HOUSTON — Paige King knew something was wrong the moment she pulled up to her house on the evening of Oct. 26.
Her partner, Dr. Carlos Araujo-Preza, was sitting on the hood of his car in their driveway. He was wearing scrubs and a respirator — the one he'd worn in the intensive care unit each day while treating coronavirus patients — and he had a duffel bag packed at his feet.
King got out of her car and asked what he was doing.
"I have Covid," he said.
For a moment, King hoped he was messing with her. In their seven years together, she'd gotten used to his playful sense of humor. But this wasn't a joke.
Araujo-Preza told King he would quarantine at his lake house to protect her and his 78-year-old mother, who lived with them. But he told King not to worry.
As a critical care pulmonologist, he'd spent months treating hundreds of critically ill Covid-19 patients at HCA Houston Healthcare in Tomball. The sickest of the sick. The vast majority of those in need of hospital care were elderly or suffered from underlying health problems.
Araujo-Preza was 51 and fit, not at high risk of serious coronavirus complications, he assured her. King, a nurse practitioner at his practice, knew he was right.
She remembers teasing him as he loaded his bag into the trunk. Araujo-Preza loved "Star Wars" and sometimes jokingly referred to himself as a Jedi.
"I was like, 'If I don't get Covid after sleeping in bed with you, then I'm the real Jedi Master,'" King said.
They both laughed and said "I love you" before hugging briefly. Then he drove away.
"Neither of us was afraid," King said. "We both thought he'd be fine."
But as the disease ran its course, fear would come. Then desperation. And finally, unspeakable sadness.
A little more than a month after their playful exchange in the driveway, King would find herself rifling through the closet of her partner — the "love of my life," she called him — looking for his favorite suit.
Araujo-Preza was a handsome man, and King wanted him to look his best at his funeral.
‘I was born for this’
As the critical care medical director at HCA Tomball, a 350-bed hospital north of Houston, Araujo-Preza was thrust to the front line of the Covid-19 crisis this spring.
His team was stretched so thin early in the pandemic that Araujo-Preza started staying at the hospital overnight in April. For weeks, he slept in a room near the ICU. That way when patients deteriorated, he'd be only steps away when it was time to intubate them.
For most of April and May, he and King, 39, saw each other only in passing. For nearly eight years, ever since King went to work for him, the two had seen each other almost every day, especially after they started dating and moved in together. But now he was staying at the hospital night and day, stopping home only for a quick shower and a change of clothes.
His 22-year-old daughter, Andrea Araujo-Preza, worked as an assistant at the clinic where her father cared for patients in need of outpatient breathing treatments, but she barely saw him those months. She and her brother, Carlos Araujo-Preza Jr., were worried about him.
"But he was so committed to his patients," she said. "His work was like his calling."
King remembers asking Araujo-Preza one morning, when he stopped home for a shower before heading back to work: "Baby, aren't you afraid of getting this?"
Araujo-Preza shook his head.
"I'm not afraid," King recalls him saying. "I was born for this."
King didn't argue. She knew he was taking every precaution to avoid contracting the virus. And it would have been selfish to ask him to stop treating patients in such desperate need of his care.
Araujo-Preza had moved to the U.S. from El Salvador in 1994 with a dream of becoming a doctor. He wanted to help people heal, he told loved ones. After completing his medical education in New York, he moved in 2001 to Houston, where he treated thousands of patients over two decades.
"He truly was born to be a doctor," King said. "He was born to help people. He was born to make people feel not afraid during the scariest time of their life."
That's how Leonor Quiroz felt when she met Araujo-Preza in May. Quiroz, 47, was having a hard time breathing and had just tested positive for Covid-19. She was terrified.
Then Araujo-Preza came to her bedside.
"He very calmly explained what needed to be done," Quiroz said. "He was honest with me. He told me: 'You have pneumonia. You have a bad case. But we're going to get it under control, and you're going to be OK.'"
The doctor's face was covered behind a respirator and a plastic face shield. But she could tell from his eyes that he was being genuine.
"He had such kind eyes," Quiroz said. "I'll never forget them."
After a couple of weeks under his care, receiving steroids, supplemental oxygen and fluids, she made a full recovery.
Araujo-Preza tried to do the same for Quiroz's husband, Valentin, after he tested positive days after her. But Valentin, 52, wasn't as fortunate as his wife. After two weeks in Araujo-Preza's ICU, he died.
In the hectic aftermath, between planning a funeral and trying to come up with money to pay their medical bills, Leonor never got a chance to tell the doctor thank you.
"I'm alive today because he was willing to risk his life to treat me," she said.
‘It finally caught up with him’
The first sign of trouble came in mid-October, just as Covid-19 cases began to surge again in Texas. It was a Monday, and Araujo-Preza was complaining about body aches.
He must have pushed it too hard while working on his boat the day before, he told King.
"I was like, 'Dude, you did not do that much exercise,'" King said.
Araujo-Preza didn't feel better in the days that followed. A week later, after spiking a slight fever, he tested positive for Covid-19.
"After all those months, it finally caught up with him," King said.
Even with personal protective equipment, medical workers are among those at the highest risk of contracting the coronavirus, especially those who treat Covid-19 patients daily. Nationally, at least 1,425 health care workers have died of the disease, according to an incomplete database compiled by Kaiser Health News and The Guardian.
But as he headed to his lake house to quarantine, Araujo-Preza told his family that he wasn't worried. He was in good shape and knew the statistics were on his side.
"For a lot of people, Covid symptoms are just like a bad flu," said Andrea, his daughter. "And at first, I think that's how it was for him. He kept saying he was feeling fine."
King called him every day to check in. On the night of Halloween, five days after his diagnosis, she heard something different in his voice. His breathing was labored, and he sounded confused.
She hung up and sped for the lake house. She put on her respirator before heading inside.
King found him in bed and quickly took his temperature: 104.8 degrees.
"We've got to go to the hospital," King recalls telling him.
"I'm not going to the hospital," he responded, insisting there was nothing doctors could do for him at that stage that he couldn't do for himself.
King pleaded with him. But instead, he directed her to go to his clinic and bring back an oxygen concentrator, some fluids and an IV kit. When she returned, she gave him a steroid injection.
"I'll be fine," he said.
But King wasn't so sure.
"I said, 'Carlos, what is it going to take for you to go to the hospital?'" King said. "And he said, 'I'll go when I think that someone else doesn't need the bed more than I do.'"
King shook her head. Even while sick, she thought, this man was still putting patients before himself.
But when he woke up that Monday, he was in respiratory distress and in need of a hospital bed as much as anyone.
From doctor, to patient
Araujo-Preza checked himself into his own hospital on the morning of Nov. 2. Chest X-rays revealed a severe case of pneumonia, and doctors admitted him to the ICU.
Araujo-Preza's colleagues began treating him with the same experimental Covid-19 therapies he'd spent months administering to patients. Physicians and nurses he considered friends infused him with convalescent plasma, donated by Covid-19 survivors. They gave him remdesivir, an antiviral drug that has shown mixed results in speeding recovery times. They administered steroids to beat back inflammation in his lungs.
But none of it seemed to be working.
Araujo-Preza, all too aware of the dangerous path he was on, refused to eat or drink, having seen too many of his Covid-19 patients aspirate food or liquid into their lungs. And he insisted that he didn't want to be connected to a ventilator, knowing how few patients recovered once it reached that stage.
King was terrified for him.
Because she had privileges at the hospital, she was able to see him every day, despite visitor restrictions. She looked in on him one morning, a few days after he was admitted, and felt a surge of panic.
King could see through a window into his room that his skin had become pale and he'd lost weight. Then she noticed an alarming set of numbers on one of the monitors: He was taking between 50 and 60 breaths per minute, four times the normal rate.
"Oh, my God," she thought.
One of the ICU doctors pulled her aside and told her they were running out of time. Araujo-Preza was going to need to be put on a ventilator if his condition worsened.
Tears streamed down King's cheeks as she stepped away and called her father.
"Daddy," she remembers telling him, "I don't think he's going to make it."
‘If I'd lost you’
That same afternoon, King was still at the hospital, rounding on her patients, when she got a text message from Araujo-Preza. He wanted her to come to his room.
She couldn't believe he was feeling well enough to use his phone.
When she arrived at his bedside, she noticed that his breathing had stabilized. He told her that he was feeling better and that he loved her.
She cried and told him she was afraid she might lose him.
"I didn't feel like he was out of the woods, but he was looking so much better," she said.
His condition continued to improve. Color returned to his skin. He was eating again.
Within days, on Nov. 9, doctors said he was free to go home. Araujo-Preza insisted on driving himself; King trailed behind, feeling more fortunate than at any other time in her life. She was still keeping physical distance and wearing a respirator around him, but at least now he was on a path to recovery.
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As they got ready for bed the following night — still quarantining at the lake house to protect Araujo-Preza's mother — King told him how scared she'd been one week earlier, when she thought he was dying.
"I couldn't have imagined my life if I'd lost you," she said.
King was still feeling giddy with relief when she woke up the next morning. But when she looked at Araujo-Preza in bed, she felt her chest tighten.
"Baby," she said, a slight tremble in her voice, "I think you've had a stroke."
Araujo-Preza got up and looked in a mirror.
"Oh, s---," he said, noticing that his left eye had turned inward.
Just as his lungs had begun to recover, the disease had shifted to his brain.
A final goodbye
King tried to stay calm as she helped him into the car and rushed him back to HCA Tomball, crying and gripping his hand as she drove.
"Tranquila," he told her. "I'm going to be OK, love. I promise."
At the hospital, a CT scan revealed what she feared. There was swelling in Araujo-Preza's brain, a serious but rare complication of Covid-19. One of the cruel tricks of a respiratory disease that doctors are still only beginning to understand.
Araujo-Preza's speech became slurred in the days that followed. It pained King to see such a brilliant man struggle to communicate.
After a few days, when it became clear he wasn't improving, King had him transferred to Houston Methodist Hospital, where doctors could offer a wider range of treatments.
King didn't work at that hospital, which meant she would no longer be able to visit him. But each day, she was allowed to video chat with him. And each day, Araujo-Preza's condition seemed to worsen.
Then, in late November, more than a month after his initial diagnosis, he slipped into a coma and was connected to a ventilator.
King knew she was losing him for real this time.
On the night of Sunday, Nov. 29, she asked one of Araujo-Preza's nurses to set up one more video call. After dialing in, she propped up her phone next to her in bed and nestled her face on one of Araujo-Preza's old scrub caps.
It still smelled like him.
And for the next two hours, she just talked. She told him about her day, like she used to each night, before Covid-19 first stole him from her in the spring.
Through tears, she told Araujo-Preza that she was going to miss him for the rest of her life.
On the screen, she could see him lying silently in bed. He was motionless, other than the rise and fall of his chest as a machine pumped air in and out of his lungs.
She tried matching her breathing to his, just as she had on so many restless nights, allowing the rhythm to lull her to sleep.
An outpouring of grief
In the days after Araujo-Preza's death on Nov. 30, his loved ones were flooded with messages from former patients. Doctors and nurses who'd worked with him reached out, too, each with a similar message:
Araujo-Preza was one of the kindest and most compassionate physicians they'd ever known.
"Oh my gosh, I have felt so much love," said his daughter, Andrea. "Patients from years ago have been sending flowers or messaging me on Facebook, just saying how much my father meant to them and that they can't believe the world has lost such a wonderful person."
Leonor Quiroz, the Covid-19 patient who felt comforted by Araujo-Preza's presence, cried when she saw news of his death. The story was accompanied by a photo of him — the first time she had seen his face without most of it covered behind a mask.
He was even more handsome than she realized.
"For him to die from the same thing that he saved me from," Quiroz said, "I don't think you can make a greater sacrifice."
On Tuesday, on what would have been Araujo-Preza's 52nd birthday, King opened an email that brought a new surge of emotions.
Anger. Despair. Regret.
It was a message from the hospital notifying her that a Covid-19 vaccine would soon be available for medical workers. They were inviting her to register to get a shot in the coming weeks.
It wasn't fair, she thought, fighting back tears.
She imagined their life together, if he'd only been able to avoid the virus for a couple of months longer. She might have been setting his favorite suit out for a celebration, instead of a funeral.