Dr. Joseph Lauro’s first patient of the night had all the telltale signs of COVID-19. 

Shortness of breath. Low blood oxygen levels. A terrible chest x-ray.

As an emergency medicine physician with admitting privileges at several Rhode Island hospitals, Lauro normally would be able to admit the patient directly into the hospital. But on this night in mid-December, all of the beds at this hospital were full. So one of the staff wheeled the patient’s cot into one of the emergency department’s isolation rooms -- and closed the door. 

For people who don’t work in health care, Lauro said, the pandemic can be hard to grasp. “They see what's on the news,” he said,  “but until you feel what's happening in the emergency department, you don't understand how bad this really is.”

It’s so bad that Rhode Island has opened not one, but two field hospitals -- with hundreds of beds. But a national staffing shortage is hampering efforts to move more COVID patients into those beds. That means patients continue to wait in emergency rooms. 

On the night of Lauro’s shift, the intensive care unit was full. So was the step-down ICU, which is used for less critically ill patients. 

“I wanted to send somebody to the field hospital last night but there wasn't enough staff even at the field hospital to send the patient there,’’ Lauro said. “So he was waiting in the emergency department to get a bed inside the hospital.”

(The Public’s Radio is not identifying the hospital where Lauro was working that night, since he was not authorized to speak on its behalf.)

“You close your eyes and you hear coughing,’’ Lauro said. “You hear retching. You hear people talking…”  That night, you would also have heard Christmas tunes that Lauro was playing on his cell phone, “to lighten the mood.” 

Rhode Island continues to have one of the highest per capita COVID-19 rates in the country, according to the Centers for Disease Control and Prevention.  And a recently published analysis by the University of Minnesota’s COVID-19 Hospitalization Tracking Project shows that Rhode Island’s hospitals are among the hardest hit in New England. About one-in-four people admitted to hospitals in Providence County as of Thursday were COVID-19 patients -- more than three times the rate of in Suffolk County, MA, which includes Boston, according to the data.

Lauro is used to caring for very sick patients under trying conditions. He is 44, grew up on Staten Island, N.Y. and started his career as a paramedic. He was 24 when he worked at the site of the World Trade Center after the 9/11 terrorist attacks. He’s married to an ER nurse. They’re raising three children.

“Death,’’ he said. “It just smells like terror.’’

On this night, Lauro had worked eight of the last 10 days, including two overnight shifts. He brought his dinner so he wouldn’t need to leave the emergency department to eat. A  hero sandwich with honey roasted turkey, cheddar cheese, like lettuce and mayo on a soft roll.

But even finding time for a water break is a challenge. Anytime he takes a break he has to take off his gear. His N95 mask and shield are both a protection and a barrier.

“I can tell so many things just by using my senses,’’ he said. “I could smell strep throat. I could smell a G. I. bleed. You know you could smell gangrene. Smell urinary tract infection.”

If he could smell COVID, what would it smell like? 

“Death,’’ he said. “It just smells like terror.’’

At one point during his shift, Lauro was treating a COVID patient and he felt the seal of his N-95 mask had been broken. “I could feel in my mask that the air is escaping through the top corner of my nose,’’ he said, “where it always does no matter what mask I wear.”

After finishing with the patient, he went to put on a new mask. But these are the risks he lives with on every shift. 

By the time Lauro’s shift ended that night, his hero sandwich uneaten, he had admitted about 14 patients. And that first patient, the one who was wheeled into an isolation room? “When I left my shift last night at 11 o'clock,’’ Lauro said, “he was still in the emergency department.”  

Lauro is among some 3,000 hospital staff in Rhode Island who are at the head of the line to be vaccinated against COVID-19. He received his first shot Friday morning.

-- Health reporter Lynn Arditi can be reached at larditi@thepublicsradio.org