As his kitchen clock ticks, Mitch Haverstuhl slides down a wall to sit on the floor. His two big black dogs sprint over for attention.
“It’s only six weeks,” he assures them. And himself.
His longtime girlfriend, Korelle Melcarek, pours coffee into a blue thermos with big white letters: MICU. It stands for the medical intensive care unit, where Mitch works as a nurse caring for the sick and dying.
He hops up. It’s almost time to go.
It is early April, and at 7 a.m. tomorrow, he will report to White Plains Hospital to begin a six-week tour in the nation's epicenter of COVID-19, the disease caused by the novel coronavirus. The small public hospital was the original pandemic hotbed in New York. It sits about 25 miles outside of Manhattan and 10 miles from New Rochelle, ground zero of the country's outbreak.
Mitch is 27 and has no idea what to expect.
Just nine days have passed since he first thought of doing this while watching news of overwhelmed hospitals and medical workers terrified for their lives.
His own world couldn’t be more different. At the Medical University of South Carolina, where he works, leaders just announced layoffs and pay cuts given most hospital beds sit empty. The MICU has so few patients — four in 17 beds — that Mitch got called off work one day.
Bored, scrolling through Instagram, he'd noticed ads for travel nurse agencies. They promised big money to go work in coronavirus hot spots on short-term contracts.
Nine days ago, Mitch mused to a friend: “I should really go up to New York.”
That was a Thursday.
On Friday, he approached his nurse manager.
On Saturday, he signed a contract. He would have caught a flight right then if things like paperwork hadn’t delayed him.
Instead, he got his start date: April 12, Easter Sunday. Tomorrow.
Korelle, a nurse at the local veterans’ hospital, fears him contracting coronavirus and dying. But he is young and healthy, and almost 800 New Yorkers are dying every day. So she hasn't objected. They’ve been together almost six years. She knows he’ll just go anyway.
Mitch, fit and tattooed, gives his dogs a final head rub and hops up. “All right, 15 minutes.”
“Got everything packed?”
He strides through their West Ashley house, then emerges with a black duffel bag and tan backpack. They head out.
At Charleston International Airport, only three other cars and a FedEx truck are parked in the entire drop-off area due to massive shutdowns across the country. It feels apocalyptic.
Korelle meets him at the trunk.
“Please be safe."
A new world
At 5:50 a.m. the next morning, Mitch emerges from the Marriott hotel he will call home for the next six weeks. His shift starts at 7.
He zips his jacket against the chilly darkness and drizzle. Ahead, the road stretches quiet, street lamps illuminating the way. White Plains Hospital is a 16-minute walk past office buildings, restaurants and a Gulf gas station. Paper signs on doors apologize for closures due to coronavirus.
He is wholly unsure what to expect when he arrives.
A couple days ago, when he spoke to a nurse manager at the hospital, he could hear it in her voice. Rushed. Panic. They have 80 ICU beds, all full.
Approaching the six-story hospital, he follows people in scrubs heading for a door near a big triage tent. Inside, a volunteer aims a thermometer at his forehead. She hands him a surgical mask.
White Plains normally houses about 250 inpatients. Now it's set up to take 375. Sick patients fill every room. About 80 percent have COVID-19.
A supervisor directs him to the hospital’s main ICU on the third floor. As he searches for it, he stops several nurses to get directions. Three of them are other travel nurses wandering around just like him, all arriving for their first shifts.
How many of them are here? he wonders.
When he finds the ICU, he enters a cramped room where staff don protective gear before going inside. He pulls on the N95 respirator he will get for the day, then a yellow plastic gown over royal blue scrubs. Blue gloves. Goggles. Booties. Face shield.
Then he opens the doors.
Commotion fills a cramped fish-bowl type of area with a few computers, telephones and printers where nurses and other staff work. Three patient rooms fan out on one side. Five stretch in front of the fish bowl.
The space looks oddly improvised. Patients’ room doors are aluminum, like you’d install on a patio. Windows in each are gone, replaced by boarding and machines that create a one-way stream of contaminated air to the outside.
The nurses look exhausted. He wonders if they will resent him, given travel nurses make much more money than the staff who have weathered two months of COVID-19 already.
Yet, when he introduces himself to one, she thanks him for coming. He sees his name on a white board beside the name .
Gina Falisi is a young nurse who has worked in the ICU for only eight months, although she’s treated COVID-19 patients since the beginning of the pandemic's onslaught.
So far, Mitch has cared for one.
He is eager to go assess their three patients. Instead, Gina sits him down. She has some advice.
Take time to read through patients’ notes. Many are written by the palliative care team and explore things like family dynamics and religious views. For instance, she'd learned that one patient didn’t want a tracheotomy, a hole cut into the windpipe to aid breathing, because the woman sang in her church choir.
Find something personal about each patient, Gina warns, something that makes each one an individual. A hobby, a passion, a loved one, a career.
It will become hard.
Mitch nods. But mostly, he wants to get to the patients.
They get up to begin work. All of their patients today are in their 40s and 50s. One is awake and following commands. One lay on his stomach to increase blood flow to the front of his lungs. One is comatose.
Throughout the 12-hour shift, Mitch studies ventilator settings, vital signs and organ failures. He analyzes medications and lab results, excited to fill his mind with new information.
However, by the shift’s end, one patient has died, the comatose man.
Into the fray
When Mitch arrives the next morning, he heads for a sheet of paper that lists each day's assignments. He will return to the same ICU.
He arrives to discover he will be responsible for two patients on his own, even though he barely knows where the bathroom is. Normally, critical care nurses get weeks of training at new hospitals.
Mitch gets started. He’d rather be on his own anyway.
Earlier in life, he tried to become an Air Force Pararescue specialist, a special force of highly trained parachutists, rock climbers and divers who rescue airmen from dangerous situations. It’s beyond competitive, and he didn’t get far enough.
He’d switched to engineering. The math was great, but it lacked much human element.
In nursing, especially the equipment-heavy ICU, he found a crossroads between engineering and humanity. Mitch loves it.
When he enters his patients’ rooms, he begins with his usual visual assessments, examines breathing, traverses their vital signs and skims their charts. One patient is in his early 60s, on maximum life support. The other is in his 40s and faring much better; he might even get removed from his ventilator.
After lunch, Mitch heads for the fish bowl to talk with his dying patient’s son. Just as he hangs up, staff rush toward a patient room. Instinctively, he follows.
Someone tosses him a powered air-purifying respirator, or PAPR, which is like a helmet that covers his whole head with a clear shield over his face. A thick pump pushes filtered air inside it through a thick black tube.
“Compressions,” a nurse barks.
The patient is in cardiac arrest and has no pulse.
Mitch tugs on the PAPR and darts into the room to replace the nurse doing CPR. It is not like on TV. The kind of CPR that might save a person cracks ribs and takes speed. It’s exhausting. Even the strongest nurses can do it well for only 2 minutes.
When Mitch’s 2 minutes are up, the man has a heartbeat again.
He steps out of the room to catch his breath. Reality hits. He knows that in those moments, he could have been exposed to coronavirus. CPR forces aerosolized virus particles up out of the lungs, and he hadn’t had time to check the PAPR for a proper seal and function.
An hour later, the man dies.
Mitch has just left his younger patient’s room when he hears. By then, he is drenched in sweat. Plastic covers everything from his hair to shoes. The N95 mask grips his face. His goggles fog. When he pulls his cellphone from a pocket of his scrubs, it is wet.
Mitch heads back to his patient's room, trying to focus on better news. A doctor is about to remove his younger patient from the ventilator, a rare bright spot. When the man becomes more coherent, his eyes open. He gives Mitch a thumbs up and smiles.
Happy, Mitch walks out. He takes a couple steps toward his other patient’s room. In those brief seconds, he must shift everything in his mind and his demeanor.
His older patient, sedated on a ventilator, probably will die today.
On an iPad in the room, Mitch calls the man’s wife over FaceTime, then angles the screen so she can see her husband. Given she speaks in Spanish, Mitch is not sure what she's saying. He hopes it's goodbye, given her husband's grim condition.
She speaks to him for a half-hour. After she hangs up, his vital signs tank.
For the rest of his shift, Mitch works to keep him from dying. But as he updates the oncoming night nurse, the man's machines are still dinging.
Mitch returns to the same ICU on Friday. The man had passed away. The younger patient who gave him the thumbs up yesterday is back on a ventilator. His lungs are just too sick to breathe on their own.
Mitch hears that 80 percent of COVID-19 patients who wind up on ventilators die.
Of his two new patients, one is on a ventilator. The other is on a bipap, a machine that pushes air into the lungs, the last treatment before intubation. He breathes 50 to 60 times a minute. Normal is eight to 16. A doctor decides he needs to go onto a ventilator, as well.
When it comes to COVID-19, few times are as dangerous for health care workers as intubations because the process causes a patient’s breath to gush out, shooting virus particles at the medical workers hovering just inches away. During normal intubations at MUSC, a half-dozen nurses, physicians and respiratory therapists cram into a room. One stands at the doorway to run for supplies and drugs should anything go wrong.
Now, a lone respiratory therapist and anesthesiologist arrive in the room. Mitch realizes it’s just the three of them. As he pulls on a PAPR, its fan roaring right by his ear, he can barely hear what his colleagues say as they all prep the man. It makes him nervous.
He begins the flow of drugs, including paralytics and strong sedatives. Timing is so key, the process can turn cataclysmic — and quickly. It is hard enough to do without struggling to hear.
He pushes drugs and calls out vital signs while the respiratory therapist runs the ventilator. The doctor opens the man's trachea with a scope, then thrusts a thin tube past his vocal cords to rest just above a fork leading into each lung.
Barely a minute passes before the ventilator breathes for the man. Mitch breathes himself. No calamities. They all return to other tasks.
As he goes about his work, Mitch notices a nurse manager on the unit. She looks drained. The entire staff seems so tired, and her role keeps her bouncing among the ICUs. Mitch introduces himself and asks how many ICUs they have created.
“Follow me real quickly,” she says.
Mitch thought he had an idea what to expect. Normally, community hospitals have a range of patients, from women giving birth to patients who stay a day or two after more major surgeries. Patients needing the kind of critical care an ICU provides are few in comparison.
On a typical day, White Plains has 16 ICU beds.
Now, it has 80.
Without visitors or patients walking around, the halls stretch mostly empty. Almost every unit has “Do Not Enter” signs. Mitch peers into operating theaters transformed into huge negative-pressure areas.
Dying patients fill room after room. He hears Code Blue called eight or nine times.
The nurse manager leads him to the hospital’s outpatient endoscopy unit, now converted into an ICU. Through a swinging door, they peer into a large atrium type of space.
Mitch cannot believe what he sees.
Twelve patients, all on ventilators, lie in beds forming a huge semi-circle. Four nurses in full protective gear rush among them. Every patient is sedated or comatose.
He can't imagine working in there. So much sickness in one room.
Semi-circle of dying
When his next shift begins, Mitch checks the sheet of assignments. He will go to the unit with the semi-circle of patients.
At least he knows ahead of time that he won’t come out for 12 hours. Because it is one open space, the whole area is considered “dirty,” or covered in COVID-19. When he needs supplies or drugs, he’ll have to write a note and stick in on a window for a runner to get.
He gowns up, walks inside and gets his patient assignments.
Both are on ventilators. One almost certainly will die. The other isn't much better off.
Given neither has emergency needs, Mitch feels like he can stop and think for the first time since coming to White Plains. He sits down to read through his patients’ notes. His sicker patient is very active in the local community. A collage of photographs on a poster board faces the man, who's in his early 70s. His family sent it in for him. In one, a child makes a pouty face at the man. A grandchild, maybe?
Mitch studies the pictures. They make his dying patient seem more like a dying man.
When he returns to his assessments, Mitch notices that the man’s body is swelling as his kidneys fail. Fluid presses his finger tight against his wedding ring, a simple gold band. If the ring becomes any tighter, his family won’t get it without cutting it.
Mitch sticks a note on the unit's entrance window asking for some floss.
When it arrives, the effort takes time, but eventually he works the wedding ring off. Mitch tapes the gold band to the poster board of photographs, which will get returned to the man’s family after he dies.
Beer to whiskey
Mitch talks to Korelle every day. Over FaceTime, she shows him the dogs, tells him stories like how one whined at the door at 4 a.m. when a car drove by, thinking it was Mitch coming home.
On his next day off, six of his MUSC co-workers and his manager texted him. He fields phone calls from his mom, siblings, friends. He wanders to the lobby to do paperwork with strangers, other travel nurses mostly, not talking to any of them.
He meanders around the hotel. The gym is closed. Pool closed. No continental breakfast. He starts ordering through Uber Eats. It gives him something to look forward to, all this great New York food.
He switches from beer to whiskey.
Korelle has sent him a 1,000-piece puzzle of outer space, something to do.
It is late April. He hears that back home Gov. Henry McMaster is beginning to re-open South Carolina, starting with beaches and retail stores, as if coronavirus is basically over.
As COVID-19 destroys patients' kidneys, demand grows for a treatment called continual dialysis, which cleanses their blood of toxins and fluids 24 hours a day, when the kidneys cannot.
Mitch is among the only nurses in the hospital who knows how to run the complex machines and corresponding drugs. More often now, he winds up doing just that.
It gives him a different pace and vantage point.
Mitch has been studying patterns. They are treating COVID-19's organ failures — dialysis for failing kidneys, ventilators for failing lungs — but they aren’t treating the underlying cause of those failures.
It’s like we’re doing things one or two days behind, he thinks.
They were missing a critical piece, a medication or therapy, that could intervene before patients reached this point.
Mitch connects his latest patient to the machine with two thick lines. One pulls blood out of the body and into the machine, the other pumps cleansed blood back in.
But COVID-19 patients often develop blood clots. When clots get into the lines, pressure builds. The machine stops to prevent pumping a clot into the machine or, worse, into the patient.
As his shift ends, Mitch sees it begin to happen. He hands the patient off to a night-shift nurse who isn't as familiar with the machine.
Mitch walks back to his hotel, mind humming. At MUSC, a larger hospital with more specialized care, they use drugs and methods that could help with this challenge. He plans to talk with the unit’s nephrologist, a kidney expert, the next morning.
When he returns to work, he doesn’t see the patient he’d put on continual dialysis the evening before.
“That patient coded and died last night,” a nurse tells him.
Disappointed, he also realizes that neither of his new patients is on dialysis. He'll have no chance to talk with the nephrologist and mention his ideas. Then again, that doctor might be gone anyway.
A revolving door of them work on the unit. They have come from Oregon, Texas, California, every corner of the country to help, as have nurses. A good 40 to 50 travel nurses are working in the hospital right now.
The rotating cast makes continuity difficult.
For 12 hours Mitch cares for two more dying people, then trudges toward the hospital’s glass front doors. A couple waits there. The woman sits in a wheelchair holding a newborn baby in a blanket.
Mitch slows as he passes.
He isn’t one to fawn over babies. But it strikes him as so strange that inside this hospital overrun by death and hopelessness, a baby has just been born.
End of the tunnel
By mid-May, Mitch spends most of his shifts running continual dialysis machines. He likes it; he can help patients in a new way.
The deluge of incoming patients also has slowed markedly. The semi-circle of dying people just closed. A staff nurse tells Mitch she can see the end of this terrible tunnel.
Mitch sees it, too, in the form of his flight back to Charleston on May 25, less than two weeks away. He can’t wait to care for patients with myriad medical problems, not only COVID-19. He’s come to value his co-workers there so much more, given their cohesiveness.
Looking ahead, he also plans to apply to nurse anesthetist school. The deadline is Sept. 15. He will have to hustle when he gets home — shadowing, resume, essays, tests.
He hasn’t had the energy, or the will, to study in New York at all.
Last dark days
He spends his last two days in New York back in the hospital’s main ICU, where he started. Both shifts, he cares for the same patient, a 72-year-old who has been on a ventilator for 29 days.
The doctor doing rounds says, “He’s going to die.”
But the man’s family still wants every possible medical intervention. It isn’t unusual. Mitch’s patients are mostly Hispanic and Catholic, and they want to keep their loved ones alive indefinitely, in case God grants a miracle.
On his last day, Mitch returns to assess the patient’s ravaged organs and his ventilator, which chugs into day 30. The man's family has sent a recording they want him to hear, so Mitch plays it beside his ear. The voices of 22 people and stretch over an hour.
They urge the man to keep fighting, though he is mostly dead.
Mitch cannot take it. He leaves the room.
He has been in New York for six weeks, worked 23 shifts. Only three of his patients even possibly left the ICU alive.
One never went on to a ventilator, by his own wishes. Mitch didn’t know if the man lived or died after that.
One was removed from a ventilator and left the ICU. Mitch didn’t know what happened to him either.
And the third got a tracheotomy and was transferred out of the ICU. Mitch hears that patient is being assessed for brain death.
When his shift ends, he's anxious to leave. But first, he stops several staff nurses he’s worked with, the ones who have been here throughout. He feels so mentally beat, and they’ve done this work for two months longer than him. He tells them he admires their care for patients, their unfathomable strength.
The next day, he packs for his flight home, then arrives at the airport three hours early.
Home, sweet home
When he lands in Charleston, he heaves his black duffel bag off a carousel and heads outside to breathe in the steamy air of home. Watching for Korelle, he clutches a cheesy gift box for her with the words New York, like a tourist.
When she pulls up, he hollers: “Pop that trunk, dude!”
Standing outside the car, facing each other, they look like strangers guessing who might make the first move. Korelle holds out her arms, and for several long seconds they hug.
“Oh, man, it’s good to be back,” he says. “It’s so damned dreary up there.”
Bags swell beneath his eyes, crowed with new lines. He hasn't shaved.
“It wasn’t the best time.”
On the drive home, Korelle tries to cheer him up. They have plans to meet friends to hang out by a river, drink a few beers. It sounds amazing. Mitch rolls down his window and sticks his head out like a dog that’s just discovered freedom.
Back to the future
South Carolina is back in business, and Mitch is back at MUSC. When he's not there, he is shocked to see so many people without face masks, hanging out in big groups, even as the state breaks records of new cases almost every other day.
First, 500 new cases a day. Then 700. Then 1,000.
The ICU where he works, already filling with its usual patients, soon overflows with a new spate of people seriously ill with COVID-19.
Two weeks ago, MUSC had seven inpatients with the disease.
On Thursday, it had 48.
Mitch gets updates about how MUSC is revamping space to house another 150 beds in Charleston. Its leaders want to be prepared for what's to come. Yet, as they open new units for COVID-19 patients, the beds fill.
Charleston officials warn the city is reaching a “critical level."
Once again, Mitch is caring for COVID-19 patients, this time at his home hospital. He watches it all with dismay. If only people here had gone to New York with him to see the endless days of endless death.
It feels like he traveled to the future, then returned to relive it.