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.
Just 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 herself.
He heard her beg doctors. “He’s the only thing I have.”
When the breathing machine was finally removed, all she could do was ask questions of 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?
In the end, her husband died just beyond the arms that had promised to always be around him.
“It’s not real,” she repeated, ”because I can’t be in there.”
It was April 2020, 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 global pandemic’s most private and painful moments.
Like colleagues across the country, Ruiz’s already tough job providing spiritual care amid loss had grown exponentially more difficult. Illness and death multiplied. Fear and uncertainty gripped front-line doctors and nurses. Visitor restrictions meant suffocating isolation for patients and families. Grief was interrupted, funerals denied. A mountain of need sprang up overnight.
Ruiz’s unassuming shuffle in hospital hallways, his calm eyes behind wire-frame glasses and easy demeanor, belied his own strains that few but his wife could see. Both to cope emotionally and knowing “we were entering something extraordinary,” he began keeping a journal the day before the first case arrived.
Ruiz pecked out dozens of pages, one finger at a time, over six months of what were 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.
Staff was upset, he wrote about the April death, 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 a pandemic still gripping the nation. “Incredible and terrible things are happening,” he said.
Pandemic storm clouds gather
On a cool March morning, 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’s and Children’s Hospital as he has for the past seven years.
On that first Thursday in March — 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 outside of New York were just beginning the scramble for masks, ventilators and COVID-19 tests. Ruiz’s hospital began what would be a flurry of changes: stricter sanitizing measures, isolation rooms, visitor limitations and elective surgery cancellations.
Ruiz still didn’t know if it would fizzle as President Donald Trump promised, or blow up into a maelstrom. No one was sure just how contagious or deadly the virus would prove. But as numbers grew in March, so did anxiety among health care staff, including himself.
Where there had been little time to plan or gather equipment, there was even less to prepare emotionally, he later reflected in his journal.
Nurses and doctors feared getting infected or taking it home to their children, he wrote. Frustrations flared over shortages of N95 masks and shifting usage guidelines. Some complained doctors were being prioritized for scarce tests ahead of nurses.
He spoke with one nurse upset about tending to COVID-19 patients because few others were volunteering. 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.
One day he noted a sports radio show called a decision to cancel ACC basketball an overreaction. There was more disagreement over the response as the state shuttered bars and restaurants, and later schools, day cares, playgrounds and parks, he wrote.
A few staff are incredibly upset that the “MSM/Dems have created this crisis to create chaos to topple the president.” I’m having a difficult time knowing how to provide pastoral care, he wrote in his journal on March 17.
On that day, Kentucky had just 26 cases. It would jump to 594 by the end of the month. Ruiz was soon asked to work in other Norton Healthcare hospitals to help with COVID-19 cases.
He was getting more prayer requests, too. One came from a nurse, scared after caring for intensive care unit patients being tested for the coronavirus. 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.
To help, he, along with other hospital staff, created a staff room with calming music. He brought chocolate or brisket barbecue 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.
But he also worried he and other Norton chaplains would soon be overwhelmed, writing on March 19 that Today was hard. I called ____ afterwards and told her we needed more help because 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.
About 7 a.m on March 27, Ruiz got a frantic call asking to help with a 12-year-old girl and her adult brother on their way to see their mother.
She had COVID-19. When Ruiz arrived, she was on a ventilator. Near death, he wrote later.
“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 recalled asking.
The woman was intubated in an ICU room, tubes and machines keeping her alive. He scrambled to reach the woman’s father, who couldn’t be brought to Louisville in time.
That night, he wrote, the patient died.
To help the young girl cope, she was given two teddy bears. One was for her. In the other, she penned a message to her mother. It would be put in her coffin and buried with her, he wrote.
Ruiz felt a heaviness. There were only seven deaths in Kentucky at that point. But that figure would grow five-fold by the following week, and leap to 213 within a month.
But it was when he was called from the ICU to Room 9 in the hospital’s labor and delivery area that Ruiz felt how far the pandemic’s impact was reaching beyond COVID-19 patients themselves.
Inside he found a mother laying in a bed. Nearby, the stillborn baby she’d delivered earlier was in a medical crib just 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 an already traumatic experience far more difficult.
Ruiz asked the baby’s name, and she started to cry.
Later, 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 and a changing chaplaincy
Ruiz’s phone rang about 9 a.m., the voice on the other end was frantic. “Hurry, he’s dying.”
It was April 21, and Kentucky’s COVID-19 cases had shot up to 3,192, with 171 deaths.
The call was about Juan Carlos Pat Morales, a 48-year-old mechanic who lives in Buechel. He’d been in Norton Audubon Hospital with the coronavirus for two weeks, among the minority groups being hit disproportionately hard by the virus.
Ruiz, who speaks Spanish, had been caring for Morales, including delivering groceries to his partner, Alvina Baires, and her teen daughter, both ill and quarantined.
“It’s COVID,” Morales had 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. So Ruiz made a promise.
“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.
In the car that day Ruiz played Gregorian chants, reverberant voices that harken to a Catholic monastery. He said they help him get in touch with God ahead of difficult times.
Ruiz parked and hustled to the hospital’s ICU, huddling with doctors and nurses in the quiet hallways, its glass-windowed rooms half-full of people on ventilators. A priest was on hand.
Ruiz and nurses briefly debated whether using Zoom would cause privacy violations. We’ve got to make a decision, he told them. This guy is dying.
Ruiz called Baires and her daughter with a FaceTime video. He told her that the priest was giving last rites. He was able to show him putting on his collar, anointing Morales and touching his forehead. The priest was holding the man’s hands in his, he told her.
Ruiz offered to call her back with updates.
“No,” she said. “Stay with me on the phone until he dies.”
Over the next 20 minutes, they talked about his hometown in 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.
The day ticked on, and Ruiz was narrating a heart or oxygen rate as nurses called them out. 59. 49. 19. 8. Baires started crying. Her daughter began crying, too.
Finally, the doctor raised a hand toward Ruiz as if he was saying goodbye, to signal a time of death.
He’s gone to Jesus, Ruiz said.
Baires, during a recent visit with Ruiz to discuss her job hunt in her apartment — decorated with her daughter’s middle school academic medals — said she couldn’t imagine navigating it all without the chaplain.
“I hope God repays him for what he did for us.”
Virus hits chaplain’s own life
On a cool late April night, Ruiz drew a breath as he pulled his 2014 Ford Focus into his driveway. A difficult conversation was ahead.
The work, he wrote, had been exhausting. His wife, Denise, had noticed that he had gone “more inside himself,” needing more solitude and quiet after work. He usually didn’t want to revisit what he did, or didn’t do, or wished he had done that day.
But Ruiz had recently grown nervous about Denise.
A week earlier, he’d been called to the room of a patient who died of COVID-19. The man’s wife was draped over him. She turned to Ruiz for a hug. He wondered, Do I do this? And go home? He gave her a hug because she needed it.
Ruiz and his wife, who met in a Texas Spanish class a quarter-century ago, had been distancing. Not seeing friends. Making sure Denise’s 85-year-old mother didn’t come over for games and meals. They were mostly homebodies, anyway.
He had a routine to keep her safe: Park the car. Go directly to his home’s lower level. Put scrubs in the washer. Hope Tide was strong enough. Play with the dogs. Shower. Then go upstairs.
But Denise had battled stage 3 breast cancer eight years earlier. And Ruiz was shaken by the hospitalization of two relatives for COVID-19: his niece’s father-in-law, intubated for nine days in New York, and his cousin’s husband in San Antonio.
They’d both left hospitals on the same April day: “Except Joe lived. And Drew got discharged to the morgue,” Ruiz said.
It’s one thing to say yes to this risk for me, he thought as he wrestled with it. But I can’t say yes for Denise. My consideration: To sleep in a separate room … and be less physically affectionate, he wrote in his journal.
“I’m going to be downstairs, you live upstairs,” he told her that night.
She thought about it. The risks, the sacrifices. Asking him to quit was unthinkable. He was where he needed to be. If it came into the home, they’d deal with it.
“No,” she said. “Let’s stay together.”
Pandemic’s private toll
By May, more than 100 nurses, doctors and staffers in Norton hospitals had contracted the virus caring for patients. Cases had topped 6,129 statewide, with 294 deaths.
Yet staff tensions had begun to ease as the month wore on, he 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 that spilled into the following weeks were filled with countless moments of the pandemic’s quiet pain.
On May 15, he wrote about seeing a doctor tell a mother of three children — one each in elementary, middle and high school — her 30-something 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.
His 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 front-line health workers scrambling bravely amid the dangers and chaos of life-and-death emergencies.
One a day 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, marveling at nurses rushing to respond with poise and compassion, doors opening and closing, phones ringing.
Around that same time, he watched another 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 himself, he thought about the brain tumor he’d battled at age 19, consuming a decade of his life with hospitals, illness and depression, but propelled him into chaplaincy.
“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 through, he could see the relief on their faces.
He recounted in a journal entry a conversation with one patient two days before he died. His family had been limited in visiting him. One night, Ruiz knocked on the patient’s door and was invited in to talk.
The light outside was fading in the darkening room. Ruiz stood at the foot of his bed. The man was freshly shaved but seemed to take effort for him 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. That was what mattered. And he told him 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.”
A pandemic persists
It was early June when Ruiz walked into a small church in Louisville.
Across the state, the numbers of new daily cases had declined. Restrictions on gatherings were beginning to ease, businesses reopening and funerals were resuming.
In a casket lay a man who died of COVID-19 after his meatpacking employer reopened.
Walking past rows of pews to the altar, family and friends moved to embrace Ruiz for helping. It made him nervous. Days later, he attended another funeral in Mount Washington that included many mourners without masks.
It was then he said he realized that people had begun to lose their discipline, potentially allowing the virus to storm back. Meanwhile, headlines about the heroics of front-line 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.
Ruiz was right. Kentucky’s cumulative cases nearly doubled from 15,842 to 30,151 in July alone, putting schools, sports, concerts, other reopenings into question, cases began to rise again at Ruiz’s hospital, too.
On July 25, Ruiz lost another relative who had attended a wedding and later became ill. Aunt Jose died today, he wrote, saying that Covid contributed to her weakened state.
His spirits sunk. He understood the public was fatigued. Some of them could forget. But as July turned to August, he could not. 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 its sickened.
There was the mother, isolated with her premature baby in the neonatal intensive care unit because of COVID-19, relying on Ruiz to see her through her baby’s heart surgery.
The elderly, one-time Bolivian farmer, from whose home he fetched his favorite CDs to play in his room as he fought for life. The daughter who had placed Ruiz “in charge” of summoning her father to rise from his sick bed, imploring him, You have to do what we cannot do.
The 19-year-old on life support with a ventilator taped to his mouth, whose girlfriend spoke to Ruiz at the ICU door. They prayed together. “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.
Chris Kenning is an enterprise reporter. Reach him at firstname.lastname@example.org, 502-396-3361 or follow on Twitter at @chris_kenning. Support strong local journalism by subscribing: courier-journal.com/subscribe.
This article originally appeared on Louisville Courier Journal: ‘Hurry, he’s dying’: A chaplain’s journal chronicles a pandemic’s private wounds