With lungs weakened by exposure to Agent Orange in the jungles of Vietnam and a heart compromised by surgery, Ralph Bye knew that contracting COVID-19 could ravage his 73-year-old body.
That’s why Debra Bye, his wife of 11-plus years, believes her late husband resisted going to the hospital late last year.
“Before he even went into the hospital, and this was going on with the virus, he says, ‘Boy, I can pretty much tell you, if I ever get that virus, I will never make it out of there with everything that’s wrong with me,’ ” Debra Bye said.
Those words proved prophetic. Ralph Bye, a native of rural southern Indiana who drove tanks for the U.S. Army in Vietnam and later served as a long-haul truck driver, died Dec. 20 while in the intensive care unit at Providence Sacred Heart Medical Center. The progress of the disease, the questions surrounding how he contracted it and the efforts in the final days to defeat the virus, which turned to comforting Bye as he died, tell an all-too-familiar story for health care workers in the Inland Northwest.
But it’s a story that they haven’t been able to fully tell the public, due to concerns about patient privacy.
“Being sick, and being in that situation, is a very personal, private situation. A lot of people don’t want to admit that kind of weakness,” said Rodger Angel, the registered respiratory therapist who cared for Ralph Bye in his final days.
Registered nurse Julie Matthews cared for Ralph Bye in the intensive care unit. Until recently, all the COVID-19 patients she treated died at the hospital.
“People will call me a hero. But I don’t often feel like a hero, because the patients that I have cared for, thus far, have not survived,” Matthews said in late December. “I’m sure some of my colleagues have had successes, but I personally have not had any successes.”
This past week, Matthews had her first patient since the pandemic began leave the ICU after contracting COVID-19. That patient was never intubated, as Ralph Bye and so many others who succumb have been, she said.
Debra Bye said her late husband always wanted to help people. Telling his final story, she said, would be a last way for Ralph to help the community.
“If it helps anybody, then Ralph would be on board 100%,” Debra Bye said. “Anything to help anybody, he was there for.”
Exposure in the war
The Byes spent much of their quarantine at home in Post Falls. Ralph Bye was designated as fully disabled by the Veterans Affairs Department, and he’d received open-heart surgery in 2005. The couple heeded advice to remain near home, despite the fact that Ralph bought a travel trailer early in 2020 and hoped to take some trips after this year’s spring thaw.
“We loved to go for long rides in the back roads,” said Debra Bye, who met Ralph in a store after her first husband died. As a long-haul driver, Ralph Bye made several trips to the Spokane area. On one visit he offered to help Debra find an item on the shelf. The pair were inseparable after that, Debra said.
She learned he came from a family of more than two dozen brothers and sisters, a product of multiple marriages by his parents. The family packed into one four-room home near Milltown, Indiana, just outside Louisville, Kentucky. They had no electricity, and the family earned money by harvesting sorghum for use in making molasses.
“His sisters slept, I think he said, six to a bed. It was something else,” Debra Bye said. “I said, ‘No wonder your mom never smiles in your pictures.’ ”
Ralph Bye completed school through the ninth grade and worked on the farm before being drafted into the Army in 1966. He was 19.
A member of the local American Legion, he wouldn’t talk much about his time in Vietnam, although he sometimes told stories about the tracks of the tanks coming loose in the middle of maneuvers.
“He was everywhere over there,” Debra Bye said. “He remembers being sprayed with the Agent Orange, when it was coming down. He said itsy, bitsy, little stuff about it. But he would have nightmares a lot.”
Tanks and other “mounted armor” were deployed in Vietnam by American forces beginning in 1965, just a year before Bye was drafted, according to an account published by the U.S. Army in 1978. Initially believed to be ineffective in fighting in the jungle terrain of the country, armored vehicles became integral escorts for ground patrols and also targets for ambushes.
“When it was done correctly it could be boring, tedious, and in the minds of many a waste of time and armored vehicles,” Gen. Donn A. Starry wrote in his report of the escort missions that were typical of tank drivers during the war. “When it was done poorly, or when the enemy was determined to oppose it, it was dangerous, disorganized, and again in the minds of many, a one-way ride to disaster.”
Debra Bye said her late husband viewed his time in service as an obligation, even after he was exposed to the chemical agent intended to kill the dense foliage that hid the Viet Cong forces. The Department of Veterans Affairs notes that certain types of respiratory cancers, diabetes, heart disease and other conditions can develop as a result of prolonged exposure to the herbicide, all diseases that the Centers for Disease Control list as factors that can exacerbate problems caused by COVID-19.
“He said it wasn’t a pleasure, but he was there for his country,” Debra Bye said. “But he was very proud of being an Army man.”
As a patriotic veteran, Debra Bye said, her husband also enjoyed watching the eagles that would alight above the waters of Lake Coeur d’Alene in the spring and summer.
“We’d go sit out there for hours, and watch the eagles. We’ve taken the boat cruise,” she said.
One trip he planned to take was a visit to the national Vietnam War memorial in Washington, D.C. Although Ralph Bye saw the traveling wall when it was on display in Idaho, he hadn’t been to the monument in the nation’s capital. Debra Bye said she’d hoped he could have made the trip as part of the Honor Flight, a group that helps fly military veterans to Washington to see the memorials.
“I had him signed up to get on the next one,” Debra Bye said. “But then, of course, this happened. So he didn’t get to do that.”
It started with headaches in late November, followed by general malaise, Debra Bye said. Then, her husband refused anything to eat.
Ralph Bye wore his mask, often one with the American flag on it, anytime he would go out, his wife said. But often it was Debra who went inside stores, to avoid exposing Ralph to the virus that was spreading quickly on both the Idaho and Washington sides of the border in late November.
“He said, ‘I don’t go anywhere. I don’t need to get tested, I hardly go out of the house,’ ” Debra Bye said. “But I said, ‘I do go out of the house, and I could be a carrier, even though I wear my mask.’
“Sometimes I feel like it might have been me, because I did go out.”
But she never got tested for the virus, and never experienced any symptoms of the disease.
Ralph Bye wanted to stay home, so his wife didn’t push it. Until the 73-year-old passed out and hit his head, sending him to Kootenai Health in December.
“He was there for eight days,” Debra Bye said, receiving treatment for pneumonia and lack of oxygen. He’d tested positive for the virus, she said. But his condition improved, and he was sent home for one night.
Debra took a picture of her husband that evening, emaciated by his health problems, but eating. In his lap is 4-year-old white poodle Toby, a companion Debra said was “definitely missing his daddy.”
“Ralph would carry this dog 24/7,” Debra Bye said.
The next night, Ralph Bye couldn’t walk or move. With the hospital in Kootenai County, Kootenai Health, filling up, he was sent to Sacred Heart, in the care of Dr. Bennett Gladden, Matthews and later Angel.
The response by the public to the coronavirus has appeared like waves to Julie Matthews, who’s worked in the Sacred Heart intensive care unit since 2009. That first hit just as schools and restaurants closed by government order in March.
“That first wave came, which looking back now wasn’t really that big of a wave, and the fact that people thought when summer comes, this is all just going to go away, because this is just like the flu,” Matthews said.
“There’s nothing about corona that is just like the flu.”
Patients who first arrive at the hospital may still be conscious and able to speak, Matthews said. They’re needing oxygen as the damage spreads in their lungs, and Matthews said she typically asks where the patient thinks they may have contracted the virus.
“One gentleman, newly diagnosed with cancer, he thinks he picked it up at the doctor’s office, because he stayed home,” she said. “Another gentleman, it was his wife that had had it the week before, and thought she brought it home to him.”
As their condition worsens, as Ralph Bye’s did, the nursing staff begins physically moving the patients in an effort to get incoming oxygen into healthy lung tissue. That means turning patients, often who have several intravenous lines and tubes coming out of their bodies, onto their stomachs, a process that even with a team of health care providers can take 15 or 30 minutes. On a recent shift, Matthews “proned” four patients, as it’s called, in back-to-back sessions that took more than an hour.
Meanwhile, other staff members have to monitor the already-proned patients, who require constant care. That’s one of the reasons why there’s so much concern about ICUs reaching capacity, Matthews said.
“It’s quite a process, and it takes a lot of manpower,” Matthews said. “When you think about taking nurses away from critically ill patients for 15, 30 minutes, who’s watching those other patients while they’re in the room repositioning these other patients? It’s an amazing team that I work with.”
Ralph Bye required even more care, because he was on dialysis in addition to his other medications. Typically, even before the pandemic, Matthews treats two patients simultaneously per shift from a perch outside patient rooms in a wing of the hospital’s intensive care unit.
In the ICU
On a recent Thursday morning, about a month after Bye’s death, Sacred Heart’s ICU beds were full, about half of them with COVID-19 patients. Another wing is on the opposite end of the floor, reserved for patients receiving cardiac care, but COVID-19 patients have been taken there as well.
The wing is quiet as many patients are heavily sedated, requiring assistance to breathe. Another wing is on the opposite end of the floor, reserved for patients receiving cardiac care, but COVID-19 patients have been taken there as well.
That unit has about the same number of doctors, nurses and therapists as before the pandemic. One difference is the number of other people who are present. Dying patients may only receive two visitors. Before COVID-19, as many as several dozen might fill a room to hold vigil for a sick family member or loved one, said registered nurse Deb Gillette, nursing manager for the ICU.
“The waiting rooms were always full,” she said.
Matthews relayed messages from Debra Bye, who was unable to see her husband. Messages that seemed to cheer him up, even as it became clear he would have to be placed on a ventilator. Debra Bye got to speak to him on the phone one last time before that happened, and she knew he wouldn’t be able to talk to her.
“I just said, ‘Hi honey,’ and he said, ‘Hi,’ in a very weak, very shallow voice,” Debra Bye said. “And I said, ‘I love you,’ and he said, ‘I love you,’ back, but very, very shallow.
“That was the last time I ever talked to him.”
That isolation, Matthews said, is typical of her COVID-19 patients.
“What I see, with each one of my COVID patients, is ultimate suffering,” she said. “I see them on more machines, more drips, I see them more isolated from their families, than I have any other patient population in my 20 years as a nurse. This is true suffering.”
Rodger Angel didn’t meet Ralph Bye until the Vietnam War veteran was heavily sedated and required help to breathe. But not every COVID-19 patient is the same.
“These patients are awake, they’re alert, they know they’re sick, they’re scared,” Angel said. “You can see their lab data, and their oxygen levels on the monitor, dropping day by day by day. No matter what we do, it doesn’t get better.
“The fact that they’re not comatose, that they weren’t in a car accident or had a stroke, and they can sit there and be scared and have a discussion with you, that’s the part that’s different.”
Angel has worked as a respiratory therapist at Sacred Heart for about 20 years. COVID-19 has him, and many of his colleagues, stumped.
“I’ve spent my career taking care of people with breathing problems. I am the guy that they have teach all the therapists, when they come in,” Angel said. “I know everything about every pulmonary disease there is. This doesn’t act like any of them.
“Everything I throw at it, it does nothing.”
Once a patient reaches the intensive care unit, as Ralph Bye did in late December, Angel estimated patients he’s seen have about a 50-50 chance of survival. Those odds drop again once they’ve been placed on a ventilator.
“We try to get them to do breathing exercises, just to get their lungs in shape to avoid the ventilator in the first place,” he said.
By the time Angel was treating him, Ralph Bye was receiving maximum oxygen levels from a ventilator and heavily sedated. Even with oxygen treatment, if the lungs can’t accept it, it simply leaves the body without being absorbed and cells begin to die.
“I was already worried there was no way this guy was going to make it,” Angel said. “I’ve had a few people make it past there, but very few. Maybe two out of the whole crisis.”
Still, Angel treated Ralph Bye. That included brushing his teeth in an attempt to prevent bacteria from forming in his mouth and infecting his lungs, an action his heavily sedated patient couldn’t perform.
“I was in there talking to him, and he started nodding,” Angel said. “Eyes are still closed, and he’s nodding ‘yes’ to me. And I’m like, ‘Oh, you’re awake? You understand?’ ”
Rodger Angel would continue to talk to his patient, up to the point of his death.
Julie Matthews asked Debra Bye if there was a plan for how her husband wanted to go.
“Deb and I talked every day, several times a day, over those four days that I was his nurse,” Matthews said. “And I said to Deb, having read the previous day’s notes, that I understand that Ralph would not want to be on a ventilator long term.”
Debra Bye had a plan for her husband’s care in a living will that had been prepared long before the pandemic. She found it and gave it to the doctors, who confirmed that Ralph Bye didn’t want to be kept alive by machines.
“I’m glad I had it,” Debra Bye said, noting the document included care for his body after death.
Matthews, who has seen many patients die since the pandemic began, said such preplanning can often relieve a loved one of feeling like they’re making the choice and living with its consequences.
“We have to honor the process of death. We can explain to them, these are the medications we’re going to provide, this is the comfort we’re going to provide,” she said. “This is Ralph’s decision. This isn’t her decision, this is not for you to feel guilty or own this.”
Gillette said the team of ICU nurses has been involved frequently in that process every day since the pandemic began, nearly a year ago. In intensive care, which includes trauma patients and those coming out of serious surgeries including operations on the brain, patients may stay several days but would get better, Gillette said. That hasn’t been true of COVID-19 patients.
“This is the most death our team has ever had to deal with,” she said.
That includes those providing what’s known as palliative care. That typically means support for families of those who are dying or experiencing grave illness that will affect them and their households for a long time. Palliative care workers have been holding virtual meetings with loved ones, letting them know the rules for visiting someone who is about to die. Sometimes that means limiting who can come to the hospital, said Dr. Lisa Stiller, a hospice and palliative care physician working in the ICU.
Sometimes, a family member on medicine that suppresses their immune system decides not to say goodbye in person because they are at even higher risk of serious complications if they catch the coronavirus.
“Once you come into the hospital, you have a high chance of never seeing your family again,” Stiller said. “It’s just layers of grief with this, because people are isolated.”
Debra Bye traveled to the hospital with her brother, a minister, to pray when it was decided to take her husband off the ventilator.
“I was a little nervous, because I knew what my husband looked like going in,” Debra Bye said. “Being sick for so long, I was a little afraid of what he looked like.”
Angel was there to remove the breathing equipment.
“You go in there, you talk to them, you tell them you’re going to make them more comfortable,” Angel said. “You take all the tubes out, and just kind of leave. Nurse Julie is the one that is tasked with being there for them.”
“We, as nurses, want to provide comfort,” Matthews said. “Comfort doesn’t always mean quantity of life, it means more quality of life.”
Ralph Bye did not open his eyes. His wife played voicemail messages from loved ones back in Indiana, some family members he’d recently reconnected with on a trip back to the Midwest a couple of years ago, saying their goodbyes. His brother-in-law prayed.
“I know that he prayed, when they took him off the life support, that he would either be healed instantly by God, or God won’t let him suffer long,” Debra Bye said. “And he didn’t. He only lived for 10 minutes.”
When Angel returned to the room half an hour later to check, his patient had died.
When will the sadness end?
Debra Bye spent the next few weeks looking after Toby, sorting her husband’s patriotic garb and planning a funeral for after the holidays. Originally questioning the severity of the virus, she said she now takes it more seriously, washing her hands and limiting contact with people even more so than before.
“We did not take it serious at first. No, we did not,” Debra Bye said this month. Still, her husband stayed home and she wore her mask.
Even after watching her husband’s decline, Debra Bye said she wasn’t interested in a vaccine, the same inoculation that her husband’s caretakers now see as a beacon of hope following 10 months and counting of suffering and death.
“My personal belief is that I won’t do it,” Debra Bye said, saying she had concerns about its rapid development.
For Matthews and Angel, who both received their first doses of the two-shot vaccine available to health care workers, the arrival of some way out of caring for dozens of people like Ralph Bye is something to be celebrated, not feared.
“I feel like I can take a deep breath again,” said Matthews, who signed up also to administer the vaccine and inoculated her daughter, a cardiac nurse at Sacred Heart, this month. “I do feel like this is the beginning of the end.”
An end Matthews has hoped would come for some time. While her husband has taken the illness seriously, Matthews said some in her family aren’t wearing masks or taking other easy steps to keep themselves safe.
“I think that’s a big thing. Until you have somebody close to you, somebody you know, affected by it – and I try to tell them, I’m affected by it. I’m tired. I’m sad, I’m stressed,” Matthews said.
Angel said that while he understands the emotions of those who have had to stay home and face economic hardship while not personally being affected by the virus, it’s fallen upon health care workers to deal not only with the physical toll of the pandemic, but also the emotional one. That’s what the vaccine also promises to help lift away.
“We are experiencing the death that they’re not,” Angel said. “We deal with death and sadness everyday, on a regular basis. So if we’re sad, people who deal with this every day, that’s got to say something.”
Debra Bye has allowed herself to feel shifting emotions since her husband’s death, the kind well-known to anyone who has mourned. Anger. Sadness. Confusion. But she knows her husband was a fighter.
“There’s a reason, I know,” Debra Bye said. “Ralph was a trooper. He fought. I know he fought.”