Miguel Ordoñez could not take a deep breath. He could not stop coughing. The symptoms of COVID-19 that began three days earlier were growing worse.
Around 11 p.m. on June 12, he walked into Erlanger Medical Center. Less than four hours later, the 44-year-old was sent home with advice to take Tylenol.
Six days later, Ordoñez was dead.
Ordoñez's unexpected death rocked a Chattanooga neighborhood already hurting from the health and economic impacts of the coronavirus pandemic. Friends and family described him as a gentle, loving man who was always there to help and who was dedicated to the Lord. At the same time, the pandemic that killed a beloved friend and brother is forcing them to grieve in solitude.
What exactly happened inside the emergency department may never be known, because patient privacy laws bar Erlanger from discussing specific cases. However, copies of Ordoñez's medical records obtained by his family and given to the Times Free Press leave his loved ones wondering if something more could have been done.
The many unanswered questions - such as why a man displaying some of the worst COVID-19 symptoms was discharged without further evaluation - have left them angry over what they consider a failure by the health care system.
"How did they let him go?" said Angelique Lopez, who will soon be married to Ordoñez's brother Eduardo. " To me, he had to stay there at the hospital and be treated."
On Wednesday, officials from Erlanger said people who are sent home but have the virus are told to monitor their symptoms and seek care as soon as the illness gets worse.
"As the COVID-19 pandemic continues to rapidly evolve, hospitals across the country are working to provide the best care possible for patients," Erlanger officials said in a statement in response to Ordoñez's death. "Those who exhibit severe symptoms are hospitalized to receive appropriate acute care. We strongly encourage discharged patients who are COVID-19 positive or who are awaiting COVID-19 test results to monitor their symptoms and seek immediate medical attention if their symptoms worsen."
As an otherwise healthy 44-year-old, statistically speaking Ordoñez's prognosis for recovery was good. But because it is a new disease, much remains to be understood about COVID-19, such as why most people recover while others rapidly succumb to the illness.
There is no specific antiviral treatment recommended for COVID-19, but some people with the disease are hospitalized and receive supportive care to help relieve symptoms and treat complications.
Some patients with initial mild symptoms may worsen in the second week of illness. The decision to monitor these patients in the inpatient or outpatient setting should be made on a case-by-case basis, according to the U.S. Centers for Disease Control and Prevention.
Ordoñez displayed many COVID-19 symptoms when he first went to Erlanger a week before his death.
Hospital records from the emergency department visit reveal Ordoñez told Erlanger staff that his shortness of breath, fever, headache and cough had gotten worse in the past three days. They also note he was a "patient with known COVID-19."
Although his body temperature and oxygen levels were normal at the time, both his pulse and respiration were elevated, according to the records. No labs were drawn to test for secondary infections or conditions, and no chest X-rays or lung scans were conducted.
The records say Ordoñez did not have chills or chest tightness. But his family said he told them he did have those symptoms. He also told his family he collapsed while at the hospital because he was so weak, Lopez said. If this happened, it did not appear in Erlanger's three-page report.
Instead, the records say Ordoñez was discharged from the hospital at 2:26 a.m. on June 13. He was told to take Tylenol at home and to seek medical attention if symptoms worsened.
Friends and family said Ordoñez was feeling somewhat better in the days after he went to the hospital. But he was still very sick, still very weak.
Eunice Mendoza, director of Latino ministries at New City East Lake, was constantly calling and texting to check in on him. The church - where Ordoñez attended - continued the meal drop off program it began when they first learned he was ill.
By Friday, nearly a week after Ordoñez visited the emergency department, his sickness took a turn for the worst. He called Mendoza that morning. His words echoed what he told her a week earlier, she said.
"He couldn't breathe," Mendoza said. "He was saying 'I am dying. I can't breathe.'"
The ambulance arrived at Ordoñez's home just after 11 a.m. on June 19. By then, Mendoza was there, too. The color was gone from his face. He had trouble standing, she said.
Ordoñez was taken to Parkridge Medical Center, where he got progressively weaker. There, he underwent a series of tests and a chest x-ray. He was given convalescent plasma and the medication Remdesivir, according to the 25 pages of medical records from Parkridge released to the family. Ordoñez was put on a ventilator but there was not much the doctors could do. His blood pressure continued to decline. At 6:22 p.m., he died.
Ordoñez's friends worry Erlanger staff did not understand how much he was struggling. Maybe, they said, he was not provided a translator.
"He didn't speak English, so he couldn't communicate with them," Mendoza said. "That was my fear. Maybe he couldn't say 'I can't breathe.'"
Erlanger officials said in an email that interpreters are available throughout the hospital.
"We also have a Spanish version of many written materials given to patients, including the discharge papers," officials said.
His brother, Eduardo Ordoñez, is mourning as he recovers from his own battle with COVID-19. The virus took a supportive older brother, he said. At just 44 years old, Miguel Ordoñez had so much of life ahead of him, Eduardo Ordoñez said, speaking through a translator.
"I feel very sad and ill," he said.
Family and friends believe he should be alive today. His sisters and nieces would be making the trip north from Atlanta to see him, to celebrate holidays, to plan for his nieces' birthdays.
Studies have shown that Latinos are more likely to avoid medical care because of a lack of trust and potential cultural barriers in the health care system - such as language barriers or lack of health insurance - making them more likely to delay needed care because of fear or an inability to pay.
They are also more likely to work low-wage jobs that do not offer health insurance or paid sick leave. Ordoñez was a self-employed painter. He did not have insurance and was not eligible for public programs.
Across the country, the coronavirus has disproportionately infected and killed black and Hispanic residents, widening health disparities already created by housing, poverty, limited access to health care and racism.
In the United States, Hispanic or Latino people are four times more likely to be hospitalized or die from the coronavirus than non-Hispanic, white Americans, according to the CDC. For Black people, the rate is five times higher than whites.
Hamilton County has the worst disparity in confirmed COVID-19 cases in the state for Hispanic residents, who make up 6% of the county population but around 60% of infections and a third of the deaths. Part of the higher case rate could be attributed to more targeted testing.
Ordoñez's death was one of four announced over a four-day period in June, part of the deadliest month in Hamilton County for the coronavirus.
Church leaders and members of New City East Lake said losing Ordoñez is devastating. The church shut down in March and developed a coronavirus task force for addressing community needs, such as food and potential housing, and for determining when the church could reopen. Amy Smith, who works on the church's task force, said the death struck at the church's worst fears.
"It's hitting our neighborhoods so it felt almost inevitable that it would impact our community and our church," she said. " And here it is. We've experienced our first case and that first case resulted in a death."
The coronavirus is striking the East Lake neighborhood harder than any other place in Hamilton County. The 37407 ZIP code, which includes East Lake and Clifton Hills and where Ordoñez went to church, represents 3% of the county population and accounts for nearly one in four the local cases. That ZIP ranks 598th out of Tennessee's 600 ZIP codes for health outcomes, according to a partnership between the Tennessee Hospital Association and the Hospital Industry Data Institute.
The pandemic has forced people to grieve at a distance. The close contact nature of services, as well as singing, makes churches among the riskiest places for the spread of the virus, Smith said.
"Trying to balance that physical, emotional and spiritual aspect as we try to care for people, we don't know the answer yet," Smith said.
Gone from the church is the man who was always willing to lend a helping hand, members said. When someone was moving, Ordoñez was there. When a meeting needed extra chairs, Ordoñez was there. He had a way of connecting with people without having to say a word, Mendoza said.
"Everyone knew Miguel," she said. "You may think, oh, he's Latino. He doesn't speak enough English. But I don't know how he found his way to know everyone at church. Maybe because of his serving heart. He was always helping, serving everyone."
Ordoñez frequently stayed late at the church's Thursday night bilingual Bible study held at J. Mark Bowers' house. Bowers would often stand in the driveway with Ordoñez, paint splatters on his clothes from the work day, and the two would talk about Honduras, where they both grew up.
"He'd open up to me about his loneliness, being single and over 40," Bowers said. "He'd confess how hard it was to always be a foreigner in this land. I am so sad he is gone - the loss of a faithful presence."
The loss is especially hard for Eduardo Ordoñez. The brothers, among six children, were especially close. They often worked side by side in their more than 10 years together in Chattanooga.
Much of the money Ordoñez made as a painter went to Honduras to support his 84-year-old father, who is undergoing treatment for cancer, Mendoza said.
"This is what really kills me: He was always helping his family in Honduras. Without Miguel, they didn't have anyone supporting them. He was the pillar of his house," she said.
Ordoñez was honored during a memorial service this weekend. His ashes will eventually be taken to Honduras, the family said.