Even on his second trip to the emergency room, Tom McNamara wasn’t especially afraid of the virus inside his cells. The first time, doctors had diagnosed him with Covid-19-related pneumonia, given him some antibiotics, and sent him home. That night, his wife had set an alarm for every two hours, rousing herself to check his oxygen saturation, and by the next morning, it had dipped low enough that she’d sped as she drove him back. But now that he was at the hospital again, his numbers seemed fine, and he thought, This is stupid, I should have just stayed home.
His daughter Caroline didn’t think it was stupid. Then again, she and her parents had been living in different worlds. Geographically, they weren’t far. They were all in Williamsport, Penn. — “the birthplace of Little League baseball,” near the green middle of the state. But to Tom and Amy McNamara, the pandemic wasn’t something to get too stressed out about. For most people, they imagined, having Covid-19 was like having a bad cold, a sentiment similar to one the president himself had expressed.
At 27, Caroline didn’t have that luxury. As an ICU nurse at the University of Pittsburgh Medical Center’s hospital in Williamsport, where her father had been taken, she knew the pandemic was anything but abstract. For her, it was pushing someone’s breathing tube to the side of the mouth so she could swab the pink ridges inside with an antimicrobial. It was jostling pads and pillows under a sedated face to prevent the skin from blistering. It was rubbing a patient’s hand with a gloved finger so nobody had to die alone.
“The patients that do end up taking a turn for the worse do it very quickly,” she said — and she saw it happening in her 59-year-old father, too. One moment, he was thinking it was stupid he’d come back to the hospital, the next his oxygen was plummeting. All he’d done was get up to go to the bathroom.
By evening, when Caroline came to see him after her shift, in her fit-tested N95 with a surgical mask pulled over it, goggles, gloves, and gown, she noticed that his toes were blue. He couldn’t get through a sentence without gasping — and, for a second, she was in nurse mode, moving to the wall to turn up his oxygen, calling in a colleague and a respiratory therapist to switch out the tubing in his nose so it could handle a stronger airflow.
It’s an enviable kind of know-how, the muscle memory of care. But like so much in medicine, it comes with complications, the everyday rifts that open up between your world and others’, the repetitive stress injuries of the soul. For months now, Caroline has maneuvered patients so their stiffened lungs might have more room to expand, which only made her more frustrated that her parents didn’t see this virus as more of a threat. She’s felt honored to sit with those her team couldn’t save, and terrified her family members would end up in their place.
And when her father did land in her ICU, she had what so many this year could only wish for: the possibility to sit with him in person. But she also knew, in agonizing detail, exactly what had happened to the previous occupants of his bed.
Lately, the work had been giving her nightmares. Caroline tried to explain to her parents what those 12-hour shifts were like, just how many Covid patients there were, just how many needs they had, from the IV meds that maintained their blood pressure to the post-bowel-movement cleanups, just how many of those people ended up dying. Her parents could tell it was intense, but there was a disconnect, something about bearing perpetual witness to desperation and loss that didn’t quite sink in. “I’ve been telling my family stories about the patients we’re taking care of, how quickly they get sick, but everyone was just saying ‘Oh, you’re just seeing the worst of the worst, you’re just freaking yourself out, we’re all doing fine,’” she said.
Her dad was a diligent mask-wearer, her mom not so much. When Caroline asked family members not to gather with friends, or urged them to wear masks, the responses made it seem like they were someplace else, where the virus and its risks were little more than a distant headline. “They were calling me the CDC Enforcer,” she said.
Days before Tom’s diagnosis, he and Amy had talked about it: They hoped they were hearing what their daughter was telling them, and answering with respect, even though her vision didn’t correspond to what they were seeing.
It was true, there hadn’t been many cases around them early in the pandemic, and later, the people they knew who’d gotten Covid-19 weren’t all that sick. Plus, as Caroline’s mom Amy McNamara explained, “The area I come from, people kind of like to do their own thing, and maybe not comply with what the CDC or the governor says.”
The place is rural enough that Caroline and her sisters grew up getting lost in the cornfield behind their house, following their dad’s voice to find their way out when he called them inside for dinner. They’d crinkle down the husks and pop off the kernels for their uncle’s pigs. As a teenager, Caroline had liked animals so much that it worried her mother, who wasn’t sure a career as a veterinarian would be practical. Amy tried to get Caroline to talk to a cousin who’s in charge of Naval Reserve nurses. Caroline wasn’t interested.
Amy did what the family always did when troubled by something. She’d grown up Catholic, but as a young adult had joined a non-denominational church more focused on a personal relationship to Christ. “We go straight to Jesus with our problems and our blessings,” she said — and she had done exactly that for her eldest daughter, praying that Caroline would shift the object of her care from pets to people.
Eventually, after around a decade, a mission trip, and studies in both molecular biology and nursing, Caroline had fulfilled her mother’s prayers.
That Tuesday night, though, when she heard her father struggling to breathe, as if his lungs had simply run out of room, she knew she wouldn’t have the mental capacity to work the next day. She texted her supervisor about switching shifts. She talked with her dad, but didn’t want him to say much. Every word, every breath, took concentration, and she didn’t want him to exhaust himself any more than he had to.
The next morning, he was in the ICU. When she found out, Caroline drove over sobbing so hard she probably shouldn’t have been driving. While on the road, her mom called, panicking, but she didn’t have much to tell her: She was panicking, too.
She sat in the ICU office for a moment to calm down, and then, shrouded in protective gear, went in. “I asked him, ‘If it gets to the point where they have to put you on the ventilator, do you want that? Or do you want to not go through that?’”
She’d had that conversation with both of her parents before, but now its details seemed so real, so close. “We’ve had patients who’ve been there for a month on tons of different machines, and we’re hopeful that they pull through and you just never know. A month is a long time to be sedated and listening to all the dings and honks of the ICU with the vents,” she said. “I think I just needed to hear him say that he was willing to go through everything, even if it took a year of physical therapy and occupational therapy and who knows what else.”
Still, he seemed not to completely expect it when the ICU doctor came to his bedside and said he was working pretty hard to breathe, how much longer did he think he could do this?
The doctor told him a vent was all but inevitable, and recommended starting it now, rather than an hour from now. Already, there was a flurry of activity, of drugs and tubes and machines being cued up. He had about two minutes for a phone call before the vent was ready, and he called his wife. She heard terror in his voice. When she told him that, he wasn’t sure if it was terror or just the effort it took him to talk and breathe at the same time.
Caroline went to see him twice a day, never staying too long so she didn’t put herself at risk. She was the only member of her nuclear family who hadn’t tested positive for SARS-CoV-2, even though she spent her days surrounded by it. Sometimes, she put her mom or sister on speakerphone — but never Facetime. She didn’t want others to see his face swollen from lying on his belly for 16 hours at a time, his lips puffy from holding the breathing tube. In the hours between visits, all she could do was sleep, or scroll through scientific articles about the coronavirus on her phone, hoping the latest research might bring her some hope. It never did.
He looked to her just like the patients who hadn’t survived. They spent a while being flipped from their backs to their bellies, wrapped in a burrito of sheets, catheters and IVs threaded through the openings by the head or the feet so they wouldn’t get too tangled during the turning. Eventually, they were weaned off some of the machines and given morphine, to keep them from hungering for air at the end.
Caroline tried to guide her family gently through the world she worked in. She told her mom not to call between 6 and 8 in the morning or evening, because changeover was at 7 — “rush hour for the nurses,” her mother said. Instead, Amy mustered up the courage to call at 4 a.m. She wasn’t sleeping anyway, and things were quieter then, the nurses had a little more time. She had enlisted friends and church groups to pray for Tom, and they did, but her phone was dinging so much that she asked people to stop texting: At every ding, she felt a jolt of horror.
Everyone kept asking Caroline for news, for predictions. Do people recover from this? Will he get any better? As far as she could tell, he was getting worse. She’d had to take time off to recover from an injury in March, and hadn’t seen the first surge. Since September, when she’d taken the ICU job in Williamsport, she hadn’t seen many people recover from being this sick. Her friends elsewhere had, and she told her family, yeah, she’d heard of people recovering. Her voice betrayed what she actually thought.
She wondered how she would ever go back to work again. Her mother wondered what would happen to Tom’s tax preparation business, and asked her brother if he’d be willing to help her run it. She began making inquiries so Caroline’s brother-in-law, who is doing military service in the Middle East, could make it home for a funeral.
Tom left the ICU on Wednesday, Dec. 16. He’d been there about a week, receiving remdesivir and steroids and the other kinds of support that have been keeping Caroline’s team busy. He ended up in room 589, the same room his mother-in-law was in when she’d been hospitalized with Covid-19. At first, he needed a walker; then he was home and could move around without it.
It was an outcome his family had prayed for but didn’t expect. Tom knew himself that his condition had been dire. It hit him especially hard just as the doctor was readying him for the ventilator. “I just realized, this might be one of the last moments of consciousness of my life,” he said. “All of a sudden hundreds of people go through your mind. You know, people I’d love to talk to again.”
The sheer crowd of them surprised him. Of course, he thought of his wife, his children, his siblings — but there were so many others there, too, so many flashes of affection, each singular and strange. “So many people that you just take for granted,” he said. “I just felt like, I’m not done yet.”
He was sedated while on the ventilator, and doesn’t remember much. What stuck with him most was feeling too weak to pray. It was something he usually did throughout the day, forming sentences in his head, sometimes speaking them aloud when something was too tightly tangled in his mind. But in those moments in the ICU — his lungs inflated by machine, his meals delivered by tube, his mouth kept moist with a jelly hand-swabbed over his tongue and teeth — he couldn’t focus on it, even when he heard a voice in his head, taunting him: Here he was, a Christian man in a time of trouble, not even praying. He’d feel bad. He’d cough up some phlegm and someone would have to rush in and suction his breathing tube free.
There’s no way to translate that kind of desolation, just as there’s no way to fully enter someone’s skin-crawling dreams. So often, we mistake information for knowledge. We think we’ve understood a story, a headline, a statistic. What we really know is so much murkier, an inner sludge of worry and denial, hearsay and bodily experience, with social and political beliefs lingering like an oil slick.
When Amy McNamara remembers the time, not so many weeks ago, when she thought the pandemic wasn’t something to worry too much about, her self-diagnosis is not that she was lacking facts. Sure, she recognizes a kind of hubris: “Who am I to think I know more than the scientists?” But she also sees a failure of imagination. She knew people who’d had Covid-19 — eventually, the list would include herself, her husband, her mother, three of her sisters, one of her brothers, two of her daughters — and most of them had pulled through just fine. Any other outcome seemed like an anomaly, a parallel world she’d heard about but couldn’t quite picture in all of its depth.
Caroline still isn’t sure what’s shifted for her since her father was in her ICU. She took meticulous care of patients before, and she still does. She might spend a little longer on the phone with families, telling them they should feel free to call again, when they’re lying awake at 4 a.m. But the last two weeks gave her a lot to unravel, and she hasn’t had much time: The day before her father got out of the ICU, she was back in there herself, working. That weekend she had three overnight shifts.