley. And in a few cases, such as in Texas and Mississippi, government officials have ordered hospitals to suspend elective surgeries.

Hospitals’ decisions to keep operating rooms open are being guided partly by money. Elective surgeries account for a significant portion of hospital revenue, and the American Hospital Association estimates that the country’s hospitals and health care systems lost $202.6 billion between March 1 and June 30.

“What we now realize is that shutting down the entire health care system in anticipation of a surge is not the best option,” said Carmela Coyle, president of the California Hospital Association. “It will bankrupt the health care delivery system.”

The association projects that California hospitals will lose $14.6 billion this year, of which $4.6 billion has so far been reimbursed by the federal government.

But some health care workers fear that continuing elective surgeries amid a surge puts them and their patients at risk. For instance, some nurses are still being asked to reuse protective equipment like N95 masks and gowns, even though hospitals say they have enough gear to perform elective surgeries, said Zenei Cortez, president of the National Nurses United union.

“They continue to put us at risk,” Cortez said. “They continue to look at us as if we are disposable material.”

Elective surgeries, generally speaking, are procedures that can be delayed without harming patients, such as knee replacements and cataract surgery.

At least 33 states and the District of Columbia temporarily banned elective surgeries this spring, and most hospitals in states that didn’t ban them, such as Georgia and California, voluntarily suspended them to make sure they had the beds to accommodate a surge of coronavirus patients. The U.S. surgeon general, the Centers for Disease Control and Prevention and the American College of Surgeons also recommended health care facilities suspend nonemergency surgeries.

The suspension was always intended to be temporary, said Dr. David Hoyt, executive director of the American College of Surgeons. “When this all started, it was simply a matter of overwhelming the system,” he said.

Today, case counts are soaring after many states loosened stay-at-home orders and Americans flocked to restaurants, bars and backyards and met up with friends and family for graduation parties and Memorial Day celebrations.

Nationally, confirmed cases of COVID-19 have topped 3 million. In California, cases are spiking, with a 52% jump in the average number of daily cases over the past 14 days, compared with the two previous weeks. Hospitalizations have gone up 44%.

Governors, county supervisors and city councils have responded by requiring people to wear masks, shutting down bars and restaurants — again — and closing beaches on the July Fourth holiday weekend.

But by and large, government leaders are not calling on hospitals to proactively scale back elective surgeries in preparation for a surge.

“Our hospitals are telling us they feel very strongly and competent they can manage their resources,” said Holly Ward, director of marketing and communications at the Arizona Hospital and Healthcare Association. If they feel the situation warrants it, “they on their own will delay surgeries.”

In some states, like Colorado, public health orders that allowed hospitals to resume nonemergency surgeries in the spring required hospitals to have a stockpile of protective equipment and extra beds that could be used to treat an influx of COVID-19 patients.

States also set up overflow sites should hospitals run out of room. In Maryland, for example, the state is using the Baltimore Convention Center as a field hospital. The state of California last week reactivated four “alternative care sites” — including a hospital that was on the verge of closure in the San Francisco Bay Area — to take COVID-19 patients should hospitals fill up.

But the decision to reduce elective surgeries in California will not come from the state. It will be made by counties in consultation with hospitals, said Rodger Butler, a spokesperson for the California Health and Human Services Agency.

The question is whether hospitals have systems in place to meet a surge in COVID-19 patients when it occurs, said Glenn Melnick, a professor of health economics at the University of Southern California.

“To some extent, elective care is good care,” Melnick said “They’re providing needed services. They are keeping the system going. They are providing employment and income.”

In Los Angeles County, more than 2,000 COVID patients are currently hospitalized, according to county data. While that number is projected to go up by a couple of hundred people over the next few weeks, hospitals believe they can accommodate them, said county Health Services Director Christina Ghaly. In the meantime, hospitals are preparing to bring on additional staff members if needed and informing patients who have scheduled surgeries that they could be delayed.

“There’s more patients with COVID in the hospitals than there has been at any point previously in Los Angeles County during the pandemic,” Ghaly said. “Hospitals are more prepared now for handling that volume of patients than they were previously.”

While hospitals have not stopped elective surgeries, many have not ramped up to the full schedule they had before COVID-19. And they say they are picking and choosing surgeries based on what’s happening in their area.

“We were all things COVID when it was just starting,” said Joshua Adler, executive vice president for physician services at UCSF Health. “We didn’t know what we were facing.”

But after a couple of months of treating patients, hospitals have learned how to resupply units, how to transfer patients, how to simultaneously care for other patients and how to improve testing, Adler said.

At Scripps Health in San Diego, which has taken more than 230 patients from hard-hit Imperial County to the east, its hospitals have scaled back how many transfers they will accept as confirmed COVID-19 cases rise in their own community, said Chris Van Gorder, president and CEO of Scripps Health.

A command center set up by the hospital system reviews patient counts and medical supplies and coordinates with county health officials to study how the virus is spreading. Only patients who need urgent surgeries are being scheduled, Van Gorder said.

“We’re only allowing our doctors to schedule cases two weeks out,” Van Gorder said. “If we see a sudden spike, we have to delay.”

In California’s Central Valley and in Phoenix, where cases and hospitalizations are surging, Mercy hospitals have suspended elective surgeries to focus resources on COVID-19 patients.

But the other hospitals in the CommonSpirit Health system, which has 137 hospitals in 21 states, are not ending elective surgeries — as they did in the spring — and are treating patients with needs other than COVID, said Marvin O’Quinn, the system’s president and chief operating officer.

“In many cases their health deteriorated because they didn’t get care that they needed,” said O’Quinn, whose hospitals lost close to a $1 billion in two months. “It’s not only a disservice to the hospital to not do those cases; it’s a disservice to the community.”

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Related Topics

California Cost and Quality Health Industry Public Health States

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

(Return to top.)


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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Health Industry Public Health

Hospital Executive Charged In $1.4B Rural Hospital Billing Scheme

A Miami entrepreneur who led a rural hospital empire was charged in an indictment unsealed Monday in what federal prosecutors called a $1.4 billion fraudulent lab-billing scheme.

In the indictment, prosecutors said Jorge A. Perez, 60, and nine others exploited federal regulations that allow some rural hospitals to charge substantially higher rates for laboratory testing than other providers. The indictment, filed in U.S. District Court in Jacksonville, Florida, alleges Perez and the other defendants sought out struggling rural hospitals and then contracted with outside labs, in far-off cities and states, to process blood and urine tests for people who never set foot in the hospitals. Insurers were billed using the higher rates allowed for the rural hospitals.

Perez and the other defendants took in $400 million since 2015, according to the indictment. Many of the hospitals run or managed by Perez’s Empower companies have since failed as they ran out of money when insurers refused to pay for the suspect billing. Half of the nation’s rural hospital bankruptcies in 2019 were affiliated with his empire.

“This was allegedly a massive, multi-state scheme to use small, rural hospitals as a hub for millions of dollars in fraudulent billings of private insurers,” said Assistant Attorney General Brian Benczkowski of the Justice Department’s Criminal Division in a statement.

Attempts to reach Perez for comment Monday evening were unsuccessful. But last year when Perez spoke to KHN, he said he was losing sleep over the possibility he could go to jail after propping up struggling rural hospitals.

“I wanted to see if I could save these rural hospitals in America,” Perez said. “I’m that kind of person.”

Pam Green, a former night charge nurse at the now-shuttered Horton Community Hospital in Horton, Kansas (population under 1,700), said she hopes Perez and his colleagues receive long prison sentences.

“He just devastated so many people, not just in Kansas, but in Oklahoma and all the other places where he had hospitals,” said Green, 58, of nearby Muscotah, Kansas. “I went months and months without pay, without health insurance. He robbed the community.”

Green recalled that money was so tight under Perez’s management of her former hospital that the electricity was shut off at least twice and staffers had to bring in their own supplies. She said she is owed about $12,000 in back pay, as well as money for uncovered dental expenses and a workplace injury that would have been covered had employees’ insurance or workers’ compensation premiums been paid.

A KHN investigation published in August 2019 detailed the rise and fall of Perez’s rural hospitals. At the height of his operation, Perez and his Miami-based management company, EmpowerHMS, helped oversee a rural empire encompassing 18 hospitals across eight states. Perez owned or co-owned 11 of those hospitals and was CEO of the companies that provided their management and billing services.

Perez styled himself a savior of rural hospitals, swooping into small towns with promises to save their struggling facilities using his “secret sauce” of financial ventures. Multiple employees told KHN they had no idea what happened to the money their hospitals earned after Perez and his associates took control, since the facilities seemed perpetually starved for cash.

Over the past two years, amid mounting legal challenges and concerns about the lab-billing operation, insurers cut off funding and his empire crumbled. Overall, 12 of the hospitals have entered bankruptcy and eight have closed. The staggering collapse left hundreds of employees without jobs and small towns across the Midwest and South without lifesaving medical care.

The four rural hospitals named in the indictment are Campbellton-Graceville Hospital in Graceville, Florida; Regional General Hospital of Williston, Florida; Chestatee Regional Hospital in Dahlonega, Georgia; and Putnam County Memorial Hospital in Unionville, Missouri.

The indictment marks the third major case federal prosecutors have filed alleging billing fraud at Perez-affiliated hospitals. In October, David Byrns pleaded guilty to a federal charge of conspiracy to commit health care fraud involving a Missouri hospital he managed with Perez. A Missouri Auditor General report previously found that the 15-bed hospital, Putnam County Memorial in Unionville, had received about $90 million in questionable insurance payments in less than a year.

In July 2019, Kyle Marcotte, owner of a Jacksonville Beach, Florida, addiction treatment center pleaded guilty for his part in a $57 million lab-billing scheme involving two Perez-affiliated hospitals, Campbellton-Graceville and Regional General Hospital. Marcotte admitted cooperating with unnamed hospital managers to provide urine samples from his patients for lab testing that was billed through the rural hospitals and, in exchange, getting a cut of the proceeds.

Perez, on his own and through Empower-affiliated companies, in 2016 and 2017 purchased South Florida properties that totaled more than $3.7 million, including three condos on Key Largo, according to property records. He told KHN last year that the Florida properties were bought with earnings from unrelated software companies but declined to give details. He and his brother Ricardo Perez, if convicted, must forfeit over $46 million, according to the indictment, as well as two Key Largo condos and other properties.

Another defendant, Aaron Durall, if convicted, could lose $184.4 million and a six-bedroom, 6,500-square-foot home in the affluent Parkland district north of Fort Lauderdale, Florida.

Perez-affiliated hospitals also face ongoing lawsuits in Missouri and other states filed by dozens of insurers asking for hundreds of millions in restitution for allegedly fraudulent billings. In those court documents, Perez repeatedly has denied wrongdoing. He told KHN last year that his lab-billing setup was “done according to Medicare and state guidelines.”

For former employees of EmpowerHMS and members of the affected communities, the indictment represents vindication. As the company foundered, hundreds of employees worked without pay in vain efforts to keep their hospitals afloat. They would discover later that, along with the missing paychecks, their insurance premiums had not been paid and their medical policies had been discontinued. In the June 2019 interview, Perez acknowledged that, as finances withered, he stopped paying employee payroll taxes.

“It’s nice to think he might be held accountable,” said Melva Price Lilley, a former X-ray technician at Washington County Hospital in Plymouth, North Carolina, which has reopened with new owners under a new name. “At least there’s a chance that he might have to suffer some consequences. That gives me some hope.”

Lilley, 56, said she and other employees could not retrieve their retirement savings from the bankrupt hospital until about three weeks ago. She has been trying to pay off about $68,000 in medical bills from a back surgery she needed for a workplace injury that wasn’t covered by workers’ compensation insurance premiums that went unpaid for hospital employees. She remains unable to work full time.

I-70 Community Hospital, an Empower facility in Sweet Springs, Missouri, has remained closed since February 2019. Tara Brewer, head of the Sweet Springs Chamber of Commerce and the local health department, said she was almost shocked to hear that Perez had gotten indicted after months of wondering if anything would happen.

While she hopes these charges bring closure to her community, she said, the charges do little to fix the closed hospital doors for a county that has had one of the highest per capita rates of coronavirus cases in Missouri.

“What he did to us will linger on for a long time,” Brewer said.

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Health Industry States

Workers Filed More Than 4,100 Complaints About Protective Gear. Some Still Died.

COVID-19 cases were climbing at Michigan’s McLaren Flint hospital. So Roger Liddell, 64, who procured supplies for the hospital, asked for an N95 respirator for his own protection, since his work brought him into the same room as COVID-positive patients.

But the hospital denied his request, said Kelly Indish, president of the American Federation of State, County and Municipal Employees Local 875.

On March 30, Liddell posted on Facebook that he had worked the previous week in both the critical care unit and the ICU and had contracted the virus. “Pray for me God is still in control,” he wrote. He died April 10.

Roger Liddell(Courtesy of Bill Sohmer)

The hospital’s problems with personal protective equipment (PPE) were well documented. In mid-March, the state office of the Occupational Safety and Health Administration (OSHA) received five complaints, which described employees receiving “zero PPE.” The cases were closed April 21, after the hospital presented paperwork saying problems had been resolved. There was no onsite inspection, and the hospital’s written response was deemed sufficient to close the complaints, a local OSHA spokesperson confirmed.

The grief and fear gripping workers and their families reflect a far larger pattern. Since March, more than 4,100 COVID-related complaints regarding health care facilities have poured into the nation’s network of federal and state OSHA offices, which are tasked with protecting workers from harm on the job.

A KHN investigation found that at least 35 health care workers died after OSHA received safety complaints about their workplaces. Yet by June 21, the agency had quietly closed almost all of those complaints, and none of them led to a citation or a fine.

The complaint logs, which have been made public, show thousands of desperate pleas from workers seeking better protective gear for their hospitals, medical offices and nursing homes.

The quick closure of complaints underscores the Trump administration’s hands-off approach to oversight, said former OSHA official Deborah Berkowitz. Instead of cracking down, the agency simply sent letters reminding employers to follow Centers for Disease Control and Prevention guidelines, said Berkowitz, now a director at the National Employment Law Project.

“This is a travesty,” she said.

A third of the health care-related COVID-19 complaints, about 1,300, remain open and about 275 fatality investigations are ongoing.

During a June 9 legislative hearing, Labor Secretary Eugene Scalia said OSHA had issued one coronavirus-related citation for violating federal standards. A Georgia nursing home was fined $3,900 for failing to report worker hospitalizations on time, OSHA’s records show.

“We have a number of cases we are investigating,” Scalia said at the Senate Finance Committee hearing. “If we find violations, we will certainly not hesitate to bring a case.”

Texts between Barbara Birchenough and her daughter, (in blue) Kristin Carbone.(Courtesy of Kristin Carbone)

A March 16 complaint regarding Clara Maass Medical Center in Belleville, New Jersey, illustrates the life-or-death stakes for workers on the front lines. The complaint says workers were “not allowed to wear” masks in the hallway outside COVID-19 patients’ rooms even though studies have since shown the highly contagious virus can spread throughout a health care facility. It also said workers “were not allowed adequate access” to PPE.

Nine days later, veteran Clara Maass registered nurse Barbara Birchenough texted her daughter: “The ICU nurses were making gowns out of garbage bags. … Dad is going to pick up large garbage bags for me just in case.”

Kristin Carbone, the eldest of four, said her mother was not working in a COVID area but was upset that patients with suspicious symptoms were under her care.

In a text later that day, Birchenough admitted: “I have a cough and a headache … we were exposed to six patients who we are now testing for COVID 19. They all of a sudden got coughs and fevers.”

“Please pray for all health care workers,” the text went on. “We are running out of supplies.”

By April 15, Birchenough, 65, had died of the virus. “They were not protecting their employees in my opinion,” Carbone said. “It’s beyond sad, but then I go to a different place where I’m infuriated.”

OSHA records show six investigations into a fatality or cluster of worker hospitalizations at the hospital. A Labor Department spokesperson said the initial complaints about Clara Maass remain open and did not explain why they continue to appear on a “closed” case list.

Nestor Bautista, 62, who worked closely with Birchenough, died of COVID-19 the same day as she did, according to Nestor’s sister, Cecilia Bautista. She said her brother, a nursing aide at Clara Maass for 24 years, was a quiet and devoted employee: “He was just work, work, work,” she said.

Barbara Birchenough(Courtesy of Kristin Carbone)

Nestor Bautista(Courtesy of Cecilia Bautista)

Responding to allegations in the OSHA complaint, Clara Maass Medical Center spokesperson Stacie Newton said the virus has “presented unprecedented challenges.”

“Although the source of the exposure has not been determined, several staff members” contracted the virus and “a few” have died, Newton said in an email. “Our staff has been in regular contact with OSHA, providing notifications and cooperating fully with all inquiries.”

Other complaints have been filed with OSHA offices across the U.S.

Twenty-one closed complaints alleged that workers faced threats of retaliation for actions such as speaking up about the lack of PPE. At a Delaware hospital, workers said they were not allowed to wear N95 masks, which protected them better than surgical masks, “for fear of termination or retaliation.” At an Atlanta hospital, workers said they were not provided proper PPE and were also threatened to be fired if they “raise[d] concerns about PPE when working with patients with Covid-19.”

Of the 4,100-plus complaints that flooded OSHA offices, over two-thirds are now marked as “closed” in an OSHA database. Among them was a complaint that staffers handling dead bodies in a small room off the lobby of a Manhattan nursing home weren’t given appropriate protective gear.

More than 100 of those cases were resolved within 10 days. One of those complaints said home health nurses in the Bronx were sent to treat COVID-19 patients without full protective gear. At a Massachusetts nursing home that housed COVID patients, staff members were asked to wash and reuse masks and disposable gloves, another complaint said. A complaint about an Ohio nursing home said workers were not required to wear protective equipment when caring for COVID patients. That complaint was closed three days after OSHA received it.

It remains unclear how OSHA resolved hundreds of the complaints. A Department of Labor spokesperson said in an email that some are closed based on an exchange of information between the employer and OSHA, and advised reporters to file Freedom of Information Act requests for details on others.

“The Department is committed to protecting America’s workers during the pandemic,” the Labor Department said in a statement. “OSHA has standards in place to protect employees, and employers who fail to take appropriate steps to protect their employees may be violating them.”

The agency advised its inspectors on May 19 to place reports of fatalities and imminent danger as a top priority, with a special focus on health care settings. Since late March, OSHA has opened more than 250 investigations into fatalities at health care facilities, government records show. Most of those cases are ongoing.

According to the mid-March complaints against McLaren Flint, workers did not receive needed N95 masks and “are not allowed to bring them from home.” They also said patients with COVID-19 were kept throughout the hospital.

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

Filing complaints, though, did little for Liddell, or for his colleague, Patrick Cain, 52. After the complaints were filed, Cain, a registered nurse, was treating people still awaiting the results of COVID-19 diagnostic tests — potentially positive patients ― without an N95 respirator. He was also working outside a room where potential COVID-19 patients were undergoing treatments that research supported by the University of Nebraska has since shown can spread the virus widely in the air.

At the time, there was a debate over whether supply chain breakdowns of PPE and weakened CDC guidelines on protective gear were putting workers at risk.

Cain felt vulnerable working outside of rooms where COVID patients were undergoing infection-spreading treatments, he wrote in a text to Indish on March 26.

Texts between union president Kelly Indish and Patrick Cain (right)(Courtesy of Kelly Indish)

“McLaren screwed us,” he wrote.

He fell ill in mid-March and died April 4.

McLaren has since revised its face-covering policy to provide N95s or controlled air-purifying respirators (CAPRs) to workers on the COVID floor, union members said.

A spokesperson for the McLaren Health Care system said the OSHA complaints are “unsubstantiated” and that its protocols have consistently followed government guidelines. “We have always provided appropriate PPE and staff training that adheres to the evolving federal, state, and local PPE guidelines,” Brian Brown said in an email.

Separate from the closed complaints, OSHA investigations into Liddell and Cain’s deaths are ongoing, according to a spokesperson for the state’s Department of Labor and Economic Opportunity.

Nurses at Kaiser Permanente Fresno Medical Center also said the complaints they aired before a nurse’s death have not been resolved. (KHN is not affiliated with Kaiser Permanente.)

On March 18, nurses filed an initial complaint. They told OSHA they were given surgical masks, instead of N95s. Less than a week later, other complaints said staffers were forced to reuse those surgical masks and evaluate patients for COVID without wearing an N95 respirator.

Several nurses who cared for one patient who wasn’t initially suspected of having COVID-19 in mid-March wore no protective gear, according to Amy Arlund, a Kaiser Fresno nurse and board member of the National Nurses Organizing Committee board of directors. Sandra Oldfield, a 53-year-old RN, was among them.

Arlund said Oldfield had filed an internal complaint with management about inadequate PPE around that time. Arlund said the patient’s illness was difficult to pin down, so dozens of workers were exposed to him and 10 came down with COVID-19, including Oldfield.

Sandra Oldfield(Courtesy of Lori Rodriguez)

Lori Rodriguez, Oldfield’s sister, said Sandra was upset that the patient she cared for who ended up testing positive for COVID-19 hadn’t been screened earlier.

“I don’t want to see anyone else lose their life like my sister did,” she said. “It’s just not right.”

Wade Nogy, senior vice president and area manager of Kaiser Permanente Fresno, confirmed that Oldfield had exposure to a patient before COVID-19 was suspected. He said Kaiser Permanente “has years of experience managing highly infectious diseases, and we are safely treating patients who have been infected with this virus.”

Kaiser Permanente spokesperson Marc Brown said KP “responded to these complaints with information, documents and interviews that demonstrated we are in compliance with OSHA regulations to protect our employees.” He said the health system provides nurses and other staff “with the appropriate protective equipment.”

California OSHA officials said the initial complaints were accurate and the hospital was not in compliance with a state law requiring workers treating COVID patients to have respirators. However, the officials said the requirement had been waived due to global shortages.

Kaiser Fresno is now in compliance, Cal/OSHA said in a statement, but the agency has ongoing investigations at the facility.

Arlund said tension around protective gear remains high at the hospital. On each shift, she said, nurses must justify their need for a respirator, face shield or hair cap. She expressed surprise that the OSHA complaints were considered “closed.”

“I’m very concerned to hear they are closing cases when I know they haven’t reached out to front-line nurses,” Arlund said. “We do not consider any of them closed.”

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Health Industry Public Health States

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.

Photo

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.

In a Hospital, Health Care Until the Clock Runs Out

Photo

Credit Jordin Isip

A 37-year-old man was admitted to a hospital several months ago with seizures. His M.R.I. was frightening, showing a brain full of holes. Medication controlled the seizures, but the drugs were just Band-Aids on a big, undiagnosed problem.

The patient was not particularly alarmed (which in itself was fairly alarming). His brain was riddled with infection or tumor, but all he wanted to do was get out of the hospital and go back to his life.

By all accounts, it was a troubled, isolated, drug-ridden existence in a fleabag hotel, a life free from anything resembling regular medical care. Still, he was ready to be on his way.

The only way to diagnose his problem was a brain biopsy. “Anything to get out of here,” the patient said, and signed a consent form.

The biopsy was performed uneventfully, and small specimens of the abnormal tissue were sent to the lab for a diagnosis. That was on a Friday.

By Monday, everyone was ready for an answer. By Tuesday, it was hard to tell who was more impatient, the patient pacing the hallways or his doctors pestering the lab.

On Wednesday, with the specimens still being processed and another weekend looming, the case had attracted the notice of the administrators known in hospital vernacular as the discharge police.

Within minutes, it seemed, the patient was out of that expensive acute-care bed and on his way to the subway, clutching a thick sheaf of instructions, appointment slips and prescriptions, still without a diagnosis, brain full of holes, but free at last.

Your reaction to this story will almost certainly depend on your understanding of the word “hospital.” The word has connotations of care and comfort dating to the Middle Ages, but its meaning is changing so quickly that even the people who work in one cannot agree on what it is.

Once hospitals were where you found a doctor when you suddenly needed one; now doctors are all over the place, from big-box stores to storefront clinics. Hospitals were where you were headed if you were very sick; now you can heed your insurer’s pleas and choose a cheaper emergency center instead.

Hospitals were where you stayed when you were too sick to survive at home; now you go home anyway, cobbling together your own nursing services from friends, relatives and drop-in professionals.

Once hospitals were where you were kept if you were a danger to yourself or others. They still serve this function — although, perhaps, the standards for predicting these dire outcomes have tightened up quite a bit.

These days, it may be easier to define hospitals by what they are not. They are not places for the sick to get well, not unless healing takes place in the brief interval of time that makes the stay a compensated expense.

Hospitals are definitely not places for unusual medical conditions to be figured out, not if the patient is well enough to leave.

Like the hospital, the patient with holes in his brain was also a puzzle of ill-defined words. He was very sick, yet not all that sick. Whether he could survive at home depended strongly on the meaning of “survive” and “home.”

He was well enough to be an outpatient, but he was far from well, and had never managed to be a successful outpatient. He was not suicidal, at least not in any immediate sense. The big holes in his brain made it even less likely that he would adhere to the complicated instructions for his new outpatient life.

But then again, a hospital is a place where hope reliably springs eternal.

The patient’s young doctors certainly hoped for the best for him. They gave him a slew of prescriptions, and expressed their hopes that he would take the pills and keep his far-flung appointments, at one of which his brain biopsy report would be retrieved and his medications adjusted accordingly.

Not so long ago, the multiple ambiguities of this patient’s case would have kept him in the hospital until at least some of the uncertainty had been resolved. In fact, it would have been considered close to malpractice to let a patient like him out the door. Now it is considered downright medieval to keep him in.

I’m sure you would like to know what happened to the patient. His doctors would, too, but he is missing. His phone goes unanswered. The name of an emergency contact is blank in his records — he refused to provide one.

It’s anyone’s guess if he filled his prescriptions. He kept none of the appointments made for him.

The results of his biopsy showed a perfectly treatable condition, an infection that the pills he was sent home with should have helped. Perhaps he got better, perhaps not.

The young doctors will never know if they managed his case correctly — that’s “manage” in its medical sense. In the word’s other senses (“succeed despite difficulty” among them), they now have a reasonably good sense of how they failed.

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

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.

Giving New Doctors the Tools They Need

Photo

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.

Picking Up an Infection in the Hospital

Photo

Credit Stuart Bradford

When the emergency room doctor pulled the blanket aside, looked at my elephant-size inflamed leg and said, “Whoa!” I knew that wasn’t a good sign.

Nor was the reaction of the emergency room nurse, who glanced down at my bizarrely swollen extremity, then started nervously backing away.

Health care practitioners are trained not to show their feelings, but there are clearly times when things look so bad that even they can’t hide their reactions.

I was in the emergency room at Los Robles Hospital in Thousand Oaks, Calif., because a few days earlier I had undergone what was supposed to be a relatively straightforward outpatient procedure to remove a skin growth on my leg. A couple of days after the surgery I felt fine. The surgeon told me I could drive whenever I was up for it, so we took our grandchildren to the Magic Castle in Hollywood. Running from room to room to see the different sleight-of-hand acts, I no longer felt fine. Now I felt a searing knife-like pain in my leg, which soon began to swell in size.

I went back to see my surgeon, who looked a little concerned. You have an infection, she said. Take these two antibiotic pills, schedule a Doppler scan for the next day, and all should be well.

That night, my leg got even bigger; from the waist down one side of me looked like I weighed 350 pounds (I’m not even half that.) My wife and I spoke to the surgeon, who was vague. “You could go to the E.R. if you want,” she said. “Or wait.”

I went and was admitted immediately. That night, a Doppler study showed no life-threatening blood clots. With no beds available, I was kept in the emergency department overnight, taking catnaps while trying to blot out the screams and moans from down the hall, before being given a room, and intravenous antibiotics, the next morning.

“This is very serious,” said Dr. Barry Statner, the infectious disease specialist who came to see me the next day in my hospital room. “We’ll cure you,” he said while firing questions at me about my medical history. “But you need to know, this is very serious.” I wondered if I was going to lose my leg.

For the first time in my life, I had entered the world of the powerless sick. Like most people, I had long heard about the dangers of contracting infections in hospitals or surgical centers, but I never took them seriously. I assumed that, except for the worst cases, such as those caused by improperly disinfected scopes and other instruments, they were little more than a minor annoyance.

In fact, infections kill, and they do so regularly, even to people who are otherwise healthy.

“There are diseases that can take a regular healthy person and destroy them within hours,” Dr. Statner told me. “You don’t get a second chance. People don’t realize how rapid and lethal infections can be.”

In the United States in 2014, one in 25 patients contracted a hospital-borne infection on any given day, according to the Centers for Disease Control and Prevention. Some 722,000 Americans developed such infections in hospitals in 2011, and about 75,000 died during their hospital stay.

I count myself as somewhat lucky. My wound was infected with a relatively run-of-the-mill strain of Staphylococcus aureus, and after a week in the hospital, followed by two weeks hobbling around the house, where a nurse visited daily to pack my wound with prodigious amounts of gauze, I was on the road to recovery. I was fortunate it wasn’t one of the more serious infections that lurk around hospitals, like MRSA, a “super bug” strain of Staph that is resistant to most antibiotics, or C. difficile, which can cause months of relapsing and severe diarrhea.

No one knows how my infection happened. It was the first, and only, case of this type of infection at the surgical center that year, I was told by Dr. Richard Hoberman, the medical director and the anesthesiologist who had put me under general sedation during my surgery. Clearly shaken by what happened to me, he unexpectedly popped in to my hospital room early in my stay to apologize.

My infection resulted in my being “the subject of several very uncomfortable meetings with the hospital administration” and a five-page written report, Dr. Hoberman said. (They passed on sharing a copy of that report with me.)

Hospitals are anxious to reduce hospital-borne infections, to reduce deaths and improve their reputations. There are also immediate financial incentives: Medicare may penalize hospitals for infections acquired in the facility.

The medical center I’d gone to for my surgery, associated with Los Robles Hospital, practices all the well-known standard forms of infection prevention: constant washing of hands; sterilizing equipment; giving patients preoperative antibiotics; cleaning operating room surfaces and thorough cleaning at night. In addition doctors are not allowed to enter the operating room wearing the same scrubs they wear in the street. To prevent the spread of microbes, cellphones and jewelry are banned, as well as ties.

But infections still happen. While most infections happen at the time of surgery, according to Dr. Statner, they can occur in the hospital room as well. A break in the skin, a lapse in the handling of a paper surgical cover, lackluster cleaning, intravenous lines or catheters that remain in too long — all can result in infection.

In the end, stamping out infections depends on the vagaries of human behavior. “Medical care is done by people. There can be gaps in quality. People must remember to do certain things,” said Dr. Arjun Srinivasan, the associate director for health care associated infection prevention programs at the C.D.C.

“Far too many Americans get sick in the hospital,” said Dr. Thomas R. Frieden, director of the C.D.C. “The importance of making care safer cannot be overstated.” One limitation is that the C.D.C. can only recommend, not mandate, practices to reduce infection, he said. And because hospitals are owned by various corporations, it can be a challenge to know how effectively patients are being protected in any one hospital. If a patient is moved from one hospital to another across town, he said, it “can cause problems,” given that one hospital may have less rigorous infection-reduction policies than another.

Hospitals are experimenting with new disinfection techniques. For example, some disinfecting machines using ultraviolet light are so powerful that no one is allowed in the room when they are in operation. And routine measures like thorough hand washing, and having patients thoroughly shower using chlorhexidine before surgery is helping bring infection rates down in the United States in recent years. In the three to six years before 2014, depending on the type of infection, the rate of surgical-site infections has dropped by 17 percent, C. diff by 8 percent and hospital-borne MRSA by 13 percent, according to the C.D.C. However, there was no change in the rate of urinary tract infections caused by catheters between 2009 and 2014.

Infection rates have dropped even more steeply in Britain, where total MRSA reduction from 2004 is now 80 percent, according to Dr. Mark Wilcox, the head of medical microbiology at Leeds Teaching Hospitals and the head of the C. difficile task force for Public Health England. Leeds Hospital used to see 15 to 25 MRSA infections per month; now it gets five per year, he said.

Dr. Wilcox attributes their success in part to having a coordinated, single health system for the entire country. To encourage hygiene, National Health Service hospitals post current infection rates on boards that can be seen by doctors, patients and visitors. Hospitals are “obsessional” about hand hygiene, Dr. Wilcox said. To do the best cleaning job, health workers must be “bare below the elbows,” with no watches on the wrist. Lab coats, while making a doctor look professional, are also banned, as they can brush up against patients and transfer bacteria from one patient to the next.

Hospitals that fail to meet infection reduction targets are visited by a “hit squad improvement team” that demands a new plan, Dr. Wilcox said. Those that fail lose the right to decide how to spend some of their annual budget.

“A decade ago, people would say that only a small proportion of infections are preventable,” said the C.D.C.’s Dr. Srinivasan. “Now we know that a large proportion are preventable. We’ve turned that paradigm on its head.”

Think Like a Doctor: Sick at the Wedding Solved!

Photo

Credit Anna Parini

On Thursday, we asked Well readers to take on a challenging case. A 38-year-old man who traveled to the mountains of Colorado for his brother’s wedding suddenly became ill. He had fevers and chills, chest pain, a severe headache and a sore throat. There was so much going on that it was really tough to see what might be underlying it all. More than 400 of you offered your diagnoses, but no one got it completely right. I had to choose two winners, each of whom was the first to get at least part of it right.

The correct diagnosis was:

Lemierre’s disease caused by an invasive strep infection

One of the winning answers came from Dr. Hediyeh Baradaran, a chief resident in the radiology department of Weill Cornell Medical Center. She recognized that an invasive strep infection could cause both the inflamed heart muscle diagnosed at one hospital and the abscess found at the other. She didn’t mention the Lemierre’s. That diagnosis was offered by Dr. Ariaratnam Gobikrishna, a cardiologist with Montefiore Medical Center in the Bronx.

The Diagnosis

In 1932, Dr. André Lemierre reported on 20 patients he’d seen who became ill with a sore throat and then went on to develop a clot in their jugular vein. The clot was infected with bacteria, and the disease spread from the jugular to the lungs, bones, brain and other organs when tiny pieces broke off, seeding the infection throughout the body. The illness came to be known as Lemierre’s disease, or syndrome.

Lemierre’s is rare, most commonly seen in teenagers and young adults. And it is frequently misdiagnosed, at least initially. In one study of hospitalized patients, a correct diagnosis of Lemierre’s was made, on average, five days after admission.

Most of the time the infection is caused by an unusual bacterium called Fusobacterium necrophorum, but it has been associated with other bugs as well. And no matter which bacterium caused it, in the era before antibiotics, Lemierre’s was practically a death sentence, with 90 percent of patients dying. Even now, it’s not a disease to be taken lightly. Up to 18 percent of patients will die of the infection.

However, it wasn’t some rare infection behind this man’s illness. Blood cultures drawn at Anna Jaques Hospital in Newburyport, Mass., where the patient went after returning home, revealed an underlying disorder that is much more common and much less feared: strep throat. There are millions of cases of streptococcal infections in this country every year, usually in the throat or on the skin. But in a tiny fraction of these cases, the bacterium will invade the surrounding tissues and cause a life-threatening illness, as it did with this man.

Both the Lemierre’s and the myocarditis were caused by this strep throat gone wild. This kind of invasive infection must be treated with antibiotics. This patient was taking an antibiotic, doxycycline, because the doctors were worried initially that he might be suffering from some kind of tick-borne infection, but that antibiotic is ineffective against most types of strep.

How the Diagnosis Was Made

After the patient’s flight back from Colorado to Boston, he had ended up in Massachusetts General Hospital, where he’d been diagnosed with myocarditis, or inflamed heart muscle. He began to feel a little better and returned home, but after a day he began to feel worse again. He was pale and sweaty, the way he’d been in the mountains. And the shaking and fevers were back. His headache was terrible, almost as bad as it had been in the hospital, where it had brought the man to tears — something his wife had never seen before.

The patient’s wife called Mass General several times with her concerns; the doctor who’d cared for the patient there suggested she take him to a local hospital. And that’s when she turned to her husband and gave him a choice: She could drive him to the hospital or she could call an ambulance, but he was going to go to the hospital – and he was going to go now.

At the Anna Jaques emergency room, the couple met Dr. Domenic Martinello. He heard their complicated story of traveling to Colorado and feeling sick, then returning to Boston and feeling sicker; then going to Mass General and getting a diagnosis of myocarditis, but not getting better. After a quick exam, Dr. Martinello decided to focus on the most prominent symptoms at that moment: the headache, the neck and throat pain, and the fever.

Scanning the Head and Neck

He would start with a CT scan of the head, he told the patient and his wife. And if that didn’t provide an answer, he would get a CT scan of the neck. And if he still had no answer, he would get a lumbar puncture, or spinal tap. One of those tests, he was certain, would provide the answer.

The head scan was completely normal. There was no tumor, no blood clot and no sign of increased pressure. That was important because Dr. Martinello suspected that the patient had some kind of meningitis, and if the scan had shown increased pressure, he wouldn’t be able to do a spinal tap. But as it turned out, a spinal tap wasn’t needed.

The emergency room doctor wanted the CT of the patient’s neck because it was swollen and tender. The patient had told him he had a sore throat, yet when the doctor looked in his throat he saw nothing. Could there be an abscess seeded deep in his oral pharynx from some earlier infection? Is that what was causing his throat and neck pain?

Photo

The arrow is pointing to a clot (darker gray) within the jugular vein (lighter gray).

The arrow is pointing to a clot (darker gray) within the jugular vein (lighter gray).Credit

It was the right question, though the result was not what Dr. Martinello expected. There was a small abscess. More worrisome, there was a blood clot in the patient’s jugular vein, on the patient’s right side. He had Lemierre’s disease, a rare infection that Dr. Martinello had seen only once before. You can see the clot in the CT image shown here.

Transferring to a Bigger Hospital

Now that Dr. Martinello knew what was making this man so sick, he was worried that his small community hospital was not prepared to care for him. They didn’t have the kind of specialists he needed on call 24/7. It seemed clear that the patient needed a hospital with more resources. So Dr. Martinello arranged for the patient to be transferred to a sister hospital, Beth Israel Deaconess Medical Center in Boston.

Identifying the Bug

Dr. Andrew Hale was the infectious disease specialist on duty the night the patient arrived at Beth Israel. When the patient and his wife arrived at the B.I. emergency department, Dr. Hale hurried to meet them. He spoke to husband and wife and reviewed their complicated history of the past week or so. But he also learned that both children had come down with strep throat while their father was at Mass General. It was an important discovery since, although unusual, it was well known that strep could cause Lemierre’s, He ordered another set of blood cultures and started the patient on broad-spectrum antibiotics.

Because the patient had been started on intravenous antibiotics while at Anna Jaques, there was a good chance that these cultures wouldn’t grow anything, but he needed to try. He also knew that Dr. Martinello had drawn blood cultures from the patient before he had started on the intravenous antibiotics, and was optimistic that these cultures would show what the bugs were. Identifying the bacteria that were causing the infection was important so that the antibiotics could be more narrowly targeted.

The cultures from Anna Jaques grew out Strep pyogenes, the most common cause of strep throat. The patient continued on antibiotics for six weeks and started a three-month course of a blood thinner to keep the clot from growing or spreading.

How the Patient Fared

That was a year ago. The patient is completely recovered. It was kind of funny, he told me recently. Even though his throat was painful, the sore throat seemed insignificant compared to the shaking chills, the fever, the headache. “I thought of it as kind of a sidebar, when in fact it was the main event,” he said.

Both he and his wife have read up on the illness and come up with a new family motto: Take strep seriously.

Pricing a Year of Life

Photo

Credit Stuart Bradford

A radio producer investigating cancer costs once asked me, “What is another year of your life worth?” During my flummoxed silence, she informed me that experts mention the figure $50,000. Can patients like me — older people with recurrent disease — estimate the expense of a future year of cancer treatment to decide whether it’s worth it?

I began to understand the origin of the number when my nephew sent me an article in The New England Journal of Medicine, “Updating Cost Effectiveness.” Its authors explain: “For more than two decades, the ratio of $50,000 per quality-adjusted life-year (QALY) gained by using a given health care intervention has played an important if enigmatic role in health policy circles as a benchmark for the value of care.”

Used by economists, the QALY calculates quality and quantity of life to judge the monetary worth of medical inventions. Since my cancer was diagnosed in 2008, I have wondered how to make this reckoning within our for-profit health system. So with misgivings I set aside the plight of the uninsured and began considering not generic measurements of cost-effectiveness but how much I — as an insured patient — had paid for one year of cancer treatment.

It turned out to be impossible. Never — during four years of operations, radiological interventions, and cycles of chemotherapy — had I been informed beforehand about the cost of any consultation, procedure, equipment or drug. Nor did I understand what would be covered by insurers and (when I got older) Medicare or what would have to be paid out-of-pocket.

After the consultation or procedure, I received impenetrable statements from providers, stamped in large letters, “This Is Not a Bill.” They were followed by cryptic printouts from the hospital that clearly were bills, although next to many entries the word “pending” appeared.

Now, given my erratic bookkeeping, I cannot calculate what I ended up spending.

The camouflaging of cancer costs poses an unprecedented problem. There is no analogue in life — including the approach of death — in which I remain so ignorant of expenditures. Although I have ascertained what cremation, a grave site, and a marker cost, I have no idea what the costs of my treatments amounted to.

During those same years, I could not predict treatment complications that required subsequent procedures and outlays. When an operation necessitated another, the bills multiplied. Humbled by my own unknowingness, I took to heart Kierkegaard’s insight that we must live life forward, even though it can only be understood backward.

Obviously, I was in neither the physical nor the psychological state needed to adjudicate the paperwork. Dazed, frightened and depleted by the alarming threat to my mortality and the debilitation of treatment, I demoted the bills to a nasty irritant. An excellent job with good benefits buffeted me from facing what less lucky people confront: a financial crisis triggered by cancer treatment.

Stints in the hospital enlighten many patients about prohibitive co-pays and costs above coverage ceilings for the large sums charged by surgeons, anesthesiologists, radiologists and oncologists; for operating and hospital rooms, tests and scans, medicine and equipment as well as a box of tissues. The title of an article in The Oncologist about the financial distress of insured patients speaks volumes: “The Financial Toxicity of Cancer Treatments.”

Add to these expenditures exorbitant out-of-network fees, the loss of wages resulting from treatment-related appointments and disabilities, the cost of travel to and from the hospital, and the need to hire child care or housekeeping or elder care assistance. All these combined payments can be staggering.

As for the new cancer drugs, pharmaceutical companies apparently charge whatever the market will bear. A new type of medication, a PARP inhibitor similar to the one I receive in a clinical trial, has been approved by the Food and Drug Administration for recurrent ovarian cancer patients. Lynparza, produced by AstraZeneca, costs about $11,000 a month. That would come to $132,000 a year. After a media flap a few years ago over Zaltrap — doctors at Memorial Sloan Kettering boycotted it, saying it was no more effective than a less expensive drug — its producers cut the price in half.

No wonder, then, that people with cancer are more likely to go bankrupt than other Americans. The authors of The New England Journal of Medicine article conclude that the QALY has been underestimated. For a single threshold now, they would suggest either $100,000 or $150,000 per QALY.

Whatever the estimate, a crude ratio of cost effectiveness, like the QALY, seems presumptuous. How can qualitative factors (nausea, fatigue) be converted into quantitative numbers? How can general calculations account for individual variations (my preference for fatigue over nausea) or overriding personal beliefs and principles about what constitutes a valuable existence?

Yet it would help patients like me to participate in sober public conversations on these issues since many of us are aware that individual decisions about medical costs sidestep vexing social questions of why they are inflated and how they will tax our children and grandchildren. At the least, more transparent communications would alleviate widespread fears that living life forward could trip us backward into penury.

For the past three years, the clinical trial in which I participate has covered most cancer-related expenses. When the drug in my trial fails, I want to have some say about whether another year of my life is worth the cost of treatment. But it will take a change in the current way of doing medical business to make that possible.

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Think Like a Doctor: Sick at the Wedding

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Credit Anna Parini

The Challenge: Can you figure out what is wrong with a 38-year-old man who suffers from fevers, insomnia and night sweats after traveling to the mountains of Colorado to be his brother’s best man?

Every month, the Diagnosis column of The New York Times Magazine asks Well readers to try their hand at solving a real-life medical mystery. Below you will find the story of a 38-year-old marketing executive from the Boston area who suddenly becomes sick when he takes his family to his brother’s destination wedding in the Rockies. Within a day of their arrival, the man begins to feel sick, though the rest of his family feels fine.

As usual, the first reader to offer the correct diagnosis gets a signed copy of my book, “Every Patient Tells a Story,” along with that feeling of satisfaction that comes from solving a difficult but really cool case.

The Patient’s Story

“Either you are getting in the car with me to go back to the hospital, or I’m calling an ambulance,” the woman announced. “It’s totally up to you.”

Her husband, 38 and never sick a day in his life, had been desperately ill for more than a week. He’d just gotten out of the hospital that morning, and after being home for less than 12 hours he was worse than ever. Though she couldn’t bring herself to say it out loud, she was worried he might be dying. And though he didn’t say anything, so was he.

It had started at his brother’s wedding, one of those destination events in the mountains of Colorado. And almost from the moment he stepped off the plane, he’d started to feel awful. His head ached. So did his body. His eyes were puffy, and his whole face looked swollen. He couldn’t eat, and he couldn’t sleep. When he went to bed that first night, he tossed and turned, though he felt exhausted. In the morning, when he dragged himself out of bed, the sheets were soaked with sweat.

Just the Altitude?

At first he wrote it off as altitude sickness. The resort was 11,000 feet above sea level, and he’d never been this high up. Though his wife and the kids felt fine, there were others in the wedding party who were feeling the effects of the altitude as badly as he did. One of the bridesmaids fainted at the rehearsal dinner. And an elderly aunt had to leave before the wedding.

The day of the wedding it snowed – in May. The kids were thrilled. His wife took them sledding. He’d spent the day in bed, trying – mostly unsuccessfully — to get some sleep. That afternoon the wedding service seemed to last forever. The tuxedo felt like a straitjacket. There was a pressure in his chest that made it hard to breathe. But he’d stood at the front of the church, proud to be best man to his younger brother.

After the service, the photographer led them outside, trying to capture the spring blossoms covered with snow that made the setting so extraordinary, and he worked hard to exhibit an enthusiasm he was too sick to feel.

By the time he made it to the dinner reception, his whole body shook with violent chills, and his head was pounding. His collar felt so tight he could hardly swallow. He’d been working on his toast for days, so his wife talked to the D.J. and changed the order of the toasts so that he could give his toast early. After completing it, he made his apologies, went back to the hotel and climbed into bed.

Feeling Worse and Worse

He figured he’d feel better when they got to the lower altitudes of Denver, where they’d arranged to spend their last night. But he didn’t. Even when he traveled back to Boston, down at sea level, he didn’t feel any better. He had some business in the city so was staying at a hotel while his wife took the two kids back to their home, an hour away. She was worried but he reassured her he’d be O.K.

But that night, alone in his hotel room, he felt so bad he began to get scared. If this was altitude sickness, he should be better by now. Everything he read on the Internet said so.

Finally he could take it no more. He went to the front desk and asked for a taxi and went to the closest emergency room, at Massachusetts General Hospital.

An Inflamed Heart

Because of his chest tightness, the doctors at Mass General ordered an EKG. To his surprise, it was abnormal, and he was rushed to the cardiac care unit. He hadn’t had a heart attack; they were sure of that. But something had damaged his heart.

After dozens of tests, the doctors told him he had something called myocarditis, an inflamed heart muscle, though they couldn’t tell him why. For three days they searched for the cause of injured muscle. Myocarditis is often due to a viral infection, but the doctors wanted to make sure they didn’t miss anything treatable.

At the top of their list, they worried that he had picked up some kind of tick-borne infection while in rural Colorado. None of the tests came back positive, but they sent him home to finish up a week of the antibiotic doxycycline, just in case.

You can read the notes from Mass General and the infectious disease specialist here.

Admission Note

Infectious Disease Notes

A Short Trip Home

In the hospital he felt a little better. His chest didn’t hurt, and his heart wasn’t racing. His fever went down. On his way home he felt like he was on the mend. His wife wasn’t so sure. And a couple of hours later, when she looked in on him again, she was frightened by how sick he looked.

He was pale and sweaty – the way he’d been in the mountains. And the shaking and fevers were back. His headache was so bad that he was crying with pain, something she’d never seen before. She called Mass General. The doctor there said that if she was worried she should bring him right back. But the prospect of an hour-long drive seemed daunting. She decided to take him to the local hospital one town over.

So, did he want her to call an ambulance, or should they go by car?

Back to the Hospital

The patient’s wife dropped off the kids at a friend’s house, then drove him to Anna Jaques Hospital in Newburyport, Mass. It was late by the time they arrived and the emergency room was quiet.

Dr. Domenic Martinello knocked at the entrance to their hospital cubicle. The patient’s wife looked up expectantly, her face tight with exhaustion. The patient lay motionless on the stretcher; his eyes were sunken, and his skin hung off his face as if he hadn’t eaten much recently. His voice was soft but raspy, and every time he swallowed, his lips tightened in a grimace of pain.

Together, husband and wife recounted the events of the past few days: the wedding, the fevers, headaches, pain in his chest, in his neck and in his throat, the four days in the hospital in Boston.

It was certainly a confusing picture, and Dr. Martinello wasn’t sure what to make of the diagnosis of myocarditis. But the patient had no chest pain now, only the headache, sore neck and painful throat.

He quickly examined him. The patient’s skin was warm and sweaty, and his neck was stiff and tender, especially on the right. He was going to approach this systematically, he told the couple. First he would get a head CT, then a scan of the neck, and then he would do a lumbar puncture – a spinal tap. He felt optimistic that one of those tests would give him an answer.

You can see Dr. Martinello’s note here.

Hospital Note

Solving the Mystery

Dr. Martinello did get an answer. But it wasn’t the one he was expecting.

The first reader to identify the cause of this man’s illness gets a copy of my book and the pleasure of making a difficult diagnosis. The answer will be posted Friday afternoon on Well.

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.

When the Patient Won’t Ever Get Better

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Credit Stuart Bradford

“Tell me,” my patient’s daughter asked at the other end of the phone line. “Is she stable?”

I wasn’t sure how to answer.

My patient hadn’t been home in nearly three months. It had all started to come apart in the fall. Until then, she’d been a healthy 90-year-old who lived alone and cooked all her own meals, played tennis in the summer, binged on movies in the winter. But then there was a strange pain in her back, a visit to an urgent clinic and a harrowing ambulance ride to the emergency room. A tear had developed in the wall of her aorta, one of the main vessels carrying blood from the heart. In a windowless conference room, the doctors told my patient’s family that without emergency surgery, she would most likely die.

To her family’s relief, the surgery went well. But there were complications – first pneumonia, then kidney failure, delirium, profound weakness. After two weeks she hadn’t died, but she hadn’t recovered, either. Because she was still dependent on the ventilator, her doctors took her back down to the operating room for another procedure, a tracheotomy, cutting a small hole in her neck to serve as a more permanent connection for the ventilator. Because patients with tracheotomies can’t eat using their mouths, at least not at first, she returned from the O.R. with another new tube, a feeding tube in her stomach.

Another few weeks passed in the I.C.U. It seemed that as soon as one infection got under control, another developed. From time to time, my patient’s delirium seemed to clear – when she was strong enough to breathe through the tracheotomy without the ventilator, she could speak with her family and offer one-word answers to questions. Her whisper was so soft they could barely hear her. On other days she was scared and wild-eyed, hands bound with soft “mitten” restraints to keep her from pulling out the feeding tube that delivered the thick white liquid slurry pumping from a bag on an IV pole above her head directly into her stomach.

One day, her family learned that she had a bed at another facility, called a long-term acute care hospital. This was good news, her doctors told the family. It meant that this weak, intermittently delirious woman who looked nothing like the spry 90-year-old who’d come to urgent clinic some months before didn’t need the I.C.U. any longer. They were cautiously optimistic.

In this new hospital, she did get better. Some days she managed to stay off the ventilator for eight hours, then 12, then a day, then two. Her tracheotomy was removed and the hole in her neck started to heal. Her delirium lifted, replaced by a dull, lifeless gaze. Her kidneys improved. And then, things stopped getting better. Time slowed. There she was – neither dead nor truly alive – stuck, it seemed, in limbo.

One Saturday, she spiked a fever. Her breathing grew ragged. Back in the E.D. she was intubated once again, then sent up to the I.C.U., where her daughter called us to ask, “Is the stable?”

I debated about how to respond. The ventilator was delivering sufficient oxygen. Intravenous med drips were acting directly on her heart to keep her blood pressure at an acceptable level. Her kidneys were functioning to make urine.

But behind the façade of stability was a more dire truth: she might never get better. With her constellation of ventilation dependence, infections and delirium, she had what doctors call “chronic critical illness.”

Her story isn’t unique; there are about 100,000 chronically critically ill patients in the United States at any one time, and with an aging population and improving medical technologies, this number is only expected to grow. The outcomes of these patients are staggeringly poor. Half of the chronically critically ill will die within a year, and only around 10 percent will ever return to independent life at home.

Chronic critical illness is not something I learned about in medical school, or something that many doctors even talk about. One reason might be that the care for the chronically critically ill quite literally takes these patients out of our view – they move, as my patient did, from hospital to long-term care and back again, accompanied by a growing stack of medical records as things slowly fall apart.

In the early moments of critical illness, the choices seem relatively simple, the stakes high – you live or you die. But the chronically critically ill inhabit a kind of in-between purgatory state, all uncertainty and lingering. How do we explain this to families just as they breathe a sigh of relief that their loved one hasn’t died? Should we use the words “chronic critical illness”? Would it change any decisions if we were to do so? Here, I find that I am often at a loss.

I was quiet on the other end of the phone line that night. Was my patient stable? For the moment, she was. But with each event like this one, and there would be more, my patient would move further from the hope of ever reclaiming that life she had had in the fall: living in her own home, watching movies, cooking. I felt that I could see the weeks and months spooling out, a moment of calm, a new emergency. But this wasn’t the time to tell her daughter, not on the phone, not tonight.

And so I told her the truth – one truth, at least. Her mother was critically ill, but stable for the night.

Daniela Lamas is a pulmonary and critical care fellow at Brigham & Women’s Hospital in Boston.

Letting Patients Tell Their Stories

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Credit Lehel Kovacs

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Credit Earl Wilson/The New York Times

Friday night in the emergency department is about what you’d think.

It starts off slow: a middle-aged man with a middling pneumonia; an older nursing home resident with a urinary tract infection that is making her delirious. Then come two heart attacks at the same time, followed by a drunken driver with a head bleed and half his rib cage fractured. At midnight, in roll the inebriated members of a bachelorette party that has not gone, one assumes, according to plan.

Amid the chaos, I break off to greet a thin, older man, quietly bundled up on a hallway stretcher. I look over his chart and prior scans. His prostate cancer has grown through several chemotherapy regimens. His spine is full of tumor and he’s been vomiting everything he eats or drinks for weeks. He can’t move the left side of his body after a recent stroke.

He smiles a charming, crooked smile. “It hasn’t been the best month of my life.”

“I’m sorry to hear that.”

I ask him about his symptoms, when they started, how bad they’ve gotten. He asks me where I went to medical school and if I have a girlfriend. I ask him if he’s dizzy and whether there’s blood in his stool. He tells me he emigrated from Greece 50 years ago, almost to the day. He won a scholarship to M.I.T. and studied electrical engineering. There he met his wife — “a fantastic cook” — and started his first company.

Now, decades later, he’s alone — in a crowded emergency room, on a Friday night, his wife dead, his two sons overseas, a nurse visiting him once a week at home to help him with some medicines and make sure the various tubes coming out of his body aren’t infected.

I ask him when he last moved his bowels.

“Son, I’m dying. I’m alone. One day you’ll learn there’s more to a good death than how often I move my bowels.”

I pause.

I am better at many things than I was when I started my journey to become a physician more than a decade ago. But I am not sure that understanding patients as people — and placing them in the context of their long, messy, beautiful lives — is one of them.

Doctors are trained first to diagnose, treat and fix — and second, to comfort, palliate and soothe. The result is a slow loss of vision, an inability to see who and what people are outside the patient we see in the hospital.

As we acquire new and more technical skills, we begin to devalue what we had before we started: understanding, empathy, imagination. We see patients dressed in hospital gowns and non-skid socks — not jeans and baseball caps — and train our eyes to see asymmetries, rashes and blood vessels, while un-training them to see insecurities, joys and frustrations. As big data, consensus statements and treatment algorithms pervade medicine, small gestures of kindness and spontaneity — the caregiving equivalents of holding open doors and pulling out chairs — fall by the wayside.

But all care is ultimately delivered at the level of an individual. And while we might learn more about a particular patient’s preferences or tolerance for risk while explaining the pros and cons of a specific procedure or test, a more robust, more holistic understanding requires a deeper appreciation of “Who is this person I’m speaking with?”

In Britain, a small but growing body of research has found that allowing patients to tell their life stories has benefits for both patients and caregivers. Research — focused mostly on older patients and other residents of long-term care facilities — suggests that providing a biographical account of one’s past can help patients gain insight into their current needs and priorities, and allow doctors to develop closer relationships with patients by more clearly seeing “the person behind the patient.”

In the United States, Medicare recently began paying doctors to talk with their patients about end-of-life planning. These conversations allow patients to discuss and explore their preferences about a slew of complex medical interventions, including clinical trials, transfers to the intensive care unit, use of mechanical ventilation or feeding tubes, and the desire to die at home or in the hospital. These discussions, too, may benefit from a biographical approach, in which patients are able to elaborate on what is and has been most important in their lives. To better serve patients, we need to see not only who they are, but also who they were, and ultimately, who they hope to become even at the end of life.

How much more effective would we be as diagnosticians, prognosticators and healers if we had a more longitudinal understanding of the patient in front of us? If we saw not just the shrunken, elderly Greek man on the emergency room stretcher in front of us, but also the proud teenager flying across the Atlantic to start a new life half a century ago?

The emergency room is, by its nature, an arena designed for quick thinking and swift action. There are certainly other places, times and circumstances more conducive to probing goals-of-care discussions and lengthy forays into the internal lives of patients.

Still, there is always some moment of grace and meaning we can help patients find in the time they have left, a moment that recalls a time when they felt most alive — even if it’s just a fleeting conversation about gyros and electrical circuits in a busy emergency room, late on a Friday night.

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Dhruv Khullar, M.D., M.P.P. is a resident physician at Massachusetts General Hospital and Harvard Medical School. Follow him on Twitter: @DhruvKhullar.

Most Dangerous Time at the Hospital? It May Be When You Leave

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Credit Stuart Bradford

His wife assured me he was the life of the party, the kind of guy “you pay to stop talking.” But her description only added to the concerns I had about my patient, a drowsy older man with gnawing abdominal pain. He listlessly told me he had noticed his stool was darker than usual, a sign of bleeding from the G.I. tract “Doc,” he could barely get the words out, “I didn’t think nothing of it till I started feeling woozy. Then I thought a lot of it.”

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Dr. Dhruv Khullar

Dr. Dhruv KhullarCredit Tom Fitzsimmons

As a medical resident, a doctor-in-training who leads much of the day-to-day patient care in the hospital, I’m among the first to see patients. Along with my team, I assume the bulk of the logistical duties of admitting new patients – interviewing them and their families, writing orders, calling consultants, scheduling appointments and responding to sudden changes in their clinical condition. When I started residency, I personally carried out most of these tasks. Now, as I progress in my training, I’m increasingly supervising younger residents doing them.

For this patient, our team immediately stopped any home medications that could further lower his blood pressure — in his case Lasix, a “water pill” that removes extra fluid in patients with heart failure. We rushed him to the endoscopy suite, where doctors placed a clip on the site of the bleeding. I was impressed with how rapidly he recovered. His wife, it turned out, was right. He did talk, a lot. I even took a small measure of satisfaction at my quick recognition and management of his condition. Victory.

Not quite. The patient was feeling better and insisted on being discharged, though we had hoped to monitor him in the hospital for another day or so before resuming his medications. Together, we decided it would be O.K. for him to leave, provided he saw his primary care doctor in a few days to restart his medications at the right doses.

I completed the discharge summary, and the patient went home. But he skipped the follow-up appointment. He still hadn’t started his water pill when he finally saw his doctor a week later. By then, fluid had accumulated in his lungs, his breathing had grown labored and I got the dreaded ping on my cellphone: “your patient has been readmitted.”

When we’re notified a patient we discharged has been readmitted, it’s generally a mark of shame, generating a sense that we failed to do enough to restore our patients to good health. But discharging a patient from the hospital is among the most difficult and dangerous aspects of providing medical care. It’s a tumultuous time, when the results of many lab tests may still be pending, medication regimens have been disrupted, and the doctors in charge are often left speculating about whether a patient is truly ready to leave. In the meantime, most patients who are feeling better just want to go home – and they let us know.

One-fifth of Medicare beneficiaries are readmitted within 30 days of discharge, and one-third are readmitted within 90 days. One study found that 20 percent of patients have a complication within three weeks of leaving the hospital — more than half of which could have been prevented or ameliorated. Thankfully most complications are minor, but some can be serious, leading to permanent disability or death. All told, Medicare spends $26 billion annually on readmissions, $17 billion of which is for readmissions that are considered preventable.

Issues crop up after discharge for many reasons. One factor is the process we use to admit versus discharge patients. In teaching hospitals, a junior resident — a year or two out of medical school — typically spends hours interviewing a patient, gathering information and developing a plan. He or she might then discuss the plan with more senior residents before ultimately presenting the case to the attending physician in charge. Together, they all examine the patient and settle on a plan, which is updated every day.

Contrast this with the discharge process. Ideally, it begins at admission through discussions with case managers and family members. But there’s often a rush toward the end of hospitalization — when a patient wants to leave or a rehab bed opens up — leading to a haphazard set of final conversations, appointments and prescriptions. And because the exact time of discharge is uncertain, the doctor discharging a patient may not be the one who knows the patient best.

It’s also often not clear exactly when a patient should be discharged. There’s no green light that turns on when a patient recovers or crystal ball that predicts what will happen afterward. In the hospital, we constantly monitor a patient’s vital signs, blood tests and clinical condition. But after hospitalization, patients live in a very different environment — and there’s tremendous uncertainty in that transition. Sometimes the difference between discharge today versus tomorrow is a more frustrated patient and higher medical costs. Sometimes it’s a devastating complication that hasn’t yet declared itself.

As patients recover from their immediate illness, the remaining diagnostics and treatments are often completed after discharge. But this is where we struggle most. Research suggests direct communication between hospital doctors and primary care doctors occurs infrequently and that discharge summaries — detailed records of a patient’s hospital course — are often unavailable at a patient’s first post-hospital visit. Almost 30 percent of patients are discharged with a plan to continue workups after hospitalization, but more than one-third of these are never completed. Similarly, more than 40 percent of patients have lab tests pending at the time of discharge — with 10 percent requiring action—but most physicians remain unaware of them.

There are steps that patients, doctors and hospitals can take to improve the transition from hospital to community — and we’re starting to make progress. Post-discharge phone calls, nurse-led discharge planning, visiting nurses, and dedicated “transition coaches” have all been shown to lower readmission rates. Pharmacists reviewing medications with patients can reduce drug-related complications. Ensuring high-risk patients see doctors within a week of discharge can prevent readmissions. Moving forward, greater use of telemedicine and dedicated post-hospital discharge clinics or specialists will be part of the solution.

More seamless transitions from hospital to clinic require recognizing that our responsibilities to patients continue, and sometimes increase, when they leave us. Like many of medicine’s important but often overlooked areas — prevention, screening, care coordination — discharge planning is not widely celebrated. But for patients hoping to stay out of the hospital, it may be what matters most.

Dhruv Khullar, M.D., M.P.P. is a resident physician at Massachusetts General Hospital and Harvard Medical School. Follow him on Twitter: @DhruvKhullar.

The Costumes That Obscure Doctor and Patient

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Credit James Yang

Is it time for new costumes in the long-running improv act featuring doctor and patient? The white coat and the cotton gown are tattered, under continual assault for their practical deficiencies and outmoded symbolism.

Along with ties and long sleeves, Britain banned white coats for most doctors almost 10 years ago. Our priestly garb turns out to harbor quantities of bacteria, including the hospital-associated germs we try to keep away from patients.

Presumably all garments carry bacteria, including the vestments of priests. The clergy, though, probably tote a less noxious load — and probably change robes more often. Doctors report that they do so only every couple of weeks, long enough for grime to accumulate.

Most American medical schools now bestow a fresh white coat on every new student, a symbol of our exalted professional aspirations. Some American hospitals now discourage those selfsame coats in the name of hygiene. Draw what moral you will. Many pediatricians would no more dress in a white coat than in a gorilla suit, lest they scare the little ones. Some adult doctors, reasoning that we are all children in illness, feel likewise. Some of us just need the pockets.

The best clinician I ever knew was draped in a grayish shabby thing spilling over with scraps of paper, vaguely redolent of his usual weekday lunch of pea soup. Whether you were a patient or a trainee, you didn’t really want him near you, until you quickly figured out that you really did.

One of the worst specimens of doctor I’ve run into wore snowy white, changed daily. You really didn’t want that guy near you, period, as many of his patients ultimately realized, including the ones who took him to court.

The symbolism surrounding patient gowns is just as fraught. They are cheap, demeaning, undignified and chilly. One way to cope is to wear two of them, one opening to the front and one to the rear. Thus encased, the patient is snug and warm, and also extremely well defended from inquisitive fingers and probing stethoscopes. It turns out that actual clothes are far easier to push aside for an examination than are two johnnie gowns firmly knotted together.

But patient gowns are out of style in some places mostly because they clash with the dominant medical fashion these days: doing everything at top speed. People need time and privacy to dress and undress. Medical settings without time or extra space find their stacks of clean gowns going undisturbed.

Instead, patients disrobe incompletely, or sometimes not at all, just opening little portals in their clothing through which what passes for a physical examination can be performed. Such accommodation is regrettable, but necessary to maintain our cruising speed. Call it laparoscopy for the nonsurgeon.

For my professors, the physical exam was a sacred ritual. I sometimes wonder which would distress them more: the thought of treating a rash glimpsed only on a cellphone screen, or the idea of asking a patient to open two shirt buttons under his tie for a quick inspection of that thing on his chest. I’ve been guilty of both.

A couple of months ago, on a frigid winter day, a stolid, silent patient came in because her knee hurt. “Just give me something,” she said. I was sorely tempted, but I couldn’t do it: I had to examine both unclad legs. She cast me a look of pure disgust and hauled herself to her feet.

It took almost 10 minutes for her to peel off the layers of tight, ill-fitting jeans, socks, pantyhose, more socks, more hose, long underwear, down to the arthritic knee. It took another 10 minutes to put it all back on.

My professors would have stepped out to give her some privacy. For some reason, I stayed where I was.

Those 20 minutes were death to the day’s schedule, but invaluable for showing the harried doctor something of the grim labor of everyday life for this patient, a heart-rending discomfort of binding elastic and straining seams she could never have articulated, and, of course, one that would have been invisible with her on display in a hospital gown.

It was the process that educated, not the final tableau.

We are never more human than when we are dressing and undressing, and yet for our medical care, we have, for some reason, decided to posture in front of one another fully costumed, pretending that, encased in our separate roles, we will get to the bottom of the pain.

Perhaps we need not new costumes but new stage directions. Perhaps doctors should routinely watch patients undress and then dress again. Perhaps, for that matter, patients should watch doctors washing their chapped hands yet again and putting on their white coats, checking the pockets for tools, phone numbers, reminders, lists of urgencies, looking at those coffee stains and wincing, vowing to get to the laundry and then forgetting.

For Transgender Patients, Challenges at the Hospital

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Beck Bailey has encountered some health care professionals who were unsure how to treat transgender patients.

Beck Bailey has encountered some health care professionals who were unsure how to treat transgender patients.Credit Kieran Kesner for The New York Times

After a skiing accident in January left him with a smashed knee, Beck Bailey, a transgender man in Greenfield, Mass., spent 15 days in a Vermont hospital undergoing a handful of surgeries. As part of his normal routine, Mr. Bailey gives himself regular shots of testosterone. But the endocrinologist on duty in Vermont told him that patients should not take testosterone post surgery.

Mr. Bailey explained that he couldn’t just stop his hormone treatment. But the doctors were so resistant that he finally had them call his primary care physician, who explained he should resume his usual protocol.

“I don’t expect every doctor in the world to become an expert in trans medicine, but I do think they should be knowledgeable enough to know what they don’t know and pick up the phone and call an expert,” said Mr. Bailey, 51, deputy director of employee engagement at the Human Rights Campaign, an advocacy group for gay, lesbian, bisexual and transgender people.

Mr. Bailey’s experience is echoed by many transgender patients, both those who have fully transitioned and those in the process. Research on nontransition-related medical needs is limited; most medical schools don’t prepare doctors for treating this community.

“What happens once you get past the immediate issues of transition, and you run into problems with diabetes, cancer, with the E.R.?” said Karl Surkan, 46, a professor of women’s studies at M.I.T. and Temple University.

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Credit Mark Makela for The New York Times

Mr. Surkan, who is transitioning from female to male, has firsthand experience: He carries the BRCA1 gene and was given a diagnosis of breast cancer. When he inquired about whether testosterone would affect his cancer treatments, his oncologist told him, “It probably would, but we don’t have any data on whether testosterone would cause a recurrence of your cancer. We wish we could help you.”

Indeed, there are few longitudinal studies on hormone use in the trans community. Many doctors aren’t aware that some transgender men may still need pap smears, breast exams and mammograms, and that all transgender women should be screened for prostate problems.

“Many transgender men and women have not had genital affirmation surgery and retain reproductive organs they were born with,” said Dr. Harvey Makadon, the director of education and training programs at the Fenway Institute in Boston and a clinical professor of medicine at Harvard Medical School. “All transgender women still have a prostate gland, and a good clinician will need to learn about the current anatomy and provide appropriate preventive screening and care.”

In addition to medical concerns, many trans patients say they are discriminated against by doctors and other medical staff members who misuse pronouns, call them by incorrect names or house them with people of the wrong gender.

According to a 2010 report by Lambda Legal, 70 percent of transgender respondents had experienced serious discrimination in health care. And a 2011 study of more than 6,000 transgender people by the National Center for Transgender Equality and the National LGBTQ Task Force found that 19 percent said they had been denied health care because of their transgender or gender nonconforming status. Many of them avoided the doctor’s office altogether: 28 percent had postponed getting health care when they were ill or injured, and 33 percent had delayed or not sought preventive care because of their past experiences with doctors.

A 2014 report by the HRC Foundation found that out of 501 hospitals researched, 49 percent did not include both “sexual orientation” and “gender identity” in their patient nondiscrimination policies.

Hospitals, for their part, are often flummoxed. Where, for example, should they put a patient who identifies as female, but is anatomically still male or listed that way on their birth certificate?

Mr. Surkan said that he has been placed in hospital rooms with other women. “It doesn’t bother me as much as it bothers people who are housed with me,” he said. “I do have a friend who is much more masculine appearing who had a hysterectomy, and he was put in the ward with women. That was pretty awkward for everybody.” He has since co-founded the TransRecord, which, together with sites like RAD remedy, act as a kind of clearinghouse for trans people seeking medical care.

In July, a transwoman alleged sex discrimination at Brooklyn Hospital Center after being placed in a room with a male roommate. “We didn’t realize that the individual was transgender,” said Joan Clark, a hospital spokeswoman. The hospital now requires all employees to undergo sensitivity training. “I think it’s made us a better organization,” she said. “They don’t want different treatment, they just want equitable treatment.”

Wrene Robyn, 46, a transwoman in Somerville, Mass., began her transition in 1989, when she changed her name on her driver’s license and Social Security cards, and the gender on her driver’s license from male to female. While she integrates fairly well into mainstream society, she has avoided the doctor for years. “Most trans people don’t go to the hospital, because they’re terrified of the room situation,” she said. “They’re terrified of it all. They don’t want to be misgendered, and they don’t want to explain what they have or don’t have in their pants.”

In April, after a bout of pancreatitis, Ms. Robyn spent a week in Massachusetts General Hospital in Boston, where she was given a single room. “Nobody really asked me what my preference was,” said Ms. Robyn, who works as a software engineer at the hospital and also serves on a transgender care committee there. In addition to worrying about being discriminated against, “What goes through a lot of trans people’s minds is, is this going to cost more? Usually we can’t afford private rooms.” (It was covered by her insurance.)

Some hospitals are now overhauling — or implementing — policies on treating transgender patients. At Mass General, for example, transgender patients are now asked if they prefer a private room or double. “If they are going to be placed in a double room, we ask them how they identify themselves,” said Terri Ogan, a spokeswoman. “If the patient identifies as a woman, they will be placed in a room with a woman. If they identify as a man, they will be placed in a room with a man.”

Transgender patients at Mount Sinai Health System, which encompasses seven hospitals in New York City, have been housed according to their current gender identity, regardless of where they are in their physical transition, since 2013. They can also request a single room. Previously, the hospital always put them in private rooms, but that had drawbacks: Many patients felt as if they were being segregated, and worried that they would be charged extra (they weren’t). “Often the transperson would be delayed or in the E.R. waiting for a single room to open up,” said Barbara Warren, the director for L.G.B.T. programs and policies at Mount Sinai’s office for diversity and inclusion.

Terry Lynam, a spokesman for North Shore LIJ Health System, which has 21 hospitals in New York City, Long Island and Westchester, said that their transgender policy, which was approved in November of 2014, is to treat transgender patients like any other patient. “So, we wouldn’t necessarily give them a private room,” said Mr. Lynam. But, he acknowledged, the issue becomes a bit more complicated with patients who still look like the sex they were assigned at birth. In that instance, if a roommate objects, “We’ll try to accommodate them and move the person who complains,” he said.

Advocates see this as a long time coming. “I’ve been telling hospitals that they really need to think about this and adopt some policies proactively,” said Tari Hanneman, deputy director of the Health and Aging Program at the Human Rights Campaign. “The first time you think about where you are going to put a transgender patient should not be when they arrive.”

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In Hospitals, Smoke-Free Doesn’t Mean Abuse-Free

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Credit James Yang

The substance user and the hospital are bound by the most ambivalent of relationships. Heavy users — of tobacco, alcohol or harder drugs — see far more of the wards than the average citizen and, it is safe to say, like them even less.

They need hospitals. They hate hospitals. Hospitals make them well and sick at the same time. We are their doctors and nurses, their parents, their arresting officers, parole officers, judge and jury. Needless to say, we are not trained for the last five roles, nor are we particularly good at them.

A single principle guides us: You cannot use your drug of choice on our premises, no matter how much you may need it and prefer it to our proffered alternatives. Around that immutable core swirl large clouds of negotiation, compromise, duplicity, manipulation and general misery for all involved.

On some days it seems as if we spend all our energies managing not the conditions we are trained to manage but the addictions that complicate them.

One patient is tying his shoes as we make our rounds in the morning, and tells us cheerfully that he is going out for a smoke. He’ll be right back. We inform him, not without sympathy, that in our hospital smoking breaks are not allowed. If he leaves for even half an hour he will officially be considered discharged. His bed will be given to someone else, and to resume his medical care, he will have to go back to the emergency room and start the cycle all over again.

We propose a nicotine patch instead, but the nurses have already given him a patch, to no effect. Few other compromises are possible between the smoke-free hospital and the hard-core, implacable smoker. The discussion grows heated. We wind up discharging him on the spot, just a little sooner than we had in mind.

The patient in the next room has been in the bathroom for almost an hour. We need to examine him. We knock on the bathroom door. He yells out that he’s fine.

When he finally drifts out, drowsily readjusting the dressing covering the intravenous line in his arm, he doesn’t look fine. He looks as high as a kite, and come to think of it, the two visitors lounging by his bed do, too. We sigh. No easy compromises will be possible for him.

It was back in the 1980s that most American hospitals became officially smoke-free (and cigarette butts began accumulating in stairwells and side exits). The big exceptions were the V.A. hospitals: In fact, theVeterans Health Care Act of 1992 specifically required V.A. facilities to establish designated smoking areas for clients. In 2008, those areas were all moved outdoors, and most V.A. hospitals still have them.

This policy has been bitterly criticized as the worst kind of tobacco industry manipulation, but it does serve a useful function: It allows medical care to proceed without major interruption. Granted, that care is often for tobacco-related conditions, a cycle that strikes some observers as a common-sense, harm-reduction approach to the real world, and others as completely insane.

Still, smokers pose fewer challenges than intravenous drug users, like that young man who wandered out of his bathroom to face our interrogation. He has an infected heart valve, and is receiving high doses of antibiotics through an intravenous line in his arm, a portal to his bloodstream that is apparently proving too tempting for him to ignore.

He needs antibiotic treatment, and we have no oral options for him. Among other considerations, if his guests keep providing him with substances to shoot into that line, it may well become infected and unusable, and he will get even sicker than he is.

He promises never to do it again.

So now what? We have a set of programmed responses, none particularly satisfying or effective.

We can give him some methadone to keep him from withdrawing. We can screen his visitors or post a watcher at his bedside. Some hospitals transfer patients like him to an expensive intensive care bed for even more careful monitoring. Some make contracts and threaten to kick patients out for violations. (Can we really kick them out, as desperately sick as they are? I’ve never actually seen that happen.)

Addiction experts point out that hospitalizations offer an excellent opportunity to urge addicts into treatment. Unfortunately, inpatient acute care hospital wards are spectacularly ill equipped to provide that treatment, which would require a specially trained, dedicated team of medical and mental health professionals able to treat infection and addiction at the same time, in the same bed, on the same premises. It doesn’t sound like a particularly expensive proposition, but it must be one, because it’s another thing I’ve never seen happen.

Instead, we routinely plan for patients to be transferred to drug treatment programs when they are discharged. Quite a few don’t last that long. Our patient will prove to be one of them: After a few more days, he will suddenly be gone, well enough to walk out of the hospital (and take his intravenous line with him).

Presumably, he will try to make it out in the world until he gets too sick and lands in another hospital, where events will repeat themselves in yet another baffling health care cycle.

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Think Like a Doctor: Drowning on Dry Land

The Challenge: A healthy 67-year-old man develops an annoying little cough that, over the course of a week, worsens and nearly takes his breath away. Can you figure out why?

Every month, the Diagnosis column of The New York Times Magazine challenges Well readers with a real-life diagnostic question. In this case, a retired Air Force officer shows up in an emergency room with chest pain so severe he can barely breathe.

I will provide you with the history, data and imaging available to the doctor who made the diagnosis. It’s up to you to make it all make sense.

The first person to identify the cause for these symptoms will win a copy of my book, “Every Patient Tells a Story.”

The Patient’s Story

“I think you’re dying,” the anxious wife told her husband of 38 years. Her 67-year-old spouse sat propped up at the head of the bed. His chin rested on his chest and his face bobbed up and down with each rapid fire breath. He gazed up at her from beneath his shaggy gray eyebrows.

“I’m going … to be … O.K.,” he panted in a whisper.

She didn’t think so, and she wasn’t alone. She had just spoken to one of his oldest friends, and he was worried too, she told her husband. The friend thought they should go to the hospital.

“Now?” the man breathed.

She nodded. He finally nodded in return. He would go.

A Knife in the Back

It all happened so fast. An annoying little tickle that started maybe a week before was now a great wracking cough. Every breath felt like a knife cutting through to his back. The pain was so severe he couldn’t take a deep breath, and he felt like there was so much stuff in his lungs that the little breaths he could take didn’t bring in enough air.

As he sat on his bed struggling to breathe, he suddenly flashed back to a morning many years ago when, as a small child, he’d fallen into the deep end of the pool. He sank to the bottom, arms and legs flailing, the need for breath overwhelming. Suddenly he saw an explosion of bubbles, then felt strong hands lift him up, back into the air. Back where he could breathe.

Now more than 60 years later he felt like he was struggling the same way. This time without the water, but still in need of rescue.

The 30-mile drive from their home to Huntsville Hospital in Huntsville, Ala., was mostly on the interstate, but every tiny bump or dip brought a soft grunt of pain. The man held onto the strap above the window, willing himself motionless.

His wife walked him into the emergency room, then hurried to park the car. By the time she got back he was already in a bed and, with oxygen piped into his nose, a little more comfortable.

Downhill at the Fishing Camp

Dr. Robert Centor, the attending physician on call at the hospital, had heard about the patient the night before and was eager to see him the next morning on rounds.

He’d started off with a little nothing of a cough, the man told Dr. Centor. He mentioned it to his own doctor just before he went out to his fishing camp with some pals. After listening to his lungs, his doctor had pronounced him “just fine.”

But the cough kept getting worse, going from occasional to constant practically overnight. He couldn’t read or eat or sleep. Lying down made it even harder to breathe, so he spent two nights in a recliner. And the friends who’d come to the camp with him got absolutely no sleep because of his persistent hacking.

The third day of their trip, his chest began to hurt. Every breath felt like a dagger. Moving made it worse. So did breathing. He got out of breath just walking to the kitchen. His friends were worried. And, finally, so was he.

As soon has he got home his wife took him to the local emergency room. A chest X-ray showed cloudy white patches over both lungs. He had no fever nor any sign of infection, and so the E.R. doctor figured it was probably his heart. The patient could stay in the hospital and see his doctor there or go home and see her in her office the next day.

It was an easy decision: He’d much rather go home. The E.R. doctor admonished the patient to see his doctor as soon as he could and let him leave.

A Problem Heart?

The patient saw his doctor a couple of days later, and a brief exam convinced her that the E.R. doctor was right: It probably was his heart. It was hard to imagine any other reason for there to be clouds all over both of his lungs. Not too many things could do that. You could see it with a whopping pneumonia – but he had no fever or other signs of infection. Or you could see it with something known as congestive heart failure, which is what the emergency room doc thought he had.

Congestive heart failure reflects a problem not with the lungs but with the muscle of the heart, the doctor explained. It gets injured somehow – maybe because of a heart attack or infection – and suddenly it can’t beat as strongly as it had. Fluid from the blood, which should have been pumped out into the body, was instead backing up into his lungs.

She sent him home on a powerful diuretic to help draw the water out of his chest and arranged for him to have an echocardiogram, an ultrasound of his heart, to confirm her diagnosis.

The diuretic kept him in the bathroom for much of the next two days, but it didn’t seem to help at all. And so his wife, with the support of his friends, finally convinced the breathless man not to wait for the “echo” but to go right then to the big university hospital in Huntsville.

A Healthy Guy, Until Now

As the man and his wife told their story, Dr. Centor took a good look at his new patient. He was tanned and trim – clearly not someone who spent much time being sick. But he coughed frequently, and every paroxysm brought a grimace of pain to his face.

Before this, the man told him, he’d been pretty healthy. He took a medication for high blood pressure and another for his heartburn. A month earlier, he’d had knee surgery, an operation that left him with a big pus-filled wound – red, hot and incredibly painful. So, for the past few weeks his wife had been injecting a syringe full of an antibiotic, called Cubicin, into an intravenous line he had snaking up through his left arm. It was clearly doing its job because, although his knee was still pretty sore, there was no more pus and it looked a whole lot better.

He quit smoking five years ago. He drank sometimes with his pals on special occasions but hadn’t had anything since he started taking the antibiotic. He exercised regularly, at least before the surgery.

The couple had a dog, but no birds or other pets. He had retired five years earlier, but during his career he had been assigned to bases all over the world – especially the Middle East. He spent a lot of time in Afghanistan. And he’d done some time as a pilot in Vietnam, where he’d been exposed to Agent Orange, the herbicide used there that had been associated with many health problems later in life.

Working to Breathe

On exam, the patient’s breathing and heart rate were high and his oxygen level was low – a bad combination.

Dr. Centor gently placed a hand on each side of the patient’s neck and could feel the strap muscles there tense with every breath. These muscles are recruited to help breathing when needed; they pull the rib cage up to help the patient suck in more air. And when Dr. Centor listened to the patient’s lungs he heard a cacophony of tiny snaps with every breath, as if inside his ribs a sheet of bubble wrap was exploding. His knee revealed a well healing surgical scar.

Dr. Centor had already seen the X-ray and CT scan done the day before. You can see the chest X-ray and the CT report here.

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The chest X-ray showed cloudy white patches over both lungs.

The chest X-ray showed cloudy white patches over both lungs.Credit

The CT Report

Reviewing the Notes

The radiologist thought it was an infection, and so the patient had been started on the usual antibiotic combination for pneumonia. But why had this healthy retiree developed a whopping pneumonia – not in part of one lung, which is usually what occurs with pneumonia, but all over, and in both lungs?

Dr. Centor reviewed the notes from the E.R. and from his resident, and the data from the labs. You can see those notes and labs here.

Emergency Room Note

The Resident’s Note

The Lab Reports

Solving the Mystery

What was he missing? Dr. Centor asked himself.

He figured it out. Can you?

Submit your responses in the Comments section. As usual, the first person to figure out the diagnosis gets a copy of my book. And that warm satisfaction that comes from solving a mystery.


Rules and Regulations: Post your questions and diagnosis in the comments section below. The correct answer will appear Friday on Well. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.