Ashley Cude helps Liz Michaud placed on a precaution robe on within the Particular Care Unit at Stephens Memorial Hospital in Norway. The 2 registered nurses look after sufferers affected by acute COVID-19 signs. Gregory Rec/Employees Photographer
They sat of their vehicles exterior Stephens Memorial Hospital in Norway on Thursday afternoon, their engines idling to maintain heat. At this very early stage of their encounter with the well being care system, every was formally categorised as a PUI – brief for “individual beneath investigation” for potential COVID-19.
“I believe there’s 4 of their automobiles presently proper now ready to come back into the emergency division,” Kevin Hodson, a nurse, mentioned throughout a short break contained in the hospital’s nine-bed emergency unit.
They usually have been out within the parking zone as a result of there was no protected place for them inside?
“Appropriate,” Hodson replied. “I don’t have any rooms acceptable for them” to await their analysis.
Down the corridor within the 25-bed hospital, respiratory therapist Ashley Cude took a second to replicate on her herculean duty in latest days – getting as a lot oxygen as potential into sufferers whose lungs have been ravaged by the virus now sweeping throughout rural Maine.
“I’ve had 4 completely different sufferers ask me immediately, ‘When can I am going residence?’” she mentioned. “And I don’t know…however it’s a protracted street.”
A street which may finish proper right here in a hospital mattress?
“That’s precisely it,” Cude replied. “However how do you say that to somebody?”
For a lot of Mainers, last week’s announcement that the sprawling MaineHealth community was at its outer restrict for dealing with the pandemic was however one other superlative at a time when the phrase “highest” appears to precede each grim replace:
Highest ever variety of circumstances reported in a day – 2,148 on Friday, obliterating Thursday’s report of 1,460. Highest ever seven-day case common – 962.4 as of Friday. Highest want for reinforcements because the pandemic started nearly two years in the past – enter the Maine Nationwide Guard and a federal “surge crew” of clinicians to assist deal with the ever-escalating load.
“We’re operating out of straws. There aren’t a whole lot of nice choices left,” Dr. Andrew Meuller, CEO of MaineHealth, mentioned throughout a Zoom press convention Wednesday, surrounded by a gallery of somber-faced executives and medical professionals from throughout the state’s largest well being community.
Amongst them was Dr. Ryan Knapp, chief medical officer at Stephens Memorial. Two beds had simply opened up at his small facility, he reported. The explanation? Two extra sufferers had died.
Knapp was talking from his residence, the place he remained remoted final week after his 4-year-old daughter, too younger to be vaccinated, contracted COVID-19. She’s doing properly, he later mentioned in a distant interview, however the implication was clear: As COVID-19’s Delta variant surges on this area with low vaccination charges, security has turn out to be elusive luxurious. And nowhere is that extra evident than on the neighborhood hospital whose medical employees Knapp oversees.
“They’re struggling,” he mentioned of the small cadre of docs, nurses, physicians assistants and medical help employees now within the struggle of their skilled lives. “It’s an emotional toll to maintain such a degree of sickness day in and day trip – one thing that they’re not used to doing.”
What’s taking place at Stephens Memorial, one in all a dozen neighborhood hospitals within the MaineHealth system, displays the pandemic’s stealth-like assault on the inhabitants’s most weak. Again when COVID-19 first hit in early 2020, the small services deliberate and ready like all over the place else for what they thought can be a sudden onslaught of severely in poor health sufferers.
However that wave by no means got here. Whereas extra populated areas reeled from COVID-19 spikes early on, issues stayed eerily quiet at Stephens Memorial, nearly as if the storm had handed them over.
Not now. The ever-opportunistic virus goes the place the vaccines aren’t – and with Oxford County among the many 4 counites in Maine with full vaccination charges nonetheless under 60 % as of Friday, COVID-19 has swept in with a vengeance.
One wing of Stephens Memorial is now sealed off for COVID-19 circumstances, which nowadays comprise roughly half of the hospital’s common each day census of twenty-two inpatients. Makeshift followers and ducts keep unfavourable air stress in that unit, holding airborne pathogens from spreading to different wards.
However in a facility this small, there is no such thing as a escaping the pandemic and its myriad challenges. Out within the parking zone, along with these ready to get into the emergency room, native residents line up at a drive-thru testing web site. As many as 100 assessments per day are being administered, with positivity charges exceeding 20 % on three separate days final week.
Non-COVID-19 sufferers who stayed away from wanted therapies early within the pandemic have returned in droves – they usually’re sicker now for having stayed away.
Hospital employees members, beneath a “surge staffing” plan now in impact via the top of March, are being requested to work extra shifts to assist deal with the heavier load. And whilst they do, they fear that they’ll carry the virus residence to family members.
Liz Michaud, a nurse within the hospital’s four-bed particular care unit, gave start to a woman in August.
“It’s not like once you go residence, it’s gone,” Michaud mentioned whereas ready for a brand new arrival to fill an SCU mattress that had simply opened up. “You continue to have your loved ones and associates speaking about COVID, asking you ways it’s within the hospital. You’re simply form of like at all times immersed in it…you simply get drained.”
Feedback like that weigh closely on Andrea Patstone, president of Western Maine Well being, which incorporates Stephens Memorial. She took over because the hospital’s chief administrator in January 2020 – simply weeks earlier than the pandemic hit – and now faces a disaster not like any she’s ever encountered in her profession.
“I went to coverage college – they don’t train this in coverage college,” Patstone mentioned. “If you see your care crew members who’re stalwart, compassionate, by no means flagging they usually break down for a second in frustration or in exhaustion, that’s once I really feel like I’m not doing my job. And I’m right here to maintain them.”
It’s a tall order, given what’s taking place solely footsteps kind her workplace. Questioned Patstone aloud, “Are you able to think about making an attempt to calm somebody down who can’t breathe?”
Hospitals, after all, are by no means straightforward locations to work. Nevertheless it’s the present diploma of problem that has Stephens Memorial, like so many rural well being outposts, so out of its component. Sufferers die every so often, however by no means so many who, when requested in regards to the pandemic’s native toll throughout final week’s go to, nobody might give you an precise depend.
“We’ve had members of the identical household in numerous beds on the alternative aspect of partitions, each of them nearing the top of life – all of it preventable,” Patstone mentioned. “And we spend our time making an attempt to determine if we will get them in the identical room collectively for a number of moments earlier than it’s throughout.”
She paused for a second, then added, “And none of that has to occur.”
That realization, just like the virus itself, is inescapable all through this 64-year-old hospital that was by no means meant to carry again this huge a public well being calamity. If solely extra folks in these elements would get vaccinated. If solely they’d put on masks. If solely they’d hold extra social distance. If solely…
Knapp, the chief medical officer, is aware of higher than most how unrelenting COVID-19’s grip is on unvaccinated Maine as one more Christmas season approaches – proper on the heels of the now-unfolding Thanksgiving surge. Every day, he participates within the “capability name” along with his friends all through the MaineHealth system to find out who wants a mattress, who has a mattress, who may need a mattress, who’s exceeding their capability beneath a federal pandemic waiver. Some days, Stephens Memorial’s each day census has climbed as excessive as 30.
On the similar time, Knapp spends numerous hours on the cellphone with higher-level-care medical facilities in Portland, Bangor, Boston – looking out, too usually futilely, for someplace that may take a affected person whose wants exceed Stephens Memorial’s capabilities. The brutal various, which has occurred, is to lose a affected person who’s intubated in his emergency division, ready for a switch that by no means materialized.
“It’s unhappy, truthfully. It’s unhappy to maintain people who’re very sick from this illness they usually might averted it,” he mentioned. “And I can’t inform you what number of instances – and my colleagues all have comparable tales – the place we’ve taken care of somebody with COVID they usually’ve mentioned, ‘Man, I ought to have gotten the vaccine. That is so unhealthy. I’m so scared. I can’t consider I didn’t do that earlier.’”
Some in these divided instances see that as simply desserts. You pooh-pooh vaccines, the reasoning goes, and also you pay the value. However for Hodson, the emergency division nurse with 4 folks ready exterior, that’s not an choice.
“I’m going to be fully trustworthy. I’m very non-judgmental,” he mentioned. “One of the best ways I can clarify it’s my position is to offer care as soon as sufferers arrive right here. What introduced them right here is predominantly out of my management, and so I simply begin treating and helping as quickly as they arrive.”
And if somebody asks him in regards to the vaccine or different prevention measures?
“Then I’ve all kinds of speak,” Hodson mentioned with a smile. “The numbers don’t lie. These which are vaccinated are at a a lot much less threat of changing into hospitalized or severely in poor health.”
As occurs with so many crises of this magnitude, calling these folks heroes now not comes near capturing what they’re going via. Simply as calling the unvaccinated ignorant or uncaring extinguishes, in Hodson’s view “any hope of adjusting their outlook.”
So maybe the most effective factor to recollect throughout these darkish days of December is that, whilst increasingly more Mainers get sick and die, a small hospital on the middle of the storm is doing the whole lot humanly potential to save lots of them.
“Yeah, there are days the place you allow and also you’re simply fully drained – anyone who says they’re not is mendacity,” Hodson mentioned. “There are a number of days – it’s not simply days, there are a number of days – the place you go residence and also you’ve obtained no phrases. You simply take your bathe, sit down and begin over.”
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