An uneasy calm has settled over East Los Angeles Doctors Hospital. Inside the emergency department on a recent weekday, it’s quiet, save for the chatter of a few nurses and the easy listening music softly playing through overhead speakers. The modest facility only contains eight beds; all of them are empty. When patients do arrive seeking care, they come in a trickle, not a flood.
The scene at the hospital might seem normal if it weren’t for what sits just outside the ER’s doors. More than a dozen four-foot-tall oxygen tanks line the perimeter of what used to be a parking lot. Now, instead of cars, the asphalt expanse accommodates two large white tents that are outfitted to screen and treat COVID-19 patients.
“They’re battlefield tents,” says Dr. James De La Torre, the hospital’s director of emergency services. He’s not being figurative. International Medical Corps, a global humanitarian aid nonprofit, donated the tents and other supplies after the second pandemic wave in July. Some of IMC’s other projects include the civil wars in Yemen, Syria, and South Sudan, just to name a few.
From November through January, the tents were essentially a war zone, where the staff waged a battle against the deadly COVID-19 surge tearing through Los Angeles. The extra space allowed the ER to accommodate more patients, but during the peak of the onslaught, every bed was full and ambulances had to be turned away. Nurses treated six or seven patients at a time. The more fortunate recovered after 30 or 40 days, potentially with lifelong damage to their bodies. A refrigerated truck waited outside in case more room was needed to collect the bodies of those who were not as lucky.
While similar scenes played out at various hospitals across the county, East Los Angeles Doctors Hospital was one of the facilities that bore the brunt of the devastation.
Located on Whittier Boulevard, the small hospital serves a predominantly working-class Latino community and is historically under resourced, especially compared to health care giants like Cedars-Sinai and UCLA Health that reel in celebrity donations and government funding. At one point during the pandemic, one in three of the ER patients at Doctors were testing positive for COVID-19. Dr. De La Torre attributes the outside positivity rate (which was one in ten at other area facilities) to the fact that many of his patients are essential workers and live in conditions that don’t allow for social distancing. He recalls a family of four that came in to the ER, all sick from COVID. He asked them about their household and how they thought they got infected. “We live with 14 people in our house,” they said.
Additional factors—including a lack of access to preventative care and high rates of preexisting conditions like diabetes and hypertension—make the patients at East L.A. Doctors Hospital especially vulnerable to COVID-19. When they arrive at the ER, they’re often much sicker than patients who show up at facilities in more affluent areas and have a lower chance of surviving as a result.
“It truly is a safety-net hospital, in every sense of the word,” says Dr. De La Torre. “Our patients don’t have access to a lot of other care, so they really rely on us as their source of health care, either for them being really sick or just for medication refills.”
The phrase “social determinants of health” has been used a lot in recent media reports, as the pandemic has highlighted and exacerbated longstanding inequities in the American healthcare system. Perhaps to some, the idea sounds abstract, little more than a collection of sweeping figures and statistics. For Dr. De La Torre, the social determinants of a patient’s health can mean the difference between their survival and death. It means inserting a breathing tube down the throat of a 47-year-old diabetic man in a last-ditch attempt to keep him alive.
“It’s really hard to see people younger than you die,” says Dr. De La Torre, also 47. He likens the months of the surge to the movie Groundhog Day, the feeling of waking up every day and doing the same thing over and over again: doing your best to save lives, often succeeding, sometimes not.
While new cases have plummeted 53 percent in L.A. County in the last two weeks, the staff at East Los Angeles Doctors Hospital are careful not to let down their guard. In fact, the calm is eerie—the emergency department’s volume is half of what it was pre-pandemic, because many people are staying away from hospitals out of fear. The suffering is still there, but it’s invisible.
In the ICU, where the sounds of hacking coughs have given way to the steady hum of ventilators, eight out of ten beds remain full. This is double the amount that the ICU would see during pre-pandemic times, and all of them are COVID patients. The majority will not survive.
“It’s really taken a toll on the emotional, physical, and spiritual health of our staff,” says Victor Carrasco, the hospital’s CEO. “There’s an immense sense of loss and grief.”
That grief is felt deeply and personally by all members of the hospital family. At the beginning of February, a longtime physician succumbed to COVID-19. But on the afternoon I visited, the relief amongst the staff was palpable, albeit tenuous.
“A month ago we were getting really bad chest X-rays every day,” says a radiology technician named Jose. He describes how during the last surge, ER physicians sent patient after patient to the radiology department, where technicians produced countless images of COVID-ravaged and fluid-filled lungs. “In the past two weeks, it’s gotten a lot better.”
Without missing a beat, Dr. De La Torre reaches out his arm, rests his knuckles on a nearby door, and knocks on wood.
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