Dispatches from Idaho’s front lines: ‘This patient isn’t leaving the hospital alive’
Idaho’s health care workers describe what it’s like going to war against COVID-19
Editor’s note: This is the first story in a series from the Idaho Capital Sun on what the Gem State’s health care workers are experiencing as they battle the latest surge of coronavirus in Idaho.
A middle-aged man arrived on a stretcher at an Idaho emergency room last month.
He’d tested positive for COVID-19 several days before, then took a turn for the worse. He couldn’t breathe. His fever was high enough to cause organ damage.
His heart stopped, twice. Paramedics and hospital staff managed to revive him. But he died later that day.
His daughter was there. She began “wailing,” a health care worker told the Sun. The child wanted to see her father.
The worker left the hospital crying that day.
The Idaho Capital Sun has interviewed more than a dozen Idaho health care workers about what they’ve seen during this fourth surge, on the front lines of the war with COVID-19.
The Sun confirmed their employment but allowed some of them to speak anonymously — so they could speak freely and because the events now happening in Idaho hospitals are so similar as to be virtually interchangeable.
No health care worker revealed any patient’s identity or private medical information.
One ER nurse’s story: ‘This patient isn’t leaving the hospital alive’
When a Treasure Valley emergency room nurse arrived for a recent shift, the department was already in chaos. The nurse in charge was crying.
Their ER had always been well staffed. Since the pandemic began, the ER nurse said, about half his coworkers have left. In their place are some new hires, some open jobs and a lot of temporary nurses placed by travel-nursing agencies.
The staffing shortages are a problem all over Idaho, and the nation.
Many frontline workers are burned out and don’t have the energy to take on extra shifts anymore. And, increasingly, they feel underappreciated and frustrated by the latest influx of preventable disease.
They told the Sun that, much like soldiers on a battlefield, they have symptoms of post-traumatic stress. They are traumatized. With a fourth surge that is already worse than anything before it, their jobs sometimes feel hopeless.
“An experience I’m having much more often: You’re admitting a patient, and you turn to the other nurse and say, ‘This patient isn’t leaving the hospital alive,’” the ER nurse said.
“They are walking and talking and looking OK,” he said. “A lot of the time, the patient is short of breath, but you can talk with them. But on the back end, we’re looking at their numbers and seeing elevated lactic acid (and other indicators that) this person who is talking with you right now is going to get significantly worse. The condition of their body hasn’t caught up with them yet, and they’re probably going to die in the next few days.”
Nurses, physicians and respiratory therapists don’t have a secret weapon to treat people who are seriously ill with COVID-19.
The resources they do have — oxygen, steroids and other medications, ventilators and a life support machine called ECMO (extracorporeal membrane oxygenation) — take a lot of time.
Many of those require ICU beds, which are full. Gov. Brad Little said Idaho had four open ICU beds in the entire state on Tuesday morning.
That means other patients in Idaho already aren’t getting the kind of health care they would in normal times.
“We are short one to three nurses, and one to three CNAs for the day,” the ER nurse said. “You go to the supply room, and it’s short on supplies.”
Patients would usually be seen in the emergency room and then, if they needed to be admitted for ongoing care, they’d be sent upstairs within an hour or so, he said.
“Now, the hospital is full. So the patient gets admitted on paper, and may be in the ER for an additional 12, 24, 36 hours,” he said.
One recent patient was “admitted” to the hospital, got a procedure done, then was brought back to the emergency room and sent home. The whole thing took a day and a half.
“While we’re all nurses — we can take care of most types of patients — (it’s hard) trying to be an ER nurse and a floor nurse, with two emergency patients and two ‘admitted’ patients,” the ER nurse said. “We aren’t used to ‘getting my patient their evening blood pressure medicine.’ The day has a different rhythm to it.”
Back on Dec. 14 of 2020, we at Saint Alphonsus Health System delivered the first COVID vaccine in the state. And at that time, I said that this is our D-Day in the war against COVID. Sadly, today, I must tell you that we are losing the COVID battle, and patients are dying unnecessarily. Dr. Steven Nemerson, Saint Alphonsus Health System, at a press briefing on Sept. 2, 2021
Every third or fourth patient in the ER these days has COVID-19 or symptoms of the disease, like shortness of breath, the ER nurse told the Sun.
“So many of my patients blur together at this point,” he said. “I did have one patient come in who was COVID-positive, oxygen was 86% on room air.”
Healthy people have oxygen levels of about 95% or higher. Below 88% is a serious medical emergency.
“He left against medical advice,” the ER nurse said. “I told him we were going to see him again, hopefully, or he’d die at home. We saw him back, and he was admitted back to the hospital in worse condition about six hours later.”
‘I wish other people could see it, because maybe they would understand’
Dr. Allison Gauthier has worked in Treasure Valley emergency departments for seven years.
“I have never seen our EDs like this before,” she said.
While doctors and nurses will always help everyone who comes through the door, they are overloaded. Hospitals are backed up from the ICU, to medical floors, on down to the ER.
“It’s a low point, I think, in the hospital right now,” Gauthier said.
Patients come into the ER with COVID-19, wishing they had gotten the vaccine, Gauthier said.
“They’re scared. They are scared,” she said. “I don’t want people to feel that way, and it’s awful to see it, and I wish other people could see it, because maybe they would understand that … we don’t want this to happen to them.”
Many patients come in without COVID-19, she and others said. But right now, COVID-19 is the driving force behind “why we’re so busy,” she said.
“I have had ICU admissions that were actually not COVID-related, but there were no beds. So I was managing ICU patients myself for seven hours … while trying to see new ER patients,” Gauthier said. “And while they did OK, it’s not optimal care, and we want to not have this be the norm.”
Most patients believe her when she tells them they have the coronavirus disease. Some don’t. She struggles to understand why people would think she went into medicine “to lie to people, and to hear people really upset and angry with me when I tell them” why they’re sick.
“I had a patient this weekend who, the patient believed me, but the family did not. Her husband just died a week ago — she thought (it was) from natural causes, but I suspect it might have been COVID.”