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‘NOWHERE TO PUT THESE PATIENTS’: Pandemic strain on hospital results in lengthy waits for emergency care

Michael D. Smith
msmith@ardmoreite.com

Many doctors and nurses at Mercy Hospital Ardmore that received their second dose of the COVID-19 vaccine this week feel that it means an end to the pandemic is on the horizon. While good news for those ready for a return to normalcy, local health care workers continue to see the Ardmore hospital pushed to its limits.

Hospital staff this week described patient beds overflowing from emergency room hallways into the waiting area and exam rooms nearly filled with patients waiting to be admitted. As the number of COVID-19 cases within the community climbs by dozens each day, cases among nurses are also on the rise — further compounding the dwindling availability of hospital beds and health care workers in Ardmore.

“Even at the beginning of the pandemic, when we read the stories about what was happening in New York...and they were having to work in crisis mode, it just seemed very far away,” said Paula Pfau, a nursing director at Mercy Hospital Ardmore. 

Staff at Mercy Hospital Ardmore care for patients in the intensive care unit in this undated photo provided by a hospital spokesperson. With over half of inpatient beds receiving treatment for COVID-19, patients are being held in overflow beds in emergency department hallways and waiting areas.

“It seemed almost Hollywood-esque because it just surely couldn’t ever be that way, and it is. It really is that way now,” said Pfau, who oversees nurses in hospital departments including ICU, emergency and respiratory therapy.

VIRUS SURGE HITS HOME

While the first case of COVID-19 in Carter County was recorded March 25 of last year, it wasn’t until Sept. 18 that the number of active cases of the disease recorded locally rose above 61, according to Oklahoma State Department of Health data compiled by The Ardmoreite. By Oct. 17, recorded active cases rose to 127 and doubled about a month later.

Carter County recorded 942 active cases of COVID-19 on Saturday.

Hospitalizations for the disease across the state and locally followed similar trends. Statewide hospitalizations for COVID-19 neared 700 through July and August, and fell before a surge started in mid September, according to OSDH data compiled by The Ardmoreite. 

Similarly, COVID-19 hospitalizations at Mercy Hospital Ardmore typically remained fewer than 10 through the summer months before rising sharply in October and November, according to a regular series of requests gathered by The Ardmoreite since July. 

Dr. Nate Claver is an emergency room physician at Mercy Hospital Ardmore and has been the department’s director for over four years. He said the hospital’s emergency department has about 16 exam rooms and up to 15 of them in recent days have been filled with patients waiting for beds to open for admissions, leaving only one exam room for emergency patients.

“We’ve been having to set up basically hall beds. Just putting beds in the hall, we put beds in the lobby, just trying to create space where we can see patients,” said Claver.

Pfau said that an additional six beds have been set up in the department’s hallways and another four have been added in the department’s waiting area. 

“We have curtains around beds and we just do our best to take care (of them),” she said.

‘NOWHERE TO PUT THESE PATIENTS’

The beds in the Mercy Hospital Ardmore emergency department — normally used exclusively for emergent patients but now boarding patients waiting for admission — are in addition to other beds elsewhere in the hospital. 

Between November and December, the hospital was able to increase the number of inpatient beds by partially closing some services and redeploying staff to medical care. Even with up to 20 additional inpatient beds depending on staffing each day, hospital president Daryle Voss told The Ardmoreite on Dec. 18 that the hospital had reached capacity.

Between Christmas Day and New Year’s Eve, the number of COVID-19 hospitalizations in Ardmore more than doubled from 25 to 51. The surge in COVID-19 patients coupled with other medical emergencies across southern Oklahoma has more than overwhelmed the available equipment and personnel.

“Even if you or your loved one comes in for some other emergency, be it appendicitis or chest pains, your ability to be seen by an emergency medicine provider is going to be drastically delayed,” said Claver.

“There’s nowhere to put these patients that need to be admitted to the hospital,” said Dr. Koby Hunter, an attending physician in the hospital’s emergency department.

PRIORITIZING CARE

Before the pandemic, Hunter said a night shift that started at 6 p.m. could usually see the waiting room emptied of patients by midnight. In recent days he estimated that some patients have waited upwards of eight hours before being seen as space and staff are stretched thin.

“We’ve had to do some things that are uncomfortable, and each provider in each specialty is having to kind of step up and take care of things that we wouldn’t normally have to take care of,” Hunter said.

In November, the Mercy hospital system announced a program to care for some COVID-19 patients through telemedicine at home. The program was implemented last month and Claver said that it has been successfully implemented in Ardmore. 

Through the Mercy COVID care at home program, some patients that would normally be hospitalized for monitoring can be sent home with supplemental oxygen and staff from Mercy Virtual will make daily contact.

For the emergency department nurses, trying to explain the delays to patients can be difficult and at times scary. Pfau said health care workers have to prioritize patients to ensure that the most ill receive the most prompt care.

“With due reason, they come to an emergency department and they want to be seen emergently. Whether or not medically it is an emergency, it’s an emergency to them,” she said. “I want everybody to be welcome and to feel cared for, and that’s hard to do when you have a lot of really sick people.”

LIKE NOTHING SEEN BEFORE

Aside from the extreme patient load, the novel coronavirus itself still poses a major threat to the men and women that make up the local health care system. Claver said that only one emergency department physician has developed COVID-19 during the pandemic, but Pfau said the community spread of the disease and surge in hospitalizations have both been reflected in her much larger nursing staff.

“We kind of just trickled along, we just had a few cases. But more recently, just in our community, we’ve had more of a surge in that,” she said.

All three health care professionals interviewed for this story were excited about receiving the second dose of the COVID-19 vaccine on Thursday. Claver and Hunter each said that physicians all received the vaccine to show that it is safe and necessary, and Pfau believes that the united front has helped convince others to receive the vaccine.

After months of the pandemic and several weeks of gradually worsening data from the state health department, multiple front line health care professionals have noted that some patients are still surprised by the severity of COVID-19.

“[W]hen I walk down the halls of our emergency department and through the halls of our ICU, it baffles me that people don’t understand. It’s not like the flu. It’s nothing like any of us have ever seen or any of us hoped that we would see. That’s the difference,” said Pfau.

After about 10 months of the pandemic that has impacted so much of daily life, Hunter believes that more people in the area are beginning to understand the full extent of the pandemic on health care.

“I think the community is coming around that this is a real public health disaster and it’s on a level of nothing we have ever really seen before,” said Hunter.

SUPPORT SYSTEMS

Considering the weight felt by front line health care workers, finding the right support to get them through a work day during the pandemic can be just as important as proper safety equipment. Pfau said counseling services and on-site chaplains provide support for hospital staff, along with small gestures from administration and community members alike. 

Hunter said claims of the pandemic being overblown are slowly being replaced by general thanks from people for working through the pandemic, and Claver recognized the weight carried by members of the nursing staff.

All three people leveled high praise for their coworkers as every aspect of local health care gets tested like never before.

“I really am overwhelmed at the teamwork,” said Pfau, adding that even the hospital employees in environmental and nutrition services are major contributors to the pandemic response efforts. 

“We could not do it without them. We’re all trying to do as much as we can and we need to have all the support. There is no hierarchy when it comes to that, we’re all just doing patient care,” she said.