Inside ICUs and ERs of flooded hospitals, an endless loop of preventable tragedies

By: - December 15, 2021 5:53 am
Nurses put on PPE

Catholic Medical Center emergency room nurses prepare to enter a COVID-19 patient’s room. (Annmarie Timmins | New Hampshire Bulletin)

A young, unvaccinated mom of three was more fortunate than some after being admitted to Catholic Medical Center’s intensive care unit recently. Before she died, she had time to call home and request that her children be vaccinated. An unvaccinated male patient in his early 50s didn’t have that option. 

He needed a breathing tube placed down his throat to his windpipe within 20 minutes of arriving at the ICU. It’s a procedure that requires patients to be sedated, and in some cases medically paralyzed so they don’t resist. They are unable to speak, so his call home fell to ICU resource nurse Lynn Harkins.

“I don’t want to cry,” Harkins said, pausing. “She was just sobbing on the phone. They’ve seen on the news that ventilation is not a good prognosis.” The man died.

But the awareness often comes too late, especially for those who think youth and health are protection enough against COVID-19 health complications, including death. The leadership teams at the CMC and Elliot Hospital, both in Manchester, allowed the Bulletin inside their emergency rooms and ICUs in recent days, hoping scenes from the front lines would persuade the unvaccinated to get vaccinated. 

“I’m not saying that people who are vaccinated aren’t getting sick. They are,” said Christine Barry, a nurse manager at CMC. “But they are able to stay home and be sick. The ones that are here? That’s where we are seeing the deaths of the ones that are unvaccinated.”

A nurse wearing scrubs behind a glass partition
Catholic Medical Center nurse Aaron Paplaskas tends to a COVID-19 patient in the hospital’s ICU. (Annmarie Timmins | New Hampshire Bulletin)

Hospital leaders from around the state are sounding the alarm as the state hits record high hospitalizations (454 on Monday) and heads into what they say will be the worst four to six weeks of the pandemic. They point to a perfect storm of the more contagious and deadly delta variant and decisions to forgo vaccination and masking while moving large gatherings indoors. 

Already out of staff and space, hospitals are sending patients out of state and boarding others in hallway emergency rooms. They say it’s preventable surges like these – not vaccine mandates – that most threaten their ability to retain workers.

“We’re all experiencing moral distress,” said Martha Leighton, Elliot Hospital’s chief nursing officer. “That’s when ethically you know the right thing to do but you just can’t do it because of constraints. Keeping people in the (emergency room) who need an inpatient bed doesn’t feel good. Not being able to provide an ICU-trained nurse for every ICU patient feels wrong. And some patients outright refuse to believe in COVID, refuse to be intubated, and we watch them die, literally suffocating to death. And that feels wrong. That constant struggle wears on you, and it beats you down.”

On Friday, CMC had about 45 COVID-19 patients, 10 of them in the ICU, most of them needing help breathing, either through a face mask ventilator or intubation, a tube inserted into their windpipe and connected to a ventilator. The emergency room was keeping up with new patients on Friday, but by Monday there were 40, enough that some patients were in hallways. 

It was a similar scene Monday at Elliot Hospital, where 10 COVID-19 patients were in the ICU and 47 were being treated on other floors. Overflow patients were in the emergency room hallway, and those in the waiting room were facing hours-long waits to be treated.

The two hospitals shared another similarity.

Unlike the pandemic’s early patients – who were largely older with pre-existing conditions – today’s are younger and previously healthy. And they are arriving in worse condition.

But they are suffering those serious health consequences for the same reasons, Leighton said. They are unvaccinated, initially because there was no vaccine and now because they have chosen not to get one. (Last week, 92 percent of Elliot’s COVID-19 ICU patients were unvaccinated.) And they are congregating in large groups. Early on, the most vulnerable were older people living together in long-term care settings. Most everyone else stayed home and masked when they went out. As those in the latter group – at least 35 percent of whom remain unvaccinated – have returned to offices, restaurants, and events, they are the ones now in congregate settings. 

The consequences of choosing to do so while forgoing vaccination, masking, and social distancing are starkest in ICUs.

On Monday, that included a young father being cared for in Elliot Hospital’s ICU. Both he and his wife are unvaccinated and both contracted COVID-19, but only he required hospitalization.

“When you’re that young, you don’t necessarily think that you’re ever going to get that sick,” said resource nurse Stephanie Joyce, one of the team members caring for him. “You just still feel like you’ll live forever.” 

While some patients still arrive at an ICU with pre-existing health conditions, as they did at the start of the pandemic, many today are unvaccinated because they are otherwise healthy or unaware they have underlying health conditions.

“Losing a 44-year-old that had no comorbidities was extremely difficult,” said Diane Kobrenski, director of the ICU at CMC. “We still have patients in the ICU who don’t believe COVID is real. It’s real, and we are seeing and living it. There was a lull, but now it’s exploding again throughout the state and throughout our hospital.”

A nurse looks a monitor in a hospital hallway
Nurse Stephanie Joyce checks the status of a COVID-19 patient in Elliot Hospital’s ICU. Staff must don PPE each time they enter a COVID-19 patient’s room and doff it off when they exit, a process that can take 10 minutes. To save time, the hospital moved monitoring equipment outside patients’ rooms, where PPE is not required. (Annmarie Timmins | New Hampshire Bulletin)

Those who do survive and return home are not necessarily in the clear and, depending on their treatment, can suffer nerve pain, breathing difficulty, muscle aches, fatigue, and foggy thinking. 

Staff at CMC and Elliot Hospital saw a surge after family and friends gathered for Thanksgiving. They are bracing for another one after Christmas. In preparation, both hospitals have issued an all-call to staff in other departments, asking them to help stock supplies, hand patients lunch trays, welcome visitors, answer the phone.

“Anything that that nurse or an LNA doesn’t have to do … all those little things help,” CMC spokeswoman Lauren Collins-Cline said. 

Tanya Flagg, an Elliot Hospital emergency room nurse, said that hospital-wide support has made a difference beyond the tasks they are performing.

“I think the overall feeling from the staff, at least in the past couple days, is more of a feeling of resiliency,” Flagg said. “All different levels of expertise are coming together to try to overcome (the increased demand). It’s exhausting, but that sense of resiliency … there’s a palpable sense of that.”

It’s especially appreciated at a time when the public gratitude for “health care heroes” has waned – or worse. 

“At the beginning you were very proud to tell people you were a nurse or in the medical field,” Joyce said. “I felt like over the summer when it started to become more of a political thing, I was like, ‘I’m not telling anybody what I do.’”

Gov. Chris Sununu is bringing in federal medical reinforcements with a goal of easing the burden by providing hospitals the staff to open additional beds. 

The first, a 24-person team, which includes a doctor, nurses, pharmacist, and a respiratory therapist, arrived at Elliot Hospital Saturday from the U.S. Department of Health and Human Services National Disaster Medical Systems. They immediately allowed the hospital to open up six new beds. But they will be here for just 11 days.

“I’m just going to enjoy and be grateful for the first seven days. And then once we hit seven days, then I’ll start thinking about, oh, no, what are we going to do, because they’re going to leave,” Leighton said. “So I am just really basking in the fact that they’re here. And it did definitely bring a sense of someone cares. Someone’s helping us.”

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Annmarie Timmins
Annmarie Timmins

Senior reporter Annmarie Timmins is a New Hampshire native who covered state government, courts, and social justice issues for the Concord Monitor for 25 years. During her time with the Monitor, she won a Nieman Fellowship to study journalism and mental health courts at Harvard for a year. She has taught journalism at the University of New Hampshire and writing at the Nackey S. Loeb School of Communications.