Leaning into a Life

How the boy from two worlds became a firefighter, paramedic, circus performer in Latin America, language teacher in Spain and doctoral student at Notre Dame, only to volunteer in New York’s COVID siege

Author: Michael Rodio ’12

On the still morning of April 25, 2020, in the time when the coronavirus silenced all but the sirens in New York City, George Azcárate ’19M.A. went to a place of terrible sickness so he might help the people there heal.

Until that moment, he was a first-year doctoral student in Notre Dame’s Iberian and Latin American Studies program, working under Professor Joshua Lund and beginning to contemplate a dissertation about healer-patient relationships in literature. When he’d arrived in Brooklyn to visit his girlfriend for spring break, back in March, the city had seemed normal, if a bit uneasy, even as the stock market started tanking and the headlines chronicled New York’s first 100 cases of COVID-19. But he paid attention to the stories from China, Iran and Italy: nurses exhausted from the flood of patients. In Washington state and New Jersey, emergency room doctors were soon hospitalized with the disease.

Then: the sirens. Days consumed by sirens, wailing to and from the two hospitals near Azcárate’s girlfriend’s apartment in Bushwick, heralding the fear engulfing New York. By March 15, when Notre Dame students should have been traveling back to campus, airports had descended into a chaos of travel restrictions. Colleges sent students home for the rest of the semester. Ten days later, the city reported nearly 5,000 new cases and more than 100 deaths in a single day. People were rapidly learning of friends and family among them.

Incomprehensibly quickly, yet as if in slow motion, the city crumpled to a halt, her metropolitan hustle ceding to an invisible dread.

Here. The virus was here.

Trapped in the apartment, afraid and frustrated by his helplessness against the worst global pandemic in a century, Azcárate wrestled with his studies and sought some modicum of control — any way to do something. So he volunteered to serve as a nurse.

Azcárate, who is 39 but seems younger in person, hadn’t worked as a nurse for six years. He hadn’t worked in an ICU for eight. But he’d been in health care in some capacity since he was 18. He said as much when he called hospitals, offering to lend a hand.

The chief nursing executive at New York Community Hospital, a modest facility serving the hard-hit Brooklyn neighborhoods of Sheepshead Bay and Midwood, called on April 24. He wanted Azcárate to start the next day.

The graduate student had heard the numbers, but he still hadn’t seen the killer up close. And when he walked into the hospital on April 25, he finally faced down the virus, watched it grip patients, trap them, strip them of their humanity.

“My first day, I remember walking in, the nurse in charge said: ‘Okay, you have this assignment.’ Literally as he said that, he was like: ‘Oh, no — that patient just died.’ They died as I was walking in.”

It seemed like every hospital patient was COVID-positive. Azcárate was assigned to room 305, a two-nurse, six-bed “pod” converted into an intensive care unit for COVID-19 cases. There he joined John Ferguson, a veteran critical-care nurse from Florida who, like many out-of-state health care professionals, had traveled to America’s first pandemic epicenter during the spring.

“I was completely blown away,” Azcárate recalls. “In the first week, I’d had more patients die on me than I did in my whole career working as a transplant ICU nurse.”

In 305, Ferguson and Azcárate cared for some of the sickest patients — often men with preexisting diabetes and hypertension, too old to benefit from advanced treatments at larger hospitals. All were on ventilators.

“The workload was tremendous,” Azcárate says. “Some of the floor nurses had 10 patients, and one or two patients would be on a ventilator. Typically in the ICU you have one nurse to one patient, or one to two. . . . There were days where I’d go in and have four or six patients.”

Even with years of ICU experience, Azcárate faced a steep learning curve — because of the virus’ novelty and because he was operating in a new hospital.

“There are constantly alarms going off: ventilators, IV pumps, tube-feed pumps, heart rate, blood pressure, oxygen,” Ferguson says. “You have to learn what every sound means. Going to a new hospital, where they have all different equipment, you hear 40 different sounds, and at first you don’t know what any of them mean. . . . It’s like learning a new language.”

Azcárate also learned some Russian.

“I haven’t had a single person who spoke Spanish,” he says. “But if patients are able to talk, they’ll always teach you something. At one point I was trying to feed a patient, and then we figured out: Kushat, kushat. ‘Eat.’”                        

Rodio Spot Brian Bloomjpg
Photography by Brian Bloom

George Azcárate was born with two names into two worlds.

From his earliest days, George was also Jorge, and he was from El Paso, Texas, and Ciudad Juárez, Mexico, and he spoke Spanish and English, and he was Mexican and American. Growing up, he navigated by the Franklin Mountains, El Paso’s tectonic backbone jutting skyward from scrubby desert. Because of this, he says, wherever he lives, he always looks for the mountain.

In 2000 Azcárate became an El Paso firefighter and emergency medical technician. “He was fresh out of high school, 18 years old, gung-ho, smart as hell,” says Felix Hernandez, who joined the department with Azcárate and became an older-brother figure to him.

Azcárate grew up fast: “By the time I was 20, I’d delivered two babies at the border. People live their whole lives without seeing dead people. I was seeing them all the time.”

He barely graduated high school, and hadn’t been much of a student. That changed in 2004, when he and Hernandez started an intensive, six-month paramedic class. School focused Azcárate — “he was really crushing class,” Hernandez says — but it also broadened his horizons to the prospect of a health care career.

In winter, Azcárate and Hernandez escaped from the grind by venturing into the mountains. “We talked about our goals — ‘What are we going to do with the rest of our lives?’ Those kinds of questions.” Hernandez says. “I told him, ‘You only really get one shot at this. Follow your heart.’”

Five years into firefighting, Azcárate started dating Betina González, an up-and-coming Argentine writer pursuing her master’s degree in bilingual creative writing. When she started her doctoral program at the University of Pittsburgh in 2006, Azcárate went with her.

There he charted his own path toward a medical career. He took classes through the diploma program at the university medical center’s St. Margaret School of Nursing while working as a nurse’s aide at UPMC Children’s Hospital of Pittsburgh: feeding babies, changing diapers, checking vital signs. In 2009, he completed a bachelor’s degree in nursing and started working in the transplant ICU at the system’s Montefiore Hospital.

He never mentioned his paramedic work, which freed him to learn anew. “If I come into a situation where someone’s going to teach me, I usually say I don’t know how to do something,” he says. “Even if you’ve done something a thousand times, someone else can always teach you something about it.”

Each day in New York, at the start of their shifts, the nurses ventured down to the hospital basement for the ritual of protection.

Wash hands. Put on gloves. Unwrap Mylar suit. Zip suit over scrubs. Wrap surgical booties over shoes. Tie back hair, secure it with a hair cap. Put on N95 mask, adjust to minimize skin abrasion. Surgical mask over N95 — a mask for the mask. Possibly goggles. Another hair cap over that. Maybe two. The clear plastic face shield. Learn to recognize coworkers by their eyes, because that is all you will see of them, and they of you.

Remember that you are still at risk.

“You’re overly neurotic about everything you touch — where you put your hands, not touching your face, not adjusting your mask,” Ferguson says. “You’re constantly cleaning your hands after touching anything. Constantly cleaning the room. That’s the nature of COVID. You’re trying not to get it yourself.”

At first, nurses and doctors weren’t sure how to treat this chimerical coronavirus. Early treatments were disconcertingly homespun: zinc, Vitamin C — even nicotine patches, because some French doctors had noticed that smokers, improbably, seemed to fare better. Scientists didn’t hit on the potential of one promising anti-inflammatory, dexamethasone, a common corticosteroid, for treating critically ill coronavirus patients
until June.

With no cure in sight, doctors and nurses focused on supportive care: maintaining patients’ vital signs, caring for basic needs. In many cases, the goal was simply keeping patients alive long enough to give their immune systems a chance.

Hence the ventilators. The coronavirus can ravage alveoli, the tiny lung sacs that draw oxygen from air to blood. Severely ill patients need ventilators to pump concentrated oxygen into the few working alveoli they can muster. Azcárate recalls the hospital intercom summoning members of the “COVID Team,” a squadron of hazmat-suit-wearing anesthesiologists, to intubate patients.

Ventilators weren’t always enough. When ventilated patients deteriorated, nurses would “prone” them, rotating them face-down in an attempt to reopen collapsed lungs. Doctors at New York Community turned to azithromycin to treat the secondary infections that often followed COVID-19 sepsis. Sedatives to keep a body from rejecting the ventilator. Drips to buoy blood pressure, perfuse kidneys, pump hearts, oxygenate lungs.

“You have to constantly evaluate and adjust these medications,” Azcárate says. “If you’re on one drip, you’re sick. I had some patients on two or three.”

Combined with all the other demands of care, and with so many patients for each nurse, each day became an uphill marathon at a sprint. Nursing shifts ostensibly ran from 7 a.m. to 7 p.m., but Azcárate often started early and sometimes ended around midnight.

“There were days when I was on my feet from 6:45 a.m. to 3 p.m. without being able to stop and go to the bathroom, or even having time to realize it,” Azcárate says. “I still felt like I had a long list of things that I needed to get done.”

He showered, dressed and quarantined himself, terrified the virus had replaced the healthy George with someone else.

Yet nurses knew most of their patients would die anyway. Even after 18-hour days, patients died. After weeks of intensive care, patients died. After glimmers of hope, of blood pressure fluttering upward only to plummet into multiorgan failure before Azcárate’s eyes, patients died.

“There’s that sensation of: ‘I’m almost there, I’m almost there, I’m almost there’ — and then either your patient would die, or they’d take a turn for the worse. You’d feel like, Where did all that work go? We were doing this all morning long. And then it’s gone. A lot of times, at the end of the day, I’d think: Am I doing something wrong? Is it me? Until you really understand that it was just too much for the hospital to handle everything at once.”

The best way to keep going, Ferguson says, was to set a goal of saving one or two patients, adding, “You’re not going to do better than that.”

On that first day, as Azcárate stripped off his protective equipment, his stomach lurched: What if, despite all the PPE, I’ve been infected?

He remembered a Philip K. Dick story, “Impostor,” in which the protagonist’s friends accuse him of being a bomb-carrying android, his real, human body swapped out by invading aliens. The narrator feels like the same person and tries desperately to convince his friends that he couldn’t be a threat — until he discovers otherwise, to disastrous effect.

“The whole story is ‘I know I’m me, I know I’m me,’ but essentially you’re causing all this harm to all these people around you without even knowing it,” Azcárate says. “And that’s the thing about COVID. It has this long incubation period where you don’t even show symptoms.”

So he went back to the apartment. He showered, dressed and quarantined himself, terrified the virus had replaced the healthy George with someone else.

It’s not exactly true that Azcárate ran away with the circus in Argentina.

It is true that he moved to Buenos Aires with Betina González in 2012, years into their marriage, as she pursued her meteoric literary career. For Azcárate, the move was a respite from health care’s bureaucracy, the way it reduced sick people to “patients,” to “the liver in bed seven.”

It’s also true he auditioned for a theater company, that he nailed the audition without a shred of theatrical training — besides his love of theater, his high school dance-crew phase and a decade of staying calm during otherwise panic-inducing medical emergencies.

And it’s true that The Performers, the educational theater company, were colorful Bohemian castaways who taught English to children via four-person Shakespeare spinoffs and a play about not throwing trash into the sea. That one had a shark puppet named Harry. Azcárate was Harry.

So, yeah: He ran away with the circus in Argentina.

“It was madness,” says Regina Brandolino, a classically trained Argentine actress-writer-producer who joined around the same time as Azcárate.

“It was a circus,” says Danni Cullen, a garrulous, fearless Irish actress-yogi-acrobat.

Day by day, Azcárate coaxed his patients to express themselves, to discern how they felt. Were they hungry or in pain? Were they struggling to breathe or emotionally overcome? Did they need someone to see them — beneath the breathing tube, the norepinephrine drip, the monitor alarms — as a whole human again?

Together with Azcárate and Englishman Simon Langley, now Brandolino’s fiancé and business partner — they formed The Performers’ dream-team cast. “I felt like it was a strange family — like a gypsy family,” Cullen says.

Month after month, they and the rest of this menagerie of actors and stagehands journeyed throughout Latin America. They performed as many as five shows a day in small schools and theaters before cramming into an overstuffed van and riding another 12 hours to the next gig.

“It was not glamorous,” Brandolino says: early-morning setups, under-the-table pay, roach motels. “It was, at moments, soul-wrenching.”

Amid the emotional drain of touring, Azcárate and González divorced. (The split was amicable, and they still keep in touch.)

On the road, Azcárate rarely talked about his past lives, except for the time Brandolino nearly died from salmonella in Mexico and he nursed her back to health. But before long he had impressed his castmates with his honesty, creativity and willingness to “stick to his truth,” Cullen says. Sometimes he’d improvise, just to tighten the screws on his costars.

“Jorge would be like, ‘Let’s spice it up, let’s go for it!’” Cullen laughs. “The approach that he had in life — just go for it — he would do it on stage as well. He was not afraid to get it wrong. Not afraid to fail onstage.”

And why would he be afraid? He’d walked away from a job, a pension and a house in El Paso to start the most radically different life he could imagine. Over thousands of miles, hundreds of shows, races up mountain trails, picante-sauce-eating challenges, dares on a stingray-infested beach and interminable inside jokes, that life took shape. He learned not to take himself so seriously. He learned to find the grace in his friends. He trusted they’d find grace in him.

Even if he played the shark puppet.

For nearly every patient Azcárate lost in New York, there was a family to tell.

One patient’s boyfriend called to ask, emotionally, “Are you doing everything you can?” Azcárate, trying to convey the severity of the illness, explained the treatment. Ventilator. Dialysis. Three blood-pressure medications at maximum dosage. He was, objectively, doing everything he could. And yet the patient was slipping away.

“That whole day, I felt this profound impotence in being unable to do something that would make the patient better,” he says. “There was absolutely nothing else I could do. It was medically futile. And in my head, I still felt this profound guilt. I don’t know what else we can do.” The patient soon died.

Another patient, suffering through an arduous recovery, was on FaceTime with his family — the video calls, delivered via iPad, are a routine COVID-19 therapy — when he started motioning with his finger across his throat, as if to cut the call short.

“I was like, ‘Oh, do you want me to hang up?’” Azcárate says. “And the patient was like, ‘No, I want to die.’ The patient had never mentioned this.

“The family was shocked. I was shocked. I had no idea that was coming. If you’re a nurse, you always have more than one patient — you have the patient and the family, too.” But the family couldn’t be present. And Azcárate couldn’t console them.

The family begged the man to wait. Eventually, he relented, and began rehab still attached to a ventilator. Over Azcárate’s weeks in the 305 ICU, he was the only patient to recover.

“Those moments make you think,” Azcárate says. “They’re ethical gray areas. ‘What’s in the best interest of the patient?’ Sometimes what the family wants isn’t necessarily what the patient wants. Being an advocate for the patient, that’s not always being an advocate for the family. That’s when it’s really tough to be a nurse. Those moments.”

Once he left The Performers, Azcárate worked briefly as a travel nurse and drifted through Buenos Aires, living in converted tenements and trying to figure out what to do next.

“It’s funny to think back to how miserable I was then,” he says. “I’d wake up and have this anxiety about my life: What have you been doing? What are you doing now? Constantly: You need to figure out what it is you’ve always wanted to do, and you need to do it.

In that winter of discontent, he formed a cluster of daily habits to stay sane. He met a neighbor, Jared McCormack, an aspiring English teacher who’d stepped off the plane with zero Spanish. “George was the most dedicated person I’d ever met in my life,” McCormack recalls. “He’d wake up at 5 o’clock in the morning, and read and write for several hours religiously.”

Over dinners at their rooftop grill, adrift but for their newfound friendship, McCormack and Azcárate hatched an escape. In 2014, they both applied for Auxiliares de Conversación, a program to bring native English speakers into classrooms in Spain. That fall, they were assigned to Mahón, the capital of the paradise island of Menorca.

For two years — one on Menorca, one on Mallorca — the friends taught 15 hours a week and spent the rest of their time exploring. When they discovered a bar featuring live-band backup for karaoke singers, Azcárate earned a reputation. “It became ‘Stick around so you can see George sing Elvis,’” McCormack says, laughing. (The bandleader always asked him to sing “Blue Suede Shoes,” although Azcárate says his go-to is Gene Vincent’s “Be-Bop-a-Lula.”)

For Azcárate, teaching felt like an exhilarating new form of acting. “Across the span of my life, acting fits into every single thing that I’ve done. Firefighter, paramedic, nurse, teacher. Acting goes into all of it.”

He thought about going back to school, about getting his doctorate and teaching Spanish. He reconnected with Joshua Lund, his ex-wife’s thesis advisor at Pitt. Azcárate mentioned grad school, and Lund asked if he could handle a winter slightly colder than Pittsburgh’s. The professor was eager to make the case for accepting a candidate with a nursing degree but far more life experience than the typical graduate student. So in 2017 Azcárate moved from Mallorca to Indiana.

He soon resolved any doubts about his scholarly ability. When the time came for Azcárate to apply to doctoral programs, professors’ questions had shifted to How are we going to keep this guy?

By then he’d fought in the Bengal Bouts, even though he had 15 years on most of the 145-pounders. (He lost his first match in a split decision.) He also starred opposite Natalia Cuevas ’14 in Staging the Daffy Dame, Professor Anne García-Romero’s play about performing a Spanish Golden Age comedy.

Weeks into rehearsals, Cuevas says, their castmates made a discovery: Each night, Azcárate walked home to his Mishawaka apartment, even during blizzards. He never asked for a ride.                                   

Until he moved to Pittsburgh, Azcárate was, simply, a firefighter. It was his occupation and his identity: a firefighter, in his hometown, after 9/11. But when he left El Paso, he was nobody in particular. So he asked himself: Who is Jorge? He could not hide behind a profession. He had to find the answer to this question for himself.

This slow-burning realization freed him — to become a nurse, yes, but also to run away with an Argentine circus, then to a Spanish island, then into the halls of academia.

He could contain all of those things. They could not define him.

As the pandemic descended on New York, and this wayward doctoral student grasped for control, he knew he could find a way to be calm on stage.

One of COVID-19’s cruelties — as bad as infected lungs, sepsis and bizarre blood clots — is its power to isolate. Patients are confined to one room. They cannot see their caregivers’ faces, “just encapsulated versions of us with the mask on,” Azcárate says. The intubated cannot speak.

So nurses, the logistical constants of patient care, become spokespersons. And here was Jorge, now the ICU nurse who, by some cosmic current of fate, spoke in stories.

Every day at shift change, the nurses told their patients’ histories: medications and treatments, yes, but also their needs and wants, their progress against the ravages of a debilitating virus.

“There would be days when patients would be upset, or want to give up,” Azcárate says, tempered emotion in his voice. “That’s the hard part. Saying: ‘I can’t begin to imagine what you’re going through right now, because I’m walking around, and I’m healthy, and I can leave here.’”

Day by day, Azcárate coaxed his patients to express themselves, to discern how they felt. Were they hungry or in pain? Were they struggling to breathe or emotionally overcome? Did they need someone to see them — beneath the breathing tube, the norepinephrine drip, the monitor alarms — as a whole human again?

“They go through this world collapse,” he says. “The person they were is gone. And even if they recover, they will still have gone through this moment in their lives when they were hospitalized. That changes your life. . . . You have to rebuild yourself from that.”

He also told his own story. When he woke up, he’d sometimes send messages to Regina Brandolino and Simon Langley about how nervous he was going into work. About how difficult it was to confront those patient stories every day.

“He felt the pain of some of the people dying, people who couldn’t say goodbye to the people they loved,” Brandolino says. “So he would stay there holding their hands. Even if he had three pages’ worth of things to do, if someone was afraid or sad, he would stay and hold that person’s hand. And then that person would leave him, and then he’d go and do the 120 tasks he had left to do, and then go home at 1 o’clock in the morning. Those moments, for him, were the hardest and the most beautiful.”

Azcárate insists he is not a hero. Health care workers, he says, should be valued for the nature of their work, not because they risked their lives absorbing the shock of a pandemic after political institutions failed to stockpile adequate supplies of personal protective equipment or take preventive steps to lessen hospitals’ burdens. He is wary of wartime metaphors that put nurses and doctors on the “frontlines.” Such language, he says, only obscures the thornier problems of public health financing that we as a society should be discussing.

He has taken a leave of absence from Notre Dame to continue caring for COVID-19 patients.

In June, as the pandemic receded in New York, he moved to the hospital in Queens where the city consolidated COVID-19 care; he is set to work there until November. Then, he says, he’ll follow the pandemic wherever people need him most. Maybe back to Texas, where his journey began.

The journey. The turn he took in his effort to find calm led him instead to a place of trust. Trust that he was doing everything he could and that he didn’t have to bear the burden alone.

It’s too soon to know how the pandemic has changed George Azcárate. It hasn’t ended yet. But wherever the healer goes, he will continue to learn. He will console the voiceless and the desperate. And he will help the people there heal.

Michael Rodio is a writer and a former intern at this magazine.