Del Rio, Texas (CNN)Azeneth Perry traced the sign of the cross on her body as she watched the ambulance drive away.
Her husband, Paul, felt fine the day before, but he woke up with pain in his legs January 25. Later that morning, she dropped him off at the hospital in Del Rio, Texas. She got a call within a few hours saying he had tested positive for Covid-19 and was being transferred for specialized treatment in San Antonio, nearly three hours away.
Azeneth raced to the hospital and said goodbye while her husband was loaded into an ambulance for transfer. With tears welling up behind her face shield, she told him she loved him and begged him to keep breathing.
Shell-shocked, Azeneth stood in disbelief at the speed of what had just happened.
"It might be the last time I see him," she said, still standing in the hospital parking lot.
Transfers to San Antonio are crucial for the Val Verde Regional Medical Center in Del Rio, a quiet town of about 36,000 near the Texas-Mexico border. The small hospital already has two Covid wings, but when it reaches capacity -- or when patients need more specialized treatment, like a pulmonologist -- they're shipped out to a bigger city with more resources.
Just down the street from the hospital, four ambulances sit ready at the edge of a hotel parking lot, standing by for the moment a bed opens up somewhere else. They're part of a five-vehicle team that transfers patients from Del Rio and Eagle Pass, another small town nearby.
Health systems face being overwhelmed
As Covid-19 cases exploded along this stretch of the border over the past couple of months, the transfers became a daily reality in the fight to keep health systems from becoming overwhelmed.
Farther south along the border, in Laredo, Texas, hospitals are also struggling to keep up with the post-holiday spike in infections. The state set up medical tents and surged resources to treat the flow of patients.
Dr. Ricardo Cigarroa, a renowned cardiologist in Laredo, said fatigue over Covid-19 restrictions became a deadly factor in this part of Texas.
"We have a sniper here that has killed 600 people and is on track to kill another thousand before this year is up -- and we don't fear it? I guarantee you if it was a sniper with a rifle, there wouldn't be one parent letting their child out," he said, referring to the 675 Covid-19 related deaths in Laredo as of Thursday.
Hospitalizations reached record highs in Texas over the past month, with more than 14,200 patients hospitalized during a mid-January peak. The South Texas area is now among the worst-hit regions in the country -- a sliver of dark red on CNN's county-by-county map of cases and deaths.
Cigarroa opens his cardiology clinic every day from 6 p.m. to midnight for coronavirus patients who don't need hospitalization but do need a doctor. On a Tuesday night in late January, his lobby had 25 patients waiting to see him. More were coming later that night.
Dubbed the "Dr. Fauci of South Texas" by Texas Monthly magazine, Cigarroa has been a prominent voice on the dire situation in Laredo for months. He routinely advocates for tougher restrictions.
"If you were to take a survey, 80% of Laredo would say we have to shut this down," he said. "Every family has had a death."
'It hit us like a train'
Back in Del Rio, nurses and doctors say the recent wave feels like a case of post-traumatic stress disorder following last summer's devastating crush of cases and deaths in their small community.
"It hit us like a train," said Dr. Aurelio Laing, a physician and president of the board at Val Verde Regional Medical Center. "We got through it. We lost a lot of friends. We lost employees. We lost family members."
At the time, military medical personnel were brought in to assist with the surge of hospitalizations. The state still provides medical staff, but Laing said the doctors and nurses feel better equipped this time around to treat patients.
Still, the dying doesn't get easier.
"It's just emotional fatigue," said Laing. "It's the loss of life. It's not our normal."
"This is cutting people's lives short. These are people who aren't ready to go," he continued. "Knowing you're going to put someone on a ventilator, and you're probably the last person they're going to see, that's a real tough one."
The lives lost
Among those lost: one of the hospital's most beloved employees, Irma Santellanes, a unit secretary who worked at the Val Verde center for 43 years. She was diagnosed on a Tuesday in July and died two days later. She was 62.
Mida Santellanes, Irma's daughter, is a nurse at the hospital and proudly carries her mother's photo on her badge, a practice adopted by many of the doctors and nurses on staff. Mida was working at the hospital the night before her mother died and got to see her one last time -- an in-person goodbye so rare amid the pandemic.
"I gave her a hug, and I kissed her forehead with my mask and my suit on. I didn't know that would be the last time I saw her," she said, growing emotional. "But I will always cherish that."
Within a few weeks, Mida Santellanes, who contracted Covid-19 around the same time as her mother's death, was back at work in the hospital and battling the summer surge of patients. She feared she would relive tragedy once again in January when her brother tested positive and required hospitalization for five days.
But he survived, sparing her family another loss.
In Del Rio, at least 179 people have died from Covid-19 -- a startling number for such a small and relatively isolated community.
"We know everybody," said Laing, who grew up here. "So when you bring in that one person, it's so-and-so's grandmother. It's so-and-so's mother."
Hospital capacity the top concern
The biggest concern for doctors and nurses is whether there's enough space in the larger cities if the Val Verde Regional Medical Center needs to transfer someone.
Sometimes it can take days for a bed to open up in San Antonio, which admits patients from rural areas across southwest Texas.
On January 25, six of the seven Covid-19 intensive care unit beds at the Val Verde center -- and 12 of 18 beds in its less-critical-care Covid-19 unit -- were occupied by coronavirus patients, amounting to 50% of the hospital's total beds.
One patient in the ICU had been on a ventilator for two days, and the medical team was relieved when they got the call that a bed opened up in San Antonio. They began preparing for the transfer immediately.
The patient died a few days later.
The fast-changing status of their charges is a roller-coaster ride of emotions for the medical staff, who not only bond with their patients but routinely provide updates to family members not allowed inside.
Nurse Lana Sanchez said that when her patients die, she holds their hands, prays for them and plays their favorite music. "It's not normal to see so much death," she said. "And I don't want it to be normal for anyone."
'We are going to get out of here'
Jose Limón, a baseball coach who's been in the Val Verde ICU for nearly three weeks, likes to peer out over his breathing mask and scroll through photos on his phone of his three children and six grandchildren.
Last week, he teared up during an interview while talking about his wife. They've never spent this much time apart in their 44 years of marriage.
Dubbed a "fan favorite" by the hospital staff, Limón was fighting for his life. "We're going to get out of here," he said, looking up at his nurse, Sanchez. "We're going to do it. We're going to make it."
A little over a week later, Limón was wheeled out of the hospital doors to greet his beloved family.
Over the past week, the numbers at the hospital have improved. As of Thursday, two patients were in the Covid ICU and six in the less-critical-care unit, according to hospital officials.
It's perhaps a sign of hope that this community could be over the hump from the most recent surge, but the medical staff know all too well that things can change -- quickly.
Meanwhile, Azeneth Perry, who watched her husband leave in an ambulance, is feeling fortunate. Her husband, Paul, was released from the hospital in San Antonio four days later, and they're now at home together in Del Rio. She also has Covid-19.
Perry said although her husband survived, she's keeping a close eye on him. He's weak and disoriented, and she has seen one too many family members and friends succumb to the virus lately.
"It's spreading like wildfire," she said. "This is real life."