Almost a year ago, intensive care unit nurse Alia Garcia took her first assignment traveling to a COVID-19 hot spot, New York City. Now, she's returned to the area to help another hospital in need with coronavirus cases, but the type of patients she's seeing has changed.
"I feel like the patients I'm having are younger and younger," she told TODAY. "As a nurse, you're often the one facilitating FaceTime calls and phone calls with the rest of the family. At the height of this, in the beginning, it was always granddaughters, grandsons, younger daughters wanting to call and give updates. And now it's wives and husbands that are much younger (with) children that are school age."
She called this recent shift heartbreaking: "I'm seeing a lot more patients in their 40s. ... Some of them don't really have a significant medical history at all."
Garcia's not sure of the reason for the change. Perhaps it's that older people were a priority group for COVID-19 vaccines, which substantially reduce the risk of hospitalization. Or that she works in an area where "COVID-19 is a lot more prevalent," she said, so naturally some young people are getting sick. But it could be as simple as those patients now "just stick out to (her) the most."
"It's a little sadder, I guess," she said. "The disease in general is just a little bit more personal."
In April 2020, Garcia, 27, traveled to a hospital in the Bronx borough of New York, where she stayed until June. At the time, the city was dealing with one of the worst outbreaks in the country. A salient memory for Garcia was on her way to work walking past the 18-wheeler truck that her facility had converted to a morgue. She spent much of her time there caring for four to five very sick patients; pre-pandemic, she usually had one or two.
After New York, Garcia went to Arizona, which experienced its own surge in COVID-19 cases over the summer. By early July, shortly after she arrived, the state had the fastest-growing case rate in the country. She previously told TODAY that the main difference between those two experiences was that the Arizona hospital had more time to prepare.
Garcia left Arizona in August and took another crisis assignment outside Miami, which had converted a new unit into an ICU treating only COVID-19 patients. That month, Florida hit a record number of hospitalizations. She stayed there until late September, "a short amount of time, just helping out," she said.
Before Garcia's next gig, a three-month assignment in Brooklyn, New York, she needed some time off, calling it a "mental health break" and "luxury" that's more available to traveling nurses.
"I'm grateful, and I just hope that the staff of wherever I'm working can also get those," she said.
Treating COVID-19 patients, a year into the pandemic, is still as physically and mentally demanding as ever, though Garcia's back to caring for one to two patients at a time.
"At the end of the shift, the idea of even going to a gym, or even before shift, just seems out of the question," she said. "I put a lidocaine (pain-relieving) patch on my lower back every day. ... I never thought I would be Googling 'discreet back brace' (at 27)."
"Mentally, we're still learning things about COVID. ... You're constantly looking at the details and making sure that you're not missing anything," she added. "Missing something could kill somebody."
And then there's the built-up emotional toll.
"Having younger patients ... and facilitating those family phone calls and now hearing daughters and sons talking about their first day of school, kindergarten or first grade ... (I'm) not saying that younger people's lives are more important, but for me, it's just a little bit more emotional and hard," Garcia added. "Then you just have to go right back to work. ... You just expect it to be very busy all day long."
"At some point, you have to compartmentalize that with the rest of your life, so you're just not depressed all the time."
As more vaccines are distributed, Garcia's eager for life to return to normal. But she's seen firsthand the "consequences" of trying to do so too soon, she said. "Nurses, we're people, too, and we miss out on the fun things in life, as well."
"Hearing people say only 1% get it and writing off the disease can be frustrating because that 1% is all we see day in and day out," she explained. "You really start to root for these people, and then when that outcome is negative, it can be really hard."
What's next for Garcia? Her work during the pandemic has prompted her to consider going back to school to become even more specialized in critical care.
"I have a lot more appreciation for my job, my co-workers, take more pride in my work," she said, while stressing this isn't the case for all nurses.
"If I didn't enjoy (my job), this would be a whole different conversation. There's a lot of nurses who are very much burnt out and hit that burnout point probably a lot earlier than they would."