Exhaustion

The toll of COVID-19 on one hospital: out of beds, out of staff, out of time

By Allison Marlow
Posted 8/27/21

There. Are. No. Beds.

When experts say Alabama is out of hospital beds, they mean they are literally out of beds.

This doesn’t mean they have simply filled the spaces earmarked for ICU …

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Exhaustion

The toll of COVID-19 on one hospital: out of beds, out of staff, out of time

Posted

There. Are. No. Beds.

When experts say Alabama is out of hospital beds, they mean they are literally out of beds.

This doesn’t mean they have simply filled the spaces earmarked for ICU patients, or COVID-19 cases. There isn’t just one area designated for those individuals while patients suffering from non-covid issues are shuffled to another floor or ward.

Patients, regardless of ailment, are waiting. But half, hospital officials say, are there because of covid.

They are waiting in the emergency room. They are waiting in hallways. Some are on ventilators, fighting for their lives, and lying on stretchers while they wait for a space to open up.

Often when a bed finally becomes available, one patient’s gain is another soul’s loss.

The staff that monitors their every breath, that consoles their grieving families on the phone and watches them disappear from this world, over and over, is exhausted.

“Every week by Friday it feels like we might be getting to a better place then over the weekend the numbers begin to climb again,” said Julie Rowell, vice president of Thomas Hospital and Nursing Chief.

Rowell said this latest surge happened quickly, overwhelming hospitals across the region in a matter of days. At Thomas Hospital in Fairhope, she believes they may finally be hitting a plateau, though have yet to see the other side of the mountain of cases, built by the delta variant fueled surge.

At no previous time during the pandemic has Thomas Hospital had to open a second covid unit. In July they did. Both were filled within days.

Two weeks ago, the emergency room held as many ICU patients as the ICU itself, she said. In the days since the list of emergency room patients waiting for a bed is often 20 names long.

They wait because there is nowhere else to go. Every hospital in Alabama, Mississippi and Florida looks the same, she said.

On Aug. 24 the Alabama Hospital Association reported that 2,786 patients were hospitalized across the state with COVID-19, 83 of those were at Thomas Hospital. Statewide there are 1,548 ICU beds and 1,608 ICU patients. Roughly 84 percent of patients across the state are unvaccinated.

Medical experts say there is just one clear path out: vaccinations.

“Please get vaccinated, help us fight this,” Rowell said “We’re going to fight for you as hard as we can once you are in the hospital, but we need the community to take this seriously and get vaccinated, practice social distancing and masking.

“It’s rampant right now. There is no requirement to get vaccinated, so it has to be something you take on personally,” she said.

So Tired

As tired as the public is of the push to vaccinate, wear masks and sideline fall plans until the crisis passes, the staff is tired too.

Their days are long. The needs of patients teetering on the edge of life are constant. The emotional toll is one that many in the medical field are beginning to compare to wartime duty.

“They haven’t had a break. If you think about it, it’s been over a year now and even when we had a little bit of a reprieve the hospital has been very busy,” Rowell said.

The care of COVID-19 patients requires constant monitoring – to help patients maintain oxygen levels, to calm their anxiety so they work with the ventilator rather than fight it, to periodically wake them up to see if they can breathe on their own.

Over the year the staff has learned to better care for patients and minimize their exposure to the disease. They’ve been able to bring many of those IV pumps into the hallways so they can make adjustments quickly and avoid suiting up in full protective gear each time they enter a patient’s room. Any time they do they must be outfitted with a respirator, face shield, gown and gloves – a lengthy process of dressing and undressing.

The staff also must work together, often four to five people at a time, to reposition an intubated patient from their back to their stomach to their side, anywhere the nurses find that person can breathe easier.

“We’ve learned to adapt and with each surge we learn something new, but it takes more staff to provide that care,” Rowell said.

Everyone works, everywhere

After three covid driven surges the hospital is just not short of beds, it is short of staff. Rowell said staff has been moved from other departments in the hospital to help with covid patients. Traveling nurses have been hired. Generous bonuses have been offered. Still, the hospital, like many around the nation, is short-handed.

“The hospital has done everything it can to try and provide the resources we need,” Rowell said. “We are stretched with the staffing shortage we have.”

Rowell said the hospital’s entire staff has stepped in to fill the gaps. Managers work on the weekends, procedural clinical staff has assumed bedside rolls, many people are working outside their normal jobs. Despite the stress, the moves are met with positivity. The staff is motivated to push back against the virus.  

“We’re grateful for that,” she said.

 So much death

More than the lengthy hours, more than the layers of gear and risk to their own health, Rowell said the hardest part has been the overwhelming amount of death. With each surge, she said, the age of their dying patients becomes younger.

“First it was more elderly and it’s hard to lose those patients, but when you start moving into the younger age groups,” Rowell pauses. Her voices wavers momentarily. “That becomes different. You have parents who have children who are grade school age and in high school. These folks have not lived a full life yet. That is really hard.”

Rowell said medical professionals are trained to save patients, not loose them. Covid-19 has been killing patients at a rate unseen in any other disease. Emotionally the toll on the hospital’s staff has been devastating.  

“When you see patients who you know aren’t going to do well, and you see this day after day after day, and you’re the one talking to the family and comforting them it takes an emotional toll,” Howell said. “The staff has done incredibly well. I’m very proud of them.”

How to help

Last week several doctors from Thomas Hospital and the community spoke at the Baldwin County School Board meeting to urge the board to continue to mandate masks in schools. Meanwhile dozens of parents showed up to fight those mandates.

Rowell said she believes that her staff “understands that people have the right to make the best decision for themselves.”

But, she said, continued and widespread vaccination will help prevent a fourth surge.

“When there is so much evidence that supports why people need to get the vaccine it’s hard when you have people that come in and say to a nurse, ‘I wish I had just gotten vaccine.’ We’ve seen entire families, mom, dad, children, grandparents and when one of those family members doesn’t do well sometimes people are angry,” Rowell said. “For our staff that is hard.

“It’s frustrating for our staff because they feel many people may have had a chance to have a different outcome but without the vaccine now, they don’t have that same chance,” she said.

Widespread vaccination is the only clear way out, she said.

“We need to get vaccinated, to slow this thing down, so we don’t keep cycling through these surges,” she said.

She also urged the public to continue to socially distance and wear a mask, noting that often she goes into a store and is the only one who is masked.

“People who have gotten vaccinated don’t typically get as sick, but we also don’t want to be asymptomatic and give it to someone else,” she said. “I wear a mask out of respect for other people not necessarily for myself.”

While the staff waits for the surge to end and the flow of patients to slow to a trickle again, Rowell said another surge could bring more death and and the national nursing shortage could become more profound. After an exhausting year, nurses are retiring or moving into jobs that pull them away from the daily grind of death brought on by COVID-19.

“It’s more than what they can deal with at this point,” she said. “We’ve had nurses say they can’t go through another wave.”