After more than three decades as a critical care nurse at the University of Michigan Hospital in Ann Arbor, Carolyn Lyles has come to depend on her hour-long commute as a refuge from the din of alarming machines and harried voices that awaits her in the ICU. On a typical morning, Lyles, 55, wakes up at 4, prepares her lunch, makes coffee, and grabs a bagel for the road.

She slips out of the house while her husband Steve and three children are still in bed, climbs into her gray Buick Enclave, and drives from her home in Grosse Ile, near the point where the Detroit River spills into Lake Erie, past sleeping neighbors in darkened houses, across the Wayne County swing bridge and past the Chrysler engine plant in Trenton. As she cruises past the red approach lights that guide airliners into Detroit-Wayne County International Airport, she thinks of her 82-year-old mother, Mary, asleep nearby in the house that she grew up in. Mary, who raised Carolyn alone, was a neonatal ICU nurse. The days Lyles spent shadowing her mom at the hospital inspired her to become a nurse herself.

A deeply faithful Catholic, Lyles usually travels the dark highway in silence. She prays that God will deliver her to the patient who needs her most. Working so close to the fragile membrane between life and death, Lyles has always prayed for strength to get through the day. After two weeks of caring for Covid-19 patients, those prayers had taken on a frightening intensity.

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On Tuesday March 24, the 20-bed Critical Care Medicine Unit, or CCMU—the only place Lyles has ever worked since she received her nursing degree in 1987, just a year after the hospital opened—was suddenly closed and emptied of patients so that carpenters could install negative-pressure filtration systems for the anticipated deluge of Covid patients. Since Lyles and her CCMU teammates have pulmonary care expertise, they were temporarily reassigned to the Regional Infectious Containment Unit, or RICU, a special negative-pressure ward on the 12th floor of the adjacent C. S. Mott Children’s Hospital that can be activated in emergencies to isolate patients with highly infectious diseases like SARS, Ebola, and now Covid-19.

It was disorienting. “We were all blindsided,” Lyles tells me. Accustomed to working one-on-one with her patients on a floor as familiar to her as her own home, with colleagues she has known for decades and come to think of as family, Lyles was suddenly thrust into a 50-bed unit in an entirely different building, assisting a swarm of unknown doctors, nurses, and technicians swathed from head to toe in protective gear that would have made it difficult to recognize them even if she did know them. “You have no idea where anything is,” she says. “How do I get help? Who do I get help from? Where is everybody?”

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Lyles did not have a patient of her own that first day in the RICU, so she served as a runner, fetching medications and supplies for nurses who were tending to patients behind glass doors that remained closed to minimize contamination. Nurses on the inside would write their orders on the glass with dry-erase markers—backwards, to make them readable to the runners—because it was impossible to communicate through N95 masks and glass and over the noise of ventilators and alarms. On the drive home that night, Lyles was exhausted, her back in spasms from the tension.

“I'm not sure I'm ready for this,” she thought to herself. “I'm really scared.”

“We are facing an unprecedented situation that none of us has lived through before. We know this is terrifying for all of us,” reads an email sent to employees of Michigan Medicine—the University of Michigan’s hospital system—on April 2, signed by CEO Marschall Runge and two other members of the executive team. By the time the email hit the inboxes of 28,000 employees—who include about 3,000 doctors, 6,000 nurses, 1,200 residents and fellows, and legions of support staff—Detroit, about 30 miles away, was reeling from an outbreak that had already filled some of the city’s largest hospitals to capacity.