LEWISTON — More than one year and three months ago, a Navy reservist in her 50s who recently returned from Italy was tested for COVID-19 at Central Maine Medical Center’s emergency department. Two days later, on March 12, 2020, state health officials confirmed the Auburn woman was Maine’s first presumptive case of COVID-19.

Since then, as of Friday, 68,924 Mainers tested positive for the viral disease and 858 died from complications.

Maine appears to be at a turning point in the pandemic: Maine’s civil state of emergency, which Gov. Janet Mills first declared on March 15, 2020, is set to expire at the end of this month; more than 57% of all Maine residents are fully vaccinated against COVID-19 and the seven-day rolling average of new daily cases is 27, the lowest it’s been since September 2020.

But when a second surge of new cases and hospitalizations erupted across the state in March and April, providers at Lewiston’s two hospitals found themselves caring for more COVID-19 patients than ever before, breaking records set by the previous surge in late winter and adding unusual stress to staff already exhausted from a year fighting COVID-19.

That period, and the overall pandemic, will not be soon forgotten by six of those providers the Sun Journal spoke to recently. Despite life slowly returning to normal for many people, the health care workers — critical care nurses Kate Dube, Suzi Morin and Suzanne Wilson, and hospitalist Dr. Zachary Mueller at CMMC, and emergency department directors Dr. Carl Ramsay and registered nurse Heather Nadeau at St. Mary’s Regional Medical Center — say the fight isn’t over.

‘NO ONE HAD ANY IDEA HOW BAD THIS COULD BE’

Morin, 29, a nurse leader in CMMC’s intensive care unit, can trace the development of the pandemic — from the first cases in Wuhan, China, to the disease’s arrival in the United States — through the weekly lectures of her graduate school epidemiology course.

First it was “Oh, it’s just something going on in China,” and then it was “This can’t last very long,” Morin said.

“No one had any idea how bad this could be,” she said.

Dube, 26, recalls walking out of CMMC following a job interview for the position she now holds as a nurse in the intensive care unit, and a notification popped up on her cellphone screen that said COVID-19 had arrived in Maine, to the very hospital she had just exited.

“I was like, ‘Oh, I signed up at the right time,’” said Dube, who previously worked in the orthopedic department.

Around the same time, Morin’s younger sister tested positive for COVID-19.

“It’s kind of very strange thinking about it from that perspective of she was one of the first cases of COVID in this country. And now here we are and it’s, you know, almost everyone that we know has been impacted in some way or another with COVID,” Morin said.

11:30 P.M., 28 DEGREES: ST. MARY’S DIAGNOSES ITS FIRST COVID-19 PATIENT

Ramsay, 68, joined St. Mary’s as the Emergency Department medical director in December 2020. Prior to that, he had a 30-plus-year career practicing emergency medicine in New York City. He cared for HIV/AIDS patients in the 1980s in Harlem and the Bronx, an experience Ramsay described as “devastating” for those on the front lines.

Ramsay said watching the initial COVID-19 outbreak in China in late 2020 and its eventual spread to other parts of the globe was for him like watching SARS and H1N1 make their way to the U.S. in the 2000s. He treated patients during both of those outbreaks in New York, too.

Soon after arriving, and before he even knew his way around the hospital, Ramsay — and soon Nadeau, who came to St. Mary’s a month after Ramsay as Emergency Department nurse director — began looking for additional space for a potential surge in patients.

“January’s when we really started to focus on what our steps would be as an emergency department,” Nadeau said.

Still, “I think as a nurse starting in a small community hospital, you never think it’s going to come to you,” she said.

Nadeau and Ramsay immediately recalled the time and date where things changed: March 15, 2020, a Sunday afternoon.

“You could feel it,” Nadeau said. They began directing less sick patients to stay outside of the emergency room, in their cars or in the ED parking lot where doctors and nurses would check on them. Ramsay said it must have been about 28 degrees out.

“Our first diagnosed COVID patient was actually a parking lot patient in a car at 11:30 at night. And then that next morning, we have a tent. And we saw 55 extra people the next few days, beyond who came into the ED,” he said.

Though they had prepared for this moment, Nadeau still said it was “nerve-racking,” especially being in a leadership position where she’s not only caring for the well-being of her patients, but of her staff.

“As a leader, you’re trying to lead a team through the unknown and they’re looking to you for answers to questions that they have. … And so you’re trying to help them navigate their own fears when you have your own, with no answers,” Nadeau said.

‘WHICH ONE ARE YOU?’

The arrival of COVID-19 and the deadly unknowns it brought with it, quickly changed life for the health care providers.

Morin told her husband to hold the dogs back when she walked in the front door because she didn’t want them to touch her until she showered. Wilson, 56, stripped at the door of her and her husband’s home out in the country and immediately got in the shower. Mueller, 37, and Dube threw their scrubs into the washing machine as soon as they got in their homes. Though they’re vaccinated now and feel a little more at ease, most of these habits have stuck.

“Cognitive load is kind of the word that comes to my mind,” said Mueller, a doctor of osteopathic medicine and assistant chief of adult hospital medicine at CMMC.

“It’s just an extra thing that you always have to be thinking about, an extra step in your life. It’s an extra, you know, 20, 30 minutes between getting home and actually being home and spending time with my kids,” he said.

Dube said she now knows it is unlikely the virus will spread from her clothes to other people, but getting out of them when she gets home is for “peace of mind.” At the beginning of the pandemic, she said, she didn’t even want to get into her car after a shift in the ICU she was so concerned about bringing something home.

Wilson has spent half of her career working in the ICU, but said this is the first time she’s ever been faced with a disease where it seems that no matter how hard everyone works, sometimes it’s not enough.

“In my mind, I’m thinking, ‘Which one are you? Which one are you going to be? Are you going to be the one who dies?’” Wilson said.

“We’ve had some really sick patients (before COVID-19), but many of them do survive. No, I assume they’re all going to live because we’re fighting like crazy to make them,” she said when asked if she ever had that experience pre-COVID.

“But with COVID, it’s like, you know, it didn’t – we did everything. And they would still die,” Wilson said. She doesn’t think she’ll ever shake that.

Morin agreed: “A lot of times it felt like it didn’t matter what we did.”

For all his experience treating patients during the AIDS epidemic and the SARS and H1N1 outbreaks, Ramsay said those diseases don’t compare to COVID-19 in a clinical setting.

“It’s not even close. It’s that much worse. (It’s) totally more unpredictable,” Ramsay said. “It’s ability to be unpredictable for so many populations and patient types and its ability to kill, or make people really sick, it’s a different ballgame.”

He and Nadeau agreed that rapid testing was a “game changer” for clinicians and their ability to quickly isolate the patients with COVID-19.

There was greater uncertainty at the beginning of the pandemic, when rapid testing was not readily available and it was taking days for labs to provide results.

“These tests were taking days to come back and I just remember going in that room for the first time,” Dube said of a positive COVID-19 patient’s room. “It felt like you were in this room with this big ominous black smoke that was gonna come at you and you didn’t know how bad it was going to be.”

“And I just didn’t want to go near my friends. I didn’t want to go near my family. And I didn’t want to walk near anybody,” she said.

Since then, the medicine and clinical protocols have vastly improved. The COVID-19 vaccines have been pivotal for the caregivers’ own sense of safety — and a sign that there’s a light at the end of the tunnel.

On Thursday, Maine Center for Disease Control and Prevention Director Dr. Nirav Shah said in a Tweet that of the 31 individuals hospitalized with COVID-19, 29 – 94% –were not fully vaccinated.

“People just feel different when they’re fully vaccinated,” Ramsay said. “They just do, (but) it doesn’t mean you let your guard down.”

SPRING SURGE WAS A ‘WEIRD TWILIGHT ZONE’ FOR CMMC NURSES

Most of Maine and its hospitals saw the worst surge in new daily COVID-19 cases and hospitalizations last fall, but Androscoggin County was hit hardest by the spike in cases this past spring. CMMC saw record numbers of COVID-19 patients, many or most of them requiring critical care.

“It felt so weird,” Dube said. “You come to work and things were the worst they had been ever in our career for COVID. But if you talk to somebody walking down the street or going to the grocery store or whatever,” and if they were not personally affected by the recent outbreaks “they’re like ‘Yeah, this is the best COVID has been.'”

At the height of the surge on April 20, Androscoggin County’s seven-day rolling average of new daily COVID-19 cases was 90.4. During the winter surge, the seven-day rolling average peaked on Jan. 15 at 73.7.

On that same day in April when cases peaked, providers at CMMC were caring for on average 18 confirmed COVID-19 patients over the past seven days, according to data provided by the hospital, a number that does not include patients with suspected cases that had yet to be confirmed via testing.

“At that point, everyone’s fed up and done with this pandemic, like it’s done. We’re all vaccinated, we’re fine,” Morin said. It was if everyone around her was saying, “I don’t know what you guys are moaning about.”

Morin said her family had a hard time understanding why she didn’t want to visit with them.

“All I’m thinking is like ‘You do not know how bad it is right now,’” she said.

Patients across the state were also trending younger and sicker. More patients needed higher amounts of supplemental oxygen, required a ventilator, required dialysis and other complications and many were in their 50s or younger, the three ICU nurses said.

TRAUMA AND JOY

“The PTSD is definitely real,” Morin said of the feelings of post-traumatic stress disorder that front line workers have experienced. It comes out in weird ways for her. Recently, she said she got “irrationally angry” at her husband because his friend’s wife did not want to get vaccinated against COVID-19.

“I knew it was irrational,” she said. “But there I am, like sitting on our basement floor, crying over it.”

Dube and Mueller both said they haven’t really begun to unravel the impact that the past 15 months have had on them personally.

Dube said she’s constantly waiting for something bad to happen “and hoping that it’s not.” Morin was often preoccupied with the thought that if something happened to her family in Florida, she wouldn’t be able to get to them.

Wilson said she had “devastating family losses” and wasn’t able to be with her family in the South, where she’s from.

“It was a rough year (in) many, many, many ways,” she said.

Mueller suspects working through the effects of the pandemic will take a long time, while also “sort of living the ramifications of it for a long time.”

Ramsay called emergency physicians such as himself “pros” at distancing themselves from the situation at hand so they can focus on the medicine.

“I’m a pro at being a dissociative, put it in a box,” he said. “I haven’t personally caught up with those emotions yet.”

All six have found some silver linings amid an exhausting and traumatic year and a half.

“It’s weird considering everything, but I still feel hopeful,” Dube said.

The four nurses — the ICU nurses from CMMC and Nadeau from St. Mary’s — said the teamwork and bond they had with their co-workers was special.

Emergency Department nurses are “a lot like family, but that really shined through this,” Nadeau said.

Morin said without her fellow nurses, “I feel like I would not have made it through.”

Mueller said he was “excited” to practice medicine throughout the pandemic.

“Everyone was scared, but at least we could kind of channel that into doing our job at the hospital,” he said. “In a way that was actually relieving.  … I felt like I had a chance to actually act on what everyone else, everybody was scared of.”

There were other moments of joy: Morin got married in October “in a mask.” Exercising with her husband and playing with her dogs have also been a huge help.

Wilson rediscovered the “Harry Potter” series. Dube got a puppy after her dog passed away earlier this year. Mueller said he’s especially thankful for his and his loved ones’ health.

Ramsay thinks the “biggest silver lining is yet to come.”

“I think there’s going to be this joy that just percolates,” he said.

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