DALLAS -- Nurses on Parkland Memorial Hospital's life-saving front line against COVID-19 have turned a corner on the most grueling medical calamity of the century.
Gone are the hollowed-out eyes and beaten-down expressions I saw during interviews a year ago. Today these same nurses laugh a lot, share personal milestones and delight in no-crisis workdays.
Most telling is this single detail: They talk about the pandemic in past tense. They are moving forward, albeit as very different people.
"We've lost a lot and we're learning to live with that loss, whether it's internal or external," nurse Fara Ajani said. "We are learning how to go on."
The entire Parkland campus feels a lot like its old self. The lobby is abuzz with visitors and volunteers. Able-bodied patients are allowed to eat meals in the public food court. Even the gift shop is open again.
Plexiglas protections are down. Walls long pinned with bags of each caregivers' personal protection garb are bare.
Nowhere to be found are the imposing locked red doors that beginning almost three years ago warned of the dangers of COVID-19 contagion on the other side.
"I am proud to say that you aren't going to find any red doors at Parkland, which is just glorious," Judy Herrington, senior vice president of medicine services, told me.
COVID-19 remains a prevalent disease, but treating it is part of the everyday business of the hospital care provided throughout Parkland.
When we talked last January, Herrington questioned how nurses "even come to work every day considering what has been thrown at them."
Today, with COVID numbers down and vaccines working, morale has vastly improved, she said. Despite continuing staffing shortages -- about 20%, the same as this time last year -- "we are just in a much better place."
"We still have a lot of work to do," Herrington said.
Nurse and unit manager Kelly Stevens, whose team has cared for hundreds of COVID-19 patients, said staff has only in the last few months gained sufficient confidence to let go of its crisis-mode mentality.
"Even when we were a normal unit again ... everyone was waiting for that shoe to drop again," he said.
The nurses said they fully exhaled during the holidays, when they finally were able to get decent time off, travel to see family and genuinely feel like there was something to celebrate.
"COVID is not holding us hostage like it was -- not in our own lives or at the hospital," Stevens said.
Ajani, who worked alongside Stevens through most of the pandemic, told me things have improved so much that she was able to take a long-awaited step -- a promotion to nursing operations specialist in Parkland's Women and Infants Specialty Health division.
"I wanted to be sure I didn't leave while we were still in that crisis mode," she said. "I had to see it through."
Stevens said managing a staff through the pandemic taught the long-time trauma nurse the need to "take a more human approach and help people more."
Having spent so much of his career dealing with cases that ended in death, he was better prepared for the pandemic. He learned a big part of his job was to help teach resilience to people who aren't wired like he is.
A key question he now asks when interviewing prospective nurses: "What do you do to protect yourself from burnout?"
"If you tell me, 'I go take a breath,' that's not the answer," Stevens said. Ensuring that he has an emotionally healthy staff is critical because "who knows when the next COVID will be here?"
Jan Noguerra, who has spent most of his first four years in nursing in the COVID-19 battle, said his lesson out of the pandemic is realizing how much "it hardened my will" to persevere in the profession.
Buoyed by his own marriage in November, Noguerra senses a sustained feeling of better days at Parkland -- a far cry from the grim atmosphere he described last January.
Now an associate nurse manager on Stevens' team, Noguerra is invested in monitoring the well-being of his team, especially the newest hires.
Recruiting good nurses is perhaps management's biggest headache as institutions everywhere try to fill holes. Since the pandemic began, many joined the lucrative traveling nurse industry, some took less stressful health care jobs and others got out of the profession entirely.
"We are not back to normal operating procedure," Teresa Taylor, director of nursing, said. "We still have times when we are scrambling for staff."
The more important message, from both Herrington and Taylor, was this: The Parkland nursing staff has come out the other side of the pandemic.
"There's a solid group that has stayed since the beginning and gone through this, and we are stronger for it," Taylor said.
Another part of the staffing challenge is too many nurses wanting to go straight into specialty work, such as in the ICU, rather than building a good medical-surgical foundation, said Kathy Doherty, interim vice president for surgical services.
She also worries the rise in violence -- verbal, emotional and physical -- caregivers increasingly face from patients and their families will keep people from becoming nurses or drive them from the profession.
All six of the nurses I interviewed on a recent Tuesday had their own horror stories to tell on this score. No one -- certainly no one trying to nurse the sick back to health -- deserves to go to work to get yelled at, to have food thrown at them or get pushed into the wall.
"I don't use the word violence often, but that's the only word for it," Doherty said. "There's no grace, no patience. It's full-on anger."
I met Doherty early in the pandemic when I reported on caregivers in the original "red box," the Tactical Care Unit where Parkland initially treated all COVID-19 patients.
Doherty said those experiences revealed a strength and fortitude she didn't know she had.
Like so many caregivers, she's also had to grapple with the aftermath of how months of often round-the-clock responsibilities forced her family to manage without her -- and cost her time that she can't recoup.
"You feel a sense of guilt that I'm still moving through," Doherty said.
My most recent interview also included Hannah Ramsey, formerly night charge nurse in the red box and now an extracorporeal membrane oxygenation (ECMO) nurse specialist in the ICU.
In 2021, Parkland added ECMO machines to its life-saving efforts for the most desperate COVID cases. The device pulls blood out of the body to oxygenate and ventilate it, functioning like pulmonary bypass at the bedside.
After grieving so many deaths in the red box, including one new mother whose unexpected passing almost broke Ramsey's team, she said the ECMO work has restored her hope that she can truly help the sickest patients.
Now she sees women go home to be mothers to their babies and finds herself with more "pep in my step."
Getting to that place amid COVID-19's toll was a rough road. Ramsey recalled the day she realized she had changed into a woman with no idea how to spark joy in her life.
Like so many of the nurses I talked with, Ramsey went to therapy. She took advantage of the resources Parkland had put into place for staff. She told family and friends, "Hey, I'm probably not OK."
She also began reaching out to colleagues, especially the less experienced nurses, to open a compassionate space in which they could talk.
There are simple acts of kindness that the rest of us might try too: Check on your nurse friends. Be gracious in all your interactions with health care workers. Try saying an extra thank you.
Even as these heroes continue to care for the rest of us, the nurses at Parkland, like those at hospitals across North Texas, have a lot of healing yet to do.
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