"A constant tsunami": N.H.'s health care workers at the epicenter of COVID surge
During the afternoon shift change inside Catholic Medical Center’s medical-surgical unit, nurses in a kaleidoscope of colored scrubs gather to complete charts. Nearby, screens flicker with patient heartbeats and oxygen levels. A nurse, hearing a steady, high-pitched alarm, swiftly puts on a gown, gloves, mask and goggles, before entering a patient room.
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It’s around 3 p.m. on the busiest day yet of the pandemic at CMC: 45 COVID-positive patients, along with other critical care patients, are filling nearly every room in this unit and the ICU.
“Chaos,” Bree Heward, a registered nurse, said. “It feels like a lot of energy all the time being utilized. A lot of worn-out people.”
After watching the rest of the country — first New York in March of 2020, then places like North Dakota and Florida — take turns having the highest COVID-infection rates in the country, New Hampshire is now the nation’s coronavirus epicenter.
According to The New York Times, New Hampshire's new case rates in have been the highest in the country over the past week, sending more people to the hospital than at any point in the pandemic thus far.
The spike has added stress to the Granite State's already-beleaguered health care system. Compared to this time last year, inpatient and ICU capacity is even more scarce, COVID-19 patients are taking up an even greater share of beds and more hospitals are reporting critical staffing shortages. And the surge isn’t expected to abate any time soon.
For front-line health workers like Heward, it’s not where they expected to be at this point. She thought widespread access to the vaccine and a decline in cases this summer would ease the situation this fall.
“Well, it seems like this might not ever go away,” Heward said. “This might just be the new norm. Something that we just have to evolve and adapt to.”
In early December, CMC was treating an average of 35 COVID-19 patients each day, compared to about 21 a day this time last year.
The recent crush in COVID-19 cases has translated into long wait times in its emergency room, where patients often spend several hours waiting for care. Nurses triage people in the waiting area or care for patients in hallways.
“It is truly exhausting, and it is the chronicity of it,” said Jessica Marchand, who’s been a registered nurse since 2006. “Because it is not where we make it through that shift, we make it through that wave. This is like a constant tsunami on a day in and day out basis.”
These scenes are replayed over and over again in New Hampshire, hospital to hospital, day after day. Hospitals have stood up new surge units, cut back on elective surgeries and restricted visitor access — all measures officials hoped would be one-time fixes earlier in the pandemic.
"It kills you when people aren’t willing to just roll up their arm and get vaccinated when the evidence is there,” Marchand said.
Teams from the Federal Emergency Management Agency and the New Hampshire National Guard have been deployed to offer backup to facilities dealing with chronic staffing shortages. In an open letter issued earlier this week, a leading doctor at Dartmouth-Hitchcock Medical Center in Lebanon said the state’s hospitals “are under siege.”
According to federal data, New Hampshire hospitals aren’t just seeing a rising tide of COVID-19 patients: They’re also seeing a larger share of COVID-19 patients younger than 60 than they did this time last year.
That trend is bearing out at CMC, too. ICU Director Diane Kobrenski said a recent 50-year-old patient went from being admitted to the hospital on a Wednesday to being intubated and put on a ventilator on a Friday.
"Now he is one of our patients that are paralyzed and very very sick," she said, "with an unknown outcome."
Kobrenski said it’s terrifying for the patients to decline so quickly, but also for their families and for the nurses at their bedside.
"One of our patients that got put on the vent, he called his family, and said, you know, 'I'm getting put on the ventilator right now. Goodbye,' basically," she recalled. "And the nurses are tearing up in the room as it's happening. Patients know and they are scared. And the nurses know because they’ve seen it. So it's emotional."
Just before doing his rounds inside CMC’s intensive care unit, Dr. Joseph Hou, a pulmonary critical care physician, sits in a windowless conference room, pushing aside the torso of a medical dummy.
“The burnout is very real. I think every day most of us have talked about burning out, both emotionally and physically,” Hou said.
Nurses and doctors continue to make difficult choices about patient care, decisions like who gets to go to the ICU and who has to stay in the emergency room to wait for a bed.
The day before, Hou intubated four COVID-positive patients during a single shift, an unprecedented number. After clocking out of work, Hou described checking his patients’ vitals and test results from his home computer before catching some sleep.
“I’m not sure this is sustainable for the long term,” he said.