Montgomery County medical heroes on the front lines of the pandemic – BethesdaMagazine.com

Meet 13 local medical heroes who are fighting to save lives as the pandemic rages on

By Caralee Adams and Mike Unger

| Published: 2020-09-14 08:12

Rarely, if ever, does Dr. Marissa Watts doff her scrubs (a term she recently learned) and go straight home when her 12-hour shift officially ends at 7 p.m. Instead, the hospitalist at Adventist HealthCare Shady Grove Medical Center in Rockville usually embarks on a newfangled version of rounds.

Something Ive tried to do is get a family member on the phone while Im talking to the patient, and we can all talk at the same time, says Watts, 35. Im trying to update family members on how their loved ones are doing.

The communication is vital because Shady Grove has allowed visitors only for those patients who are near death since the onset of the coronavirus. For the people under her careWatts sees patients with a variety of illnesses, including COVID-19she says the isolation can be almost as debilitating as the physical symptoms.

When the pandemic exploded in March, Watts often was short on good news to report during these calls. You would see somebody first thing in the morning, and before the end of your shift theyd go from needing two or three liters of oxygen to being put on a breather mask, which is a higher level of oxygen, to being put on high-flow oxygen, which is liters and liters more of oxygen, she says.

Just watching them deteriorate so fastI had not seen anything like that before.

After a particularly tough day, Watts would often call her mother, who is a nurse in Michigan, on her drive home. Im holding back tears half the time while I explain my frustrations, she says. It has been hard to sleep sometimes. Even when youre not working, youre worried about the patients, youre thinking about their family members. A lot of the time, youre up at 5 in the morning even though your alarm wasnt going off until 6.

In late winter and early spring, Watts felt hamstrung by the lack of tools at her disposal for treating COVID patients. At one point she was prescribing hydroxychloroquine, the anti-malaria drug that has since been linked to potentially serious side effects. For me, personally, I did see patients that were having consequences from the medication, she says. A lot of people had diarrhea, nausea and vomiting, or they had this prolongation of the heart complication that people really worry about. Once that starts, we have to stop the medication.

As therapies like proning (flipping a patient onto his or her stomach), convalescent plasma and the drug remdesivir have emerged, positive outcomes have become more common. In July, Watts was there when an elderly patient spoke to their family on speakerphone. The patient was disoriented when they arrived at the hospital, but the next day they had drastically improved.

A lot of the time, just for the ease of things, I wind up using my personal cellphone, Watts says. I block the number, so Im always praying that they answer a blocked number. There was a granddaughter that happened to be nearby, too, so [the patient] got to talk to the daughter and the granddaughter. It was a nice moment that I got to witness.

I like to think of myself as pretty capable and thorough and competent, and this [virus]really just knocks you back, says Watts, who graduated from George Washington University School of Medicine in 2012 and often gets coronavirus-related questions from her friends about things like whether its safe to travel. In the beginning, I wasnt sure what I was doing was helping. Thats what really terrified me. But now, because we have these other treatment options and there are more clinical trials that are going on, I am really hopeful.

Becoming a father was better than Dr. Manu Kaushal could ever have imagined. It was such a blessing. My soul was at peace, he says. Kaushal, 40, and his wife, Dr. Vandhna Sharma, welcomed their daughter, Reva, in late January.

Everything changed for Kaushal on March 17, when he read an article about a 2-month-old girl in South Carolina being admitted to an intensive care unit with COVID-19. As medical director of critical care and pulmonary rehabilitation at MedStar Montgomery Medical Center in Olney, Kaushal works with the sickest patients in the hospitals ICU and wears personal protective equipmentor PPEfrom head to toe. The news heightened his concern about the severity of the disease, so he texted his wife that he would be moving into their basement.

Kaushal says his dog, Demo, a Cavalier King Charles spaniel, helped fill the void while he self-isolated at his Rockville home. Kaushal carried the dog around, constantly sniffing him to make sure he still had his sense of smelllosing it is an early symptom of the virusand letting Demo sleep on his pillow. I would never be able to live with myself if something happened to my daughter, says Kaushal, who left his scrubs in the garage and headed straight to the shower after putting in 10- to 14-hour days at work. There is a constant worry about catching this disease and succumbing to it.

Kaushal says not being able to hold Reva for two months was the biggest anguish of his life. He credits his wife, an endocrinology fellow at the National Institutes of Health in Bethesda, with keeping him going, FaceTiming him during breaks and in the evening so he could see his daughter smile. By late May, Kaushal finally had time away from COVID patients, so he felt safe enoughafter five consecutive days off and with no temperatureto hold Reva again (he wore a face mask), an opportunity that comes about every two weeks with his new schedule. On Fathers Day in June, he was able to hold his daughter without a mask and to kiss her and his wife after he got a COVID test that came back negative.

During the first few months of the pandemic, the hospital doubled its ICU capacity. Kaushal was caring for patients in their 20s to their 80s; about half did not survive. One of the hardest parts of his day was calling one family member for each of the 12 to 18 patients in his care.

I have to find a balance of being honest and being realistic, but trying to stay positive and giving them a little bit of hope, says Kaushal, who found that a minute or two of silent mindfulness meditation between patients, and again at night to unwind before going to sleep, helped sustain him. Before this disease hit us, we could predict things much better. We could tell the trajectory of which patients were going to do well and which [were] not. This disease, it has really humbled me as a physician. I cannot predict what will happen tomorrow with a patient.

At one point, the wife of a 48-year-old man who was about to be taken off life support after 35 days in the hospital thanked Kaushal on the phone and told him that the couples 10-year-old son wanted to be like him and save lives.

It was a mix of emotions for me which I cannot describe. I was left speechless, Kaushal says. The boy was about to lose his father. I requested to call her back and hung up. [For] the next 15 to 20 minutes, I sat in my chair looking out of the window, convincing myself that it was his time [and] to let him go.

On days when a patient is wheeled out of the ICU and to another floor at the hospital, Kaushal often picks a song from what he calls his COVID playlist, such as Journeys Dont Stop Believin or Pharrell Williams Happy, and enjoys a moment of shared celebration with the staff.

A couple years from now, well tell Reva of the sacrifice my wife and I made at this time so we could all be safebut at the same time battle this horrible, horrible disease, Kaushal says. The disease separated us physically for a long time, but my love for my daughter and respect for my wife only grew during this time.

The first COVID-19 patient Patricia Aparicio admitted to the intensive care unit in March was a woman exactly her age, 46. I remember her words: If I come to the ICU, it means Im going to die, recalls Aparicio, nurse in charge of the ICU at Holy Cross Germantown Hospital.

No, Aparicio told her, we are in this fight together.

While health care workers offer assurances, the reality is that there are no guarantees with the unpredictable coronavirus. This spring, patients stayed longer than usual (some for three or four weeks) in Aparicios unit, and manyincluding this womandidnt make it. I still remember her, says Aparicio, who has been with Holy Cross for 15 years. Nurses get attached to their patients. We are the ones that hold their hand. It takes an emotional toll. In the early days of the pandemic, Aparicio and her fellow nurses were concerned about how the disease might impact their health and the health of their families. But in her role, she says she had to be the strongest link so she could support the rest of the team. She made sure the nurses took all necessary precautions and that they checked each others personal protective equipment, including face masks, face shields, goggles, gowns and double gloves, before entering a patients room.

We have to be very careful, because one mistake and we contaminate the whole unit, says Aparicio, who had to coordinate care for twice as many patients as usual in the ICU, and administer new treatments. Every day we would come to work and there were new studies. Protocols keep changing.

With visitors prohibited, Aparicio says the unit had to be innovative with communications. Once during the day and once at night nurses would connect patients with their families through Zoom or FaceTime. That would cut the anxiety for the family members, Aparicio says. Its so hard to accept whats happening unless they can see it.

Aparicio recalls a 53-year-old who had been on a ventilator, and they didnt think she would make it. She ended up improving and eventually going home. When she was discharged from the unit, her whole family got together to celebrate, and Aparicio did a FaceTime call with the patient. They were crying and were very grateful, she says. You see tears a lot of times in the ICUtears of frustration, tears of sadness and all kinds of emotions.

After work, Aparicio is cautious around her family. No hugs and kisses at home for a long time, says Aparicio, who lives in Boyds with her husband, mother and two children, ages 18 and 21. Sometimes shell mention if its been a hard day, but she says she doesnt want to make anyone else sad. Our family in the ICU is so tight that we can discuss and vent, so when we leave work, then home can be your priority.

Members of the hospital staff have been grateful for the outpouring of supportincluding snacks and mealsfrom the community. Aparicio says children have made them cards that read: Keep going and Were praying for you, which are taped on the walls of the ICU.

As Suburban Hospital in Bethesda prepared for its first COVID-19 patients, there were so many unknowns: How many beds would be needed? What kinds of treatment would work? How could staff remain safe around such a contagious disease?

Dr. Atul Rohatgi, 44, a hospitalistan internal medicine physician who cares for patients exclusively in the hospital settinghelped lead the response. I went in and saw the first patient, says Rohatgi, who donned the cumbersome but necessary personal protective equipment (PPE). I know people were scared. I think them seeing me go in [the room] and saying its OK probably went a long way to allay their fears.

Rohatgi shared his experience with colleagues and developed a manual for the hospital on how to care for COVID patients from admission to discharge. The digital document was constantly updated. Rohatgi would sift through the latest medical information about treatments and pass it along to his team of about 50 physicians, nurse practitioners and physician assistants.

People tried to make the best of it. We have a group, for the most part, that is glass-half-full, which goes a long way in times like this, says Rohatgi, who feels hes part of a close work family rather than a work team. There definitely were times when people were crying and breaking down, but they relied on the others to pull them through.

Changing in and out of PPE between every patient could add up to more than an hour a day. It was extremely draining and demoralizing, Rohatgi says. It was hard to be heard, and sometimes he had to yell. Then there was the time he sneezed in his PPE. I was like, Oh no. It all blew back in my face.

Rohatgi, who has worked at Suburban for 16 years, grew up in Rockville, the son of two doctors. He says he was encouraged by how the hospital adapted during the crisis. For instance, his team found creative ways to blow off steam. At the end of a crazy day, Rohatgi sometimes would be corralled into doing a TikTok dance video with a group in a hospital hallway. I said, If it puts a smile on your face, I will complain, but I will do it, he says.

After long shifts, Rohatgi says his home in Bethesda was a sanctuary. During the early weeks of the pandemic, he found that playing video games (such as Call of Duty) with his two teenagers was a good release. Plus, the family got a black Labrador-boxer mix, Clover, in March. You come home and you get puppy kisses, he says. How can that not be a good thing?

Matt Hopper occasionally likes a little music to liven up his workday. One day this spring, he had been listening to tunes from the Whoopi Goldberg movie Sister Act 2 before a patient came into the emergency room at Sibley Memorial Hospital in Northwest Washington, D.C., where Hopper has worked as a nurse since September 2019. The woman was unconscious, and when it became clear hours later that she was dying, presumably from COVID-19, Hopper grabbed her hand and began to serenade her with a song from the film.

Hopper is convinced that she could hear his admittedly out-of-tune rendition of Oh Happy Day. And he likes to think that his singing comforted the woman, who was in her 90s, during her final moments. Anytime that we have someone who is nonresponsive, I try to at least talk to them or tell them whats going on, says Hopper, 30. Theres evidence that even people who are nonresponsive verbally can still have awareness of stimuli around them. Sometimes you dont have the time to sing because youre providing all these interventions and their loss of life is unexpected. But sometimes its sort of a natural, calm thing, and you can add peace to that.

Nursing is in Hoppers blood. His mother and brother are both nurses, and after a stint in education technology he became one too.He graduated from Johns Hopkins School of Nursing in August 2019, but while he was there, he wasnt taught anything about the then unknown disease that would reshape his professional life.

You feel bad because there was no way to prevent how sick they were going to get, he says of COVID patients. There is no medication or exercise or piece of equipment.

Before, there was a pathway. If someone comes in with a bowel obstruction or theyre having a heart attack, we have a checklist and a process. Or, if we dont know whats going on, we have diagnostic testing and we are able to rule things out. But with COVID there is not a clear-cut pathway of what your hospital stay is going to look like and how youre going to feel in 10 to 15 days.

So Hopper, who lives in Columbia Heights in D.C., leans on what drew him to the field. He continues to speak to patients who are mechanically ventilated or sedated as if theyre awake because he believes its the humane and kind thing to do. Despite fears about contracting the virus himself, he strives to treat COVID patients like all others.

Theyre more scared than you are about the virus, he says. Talking to the patients who are unconscious is especially important now because often their family members are not there to talk to them at their bedside.

Hopper is continuing to educate patients about whats happening to them, helping them feel calmer and more in control, whether theyre conscious or not. And when he can, hes continuing to sing.

The way Kim Kelly describes her job may offer a hint as to why shes been so successful in her field. I take care of the people who take care of people, she says.

As Suburban Hospitals nursing director for critical care units, Kelly oversees a staff of about 160. At the start of the pandemic, she helped develop plans for securing supplies, while also creating new units and properly staffing them. A nurse since 1982, Kelly is well aware of the toll the job can take. Thats why she brought in Johns Hopkins Resilience in Stressful Events (RISE) team to talk to her staff during the darkest days of the pandemic. (Suburban Hospital is part of Johns Hopkins Medicine.)

RISE is an emotional peer support structure for second victims who were impacted by a difficult patient-related event or unanticipated adverse situation. Kelly says her staff discussed the emotional toll, stress and sadness they were experiencing, all of which was exacerbated by the fact that patients families could not visit them. Tears were shed.

Our patients usually dont have a plan to be admitted to critical care, Kelly says. The rug of life gets pulled out from under themand it happens to staff, too.

Kelly, who has been at Suburban since 2005, worked from March 7 through Mothers Day without taking a day off. She didnt have to work that muchshe wanted to. When the hospitals first COVID-19 patient arrived on a Saturday in March, she went to the hospital. On Easter, which fell on her birthday this year, she worked for eight or nine hours. It was one of Suburbans peak days of activity.

We were changing the modalities of ventilation for our patients. The nurses just rolled with every change, she says. We realized we were going to need more than just the ICU staff to care for patients on ventilators. Thats when we trained all the progressive care unit nurses to take care of patients on ventilators. Nobody freaked out. I didnt have a single staff member say, I didnt sign up to do this.

Kelly spearheaded an effort to adjust the position of some equipment in patient rooms so that the beds faced the door and pumps could be adjusted without a nurse entering the room. She worked to acquire personal protective equipment for the hospitalnot only the standard gowns and N95 masks, but also PAPRs (Powered Air-Purifying Respirators) and N99 masks with built-in air filters.

The staff always had three [mask] options that they could switch between during the day because all of them have their pluses and minuses, she says.

Kelly was responsible for hiring at least 20 traveling nurses to beef up her staff. Initially, they were hard to find. Many were in New York, but as those assignments ended, more became available. We look for nurses who can care for the sickest of our patients, Kelly says. Nurses who have experience in stroke centers, trauma centers, and open-heart experience.

If nurses needed a breakall the donning and doffing is hot and exhausting, and youve got to be so careful that its [also] mentally exhausting, Kelly saysthey could switch to a non-COVID assignment. Their well-being is of paramount importance to her. Nursing is not merely a job, Kelly believes. For her, its a calling.

In late April and early May, when a seemingly endless stream of COVID-19 patients poured into the critical care unit at Holy Cross Hospital in Silver Spring, Dr. Rachel Vile became, in her words, depressed.

I didnt get into this field to see so many people die, says Vile, the hospitals medical director of critical care. Shes the liaison between the hospitals critical care unit and its administration. There was, I think, a 12-day period that there was not a day that went by that I didnt call a family to tell them that their loved one had passed away. Coronavirus is humbling. I have watched mothers, brothers, uncles, daughters die of this virus. I have had to tell a child that her father has died. That type of raw grief, I wish I could let go, but its not going to go away. Some days were unbelievably hard, and I didnt think I could come back.

But Vile, 51, always returns, pushed by the reason she got into the field: to help people. She had planned to be a veterinarian, but after a trip to Kenya and Tanzania between her freshman and sophomore years at Tufts University in Massachusetts, she decided she could make more of a difference by becoming a doctor.

In the early days of the coronavirus outbreak, failures seemed to outpace successes, she says. Conventional wisdom was to put patients on ventilators, but that led to prolonged hospital stays and outcomes that werent always positive. Plus, the influx of new patients was unrelenting. From March 15 to June 25, Holy Cross Hospital served 9% of the population that needed hospitalization in the state of Maryland (behind only the University of Maryland Medical Center and The Johns Hopkins Hospital, according to a Holy Cross spokesperson).

It was exhausting for Vile, who worked 12-hour shifts and then participated in Zoom meetings with other physiciansboth from her hospital and othersto discuss treatment options and strategies. She contemplated quarantining herself from her husband and three children, who quickly rejected the idea. One night in May, she walked through the door of her Chevy Chase home and her 14-year-old son, Jacob, was playing Xbox. I collapsed on a chair, and [he] looked at me and said, Mom, you know youre a hero, right? she says. It probably was the best moment of my life.

As the hospital implemented a trial involving the drug remdesivir and other treatment options became available, some outcomes were better. I remember a 38-year-old patient, Vile says. I came in in the morning and the night [intensive care doctor] had seen the patient, started remdesivir and screened the patient to get convalescent plasma. The patient got better and left the ICU without ever needing the ventilator. Thats the kind of thing I hold on to. I dont know if it was the treatment or they just got better because they were 38, but I feel like the treatment helped.

Now when a COVID patient leaves the hospital, the Beatles song Here Comes the Sun plays over the PA system. Those victories, and an intellectual curiosity, keep Vile going. This is the most fascinating disease, she says. [Patients] bleed and then they clot. Their kidneys fail, their liver fails, they get strokes. They have COVID toes. I want to get to the bottom of it, and I want to be able to cure it.

When Nimeet Kapoor joined Adventist HealthCare Shady Grove Medical Center as nursing manager of the intensive care unit last December, the Rockville hospital had one 28-bed ICU. His workload essentially tripled with the addition of two more ICUsone with 17 beds in March, and the other with a 21-patient capacity in Aprilto serve COVID-19 patients.

It was a really big change, says Kapoor, 32, a nurse for eight years who is charged with recruiting, coaching employees, and ensuring that there are enough beds for patients. I was hired to manage the ICU and the rapid response team. I had about 60 to 65 people I managed. At the peak, we had about 150 to 180 employees that I was managing. At the time it was happening, there was an adrenaline rush going through me.

Kapoor is constantly reexamining the hospitals safety measures and action plans, and he was part of a group that created a proning team to turn COVID patients from their backs to their stomachs. Before the pandemic, the ICU proned one or two patients a month, but that became two or three people per shift when doctors realized that it helps COVID patients breathe more easily. It takes six to eight people to turn each patient, and Kapoor often helps out.

As COVID cases increased, staffing was a challenge. The hospital hired about 100 new nurses to join its existing ICU staff of roughly 50, and Kapoor tried to meet with each of them. He had to reassure staff that they would be safe. We did have a lot of employees raise concerns, he says. They were worried about their loved ones, and they did not want to be exposed to [the virus]. The fear is just as real as the disease. One of the things I did was recognize that fear and tried to understand the root of their concerns. I let them know that if you have the proper protection, you dont have to worry about that. Most people were able to understand that, but some people were not and ended up leaving because of it.

Two or three employees quit, says Kapoor, who sees remarkable acts of kindness performed daily by those he works with. When an improving COVID patients breathing tube was removed in the darkest days of the pandemic, a nurse threw confetti (with the patients approval) to mark the occasion. Although Kapoor works primarily with staff and not patients, he ditched his shirt and tie for scrubs to show solidarity with his employees. He now checks in with the charge nurse on nights and weekends.

The hospital closed the third ICU in May, but Kapoor is always preparing for what could come next. The recruiting and hiring of nurses has not stopped just because the number of COVID patients has decreased during the summer.

We are seeing the tail end of the peak now, Kapoor says in late June from his Gaithersburg home during a much-needed week off. We still have COVID patients in the hospital, we still have COVID in the community. With the economy opening up, with things happening in the community, we just dont know what direction this is going to go, how lax people are going to be.

Lauren Sundergill was working as a behavioral health nurse in the psychiatric unit at MedStar Montgomery Medical Center in Olney when the COVID-19 crisis hit. A nurse for 15 years, including seven in intensive care, she had recently switched jobs and was helping adolescents develop coping skills as they struggled with mental health issues. Sundergills manager told her that staff was working overtime with the influx of COVID patients, so the 36-year-old spoke with her fiance, Peter Koop, about volunteering to help. They had heard on the news that nurses were dying from the disease in New York City, so they knew the risk on the front line was real.

It was really scary, but I just knew I had to do it. It was as if the choice was already made, recalls Sundergill, who lives in Rockville. I just felt it in me that I could make more of a difference working with the COVID patients.

In the ICU, Sundergill works four 12-hour shifts a week, and early on she paid close attention to the emotional challenges patients faced after being hospitalized and isolated for so long. She says many cried. Some were restless and yelled unless someone was in the room with them. Others spoke very little and didnt make much eye contact.

A lot of times theyd come off the ventilator and be unbelievably depressed, says Sundergill, who played music recommended by patients families to improve their moods. You have people that were healthy and independent beforehand, and now they cant walk or feed themselves. We need to do every little thing we can to help them feel more in control and normal.

One 73-year-old man told Sundergill he felt helpless and hopeless after weeks in the ICU. Determined to turn the situation around, she got him up and gave him a shave with a disposable razor. I did a terrible job. I told him it was the first time I had shaved a patient. He said in a weak voice, I can tell. And then I knew he was going to be OK, Sundergill says. The patient was released after 51 days in the ICU.

Another patient in his 40s kissed Sundergills gloved hand after she got him up to brush his teetha return to normalcy after a couple of weeks of being intubated. The day he went home, she says, the nurses were dancing with him on the other side of the glass doors.

Sometimes, simply moving patients beds to face the window was a motivator. Even if all they could see was the sky, it was a reminder that there was life out there, says Sundergill, who was tagged the out-of-bed queen by staff for pushing her patients to stand up, walk and resume routines.

As patients got stronger, Sundergill would get them coloring books and word searches to distract them from their loneliness. Shed call family members who needed someone to listen while they cried. Thats how I deal with it, she says. I try to put all my energy [into] making it as easy and painless as possible for the family. When a patient was near death, Sundergill would arrange video calls with relatives. I try to focus on [the] fact [that] they now are at rest and peace, she says. They dont have tubes in them anymore, they are not struggling to breathe.

Laura Ventura graduated from nursing school in May 2019 and started working in Suburban Hospitals progressive care unit two months later. Then, in late winter, the coronavirus hit.

Talk about being thrown into the deep end.

No one graduated nursing school and was ready for a giant pandemic, the 25-year-old says. I had [about six months] to learn how to be a nurse and get comfortable with my [unit]. Im only a year in and Im still learning. Everyone is.

Still, the adjustments Ventura needed to make in order to care for COVID-19 patientsshe moved out of her fathers house and into an Airbnb, a hotel and then a shared house in Silver Spring in Julyare a small price to pay for the privilege of being a nurse, she says.

We have a mixture of people who are able to talk to you and people who are not able to have a coherent conversation or interact at all, she says of the patients in her unit. I love caring for all of those different kinds of people because I love connecting with the people who Im taking care of.

When Ventura first heard about the coronavirus outbreak in China, she didnt expect it to affect her. But soon her unit was transformed from one for pre- and post-cardiac intervention, among other things, into COVID care, and she admits that she was frightened to go to work. In fact, she says shes still scared when she walks through the hospital doors (she occasionally journals in her phone to relieve some of the stress), but three times a week, for 12-hour shifts, she puts that fear aside to tend to her patients.

The people suffering from COVID at Suburban Hospital are generally older, but she has seen patients in their 30s and 40s who were profoundly ill. A lot of these patients havent been in the hospital beforeand now theyre in critical condition, she says.

Ventura hasnt lost a patient under the age of 50, and shes seen some inspirational stories of recovery. When one of her patients was discharged after fighting off the disease, hospital staff played music as the person was wheeled down the hall. Ventura was in another patients room, but says she saw the scene unfolding from the window and danced with joy even though she couldnt hear the music.

In May, she met a patient in his 90s. When she walked into his room, he began to tell her his entire life story. He was the sweetest man, she says. I sat there and listened to himbeing a teenager, getting married, having kids, moving all over the worldfor a long time. He was very elaborate in his storytelling. After I gave him his medications, I started to leave the room. He said, Dont be surprised if I call you back immediately, simply because I miss your company. I thought about that for a while. COVID patients obviously have to be isolated. I cant even imagine what its like where the only people you interact with are covered head to toe in plastic and youre just alone in your room. It was heartbreaking, and it made me want to go back in there and sit with him and talk to him.

The man died less than a week later, but in his final days he was not alone. Ventura was with him.

While its the health care workers who operate on the front lines, hospitals wouldnt be able to function without the help of hundreds of support staff who often toil in obscurity. People like Emerita Larios.

Larios, 52, has been an environmental services attendant in the Adventist HealthCare White Oak Medical Center emergency room in Silver Spring since the hospital opened last year. Her responsibilities are easy to define but difficult to execute: Shes tasked with keeping the ER clean. The COVID-19 virus is so contagious that maintaining sterility in the ER is essential. Larios reports to work at 7 a.m. each day, changes into her scrubs, and gets to work disinfecting and bleaching every square inch of workstations and many of the 40 patient rooms.

We clean from the top to the bottom and the bottom to the top, says Larios, who worked at Washington Adventist Hospital in Takoma Park for more than eight years before it moved to White Oak. In every single room that we clean, we change the curtains. We clean the walls, the chairs, everything you can imagine.

When she goes into a room thats occupied by a person under investigation for COVID or someone with a confirmed case, Larios puts on a gown, gloves, goggles, a hair cover, and an N95 mask with a surgical mask over it. She spends about 30 minutes cleaning each room. It takes more time because you never know, she says. If I make a little mistake and dont wear the proper PPE [personal protective equipment], I can get infected. I have to be 100% focused. Were always around sick people. Thats a big change. There are some days that are very stressful.

One day in particular sticks with her. In June, her friends father was hospitalized at White Oak with COVID. Because no visitors were allowed, Larios made a point of checking in on him, although doctors werent allowed to give her any information about his condition. He died days later. Larios worries about bringing the virus into her Silver Spring home, where she lives with her 26-year-old son (she has two other grown children who live in California and New York), so she takes precautions like bathing and washing her clothes right after work. Despite that fear, quitting has never crossed her mind. She loves the job because of the sense of accomplishment it provides.

There are a lot of ways you can help in a hospital, she says. Larios rarely speaks with COVID patients, who are usually wearing oxygen masks, yet some of them, or their families, have sent her cards, cookies or flowers just to thank her for the job she does.

Seven days a week from March through May, Scott Graham left his farm near Sugarloaf Mountain in the 5 a.m. darkness to head to work at Holy Cross Hospital in Silver Spring. He returned at about 9 at night, often listening to country or worship music during his commute.

As director of emergency preparedness/Emergency Operations Center life safety and workforce wellness for Holy Cross Health, which also includes a hospital in Germantown and several clinics in the state, Grahams task during the coronavirus outbreak was to make sure everyone had what they needed to do their jobs. The Silver Spring hospital had an advantage as a designated Ebola/special pathogens assessment center, meaning it had staff that was trained to work in personal protective equipment (PPE) for long periods of time, and that it had certain crucial supplies on hand. In his position for six years, Graham had devised plans for a variety of disaster scenarios, including a flu outbreak or a mass casualty, but COVID-19 presented a new challenge. We completely had to change our processes. There was really no playbook written, he says.

On March 2, Holy Cross activated its incident management plan, and Graham served as deputy commander to Holy Cross Hospitals president, Dr. Lou Damiano, overseeing teams that managed operations, finance, communications and logistics. Graham spent his days in an education classroom at the hospital that had been transformed into a command center with sophisticated visual displays of the hospitals capacity data, supplies on hand, weather and real-time news. Twice a day, at 8 a.m. and 4:30 p.m., Graham led a briefing of the incident team, and needs were written on a whiteboard and assigned. You put talented minds in a room, you come up with a solution. It may not be a traditional solution or in the textbooks. Its not perfect, Graham says. Its a disaster. Things are done differently during a disaster or in this pandemic. His job included making sure there was enough PPE for the health care workersonce driving a box truck to New Jersey to secure supplies.

Staff had to be reassigned to cover the fluid situation. Physical therapists were trained to help with food services and keep the building clean. Employees who worked in guest relations had no visitors coming in, so they were sent to tents to help process patients before they entered the emergency room, says Graham, who also made adjustments to the physical layout of the hospitalssuch as adding a tent in the parking lotand to procedures as the systems facilities operated at surge capacity.

Graham, 56, previously worked with Montgomery County Fire and Rescue for 27 years. He was part of an urban search and rescue teamfirst as a medic and then as a task force leaderthat deployed to help in the federal response to disasters including 9/11, Hurricane Katrina and the Oklahoma City bombing. At work during the early weeks of the pandemic, he says he felt the same sense of dedication among his tight-knit team as he did with the fire service. At home, nightly family dinners with his wife and two daughters, ages 18 and 24, helped him stay grounded. Graham says he found inspiration from the book Halftime by Bob Buford, which explores how to reflect on past experiences as you enter the second season of life. He also relied on his faith. No matter what your spiritual walk is, I believe we are placed in positions at times to lead. We are called to do this, Graham says. I believe God gives us all an ability and gift to make a difference, and its up to us to realize that.

The patient, a woman in her early 50s, worked at a large distribution center where another employee had tested positive for the coronavirus. It was the beginning of March, and the pandemic was in its earliest stages. The woman didnt know the identity of the infected person, but that night at Sibley Memorial Hospitals emergency department, she did know that she needed help.

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Montgomery County medical heroes on the front lines of the pandemic - BethesdaMagazine.com