READING, Pa. — Angela Barbeito’s eyes tell the whole story.

The smile with which the registered nurse greets patients in the COVID-19 Unit at Penn State Health St. Joseph Medical Center is hidden behind a surgical mask, but it pinches Barbeito’s eyes into twin upended crescent moons.

You’ll find the same eyes up and down the hallways at St. Joseph. Smiling, but weary. Careworn around the edges. The smile isn’t forced. Rather, it’s defiant; fierce positivity in the face of the nation’s most serious health crisis of modern times and all the darkness that has piled in around it: The rapid-fire changes to her job. Fear for herself, her husband and her two children, not to mention the dozens of patients who can turn from pleasant conversation to flatline in a matter of hours.

More are coming every day.

On this day, there are 20 at St. Joseph and eight more suspected to have COVID-19 — nearly a third of all the patients in residence at the hospital in Bern Township, Berks County. They lie in beds in rooms behind sealed glass doors. To enter the rooms for any reason, Barbeito and her colleagues must undergo a ritual that looks more like a deep-sea diving expedition than a patient consultation. Outside the rooms, everyone wears masks and scrubs. Every surface is mercilessly disinfected and wiped down. The simplest of tasks — getting a patient a ginger ale, for example — requires either arduous reapplication and removal of emergency gear or inventing a new method of not entering a room.

“Nothing,” Barbeito says behind her mask, “is the same.”

The staff has converted Barbeito’s section of the hospital ― the Clinical Decision Unit, which is reserved before the pandemic as an admission area for newly admitted patients en route to other parts of the hospital ― into the place for coronavirus patients who aren’t critical. In the old normal, the rooms in the area were usually mostly empty. On this day, 16 COVID-19 patients are there, and the hallway is filled with men and women in blue scrubs.

Numbers written in marker are scrawled across glass doors that line the hall. That’s one of many innovations, said Karen Palladino, manager of the COVID-19 Unit, part of a never-ending array of intangibles health care workers are discovering on the fly. Ordinarily, nurses go into and out of rooms to check vital signs like temperature, oxygen levels and pulse rates. Now, only one nurse or health care worker enters a room at a time to cut down on exposure to the virus, so writing statistics on the window limits the number of visits.

The health care workers at St. Joseph say they are well-trained and well-equipped. But COVID-19 is still new.

Just after 10 a.m., a nurse stands outside one of the rooms and dons her personal protective equipment. She pulls on rubber gloves, lowers a clear-plastic face shield over her face, and wraps herself in a smock — all equipment that has been painstakingly disinfected many times. Kristin Gilbert, a registered nurse who usually works in the Clinical Decision Unit, helps tie the gown in the back.

The door slides open, and the nurse slips inside. In the bed is a woman lying face down, her hair a dark cloud in white sheets. The nurse approaches her with an inhaler for asthmatics.

“Shake it,” Gilbert yells through the window.

The nurse looks up behind her face mask.

Gilbert pantomimes. “Shake it,” she yells again. “One puff and hold it for five to 10 seconds.”

The nurse nods and kneels next to the patient.

The nurse, Gilbert explains, speaks Spanish and is helping to translate for the patient. More than 64% of Reading’s population is Hispanic, and the hospital employs many Spanish-speaking nurses. Since the COVID-19 crisis began, the unit has borrowed nurses from other sections of the hospital who may or may not regularly use some of the equipment necessary to treat the pandemic but who can help with issues like language barriers.

The work is often done in tandem. Health care workers stationed outside the rooms are frequently from different departments. They’re called runners. The health care worker inside the room, covered in personal protective equipment, often knocks on the windows to ask for something. In a carefully scripted way, the runner obtains it, rather than forcing his or her counterpart to doff all the protective equipment and mar its sterility.

This particular patient, Gilbert says, was fine just a few days earlier. Her temperature was still high, but she seemed perfectly healthy. The virus attacked her breathing over the weekend. Since then, her condition has worsened.

“It’s scary,” Gilbert says.

But less scary with each passing day, says Tony Catanzaro, a critical care nurse educator. Catanzaro helps the critical care nursing staff learn the latest about research and share common practices. On this day, one floor up from the COVID-19 Unit, six patients are in Critical Care.

Since the crisis began, St. Joseph has become far better equipped to handle the pandemic, perfecting processes that hadn’t even been invented there just three weeks ago, such as the outdoor screening of potential COVID-19 patients, Catanzaro says.

“It gets better every day,” he says. Sometimes the improvement is incremental. Sometimes, it’s bigger. As the number of cases mounts worldwide, Catanzaro says health care professionals have learned when and when not to put a patient in prone position (having a patient lie on his or her stomach, which can help with air flow). They’ve also learned about the timing of when to intubate a patient. Such discoveries can help minimize damage to lungs and make all the difference in recovery, Catanzaro says.

Many staff members waging war on the illness are battling their own stress, he says. Members of his team have reported the same waking nightmare. In it, they find themselves in a hospital room. They aren’t wearing protective equipment. They’re coughing.

Days earlier, St. Joseph had its first COVID-19 fatality. It was a somber moment for everyone, Catanzaro said. The patient, a 56-year-old man who’d been in town staying with family, had seemed to be on an upswing and suddenly nosedived.

There are setbacks, but Catanzaro says many members of his team are energized by the challenge. He finds his own personal respite by spending time with his kids at home and his parents — who he avoids, following the auspices of social distancing — from afar.

Palladino, who has three children at home, agrees. “You cherish them more.”

She asks some of her colleagues walking past, “How do you cope?”

“I take my mask off,” one says. “It’s so freeing.”

Her coworkers laugh. Laughter is helping to pull everyone through, Palladino says, and jokes in the COVID-19 Unit are sometimes greeted like expensive gifts.

“You can’t breathe in these things,” Palladino agrees.

The masks and the protective equipment “take a toll,” Barbeito agrees.

Like everyone else, Barbeito’s entire life has been upended by the virus.

Even her commute home has become a new ritual. Before COVID-19, she jumped into her car and drove home at the end of her shift. Now, before leaving, she visits a room in the COVID-19 Unit, for a shower. A few weeks ago, Palladino posted a request on Facebook for people to donate special soaps and bottles of body wash for nurses after their shifts. The response has been enormous – now the COVID-19 Unit’s makeshift locker room is overflowing with fancy bath goods.

After her shower, Barbeito changes into her street clothes. She goes to her car. Using disinfectant and a rag, Barbeito wipes down the interior of her car, changes into shoes she’s left there. She drives home. She goes inside and takes another shower.

Then, she can hug her children.

“I’ve been a nurse for 20 years, and I’ve never …” she says. She doesn’t finish the sentence.