Last Thursday, respiratory therapist Valerie Love stood next to the bed of the Aurora VA Hospital’s first and longest COVID-19 patient, the Rev. Terrance Hughes, and slowly, carefully, began disconnecting him from the ventilator that had helped keep him alive for nearly a month.
She counted to three before pulling the clear plastic tube out of his swollen airway.
Love stood over him, holding her own breath, watching and waiting. Doctors had hoped to wean him from the machine days earlier, fearing infection and other complications from the breathing tube. But his vitals had been too erratic.
Breathe, she urged him. Keep breathing. Just keep breathing.
And he did – slow, steady breaths strong enough that nurses grabbed the iPad next to his bed to ring his wife, Rachel Hughes, on FaceTime. She cried seeing his tube was gone, and says he cried, too, even in his half-consciousness.
Big T — as the beloved 56-year-old Denver pastor and civil rights leader is known — managed to keep breathing on his own Friday and Saturday and still on Sunday when, in the process of moving him for the first time out of bed into a chair, one of his nurses quipped, “He has risen. Amen!” in honor of Easter.
With that, he spoke for the first time since waking from his medically-induced coma.
“Amen,” Big T said. “Amen.”
These milestones, “small wins,” as the VA calls them, have buoyed the medical staff after a grueling month in the intensive care unit fighting a virus that has proven formidable and unpredictable.
During a group phone interview Sunday, Meg Zito, a registered nurse in the ICU, acknowledged feeling afraid when Big T was admitted March 9, crashing with COVID-related pneumonia.
“He was our first patient. It was almost like we were going into the unknown. We didn’t know if it was on us, if it was in the room. And we didn’t know what medical path these patients would take. … We still don’t know,” she said.
Big T’s two “Amens” on Easter, she noted shortly after he uttered them, went a long way in lifting her spirits.
“It was wonderful.”
The VA’s medical team, like those in every hospital in every state and country the new coronavirus has struck, yearn for something hopeful, something meaningful to come out of this pandemic. After Big T’s tube was removed last week, some ICU staffers took to standing outside his room, giving him thumbs up and waving to him through the window.
“The need for good news is unilateral,” VA spokeswoman Brandy Morrison said Sunday.
But by Sunday evening, Big T was struggling again to breathe. He was agitated, confused from not getting enough air into his lungs, and his blood pressure had plummeted.
These are the rhythms of this virus, two steps forward, one step back, jerking patients, their medical providers and families around from one day to the next. Rachel — who is recovering from her own bout with COVID-19 and has been quarantined alone at home in northeast Denver for more than a month — has become all too accustomed to this fitful dance.
A doctor urged her early Monday morning to mentally prepare for the possibility of Big T going back on the ventilator.
“Gosh, we were just celebrating yesterday about him talking. I’m sorry. I wish I had better news right now,” the doctor said a few hours later, checking to make sure Rachel wanted her husband back on life support.
Yes, Rachel responded. “He would want whatever’s best to keep him going.
“Keep him alive,” she said, knowing a second stint on a ventilator is not a lasting solution.
Dr. Tim Amass, one of Big T’s pulmonary specialists, said Sunday that despite “huge progress” removing Big T’s breathing tube last week, he was still at risk of infection, organ failure or other problems the virus, if still active, could cause. He worried about “profound weakness” that made it hard for Big T even to lift his hand off the bed. Though brain scans had come back clear and Big T seemed to be “all there” cognitively before being reintubated this morning, Amass noted that four weeks on a ventilator, dialysis and heavy sedation would be a lot to overcome.
“With COVID, we’re learning that patients need a lot longer support than we’re used to,” he said. “It’s not the type of strength you regain in a couple of days. We’re prepping everyone, including him, for a long road to recovery, although a week ago, I was worried that we’d never get even this far down that path.”
Amass said Big T’s starts and stops these past several weeks are “the perfect example of how humbling” treating COVID patients can be, both medically and emotionally. He spoke of the faith Rachel has put in him and other strangers to care for the man she calls her “sweetie” at a time when she cannot be at his side.
“It’s almost trite to say that it’s stressful to us because I can’t begin to imagine what it’s like for her,” he said. “We’re sort of exposed to profound humanity on a daily basis. … We’re very lucky to be in the room with people going through things like that.”
Love, the respiratory therapist, has spent 18 years helping treat countless veterans suffering from “asthma, COPD, emphysema, some TB, (and) things of that nature.” But COVID-19 is “a different animal,” she said, not just because it is so contagious, but because it attacks patients so ferociously.
She has driven home from work these past weeks in tears about what she is witnessing.
“You see stuff. Sometimes it hits a nerve where sometimes you just need to cry. I don’t know if it’s for me or for other people. There’s just a sadness about it.”
That’s why removing Big T’s tube last week felt like such a victory: “I was watching him and hoping. And when he (kept) breathing, it was like a big ‘ah-ha,’ a big exhale, a big, gigantic relief.”
As members of Big T’s medical team wrapped up our interview and prepared to get back to their patients, a long silence stretched. I could faintly hear one of the nurses crying. Their fatigue, their frustration felt almost palpable through the phone line, as did their longing for wins, however small, to endure.