6 a.m., Jake Perkins

Jake Perkins, 24, zips through downtown Birmingham on his bike, heading toward UAB Hospital. He’s a registered nurse, working in the medical intensive care unit that cares exclusively for the sickest COVID-19 patients.

The wind in his face is particularly welcome on the way to and from work, he says. Once he steps inside the hospital, he’ll spend the next 12 hours in an N95 respirator mask. It’s left a pink stripe above his nose, where it rubbed his skin raw.

This is the story of two nurses working in Alabama’s largest city, at Alabama’s largest hospital, as told to AL.com through multiple phone interviews. They describe a typical day and the situations they often face in a new and trying environment.

UAB Hospital has one of the highest numbers of COVID-19 patients in the state. Jefferson County is home to the highest number of COVID cases in the state, at nearly 600 confirmed cases on Sunday and climbing. Projections show that Alabama hasn’t hit its infection peak yet, which is expected in the next week. UAB has already been prepping contingency plans for how to handle a surge in COVID-19 patients.

Read more: Coronavirus in Alabama

“It’s kind of the calm before the storm,” Perkins said. “We weren’t the first state to see insane numbers of patients coming through like in New York, and we’ve been able to learn from their experience and hopefully be more prepared. I think we will be ready.”

Three weeks ago, he was the first nurse in his unit to admit a patient being tested for COVID-19.

“But after the initial shock of it,” he said, “the feeling was like, OK, (coronavirus) is here. It’s go time.”

7 a.m.

After clocking in, Perkins learns which patients will be his for the day. UAB’s medical ICU is now an all-COVID unit. It has 25 beds, most of which stay filled. All of Perkins’ patients are typically on ventilators and most are not awake. He’ll have a maximum of one and a half patients in his charge.

Before COVID-19, Perkins could pop into a patient’s room to check on the patient any time. Now, visits are limited in order to conserve scarce protective supplies and limit transmission.

Before he walks into a patient’s room, Perkins dons a yellow gown, called a contact gown, and gloves, in addition to his N-95 respirator mask and plastic face shield. Protective supply shortages around the country mean that hospitals and nurses like Perkins must conserve masks, gowns and gloves whenever possible. At UAB, that means nurses try to accomplish as many things as possible after entering the patient’s room.

Perkins will head into the room with an armful of medication, supplies for collecting lab work and a list of things to do while he’s there.

He stays in the room with the patient for around two hours each morning, and the process repeats at least twice more during the shift. Depending on the need, he could be in there anywhere from 15 minutes to four hours, he said.

At UAB, the only people usually allowed in a patient’s room during a shift are one nurse, one doctor and a respiratory therapist.

Because of that, Perkins now does jobs previously done by other staff, such as hooking up dialysis machines or delivering food trays. He even cleans the rooms and empties the wastebaskets.

He talks to his patients when he enters their rooms, narrating what he’s doing even though they’re often not responsive.

“Even before all of this, I always operated under the understanding that even though my patients couldn’t respond to me, I act as if they can,” he said. “If I go in and turn them from one side to the other, I’ll say, ‘Hey Mrs. Smith, I’m going to tilt you, make sure you don’t get any bed sores.’”

Once he leaves, he must throw away the gown and gloves, and sanitize the mask and shield for reuse.

Jake Perkins wears protective equipment while working in the medical intensive care unit at UAB Hospital, where he cares for patients battling COVID-19.

9 a.m.

Without family or loved ones allowed in the hospital, nurses like Perkins become the patient’s moral support as well as medical caregiver.

“Previously, having a family member hold the patient’s hand while they’re going through something was enough for me to be able to step away emotionally and focus on what I could do for this person medically,” Perkins said. “But now, we have to be both.”

It can be intense. He deals with the extra emotional load by leaning on coworkers who are going through the same thing.

“I’m lucky I work with who I work with because I love them all to death,” he said. Their working conditions might not be normal, but he said it’s been heartening to see nurses, doctors and staff rising to the challenges as though they are normal.

He talks to patients’ families on the phone and tries to help them feel involved in the patient’s care even though they can’t be there. It’s not always possible. If he’s in a patient’s room, gowned and gloved, and his phone rings in his pocket, he can’t take it out to answer it. He can’t risk contaminating the patient or the phone.

The medical ICU has telemedicine tablets on carts that nurses can wheel into a patient’s room so that family members can see their loved ones.

“It seems to be really helpful for them, because even if the patient can’t talk, (family members) are able to see and ask about the IV pumps or the ventilator,” he said. Sometimes the conversations are difficult. “It’s hard to tell them helpful things without making them sound scary.”

And sometimes, doctors or nurses have the hardest conversation with family: telling them a loved one may die from the disease.

“We’ve had several of those situations, and you can tell it takes a toll on everybody” in the unit, Perkins said.

He hasn’t had to make that phone call. He did once have a patient who wanted to say goodbye to family before going on the ventilator.

“They wanted to call their loved one and speak with them in case they weren’t able to again,” he said. “That wasn’t an end-of-life conversation, but it felt like a goodbye because they didn’t know (if they’d get better). And it’s impossible for us to know.

“The nature of our unit is unfortunately slanted toward the really sad situations because we’re the critical care unit,” he said. “A lot of patients we get don’t have great outcomes before they even get to us.”

But there are moments of celebration, he said. Last weekend, a patient was able to come off the ventilator and get transferred to a regular floor.

“He was overwhelmed when he was getting to leave, sobbing and thanking us, and so excited to be closer to getting home to be with his wife,” said Perkins. “That was a great moment.”

11 a.m.

Now that shifts are more intense, and masks are a round-the-clock requirement, the hospital has given nurses two 30-minute breaks in addition to lunch.

Those breaks are “a time to step away, take the mask off and feel like a person again,” said Perkins. “To be totally honest, it’s not always feasible to leave your patient for 30 minutes. But we try to when we can.”

He spends that time in the break room, “chugging a Coke Zero” because staff can’t keep bottled water or other drinks at the nursing station or anywhere else in the unit. It isn’t safe.

Before COVID, he said, “it didn’t feel as risky to take a sip of water in the hallway or at the nursing station.”

3 p.m.

The most dangerous moment for a nurse like Perkins, when it comes to potential infection, is during a procedure like inserting a high flow nasal canula, a device that blows oxygen into a patient’s airway, or intubation, when a tube is inserted into a patient’s airway so the patient can be put on a ventilator.

The air is flowing so quickly that “it could push the virus into the air at such high rates,” he said. “You can hear the air moving and just know it’s pushing it right in your face.”

For those kinds of situations, he said, there are extra layers of protective equipment and that makes him safer – an impermeable gown, a second layer of gloves that reach up to the forearms, a surgical hair net.

A few weeks ago, he said, he was on several shifts in a row where at least one patient coded, needing emergency, live-saving intervention.

“We had a spike in new admissions that we were urgently intubating,” he said. “We had patients come to us requiring critical care, and COVID-19 patients who had previously been stable and all of a sudden were not.”

But things have leveled out for the moment, he said. His unit hasn’t seen as many patients coming in from other departments or other hospitals.

The number of COVID-19 patients at UAB Hospital has decreased slightly in the past week, although the number of cases statewide continues to rise.

Taylor Floyd, 25, works as a nurse in an all-COVID acute care unit at UAB Hospital.

5 p.m., Taylor Floyd

Taylor Floyd, 25, wakes up in the late afternoon to shower and eat dinner. These days, the Smiths Station native gets a few extra minutes of sleep because she no longer puts on makeup for her 12-hour nursing shift. She’s in a mask the whole time, and it can get hot and sweaty.

After a quick dinner, Floyd says goodbye to her roommates and pulls her car out of the driveway just before 6 p.m. On her way to UAB Hospital, she calls her fiancé or her mom to chat.

Floyd is a nurse in an all-COVID acute care unit. Every patient on her unit is either COVID-positive or has COVID-like symptoms and is waiting on a test result.

“We have patients who are up and walking around, totally alert and oriented,” she said. “We have other patients who are more critically ill, not enough to be in the ICU but they are sick. Some might be on a feeding tube, some have high oxygen requirements.”

Once she arrives on her floor, just after 6 p.m., she looks over her charge sheet to find out which patients she’ll have for the night. Before COVID, she’d be in charge of four or five patients. Now she has two to four.

And before COVID, she’d get the report on each patient at the patient’s bedside. It gave her a sense of safety, she said, to see and talk to her patients in person during that time.

Now that report happens outside the patient’s room, to limit the number of healthcare workers exposed.

“That’s something that’s been really difficult,” she said. “We’re used to going into the rooms when we want, pop our head in and ask, 'Hey, do you need anything?'

“Being able to lay your eyes on your patient and given them what they want when they want it is something I totally took for granted.”

7 p.m.

When Perkins clocks out, he bikes home to his apartment where he lives with his partner and their dog. He heads first to the apartment gym, where he puts his scrubs in a plastic bag stashed in his locker. He showers before going upstairs.

Before the stay-at-home order, he taught yoga part time. Continuing to practice yoga, in addition to working out, has helped him cope with a high-intensity job.

“Our apartment building has a rooftop area, so I’ve been doing a lot of rooftop yoga in the mornings to relieve stress and be present in the day,” he said. “And I cuddle a lot with my dog.”

8 p.m.

If Floyd’s patient is awake and alert, she calls the patient on the phone before entering the room: “Hey, I’m coming into the room. Do you need anything?”

She’ll garb up: gown, gloves, mask, face shield. Then she’ll grab the patient’s medication, a dinner tray if it hasn’t yet been taken in, and push open the door.

The patient wears a mask as well. Floyd takes vitals, administers medication, takes blood for lab work, helps the person go to the bathroom.

Patients who come to Floyd’s unit from the emergency room are often fearful, waiting for their test results, she said.

“The ones from the ER, with shortness of breath or chest pain, it’s scary for them,” she said. “We have to assure them we’re keeping an eye on everything.”

10 p.m.

Most of Floyd’s patients are able to communicate with their families. But even if they’re not aware, Floyd says she talks to them anyway.

“I believe, even if they don’t seem like it, somewhere they’re hearing me say, ‘Your daughter called to check on you,’” she said.

Some relatives send in family photos that she can show the patients; others tell her about favorite movies or TV stations.

“I love to talk with patients and families and get to know them,” Floyd said. “That’s something I miss. Now you’re having to do that at a distance. But I’m trying to give them hope and a hopeful attitude. It seems all doom and gloom, and it is, but it doesn’t have to be all bad.

“I like to think they might be able to tell their family one day, ‘I had this nurse, and she was great and I felt like she was on my side.’”

Midnight

When patients in Floyd’s unit get worse, the decline often happens quickly, she said. One of the biggest warning signs is an increased need for oxygen, especially if it happens suddenly.

“You have to know what to look for and when to page the medical emergency team,” she said. “Then it’s kind of ‘all hands on deck,’ a teamwork thing from the bedside nurse to the charge nurse, to the physician assistants and the doctors.”

The first weeks after her unit began accepting COVID patients were stressful, she said, but the unit has settled into something like a new normal.

“Going into this, I assumed every patient we had was going to be so incredibly sick, knocking on death’s door,” she said. “And we do have those patients. But we are also seeing patients going home, discharging; even if they’re positive, they’re stable.

“Some of the first patients in the ICU were younger. Now we’re seeing some of those young patients coming back (to our unit) and doing well.”

1 a.m.

Before COVID, the night nurses often walked over to a café at Children’s Hospital for dinner. But the bridge to Children’s is closed now. And anyway, the nurses don’t like to leave the floor in case something happens.

“If I did have somebody bring me food in the middle of the night and I had to walk down to meet them to get it, there’d be an anxiety about leaving my patients for that period of time,” she said.

Most of the time, Floyd and her fellow nurses bring their lunches from home. But sometimes friends or outside groups order food delivered to the unit. A family friend sent Floyd money to order dinner for her entire unit; another time her nurse manager ordered pizza for everyone.

Even other units in the hospital send treats to each other. Last week the medical ICU sent a big Easter basket filled with snacks and a thank-you note for the work the unit is doing.

The nurses stagger their lunch breaks, eating in the break room with just a few others. Sometimes they trade stories with nurses from the “float pool,” a group that travels to different units. Sometimes they watch the TV, usually HGTV or the Food Network or the news, or scroll through social media on their phones.

Floyd sometimes reads news stories about hospitals in other states that have been overwhelmed with patients. But she tries not to let it consume her time outside of work.

“The unknown of everything is scary,” she said. “That’s what frightening about this. There is so much we don’t know.”

5 a.m.

Floyd begins checking on her patients for the last time around 5:30 a.m. and clocks out shortly before 7 a.m.

Before she leaves the hospital, she wipes down her shoes, badge, watch and phone with disinfectant wipes.

At home, she changes clothes in her car, stuffing her scrubs into a plastic garbage bag she’ll later carry into the laundry room. She leaves her badge and watch in the car, goes into the house and heads straight for the shower.

“We’re gowned up and gloved at work, and we do what we can,” to reduce possible contamination, she said. “But you never know. I try to be extra careful.”

7 a.m.

Floyd and her fiancé were supposed to be married at the end of April, at the art museum in Auburn. After schools began closing in mid-March, they rescheduled the wedding for August.

“Those first few weeks were really challenging,” said Floyd. “Here in the last week or so, we’re getting more used to the new normal we’re in. I feel like that’s (caused a) change in my attitude, to stop being upset or bitter, and this is just where we’re at, what we have to do. At some point, we’ll get back to normal.”

She’s determined to get married in August, even if it means a tiny family ceremony in the field behind her parents’ house, she said. She hasn’t seen her parents since February, which has been hard.

When she’s not working, Floyd likes sitting on her back porch with her roommates and going for walks with her fiancé and his dog.

“Really, just trying to spend time with people and not talk and live this virus because I live it at work, and it’s hard not to live it at home and worry about it,” she said. “Anything to take my mind off it.”

But she’s been encouraged by seeing the community show appreciation for the work she and her colleagues do.

“Really we’re just doing our job,” she said. “Three weeks ago, I didn’t know this was the position I’d be in. Now I’m just going to work like anybody else.”