In Paonia, a rural part of Colorado’s Western Slope, 60-year-old Harold Burch lives in a home at the foot of Mount Lamborn with a spectacular view. But that’s been little consolation as he’s battled a cascade of health problems.
“It's been a real rodeo,” Burch said. “It's been a lot of ups and downs and lately it's been mostly just downers.”
Burch has battled chronic osteoarthritis, rheumatoid arthritis and had two major intestinal surgeries. One specialist he was seeing left her practice last year. Another wouldn’t accept his insurance. Then, Nov. 1, he started experiencing major stomach pain.
“When we talk terrible problems, I can't leave the house. I need to be right near a restroom all the time,” he said.
He says he hasn’t eaten anything substantial in three weeks.
Burch had to wait that long to be seen by a primary care doctor. He said the doctor told him, “if things were different, I would tell you to go to the hospital and be diagnosed, have some tests run and see what's going on with you. But he says, as of today, Delta County hospital is clear full. There are no beds available.”
Hospitals on the Western Slope have been slammed for weeks, and the statewide picture is similarly grim. As of Wednesday, 1,419 patients were hospitalized with COVID-19. Half of the state’s hospitals said they anticipated a staffing shortage in the next week; more than a third of them anticipated ICU bed shortages in the next week.
And behind those numbers, patients are feeling the impact.
Burch’s doctor told him he could go to the ER, but he might have to wait hours, perhaps with people who have flu or COVID-19 symptoms.
So Burch stayed home.
He’s fully vaccinated. But the rate of those with one dose in Delta County is 57 percent. And 84 percent of hospitalized COVID-19 patients are not.
“It's really frustrating because I did the right thing and like so many other people have, and we're being just kind of like told, unless you have a really serious problem, like a heart attack, a stroke, you're going to have a baby or, something like that, we really don't have time to mess with you,” Burch said. “I mean, it's just wrong.”
Burch’s situation is not uncommon this fall, as the state faces its second-worst COVID-19 surge for hospitalizations and deaths. Hospitals are under tremendous strain and that means delays and changes from normal care, as strapped providers do more with less.
And the situation for some patients is affected by others.
“Frustration, extreme frustration, actually anger, because I said a bad word. What I said to the doctor was ‘f****** idiots, who won’t get vaccinated,’” said Diann Cullen, a 72-year-old retiree from Broomfield. That was her reaction when her doctor told her that her hernia surgery would be postponed for weeks.
Cullen said he told her the hospital was too busy dealing with coronavirus patients.
“Absolutely. I mean, he flat out told me we can't even do it because of too many COVID patients,” she said.
A system in crisis
And that number of patients and a shortage of staff have pushed hospitals into crisis.
Consider this recent remark, the kind of thing that would have been unheard of pre-pandemic, from one hospital CEO, Denver Health’s Robin Wittenstein, who says hospitals are dealing with COVID-19 patients and those who delayed care.
“They're coming into hospitals now sicker than ever before. And they're coming in larger numbers than we've ever seen before,” she said on the day when most metro-area counties announced they were enacting a new indoor, public mask mandate. “Our system is on the brink of collapse.”
What’s the big picture impact when hospitals are on that brink? UCHealth ICU Dr. Abbey Lara puts it simply — it means things like care gets delayed, patients face more waits or they don’t get much-needed diagnostic tests. In the worst-case scenario, “patients who could have survived something, they had their life cut short because they weren't able to access care,” she said.
And when there are too many patients being treated by too few staff, Lara says, that ratchets up the difficulty for providers.
“I just worry that there's going to be not only a lot of turnover in the near future,” Lara said. “But I think that access to healthcare is just going to get even worse in the future,” she said.
Lara believes the effects of the pandemic will be felt long after it fades.
“The sky isn't falling, but the sky is going to turn a very different color,” she said.
Nurses under stress and in distress
The changing landscape is inspiring more nurses to speak out, like at an event last week. Across the street from Longmont United Hospital, a group held signs reading “patients first in the hospital.”
Critical care nurse Stephanie Chrisley told a crowd that normally a registered nurse would care for two ventilated, sedated, critical care patients.
“And the last few weeks we have regularly had RNs taking three, and sometimes four patients, at a time,” she said, which prompted boos from the crowd.
That’s unsafe, she said, and now the nurses are looking to unionize. Longmont United says it is focused on the well-being of patients and staff and that its top priority is high-quality care.
Chrisley, a mother of two, said nurses need more hands on deck.
“I have lately been in a state of chronic stress over the crushing guilt that I feel to ensure my patients get the care they need. And yet, somehow still care for myself and my family,” Chrisley said.
Kris Kloster has been a nurse for 32 years, much of that in the ICU. So she’s seen layoffs and staff reductions even before the pandemic hit. Now ICU nurses are dealing with colleagues quitting, restrictions on visitors, worries about catching the virus, anger from some patients not believing they have COVID-19, and coping with suffering and deaths. She said it’s been “soul sucking. I was like, that is the hardest job. That's the hardest I've ever worked.”
She’s since moved to the recovery room. But Kloster worries about patient care, safe staffing, recruitment and retention of experienced staff. She has been speaking out in hopes that Coloradans will understand the physical, emotional and psychological toll on nurses.
“This kind of staffing, this kind of stress is not sustainable,” Kloster said. “And something has to change.”
Nearly a third of the hospital's registered nurse staff has left since the start of July and many have not been replaced, she said.
The stress nurses and doctors feel is compounded when they feel powerless to take what they regard as an ethically correct action in treating a patient.
There’s a term for that, “moral distress,” said Dr. Barbara Statland, a hospitalist at Denver Health. The tension comes “because you can't do what you feel is ethically proper. And I'd say that health care workers have been riddled with this.”
‘They saved my life’
Despite the stress and distress, many frontline providers are hanging in there, continuing to care for patients every day. That made the difference for at least one COVID-19 patient who said he was appreciative he was able to get care — just in time.
“They saved my life. I do feel grateful for everything they did,” said 58-year-old Rob Blessin, from Fort Collins.
He caught the virus this fall and spent 30 days in an ICU ward with pneumonia at North Colorado Medical Center in Greeley. He described the efforts of his doctors and nurses as heroic, some working nine or 10 days in a row, many taking overtime. And others, Blessin says, were filling in.
“So often you’d have people from different departments being trained on the fly,” Blessin said. “So there's a lot of pressure on people. They're just trying to get warm bodies in there.”
Respiratory therapists are in short supply in hospitals, and Blessin says as more coronavirus patients got admitted staff struggled to keep up.
“There was just so many people there and very few staff,” he said.
Blessin said he was unvaccinated, that he’d been swayed by internet anti-vaccine misinformation. It’s a decision he came to regret.
“I guess my recommendation would be to get vaxed, you know, even if you’re totally against it, don't fall into the internet hype,” Blessin said.
After his experience being hospitalized for a month due to the coronavirus, and having talked with his physicians there, he now plans to get vaccinated.
The big picture impact of hospitals in crisis
The health system is complex, a meshwork of interacting pieces, said Dr. Steve Cantrill, a Denver Health emergency medicine physician. “So it's not a matter of the whole system, but you have little pieces that are breaking,” he said. “And then the number of pieces that are breaking increases.”
Despite that, frontline providers aren’t just going to pack it in and go home, he said. “We'll still be providing care, but you don't have the resources that you used to have to get the care to the people that you'd like to get to them.”
“Hospitals across Colorado are in critical condition. We have been at 90 percent-plus capacity in our ICU and acute care beds for weeks now. And unfortunately, there doesn’t appear to be an end to that situation in the near future,” said Cara Welch, a spokesperson for the Colorado Hospital Association. “This is especially true as we look forward to the holiday season and an increased spread of flu throughout our communities.”
Just last month a Centers for Disease Control and Prevention study estimated strain during the pandemic on hospitals nationally is linked to tens of thousands of excess deaths, of all causes.
To deal with the current crisis in Colorado, hospitals stepped up a patient transfer center. The state activated an emergency plan for staffing, to give more leeway to deal with staff shortages. The state’s top pandemic response board amended a plan, not yet activated, to help hospitals “triage” patients.
Denver Health’s Dr. Anuj Mehta said the new rules will help “so we can take care of the other patients in the hospital better and likely improve survival for everybody.”
Because of capacity issues, Welch said the hospitals have been trying everything to continue providing care. “That may include postponing certain scheduled procedures, refusing out-of-state patient transfer requests, transferring Colorado patients through the Combined Hospital Transfer Center to another hospital that has the necessary resources, holding patients who need to be admitted in the ER until a bed becomes available, and more,” she said.
“We recognize that none of this is ideal or what Colorado patients are typically used to in their health care system,” Welch added. “But we are in unprecedented times that require these extraordinary measures.”
