APPLE VALLEY, Calif. — The hospital spreads over a block along Happy Trails Highway, which splits this high-desert town in half as it runs low and wide down a gentle hill.
All around St. Mary Medical Center is a new silence.
Fat Jack’s Bar & Grill is shuttered, never to reopen. The Chamber of Commerce, featuring a rearing, life-size model of the mid-century movie-star horse Trigger, is empty.
“Intermission,” reads the marquee of the High Desert Center for the Arts, which sits at the edge of this longtime home of antique Hollywood royalty, the singing cowboy Roy Rogers and his co-star wife, Dale Evans.
The hospital, though, is alive with the dying.
Ambulances, sirens screaming, pull off Happy Trails onto Kasota Road to reach the hospital’s frenetic emergency bays. The main lobby is a white tent in the visitors parking lot, which triples at times as a venue for community prayer vigils.
The lobby itself is lined with patients, most with tubes running from oxygen tanks into their noses, heads resting on the backs of wheelchairs, recliners or relatives.
The 60-year-old hospital is growing in all the wrong ways — by scores of patients, every day, most of them very ill with covid-19. The same is true of hospitals across California where, just one month ago, the number of new daily coronavirus cases was 8,743. It is now nearly seven times that amount.
What was the daily statewide total a month ago is now the countywide daily total here.
The growth is also reflected at Sunset Hills Memorial Park and Mortuary, set on a rocky plateau a few miles away. This week the staff there began working 24-hour shifts to keep up with the pace of covid deaths, including those from St. Mary.
Rosa Galdamez waited in the parking lot on a breezy recent morning, her 19-year-old granddaughter, Joana, piloting her wheelchair. Galdamez, 71, wheezed behind a blue mask as she awaited triage between the sliding-glass doors that once served as the entrance to the hospital.
“She has problems eating, she’s not eating,” Joana told a nurse, who performed an initial assessment on Galdamez. “And she’s diabetic.”
“How many days has she been like this?” the nurse asked. “Cuantos dias?”
Galdamez, pallid behind her blue mask, was quickly wheeled past the patients lining the wall to a waiting bottle of oxygen. The steady rasp of a dozen chest coughs accompanied her, moaning, as she was pushed toward a bed in a makeshift covid ward.
Joana sat near the bed, a plastic visor covering her frightened face. Mendy Hickey, St. Mary’s quality director and a registered nurse, leaned toward Joana, their visors almost touching.
“We’re going to do everything we can,” said Hickey. “That’s what I can promise you, okay?”
After some gentle coaxing from Hickey, Joana stood to leave as the nurses worked.
“Voy a ir, pero voy a regresar,” Joana told her grandmother. “I am going to leave, but I am going to return.”
Moments later, nurses wheeled in an empty gurney, squeezing it in next to Galdamez’s bed where Joana had just been sitting. A covid patient filled it within a few minutes.
The constant battle
What California sought to avoid throughout the pandemic is happening now from the high desert to the beachfront cities, from the Sierra Nevada resort towns to the fields of the San Joaquin Valley.
The hospital system in the nation’s most populous state is simply and brutally overwhelmed.
St. Mary Medical Center offers a view of the awful volume, grim choices and personal sweep of the pandemic happening as Californians begin to receive the coronavirus vaccine. For the majority here, that protection is months away.
The state on Friday reported 53,326 new daily coronavirus cases, a new single-day record that ended a week when California averaged more than 40,000 new cases a day. At the height of the post-Memorial Day summer spike, the daily peak was less than a quarter of the new daily high.
More than 22,000 Californians have died of the virus. On Friday, the state reported that covid-19 had killed 265 residents. The peak in deaths was set two days earlier when 379 residents died statewide of the virus.
In San Bernardino County, the toll has been extraordinarily high. The county trails only its more-populous western neighbor, Los Angeles, in the number of cases. More than 126,000 residents have contracted the virus.
This summer the number crested at just under 1,500 daily cases. On Dec. 10, when a Post photographer and videographer reported from inside the St. Mary Medical Center, the county reported what was then an all-time high of 5,670 new cases of the virus. A week later the daily caseload had jumped 48 percent.
Gov. Gavin Newsom (D) imposed shutdown orders on regions where ICU capacity dipped below 15 percent, a threshold this region is well beneath. Only the far north of the state is above the 15 percent mark.
The Southern California region, which includes Apple Valley, and the adjacent San Joaquin Valley region eclipsed full capacity this week.
The state’s top five counties in terms of total cases are all in Southern California.
Newsom announced this week that the state had ordered 5,000 additional body bags, sending most of them to southern counties. He also made 60 refrigeration units, used to store bodies, available to regions that need them.
Here in Apple Valley the only capacity is overcapacity — sometimes by double and even triple the number of beds. Officially, there are 213 beds in the hospital and about 20 ICU spaces. But those numbers are meaningless now as patients are treated in hallways, lobbies and other improvised wards.
“Every day we’re running at 200, 250 percent capacity. That includes the emergency department, the ICU, all of the inpatient units,” said Randy Loveless, the interim director of St. Mary’s emergency department, among other critical areas. “We have well over double the number of patients that we were built to house.”
The hospital has set up “covid pods” in hallways, waiting rooms and wards to provide as close to intensive care standards as possible. Forty patients, including Galdamez, were being treated in the pods on a recent day.
“I don’t think that most of the general public around the area really understands what’s going on inside the walls of the hospital,” Loveless said. “I’ve been doing this 25 years. I’ve been all over the country with my career. I’ve never seen anything like this. … And one of the worst things about it is there’s no end in sight.”
The result is that the health-care system here has been reduced to one available only to those with the gravest, most urgent medical conditions.
On a recent blue-sky morning, masked construction workers assembled a second triage tent three times the size of the first, evidence of the hospital’s grim expectations for the weeks ahead.
“We are canceling surgeries. We’re canceling all procedures. We’re pulling staff from administrative offices. We are getting nurses competent to take care of patients that have not done so in years,” said Hickey, the hospital’s quality director.
“We have deployed five operating room nurses to come help them out down here to do vital signs, to start IVs, to help with treatments, give patient care and relieve some of the nurses that are down here,” she said. “So that’s a constant battle. We’re doing that all day long — 24 hours a day.”
Threatening a way of life
Apple Valley is hidden slightly from Interstate 15, which from the Pacific coast climbs east through San Bernardino National Forest, over the nearly mile-high Cajon Summit and onto a sere plain covered by palms, Joshua trees and brush.
Here on the edge of the Mojave Desert, the landscape appears as a distillation of American capitalism settled on a dry, distant planet.
This is a region where “super” modifies the name of many strip-mall stores. Food franchises cluster as thick as creosote bush along highways, a billboard along one reading, “Prayer Changes Everything.”
American flags stretch stiff on flagpoles in the desert gusts, which blow down through the mountain passes and coastal canyons to create the fire season’s fearsome Santa Ana winds.
Billowing too are Trump 2020 flags, including a pair of them in a front yard a few blocks south of the hospital. Nativity scenes, old Western wagons draped with lights and glowing Santas decorate surrounding yards.
Voters in vast San Bernardino County, which stretches from the eastern edge of Los Angeles to the Nevada border, chose the Biden-Harris ticket last month. The county has a Latino majority, a fact reflected by the pool of covid patients in its hospitals.
Here in Apple Valley, though, a predominantly White population infused with a frontier ethic traditionally chooses Republicans for Congress. Mandates are anathema. The public approach to mask use has been cavalier, health workers say, for much of the pandemic.
“This virus is not only attacking our bodies, but also threatening our way of life,” said Charlie Abraham, St. Mary’s chief medical officer.
“There are some of us and, you know, that had the initial doubts about how real this virus is, how aggressive it is,” he continued. “What’s happening here in this hospital particularly is just an example of how threatening it is and how aggressively this virus tends to evolve.”
Abraham said the way he sees it is that “when you wear a mask out in the community, it’s a sign of compassion, a sign of empathy.”
“The story does not begin and end at the hospital,” he said. “The community is the bigger part of this, in fact.”
On a lunch break, Chandra Dixon put on a Santa hat and a mask before jumping out of her car in the Walmart parking lot. She calls the mask “a bit Halloweeny,” given that it features a sequined pair of lips smiling to reveal vampire fangs.
But it doesn’t stick to her face inside the freezer at Albertsons, the grocery store where she works.
“Me and my mask, together all the time,” said Dixon, 36, part of the small Black population here. “That was not true around here for many people for a long time. Now it sure is.”
Pricilla Polanco wears a mask. She is 15 years old, a Dodgers fan.
Two containers of pump-action hand sanitizer sit on top of the orange cooler that holds homemade tamales, which she sells out of the back of a Dodge Caravan in the parking lot shared by a 99 Cents Only store and a Super Target.
Her cousin’s house has been infected by “corona,” as she calls it, after a grandmother was diagnosed with the virus.
The house has been divided in half, she said, with one side a makeshift quarantine unit and the other open to family. Latinos account for almost half of those who have died of the virus in San Bernardino County.
“Corona has been hitting all of us much harder than it had,” Pricilla said. “I’m trying to be as careful as I can.”
Prayer walls and bike rides
Mendy Hickey’s workplace doesn’t look as different from the house divided by Polanco’s cousin as it once did. St. Mary Medical Center is now a maze of quarantine pockets, sectioned off or behind closed doors.
The ratio of haves to have-nots is shifting.
“Today we have 140 covid patients in a 213-bed hospital,” Hickey said. “It’s only going to get worse before it gets better.”
A mother of three, Hickey has been working 12 to 15 hours a day, shifts she quickly notes that all of her colleagues have been working, too.
There is no rest.
And the beginning-to-end care has exacted an emotional price on her and the rest of the staff.
“We never let someone die alone in the hospital,” she said. “But there is definitely a length of time between when you drop your loved one off and when you come back in. And, I just think, my heart breaks about that time apart.”
The hospital staff created “prayer walls” on the upper and lower floors. Using whiteboard markers, patients, relatives and staff are encouraged to leave inspiring words, observations, prayers and other messages, some of them later answered in the same way.
Spiritual caregivers, as Hickey describes them, have begun offering regular Zoom town hall meetings to staff.
“They don’t have to talk, but they can listen,” Hickey said. “Spiritual care is there to pray with us, to really let everyone know that we’re in it together. And that it’s hard for everyone. It’s not just hard for you.”
Her own kids are “stuck at home,” in her words, doing online school. But they are on her mind. An afternoon bike ride is in the cards for the following afternoon, after her shift, a rare block of family time.
“We can get some fresh air and kind of enjoy one another,” Hickey said, “while we have it.”
Knowing the dying
This is a place that can feel smaller than its population of nearly 75,000 people. It feels particularly small within the hospital.
Jorge Silva Jr., born and raised in the desert town of Barstow to the north of here, is a registered nurse. On a recent morning, he and a team of colleagues “proned” an intubated covid patient, turning him over gently to allow the lungs to fully ventilate.
It is a task both strenuous and delicate, a choreography that takes place every 18 hours and requires a half-dozen nurses from the overstretched staff.
The patient on this morning was a neighbor.
“The family one day saw me coming home from work and I come home wearing my scrubs,” Silva said. “And they are, ‘So you’re a nurse?’ And I said, ‘Yeah, how are you guys doing?’ They said, ‘Oh, well, you know, not too well. We just found out our family member is in the hospital.’”
The pandemic had reached his street.
“They gave me the name,” Silva said. “And so I’ve been keeping an eye on him all I can.”
During the pandemic, Silva has treated 10 people he knows for the virus. Three of them have died.
“You know, some people succeed and some people, you know, unfortunately …” he said, his words trailing off. “Covid is a tragic, tragic process.”
Burial in the desert
Against the rocky hills on the far side of the valley from St. Mary is a cemetery, the most prominent one in town. Roy Rogers and Dale Evans are buried within the nine acres of Sunset Hills Memorial Park and Mortuary that have been “developed” so far.
Chet Hitt, the founder and president, said no previous covid spike has resulted in a net jump in business. This one has, a fact he finds sad and sobering rather than commercially appealing, the paradox of his business and his place as a longtime area resident.
“Now we all know someone who has it,” Hitt said.
The extent of the surge has raised new questions for him and his staff, which began a round-the-clock work schedule this week to keep up with the coronavirus business.
About 30 percent of the bodies in the mortuary’s freezer are victims of the virus, and Hitt has ordered a second refrigerator to meet the grim mortality projections.
“And we are doing everything in our power to protect our employees,” he said. “All of them are working hours they never have before.”
The cemetery plateau here overlooks the valley and, in the desert twilight, a warm golden hue imbues the patches of grass and graves amid the hard ground. Beneath a willow is a child’s section, a candy cane set on each marker.
A backhoe has dug a fresh grave. The following day another victim of covid is scheduled to be buried.
No one mourns alone here. But even with masks, Hitt has been challenged to make sure that mourning, especially in the Roy Rogers-Dale Evans Sunset Chapel, is safe for all those gathered.
“It’s a question we have to ask ourselves and we are committed to answering,” he said. “How do you serve a grieving family right now?”