The first call in early April was from the testing center, informing the nurse she was positive for COVID-19 and should quarantine for two weeks.
The second call, less than 20 minutes later, was from her employer, as the hospital informed her she could return to her job within two days.
"I slept 20 hours a day," said the nurse, who works at a hospital in New Jersey's Hackensack Meridian Health system and spoke on the condition of anonymity because she is fearful of retaliation by her employer. Though she didn't have a fever, "I was throwing up. I was coughing. I had all the G.I. symptoms you can get," referring to gastrointestinal COVID-19 symptoms like diarrhea and nausea.
"You're telling me, because I don't have a fever, that you think it's safe for me to go take care of patients?" the nurse said. "And they told me yes."
Guidance from public health experts has evolved as they have learned more about the coronavirus, but one message has remained consistent: If you feel sick, stay home.
Yet hospitals, clinics and other health care facilities have flouted that simple guidance, pressuring workers who contract COVID-19 to return to work sooner than public health standards suggest it's safe for them, their colleagues or their patients. Some employers have failed to provide adequate paid leave, if any at all, so employees felt they had to return to work -- even with coughs and possibly infectious -- rather than forfeit the paycheck they need to feed their families.
Unprepared for the pandemic, many hospitals found themselves short-staffed, struggling to find enough caregivers to treat the onslaught of sick patients. That desperate need dovetailed with a deeply entrenched culture in medicine of "presenteeism." Front-line health care workers, in particular, follow a brutal ethos of being tough enough to work even when ill under the notion that other "people are sicker," said Andra Blomkalns, who chairs the emergency medicine department at Stanford University.
In a survey of nearly 1,200 health workers who are members of Health Professionals and Allied Employees Union, roughly a third of those who said they had gotten sick responded that they had to return to work while symptomatic.
That pressure not only stresses hospital employees as they are forced to choose between their paychecks and their health or that of their families. The consequences are starker still: An investigation by KHN and The Guardian has identified at least 875 front-line health workers who have died of COVID-19, likely exposed to the virus at work during the pandemic.
But the dilemma also strains health workers' sense of professional responsibility, knowing they may become vectors spreading infectious diseases to the patients they're meant to heal.