This time last year, we were just beginning to feel the effects of the coronavirus pandemic.
Shutdowns, quarantining and mask-wearing quickly became a strange "new normal" in response to the novel virus.
On the frontline, healthcare workers witnessed the worst of it, especially those working in hospital intensive care units.
Respiratory therapist Jonathan Settles says COVID-19 initially felt like a faraway problem.
"We were starting to hear about it China," Settles said, remembering the early months of 2020. "I wasn't too concerned about it at first."
But quickly, things changed at his workplace: French Hospital Medical Center in San Luis Obispo.
"We basically went to airborne precautions which is one of the highest PPE levels that you go to because we didn't know what to expect," Settles said.
The unknowns of COVID-19 were frightening to even seasoned nurses like Jennifer Neff.
"It was scary at first," Neff said. "Even being a nurse for over 20 years, I was scared."
French Hospital's ICU director, Rose Bray, remembers bracing for a surge of COVID-19 patients.
"We just went ahead and got ready on every possible level," Bray said.
Nurse Michele Constable has cared for some of the sickest COVID-19 patients in San Luis Obispo County and describes the virus's common side-effects in severe cases.
"Respiratory distress if not failure, high fever, altered level of consciousness... multiple days of lethargy, across the board multi-organ failure," Constable said.
Losing patients is now an everyday reality for these everyday heroes.
"Sometimes when driving home, you just start crying and that's okay. It's hard not to get attached," Neff said. "There have just been too many that have passed."
Despite all the loss, the ICU staff soldiers on.
Before going into a COVID-19 patient's room, Neff must don a special hood called a power air-purifying respirator (PAPR) because N-95 masks don't fit her face well enough to protect against virus-exposure. Neff says the tedious process of putting on PAPR now feels second-nature.
"I don't even think about it anymore. At the beginning, it was such a process to do it and now, you just do it," she said.
Once thought of as a last-ditch effort, Constable says the process of proning, or turning patients onto their stomach, is now done right away.
"When you are flipped on your stomach, the backside of your lungs are able to expand," Constable said. "It's an intervention that I think from the nurses' perspective that's given us hope. I've seen patients improve on a ventilator just from proning."
"We're constantly bringing new science in," Bray said. "Our unit is run by intensivists who are very, very aware of the new science and we are trying everything we can to get these patients to survive."
Survival in the ICU often hinges on the work of respiratory therapists and ventilators.
"Simply put, this [ventilator] is life support," Settles said.
Settles says outcomes for COVID-19 patients are often unclear.
"There's been moments where I was like, we're still going to do everything that we can but I don't know," he said. "And then all of sudden, maybe a week, two weeks later, they're walking out and they're saying 'thank you.'"
Bray says her staff takes time to celebrate the victories.
"The day a COVID patient leaves the hospital, we'll play a song overhead and we'll do an honor walk," she said.
They also take time to process their grief.
"If we do have a passing of a patient, we call for a debriefing," Bray said.
The ICU staff say the silver lining of the pandemic is how it has bonded them.
"They get it, they get what goes on here. My family and my friends, they don't get what we see back here," Neff said.
"I'm thinking about how very hard my staff works, they are amazing and I am very proud of them. I'm very honored to be their director," said Bray.
A year into the pandemic, ICU workers continue to face each day with grit and grace.
"I learned that I'm a lot stronger than I thought I was," Neff said.