A Big Horn Basin nurse who trained at Northwest College and who has worked in Cody is in the epicenter of the COVID-19 pandemic.
Amber Espinoza lives in Otto with her boyfriend Rodney Tolman, also a nurse, and their six children. But since the end of March she has been working at a hospital in New York City, which has more cases of coronavirus than anywhere else in the country.
“The New York health care system was being inundated with patients, and in desperate need for help,” she said. “Their nurses were drowning in patient care. There was not enough staff. They were running out of supplies.
“Nothing could have prepared us for what we were about to walk into.”
Before New York
Espinoza, born and raised in Rawlins, has been in the medical field for 21 years and has been a traveling nurse since 2011, initially as a licensed practical nurse.
With Tolman’s encouragement, she enrolled in and was accepted back into nursing school in 2015 as an advanced placement LPN student, graduating with honors from NWC in 2016 as an registered nurse.
She has continued to be a travel nurse, while picking up per diem hours as a float nurse at Cody Regional Health’s Cathcart Building and the Detention Center.
Before New York she had a long-term assignment with St. Vincent in Billings, extending the typical 13-week contract for a year, receiving awards for her work.
“I am very passionate about my career. It does not feel like a job to me,” she said. “I am dedicated to my patients. This is my calling.”
Unlike anything else
Espinoza said she questioned herself about whether she was up to taking the offer to go to New York – on top of everything else she’ll be required to quarantine for two weeks once she returns.
After accepting and spending a final 48 hours with her family, she deployed along with thousands of nurses from all across the country, all being housed in a hotel in Times Square for medical staff only. Nurses travel to and from work on charter buses.
The work is grueling. She started working 21 days straight, 84-hour weeks. After two days off, work starts again – it’s now 16-hour shifts.
She’s not giving up – recently she extended her contract and is now working 60-hour weeks.
She’s not allowed to say what hospital she works at per the terms of her contract.
“As my team walked off the elevator onto the floor for our first assignment in New York City, the nurses praised us with joy and gratitude,” she said. “Their eyes spoke volumes through all their PPE (personal protective equipment). They had been returning to this same hospital for days on end with no relief in sight.”
The emergency staffing company that employs Espinoza planned to flood all 30 hospitals in the city with nurses and technicians. What started as a 12-15:1 ratio between patients and nurses has dropped, she said, as patients with the virus have either died or been discharged.
“We are still seeing more deaths than discharges, however, we are seeing a drastic change in the amount of care these patients are receiving,” she said. “The admissions are decreasing, but we are still running out of supplies. We have seen patients from 9-99 years old admitted with this virus.”
Espinoza’s unit alone has 55 beds – in a hospital with 30 floors.
“That is about half of the total beds at Cody Regional Health including their Long Term Care Center, yet on one floor of this New York City hospital,” she said. “This is one of the smaller hospitals in NYC.”
More than 53,000 people in the United States have died from the coronavirus, more than 12,000 in New York City.
Conditions on the ground
The hospital didn’t have enough beds when the travel nurses arrived, so Espinoza said they closed a floor under construction and made a unit.
“This is a disorganized disaster,” she said. “We are a full COVID unit and we are at capacity. We are housing four patients to one room at this point.”
The rooms have no curtains, no TV and no visitors. When no beds are available, patients sleep on gurneys. Staff don’t have enough of almost anything they need, including ventilators and blood pressure machines.
They don’t even have space to house the bodies of those patients who don’t survive.
“Our morgue space is at full capacity, so we are using freezer trucks to store the bodies,” she said. “This is demoralizing to our profession.”
She said the medical staff is also put in danger themselves.
“Our PPE is scarce,” she said. “We get one surgical gown for the whole shift. We use polyethylene gowns over our surgical gowns between each patient. We are double gloved and masked.”
She said they preserve effective N95 masks by covering them with a cloth mask. Nurses cover their shoes, hair and eyes and ask the patient to wear a mask when they are providing care if possible.
“When we return to our hotel room, we have decontamination station in our rooms and shower immediately,” she said. “We are not allowed anywhere in the hotel in dirty scrubs. We have our very own doctors and nurses dying with adequate PPE in place.”
Espinoza and other nurses were recently issued iPads to give patients the personal connection to family that’s been conspicuously absent during this crisis.
“They are still very grateful for this opportunity,” she said. “Majority of the time our patients only have us when they pass away.”
When one patient passed away recently, she said the staff gathered around the patient’s bed, held his hands, stroked his head and sang “Amazing Grace” and “Swing Low Sweet Chariot,” before ending in a prayer.
When patients recover after being on a ventilator, the hospital plays “Fight Song,” “Three Little Birds” or other uplifting songs over the intercom.
“At the end of the day, there is still so much to be grateful for,” she said. “Every day our bus pulls in, we are cheered on with flashing lights, horns and celebration from the NYPD, NYFD, and residents of NYC. We are thanked and clapped for when we walk down the street on any other given day.”
Espinoza said the experience has changed health care, humanity, family and faith. It’s given her a bond with her fellow nurses.
“We were all once strangers, with different backgrounds, from different states,” she said. “Now we are like family. We have spent every waking hour together. We have laughed, cried, celebrated and prayed together. We have depleted supplies, embraced the chaos and assembled a new unit in the hospital together.
“We have pulled from each others’ strengths and built some lifetime friendships. All together.”
She described the decision as the best one she’s ever made.
Message for home
She looks at the Wyoming numbers from her New York hotel and said she hopes fellow residents don’t let down their guard.
“We are seeing low numbers in our state because we already have a low population,” she said. “Which in turn means our hospitals have a low capacity for bed space. We have limited high-level trauma and ICU beds. I cannot even imagine what would happen to our Wyoming hospitals if they were to be overrun by COVID-19 patients.”
She said it could overwhelm the hospital system, already suffering from a nursing shortage.
“What happens when the health care workers start getting sick because our own hospitals our inundated with COVID-19 patients?” she said. “If people start spreading this virus at a quicker rate, we will not have the staff, beds, medications or supplies to take care of everyone.”
Espinoza said Wyoming residents have done well but can’t stop now.
“Social distancing is working,” she said. “Please continue to follow the CDC guideline. Wash your hands, sanitize, wear a mask, small groups, 6-foot distance, one person does the grocery shopping, etc. Please continue to be patient.
“We are working diligently on vaccines and treatment regimens. Let us continue to prove to the rest of the world that our great State of Wyoming was able to beat this virus and keep our numbers low. Death is permanent, quarantine is not.”