‘Double-headed surge’ strikes rural hospital
‘We’re maxed out,’ says ER doctor at Hollister facility. Nevertheless, ‘We make it work’
Every morning since the new coronavirus surge began, Dr. Michael Bogey gathers his staff into a huddle at San Benito County’s only hospital.
They talk about morale and keeping up energy and staying positive.
“Sometimes people cry. Sometimes people laugh,’ said Bogey, the chief medical officer and head of the emergency department at Hazel Hawkins Memorial Hospital in Hollister. “It’s trying on everyone because we’re maxed out.”
Hazel Hawkins is a small, rural hospital an hour south of Silicon Valley, surrounded by orchards and grazing cattle. It has just 25 beds, and every bed is full this week, straining the hospital and the staff. Gov. Gavin Newsom has warned that hospitals in this newly designated San Joaquin Valley region have only 6% capacity left in their intensive care units — on average. But that also means many of those ICUs in hospitals from Sonora to Bakersfield, including Hollister, are already full or spilling over.
Hazel Hawkins’ four-bed ICU reached 100% capacity last week and has stayed there. Of the nearly 90 patients that come into the ER every day, nearly half are experiencing COVID-19 symptoms. A three-room tent is set up in the parking lot for testing and screening after which most people are sent home. The hospital is so full that people waiting to be admitted often are held in the emergency room for hours — or days — until other patients are discharged, before moving into a room.
“We’re getting a doubleheaded surge. We’re getting COVID and really sick patients” with other ailments, said Bogey, 51, the only doctor on duty in the emergency department Tuesday. “I don’t
“It’s like you’re trying to outrun the bulls in Spain.”
— Liz Thurstone, nurse
think we’ve seen the sickest from Thanksgiving gatherings yet.”
It’s even worse elsewhere: In the Central Valley town of French Camp, the ICU at San Joaquin General is at 113%, meaning that all ICU beds were occupied and other severely ill patients needing intensive care were held in other parts of the hospital, said Marissa Matta, spokeswoman for the San Joaquin County emergency services agency. St. Joseph’s Medical Center in Stockton hit 123%.
These smaller hospitals are bellwethers, signs of dire things to come for larger hospitals around the Bay Area and across California. Newsom’s new lockdown was ordered precisely to avoid overcrowding hospitals.
But by Monday evening, the virus had been spreading so quickly, in part because of a post-Thanksgiving surge that has yet to peak, that East San Jose’s Regional Medical Center announced its 40-bed ICU had reached its limit, too, along with its emergency department and COVID-19 ward.
If there’s a metaphor for what hospital staff is experiencing in all the hardesthit hospitals — with little downtime since the pandemic began in February — perhaps Regional’s nurse Liz Thurstone put it best:
“It’s like you’re trying to outrun the bulls in Spain,” Thurstone said. “You’re looking over your shoulder and they keep getting closer and closer and all of a sudden you’re being stampeded. That’s the way it is at the moment. The bulls have finally overtaken you.”
At Hazel Hawkins Memorial, Bogey and his staff are trying desperately to stay ahead of the bulls, treating every patient that arrives and hoping to avoid transferring anyone outside the region. If more patients need ICU care — and the ICU is as full as it is now — they will be held in the emergency department where doctors have the ability to intubate patients to help them breathe if necessary. A 72-inch digital screen in the emergency room keeps track of all the patients.
“Right now, we’re playing a game of chess. We’re just kind of moving on the fly and adapting as things change,” Bogey said. “We brought that emergency room mentality to the entire hospital. We make it work.”
Beds in the maternity ward have been shifted to the medical surgical wing to accommodate people with the virus and other patients. Hospitals administrators are talking about canceling surgeries and doubling up COVID-19 patients into shared rooms. Local officials are discussing opening a middle school for spillover patients and Bogey is considering asking the National Guard for help.
Hazel Hawkins Memorial was founded in 1907 by T.S. Hawkins in memory of his granddaughter, who died of appendicitis while being taken by horse and buggy to Monterey because Hollister had no hospital.
For Bogey, it’s a matter of pride and practicality to keep his patients within the community instead of shipping them to hospitals miles away, where follow-up appointments would be taxing. Although there are still ICU beds available in the Bay Area — just an hour’s drive north of Hollister if needed — there are few left in the Central Valley.
At John C. Fremont hospital in the Sierra foothills town of Mariposa, outside the gates of Yosemite National Park, the lone hospital in the region that has no ICU is struggling to find hospitals that can take its high-risk patients.
“We really are seeing not only a scant number of ICU beds, but it’s hard to find them,” said Mariposa County Health Officer Dr. Eric Sergienko. “There’s no unified bed finder. A clerk has to pick up the phone and continue dialing around to find an ICU bed. That creates a whole lot of inefficiencies when that patient is sitting in Sonora or Mariposa maybe for hours.”
In Hollister on Tuesday morning, eight of the 25 admitted patients at Hazel Hawkins were being treated for COVID-19, including two of the four in the ICU and six in medical surgical wing rooms down the hall. Another four COVID-19 patients were being treated in the emergency room.
By early afternoon, upward of 20 people with coronavirus symptoms pulled up in their cars for tests and screenings. One was admitted. Most were sent home.
“It’s the ebb and flow of chaos this week,” Bogey said.
In the midst of the pandemic’s surge, Bogey says he is fortunate that the old hospital was retired and a new one was built just 10 years ago, with an impressive emergency department and state-of-the-art trauma rooms. But the ER that normally serves 60 to 70 patients is now seeing closer to 90 a day. Nurses are routinely working overtime shifts and travel nurses have been brought in to help with the surge. Many employees are doing double duty, especially unit clerks who answer phones but are now asked to clean rooms and transfer patients throughout the hospital. A COVID-19 hotline in the ER rings constantly with people worried they might have the disease.
“We’re doing triage after triage on the phone,” said one nurse named Ariahnna, who couldn’t give her last name because of hospital policy. “People are panicking. It’s a lot for us. It’s a stressful time for everyone.”
Some of the patients are getting difficult, too. Some are refusing to wear masks.
“Early on, we were heroes,” Bogey said. “But that has shifted as we have been bombarded with cases. People have been more impatient.”
That’s why the morning huddles are helpful. They didn’t need them for months, but Bogey started them back up during the surge last week. With about six nurses, Bogey discusses their game plan for the day and assesses where spare beds may be found.
But mostly, it’s a chance to vent and bond.
“It’s teamwork. It’s coming together,” nurse Ariahnna said. “We are surviving.”