PHOENIX (AP) - They saw the ominous photos: Crowded hospitals, exhausted nurses, bodies piling up in morgues. It was far away, in New York, northern Italy and other distant places.
Now, after three months of anxiously waiting and preparing, Arizona nurses and doctors are on the front lines as the coronavirus rips through the state, making it one of the world's hot spots. The trickle of a few virus patients in March became a steady stream two weeks after Arizona Gov. Doug Ducey ended a stay-at-home order in mid-May and allowed most businesses to reopen, and is now a scourge with no end in sight.
An intensive care nurse in metro Phoenix said she cries when she thinks about all the people who have died from the virus in her hospital, or the times she clutched a frightened patient's hands during an intubation. Medical staff describe crowded emergency rooms where patients are put on ventilators waiting for a spot in the intensive care unit to open up. There are tearful goodbyes through a patio window in Tucson.
Angela Muzzy, with 31 years experience, said she tells younger nurses they'll remember their role helping people during a historic national crisis.
"We're caring for physicians who have contracted this, we're caring for mothers. Last week, we withdrew life support on a 48-year-old mother, and I stood out there with her 17-year-old son as she passed away," said Muzzy, a clinical nurse specialist at southern Arizona's Tucson Medical Center, where all 20 of 36 ICU beds dedicated to virus patients are full.
Hospitals across Arizona, a state of more than 7 million people, spent a six-week lockdown and a nearly two-month ban on elective surgeries getting ready for the surge that's appearing now. They polished emergency plans that require them to ensure they can increase capacity by 50 percent. They stocked up on masks and gowns, and trained professionals who normally work in operating rooms or other areas to care for virus patients. Dr. Lisa Goldberg, director of Tucson Medical Center's emergency department, said her staff did drills, trained, and prepared.
Meanwhile Ducey, a Republican, argued the closures he ordered had slowed the spread of the disease and hospitals were now much better prepared. While he stressed the need for social distancing, he resisted wearing a mask himself in public even as cases mounted, batting away calls by some cities to allow them to require masks.
When the case surge became impossible to ignore, Ducey reversed himself June 18 and allowed cities and counties to require masks in public, but didn't issue a statewide order. Most have, including Phoenix, Tucson and Yuma and the counties that surround them.
Today, hospitals statewide are filling up with patients, some critically ill. The state had more than 70,000 confirmed cases as of Saturday, up from just more than 20,000 on June 1. Thousands more are being reported each day, and 1,535 people have died.
More than 2,400 people are hospitalized with coronavirus this week, up from about 1,000 three weeks ago. More than 600 ICU beds were filled with virus patients this week, two-thirds of them on ventilators and sedated.
Arizona has just more than 200 empty ICU beds, out of about 1,600 in the state. More are being added as hospitals brace for a flood of patients as newly infected people slowly get sicker. Traveling nurses are being hired from other states to back up overworked staff.
"This is not a sprint, this is a marathon. In fact it's an ultra-marathon," Goldberg said.
Death is ever-present in ICUs, but with virus patients, it is even more common, and often grueling and drawn out.
Patients on ventilators are put in what is essentially a medically-induced state of suspended animation as machines breathe for their virus-ravaged lungs. They're hooked up to multiple IVs and drains, with a ventilator tube down their throats. They can stay in the ICU for weeks or months.
Nurses walk into their units for 12-hour shifts, gear up in gowns, respirators, gloves and goggles and enter an other-worldly setting. Patients are cut off from their families, and often all reality. They're frequently flipped onto their stomachs for hours at a time, a move called proning that has become a go-to for helping those patients breathe but is a grueling task that can take six to eight nurses, respiratory therapists and doctors to accomplish.
For younger nurses, some of the hardest deaths are those of young, previously healthy patients, including a woman less than 25 years old who died in Scottsdale.
She deteriorated rapidly, said Caroline Maloney, a nurse at HonorHealth's Scottsdale Osborn Medical Center with 28 years' experience working in ICUs.
"And it was very emotional. I know one nurse in particular couldn't even talk about it," she said. "They're seeing this first-hand, and its unnerving for them to see when their peers are in a hospital bed and they have to take care of them."
She said, however, that her hospital is seeing "amazing outcomes" and most of her ICU patients are recovering.