As Dr Rishi Seth rolled up his left sleeve on Monday to receive one of the United States' first COVID-19 vaccines, he thought of his patients back in the Special Care Unit. There was the Uber driver who had walked out of the hospital after being on a ventilator. The dying father who said goodbye to his two college-age daughters on a video chat. The four coronavirus patients Seth had treated just on Monday morning, checking their oxygen levels and reviewing treatment plans before he stripped off his protective gear and joined a first wave of health care workers to get vaccinated in hospitals across the country.
"That's why today is so emotional," said Seth, an internal-medicine physician with Sanford Health in North Dakota, a state that has been ravaged by the virus. "You're still fighting a battle, but you're starting to see the horizon."
Monday's vaccinations, the first in a staggeringly complicated national campaign, were a moment infused with hope and pain for hundreds of America's health care workers. Even as doctors and nurses lined up for the first shots, cheered on their colleagues and joked about barely feeling the prick of the syringe, they also reflected on their grueling months in the trenches of the country's coronavirus nightmare.
They have scrounged for protective gear and tried treatment after treatment. They have coordinated final phone calls and held patients' hands when families could not visit. They have come running when alarms warned that a patient was on the edge of dying.
"This is really for all of those patients that unfortunately didn't make it, all those patients still coming through the doors," Mona Moghareh, a 30-year-old pharmacist in New Orleans, said on Monday morning as she administered the first shots at the Ochsner Medical Center with journalists and state leaders looking on.
Across the country, hospital auditoriums and conference rooms became makeshift vaccination sites, the first stages for a mammoth, monthslong campaign to vaccinate millions against a rampaging virus that has now killed more than 300,000 people in the United States.
In Fargo, North Dakota, 155 doctors and nurses with the highest risk of exposure to the virus trickled into a repurposed veterans' lounge where nurses waited, clustered around a few small round tables. One nurse drew up initial doses of the Pfizer-BioNTech vaccine that recently received emergency authorization. Others asked questions about people's health history, took their information and then inoculated them with a quick needle prick. It was over in seconds.
"It is hope," said Kenzie Frankl, a registered nurse and clinical care leader for Sanford Health in Fargo who volunteered nine months ago to work in the hospital's coronavirus unit and walked out of the vaccination room with a Day-Glo bandage on her arm.
New coronavirus cases have receded recently in North Dakota - which had the country's highest rate of infections earlier this fall. But the pandemic is worse than ever in Kansas, where Dr. Maggie Hagan took a break from her rounds in Wichita to get vaccinated.
Hagan, the director of infection prevention at Ascension Via Christi hospitals in Kansas, has been working 12-hour shifts every day for the past month and a half to manage the surge in hospitalizations. Five units in her hospital have been turned into coronavirus wards. She sees 50 patients each day.
"I almost could cry talking to you now," she said. "I feel like I didn't just get a vaccine, I got a shot of hope. It's hope that this is the beginning of the end of this terrible pandemic that we've all been experiencing - but us on the front line have really seen the suffering and the tragedy associated with it."
Those tragedies are legion. Some patients have to be sedated and flipped on their stomachs to better oxygenate their bodies. Many also require dialysis for kidney failure. Some arrive gasping for air but recover. Others appear stable with a little oxygen, and then crash.
Then there is the personal toll of working 12-hour shift after 12-hour shift sheathed in protective gear, worried that while one patient is treated another may be deteriorating. Some worried about carrying the virus home while others were treated by friends or neighbors as if they had the plague. Some have experienced post-traumatic stress disorder. Many have spent hours after work agonizing over the challenges of treating coronavirus patients.
"They were consumed with what they had seen at work," said Maggie Hansen, the chief nurse executive of the Memorial Healthcare System in Southern Florida. "They have been taxed by this. Imagine trying to do everything you can to reduce the suffering and it doesn't always work out and patients die."
Hansen described the 5,000 frontline nurses of the Memorial Healthcare System as resilient but physically and mentally exhausted by the pandemic, by being the one to hold the iPad while a dying man in his 60s told his wife that they would meet again in heaven.
In the parking lot of a pharmacy in Miramar, Florida - where hours earlier, the very first shipments of the vaccine arrived and health care workers were inoculated - Hansen said the vaccine brought a breath of relief after so much sickness, suffering and death.
In Columbus, Ohio, Dr. Mark Conroy, 41, an emergency medicine physician and the medical director of the Ohio State University Hospital emergency department, was one of the first to receive the vaccine on Monday morning. He has been working with COVID-19 patients in the emergency department since February and said he has lost friends to the virus.
"It's been a long 10 months of work and protecting ourselves and protecting our patients," he said, "and so to have the opportunity to be a little bit safer going forward means a lot to me."
Conroy said the year had been plagued with anxiety over how to keep himself healthy so he would not infect his family. Receiving the vaccine alleviates some of his fears, but he said he would continue to wear a mask and practice social distancing, just to be safe.
"We still are learning a lot about how this vaccine works and how people respond to it," he said, "so I certainly don't want to take any chances and see myself get sick."
The lack of concrete options left him and his colleagues feeling demoralized about their ability to help their patients, who were some of the sickest they had ever seen. After long, desperate shifts, they sometimes talk on the phone about the challenge of treating such an aggressive and unknown illness.
"We talk about the uncertainty of the care that we're providing," he said. "That's what is really at the root of a lot of the challenges that people are feeling - there is so much uncertainty around it, especially early on in the pandemic."
Like many of the doctors and nurses who lined up on Monday, Yvonne Bieg-Cordova, a radiology manager at Christus St. Vincent in Santa Fe, New Mexico, has watched lots of people die. But nothing prepared her for COVID-19.
Bieg-Cordova received her first dose of the vaccine on Monday, a bright moment after a bleak year.
"There's that time where you just want to get in the shower and you cry for your 10 minutes to get out what happened at work today," she said. "Then you get out and you go on with your life because you have to go home and take care of your family."
Bieg-Cordova said that the past couple months have been trying, but that the vaccine did provide the hope that an end was coming. One of her colleagues told her that she danced into the hospital this morning. It will be months before the vaccine is available for most Americans, and many experts and leaders are bracing for a deadly winter. But Bieg-Cordova said she saw something else ahead, too.
"I definitely see that light," she said.