ROCHESTER, Minn. — Gabriel Pastores spends the morning of Christmas Eve in sedated repose, watched over by a small forest of sophisticated medical electronics.
Here in the closing hours of this humbling moment that is 2020, Gabriel has become tethered to life by tracheotomy, extracorporeal membrane oxygenation, a trio of sophisticated monitors and a cocktail of intravenous drips.
They all share the same soaring view that Gabe cannot see behind him, bright sun and new snow down on 2nd street as seen through a gleaming bank of windows on 6B Mary Brigh, otherwise known as the Mayo Clinic COVID-19 ICU.
Gabe likely caught COVID-19 while working part-time at a grocery in nearby Cannon Falls. It was job he picked up when the cases plummeted, back in the hopeful days at the end of summer.
Back then, it seemed like a good way to stay busy after months of laying low.
Gabe always wore a mask over the nose and all the way into his car at the end of each shift. He kept his six feet from others, carried sanitizer in his pocket, cleaned his mask at night and always washed his hands when he got home.
He is 56, athletic, and was never sick a day in his life.
"He's a hard worker, very strong, very loving, very smart," Cindi Pastores will tell you. "He's great."
When you call Gabe's wife for these details, on the night before your visit, his partner of 13 years needs to call you back. She is out shoveling in the darkness, something Gabe would have done, had he not been here on 6B since the start of December.
"Yesterday I went out and finally did some Christmas shopping," she says, holding back the tears. "That was a pretty hard day. I cried all the way home, because he loves to pick out presents for people, especially the grand kids."
Cindi doesn't want to be sad about it.
"I have hope," she says. "He's hooked up to some machines, but I am a firm believer that his lungs are going to survive this. That's the only way I'm looking at it."
Quiet care, an unknown illness
It's eight a.m. and the ICU is peaceful. Intensive care specialists cluster as they round from room to room in their scrubs, data specialists following behind with computers on tall carts.
Although a nurse is in every room and five sit in the center, you'd hardly know it was the epicenter for such struggle and frustration, months of quiet planning followed by a surge that elicited get-arounds, patient pivots, respiratory up-staging and too many goodbyes.
The Mayo COVID-19 ICU isn't appreciably supersealed. You might picture a pressurized chamber with card-passes, guards and workers dressed like astronauts, but it's just a few steps off the elevator and down the way.
Gowns, gloves, N-95s and shields all go on in wordless choreography. But just steps away its sweaters, scrubs and surgical masks.
The job is part medical, part informational, part spiritual.
"When you can't catch your breath you're very anxious," says Pamela Maxson, ICU nurse manager who helped establish the unit. "Being intubated is another source of anxiety, and you don't have the support system of your family."
Just being in the ICU can itself be a source of delirium, Maxson says. COVID ICU nurses must constantly let patients know "where they are at, what time it is, what day it is."
So tomorrow, part of that job could be to deliver the message that it's Christmas.
Gabe and Cindi moved to Minnesota a year ago in September, after selling his tile business down in Arizona to be closer to the grandchildren.
Gabe's father, who lives with the family at 96, parachuted into the South Pacific to rescue downed shipmen during the Second World War, and Gabe was raised in Winterhaven, Calif., home of the Quechan tribal nation.
There are rows of identical rooms to Gabe's right and to his left on 6B, and just outside of Gabe's room, a column is decorated with Christmas cards.
They keep coming, these holiday cards.
The Mayo Clinic COVID-19 ICU has received so many well wishes, messages of love scrawled in crayon and in pen from faraway states, towns and places, that nurses hang them on the walls, bring them into patient rooms, and carry them over to other wards that need cheering up.
"Have a Holly Jolly Christmas," reads one from a school boy in another state, complete with backwards lettering. "Your friend, Jack."
Gabe hasn't seen the cards or the view behind him, because he's been struggling in this bed since the end of November.
He came down with COVID-19 on their anniversary, Nov. 10. He sunk into his chair and the symptoms hits within hours. "He just got worse and worse and worse and worse," Cindi remembers. They all got tested, then quarantined in different parts of the house when he got his results.
After eight days, when his oxygen hit 88, they took Gabe to the hospital in Cannon Falls, which sent him to Red Wing, which sent him home at his request a few days before Thanksgiving. Five days after that he could barely catch his breath, and a doctor in Red Wing had him transported to Mayo. He's been here ever since.
There are currently 50 patients hospitalized with COVID-19 at Mayo, 12 in the COVID ICU, and 9 in an overflow COVID unit. The unit has cared for 411 patients from 21 states since the start of the pandemic, 73% of them from Minnesota but also 10% from Wisconsin, 9% from Iowa and small numbers of others from places across the country.
Today the ages here range from the 30s to 80s, but the ICU has treated COVID-19 patients from infancy to 99 years of life. The longest stay prior to discharge has been 85 days. Someone lasted 55 days on a ventilator prior to going home, with another patient spending 180 days over three different stays before discharge.
For 60 patients during this time, the ICU could not save them from the devastating illness.
'It's still here'
"I think nurses go into every holiday knowing these patients aren't with their family," says Lisa Bungum, nurse administrator. "I think a caring nurse just has it in their soul to understand and embrace the holiday while at work. I know I did."
The COVID-19 ICU is a voluntary nursing assignment, it has been since August, and they think that works the best. Nurses are only here if they asked to be part of the mission, and 45 raised their hands.
Emily Jansen volunteered because it was "a once in a lifetime opportunity to step up in a pandemic... I thought that somebody's got to do it." She watches Gabe today.
"A lot of times with our COVID patients we see a lot of progress, but it's one step forward and two steps back," says Jansen. "He's definitely making progress. Our goal today is to let him breathe on his own for a little while. We'll see how that goes. That's a huge step."
Jansen has not been able to talk with Gabe, though she has cared for him since the start of December. "We do a lot of lip reading," she says. "A lot of trying to write things down."
"Before COVID we would see a lot of hard situations, and since COVID it's been a lot lot harder," says Madi Van Horen, a nurse on the COVID ICU overflow unit down the hall.
"We've had a lot of deaths. I worked last weekend and was gone for two days and I came back and like six people died."
Allison O'Connell has a simple message for the world outside:
"It's still here, and it's still happening," she says. "I feel like a lot of people have kind of moved on from it. Pretty much all we do is work, home, sleep. Work, home, sleep."
"I've got three kids at home, so I wish I were there," says Nicole Barbour, a respiratory therapist. "But I get to work with these patients, who are also missing their family, and who don't get to go home at the end of the day."
She's heard from those who don't take COVID seriously.
"They don't wear the masks, they don't think it's a big deal, and they tell me it's a very survivable virus," she says with a trace of sadness. "I wish people could follow us around. I think that would open their eyes. There's a lot of times that we cry on the way home."
Cindi Pastores is focusing on the positive.
"The staff at Mayo has been wonderful," she says. "They treat us like family. They call me. I can call them any time. Whether I call them, or they call me, whether it's a person behind the desk, a nurse or a doctor, the first question they ask me is, how I am doing."
She says she is doing OK.
"I have my moments. There's crying every day. But I have a really strong faith. I trust that God is going to get him through this. I don't think that he's done... He is in the best place on the planet for health care."
"This would be hard any time of the year. Christmas is tougher...But there's a lot of people way worse off that I am. There's so much good if you look for it out there. But it is hard. I want him to be home."
- Minnesota Department of Health COVID-19 hotline: 651-201-3920.
- COVID-19 discrimination hotline: 833-454-0148
- Minnesota Department of Health COVID-19 website: Coronavirus Disease (COVID-19) website.