Madhvi Aya worked long hours in the emergency room of a hospital in Brooklyn that was battered by the coronavirus. Then she caught the virus herself.
Lying in a hospital bed last month, Madhvi Aya understood what was happening to her.
She had been a doctor in India, then trained to become a physician assistant after she immigrated to the United States. She had worked for a dozen years at Woodhull Medical Center, a public hospital in Brooklyn, where she could see the coronavirus tearing a merciless path through the city.
Within days of her last shift as a caregiver, Aya became a patient. She had worked in Woodhull's understaffed emergency room, taking medical histories, ordering tests and asking about symptoms. Now she had become infected.
Aya, 61, was alone in a hospital, less than 4km from her husband and 18-year-old daughter on Long Island, who could not visit her. She did not have the solace of familiar colleagues; she had been admitted to a different facility nearer her home. In a text with her family, she described horrible chest pain from trying to get out of bed.
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"I have not improved the way should have been," she wrote her husband, Raj, on March 23.
As she grew sicker, her texts came less frequently and in short, sporadic bursts.
"I miss you mommy," her daughter, Minnoli, wrote on March 25. She craved the reassurance of her mother's hugs, the comfort of crawling into her bed. "Please don't give up hope because I haven't given up. I need my mommy. I need you to come back to me."
"Love you," Aya wrote the next day.
"Mom be back."
Aya could not keep that promise.
Front-line health care workers face a high risk of contracting the coronavirus, and scores have become sick. But it is less known how many have died in New York from the virus after working closely with COVID-19 patients.
Health care systems by and large have not publicly revealed the identities of those employees, who include Kious Kelly, a nurse manager at Mount Sinai West in Manhattan, and Dr. Ronald Verrier, a surgeon at St. Barnabas Hospital in the Bronx. Doctors, nurses and staffers who worked in other capacities at hospitals that have been flooded with virus patients have also died, according to their families and colleagues.
Aya's text messages and her family's account of her final days reveal a woman who spent much of her life devoted to medicine before succumbing to the cruel and familiar arc of a patient with Covid-19. Her early mild symptoms and quarantine at home were followed by a rapidly escalating illness and long waits for care, until she died alone.
"She was always there for us, whenever we wanted," her husband said. But when she got sick, "no one was next to her," he said.
Aya moved to the United States in 1994 to join her husband, who had immigrated a decade earlier and met her on a return trip to India. She started working at Woodhull in 2008 and became a senior physician assistant. Colleagues said she nurtured younger co-workers by drawing on the experience she had gained as an anaesthesiologist and internist in India, along with her instinct as a caretaker.
"This has been a heavy blow to us all," Dr. Robert Chin, Woodhull's emergency department director, said in an internal email on April 1, asking for donations to help Aya's family, for whom she had been the primary wage earner.
Like many other hospitals, Woodhull had converted one ward after the next into makeshift intensive care units when the virus began its surge in New York. As the hospital verged on running out of ventilators, protective gear for medical staff and other equipment, it appealed to affiliated medical centers for help and transferred patients elsewhere.
In the week of Aya's death, Woodhull's emergency department alone had 20 patients on ventilators, Chin said.
Another Woodhull employee, a radiology clerk named Thomas Soto, died of the virus at the hospital last week, 12 days after his first symptoms. Soto, 59, worked there for decades and was close to retirement. "The only reason my dad pushed to work that extra year was to retire with full pension, and I lost him because of that," Jonathan Soto, the older of Soto's two sons, said through tears.
A former hospital police officer, Herb A. Houchen, 35, returned to Woodhull as a Covid patient and also died. He had worked at Woodhull for more than five years and left behind an 11-year-old daughter.
Aya's daughter, Minnoli, said her emotions have ranged from intense grief to disbelief. She thinks about becoming a doctor herself and is angry at a health care system that she believes did not protect its front-line workers. Sometimes she is angry at her mother for not coming home.
"I just want to be able to hug her and have her tell me everything is going to be OK," Minnoli said.
There is no way to determine how Aya became infected. While she worked at Woodhull in early March, front-line employees had not yet been instructed to wear protective masks for all patients, one staff member said. Later, as the crisis grew, hospitals realized that people coming in for apparently unrelated problems were also testing positive for the virus, potentially exposing unwitting health care workers.
On March 17, Woodhull's administration advised emergency department workers to wear masks for all patients. A spokesman for New York City's Health and Hospitals Corp., which oversees Woodhull, said protective equipment was available to its health care workers.
Aya's shifts could be gruelling at Woodhull, a 320-bed public hospital at the intersection of Bedford-Stuyvesant, Bushwick and Williamsburg. Her husband often drove her to work from their home in Floral Park as early as 6 a.m. and picked her up 12 hours later so she could relax in the car.
"We have to take care of our patients first," she often said.
At the beginning of the outbreak, Aya worried about bringing the virus home to her 64-year-old husband, whom she had guided through an aortic bypass in 2017, and her 86-year-old mother, Malti Masrani, for whom she had cared after a stroke late last year.
She began coughing around the time of her last shift on March 12, Raj Aya said. He drove her to Woodhull the next evening so a doctor could examine her, picking her up many hours later, after she was tested.
For the next few days, they quarantined on different floors of their Cape Cod-style home. Aya had no underlying medical conditions, family members said.
But her cough worsened at home, and she developed a fever. In the early afternoon of March 18, Raj Aya dropped his wife off at Long Island Jewish Medical Center, near their home. He would not see her again.
For an hour and a half, Raj Aya sat in his car in the hospital parking lot, texting his wife — almost always addressing her as "SH," for "sweetheart"— to check if she had received a chest X-ray and to say that he had tried to get in to see her.
"You go home I call you I am waiting," she wrote.
At 4:47am the next morning, Aya texted that she was still waiting for a bed. When Raj Aya woke up, he asked if he could bring her coffee. She said no. She reported her test had come back from Woodhull. Positive.
"I'm so sorry to hear," he replied.
They spoke by phone, and she told him to take care of her mother and bring her daughter home from school.
The next day, Minnoli Aya returned from the University at Buffalo, where she was a freshman. She believed her mother had pneumonia and hoped to surprise her. Instead, she learned her mother had contracted the coronavirus.
"I was just on the floor, and I was broken," Minnoli said.
Over the next week, she texted with her mother, who continued to deteriorate. Doctors called Raj Aya daily. By the end of the week, his wife was increasingly having trouble breathing.
By the morning of March 29, doctors got ready to put Ms. Aya on a ventilator. But there was a life-threatening complication, and they asked Mr. Aya if he wanted to see his wife for what could be the last time. He worried that his heart condition would put him at risk if he caught the virus, and Minnoli could be left without a parent.
The decision not to go, he said, has haunted him. That afternoon, the hospital called to say that his wife had died.
Minnoli, her father and grandmother could not hug each other, because they were required to stay six feet apart, even though they lived in the same house. Nor did they want to plan a funeral service that almost no one would attend, one where they would not be able to view Aya's body. They decided to have her cremated.
Even after her mother died, Minnoli still texted, trying to stay connected.
"I miss u," she wrote before going to bed that night. When she woke the next morning, Minnoli texted, "Thank you for coming to me last night in my dreams."
Raj Aya, concerned about Minnoli, arranged for her to speak to a therapist by video after his wife's death. But he is not sure how long he can afford the expense because Aya's health care plan had covered the family. A representative of her union benefit fund told him by email that benefits would end 30 days after his wife's death. "My heart is broken for you," the representative wrote in the email, which was reviewed by The New York Times.
In the weeks since Aya has been gone, Minnoli has pored over the messages still sitting in her phone.
"Hi mommy. College is getting so much more stressful now that it's at home," she had written, three days before her mother's death. "The good thing is I'm home but I need you to come back here to me. I hope you ate dinner and I'm still praying for you and haven't gave up hope."
"Concentrate," Aya responded.
"I am but I want u home."
"I love you mommy with all my heart."
Those were Aya's final words to her daughter.
Written by: Michael Rothfeld, Jesse Drucker and William K. Rashbaum
Photographs by: Hilary Swift and Victor J. Blue
© 2020 THE NEW YORK TIMES