Moments before Dr. Auna Leatham walks out of the hospital, her eyes dart to the nearest restroom or locker room.
That’s when she begins her flight from the coronavirus.
She changes out of her hospital scrubs and stuffs them in a bag that gets stashed in a box in the trunk of her car. She washes her hands “a million times,” puts on some street clothes and drives home — parking in a garage that’s become off-limits to her kids.
Then comes a second wardrobe change. And a wipe down of her car. And then a shower.
Only then can she see her toddlers.
“I don’t want to put any of my family at risk,” said Leatham, 33. “That’s an additional stress that I can’t risk, and I don’t want to risk. It’s dangerous for the whole community to do that.”
Across the Pikes Peak region and beyond, doctors, nurses and hospital staff working on the front lines of the coronavirus pandemic are forced to walk a dangerous tightrope — asked to treat the sickest among us, while keeping the virus from their own spouses, children and friends.
They don full-body protective gear and two layers of gloves to treat patients whose faces they sometimes never see. And they’re doing it all amid an eerie loneliness, with the family of each patient forced to remain home, lest they risk becoming the next one needing a bed.
“The hardest thing is there are patients who come in and they’re afraid,” said Dr. Sanjay Ratnakant, a pulmonary specialist in Colorado Springs. “They see and hear things in the media, and they have this difficult question of, ‘Doc, am I going to die? Are you going to be able to do anything for me?’”
Answers of any kind are few and far between with COVID-19, for which no proven treatments or vaccines yet exist.
Unlike with other diseases, doctors treating the novel coronavirus can’t rely on institutional knowledge or online databases with years of research and reports, said Dr. Ronald Rains, a pulmonologist and director of critical care for UCHealth Memorial Hospital.
“We’re dealing with a disorder that, up until three months ago, nobody in this country had ever seen and, six months ago, nobody had ever heard of," Rains said. “Management of these patients is constantly changing, even over the last 48 hours, based on new information. It’s just something that we as physicians are not used to.”
The array of traditional diagnostic tools, as well, might be limited. A CT scan of a patient's chest, for example, would require transport to the radiology suite, potentially contaminating that space and everything in between. All would have to be closed and thoroughly sanitized.
“Because of the highly infectious nature of this disorder, we have to really weigh the risks and benefits of doing a certain diagnostic procedure. We’re having to do things with less information than what we’re used to,” Rains said. “I basically eat, sleep and drink COVID-19. It’s stressful, but I think everybody’s kind of becoming somewhat accustomed to a new paradigm.”
'Clean spaces, dirty spaces'
For doctors and nurses, that new paradigm means they end each shift with a final question: What if I bring the virus home?
That’s why Leatham doesn’t consider her routine overkill.
It’s just commuting in the age of coronavirus.
For her, life outside the hospital is now defined by “clean spaces” and “dirty spaces.”
No one uses the car she drives to work except for her. Her husband can’t use it on grocery runs.
Her in-laws, mother and sibling in the Springs — normally reliable babysitters for her two children, ages 3 and 5 — are banned from the house. So too are more relatives that live down the block.
“It’s very important to socially isolate,” said Leatham, who works in Memorial Central’s emergency room while also overseeing ER care at Pikes Peak Regional Hospital.
Hospital and health care workers across the Pikes Peak region say so far the area has avoided the dire situations found in other parts of the nation, such as in New York and New Orleans. Hospitals here are strained, they say, but have yet to become overwhelmed to the point of rationing care and forcing doctors to decide who lives and who dies.
In many ways, efforts to “flatten the curve” through social distancing and broad stay-at-home orders appear to be be working.
“Colorado has done such a nice job of social distancing, we've had the time to learn from the experts around the world to protect people from that,” Leatham said.
Importance of self-isolating
All this comes at a time when hospitals are reorganizing entire floors and hospital wings to accommodate an expected surge of coronavirus patients.
Operating rooms normally brimming with joint replacements are stilled. Most elective surgery is postponed. Rooms normally reserved for patients fresh out of surgery have been transformed into intensive care units for COVID-19 patients.
Optum, which operates primary care offices across the Pikes Peak region, shut down eight of its clinics and opened multiple respiratory clinics — specialized zones where people suffering from anything resembling the coronavirus can be seen by primary care physicians.
And some doctors aren’t taking any chances.
When Lonna Hunter, a recent nursing school graduate, learned her new job would include alternating weeks on the COVID-19 wing, she said she worried about her housemates, both of whom are over 60.
“Even though the people I live with are really gracious and said, ‘You don’t need to find a new place,’ I don’t think I’m willing to take that risk for them,” said Hunter. “My aunt has an RV. I was even considering, I could just live in the RV for a while, cause I don’t want to get anyone sick.”
Dr. Ken Lyn-Kew, 44, has been eating and sleeping in his basement — allowing himself only brief moments every day to see his wife and three children while upstairs with a mask.
He lives like that for four straight days after each seven-day shift in the intensive care unit at National Jewish Health in Denver, a hospital that specializes in respiratory illnesses.
“The hard part’s the coming home part,” Lyn-Kew said. “With family, that’s the one unit that should be able to be together during a time like this.”
He knows many of his colleagues in New York and New Jersey, where he grew up, are isolating from their families.
“None of us know what the right answer is, how to go about doing this,” Lyn-Kew said. “It makes the decision easier, when you think about what happens if they get sick. We’re relatively low risk. But low risk doesn’t mean no risk.”
Those choices are affecting everyone, said Dr. Alain Eid, a Colorado Springs Pulmonology Associates doctor who normally works in Penrose Hospital's intensive are unit.
"I can tell you, my wife has not kissed me in three weeks” he said, with a laugh.
Still, he pointed out that many patients — especially those without other serious health conditions — are recovering.
"The panic is way out of proportion to reality," Eid said. "We should not underestimate this. We just have to have some perspective.”
'A little hyper-vigilant'
The stray cough, the scratch at the back of someone’s throat.
It’s a constant thought in the halls of Memorial Hospital Central.
Little data exists on how frequently health care workers are becoming infected with COVID-19, the disease caused by the novel coronavirus. But a few indications suggest they are among the most at-risk in the nation.
In Minnesota, 28% of the people who tested positive for the virus were health care workers, the Associated Press reported earlier this month. In Ohio, nearly one out of every six people infected were in the health care industry.
It mimics high rates in other countries, such as in Spain, where nearly 13,000 people — 14.4% of those sickened by the virus — are doctors or nurses, the AP reported.
Colorado has not released information on health care workers infected by the disease, and the state health department said its data on the issue was “incomplete.”
For many, it's a constant consideration.
“It’s in the back of all of our heads,” said Dr. Jennifer Kollman, who oversees anesthesiologists for UCHealth in southern Colorado. “We all are probably a little hyper-vigilant right now, checking ourselves for random temperatures and making sure that the tickle in our throats is just dry air and not illness setting in. I think everybody’s mentioned a little bit of a sore throat from time to time during this.
“But we have been very lucky in our anesthesia department, knock on wood. And we have not had anyone out who has been positive for COVID-19."
The job that Kollman’s team faces ranks among the most critical but dangerous in this pandemic.
Not only do anesthesiologists such as herself keep patients from flatlining on operating tables, but they are the go-to experts in every hospital for placing breathing tubes down the windpipes of patients, a process called intubation.
It’s a complicated process fraught with risk.
Each anesthesiologist wears masks that look like they’re better suited for space travel, covering their entire face and outfitted with a tube to pump in clean air, Kollman said.
It’s because anyone intubating a patient is exposed to extraordinary levels of the virus. Patients cough. They hack. And each procedure means opening up a pathway to the most infected part of the human body — the lungs.
In those moments, the virus can aerosolize, meaning it can travel freely in the air and infect people nearby.
“We are very lucky here in that we’ve been provided all of the appropriate equipment to do our job,” Kollman said. “And our system has done a fantastic job of procuring all that equipment for us, even when it’s been very difficult to get.
“We trust our equipment, we’ve tested our equipment.”
Perils outside the hospital
And the impacts of the virus on health care — and human — dynamics certainly aren’t confined to the “negative pressure” hospital rooms where patients are fighting for their lives.
Doctors in nearly every specialty have had to encounter the disease, or deal with its impacts in one form or another.
Dr. Michael Wahl, of West One Family Dental, has a patient base of about 10,000 and, though his office has cut back hours, it’s still taking established patients for emergency appointments. If it didn’t, Wahl said, patients in crisis would have nowhere to turn but an emergency health care system that’s already struggling with a limited amount of personal protective equipment.
And for now, he’s got the gear to do his job safely.
“What makes our office kind of unusual, with even the wisdom teeth and extractions, because I do sedations and oral surgery, I have got the full setup in my office — the full gear of personal protective equipment, caps, booties, gowns, face shields, a couple N95 masks. If someone came to the office today and watched myself and Michelle work, it would look just like we just walked out of an ER in a big city,” Wahl said. “Some of the stuff, as things wind down, we'll probably donate (to hospitals).”
But with so many unknowns about this disease, and reports that even those with no symptoms can transmit the virus to others, Wahl knows his work comes with inherent risks. No matter the precautions.
Even talking or breathing can spray tiny particles of mucus and saliva into the air. Add a drill and spraying water, and potential risk spikes.
“If I'm doing anything getting close to a patient, where I'm touching, injecting, pulling teeth, or God forbid taking out a drill … I’m in full garb,” Wahl said. “When you're drilling in the mouth, and there’s water coming out of the handpiece to keep things cool, when you have a handpiece in your hand and water spraying, there's some splash back. When I get done, if I’m doing something a little more aggressive, I take off my shield and look at it, really look at my shield, and see if I can see any type of particles on it.”
Wahl’s office has a washing machine and a dryer for the day’s work clothes, and a shower Wahl uses each night before changing into street clothes and heading home to his wife and three kids.
“I feel like I’m pretty clean when I go home,” he said.
A stillness in the noise
At a time when the nation’s “heroes” must go to extraordinary lengths to keep from contracting or spreading the virus, they can’t help but carry it in their souls.
“It’s been hard, particularly at the beginning, when we were seeing patients come into the intensive care unit and they weren’t getting better — or not better quickly,” said Rains. “And there for a while ... there was nobody leaving, just more coming in.”
These days, most hospital halls are lonely but noisy.
They’re so much emptier than normal, the byproduct of all those elective surgeries and routine admissions that can fill a hospital to capacity any other month.
But goodness, is it noisy, Ratnakant says.
At some places, large filtration units have been installed in rooms bearing coronavirus patients — each seeking to filter air outside, rather than let it swirl around the hospital’s hallways.
“So the rooms are noisy, the rest of the hospital’s quiet,” Ratnakant says. “It’s a different feel, in terms of practice.”
Walking the halls and poking his head into rooms, he’s seen patients sorting out their wills and life insurance policies.
“It’s a difficult conversation to walk into,” Ratnakant said. “As much as we know about this disease, we can’t offer them hope and a guarantee and say ‘You’re going to be fine. You’re not that old, you’re going to be just fine.'
“Because there are people who are young … who are still dying from the disease. And there are old people who are surviving.”
The faceless patient, doctor
The hardest part of the job can be treating patients that, out of necessity, have to remain faceless.
Normally, Lyn-Kew learns patients’ names by asking their family for an introduction. With visitors limited or outright banned, that’s impossible.
Then come the layers of protective gear. And with the coronavirus specifically, patients often must be rolled prone onto their bellies to allow gravity to help work the puss and moisture from their lungs.
“A lot of times with all of the tubes and IVs and tapes and everything, it’s actually hard to put a human face to the patient in the ICU bed,” Lyn-Kew said. “And then when we lay them prone … all we see is the back of the head and back. It makes it really hard to get to know the patient.”
It’s a problem for doctors across the state.
“Typically, you’re trying to make a connection with patients, right?” said Dr. Michael Roshon, an emergency room physician and chief of medical staff for Penrose-St. Francis Health Services. “You’re trying to understand them, get them to open up to you, to tell you what their symptoms are and what’s wrong.
“And it’s hard when you’re standing 6 feet away, and when they’re wearing a mask and you can’t see their facial expressions. And you’re wearing a mask, and they can’t see you smile."
Leatham knows that struggle all too well. It’s especially critical in an emergency room, when doctors may only have minutes or seconds to get the information they need from a patient, and to communicate that to other nurses and specialists, before that patient dies.
“A lot of us look at each other’s mouths for reassurance, to see how the person’s feeling, to hear you,” Leatham said. “It’s so hard to hear somebody when you can’t see their mouth.
“Honestly, this pandemic has made us all human,” she added. “It really has brought everybody together. We are all sacrificing in this pandemic.”