Editor’s note: This is the second 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. Visit bitly.com/COVID-dispatch-1 to read the first story.
The morning after a middle-aged man with COVID-19 died in a Treasure Valley emergency room last month, a health care worker who’d been there for his death couldn’t bring herself to go back into the hospital.
She sat in her car that morning, trying to process what happened. She recorded herself thinking out loud.
“I’ve seen people die in the ER,” she said in the recording. “Things like that stay with me. I remember those people, I can see them very clearly.”
This felt different, she said. Maybe it was because health care workers believed they’d made it through the worst of the pandemic — only for COVID-19 to return, killing patients who chose not to get a vaccine. Or maybe it was because of the man’s daughter, whose cries had echoed down the hallway.
“I just can’t stop thinking about that girl. I just can’t. I see her face, and her puffy eyes,” she said. “It was so sad. It was so, so sad. I just think, my God, it’s just a shot … and this could’ve been avoided, right? It just broke my heart, and I can’t stop thinking about that girl, I can’t stop thinking about her.”
The pandemic is leaving scars on Idahoans. For health care workers, the scar thickens with every 12-hour shift they spend trying to save people from COVID-19.
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.
‘I’m sorry about the position that they found themselves in’
Health care workers across the state are fighting an internal battle, on top of their fight to keep people alive and healthy.
Dr. Patrick “Paddy” Kinney, a family physician in rural McCall, is one of them.
He is distraught when his patients choose not to be vaccinated against a fast-spreading virus.
He is distraught when those patients later get COVID-19.
And he’s distraught that, when they come into the emergency room, they need a bed in “an overburdened system that’s about ready to topple,” he said in an interview last week.
For the past 18 months, Kinney said, he’s talked with his patients about COVID-19. Tried to answer their questions. Tried to assuage their concerns. Urged them to get vaccinated.
“But then, I’m also the guy that when they don’t make that decision (to get vaccinated) and they come in super sick to the ER, here I am again,” he said.
“A lot of them apologize, like, ‘I’m so sorry that I didn’t listen to you.’ And I don’t want them to say that they’re sorry. I’m sorry that they’re sorry,” he said. “I’m sorry about the position that they found themselves in. Clearly, I think that they’re paying the price for that decision. At the same time, I’m struggling with (whether) I could have done a better job explaining the risks and benefits of the vaccine to you.”
Kinney said it’s “really hard when I’ve got one of my patients in the ER … and they cannot even speak in full sentences because they’re short of breath, and they’re hacking and coughing, and they look scared and sick.”
Many health care workers told the Sun they struggle with the same mix of emotions. Vaccines are very effective at keeping people out of the hospital from COVID-19. Yet, many patients show up unvaccinated.
The Idaho Department of Health and Welfare’s statistics show that 91.6% of all hospitalizations for COVID-19 in Idaho since May 15 are among people who aren’t fully vaccinated. Hospital administrators and frontline health care workers have confirmed for months that almost everyone admitted to a hospital with COVID-19 is unvaccinated.
Health care workers still take care of everyone, regardless of vaccination status. Not only because they have to, but because they got into medicine, nursing and therapy to help people.
“I’m doing so at the expense of everyone else,” Kinney said. “When there’s not enough rooms, when there’s not enough nurses, when everybody’s exhausted, when the hospitals are at 105% capacity, when there’s three ICU beds left in the state, that is hard.”
His patients sometimes wait six to eight hours in the McCall emergency room for a bed to open up in Boise, where they need to go, he said. When the Treasure Valley hospitals are full, the patients are sent to Twin Falls.
But even those larger hospitals around the state are at a breaking point. When they’re full, they can no longer take patients from small hospitals like St. Luke’s McCall.
“I think it was Friday night or Saturday night, I had a bad COVID patient who needed to be admitted — again, 16 liters of oxygen and very sick, and he was ready to go at 9 p.m.,” Kinney said. “Now, I knew that he needed to be admitted, and the hospitalist down in Boise agreed that he needed to be admitted. There was not a bed available for him until 2 a.m.”
Kinney told the man he would keep doing his best to take care of him in the ER for the next five hours.
“What’s going to happen at 2 a.m.?” the man asked.
Kinney had to be honest. There’s one reason a bed opens up at 2 a.m., he said.
“There’s a chance that your bed is going to be made available by somebody else dying,” Kinney said.
The patient’s face was covered by an oxygen mask, but Kinney could see the man’s eyes. He was terrified.
The patient did get that bed in Boise at 2 a.m. But he declined rapidly. He, too, recently died, “making room for someone else,” Kinney said.
All hands on deck in Idaho hospitals
Idaho this week turned a grim corner in the pandemic.
The state activated “crisis standards of care” for North Idaho — a decision that will allow overwhelmed hospitals to triage patients and ration medical care to save as many lives as possible.
That decision will have a ripple effect throughout the state and the region, where hospitals and especially intensive care units are hanging on by a thread.
Health systems have begun to pull in more doctors and nurses to work in the hospital.
Kinney usually has 1,200 to 1,300 patients under his family practice clinic’s wing at any given time. He’s been the family doctor for some of those Idahoans since he joined St. Luke’s McCall in 2014.
“I managed their pregnancies, I delivered their babies … acted as their pediatrician and took care of multiple generations,” Kinney said.
He sees his regular patients in his clinic three days a week, takes on-call shifts at the hospital and works in the ER three or four times a month.
Now, the surge is taking him away from his usual patients.
“I’m going to be spending about 80% of my practice over in the ER,” he said.
For now, St. Luke’s McCall can take care of everyone who comes through the ER doors, Kinney said. But if Idaho enters statewide crisis standards, that may not still be true.
“The game changes a little bit, because at that point we’re admitting that we can’t care for everybody in the way that we want to,” he said.
Kinney is tired.
He keeps “wondering and trying to figure out why my patients disdain and refuse my advice, in just this one particular area, where they trusted me and in all the other areas of their care,” he said.
“We just don’t understand why people have trusted us for years, and they’ve gone through all manner of uncomfortable things on our recommendation. Right? Like every 10 years, they’ve agreed to letting us put a 6-foot camera up their butt for a colonoscopy,” he said. “Every year or three years or five years … they’ll get up in the stirrups, get a cold metal speculum put in their vagina for a Pap smear. And, you know, get a flu shot and get a pneumonia shot, get a shingles shot.”
Patients take medications their doctors prescribe to them, even when those medications might have side effects.
“They’re willing to accept it because they have trusted us (to know) that these things are worth it, and that it’s in their best interest,” Kinney said.
“And yet in this, it’s like you just say the words ‘COVID vaccine,’ and their faces change, their eyes glaze over,” he said. “They somehow feel like they’ve got better information than we do. And I don’t understand it, I really don’t. I don’t get it.”
‘They’re making the choice for everybody, and we’re all living with that choice’
People have always been hospitalized for reasons within their control, to various degrees. Drunk driving. Riding a motorcycle without a helmet. Smoking-related diseases. Untreated diabetes.
The difference now is that health care workers are hearing patients make choices based on disinformation, some of that propagated by doctors in the community.
“Every day in my office, I see patients who haven’t been vaccinated, and I hear an incredibly wide spectrum of reasons,” a Treasure Valley internal medicine doctor told the Sun in an interview last week. “Today in my office, I had only two of my patients who had not been vaccinated, and neither of them was in any way willing to consider it.”
The doctor said one of his patients is young and works in local health care.
“I’ve been trying to convince him since December to get a vaccine. His mom had been hospitalized with COVID,” the doctor said. “And then he got hospitalized this weekend. He told the hospitalist that he’d taken care of patients in the hospital who had been injured by the vaccine, which is ridiculous. … How do you get through to somebody like that?”
One of the spirit-crushing pieces of this surge is that 2021 began with “so much optimism and excitement because we had this vaccine,” he said. “And it worked better than anyone dreamed that it might. And then there were two of them! And patients, they were clamoring for them.”
But in early April, the phones stopped ringing. Idaho had arrived at a wall of vaccine hesitancy.
“Nobody taught us that in medical school. ‘One day we’re going to have this disease that’s going to overwhelm the hospitals, burn out all our health care workers, and it’s going to be preventable.’ … Now, there’s not much cause for optimism.”
His most optimistic thought now is that Idaho will reach herd immunity “by a bigger proportion of natural infection,” but that eventuality will take countless lives and healthy bodies with it.
“I tell patients in the office, this is not a good time to have a heart attack or a stroke or get in a car accident or get your appendix removed,” he said. “But honestly, I don’t think people are concerned. … I do not see people thinking outside the scope of their individual bubble, that’s probably the (hardest realization).”
The doctor has been told to prepare to go back into the hospital to help with the surge, he said.
That means he’ll be away from his patients, most of whom have chronic diseases.
For now, he is writing orders for them to get monoclonal antibody treatments, he said. But those must be given soon after infection to work, and there was a four to five day wait last week, he said.
He hopes those infusions will keep patients out of the overwhelmed hospitals. But he wishes there was no need to give the infusions in the first place.
“I think the data for it is not the greatest,” he said of the infusions. “It’s not as good as vaccination by like a factor of 1,000.”
“We’re still in a pandemic, but we’re now in a pandemic of a preventable illness,” he said. “We’re making a choice as a society to live with this now, and we didn’t have to.”
But not everyone is involved in that decision, because those who are unvaccinated and get hospitalized can crowd out others who got the vaccine, he noted.
“They’re making the choice for everybody, and we’re all living with that choice. It’s not an individual choice.”
Editor’s note: This story was updated Wednesday morning to include the recent death of Dr. Paddy Kinney’s patient.