For Dr. Anita Sircar, an infectious disease specialist, there are no breaks and few days off.
An implacable surge of Covid-19 cases has overwhelmed Southern California hospitals and intensive care units for most of December after public health officials warned for weeks that people should refrain from gathering with those outside their households over the holidays.
Yet millions of Americans desperate to reconnect with loved ones and restore a sense of normalcy ignored the warnings on Thanksgiving. As a result, coronavirus cases spiked, and ICU capacity dwindled.
"It's relentless," Sircar said, speaking on the phone between patient rounds and doctor meetings at Providence Little Company of Mary Medical Center in Torrance.
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State public health officials recently extended modified stay-at-home orders for the regions hardest hit by the surge, including Southern California and the San Joaquin Valley, where ICU capacity has been at 0 percent for several weeks.
Hospitals have built makeshift ICUs, and they sometimes move patients into gift shops or pediatric wards to care for the sick and dying. At Providence, a tent has been erected in the parking lot to accommodate overflow patients when the time comes. And the time will come, said several medical professionals working on the front lines of the pandemic.
"We're on this wheel that just keeps turning," Sircar said. "It's a revolving door that doesn't stop."
Throughout Southern California, hospitals and their employees are forced to make difficult decisions as the Covid-19 surge continues to pummel the battered region.
California has recorded more than 2.2 million coronavirus cases and 25,000 deaths. In Los Angeles County, home to 10 million residents, public health officials have recorded about 756,100 confirmed cases and more than 10,000 deaths.
In Los Angeles County, a person dies every 10 minutes from Covid-19, public health officials say. More than 7,400 people were hospitalized with Covid-19 on Wednesday. The data were released just hours after Gov. Gavin Newsom revealed that a potentially more contagious variant of the coronavirus had been found in Southern California.
Los Angeles County Public Health Director Barbara Ferrer said in a statement, "Our healthcare workers are overwhelmed with Covid-19 patients and this current path of surging Covid-19 hospitalizations is not sustainable."
Yet medical professionals must press on even as the surge takes an emotional and mental toll on front-line workers.
For ICU nurse Lindsey Burrell, who works at Providence hospital with Sircar, trying to balance family life with work life sometimes means bottling up her pain and anxiety after having watched patients die day in and day out.
Often, Burrell turns on music in the car while driving home just to clear her mind and prepare for the transition from nurse to wife and mother. Before she enters her house, she sits in complete silence and tries to let go of whatever she saw that day.
Three years ago, Burrell underwent open-heart surgery and suffered a stroke shortly after the birth of her first child. Because of her comorbidities, Burrell maintains a strict regimen of stripping off her protective gear before she walks into her home, immediately throwing whatever she wore into the washing machine, taking a hot shower and gargling with Listerine as an added precaution.
"We suffer silently," she said. "I don't even know how to put into words sometimes what I see and what I feel. It's something you're not prepared for at any level."
Burrell knew when she became an ICU nurse that she would see death and families grieving unexpected losses. But she never expected to see the "inhumane" nature of Covid-19.
Many of her sickest patients are intubated, lying facedown on their stomachs with one arm stretched up and the other down to help clear breathing airways. Tubes and intravenous drips extend through their bodies while dialysis machines help filter blood. When a patient's heart stops, a team of doctors and nurses suit up in protective equipment before they enter the room. Sometimes Burrell must call loved ones to ask whether they would like to Zoom or FaceTime to say their goodbyes.
"Patients are scared to death," she said. "They plead for their lives. They know they're going to die. It tears us apart."
Burrell hasn't been able to shake the recent death of a beloved grocery store worker known to many in the beachside community where she works. The man had been weaned off a ventilator and appeared to be awake, giving Burrell hope that he might survive. One day shortly before Christmas, Burrell went into his room and held his hand. She begged him to keep fighting. He gave her a thumbs up.
"I could see the despair in his eyes," she said.
To cope with grief, Burrell leans on co-workers who understand what it is to fight for people's lives, only to hear about their deaths days later.
"We can't take much more," she said.
Early in the pandemic, Sircar made the difficult decision to move out of the home she shared with her mother for fear that her mother would contract Covid-19 and not survive its ravages. Sircar has been living in a rental unit near the hospital ever since, one block from the Pacific Ocean. She hasn't made it to the beach once since she moved.
"I don't socialize outside of work," she said. "It's basically just apartment, hospital, apartment, hospital. After a while, you forget there is life outside of here."
Sircar typically works 12-hour shifts and takes only four days off a month. Before the pandemic, she would see about 12 patients a day. Now it's closer to 27, and many die.
"It has not stopped since Thanksgiving," she said. "The virus is not out of control. People are out of control."
Of those on her current patient list, Sircar estimates that more than half attended large Thanksgiving gatherings. A 31-year-old woman told Sircar that 30 people were at one dinner she attended. Seventeen people later tested positive for Covid-19, and at least one is fighting to survive.
Sircar's patient was discharged after several days and said she regretted attending the Thanksgiving dinner.
Across the county, in Los Angeles' Boyle Heights neighborhood, the emergency department at Adventist Health White Memorial Hospital is already at capacity but still accepting patients. Dr. Juan C. Barrio, director of the hospital's internal residency program, said residents are so overwhelmed that attending physicians are forced to add to their patient lists.
"This is completely unprecedented," he said. "We have enough ventilators, but patients in the ICU are coming in sicker and more critically ill."
Makeshift ICUs are springing up throughout Adventist Health to accommodate the increase in patients, including the former cardiac care unit. Barrio described the scene inside as a "mess of PPE and activity," with some emergency room patients being treated in the hallways.
On Tuesday, Dr. Mark Ghaly, the state secretary of health and human services, said some Los Angeles hospitals are turning to "crisis care" and bracing for a more dangerous coronavirus surge that is likely to worsen after Christmas and New Year's Eve. Ghaly said that while positivity rates from the Thanksgiving surge appear to be stabilizing, that doesn't appear to be the case in Southern California.
"We have not heard yet that any hospital is at the point where they need to make a decision between two patients who both need a ventilator and they only have one ventilator," he said, adding that some hospitals don't have space to unload ambulances or get oxygen to patients.
State officials notified hospitals this week that they should prepare for the possibility that they will have to resort to "crisis care" guidelines, which would allow for rationing of treatment when staff members, medicine and supplies are in short supply.
Cedars-Sinai Health System, arguably the most famous hospital in Los Angeles, issued a "crisis alert" Wednesday, imploring its patients not to gather for New Year's Eve.
"We know these recommendations are challenging, but it's important to remember the actions you take in the next few days can help protect you, your family and your loved ones — and those fighting for their lives in our hospital beds right now," the hospital said. "Compliance is crucial if we want to prevent what is already a public health emergency from becoming even worse."