'Hurry, he's dying': A hospital chaplain's journal chronicles pandemic's private wounds

LOUISVILLE, Ky. - Through the hospital room window, she could see her husband laid face down, a ventilator plunged down his throat. Muted beeping filled the ward's sterile air. 

Weeks earlier, the man seemed to have beat COVID-19. Now life was slipping away. 

Chaplain Adam Ruiz stood beside the man's wife, who watched helplessly through the glass for fear of being infected.

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She begged doctors: "He's the only thing I have." 

When the breathing machine was removed, all she could do was ask the nurses: Why is his mouth staying open? Can he hear anything? Why is his body suddenly jerking? Why is he gasping for breath? Is he in pain?

Her husband died beyond the arms that were promised to always be around him.

"It's not real," she repeated, "because I can't be in there."

It was April, barely a month after the first coronavirus case arrived in Kentucky, and the 58-year-old hospital chaplain found himself thrust into some of the pandemic's most private and painful moments.

Ruiz's tough job providing spiritual care amid loss had grown exponentially more difficult. Illness and death multiplied. Fear and uncertainty gripped doctors and nurses. Visitor restrictions meant suffocating isolation for patients and families. Grief was interrupted, funerals denied. A mountain of need sprang up.

© Alton Strupp/Courier JournalAdam Ruiz prays with new mother Candice Burnett and her son, Elijah Cousin. "I feel like I've been in quarantine my entire pregnancy," Burnett says. "It's been overwhelming."

Ruiz's unassuming shuffle in hospital hallways, his calm eyes behind wire-frame glasses and easy demeanor belied strains that few but his wife could see. To cope emotionally, knowing "we were entering something extraordinary," he began keeping a journal before the first case arrived.

Ruiz pecked out dozens of pages, one finger at a time, over six months of often 12-hour days. He chronicled hospital strains, prayers, doubts, coronavirus counts, quiet conversations, stress and heroics of health care workers, knife-sharp miseries and sacred moments that otherwise went unseen.

He comforted a woman forced to sit alone with her stillborn child. He used FaceTime to show the last rites of a coronavirus victim to his family. He watched people struggle with mask shortages, argue divisive politics and battle crippling anxiety.

© Alton Strupp/Courier JournalNorton Women's and Children's Hospital chaplain Adam Ruiz walks the halls while working in the NICU. July 29, 2020

Staff was upset, he wrote about the death in April, recording the anguish of a nurse. If it was that hard for families socially distanced from dying loved ones, the nurse told Ruiz, what must it be like for the patient? It's horrible. 

Ruiz's experience offers a rare and intimate window into the personal toll of the pandemic. "Incredible and terrible things are happening," he said.

Pandemic storm clouds gather 

On a cool morning in March, Ruiz rose as usual before 6 a.m. in his split-level brick home in suburban east Louisville, donning his navy blue scrubs and downing a plate of eggs. 

Careful not to awake his wife of 25 years, Denise, he fed his dogs, Buddy and Molly, and grabbed his ever-pinging cellphone. He steered his car toward Norton Women and Children's Hospital as he has for the past seven years.

© Alton Strupp/Courier JournalChaplain Adam Ruiz checks in on a person who is on a ventilator at Norton Women's and Children's Hospital on July 29 in Louisville, Ky.

On that day  - nearly seven weeks after the first U.S. case in Washington state - Ruiz recorded the beginning of Kentucky's fight with COVID-19 on a blank word document in his spare hospital office. Governor announces state of emergency. First KY Covid patient. 

Hospitals were beginning the scramble for masks, ventilators and COVID-19 tests. Ruiz's hospital began a flurry of changes: stricter sanitizing measures, isolation rooms, visitor limitations and elective surgery cancellations. 

Where there had been little time to plan or gather equipment, there was even less to prepare emotionally, he reflected in his journal.

Nurses and doctors feared getting infected or taking the virus home to their children, he wrote. Frustrations flared over shortages of N95 masks and shifting usage guidelines. Some complained doctors were prioritized for scarce tests ahead of nurses.

He spoke with one nurse upset about tending to COVID-19 patients because few others  volunteered. He comforted another, writing, I ask if I can quietly pray with her. She says yes. We pray at the nurses' station. She cries softly and says she feels better. 

He got more prayer requests. One came from a nurse scared after being around patients tested for the coronavirus in the intensive care unit. She told Ruiz she'd emptied her bank account to stock up on food and worried about her 72-year-old mother. Please pray for my mom who works and is scared. She is 72 and is worried every single day.

© Alton Strupp/Courier JournalAdam Ruiz is chaplain at Norton Children's and Women's Hospital.

He and other hospital staff created a room where calming music is played. He brought chocolate or brisket BBQ to a team caring for COVID-19 patients. He listened and gave out spiritual reassurance. He created a group text of stressed chaplains. He emailed a worried colleague: Covid is big. We're bigger. ... Stay together with me. We will be okay.

He worried Norton chaplains would be overwhelmed, writing March 19, Today was hard. . I felt the work we had to do was going to be more than what we (chaplains) could handle.

By late March, the hospital's overworked intensive care unit was half-full of COVID-19 patients, many depressed and alone. Some funeral homes were limiting or denying family visitation or services. Staff was thin as nurses left to quarantine.

Ruiz knew some New York City hospitals were overwhelmed by patients struggling to breathe, forced to use refrigerated trucks to handle all the dead bodies. He knew the pandemic was pulling him to a place he didn't want to go, he said. 

Around 7 a.m March 27, Ruiz got a call to help a 12-year-old girl and her adult brother on their way to see their mother, who had COVID-19. When Ruiz arrived, she was on a ventilator. Near death, he wrote.

"There were a lot of unknowns," Ruiz said, including how safe it was for him, staff or the mother's children, who weren't finished with their 14-day quarantine. "What's our policy? Let them in? Not let them in?" he asked.

The woman was intubated in an ICU room, machines keeping her alive. He scrambled to reach the woman's father, who couldn't be brought to Louisville in time. 

That night, the patient died.

© Alton Strupp/Courier JournalNorton Children's and Women's Hospital chaplain Adam Ruiz takes notes at his computer in his office at the hospital. Ruiz has made sure to record significant moments during the COVID-19 pandemic.

The girl was given two teddy bears. One was for her. On the other, she penned a message to her mother to put in her coffin.

Ruiz felt a heaviness. There had been seven coronavirus deaths in Kentucky. That figure would grow fivefold by the following week and leap to 213 within a month.

When he was called from the ICU to the hospital's labor and delivery area, Ruiz found a mother lying in a bed. The stillborn baby she'd delivered was in a medical crib feet away.

She was alone, she told him. Her husband was stuck in quarantine in another state. Her mother was high-risk and couldn't come. The pandemic's isolation had made a traumatic experience far more difficult. 

Ruiz asked the baby's name, and she started to cry.

He wrote in his journal: She doesn't know what to tell her other children. She asks me to help her decide what to do with the baby. "You decide for me," she says. "I can't think." 

Then she says, "Can you pray? Like a funeral type prayer?" 

Alone and scared with nothing and no one familiar to lean into and lean on, she asks me and the nurse to be her proxy family; to help her bless her baby to heaven. And so we pray. . We pray, and I leave, and I know I haven't really done much to comfort this mother. I write this not out of guilt or feeling of failure. I write it because it is the reality.

A family's loss

Ruiz's phone rang around 9 a.m. April 21. The voice on the other end was frantic: "Hurry, he's dying."

Kentucky's COVID-19 cases had shot up to 3,192 and 171 deaths.

Juan Carlos Pat Morales, 48, a mechanic in Buechel, had been in Norton Audubon hospital for two weeks, among the minority groups hit disproportionately hard by the coronavirus.

Ruiz, who speaks Spanish, had been caring for Morales, delivering groceries to his partner, Alvina Baires, and her teen daughter, both ill and quarantined.

© Sam Upshaw Jr./Courier JournalAlvina Baires' partner, Juan Carlos Pat Morales, died from COVID-19 in April.

"It's COVID," Morales told Baires in the last phone call the couple shared before he was put on a ventilator. Both knew his diabetes put him in grave danger. 

Baires was scared. She wanted to rush to the hospital, but because of her coronavirus symptoms, it wasn't allowed. Ruiz made a promise. 

Related: Louisville health authorities want to expand COVID-19 testing for Hispanic residents

"I can be your eyes and ears - look in on your husband, call and tell you what I'm seeing. And that way, in a sense, you can be there," he told her.

Ruiz hustled into the hospital's ICU, huddling with doctors and nurses in the quiet hallways. 

Ruiz called Baires and her daughter in a FaceTime video. He told them a priest was giving last rites. He showed him putting on his collar, anointing Morales and touching his forehead. The priest held Morales' hands, Ruiz said.

Ruiz offered to call back with updates. 

"No," Baires said. "Stay with me on the phone until he dies."

Over the next 20 minutes, they talked about Mexico, sunrises and flowers, her faith, how difficult it was not being there with the man with whom she'd moved to Louisville when his Shelbyville factory closed, how he'd gone from healthy to death's door in two weeks. 

Ruiz narrated heart and oxygen rates as nurses called them out. Baires and her daughter started crying.

The doctor raised a hand toward Ruiz to signal a time of death. 

He's gone to Jesus, Ruiz said. 

© Michael Clevenger/Courier JournalAdam Ruiz enjoys time at home with his wife and two dogs July 24.

Pandemic's private toll

By May, more than 100 nurses, doctors and staffers in Norton hospitals had contracted the virus caring for patients. Cases topped 6,129 statewide, including 294 deaths.

Staff tensions eased as the month wore on, Ruiz wrote. People felt safer and more certain of protocols. His hospital's ICU hadn't run out of beds or ventilators. 

Even so, Ruiz's journal entries in the following weeks were filled with pain.

On May 15, he wrote about a doctor telling a mother of three children - in elementary, middle and high school - her husband was going to die of the coronavirus.

Doctor: He is dying

Please don't tell me that, the mother responded. 

Doctor: "The three of you have to now help your mother. And you (the oldest at 15), you have to now be the man of the house."

This kid goes over and touches his 7-year-old sister's head in a loving, protective manner.

Ruiz's journal, alternating in tone between the brevity and stoicism of a sea captain's log about a gale to passages of emotional storytelling, is filled with instances of health workers scrambling bravely amid the dangers and chaos of life-and-death emergencies.

In mid-May, he wrote, bells and whistles were going off everywhere in the ICU, a cacophony of alarms from ventilators, oximeters, IV infusions and heart monitors. He marveled at nurses rushing to respond with poise and compassion. 

He watched a woman sing to her 88-year-old mother. And then, three gentle breaths later, she departed this world. She was home now. The daughter stood up from her chair and draped herself over her mother.

 "I love you, Mom. I love you. I love you so much." (She) quietly cried next to the bed, and I stood as well in awe and wonder at what I had seen.

Her daughter, alone because of restrictions, thanked him. "I couldn't have done this alone."

Often limited from walking in and out of rooms, he thought about the brain tumor he'd battled at age 19, consuming a decade of his life in hospitals, illness and depression.

"So we pray outside. I think about how I was when I had my brain tumor. Totally vulnerable. I would imagine them feeling the same. And I'd pray, send them love, and trust in some way it would reach them," he said.

When he told patients he was going to stay with them, to see them though, he could see the relief on their faces.

© Alton Strupp/Courier JournalChaplain Adam Ruiz takes a phone call while working in the ICU July 29 at Norton Women's and Children's Hospital.

He recounted a conversation with a patient two days before he died. His family had been limited in visiting him. Ruiz was invited in to talk.

Ruiz stood at the foot of his bed. It seemed to take effort for the man to talk. 

"I think I'm at the end now. "

"You've been praying all this time?"

"Oh yeah. All the time. I'm not sure about what but I pray. Mostly forgiveness, really. That's the main thing. Maybe the only thing I need now ... We all do things we regret. Things that we shouldn't have done. Things we could've done better. I just need to feel forgiven for all my mistakes: for all the times I was not a good husband or could've been a better father or a better person. I did things. But maybe what I did best was my grandkids. Maybe I did that right. They're everything, really."

Ruiz told him he seemed like a man of faith and he'd done well. The man seemed to find acceptance. 

"I'm glad you came. Don't leave. Stay a little longer if you can."

"I will."

'I'm out of control'

In early June, Ruiz walked into a small church. 

Across the state, the numbers of new daily cases had declined. Restrictions on gatherings eased, businesses reopened and funerals resumed.

In a casket lay a man who died of COVID-19 after his meatpacking employer reopened. 

When family and friends embraced Ruiz, it made him nervous. Days later, he attended a funeral in Mount Washington that included many mourners without masks.

He realized that people had begun to lose their discipline, potentially allowing the virus to storm back. Headlines about the heroics of health care workers had given way to politics, mistrust and suspicion. The mask issue seemed to be a control issue. I'm afraid, I'm out of control. Here is something I can directly address, attack, seek redress, he wrote. 

Kentucky's cumulative cases nearly doubled from 15,842 to 30,151 in July, putting schools, sports, concerts and other reopenings into question. Cases began to rise again at Ruiz's hospital, too.  

On July 25, Ruiz lost a relative who attended a wedding and became ill. Aunt Jose died today, he wrote. Covid contributed to her weakened state.

His spirits sunk. Nearly 400 health care workers across Norton's hospitals, clinics and offices had contracted the coronavirus by Aug. 18. In the halls of the hospital, Ruiz continued to tend to the sick. 

A mother, isolated with her premature baby because of COVID-19, relied on Ruiz to see her through her baby's heart surgery.

The girlfriend of a 19-year-old on life support with a ventilator taped to his mouth prayed with Ruiz at the ICU door. "Thank you for the miracle of his life," he said.

Ruiz said goodbye, straightened his glasses and ambled down the hallway.

Another room, another troubled family.

His shift wasn't over, and neither was the pandemic.

Follow Chris Kenning on Twitter: @chris_kenning.

This article originally appeared on Louisville Courier Journal: 'Hurry, he's dying': A hospital chaplain's journal chronicles pandemic's private wounds