GREENSBORO — Dr. Brent McQuaid stood in the shadow of the city’s field hospital for COVID-19 patients. It was a bittersweet day. Workers last week had begun dismantling an operation that for nearly the past year stood as ground zero in one community’s fight against the deadly respiratory illness.
Like the Overseas Replacement Depot during World War II, Higher Ground at the beginning of the AIDS crisis and the old downtown F.W. Woolworth store during the civil rights movement, this place will forever be a marker for a mission bigger than itself.
McQuaid pointed to an area on the second floor, where the sickest of patients were treated, and had in a past life been a neonatal intensive care unit.
“So sick they need someone to respond to them in seconds,” he said.
Many came through here as the coronavirus pandemic gripped the county, state and nation. They were from all walks of life — young and old, men and women, mothers and fathers. Some never made it home. That was after struggling with a disease that has taken the lives of more than half a million people in the United States.
But thousands of others passing through these doors were able to get back to their families.
This was where the recovery of the man called Salvador, a Mexican immigrant who had come to the United States to work on local strawberry fields, took place to a salsa beat that brought doctors, therapists and nurses dancing his way.
And where a man named Mark Thomas, dressed by nurses in a white shirt, bow tie, yellow rose boutonniere — and personal protective equipment — was able to virtually attend his daughter’s wedding.
This former Women’s Hospital on Green Valley Drive opened as the country was in the throes of the first pandemic in a century, with health professionals volunteering to be on the front lines of a war they didn’t start but are expected to fight.
The battle goes on, but it’ll have to do so without this building.
The effort to turn the closed maternity hospital into an ICU-level campus received early international applause from medical professionals.
“Hats off to you for this brave solution,” one medical professional wrote.
Another physician wrote: “Great job thinking outside the box!! Outstanding work.”
But with COVID-19 cases declining, and now three vaccines to treat the respiratory disease have been approved, the tireless work fighting the coronavirus here is done.
“Heroes Work Here” murals line the walkway just through the doors of the single entrance designated for employees who also undergo daily temperature checks there.
Women’s Hospital had moved into a multimillion addition at Moses Cone Hospital just as the pandemic had crossed the world and reached the state.
At the same time, there had been conference calls and near daily conversations with federal agencies such as the U.S. Centers for Disease Control and Prevention, and state and local health officials.
The uncertainly created a war room of sorts for Cone Health, with staff representing every department in the multi-campus hospital system — from the people who cleaned the floors to doctors who would be conducting research.
Cases in Guilford County had begun to rise and it wouldn’t be long before North Carolina was under siege.
The deadly respiratory virus has since then infected more than 22 million people in the United States.
Across the state, hospitals took a variety of approaches to combat the surge of COVID-19 patients, including designating hospital wings expressly for that care.
Greensboro was the only one to set up a free-standing hospital, although the nonprofit Samaritan’s Purse opened a 30-bed emergency unit on the grounds of Caldwell UNC Health Care in Lenoir this past January to support surrounding hospitals.
McQuaid was asked to oversee Cone Health’s effort.
Steve Minor, a nurse practitioner with decades of experience, was the first to mention using the former Women’s Hospital building to him.
“It was the most brilliant solution to a problem I thought I had ever heard,” McQuaid said.
About the same time, Terry Akin, Cone Health’s CEO, had called nurse Karin Henderson, another leader, and asked what it would take or if it was even possible to turn the maternity-care campus into a critical-care hospital for coronavirus patients.
The system’s leadership reviewed all of the CDC and statistical data and decided to reopen the campus.
“They said this is the right thing. Let’s go do it,” McQuaid remembered.
For 28 days, people behind the scenes — notably the staff who had just planned the move out of Women’s Hospital — worked “incredible hours with incredible intention,” said Dr. Mary Jo Cagle, Cone Health’s chief operating officer. “We had people with the right gifts, the right building, and we had people with the right heart who gave all of their energy and their enthusiasm and made it happen.”
It would mean changes big and small, from re-configuring the ventilation in rooms so that air didn’t leak into the hallway but instead passed through a filter and was piped outside, to removing locks and door handles and replacing them with wave plates so staff had fewer touch points in the hospital.
Administrators also equipped staff with devices such as voice-controlled badges that could be worn under personal protective equipment for hands-free communication.
“We need to be the safest building in Greensboro,” McQuaid told them.
Interestingly enough, he observed, the neonatal ICU had been originally designed so that moms could be wheeled into the room in bed to be with their children. That feature would come in handy with coronavirus patients.
“Somebody 30 years ago decided to to do that, and it was there for us to use with COVID,” McQuaid said in an emotional moment. “It makes you feel like it was designed for this purpose.”
That first morning, before staff began arriving, Ann Councilman, who served as head of nursing for the Green Valley campus, made a final, quiet trek through the building.
“I prayed over the space for the patients we would care for and for those providing care,” Councilman said. “I specifically prayed for safety of our staff as they cared for the COVID patients.”
Grueling, intense days were ahead.
“I was rounding with the chief nurse and she was telling me the staff was so dedicated that they have to put a timer up to remind them that it’s time for them to take a break,” Cagle said.
That would be extremely important, Cagle explained, because the layers of protective gear could leave them dehydrated.
She recalled one nurse being helped out of her gown.
“Her scrubs were covered in perspiration and the last thing she took off was her mask,” Cagle said.
Cagle noticed that the ridge of her nose had a blister from wearing face masks for extended periods.
Someone asked the nurse if she needed a break.
“She looked at them and said, ‘I’m not going to leave my patients,’” Cagle recalled.
Over the last year, nurses have held the hands of those who lay dying because family couldn’t be there. Or held a phone for what ended up being a patient’s last conversation.
To be around patients, doctors and nurses must layer on the time-consuming protective gear. And every time they came out of that gear increased the risk of exposure.
Prior to the pandemic, a default response when a patient’s oxygen level dropped to a certain point was to put them on a ventilator. But ventilators were in short supply nationally.
Cone doctors successfully made the decision early on to not place some patients on ventilators but on therapies later proven to be useful in treating people with COVID-19. It helped shape their response to severe respiratory failure.
“We noticed early on, before all the studies told us it was the right thing to do, that giving steroids helped our patients,” McQuaid said.
Some of that came about because so many professionals, from doctors to pharmacists, were in one place sharing ideas.
That is also how they came to try an arthritis drug called Actemra.
“It now has multiple clinical trials that show, hey, this really works. This is a good drug for people with COVID,” McQuaid said. “But when we were living in that realm of ‘We don’t have the benefits of the trial to tell us what to do,’ we were learning from experiences.”
At a physician’s suggestion, nurses began placing patients with breathing problems on their stomachs, which helped oxygen to circulate. That helped some patients be able to get out of bed.
Ultimately, Cone Health was able to reduce the percentage of COVID-19 patients in ICU to half that of other health systems around the country.
“We could take care of patients who were sicker outside the ICU and still do well with it,” McQuaid said. “It helped to save our resources quite a bit.”
And save the man called Salvador.
During his time as a patient, he was on life support, dialysis and had to undergo a tracheotomy.
“All the numbers told you there was no way he could survive, but yet he did,” McQuaid said.
The team had worked through the hurdles so they could video-conference with his family back in rural Mexico.
Because he loved salsa music, the nurses and respiratory therapists would dance around his room.
“You’d be rounding in the ICU with all these patients who are so sick and he had his pod over there and you could look in there see people in there dancing,” said McQuaid, who was among them.
After three months, Salvador was taken off the ventilator and left for the strawberry farm.
His is one story. But there are so many others. Stories of people who were on life support for weeks. People who might not have been expected to breathe without the aid of a ventilator.
Those stories drove doctors and nurses to give everyone the best opportunity at life.
“Because there’s so much death,” said McQuaid, his voice in a quiver. “Lots and lots of death. And that’s part of being in a medical ICU. We’re put in a situation where we are trying to fight a very difficult disease. But in order to stay positive, these cases drove us.”
They weren’t alone in the fight.
“I think the community showed our team such an outpouring of support and love,” Cagle said. “Through notes. Through meals. Bringing coffee and having it waiting outside.”
When the personal protection equipment was low, local manufacturers came through with more.
“It would be a symbol of the fight that the whole community has been in,” Cagle said.
The pandemic also amplified the problems with health care.
Patients, especially minorities, for example, were being admitted with “no other known health problems” on their charts, only for doctors to find that there were health issues that hadn’t been addressed by a doctor.
That has prompted more discussions on ways to treat those who don’t have access to the kind of care many of us take for granted.
“It’s the future of health care,” said Councilman, the nursing director.
McQuaid’s own emotions ran raw earlier this past week as he prepared for the last patients to be discharged.
Those patients still requiring critical care were absorbed by Cone Health’s other hospitals.
Barbara Curtis, the last patient out the door at 2:30 p.m. Wednesday, was surrounded by a cheering staff. As she left, Curtis said she would never forget them.
Cone Health plans to retire the building, although the parking lot and a portion of the building are now being used for COVID-19 testing.
“We love what we built,” McQuaid said. “There is a definite sadness that we are not going to come together in this building and do that any more. However, there is very much a sense of peace and joy that goes along with that sadness because of how great the (patient) numbers were.”
McQuaid doesn’t want anyone to see the closing of Green Valley as an end to COVID-19. Nor should the availability of a vaccine change the mantra of wearing mask, standing 6 feet apart and washing hands religiously.
Now, he said, is not the time to relax.
He wants to believe everyone has gotten the message.
Yet there he was at one of the busiest home improvement retailers for about 10 minutes on Friday.
In that short time he saw four shoppers walking around without masks.
“We are,” he said, “in dangerous territory.”
Contact Nancy McLaughlin at 336-373-7049 and follow @nmclaughlinNR on Twitter.