It started last Monday, March 23, with a dragging fatigue and a low-grade fever he just couldn’t shake. The emergency room nurse at HCA Houston Healthcare Northwest had worked nine days straight, testing patients with symptoms of the new coronavirus.

He told his wife he only was allowed to test the really sick ones, based on his hospital’s interpretation of Centers for Disease Control and Protection guidelines. And almost always, he said, the deep thrust of the throat swab made patients cough or gag, spewing spit and mucus on him.

The 39-year-old, whose name is being withheld to protect his privacy and that of his family, stands 6-feet tall and weighs 350 pounds. The hospital couldn’t find a specialized N-95 protective mask that fit. He was told to wear a looser-fitting, thinner surgical mask instead, his wife said.

By last Tuesday his fever started to rise. The next day it spiked at 102.8 degrees. On Thursday, after calling in sick for the third day, he was told he might want to get tested because some of the patients he had screened had come back positive, his wife said. By Saturday night, March 28, he was barely able to lift his head, coughing up blood, staining the pillowcases.

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“Even as a physician I was scared to death,” said his wife, who works at another hospital. She knew what was happening. Most everyone in Houston’s health care community had been bracing for the deadly virus that had already circled the globe. Now she was looking it in the face.

Yet for weeks, health care workers in Houston and elsewhere in Texas say they have been locked in a second battle, this one with some hospital administrators to get better equipment to protect themselves against a virus that spreads rapidly and in stealth. They worried the virus would not only infect them, but also fellow staff members, patients, and then follow them home at shift’s end.

Those pleas, though, have been met with inconsistent and delayed responses, and in some instances, even with hostility. In one Texas case, for instance, an El Paso doctor was suspended for wearing a mask to protect himself without his hospital’s permission. The Chronicle interviewed a half-dozen doctors at four hospitals for this story as well as obtaining internal hospital emails.

Hospital administrations have previously said they were merely following CDC guidelines that allowed restricted use of personal protective equipment to better conserve supplies against the gathering storm.

In recent days, though, hospital systems across Houston began revising policies so in most cases anyone involved in patient care or who works in patient areas now are to wear masks. Some institutions, though, continue to restrict the use of certain protective gear.

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For some Houston health care workers, the plight of one of their own, now near death, has only widened the divide between the front lines and the front office.

“They are slow to act. They don’t listen until it’s too late,” said an obstetrician-gynecologist at Women’s Hospital of Texas, also part of the HCA network. She asked to remain anonymous for fear of reprisal. “I feel so horrible for this nurse. He doesn’t deserve this.”

A plea for prayers

On March 29, as his wife helped him into the car for the short drive to Memorial Hermann Sugar Land Hospital, the stricken nurse’s breath had become so ragged he could barely speak, she said. Almost immediately he was whisked from the emergency room to the intensive care unit. A healthy amount of oxygen in a patient’s blood should register at about 95 percent. His level was 60, he posted on Facebook.

“(Expletive) me,” he wrote, “for now all I can do is ask for a few prayers.”

Doctors wanted to put him on a ventilator, a machine that pumps air into a patient’s lungs when their own body can no longer do so. The couple resisted, desperate for another solution. Both knew the statistics: most people put on a ventilator do not survive. By nightfall there was no other option.

HCA Houston Healthcare, a for-profit health system that operates 13 hospitals in the Houston region, declined to comment on the nurse’s case, citing patient privacy laws. But in an emailed statement the company said, “we take any reports of (personal protection equipment) shortage, improper use or failure to follow CDC guidelines seriously.”

“If anyone at HCA Houston Healthcare contracts an infectious disease, our team immediately begins the rigorous process of identifying everyone that that individual may have come in contact with while at the hospital. This includes all healthcare providers, staff and other patients,” the statement said.

But most of the nurse’s co-workers had no idea he was sick until his family began posting on social media, said a doctor in that department who is speaking anonymously out of fear of losing his job. He said most doctors and nurses are now afraid to speak out about conditions.

Also, in the days surrounding the nurse falling ill, a second person - a physician -in the same HCA Houston Healthcare Northwest emergency room also tested positive for the virus, according to two internal emails obtained by the Chronicle.

“ER doc at HNW tested positive for COVID (he’s doing fine)” said the first email. Its date is unclear. A second one, dated March 24, said the doctor is “doing well,” and added, “the health department was consulted by the hospital. They responded that we do not need to test/furlow (sic) staff because he developed symptoms more than 24 hours after the end of his last shift. That said if you want to wear a mask for the next 14 days, as many staff already are, that is fine.”

The CDC has said symptoms may not develop in someone who has been infected for up to 14 days.

HCA also declined to comment on the doctor’s positive test result because of patient privacy laws. Nor did it explain why two employees who worked in the same unit were unaware the other had tested positive. The nurse’s wife said she only learned of the doctor on Tuesday, hearing about it for the first time from the Chronicle.

Policy change

On Monday, HCA announced a shift in policy, adopting what is known as universal masking. “All staff and providers in all patient care areas will now wear masks, expanding their use beyond suspected or positive COVID cases,” the press release said, adding that masks were optional for those without patient contact as long as social distancing of at least 6 feet could be achieved.

“We are taking this step now because of evidence we see that, while social distancing is a key strategy for interrupting the spread of coronavirus, it is difficult to maintain in the busy patient care environment,” according to the statement. HCA also said its analysis showed it would be able to meet the demand of additional use of masks but would continue to preserve personal protection equipment by “reuse and reprocessing PPE where appropriate.”

The move came as other Houston institutions adopted new guidelines in recent days. Memorial Hermann Health System announced that beginning March 28 anyone entering its facilities will be provided with a surgical mask once they have cleared pre-screening. Houston Methodist employees and physicians who have patient contact are also now asked to wear a mask.

“Employees will receive their daily mask and a paper bag to store it in when they check in with their unit,” the Houston Methodist directive said, adding that clinical staff should wear one mask all day.

Harris Health System, which operates the city’s two safety net hospitals, similarly announced it was “strongly encouraging” its employees to wear masks while in its patient care facilities.” It said a surgical or procedural mask would be provided once an employee had been screened. N-95 masks would be issued for certain procedures and cannot be brought from home, the announcement said.

Texas Children’s Hospital said it was implementing a voluntary program for employees who had patient contact, adding “we respect the choice of each employee to decide whether or not to wear a mask.” The hospital said protective gear would be used in procedures where it was required.

Still, some doctors are not sure the new policies are enough, especially as the equipment that offers the most protection is still being rationed at some institutions. But mostly they worry the changes comes too late. It is unknown how far the virus has already spread undetected since some infected patients can be without symptoms and testing remains spotty, they said.

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That leaves health care workers with a terrible choice. Hospitals “have to give providers the right personal protection or they will walk off the job. And that’s the last thing you need,” said Dr. Cedric Dark, an assistant professor of emergency medicine at Houston’s Baylor College of Medicine. “Every single person is having to make that personal calculation. It tells you how serious this is for us, that we are willing to lose our jobs to save our lives.”

Punished for protection

Dr. Henry Nikicicz, an anesthesiologist at University Medical Center in El Paso, made a choice. And he paid for it.

In the early morning of March 18, Nikicicz, 60, had just finished intubating a patient in respiratory distress and had his N-95 mask in his hand as he walked down the hall. As a group of people approached, he said he instinctively raised the mask to his face, not only for his own protection but also for theirs. Among those in the group was Jacob Cintron, hospital CEO, who Nikicicz said became furious and wanted him fired.

The doctor said in an interview with the Chronicle he was told the administration was angry because wearing such a mask could lead to public panic. “U R WEARING IT WALKING DOWN A PUBLIC HALL. THERE’S NO MORE WUHAN VIRUS IN THE HALLS OF THE HOSPITAL THAN WALMART. MAYBE LESS,” came a text message in all caps from Nikicicz’s supervisor.

In addition, Nikicicz said he was told his wife, Irma Nikicicz, must remove her Facebook post about the situation. She refused. Although the doctor said Sunday he was initially off the schedule for April, he was reinstated on Monday after a meeting between his supervisor, his physician group and hospital administration. But he said he remains forbidden from wearing a N-95 mask in hallways or patient rooms unless he is performing specific treatments.

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University Medical Center confirmed in a statement that Nikicicz was “briefly” removed from the rotation for “insubordination.” The hospital said the doctor had been “told on numerous occasions by his supervisor to not wear the N95 surgical mask while not in the operating room area or while not treating patients with infectious disease.”

“We have always welcomed anyone wearing masks, primarily simple masks when in common areas of the hospital. However, for the safety of our patients and healthcare providers, we are trying to conserve N95 masks for patient care,” the hospital statement said, adding that the CDC did not require masks for health professionals if they were not treating infected patients or in surgical areas.

For now Nikicicz plans to return to work but doesn’t know if his job will last. The last few days have left him shaken.

“I should be able to protect myself,” he said, “in the middle of a pandemic this is just wrong.”

A mother’s dilemma

Mixed into the terror and exhaustion of the past few days, the wife of the infected Houston nurse said she is now feeling the beginnings of something else - anger. She is horrified that any employee on the front lines facing a deadly virus could be left so underprotected.

“It’s like sending a soldier into a fight with a BB gun,” she said.

Her husband remains in critical but stable condition. His doctor sees glimmers of improvement, she said, but it is still touch and go. The hardest part, she said, is knowing what to tell their children, ages 9, 7 and 6.

“I couldn’t promise them that Daddy was going to get better,” she said, her voice catching. “I couldn’t promise them that Daddy was going to come home.”

jenny.deam@chron.com

@Jenny_Deam