Tragedy is an everyday occurrence in a large hospital’s emergency department but COVID-19 has added new layers to it, with harm from misinformation coming atop different types of sickness.
“The single most tragic story would be a young woman, a mother with children, who came in, in distress, and died 12 hours later despite everyone’s heroic efforts,” said Dr. Christopher Fore, chief quality officer for Concord Hospital. The woman was not vaccinated. “That’s the kind of thing you don’t normally see – it’s really heartbreaking to see and to acknowledge that to some degree it was probably avoidable.”
“When you have folks coming in that you feel could have done something for that situation, it is a different level of frustration,” said Jody Case, RN, who also worked with the patient.
The two, along with Stephen Melchiore, director of acute care services, met Tuesday with media to describe how life has been in the city’s hospital since the pandemic arrived. The conversation happened even as they dealt with another winter surge and concern about the effect of the new, more contagious Omicron variant.
Like most hospitals throughout the country and much of the world, Concord Hospital has been almost overwhelmed at times in the past 21 months, as waves of patients have arrived carrying a new disease that forces people to stay in the ICU longer, on top of staffing shortages from a multitude of causes, including burnout.
“It’s the age of resignation,” said Case, who is administrative director of the Inpatient Value Stream, which covers everything but surgery. “We’ve had a pandemic on top of what was a shortage to begin with. … Trying to find the answer to what seems like an impossible equation – that has been the biggest challenge.”
She mentioned a moment when there were six patients at one time who needed to be placed in the ICU.
“What we need to do is really play what I call a shell game. What can we do to put patients in the right spot, to give them the best care they can get. But it is difficult: you can’t invent a bed, you can’t invent a nurse to take care of patients,” Case said. “In those moments the phrase is, I’m running out of tricks here … Well, we can’t say that – we’ve got to find another trick.”
One of the complications faced by the emergency department has been a change in the basic pattern of patient arrivals caused by the effect of the SARS-CoV2 virus in people’s lungs.
“The thing that’s interesting about COVID – interesting medically, not necessarily in a good way – is how sick patients can be before they seek care. It’s a bit unlike anything I’ve seen before,” said Fore.
He said people regularly show up at the emergency room in their own cars even though they have oxygen saturation levels, a key measure of lung health, far below the normal level of 95% – so far that they would normally have to be transported in an ambulance. “You’ll see patients literally walk into the waiting room with saturations in the 60s and 70s, which is something in my entire career I have never seen. That forces us to spring into action in a way we’ve not had to before.”
In response Concord Hospital has changed the way it handles triage, the process of sorting through patients as they first arrive to determine who needs what care and how quickly, adding a physician to the mix from the very start. Even so, ER backups have been common.
The Delta variant has also changed who gets sick. Early in the pandemic most patients were older but now they can be middle-aged with no obvious weakness until COVID arrived.
“The severity of illness in people you would not expect … you can see young mothers with kids who are struggling to breathe,” Fore said. “They are patients who don’t have a lot of risk for life-threatening illness.”
On top of this is the struggle, in the face of so much wrong information peddled online and via media, to get some people to believe that COVID-19 is a real problem even when they’re already sick, and to accept that vaccination and boosters are safe and effective.
That frustration “does take a toll on the bedside team,” said Case. She said staff have to remind themselves that they often treat patients suffering partly because of their own actions, such as people who smoke cigarettes or diabetics that don’t follow proper nutrition, although debate over COVID-19 has brought this paradox to the forefront.
While nobody had stories of patients berating staff about COVID-19 being a political hoax, all have had patients who had believed lies and errors about the pandemic until they had to go to the hospital.
“Most people, once they’re symptomatic with a COVID infection, suddenly become believers in COVID,” Fore said. It can also change opinions about getting the jab: “I have had quite a few patients express some degree of remorse about avoiding vaccination.”
Asking vaccination status is one of the first steps in taking any patient’s history, no matter what they have come to the hospital for, which leads to conversations with unvaccinated patients being treated for non-COVID reasons.
“I like to think I have a 50-50 success rate in convincing people that vaccination would be a meaningful strategy for them,” he said. “But I haven’t gone out in the public to take it on, head on, in a large social media way.”
Melchiore said that even as Concord Hospital has changed to deal with the pandemic it is considering what further changes may be needed.
“We have talked about what an expansion of the (emergency department) might look like. Hopefully we don’t have to expand, but we’re always planning for the next piece,” he said.
Despite the struggles, all three said Concord Hospital staff have banded together to improve procedures and fill gaps as needed.
“It is fatiguing, it is hard to turn off, it has become a 24/7 ordeal,” said Fore. “But as a team I feel like we have risen together, it’s all hands on deck.
“Twenty months ago, we all talked about how this could be a year or two. We’re hoping that it couldn’t go on for another two years but it might. It could be another 20 months, or it could be two months. We’ll just have to see.”
(David Brooks can be reached at (603) 369-3313 or dbrooks@cmonitor.com or on Twitter @GraniteGeek.)
