(Editor’s note: Attention to expletives in 4th and 9th paragraphs that some may find offensive.)

FILE PHOTO - Healthcare workers rush a patient on a stretcher into the Wyckoff Heights Medical Center during the outbreak of the coronavirus disease (COVID-19) in the Brooklyn borough of New York City, New York, U.S., April 6, 2020. REUTERS/Brendan Mcdermid

NEW YORK (Reuters) - Sam remembers the moment he realized he could no longer smile at patients. He was helping a nervous man suffering from COVID-19 at the New York City hospital where he works as a nurse. The patient cracked a joke, and Sam laughed. Then he felt air in his eye.

“It was a bleak moment,” he said.

The smile had lifted Sam’s N95 respirator mask off his face, creating an air leak. With COVID-19, the deadly respiratory disease caused by the new coronavirus, transmittable through the air, that’s a risk.

“A big smile helps things feel less scary,” said Sam, who was not authorized to speak to the media and asked that his last name not be used. “Not having that, in a time when my patients are scared shitless, is challenging.”

Already battling overcrowded hospitals and equipment shortages, healthcare workers on the front lines of New York’s coronavirus outbreak say the highly contagious virus has hampered their ability to comfort patients fighting to stay alive.

COVID-19 has infected more than 161,000 people in New York and killed 7,000.

One of nurse Peggy Desiderio’s elderly coronavirus patients at Mt. Sinai Hospital in Manhattan calls her into her room every time she walks by. But Desiderio doesn’t have much to give.

“I have to say ‘wait a minute,’ then put on my PPE,” says Desiderio, referring to personal protective equipment like masks, gloves and gowns. “Then I feel guilty because I need to rush her. She really needs company, a human voice.”

Slideshow ( 2 images )

`YOU WANT TO SMILE`

When one coronavirus patient wandered from her room in search of a nurse, Sam said, “Normally we’d politely redirect her. Now it’s more like screaming: ‘Get back in the fucking room.’”

A good bedside manner is crucial for Dr. Sonika Randev, 35, a physical medicine and rehabilitation resident at Metropolitan Hospital Center in Manhattan.

Randev provides palliative care to terminal COVID-19 patients and assesses the physical and mental capacity of elderly patients who may have recovered enough to leave the hospital. “Our responsibility is to comfort them,” she said.

Through tears, Randev recalled trying to tell an elderly patient with early signs of dementia, through layers of PPE, that he could not yet go home to his family. “You want to smile, you want to hold their hand,” she said.

Occasionally, frail COVID-19 patients fall out of bed, said Emily Muzyka, a nurse at NewYork-Presbyterian Hospital. Normally, nurses would rush to help, but now, Muzyka says, they must pause to first put on gowns, masks and gloves.

Muzyka has held patients’ hands through final breaths in the past, but things have changed.

“If I have to do that now,” she said, “it will be through gloves.”

A lack of warmth from doctors can make an already stressful hospital visit harder to bear, said Jacqueline Sperling, a psychologist and instructor at Harvard Medical School, saying that doctors looking to make patients’ experiences a little smoother can try to smile with their eyes.

“One can sometimes determine the emotion someone is communicating just by seeing the eyes,” Sperling said. “Practice in front of a mirror at home. See what that looks like, remember through muscle memory.”

Some doctors are finding other ways to create bonds.

Randev is planning to show patients photos of herself on her phone, or via printouts, so they can see what she looks like unmasked, hoping it will make patients feel a little safer.

“To be able to say, ‘Hi, my name is Sonika, and this is me,’” she said. “‘This is what I look like. I know it’s scary.’”