The doctor will see you now – In the hallway

Nurse Heather Gatchet’s shift in the emergency department at Salem Health Hospital in Oregon typically begins at 6 a.m. Before that, she prepares her daughter’s lunch, drinks tea and, to avoid her panic, calls her mother on her way to work.

“My mom is like my cup of coffee,” Gatchet said, her voice cracking, “to mentally prepare me for what I’m walking into.” Gatchet’s mother reminds her that she is good at what she does and that she is loved. After walking in and seeing her co-workers in the break room, Gatchet said, her panic subsided: “This is my team, and they feel safe again.”

More than 700 days have passed since the first case of covid-19 was confirmed in Oregon. Like the rest of the country, Oregon had far more cases during the early 2022 omicron surge than during any previous peak of the pandemic. New cases have started to recede, but the sheer volume of infections continues to flood hospitals across the country. The Salem hospital, where Gatchet works, is once again adapting to accommodate more patients than it is authorized to accommodate.

Dr. Peter Hakim works alongside Gatchet. Recently, her mother-in-law had a heart attack and was taken to a small rural hospital. She needed specialist care that was not available there. “They couldn’t find him a bed anywhere in Washington or Oregon for 24 hours,” Hakim said. “So she was sitting in this little six-bed emergency ward and couldn’t be transferred.”

Her mother-in-law finally got the care she needed. A lot of people, Hakim said, “are not so lucky.”

Salem Hospital’s emergency department has 100 beds. To cope with the influx of people seeking care, hospital staff made room by installing dozens of beds in the corridors.

At noon these ward beds are full and the ambulances pull up in the bay behind the hospital – seven, eight, nine at a time.

The pressure mounts throughout the afternoon as more patients arrive. Three years ago, treating people in the hallways would have been an extraordinary measure. Now Gatchet and Hakim prepare for it every day.

Some of what Hakim does as a doctor, like cutting a patient’s clothes to examine a broken hip, is too sensitive for the hallway. He said he took a patient to the bathroom to perform an examination: “It was the only private space we could find at the time.”

The hospital was 100% over capacity for months, with patients doubled – and sometimes even tripled – in their rooms, according to hospital officials. Salem Health allowed a reporter to follow Gatchet and other staff on January 27, which turned out to be the day with the highest number of covid patients yet – 122 people, nearly one patient in four in the hospital had the virus.

About 70% of those covid patients were admitted with respiratory symptoms, while the rest were asymptomatic cases discovered during admissions screening, according to hospital officials.

But those 122 patients were only part of the pressure of the pandemic. If the healthcare system were a series of dominoes, emergency medicine would be at one end. But the domino that tipped first and toppled other parties was long-term care. Statewide, more than 70% of long-term care facilities had a staff member or resident test positive for covid in January, with many reporting full-blown outbreaks.

Low-paid carers are burnt out and leaving the long-term care sector in large numbers – it’s one of many industries competing for workers in a tight labor market that’s seeing record quits and retirements .

The covid outbreaks and staffing shortages mean Salem Hospital cannot send patients back to nursing homes. These establishments are closed to new admissions.

It is also more difficult to find help for patients who need help to return home after a debilitating illness or accident. The pandemic has made hospital beds, home caregivers and even wheelchairs harder to come by.

Dr Sarah Webber, a hospitalist, said that before the pandemic, coming up with a safe discharge plan for patients took her team a few days. “And now sometimes it takes a week or two. And I have patients who have been here for several weeks,” she said. Of the 20 hospitalized patients she was responsible for the previous week, eight were stable and ready to go but had no discharge plan.

Statewide, nearly 600 patients are ready to leave the hospital but are awaiting a discharge plan. One in 10 patients in an Oregon hospital bed could leave but have nowhere to go.

As in the delta wave, a majority of covid patients hospitalized at Salem Hospital are unvaccinated people.

Patients infected with the omicron variant require, overall, less oxygen and less intensive care. “I see more patients living,” said Jackie Williams, a respiratory therapist who works on every floor of the hospital. “It’s like a small ray of hope.”

Many of the less critical covid patients are behind closed doors in the medical-surgical unit of the hospital. Being hospitalized with covid – even a milder variant – is a lonely experience.

In the hallway on January 27, a nurse manager spoke to the wife of a covid patient who had been transferred from the emergency room. The manager explained that the patient’s wife had to leave the unit because she was exposed to covid while caring for her husband and could infect hospital staff members or patients. The wife calmly fought back tears as she handed a bag with glasses and a change of clean clothes to her husband.

“Does he have a cell phone?” asked the nurse manager. “The nurses, they can help her FaceTime so you can talk to her, okay?” She added, “I’m sorry.”

A member of the Oregon National Guard fanned out to the hospital to help nurses push a cart full of supplies down the hall and salute. Members of the guard are giving a little nudge – and a show of solidarity – to staff members who are feeling down.

For Webber, it stings that many of his patients don’t follow his advice to get vaccinated after they recover. “People come to the hospital sick and they want me to help them, but they don’t trust me on the basics of prevention,” she said.

At home, she has less patience for her children — and they seem to need her more. Her 6-year-old daughter recently asked why Webber couldn’t stay home with her.

“She asked me: ‘Are the sick more important than me?’ said Webber.

In recent days, hospitalizations in Oregon appear to have peaked and are leveling off. Salem hospital staff members are hoping that as the omicron wave subsides, the pressure will ease a bit.

Even then, it’s still flu season and the health issues that escalated during the pandemic in Oregon will resurface. “It may not be respiratory problems, but it is alcoholism. This is suicide,” said Williams, the respiratory therapist. “It’s trauma, it’s all these other things that the world is dealing with after coming out of two years of a pandemic. And these are also serious diseases.

This story is part of a partnership that includes Oregon Public BroadcastingNPR and KHN.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polls, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.

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