The pandemic isn’t past tense. While COVID-19 vaccines have made it possible to gather with friends and hug loved ones again, the world is still living with the virus – and too many people are still dying because of it. More than a million people in the United States have died from COVID-19 since the pandemic began, including about 250,000 people in 2022. To reflect on the lives the world has lost, we’re revisiting an episode that follows a young doctor through her first year of medical residency during the height of the pandemic. 

Kaiser Health News reporter Jenny Gold spent eight months following Dr. Paloma Marin-Nevarez, who graduated from the Stanford University medical school in June 2020, right before the virus began its second major surge. She was one of more than 30,000 new doctors who started residencies in 2020. Just weeks after graduating, Marin-Nevarez began training as an ER doctor at Community Regional Medical Center in Fresno, one of the areas in California hardest hit by the pandemic. 

Marin-Nevarez faces the loneliness and isolation of being a new doctor, working 80 hours a week in the era of masks and social distancing. She also witnesses the inequality of the pandemic, with Latino, Black and Native American people dying of COVID-19 at much higher rates than White people. Marin-Nevarez finds herself surrounded by death and having to counsel families about the loss of loved ones. We view the pandemic through the eyes of a rookie doctor, finding her footing on the front lines of the virus. 

This is an update of an episode that originally aired in February 2021. 

Credits

Reporter: Jenny Gold | Producer: Neroli Price | Editors: Brett Myers, Deborah Anderluh and Taunya English | Production manager: Steven Rascón | Original score and sound design: Jim Briggs and Fernando Arruda | Post-production team: Claire Mullen and Kathryn Styer Martinez | Digital producer: Sarah Mirk | Episode art: Heidi de Marco of Kaiser Health News | Interim executive producers: Brett Myers and Taki Telonidis | Host: Al Letson 

Special thanks: Dr. Atul Grover, Tochi Ajiwe and Samantha Gottlieb

Support for Reveal is provided by the Reva and David Logan Foundation, the John D. and Catherine T. MacArthur Foundation, the Jonathan Logan Family Foundation, the Ford Foundation, the Heising-Simons Foundation, Democracy Fund, and the Ethics and Excellence in Journalism Foundation.

Transcript

Reveal transcripts are produced by a third-party transcription service and may contain errors. Please be aware that the official record for Reveal’s radio stories is the audio.

Al Letson:From The Center for Investigative Reporting and PRX, this is Reveal. I’m Al Letson.

Three years ago, as families gathered around for the holidays, a pneumonia-like virus was growing, but it didn’t have a name yet, and few knew it existed. But it wouldn’t be long until COVID, like some giant tsunami, would wash over all of us, changing everything.

So much has happened in the last three years and we’re in such a different place now. Gone are the days of banging pots and pans for emergency workers, or fearing that touching a door handle may endanger your life. More importantly, we can hug the people we love again, gather with family. The vaccines have made that possible. Lessened the danger. Saved countless lives.

But the pandemic isn’t past tense. We’re still living with it, and too many people are still dying because of it. According to the CDC, roughly 250,000 people in the U.S. have died from COVID so far this year, and more than a million since the pandemic began.

So as families and loved ones gather together, some with empty seats at the table for those who have been lost, we want to revisit a show we first brought you last year. It follows one remarkable young doctor through her first year of medical residency during the height of the pandemic. The story begins in the final days of medical school.
Paloma Marin-Ne…:[Spanish]. Good afternoon, graduates, families, faculty, and staff.
Al Letson:Back in 2020, Paloma Marin-Nevarez spoke at her virtual graduation ceremony at Stanford med school.
Paloma Marin-Ne…:Let’s be real, the class of 2020, this was absolutely not the way that we envisioned medical school ending.
Al Letson:Paloma was one of more than 30,000 new doctors who started medical residency that year, heading out to hospitals and clinics across the country to learn the basics of how to be a doctor, just like they do any year. Except now, those hospitals and clinics were being overrun with COVID.
Paloma Marin-Ne…:This is a lot of pressure on you, and I will be the first to admit that this is scary.
Al Letson:We teamed up with Kaiser Health News and spent eight months checking in on Paloma as she started working in a predominantly Latino part of California, a community devastated by COVID. The virus has been deadlier for Native American, Black, and Latino people compared to White people. In fact, Latinos have been nearly twice as likely to die from the virus, and Paloma would confront these disparities firsthand.

Reporter Jenny Gold from Kaiser Health News picks up Paloma’s story in the summer of 2020, as the first wave of COVID infections was slowing and the second larger wave was about to begin.
Jenny Gold:I started talking to Paloma right before she started residency. It’s been clear to me, since those very first conversations, that she’s kind of a superstar. Stanford graduation speaker, first doctor in her family, former eighth grade science teacher. So can you start just by introducing yourself, telling me a little bit about you?
Paloma Marin-Ne…:Yeah, so my name is Paloma. Paloma Marin-Nevarez. I have two last names. I have two last names because I was born in Mexico, where people typically have-
Jenny Gold:When Paloma was nine, her father died suddenly of a heart attack, and her mom decided to move her and her two siblings from Durango, Mexico to Los Angeles, California, where they packed into a one bedroom apartment.
Paloma Marin-Ne…:So that meant that my mom had to raise us as a widow and pretty much as a single mother after coming to the United States.
Jenny Gold:Paloma grew up in an almost entirely Latino neighborhood. Her mom, Hortencia, worked two jobs, one at a supermarket and another at a 99 cent store. And the whole American dream thing, it kind of paid off. Paloma and her siblings, they all earned college degrees.
Paloma Marin-Ne…:The moment I stepped into Williams College, I realized that I was really poor compared to my extremely wealthy classmates, and that’s when I realized that there’s a ton of social inequity.
Jenny Gold:She sees medicine as a way to heal some of that inequity. So when it came time to pick where she would do her residency, she thought about where she could make a difference, and she thought about her mom who doesn’t speak English.
Paloma Marin-Ne…:When she goes to the doctor, she’s worried about what might be wrong with her health-wise, but she also feels this incredible shame in not being able to speak the language and she feels like she’s a burden. I feel like patients should never feel that way. All they should worry about is how the doctor is going to help them feel better.
Jenny Gold:Only 6% of doctors in California are Latino, compared to nearly 40% of the state’s population. And nationally, Latinos are twice as likely to be uninsured.
Paloma Marin-Ne…:I wanted to go to a place where I was needed, first and foremost. This was the patient population that I wanted to take care of, and so it is my privilege and my pleasure to come to Fresno.
Jenny Gold:Fresno is a majority Latino county. It’s part of California’s Central Valley, a vast area of farmland in the middle of the state that supplies about a quarter of the nation’s produce. This region often has a hard time recruiting healthcare workers.

Paloma went to one of the top med schools in the country. She probably could have had her pick of residency programs, but she wanted to go to Fresno. She was so certain, that she bought the sweatshirt before she even found out she’d gotten in.
Paloma Marin-Ne…:All right, everybody.
Jenny Gold:She recorded this Instagram video when she got the news.
Paloma Marin-Ne…:Congratulations, you have matched into UC San Francisco Fresno.
Jenny Gold:When she finishes med school a few months later, Paloma packs up her apartment, gets in the car, and starts driving toward Fresno, leaving the Stanford campus gleaming in the rear view mirror. She’s leaving one of the richest communities in the country, Silicon Valley, for one of the poorest. One in three children in Fresno County lives below the poverty line. Many of the people who pick the crops in this area are low wage migrant farm workers, and they keep coming back to these fields day after day despite the risks of COVID.
Paloma Marin-Ne…:Entering Fresno, the first thing that I noticed was just green. A bunch of green, lots of farms. And then eventually, the farms start to become grape vines. And then you know you’re really in the Central Valley when the Trump signs start to come up.
Jenny Gold:California’s Central Valley is a Republican stronghold, and the Fresno County sheriff refused to enforce the governor’s mask mandate. By June 2020, it’s been four months since the first COVID case was recorded in the U.S., and already more than 100,000 people have died.
Lester Holt:Tonight, the country has reached another sobering milestone in the coronavirus pandemic, surpassing two million cases, and this warning sign, hospitalizations are surging in many states.
Jenny Gold:When I speak to Paloma over Zoom, she’s just settling into her new apartment in Fresno. So I see behind you, all your walls are blank.
Paloma Marin-Ne…:Yes.
Jenny Gold:They’re all totally white.
Paloma Marin-Ne…:Yes.
Jenny Gold:When did you move in and how’s the unpacking going?
Paloma Marin-Ne…:I moved in about a week ago. The unpacking’s been good. It’s been really exciting.
Jenny Gold:It’s the first time she’s had a place of her own, and she adopts a kitten to keep her company.
Paloma Marin-Ne…:He’s just really adorable, very playful.
Jenny Gold:What’s his name?
Paloma Marin-Ne…:His name is John Charleston Oliver. His real name was-
Jenny Gold:Wow.
Paloma Marin-Ne…:His given name was Chuck.
Jenny Gold:Paloma is about to start training to be a fully fledged ER doctor, something she’s been working towards for years.
Paloma Marin-Ne…:In emergency medicine, we talk a lot about being the people that run into a burning building. When things are breaking down and when things are chaotic, we are the ones who kind of run in there and try to figure things out.

All right, let me pull up my pads. How are you doing this morning?
Speaker 5:I’m doing good.
Jenny Gold:On June 26th, 2020, Paloma has her first shift in the hospital.
Paloma Marin-Ne…:There you go. 97.1. All right. Have a wonderful day. Take care.
Speaker 5:You too. Have a good one.
Jenny Gold:Paloma is working at Community Regional Medical Center in Downtown Fresno. It’s big. 10 stories high and 685 beds. It’s a safety net hospital that serves lots of low income and uninsured patients. And it doesn’t take Paloma long to notice how different things are here compared to Stanford.
Paloma Marin-Ne…:I’m starting to see just how the shortage of medical providers really translates to patients waiting a very, very long time for care. The waiting room starts to fill up quickly in the day. There’s a hallway where patients wait for care, and it’s really hard to see them waiting.
Jenny Gold:For the most part, Paloma’s first few weeks aren’t so different than they’d be any other year. She’s in charge of her own patients, taking their medical histories, performing exams, and coming up with a plan for care. And on a moment’s notice, her supervisor, the attending doctor, could quiz her about pretty much anything, like, “Tell me the name of every nerve in the hand.”
Paloma Marin-Ne…:So it’s almost like you have this ginormous hat and it’s just full of facts, and you just have to pull five random facts out of this giant hat. And then sometimes you’ll get it, like, “Wow, this was actually relevant,” and sometimes they won’t.
Jenny Gold:Was there a moment when you were like, “Ugh, I don’t feel like a doctor. I’m falling on my face.”?
Paloma Marin-Ne…:All the time. Literally, I call myself the CEO of hot mess central. I feel like a train wreck all the time.
Jenny Gold:Reality check here. When I interviewed Paloma’s supervisor later, she told me Paloma is super organized, definitely not a train wreck.
Paloma Marin-Ne…:And I’ve been told that I’m really harsh on myself, but I also… It’s how I cope. I feel like making fun of myself is how I get through things.
Jenny Gold:Early on, Paloma’s program tries to protect residents by keeping them away from COVID patients, but that will eventually change as the pandemic gets worse.
Speaker 6:California hospitals are rushing to make room as they prepare for a surge in COVID-19 patients.
Speaker 7:Well, we are seeing a dramatic spike in cases in California over the past 24 hours.
Speaker 8:The White House task force advising hotspots to buckle down.
Jenny Gold:This is the beginning of the second wave of COVID cases in the U.S.. As infection rates climb, the virus catches up with Paloma’s personal life. On July 7th, 2020, during one of our regular check-ins, she breaks the news to me.
Paloma Marin-Ne…:Actually, my mom just got COVID.
Jenny Gold:What?
Paloma Marin-Ne…:Yeah, so my mom tested positive last week. My mom doesn’t like to tell me anything. She doesn’t want me to worry. And I told her, “Hey mom, I need you to talk to me and to tell me the truth,” and she finally did. And the moment when she said, “I’ve lost my sense of taste,” I said, “I’m diagnosing you with COVID right now. I need you to go get a test ASAP.”
Jenny Gold:Her mom’s case is fairly mild, but back at the hospital in Fresno, more and more patients are coming in with severe cases of COVID. PPE is in short supply.
Paloma Marin-Ne…:I have been getting the emails from management to always be very thoughtful about the PPE that we’re using, asking us to be very thoughtful about the tests that we’re ordering so that we can conserve supplies. But it does make me wonder what is it going to look like a month from now.

I have this dissonance between me going into work, knowing that we have this incredibly contagious virus and we are respecting it and doing our best to stay safe in the hospital, and then the general public just frankly doesn’t really seem to care. Then I think that’s been one of the most disheartening things.
Jenny Gold:In July, protestors organize an anti-mask rally that takes over a city block in Fresno. They hold signs that read, “Honk for Trump.”
Speaker 9:We’re here to protest the tyrannical rules that Governor Gavin Newsom has placed on us.
Paloma Marin-Ne…:People just gathered without wearing masks and with their signs that are like, “End the tyranny.”
Speaker 9:He said that our number one priority was to flatten the curve. The curve has been flattened.
Paloma Marin-Ne…:And I’m like, “I hope I don’t see you at the hospital, people.”

I will now begin donning my PPE.
Jenny Gold:On July 20th, 2020, Paloma has her first shift in the intensive care unit, just as the second wave of COVID is nearing its peak.
Paloma Marin-Ne…:I’ve got my blue gown.
Jenny Gold:The ICU is where the very sickest COVID patients end up, and many of them are on ventilators.
Paloma Marin-Ne…:I’m already wearing my N95 mask. Putting on my goggles. I’m ready to go in.
Jenny Gold:Just a few days into Paloma’s time in the ICU, hospitals in the region are so overwhelmed that the Air Force deploys teams of healthcare workers to help. Paloma works beside them.
Speaker 6:The Central Valley is now the state’s hotspot for COVID-19, as it’s seeing more than double the statewide positivity rate.
Paloma Marin-Ne…:Today is the last day of July, and it is the 12th day in a row that I’ve been working since I started my ICU rotation. I have been working for two weeks straight without a break. I am absolutely exhausted. I’m so tired.
Al Letson:By the end of July 2020, the total number of COVID deaths in the U.S. reached 150,000. The most of any country in the world. For first year residents, learning to deal with death is a part of becoming a doctor. But for Paloma’s class, death was a constant. She’d been a doctor for just five weeks and was already taking care of some of the sickest patients on the front lines of the pandemic, and things were about to get even harder.
Paloma Marin-Ne…:There are so many patients here who have COVID. 70-year-old patient with COVID. 80-year-old patient with COVID. 50-year-old patient with COVID. It’s just everywhere.
Al Letson:That’s next on Reveal, from The Center for Investigative Reporting and PRX.

From the Center for Investigative Reporting and PRX, this is Reveal. I’m Al Letson. When we left off, Dr. Paloma Marin-Nevarez was just over a month into her first year of medical residency. It was July of 2020, and the worst of COVID was still to come. Reporter Jenny Gold of Kaiser Health News started following Paloma that summer, trying to understand what it was like to be a brand new doctor staring down a global pandemic. Jenny picks up the story later that summer.
Jenny Gold:By early August, Paloma is in the middle of her ICU rotation. COVID is surging in California’s Central Valley, and many of the sickest patients are coming to Paloma’s hospital in Fresno.
Paloma Marin-Ne…:I’m here sitting in the cafeteria. I was luckily able to sign out early today and… Rare occasion. Because it’s been a long time since I have been out of the hospital and been able to see the sunlight.
Jenny Gold:In the ICU, Paloma’s usually in charge of five patients at a time, which is a lot. An older resident tells her that in non-COVID times, she probably would’ve had just two. She monitors her patient’s ventilators and heart monitors, and checks in on them constantly.
Paloma Marin-Ne…:It’s really hard to say no to families, that they can’t come visit.
Jenny Gold:Families usually spend a lot of time with loved ones in the ICU. They play music, offer prayers, and ask questions of the doctors and nurses. But these days, the ICU is a lonely place.
Paloma Marin-Ne…:There’s a very strict policy right now that the only people who are allowed to visit their loved ones is if they are actively dying.
Jenny Gold:So it falls to Paloma and the other hospital staff to bridge the gap. At the end of every day, she steps into an office and calls her patients’ families to give them an update. The news is usually not good, and these conversations are complicated by all the misinformation that’s floating around at this point.
Paloma Marin-Ne…:After I let the family member know that the patient had COVID, the family member let me know that they didn’t really think that COVID was a thing. It makes me sad that people kind of have to wait until COVID hit somebody that they love for them to start believing in it.
Jenny Gold:Brand new doctors, like Paloma, face a catch-22. On the one hand, they’re needed now more than ever. But on the other, they’re still learning and only have so much to offer.

In the ICU, Paloma is seeing more and more patients who don’t make it out, just to keep calling families to tell them their loved ones aren’t getting any better day after day. It’s exhausting, and I can hear it taking a toll on her.
Paloma Marin-Ne…:If there is one thing that I can do well right now as an intern in the pandemic is connecting with the families, and I find that to be a really, really important responsibility. I might not have all the answers, but I can make time to give them an update.
Jenny Gold:Sometimes Paloma stays late, volunteering to call the families of other doctors’ patients so she can speak to them directly in Spanish without an interpreter.
Paloma Marin-Ne…:There was this family who I spoke to who told me that they hadn’t talked to a doctor in a while. And of course, they were a Spanish-speaking family. And just at the end when I’m about to hang up, the patient’s wife just asks me, “So what was your name again?” And I just said, “I’m Dr. Marin or [Spanish] Marin,” and she was like, “I’m so grateful that you’re taking care of my husband.” And I just… They’re not a patient who I can confidently say will be able to make it, and I’m just so afraid of having to talk to this person and give them bad news after they said that. I’m afraid. I’m afraid of this patient’s family being grateful for a doctor who doesn’t know what she’s doing.
Jenny Gold:I wanted to know what it’s like to be a family member on the other side of the line with Paloma. Denise Munos agreed to talk to me. Her dad is a truck driver, 69 years old. And he’s actually the only COVID patient Paloma treated, who she remembers getting off of a ventilator and out of the hospital.

Thank you again so much for doing this. I know you just must be incredibly busy right now.
Denise Munos:It’s more than I anticipated.
Jenny Gold:Yeah, I can imagine.

When I reached Denise, she’s at home, taking care of her dad. She happens to be a nurse in a COVID unit in Southern California. She knows how busy things are, so she was even more impressed by Paloma’s calls.
Denise Munos:For me, her voice just brought me comfort. She told me that she would call me every day that she was assigned to my dad to give me an update, and followed through. She called me every single day, which was just amazing to me. I just knew, “Okay, I’m going to get a call from Dr. Marin today. It doesn’t matter what time. She’s going to call me.”
Jenny Gold:Denise says she didn’t get to talk to her dad much in the hospital and she wasn’t allowed to visit. Paloma became the lifeline for her and her family, especially when they had to make difficult decisions about his care.
Denise Munos:When she called and said that my dad was going to be intubated, it was a scary conversation for me when I hear, “Ventilator.” It’s like, “Oh no, this is bad.” She presented it in, “This is not a bad thing. He’s getting worse, but this is going to help him.” And that’s exactly the same thing I told my sisters, which I think brought comfort to them as well.
Jenny Gold:Her dad needed to be part of these conversations too, and he doesn’t speak much English, so having a Spanish-speaking doctor like Paloma was critical.
Denise Munos:I don’t really know that he would understand if somebody spoke to him in English about medical stuff that was going on. So for her to speak Spanish, there would be no confusion or him saying yes to something that he didn’t really understand.
Jenny Gold:The way that COVID has disproportionately hit communities of color has exposed the vast inequalities that have long defined this country. Many of Paloma’s patients in the ICU, like Denise’s dad, are Latino.
Paloma Marin-Ne…:For me, it’s really hard to witness my people just getting absolutely destroyed by COVID, knowing that often we’re the ones at the front lines.
Jenny Gold:More than half of Latino workers in California are in jobs that have been deemed essential during the pandemic.
Paloma Marin-Ne…:So it’s hard to see us working so hard and then paying the price for it.
Jenny Gold:In the ICU, Paloma is on the front lines of dealing with these inequalities, and she’s the one who has to talk to patients and their families when it becomes clear that the patient isn’t going to get better. It’s Paloma’s job to walk families through really difficult decisions about when the medical interventions used to prolong a patient’s life have started to cause more harm than good, and whether it’s time to shift away from aggressive treatments to focus instead on giving the patient comfort as they die. She sometimes rehearses with her team ahead of time about what she’s going to tell a family. I called her to ask, “What do you say?”
Paloma Marin-Ne…:There’s a very tricky shift that needs to occur. We want them to understand that at this point, the health of their loved one and their prognosis is so poor that us continuing to do invasive things like ventilating them through a machine, like injecting them with medicines is not doing good anymore and is causing harm. So it’s a lot of pausing, it’s a lot of listening. It’s a lot of giving the family the space to cry. It’s my job and I come in and I do this multiple times a day. But for them, it’s an incredibly significant event in their life.
Jenny Gold:Did you learn this in med school? Did they teach you this? Or is this stuff you’ve just figured out on the job?
Paloma Marin-Ne…:No. No, they don’t teach you this in medical school.
Jenny Gold:Paloma remembers a one hour seminar, but that’s about it. I spoke to Paloma’s mentor at Stanford and he agreed that medical schools spend a lot of time on topics like molecular biology, but not enough on issues like talking about the end of life.
Paloma Marin-Ne…:I think that we need to improve our fluency in discussing emotions. We need to improve our skill in sitting in a room with someone in silence and just letting them cry and letting them grieve.
Jenny Gold:Medical residents like Paloma almost always have to confront the death of a patient at some point in their training. But because of COVID, the number of deaths is just overwhelming. Paloma often finds herself witnessing a patient’s last words or their final breaths.
Paloma Marin-Ne…:I hold in my memory one of the last interactions that this person had with someone on earth.
Jenny Gold:One day, she helps interpret a conversation for a Spanish-speaking patient who then dies just hours later. Paloma was the last person to speak to them in their native language.
Paloma Marin-Ne…:It is a gift, but it’s also a gift that I wish that I hadn’t received, really. I wish that I would’ve been able to provide those last moments to the family.
Jenny Gold:Every time I talk to Paloma during her month in the ICU, she tells me about another patient she’s lost. Another grief-stricken family. She’s working almost nonstop. One week, she clocks 87 hours in the ICU. I can tell she’s feeling rundown and I’m starting to worry about her a little. Her mom, Hortencia, is also concerned.
Paloma Marin-Ne…:And I woke up to about five texts from my mom, who’s kind of worried because I haven’t called her in a while. So I’m going to do that now.
Hortencia:Hello?
Paloma Marin-Ne…:Mommy?
Hortencia:[Spanish]?
Paloma Marin-Ne…:[Spanish].
Hortencia:[Spanish].
Paloma Marin-Ne…:[Spanish].
Hortencia:[Spanish].
Jenny Gold:Hortencia does her best not to show it, but Paloma tells me that she knows her mom worries about her.
Paloma Marin-Ne…:She just texts me a little blessing every day. My mom’s very religious.
Jenny Gold:Will you read me one of her blessings?
Paloma Marin-Ne…:Sure. They’re in Spanish. Okay, so what she’s saying, she’s like, “Palo,” that’s how she calls me. [Spanish].
Jenny Gold:And what does that mean?
Paloma Marin-Ne…:Just means I hope that God gives you wisdom in your work, and that I hope you don’t have to stay for too long. I hope that He protects you and takes care of you and everybody as well, and that God helps you as you guys help people.
Jenny Gold:She sends you one of those every day?
Paloma Marin-Ne…:Mm-hmm.
Jenny Gold:Wow, that’s pretty lovely.
Paloma Marin-Ne…:And she’s blessing all the other doctors and the nurses, and it’s so cute. And there was one day when she forgot to do it, and the day was really busy. And I joked with my team, “You know why, guys? It’s because my mom didn’t send her blessings.”
Jenny Gold:Maybe it was.

Everyone I’ve talked to who knows Paloma tells me she’s an extrovert, which makes this time feel even more isolating. She doesn’t know anyone in Fresno. She’s trying to make friends, but it’s hard when she can’t even hang out in person with her fellow residents. It’s not like they can just grab a drink or go out for brunch.
Paloma Marin-Ne…:I feel pretty disconnected from people right now, honestly. And I’ve had to call my therapist and call my old friends, just because I just don’t really feel very connected to people right now. And it’s nobody’s fault. It’s just the pandemic.
Jenny Gold:Well, I hope you’re getting some quality time with the kitty at least.
Paloma Marin-Ne…:Actually, my mom ended up taking him for a bit.
Jenny Gold:Really?
Paloma Marin-Ne…:I was not home at all to take care of him. I was feeding him and cleaning his litter box, but he was getting really anxious and he was not playing, so my mom took him.
Jenny Gold:Now that Chuck the cat is gone, Paloma is all alone when she gets home. I can tell she’s worn out and lonely. So many healthcare workers are struggling right now. All over the world, people are trying to cheer them on, calling them heroes.

Back in the spring of 2020, when the first wave of COVID cases hit New York, there was a nightly ritual where people clapped for healthcare workers, banging pots and pans. Every day when Paloma heads into the hospital, she walks past these signs, a superman silhouette wearing a mask, and the words, “Heroes work here.” It bothers her.
Paloma Marin-Ne…:I don’t feel like a hero. That’s not me. I’m not doing the impossible. I’m not bringing people back. Of course we’re doing the best that we can, but at the end of the day, people are still dying. There’s so much that I wish I could give to my families, like their ability to visit their loved ones, their ability to have those moments that I have taken with me of seeing their loved ones’ last words, last interactions with the world, last opening up their eyes on their own. I wish that I could give that to them. I wish that was my superpower.
Jenny Gold:By September, Paloma finishes her ICU rotation. She gets a much needed vacation and drives down to LA to see her family for her birthday. She stays in an Airbnb to keep them safe.
Paloma Marin-Ne…:It was kind of nice, in some ways, that my mom had already recovered from COVID, and so it didn’t feel as socially irresponsible to go see her. They got me a really nice tres leches cake. My mom made me pozole. It was awesome.
Jenny Gold:It was a big one. She turned 30.
Paloma Marin-Ne…:I grew up in a Mexican household with a lot of soap operas, and that was kind of like the measure of a woman’s success is finding a man and having children. And I guess the only thing I’ve done in my life is get a doctorate, and I have no partner and no children. So according to Mexican soap operas, I would be a failure, but that’s okay.
Jenny Gold:When she gets back to the hospital, she stops by the ICU to check in on her former patients. She has a list of people she’s been wondering about.
Paloma Marin-Ne…:I went back to look at the ones that I had taken care of and go down the list and see, “Deceased, deceased, deceased, deceased, deceased.” All of them except one had died.
Jenny Gold:On September 22nd, 2020, another milestone. 200,000 Americans have died of COVID. But the second wave of infections has finally flattened and things seem to be turning around. Around the same time, Paloma gets a little space from the virus. She begins rotating through departments where COVID is less prevalent, and she sends me audio dispatches along the way.
Paloma Marin-Ne…:Testing, testing.
Jenny Gold:First, she heads to the trauma ward, where she works the overnight shift.
Paloma Marin-Ne…:I’ve been running around, responding to a bunch of pages. It is just a matter of time before I get another page. I’m currently… There’s the page. I knew it was just a matter of seconds.
Jenny Gold:In October, she moves to anesthesiology, where she learns how to intubate a patient.
Paloma Marin-Ne…:Big, deep breaths, dear. We want to fill your lungs with oxygen, okay?
Speaker 12:Take your time. [inaudible] with your eyes. Perfect.
Paloma Marin-Ne…:There we go.
Speaker 12:There you go.
Paloma Marin-Ne…:Do you have the tube? Whoops.
Jenny Gold:In November, she works with kids at a pediatric clinic.
Paloma Marin-Ne…:All right. Let’s see what hair cap am I going to go with. Dinosaurs or whales today? Let’s go with whales for mammal Monday.
Jenny Gold:Gathering one new skill after the next is exhilarating.
Paloma Marin-Ne…:My brain is just swelling with knowledge, and it’s really amazing to see the growth. I mean, I’ve only been a doctor for a few months, and so just to think that I’m going to continue to have this incredibly steep curve of learning is pretty exciting.
Jenny Gold:But by November, COVID cases have started to climb again. On November 18th, the U.S. records 250,000 COVID deaths. Then come the holidays.
Speaker 13:Millions of Americans ignoring warnings from the CDC not to travel tonight.
Speaker 14:Officials are seriously concerned. Thanksgiving gatherings are going to amplify an already overwhelming problem.
Speaker 15:The Thanksgiving surge experts feared is now here and just beginning to cripple states like California.
Speaker 14:This morning, the coronavirus accelerating through the holiday season. Another million more infections added in the past six days.
Jenny Gold:Public health officials pleaded with Americans to please stay home over the holidays, but millions didn’t listen. Across the country, this is the beginning of the third wave, and it’s the one that hits California the hardest. Daily cases in the state double then quadruple.

It’s hard to describe just how much worse the situation is by December, compared to July when Paloma was in the ICU. Looking at the graph of the surges, the summer wave looks like a tiny mole hill compared to the Mount Everest of the winter wave. And once again, Fresno is a hotspot.
Paloma Marin-Ne…:COVID is wiping the floor with the United States of America. Right now in the emergency department, the entire what we call the red zone, where they take the absolute sickest patients, has been turned into a mini ICU. So patients are spilling out. The hospital is bursting at the seams.
Al Letson:By mid-December 2020, the U.S. hit 300,000 deaths. In Fresno, there were just a handful of ICU beds available in the entire county. That’s when Paloma got the email.
Paloma Marin-Ne…:One of the emails that I got today was from my program director letting us know that they need backup in the ICUs, since some of the residents have started to get symptoms.
Al Letson:The hospital was looking for residents to go back into the ICU just as cases are at their worst. When we come back, Paloma has to make a very big decision. That’s next on Reveal.

From The Center for Investigative Reporting and PRX, this is Reveal. I’m Al Letson.

The pandemic forced healthcare workers to make enormous sacrifices. Kaiser Health News and The Guardian found that more than 3,600 healthcare workers in the U.S. died from COVID in just the first year of the pandemic alone. Nurses were hit the hardest, making up nearly a third of all deaths. And nearly two-thirds of health workers who died were people of color.

This week, as loved ones come together to celebrate the holidays, we’re revisiting a show that looks back two years to a time when it wasn’t safe to gather in groups because COVID deaths were surging. When we left off, it was December of 2020, and Dr. Paloma Marin-Nevarez had just gotten an email asking if she’d be willing to volunteer to go back into the ICU. At that point, her hospital, Community Regional Medical Center in Fresno, was overflowing. The medical ICU had nearly three times as many patients as normal and was desperately short-staffed. So Paloma had a decision to make. Jenny Gold, a reporter with Kaiser Health News, brings us the rest of Paloma’s story.
Jenny Gold:It’s December 15th, 2020 when Paloma gets that email asking her to go back into the ICU. She’s in her apartment, staring at her computer screen, trying to decide should she go back into the breach.
Paloma Marin-Ne…:I took approximately 45 seconds before replying to this email, saying that I was happy to go back to help.
Jenny Gold:At this point, it’s been four months since Paloma was last in the ICU. She’s still trying to process all the death she saw there. It’s a big risk to go back, emotionally and physically, and Paloma could be weeks away from a vaccine. Going back into the riskiest place in the hospital is scary, but it’s exactly where she wants to be.
Paloma Marin-Ne…:When I am a faculty member, hopefully one day, in a medical school, and my students ask me, “What did you do in the 2020 pandemic?” I wanted to be able to have an answer that I felt proud about. That email that my program director sent was my answer.
Jenny Gold:December 21st, four days before Christmas. It’s Paloma’s first day back in the ICU, and it’s a long one. She crawls into her car at the end of a 13 hour shift.
Paloma Marin-Ne…:Oh my God. I can finally take off the mask.
Jenny Gold:The ICU was busy the last time she was here in August, but it’s so much worse now.
Paloma Marin-Ne…:When I came into the ICU, God, I don’t even remember how long ago that was, there were only two teams, and now there’s like five. It is absolutely bursting at the seams. It is so full. It is so busy.
Jenny Gold:These are not good conditions for doctors or patients. One study found that when ICUs were at their most crowded during the pandemic, COVID patients were twice as likely to die. But there’s not much doctors and nurses can do. They’re just scrambling, trying to provide the best care they can to the most patients.
Paloma Marin-Ne…:Today’s Christmas Eve, December 24th, 2020, just coming home now. Today was rough. I was probably done at around 5:00 PM today and I stayed an extra two, almost three hours.
Jenny Gold:Paloma gets her first dose of the vaccine that day and she stays late in the ICU. There’s a patient there, who Paloma’s been taking care of, who’s already lost her family member to COVID. Now she’s sick too. All the patient wanted was to go home and spend Christmas with her dog. Instead, she’s dying in the hospital.
Paloma Marin-Ne…:I followed this patient’s wishes and I did not allow them to die alone. I was there and the patient’s bedside nurse was also there, and she was so sweet. She was kind of brushing her hair and lightly touching her on her head as if she was comforting her. I got very emotional and I cried. I allowed myself to cry at the moment because it was overwhelming and I think it was kind of a culmination of a very long week.
Jenny Gold:It might not sound like much, but I’m starting to notice a change in Paloma. In the past, she’s given herself a really hard time for crying. But this time, she doesn’t beat herself up. Paloma seems like she’s figuring out how to protect her own mental health even as the pandemic rages around her.
Paloma Marin-Ne…:I’ve had to be very strategic about my own. If I run into a burning building and I burn myself and then I become another casualty, then that’s not helping anybody.
Jenny Gold:On our next call, I ask her if things feel different this time in the ICU.
Paloma Marin-Ne…:I felt like this power where I could advocate for my patients versus before this rotation, I was like, “Well, I’m just an intern. I’m really scared.” And I was just like, “No, I’m going to handle it. I’m the doctor now.”
Jenny Gold:Gosh, Paloma. Hearing you talk about this just feels completely different than the last time you were in the ICU.
Paloma Marin-Ne…:Yeah.
Jenny Gold:You have confidence. You are confident as a doctor.
Paloma Marin-Ne…:Sorry. Yeah. Yes.
Jenny Gold:What do you think changed?
Paloma Marin-Ne…:I do think that I have some skills. I remember a lot of things that I learned in my first rotation on how to take care of patients with COVID. Like I usually would ask my attending, “Do you want an X-ray every day for a patient so that you can track the progress over time?” I didn’t do that anymore. I asked myself that question. I said, “Do you, Dr. Paloma Marin-Nevarez, do you need the X-ray to figure out what’s going on with the patient?” and pushing myself to do those things.
Jenny Gold:On January 3rd, 2021, the U.S. hits 350,000 deaths from COVID.
Paloma Marin-Ne…:This is my second dose.
Jenny Gold:A few days later, Paloma wraps up her time in the ICU and she’s able to get her second dose of the vaccine.
Paloma Marin-Ne…:Let’s do the left side.
Speaker 16:Okay. [inaudible].
Paloma Marin-Ne…:Yeah.
Jenny Gold:Daily COVID cases in California are still at an all-time high.
Speaker 16:You’re okay?
Paloma Marin-Ne…:Yeah.
Speaker 16:All right. You’re good. 15 minutes on your timer, okay?
Paloma Marin-Ne…:Sure. Over there on those chairs?
Speaker 16:Yes.
Paloma Marin-Ne…:Perfect. Thank you so much.
Speaker 16:[inaudible].
Paloma Marin-Ne…:Awesome. Thank you very much.
Jenny Gold:I’ve been talking to Paloma for the past eight months. I’ve witnessed firsthand the challenges she’s faced and the risks she’s taken on throughout the pandemic. The vaccine is a glimmer of hope. Thinking about all the people like Paloma who’ve risked so much, it made me think again about something Paloma told me back in August about her discomfort with being called a hero. I wondered if she sees it any differently now.

I wanted to play you some tape of yourself from earlier on and have you reflect on it, and then I’ll ask you a question.
Paloma Marin-Ne…:Sure.

I don’t feel like a hero. That’s not me. I’m not doing the impossible. I’m not a superhero. I’m not bringing people back. Of course-
Jenny Gold:Paloma, following you as you’ve been on the front lines, you’ve done a lot of heroic things, not the least of which has been talking a lot of families through end-of-life issues. I wondered how you think about this idea of heroism now.
Paloma Marin-Ne…:This pandemic was a catastrophic failure, and there’s almost 400,000 people who are dead in this country because we expect that the job of taking care of others lies only in those who get paid to do so. And by calling other people heroes, we’re separating ourselves from that job. What if every single person had seen themselves as a hero and had said no to traveling during the holidays, or had said no to throwing a wedding during a pandemic, or had said no to having a party or to have a get-together or to give something up? What if everyone had thought of themselves that way and had said, “It is also my job to take care of others.” And we are all doing what we can as physicians, as nurses, as social workers, as custodians, as everyone who works in a hospital, but what the (beep) is everyone else doing?
Jenny Gold:Paloma tells me that by calling healthcare workers heroes, it’s like the rest of us get to let ourselves off the hook. We get to absolve ourselves of all the things we could have done differently to protect one another.
Al Letson:More than a million Americans have died from COVID-19. More people than any other nation in the world. At the height of the pandemic, Paloma was one of 12 first year emergency medicine residents at Community Regional Medical Center in Fresno. When that email went out asking for volunteers to go back into the ICU, all of them signed up.

It’s been nearly two years since we first aired this story, and we recently checked back in with Paloma to see how she’s doing. She’s well into her third year of residency and tells us that she’s feeling pretty burnt out, not just by the pandemic, but also medicine, which she says is often and unnecessarily toxic and grueling. She’s frightened by the way that COVID and vaccines became politicized, and she’s heartbroken at the continued inequities in healthcare.

But she says one thing that’s always been important for her is to help make things better for the people who come after her. That’s why she’s considering a fellowship in medical education to help train and empower the next generation of doctors and ensure that some of the lessons of this pandemic aren’t forgotten.

This week’s show was a partnership with Kaiser Health News. It was reported by Jenny Gold. Neroli Price produced the episode. Brett Myers edited the show with help from Deborah Anderluh and Taunya English at Kaiser Health News.

Nikki Frick is our fact checker. Victoria Baranetsky is our general counsel. Our production manager’s Amy the Great Mostafa.

Original score and sound designed by the dynamic duo, Jay Breezy, Mr. Jim Briggs, and Fernando, my man, Arruda. Our post-production team is the Justice League, and this week it includes Claire C Note Mullen and Kathryn Styer Martinez.

Our digital producer is Sarah Mirk. Our COO is Maria Feldman. Our CEO is Robert Rosenthal. Our interim executive producers are Brett Myers and Taki Telonidis. Our theme music is by Comarado Lightning.

Support for Reveal is provided by the Reva and David Logan Foundation, the John D. and Catherine T. MacArthur Foundation, the Jonathan Logan Family Foundation, the Ford Foundation, the Heising-Simons Foundation, the Hellman Foundation, the Democracy Fund, and the Inasmuch Foundation.

Reveal is a co-production of the Center for Investigative Reporting and PRX. I’m Al Letson, and remember, there is always more to the story.

Brett Myers is an interim executive producer for Reveal. His work has received more than 20 national honors, including a George Foster Peabody Award, four nationalEdward R. Murrow Awards and multipleThird Coast/Richard H. Driehaus Competition awards. Before joining Reveal, he was a senior producer at Youth Radio, where he collaborated with teenage reporters to file stories for "Morning Edition," "All Things Considered" and "Marketplace." 

Prior to becoming an audio producer, Myers trained as a documentary photographer and was named one of the 25 best American photographers under the age of 25. He loves bikes, California and his family. Before that, he was an independent radio producer and worked with StoryCorps, Sound Portraits and The Kitchen Sisters. Myers is based in Reveal's Emeryville, California, office.

Portrait of steven rascón

Steven Rascón (he/they) is the production manager for Reveal. He is pursuing a master's degree at the UC Berkeley Graduate School of Journalism with a Kaiser Permanente Institute for Health Policy Fellowship. His focus is investigative reporting and audio documentary. He has written for online, magazines and radio. His reporting on underreported fentanyl overdoses in Los Angeles' LGBTQ community aired on KCRW and KQED. Rascón is passionate about telling diverse stories for radio through community engagement. He holds a bachelor of fine arts degree in theater arts and creative writing.

Jim Briggs III is the senior sound designer, engineer and composer for Reveal. He supervises post-production and composes original music for the public radio show and podcast. He also leads Reveal's efforts in composition for data sonification and live performances.

Prior to joining Reveal in 2014, Briggs mixed and recorded for clients such as WNYC Studios, NPR, the CBC and American Public Media. Credits include “Marketplace,” “Selected Shorts,” “Death, Sex & Money,” “The Longest Shortest Time,” NPR’s “Ask Me Another,” “Radiolab,” “Freakonomics Radio” and “Soundcheck.” He also was the sound re-recording mixer and sound editor for several PBS television documentaries, including “American Experience: Walt Whitman,” the 2012 Tea Party documentary "Town Hall" and “The Supreme Court” miniseries. His music credits include albums by R.E.M., Paul Simon and Kelly Clarkson.

Briggs' work with Reveal has been recognized with an Emmy Award (2016) and two Alfred I. duPont-Columbia University Awards (2018, 2019). Previously, he was part of the team that won the Dart Award for Excellence in Coverage of Trauma for its work on WNYC’s hourlong documentary special “Living 9/11.” He has taught sound, radio and music production at The New School and Eugene Lang College and has a master's degree in media studies from The New School. Briggs is based in Reveal's Emeryville, California, office.

Fernando Arruda

farruda@revealnews.org

Fernando Arruda is a sound designer, engineer and composer for Reveal. As a multi-instrumentalist, he contributes to the original music, editing and mixing of the weekly public radio show and podcast. He has held four O-1 visas for individuals with extraordinary abilities. His work has been recognized with Peabody, duPont-Columbia, Edward R. Murrow, Gerald Loeb, Third Coast and Association of Music Producers awards, as well as Emmy and Pulitzer nominations. Prior to joining Reveal, Arruda toured as an international DJ and taught music technology at Dubspot and ESRA International Film School. He worked at Antfood, a creative audio studio for media and TV ads, and co-founded a film-scoring boutique called the Manhattan Composers Collective. He worked with clients such as Marvel, MasterClass and Samsung and ad agencies such as Framestore, Trollbäck+Company, BUCK and Vice. Arruda releases experimental music under the alias FJAZZ and has performed with many jazz, classical and pop ensembles, such as SFJAZZ Monday Night Band, Art&Sax quartet, Krychek, Dark Inc. and the New York Arabic Orchestra. His credits in the podcast and radio world include NPR’s “51 Percent,” WNYC’s “Bad Feminist Happy Hour” and its live broadcast of Orson Welles’ “The Hitchhiker,” Wondery’s “Detective Trapp,” MSNBC’s “Why Is This Happening?” and NBC’s “Born to Rule,” to name a few. Arruda also has a wide catalog of composed music for theatrical, orchestral and chamber music formats, some of which has premiered worldwide. He holds a master’s degree in film scoring and composition from NYU Steinhardt. The original music he makes with Jim Briggs for Reveal can be found on Bandcamp.

Claire Mullen worked at The Center for Investigative Reporting until September 2017. is an associate sound designer and audio engineer for Reveal. Before joining Reveal, she was an assistant producer at Radio Ambulante and worked with KALW, KQED, the Association of Independents in Radio and the San Francisco Bay Guardian. She studied humanities and media studies at Scripps College.

Kathryn Styer Martínez

kstyermartinez@revealnews.org

Kathryn Styer Martínez (she/ella) is a production assistant for Reveal. She studies audio and photojournalism at the UC Berkeley Graduate School of Journalism. She is also a Greater Good Science Center reporting fellow, focusing on Latino well-being.

Martínez was the 2020-21 Toni Randolph reporting fellow at Minnesota Public Radio, the 2019-20 New Economy Reporting Project fellow and the former director of KGPC-LP FM, Peralta Community Radio. Her work has appeared in El Tecolote, The Oaklandside, MPR News, National Public Radio, Outside Online, Talk Poverty, New Life Quarterly and Making Contact.

She earned bachelor’s degrees in Raza studies and political science from San Francisco State University.

Taki Telonidis is an interim executive producer for Reveal. Previously, he was the media producer for the Western Folklife Center, where he created more than 100 radio features for NPR’s "All Things Considered," "Weekend Edition" and other news magazines. He has produced and directed three public television specials, including "Healing the Warrior’s Heart," a one-hour documentary that explores how the ancient spiritual traditions of our nation’s first warriors, Native Americans, are helping today’s veterans diagnosed with post-traumatic stress disorder. Telonidis also was senior content editor for NPR’s "State of the Re:Union." Before moving to the West, he worked for NPR in Washington, where he was senior producer of "Weekend All Things Considered" between 1994 and 1998. His television and radio work has garnered a George Foster Peabody Award, three Rocky Mountain Emmy Awards and the Overseas Press Club Award for breaking news. Telonidis is based in Salt Lake City.

Al Letson is a playwright, performer, screenwriter, journalist, and the host of Reveal. Soul-stirring, interdisciplinary work has garnered Letson national recognition and devoted fans.