When Liam St. John entered his mother’s hospital room in head-to-toe protective gear, his instincts as a nurse took over. He surveyed the accouterments of her medical care, the drips and the IV and the ventilator, and carefully read over the monitors showing her vital signs. It all seemed clinical, familiar.
But when the goodbyes began, with him dialing in loved ones on a cellphone in a plastic bag, and playing recorded messages from his two kids in hopes their grandmother would somehow hear, all his medical training fell away, he said, and “a very different feeling” took hold.
“Then you’re a scared kid who’s worried about losing his mom,” St. John said Monday, two days after his mother, Evelyn Caro, also a nurse, succumbed to the ravages of the coronavirus. “It’s just like a light switch, where it just really becomes real all of a sudden that you’re going to be saying goodbye.”
St. John is still trying to wrap his head around what happened. It was so fast. He keeps having a dream in which his mother is trying to tell him something, but he can’t make it out over the din of the hospital. He’s mulling the role of health care workers like the two of them in this pandemic, recalling her pride whenever they chatted about their shared profession.
He hopes sharing her story will help others avoid a similar fate, and get them to see nurses less as heroes and more as the most vulnerable among us — as reflected by a U.S. Centers for Disease Control and Prevention estimate Tuesday that healthcare workers account for 10% to 20% of all coronavirus cases in the country.
“It’s a nightmare, and it’s so fast, and it’s so aggressive,” he said of the illness caused by the virus. “This is not something I ever want anyone to go through. But if we don’t take this seriously, if we don’t limit ourselves, if we become selfish and just thumb our nose at this thing, it’s going to have some drastic consequences for people, and it’s going to be someone else’s mom, someone else’s sister, someone else’s grandmother.”
St. John never thought it would be his mother, until it was.
Caro, 69, was the life of the party, a tough but loving grandmother who was born in the Bronx to strict Puerto Rican parents and who had wanted to be a nurse ever since she left New York City to join the U.S. Navy at 19, said her son and her only sister, Patricia Caro.
Even after she got pregnant, left the military and had three sons, whom she would go on to raise as a single mother, she "never let go of that dream,” St. John said.
Through many tough years, when the family relied on public assistance, she always worked hard, her son said. She labored at a string of low-paying jobs, including in the medical field, before she finally caught her big break: a program for Holy Cross Hospital employees to go back to school for nursing.
She took the leap, and finally realized her dream of becoming a registered nurse at the age of 50. By last month, Caro had been in the field for 19 years, and was working part time at a gynecology practice near Holy Cross in Silver Spring — which has one of the highest concentrations of coronavirus cases in the state.
Ten days after feeling a slight fever, she was on her death bed at Johns Hopkins Hospital, intubated and depleted. On Saturday, with her lungs destroyed and her strength gone, St. John decided, along with other family members, and in consultation with her physicians, to take her off the various machines keeping her alive.
“She looked like a shell of a person, and not the vibrant, beautiful woman that she is,” he said. “That’s not how I want to remember my mom.”
Before the virus, Caro spoke her mind, and doted on her two chihuahuas — Dulce and Bori, short for “boricua" — at her home in Jessup. She had a habit of tossing things, anything, big things, on top of her head to make her grandchildren laugh. She would always go to the beauty parlor on Saturdays to have her hair and nails done, and was always in church on Sunday.
She and St. John would often sit and chat over café con leche — always Café Bustelo — in her kitchen. Their work a constant source of camaraderie.
“She and I could talk to each other as mother and son and as professional colleagues. She loved that,” said St. John, who works at a Baltimore hospital and lives in Columbia. “Being a nurse defined her. And unfortunately, being a nurse is what killed her, too.”
“Being a nurse defined her. And unfortunately, being a nurse is what killed her, too.”
Liam St. John, Evelyn Caro's son
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St. John believes his mother contracted the coronavirus at the practice where she worked and was still going in two days a week. On March 18, she texted him: “Hey sweetie! My colleague is still under the weather! I’m going in tomorrow.”
On March 26, the low-grade fever began. He texted, asking her if she had any shortness of breath. “Not to worry! I think it’s my allergies," she said.
On March 27, she was tested for the coronavirus at a drive-through testing facility, but “the doctors kept telling her, ‘Keep an eye on things, and pushing fluids, and try to soldier through,’” St. John said. “We didn’t really think that this was going to be COVID, because you never do think it’s going to happen to your family."
Over the next several days, her temperature would spike and fall, her condition worsening and ebbing.
“Sometimes she would be feeling better, she would be on the phone with us telling us, ‘Oh it’s not that bad.’ Other times she was telling us she was afraid to move, or so sore she couldn’t get out of bed or change her sheets,” St. John said.
On March 30, Caro texted her son again: “I’m scared! I’m hurtin really badly."
On April 1, she told her son she was having trouble breathing, and that, on the little device he’d bought her to test the oxygen levels in her blood, the readings were startlingly low. He told her to call 911.
“My last words to my mom were, ‘Just calm down, I’m on my way.’”
By the time he got there, the paramedics were outside, taking off their protective gear, he said. “They had her in the ambulance, but I couldn’t open the door to see her," he said.
Caro was put on a ventilator that day, existing in a twilight sleep or an even deeper anesthetized state for days as doctors, first at Howard County General Hospital and then at Johns Hopkins Hospital, tried all they could to save her. St. John said Caro had Type II diabetes and was overweight, which complicated her treatment, worked against the ventilator and undercut her recovery.
On Saturday, St. John and his sister-in-law Jennifer Buckle, who also is training to be a nurse, were allowed into Caro’s room to say their last goodbyes — a final mercy after a week of forced distancing.
They called Caro’s sister, Patricia, who was at home in Connecticut, distraught that she couldn’t be there for her only sister, the one who shared her voice and sense of humor, for whom she could never do any wrong.
“I told her that I loved her, that I would honor her and her memory. I would continue being there for the kids. And I apologized to her that I couldn’t be with her there, but that I loved her, and that it was OK, she could let go, because we were going to be OK. We were going to be OK,” Patricia Caro recalled through tears. “This is a horrible, horrible virus that steals people’s last moments with their loved ones.”
St. John also spoke to his mother.
“I told her I wished she was strong enough to hold on, but that if she needed to go, she could go, that we would be OK, that we would take good care of her dogs ... and that she would always be part of our lives,” he said.
She went quickly after that, he said.
Dr. Darryn Band, managing partner of the Capital Women’s Care practice in Silver Spring where Caro worked, said she was “a valued member of our team and her loss will be felt by her co-workers and patients."
After learning of her diagnosis, the practice “immediately notified the appropriate authorities and those patients who might have been impacted,” Band said. It also cleaned its offices in accordance with CDC guidelines, he said.
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“Our thoughts and compassion go out to her family during this most difficult time,” he said.
Caro will be cremated, but it’s unclear what sort of services the family can have, or should have, given the circumstances. St. John still needs to find his mother’s will, and other important documents, “but at the same time you’re terrified to go into that house, because of what’s there,” he said.
He struggles when he sees people still not heeding social distancing restrictions, who don’t understand when he tells them at his own hospital that there are new control measures in place, who lined his block with their cars on Easter Sunday, gathered together with the people they love.
He is horrified by the suggestion that shutdowns should be lifted.
“People don’t realize that we’re still right in the middle of it,” he said, frustration in his voice. "Everyone needs to treat this seriously. If they couldn’t do it for my mother, I wish they could do it for theirs.”