A doctor closes her eyes and takes a moment to make a final adjustment to her mask as she prepares for rounds on a COVID-19 floor. Joshua Gunter, cleveland.comJoshua Gunter, cleveland.com

CLEVELAND, Ohio – When is it going to end? It’s a simple question with no answer.

Doctors and nurses have been fighting COVID-19 on the front lines for nearly two years, coping with death, fear and exhaustion, as they set aside their own trauma to help others.

They’re haunted by their patients’ final moments. The guttural screams of a mother who just lost her child. The image of a husband watching through a glass wall, as his wife loses consciousness and slips away. They are caregivers forced to play God, deciding who gets access to life-saving equipment. They’re preparing COVID-19 bodies for the morgue -- a grim duty that torments their dreams.

Often, these health care heroes are treating people who are abusive and combative toward hospital staff, having refused to take the simple preventive step of getting vaccinated. Some of these patients spend their final breaths denouncing the science behind the vaccine -- or regretfully wishing they had gotten one.

And the numbers speak for themselves. More than 800,000 people have died from COVID-19 in the U.S. as of Wednesday. And while unvaccinated people face 20 times the risk of dying from COVID-19 than those who are fully vaccinated and received booster shots, less than 30% of the U.S. population has been fully vaccinated and boosted.

Cleveland.com and The Plain Dealer spoke with four local health care providers on the condition of anonymity, so they could freely describe what’s happening inside area hospitals and the toll it has taken on them. A fifth interview was scheduled, but the nurse tested positive for COVID-19 and had to seek emergency department care. All names have been changed to protect their identities.

This is the second article sharing stories from frontline heath care workers. Find the first installment here.

Laura: Nurse, working in a COVID-19 Intensive Care Unit

Before the pandemic, Laura would have good days and bad days but rarely two bad days in a row. Now, she can’t remember the last time she had a good day at work.

“We’ll have three patients waiting in the emergency department, and the only way they can get a bed in the ICU is if someone dies,” Laura said. “You don’t even have time to recover from the death you just had before you have to brush yourself off because another one is coming. And then you get back up, and you do it all over again.”

After working in the ICU for years, she’s used to dealing with death and dying, but having so many younger patients because of the pandemic is taking its toll. Many of her colleagues, some of whom have been working among the tragedies in critical care for decades, are leaving because the emotional stress from the pandemic is too much to bear.

“These patients are in their 30s and 40s. They have babies at home,” Laura said. “They might be with you for weeks. You get to know them and their families, and then at the end, they’re terrified, begging for you to save them, and you can’t.”

A woman in her 20s and her mother -- both unvaccinated -- were critically ill with COVID-19 and were intubated in the ICU at the same time. The daughter was moved to a different hospital for additional care, but the mother wasn’t eligible for transfer. After her daughter left, she took a turn for the worse, and there was nothing else the team could do.

“That was a tough one because she had no family there when she passed,” Laura said. “Her daughter will never be able to say goodbye to her mom, if she even survives herself.”

For Laura, one of the most challenging parts of working in the COVID-19 unit is what happens after a patient dies. In non-COVID deaths, patients’ families come in, and the nurses make the room peaceful and quiet with music and other comforts.

Laura can’t provide those services after a COVID death.

“You can’t take the tube out of the patient’s mouth, which is horrible for the family to see while they’re saying goodbye,” Laura said. “After the family leaves, we put the patient in a body bag, pour peroxide in every hole, fill their nose and mouth with gauze and cover their head with a towel soaked in peroxide. Afterward, you think, what did I just do? Sometimes we have these patients for months, and then I have to do that to them. It’s absolutely terrible.”

One patient in his 30s came into the ICU needing intubation. Before they started the procedure, he told his mom the first thing he would do when he got off the ventilator was get vaccinated.

“He never got that chance,” Laura said. “I was talking to his mom outside his room the day we called the family in to say goodbye, and she asked if this would be happening if he had gotten the vaccine. I don’t have a crystal ball, but probably not. He would have gotten sick, I’m sure. But this sick? Probably not.”

Laura believes people are choosing not to get vaccinated for the wrong reasons. They are being lied to by people in positions of trust, feeding on diets of disinformation or putting their faith in so-called wellness experts promising false hope through untested remedies. She’s been told by patients that they decided not to get the vaccine because they didn’t want the government tracking them or that they read that 90% of people who are vaccinated will die within a year. Both are dangerous lies.

“It’s just frustrating because you try to educate people, and it goes in one ear and out the other,” Laura said. “I’ve done my part. I’ve been vaccinated. I’m seven months pregnant right now with an almost-two-year-old at home, and I’m exposing myself to unvaccinated patients for hours on end. If you don’t care about yourself, fine, but what about the rest of us?”

The emotional and physical fatigue has taken a toll on Sarah as the pandemic persists with no end in sight, feeling defeated every time she tries her best, and it just doesn’t work.

In the emergency department, she and her colleagues work tirelessly to treat those critically ill, knowing the implications each time a patient needs to be sedated and put on life support.

“Eight out of 10 COVID patients who go on a ventilator don’t come off it alive. We don’t like doing it because we know the stats, but at that point, we’ve tried everything else, and there’s no other option,” Sarah said. “When you’re putting someone on the ventilator, you know that this might be the last time they talk to anyone ever again. The last person they look up and see may be me. I always pray that it’s not, but I know that statistically speaking, the odds are against them.”

Which makes it all that more frustrating when people come into the emergency department criticizing her medical guidance, denying the severity of the pandemic and doubting the necessity of COVID-19 vaccination.

“It’s true. You can be vaccinated and get COVID anyway, but how sick you get is going to be different. It’s the difference between having the sniffles and being on a ventilator,” Sarah said. “Unfortunately, most of the ones who don’t make it out of the hospital are unvaccinated.”

Compounding that frustration is a lack of respect and kindness from patients, which has caused an increase in the rate of verbal and physical abuse toward health care providers, according to Sarah.

“I think there’s a lack of compassion,” Sarah said. “In the beginning, everybody was trying to come together, and now it’s become a very divisive thing.”

Sarah told of a family reunion with many unvaccinated attendees. Someone with COVID-19 was at the reunion, and it spread among those who attended, causing one woman to have to bury her husband, brother and father within a week.

“They all ended up in the hospital, and one by one, they all died. What do you even say? There are no comforting words for that kind of a loss,” Sarah said. “We’re used to death in the emergency department. It’s part of the job. But the volume we’re dealing with recently is overwhelming. Telling family that someone died never gets easier and to have to do it over and over again. To see the devastation in people’s eyes is really hard.”

Jennifer: Nurse, working in a COVID-19 Intensive Care Unit

Jennifer’s unit saw a substantial increase in patient numbers in the weeks following Thanksgiving, something she attributes to the Delta variant, which she says is far from gone. Before the holiday surge, her unit was full but could maintain two to three crash beds for intubation emergencies. In the weeks following Thanksgiving, however, dedicating crash beds was no longer feasible, and staff has been forced to intubate patients on regular medical floors and place them on sub-par portable ventilators while they wait for a bed.

“We’re moving unstable people out of the ICU because people who are more unstable need the room,” Jennifer said. “Patients who require elevated ICU care are not receiving it because they have to stay in the emergency department. This is happening up to 10 times a day.”

One of her patients was an unvaccinated older man whose daughter was pregnant. He became sick enough that he had to go on a ventilator but first called his daughter to tell her he would fight as hard as he could to meet his granddaughter but that she had to get vaccinated to protect her and her baby.

“He didn’t end up making it,” Jennifer said. “His wife just kept saying, ‘he needs to survive to meet this grandbaby. That’s all he wants.’ Unfortunately, he was never able to meet the baby. Having a child should be such a joyful time in your life but having your dad actively dying during your pregnancy, how do you even enjoy that?”

In another case, the child was the patient. A man in his 20s came into the ICU close to cardiac arrest. The team quickly got him on a ventilator, but he didn’t make it out of the procedure.

“Calling his mom in, explaining to her that he died and hearing her scream for her baby was one of the most heart-wrenching things I’ve ever heard,” Jennifer said. “That’s a sound I’ll never forget. The entire unit could hear it all the way down the hallway. Everyone was in tears, and we’re dealing with this every day.”

Knowing the statistics, patients are more often expressing fear of being put on the ventilator or refusing it entirely. Jennifer had many stories of patients passing away after refusing to be intubated or agreeing when it was too late, but one story from early in the pandemic left a lasting impact.

“One young woman absolutely did not want to go on the ventilator because she was certain that she would never wake up,” Jennifer said. “She died while her husband watched her from outside her room with his hand on the door. They talked on the phone until she went unresponsive. She died while he was there, watching her, and he couldn’t even hold her hand.”

When no one is around, Jennifer is the one there holding the patient’s hand, as she did for one man as his children said their goodbyes on FaceTime.

“I’m fairly certain My N95 was soaked with tears. I don’t even know if it was effective,” Jennifer said. “But I was the only one who could be in there. And I would hope someone would do that for my family too.”

Even with the relentless COVID battle, Jennifer says the most draining part is dealing with people who think the health care field is lying.

“It’s just so frustrating because none of them have witnessed what we’re actually doing, how hard we’re actually working, and the toll it’s taking on us,” Jennifer said. “I can’t believe people would think that about the health care system that’s literally dying to help them.”

She and her colleagues are forced to choose a small number of treatment plans for each patient because time and equipment are so scarce that life-saving measures have to be rationed. Because of that, people remain on transport ventilators that don’t provide adequate treatment. Some patients require intubation because the machines that could prevent intubation aren’t available.

“I could never tell a family member that I’m treating their patient to the best of my ability because it’s just not possible to do that right now,” Jennifer said. “We don’t have the beds, and we don’t have the resources. We’re being told by our system that we have adequate equipment but that we need to limit our use substantially. I don’t know how they can say what we have is adequate when we don’t have enough for the number of people who need it.”

Jennifer said most patients -- and the sickest ones -- are unvaccinated. Some ask if COVID-19 would have been so bad if they had gotten the vaccine. She admits, “unfortunately, it wouldn’t have been.”

“I go into work every day to take care of people, and I’m expected to bend over backward to fix them when they won’t help themselves by getting vaccinated,” Jennifer said. “I went into this profession to help people when they’re sick, but it kills me inside to know that they didn’t have to be here.”

Megan: Nurse, working in a COVID-19 unit

Megan feels abandoned by the people who have downplayed the severity of the pandemic for the past two years and by her colleagues, who are no longer coming into the COVID-19 unit out of fear for their own health and safety, creating even more work for the already understaffed nurses.

“I don’t think people truly understand what we’re facing and the lack of support that we have at this point,” she said. “There’s a major surge. Sometimes we don’t have enough beds. As soon as someone discharges, we get a new patient.”

Most of those patients are so critically ill that discharge seems like an unattainable dream. But one of Megan’s patients, a man in his 40s who, besides having COVID-19, was an otherwise healthy person, recovered enough that his discharge day arrived.

“While our team was on the phone with his wife explaining where she would be able to pick him up an hour later, his roommate called out crying for help,” Megan said. “We ran in to find the patient had collapsed from what we later found out was a blood clot. We worked on him for over an hour, but he still passed away. The next call the doctor had to make was to tell his wife that he died less than an hour before she thought he was coming home.”

She said the toughest part of battling the pandemic is not having enough time and resources to provide patients the care they need and deserve.

“Patients are not getting the best care, and that’s the truth,” Megan said. “It’s not the work that I signed up to do, and it makes me feel like a terrible nurse. I dread walking into work, which I never have before.”

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