Whenever ICU nurse Tiffany Hughes is having a tough day at work, surrounded by patients sicker and more immobilized by COVID-19 than at any point in the pandemic so far, all she has to do is look at her forearm.

There is a single tattoo — the tip of a spear pointing down to her left wrist with a heart rate monitor line in place of a shaft. In military circles, a spear tip is the combat force that first penetrates the enemy’s defense.

Hughes isn’t the only one with this marking. A team of a dozen or so intensive care nurses at Mission Hospital in Mission Viejo, where area patients are admitted and transported from the facility’s affiliate hospital in Laguna Beach, got inked together this summer as a sign of solidarity.

Working in the trenches of the hospital’s COVID-19 ICU unit, they started calling themselves “the tip of the spear” after a respiratory therapist posted a sticker with the phrase above an entryway.

If the coronavirus is the enemy, they are the ones at the head of the frontline.

“It really does feel like a MASH unit,” the 38-year-old Rancho Santa Margarita resident said conjuring the image of a mobile army surgical hospital. “It’s not like we have missiles flying over our heads, but there is a certain amount of trauma you see.”

In the past 10 months, nurses like Hughes have watched the perils of the coronavirus unfold in Orange County hospitals. They’ve seen facilities scramble to prepare for a pandemic whose depth and reach even science didn’t understand.

After a summertime lull, the pace of patients requiring intubation and other intensive care services gained speed. Now, area hospitals seeing record numbers of COVID-19 patients are implementing surge plans to deal with an overflow of patients.

The Orange County Health Care Agency on Friday reported a record 2,259 individuals were hospitalized with COVID-19, a 3.2% increase in the county’s three-day average. Of those patients, 514 occupied intensive care units.

With 638 adults currently admitted into ICUs countywide, only 34 adult beds remained in all of Orange County as of Thursday, according to data collected by the California Department of Public Health and updated by OCHA.

Dr. Philip Robinson, director of infection prevention at Newport Beach’s Hoag Hospital, said the site has canceled elective surgeries and is redeploying nurses from other service lines to COVID-19 units while medical-surgical nurses are trained to care for critical patients.

“We are experiencing a surge that is expected to continue for several weeks, like the rest of the region,” Robinson said in a statement. “We have many physicians and medical staff stepping forward and working long hours to meet the needs of the community.”

Representatives from hospitals throughout the county — including Hoag, Mission and MemorialCare Orange County Hospital in Fountain Valley — would not provide specific information on the number of COVID-19 patients being treated facility-wide or in intensive care units. They similarly declined to share ICU bed capacities, claiming such numbers are too fluid to report, even though each hospital is obligated to provide daily counts to the healthcare agency.

At Fountain Valley Regional Hospital & Medical Center, a union representative recently said staff were caring for 189 COVID-19 patients. Jennifer Bayer, a spokeswoman for the Tenet Healthcare-owned facility, did not confirm that number but said by email Tenet is readying mobile field hospitals at Fountain Valley Regional and its Los Alamitos Medical Center.

“We have reached our licensed adult ICU bed capacity but have enacted our surge plans and are currently able to provide ICU care for patients requiring it in other units within each of [our] hospitals,” Bayer wrote.

At Mission Hospital, the COVID-19 intensive care unit holds just 14 beds, but the Mission Viejo site has reoutfitted its cardiac ICU to admit 20 to 30 more infected patients, Hughes said.

As healthcare experts urge those with nonserious viral symptoms to self-quarantine in lieu of visiting packed emergency rooms, the patients who make it to the ICU are sicker than ever.

Hughes described holding iPads up to comatose and intubated patients so families could say virtual goodbyes. Sometimes employees break down for just a minute, then get back to work.

As a single mom, it’s hard for her to leave her 6-year-old daughter with her parents, knowing she is exposing herself to the virus. But duty calls.

For Hughes and her “brothers and sisters at the bedside,” the COVID-19 pandemic will eventually end. But, in ink, they will carry the memory of their time together on the frontline.

“I would mark my body forever to remember I’m part of a crew and we helped the world in this way,” she said.

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