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Okay, it's 9:20 at night and I'm coming back into the hospital. I went home to eat supper, so I'm coming back in to finish my work for the day. I've got lots of notes to write. I've got a patient to see. We have had a very busy day. For the past two months, Dr. Rachel Fott's job at her hospital, where she made this recording, has been to take care of the sickest COVID-19 patients, trying to keep them alive.
She works at a hospital with just 208 beds in the small city of Greenwood, Mississippi, right on the edge of the Delta. For weeks, we've been following Dr. Fott and other staff at the Greenwood LaFleur Hospital as they confront this deadly virus. This is In the Dark, Coronavirus in the Delta. I'm Madeline Barron. I've spent the past two months, along with the rest of the In the Dark team, reporting on coronavirus in the Mississippi Delta.
The poorest part of Mississippi and one of the poorest places in the entire country. In this series, we're bringing you stories of people trying to live in this really hard time, trying to make decisions, trying to get by in a situation that none of us have faced before. In this episode, we'll take you inside a hospital where doctors and nurses are figuring out how to cope with a pandemic, not in a big city like New York, but in the much smaller town of Greenwood, Mississippi, where every patient, every loss, every
Feels personal. Episode three, the hospital. I'm Dr. Rachel Fault. I am a pulmonologist and intensivist at Greenwood of War Hospital, which means that I am a lung doctor and also an ICU doctor.
Rachel Fott grew up in Greenwood, and she comes from a long line of small-town doctors. Her great-grandfather was a doctor, and so was her dad, who's also spent his career at Greenwood LaFleur Hospital. When I was little, I used to love to come to the hospital with him. I would take her with me, and she'd play on the floor while I was seeing patients in the ICU, you know? This is Dr. Fott's dad, Dr. Randy White. She's working where she used to play when she was three and four and five and ten.
Dr. Fott went to medical school in Florida and trained at a big hospital in Jackson, Mississippi. But she came back home to Greenwood four years ago to work in the intensive care unit of the hospital here. She says she loves practicing medicine in a small town. If I don't know you, I probably know somebody that you're close to. I love that about my job. And in the grocery store, you know, people speak to me, hi, Dr. Fott, all the time. And I'm like,
There are times when I'm like, oh gosh, who is that? You know, I'm like, is that a patient? Is that a patient's family member? Is that a hospital employee who's just not in uniform? The hospital where Dr. Fott works, Greenwood LaFleur Hospital, is on the eastern edge of the Delta in the city of Greenwood. It's close to the center of town, a five-story brick building built in the fifties.
So, I'm walking through the front door. The gift shop is to my left. It's a pretty large hospital, considering Greenwood's size. The city has around 14,000 people. And the hospital ends up serving people who live outside the city, in small towns and rural areas in the Delta. Smaller hospitals that don't have ICUs will sometimes send their sickest patients here. It's been fairly quiet here recently.
We first started talking to Dr. Fott back in March, back in the early days when the pandemic had barely reached the town. The state health department reported the first confirmed case of COVID-19 in Leflore County, the county where Greenwood is, on March 13th. The hospital made a plan for dealing with the pandemic. It set up a new 16-bed unit, a unit reserved solely for COVID patients.
Staffing the new unit would be Dr. Fott and her team, the doctors and nurses who work in the ICU. They're specialists in critical care, trained to help patients who have trouble breathing, who might need to go on a ventilator. They would be the ones on the front lines when the virus hit Greenwood. I'm headed up the stairs now. I always take the stairs. Sorry for the loud door slam. I'm in the stairwell, so it's kind of echoey. The ICU is on the second floor.
It's not unusual for Dr. Fott to get called into work late at night. For stretches of seven days at a time, she's the only doctor on call in the ICU. So she'll be at the hospital all day and sometimes all night. So we have a regular 16-bed ICU that has been what we have converted into the COVID unit because it has two double doors that you have to get through. And we wanted that to be...
completely sectioned off from the rest of the hospital. I'm about to go through the ICU. Double doors. In the middle of the COVID unit is a central nurses' station. It's surrounded by patient rooms with glass front doors. Hi. We call it the fishbowl because you can see inside every room and it makes a big semicircle, basically.
Inside the rooms, the patients are hooked up to machines that monitor their blood pressure, their heartbeat, their oxygen levels. Monitors at the central nurse's station are dinging all the time. So that's what you're hearing that's going off. Brianna Elam is an ICU nurse on the unit. She's in charge of the other three or four nurses on her shift.
When the hospital created the new COVID unit, Brianna was one of the first to volunteer to join it. She talked about it with our producer, Natalie Jablonski. I was just like, OK, well, I'll do it. It sounds like a lot of other people didn't want to do it. Well, yeah, I mean, you can't blame them. You know, they have big parents at home and like myself, even though I chose to, you know, help out and do it because I know somebody got to take care of these patients.
Breonna said that since someone has to take care of these patients, it's better if it's someone who wants to do it. Working on the COVID unit means Breonna is exposed to the virus all the time.
She says she's come to terms with this, but she's had to make sacrifices. And so like myself, I have a daughter. Brianna's daughter Kaylee is 11. Brianna told us the two of them were on a spring break trip to Atlanta when the pandemic upended everything. Kaylee's school closed, and then Brianna signed up for the new COVID unit.
And Breonna's daughter is, like her mother, a pretty practical person. And so when Breonna told Kaylee about her new assignment... She was like, well, I think I'm just going to stay over here with my grandmama while you work on the COVID unit because I don't want to get COVID. Natalie talked to Kaylee about how she felt about not staying with her mom. It's complicated.
I didn't want her to get sick and get in the virus or nothing. So it was your decision, right? Yeah. Sometimes I do feel bad, you know, not being there. But we talk on the phone all the time. I'm going to talk to her in the morning before I go to work. I'm going to talk to her. She's going to FaceTime me. I'm going to call her and FaceTime her and talk to her every night.
Before I go to bed? Oh, we'll talk about how both of us have been doing while she's been at work and how I've been doing while I'm at my grandma's house. And we'll just talk about a lot of stuff. Yeah. Do you miss your mom? Yes, ma'am.
Breonna says in some ways it's a relief to have Kaylee at her grandmother's. Because right now, Breonna has so much to do at work. She's working 12-hour shifts during the week, at minimum. Sometimes she's there even longer. I know that, you know, I don't have to worry about coming home, trying to cook, feed her. All I have to do is come home, bathe.
The doctors and nurses on the COVID unit were dealing with an unknown disease that no one really knows how to treat. Work on the unit was exhausting. The hours were long.
There are times when I'm like, all right, we're going to be okay. And then there will be times where I have just major anxiety. And what will happen is my heart rate will start to go up and I'll start to feel flush. And I'm like, am I tachycardic and feeling flush because I have a fever or because I'm just having anxiety? And like, I can't clear my head. And the other day I just had to go take my temperature. And I was like, okay, temperature's normal. This is anxiety. Like you got to get through this.
in order to, like, go back to being an effective doctor. A lot of the work that Dr. Fott and Brianna were doing was actual physical work, not just monitoring vital signs on a computer. One of the most intense things they have to do is put a patient on a ventilator. This moment, the moment of going on a ventilator, is critical. It's when, in most cases, the patient stops being able to communicate. It's also a moment when the risk of spreading the virus is greatest.
The process of putting a COVID patient on a ventilator takes three people. First, a respiratory therapist places an oxygen mask over the patient's face. They turn the oxygen up to 100% and put that on the patient to try and get the oxygen levels up. Then one of the nurses, like Brianna Elam, connects a syringe to an IV and starts pushing medicines. A sedative, so that the patient isn't alert. An anesthetic, so the patient doesn't feel the pain of what's about to happen.
and a paralytic, so the patient can't move. That's going to work very quickly. The paralytic kicks in. The person stops breathing. And so you need their oxygen levels to be up, so that gives you time to get in their airway. Dr. Fott has only a few seconds for what comes next. Brianna lays the patient back. Dr. Fott stands behind the patient's head, tips it back, and opens their mouth to see all the way down their throat.
She uses a plastic tool to hold the patient's tongue down. It has a tiny camera inside. A little video camera thing that, so you put it in the mouth and you can see the vocal cords and you can watch it go in. She takes the tube and slides it through the vocal cords into the patient's windpipe and connects it to the ventilator. The ventilator looks kind of like a robot. It's this white box that gets moved around on a cart with a screen with buttons on it and tubes coming out the side. It's actually a computer.
And the ventilator pushes air into the patient's lungs. It regulates how much air is going in and with how much force. It's forcing air in and letting air out. So that's going to breathe for him. Yep. And then it's done. The machine is breathing for the patient. It goes very quickly. If I do it on the first try, which it almost always can get it on the first try, then it takes me about 15 seconds, you know. So it goes very quickly. Patients on a ventilator need a lot of care.
And much of that care falls to the nurses, like Brianna Elam. She spends a lot of time in her patients' rooms. And because they're on ventilators, Brianna's patients can't talk to her. They're sedated. And so when she walks into one of her patients' rooms in the fishbowl, she doesn't hear hello or good morning. She just hears the same familiar sounds, the beeping of the machines and the whoosh of the ventilator.
Breonna told her producer Natalie that even though her patients can't talk to her, she talks to them. When I go in the room, I'm still going to introduce myself. Hi, good morning. I'm Breonna. I'll be your nurse taking care of you today. So anything that I do to them or before I do it to them, I let them inform them of what I'm doing, even though they're on a ventilator and their life is sedated. Breonna thinks about how she would want to be treated if she were the patient.
I wouldn't want nobody to just come in my room and just start taking care of me, touching on me, and doing stuff to me without letting me know I'm about to do this or I'm about to do this. It's almost like, okay, Mr. John Doe, I'm about to get rid of suction, or I'm about to wash your face, or just let them know that somebody's in the room.
So you just kind of narrate what you're doing as you're doing it. Well, my understanding is they still can hear. They may not remember, but they still can hear. So the patients can't have any families. They can't have visitors here like their families called, but we're pretty much their family. Our voices and our faces are pretty much the only face and voices that they see.
Brianna called Natalie at the end of March. Hey, Natalie. Yeah. At this point, things were starting to get busier in the COVID unit. The number of patients was ticking up.
In the early days, it was just a few. Now... We have a total of seven today, seven patients today, and four of those are ventilated patients. How are you feeling about things overall? It has been a little overwhelming, but I am glad to be a part of this team. I feel, I mean, I'm up for the challenge. I think...
It's been about, this is going on about the third week. Brianna was working long hours. Her daughter was staying at her mother's. But Brianna felt confident. The COVID unit was humming along. Yes, they had more patients. And yes, it was a challenge to care for them. But both Brianna and Dr. Fott were still upbeat. They were like, we've got this. After the break, the virus strikes one of their own.
He killed at least 19 people during the 1980s in South Africa. Very dark times. People were desperate. We were looking for him. We couldn't find him. And nobody knew where he was. Every single one of his victims was black. He reached such a stage where he was now hunting. World of Secrets from the BBC World Service. Season 3, The Apartheid Killer. Search for World of Secrets wherever you get your BBC podcasts.
Dorothy Bowles had been working nights on the surgical floor of the Green Midland Floor Hospital. She'd been a nurse for 42 years. A lot of people call her Ma Bowles. Dorothy Bowles didn't just care for patients in the hospital. Sometimes, when her patients had nowhere else to go, she would take them in and care for them at her home herself. One guy in his 20s was a patient of Ms. Bowles in the hospital after he'd been shot, and his recovery was pretty hard. He had to use a colostomy bag.
And Ms. Bowles basically told him, you can stay with me for a while, and I'll help you out until you're able to take care of things yourself. The man ended up staying at Ms. Bowles' house for five years. One day in March, Ms. Bowles wasn't feeling well, and she went to the ER at the Greenwood Hospital. Dr. John Lucas had worked with Ms. Bowles for his entire career. He's a surgeon at the hospital. And it didn't take him long to find out that she was there.
Right away, Dr. Lucas went to see her. I could see that she was short of breath and knew that, you know, she needed to be in the hospital to get extra oxygen. Did you think it was COVID at that point? No, she had another medical problem that actually brought her in, but she was short of breath. So it was something we all...
worried about. They tested her that night, but it was several days before we got the results back. The test was positive. Dorothy Bowles had COVID-19, and she was moved downstairs to the COVID unit, where her colleagues Dr. Fott and Breonna Elam worked. She actually wanted to do everything on her own and really didn't want us to take care of her at all. And I told her she had to be the patient and not the nurse.
So she didn't want to be taken care of? She wanted to take care of herself. We just kind of laughed it off when I told her she'd been taking care of patients all her life.
And now it's time for her to let somebody else take care of her. She just kind of looked at me and smiled and laughed. I told her, I said, I know you used to being independent and doing everything on your own. I said, but you got to let us help you and take care of you so you can get your strength back. They gave Ms. Bowles oxygen. They encouraged her to rest, to try to eat. They monitored her pulse and her blood pressure, hoping that Ms. Bowles' body would fight off the virus.
And during all this, Ms. Bowles' family couldn't visit her because of restrictions on COVID patients. So she was talking to them on the phone instead. You can kind of tell that she was a little gaspy for her wind. Very minor. Spencer Banks is Dorothy Bowles' younger son. He made a recording of himself talking to his mom while she was in the hospital, and he shared it with us. Mama, is it troubling you to talk? Because I'm feeling like you talking is taking your breath.
And I don't want to take your breath. It is what it is. Ms. Foles tried to reassure her son. Everything is well. You got to take care of those children. And that's one thing I was having a bit about, is my grandchildren. And let God do what he got to do with me. I'm well.
Spencer read his mother a passage of scripture. I'm going to read Psalms 91. Uh-huh.
Verse 5 it says that don't be afraid Of the terrors of the night Nor the arrows that flies In the day Do not dread the disease That stalks in the darkness Nor the disaster that stalks That strikes at midday Though a thousand fall at your side Though ten thousand are dying Around you These evils will not touch you Amen Amen Amen
In the days that followed, Ms. Bowles got sicker. Her lungs weren't sounding good. She was having trouble with her kidneys, and her oxygen levels were dropping. It looked like she might need to go on a ventilator. My mother did not want to go on the ventilator at all the entire time that she was there. She did not want to go on the ventilator. And her reason was because my mother, of course, she was a nurse, and when my grandmother was in her dying age or dying times, my grandmother had the ventilator on her
And my mother was her caretaker. Of course, my mother was watching her. So she was just, well, the ventilator is what took my mom. And I don't want you guys giving me the ventilator. So reason being, I think I understood why she didn't want to. Like she was afraid that she wouldn't come off of it. I would say, yeah, yeah. I would say that that's what it was. She was afraid that once she'd go in that ventilator, I think she knew that ventilators is an ultimate sign of...
But, um, yeah, I think she just knew it. But Ms. Bowles did go on the ventilator. She could no longer talk. But Brianna kept talking to her. A few days passed, and then Ms. Bowles' condition suddenly changed. It's the sort of thing that happens with a lot of COVID patients. So in these people, they frequently have what we call a cytokine storm. And so they'll be getting better, beginning better, and then all of a sudden they just get worse. Ms. Bowles got worse.
And then her heart stopped. They called me and said she coded. And we were like, what? You know, coded? And, you know, you mean like died? And, well, we don't want to say that, but because we got her, we revived her back, and her heart rate is fine, and we got a pulse. But then Ms. Bowles' heart stopped again. And again they revived her. But it happened one more time. And this time, she didn't come back.
Dorothy Bowles died at the Greenwood Hospital on the evening of April 3rd, surrounded by three of her colleagues who worked so hard to save her life. One of those people was Dr. Fott. The two nurses that were with me, they were just crying and we just kind of didn't say anything because it was like,
One nurse said, she said it hits differently when it's one of your own. And it was just like, yeah. I felt like I was, at the moment, I was just kind of like emotionally stunned. Dr. Fott had to notify Ms. Bowles' family, and she knew she had to do it fast. Since so many people at the hospital knew Ms. Bowles, word would get out quickly. And she wanted Ms. Bowles' family to find out from her directly.
She called Ms. Bull's oldest son, and he called Spencer. I said, oh my goodness, and that's how I answered the phone. And he was like, yep, she's gone. It was like, I felt like I couldn't offer my condolences the way I meant them. You know, just like, I could say I'm sorry, but it was just, I'm like, I'm also exhausted, you know? So it was hard for me to...
to, you know, convey how sorry I was, I think. Dr. Fott kept working until after midnight. That night, she couldn't sleep. Sometimes you lay there and you think, what more could I have done? In that particular situation, I didn't really feel like there was a lot more I could have done because I felt like we tried very hard all day long and thought of everything I could think of. And then you're just sad, you know, especially, you know, when you know somebody and you know their family and you know that they're hurting.
Hello. Hey, Dr. Fudd. Hi. Can you hear me okay? Yes, I can hear you. In the weeks after Dorothy Bowles died, more and more patients started showing up in the COVID unit. How many beds are full today? I think we're at 10. We're at 10 right now. We've been able to discharge some people today. So we were at 15 this morning. Wow. Yeah, we're at 11 with one waiting to go home. There was some good news.
We've had one person who's come off the vent and stayed off the vent. She's doing better than ever today. We had one. That's great. Yeah, we had one that we were able to avoid being on the vent. And we've had some, you know, we've had several people who have discharged. But there was some hard news, too. I have had a rough few days. I'm sorry. Yeah. Yeah.
We had kind of several deaths at once, and one of them was unexpected. Dr. Fott told Natalie that the past few days had actually been some of the roughest of her career. There'd been an outbreak at one of the nursing homes in the area, and several elderly patients had died. And then there was this other patient, a woman in her 40s. I'd made rounds before.
On the ventilators right before I left, my partner had come in to relieve me so I could go get some sleep. And I'd made rounds on the ventilators right before I left, and she was fine. Dr. Fodd had gone home to rest. She was watching TV with her husband when she got a text from the other ICU doctor who'd come in to relieve her. He told me that she had all of a sudden had gone asystole and that they never got her back from the initial code. So...
Dr. Fott said, after weeks of patients dying, this patient, this death, really hurt. It just hit her all of a sudden. And I had, you know, just a big, long, huge cry. And, you know, just said, there's a lot of things like, I'm so upset that this has happened. I am so upset that...
And now the deaths seemed like they were coming one right after the other. Another person admitted, another person whose breathing worsened, another person whose organs failed, another person who couldn't be saved.
It's like every time we turn around, somebody's decompensating in some way, you know? Everything is different right now. And then I'm just tired of being sad, you know? It's like you can't get over being sad for one patient and then the next one comes along. Since Dorothy Bowles died on April 3rd, Dr. Fodd and her colleagues on the COVID unit have lost another 18 patients.
And now, as of Wednesday, there are six patients in the unit. Tomorrow, Dr. Fott will head back in. Her rounds start at 9. In the Dark, Coronavirus and the Delta is reported and produced by me, Madeline Barron, managing producer Samara Fremark, producer Natalie Jablonski, associate producer Raymond Tungakar, and reporter Parker Yesko. The series was edited by Catherine Winter. The editor-in-chief of APM Reports is Chris Worthington.
This episode was mixed by Corey Schreppel. Original music for this series by Gary Meister. To see photos that accompany our series, you can go to our website, inthedarkpodcast.org. Photography for this series by Ben Dent. We've also posted a video on our website of Dr. Fawke showing us how she puts on protective gear in the ICU.
Hi, this is David Remnick, and this year's New Yorker Festival returns October 25th through the 27th. We'll be joined by Rachel Maddow, Sarah Bareilles, Atul Gawande, Seth Meyers, Mohsin Hamid, Audra McDonald, The National, Julio Torres, Ayad Akhtar, and many others. Plus live podcast recordings and panels on politics, literature, technology, and much more. And you can learn all about it at newyorker.com slash festival.
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