The Deeper Dig is a biweekly podcast from the VTDigger newsroom, hosted and produced by Sam Gale Rosen. Listen below, and subscribe on Apple Podcasts, Google Play, Spotify or anywhere you listen to podcasts.
Vermont hospitals are feeling the strain from the recent surge of Covid-19 cases — and so are patients.
The state’s Covid hospitalization rates have been climbing throughout the fall, peaking about two weeks after Thanksgiving. But they’re expected to start climbing again after the New Year, when the more contagious Omicron variant spreads further.
Doctors and nurses are caring for an overwhelming number of people — many of whom are sick with severe Covid, while even more are crowding facilities after delaying care earlier in the pandemic.
The Biden administration has sent federal reinforcements to several Vermont hospitals, and the surge has forced some patients to delay procedures they see as essential.
On this week’s podcast, patient Pete Engle describes his experience seeking care during the surge, while VTDigger’s Riley Robinson discusses the impact on one hard-hit hospital, Southwestern Vermont Medical Center in Bennington. Below is a partial transcript, edited for length and clarity.
A couple weeks ago, we put out a call to readers to tell us about their recent medical experiences. Lots of folks said they got the care they expected: people saw their primary care doctors, got things like knee surgeries and colonoscopies.
But others were not so lucky.
Pete Engle: Vermont has access to two facilities that can do spine surgery. One is UVM, and one is Dartmouth. And neither one of them is accepting new patients for two or three months out. And so you basically can’t get treatment in Vermont. It’s not a question of whether your insurance is going to pay for it. You just can’t get treated in Vermont.
This is Pete Engle. Pete said he was kayaking on the Green River Reservoir back in October. And at the end of the day, when he picked up his kayak, he felt this sudden pain in his back.
Pete Engle: And by that evening I was in — I mean, screaming puddle-of-jello-on-the-floor kind of thing.
Is this something that happened to you before? Did you kind of have a sense of what was going on?
Pete Engle: I’ve had some back issues before … a little bit of degenerative disc disease like kind of everybody has. And so I’ve strained my back on occasion, bad enough that once or twice I’ve been on the floor for a day or two just recovering. But those were all the type of thing that I could do exercises and rest it, and after a few days or a week, it would be basically all better.
But this one is not getting all better because it’s a fully herniated disc. I mean, anybody who’s looked at my MRIs says there’s no question here. This is not something that’s going to get better. You need surgery and you need surgery right away, or you might be paralyzed.
Pete called his doctor’s office. They said it would be four days until he could get an appointment. So he went to the emergency room at Copley Hospital and got an X-ray. And when he finally saw his doctor, Pete had to convince him that an MRI was necessary.
Pete Engle: But the MRI was scheduled like another three weeks out, December 3. It’s like, if something’s not bleeding or falling off, nobody wants to talk to you.
This whole time, Pete said, he was in chronic pain — barely walking, sleeping a lot. He couldn’t work.
But even after he got an MRI, it took weeks to get in to talk to his doctor about it. So Pete sent his results to a friend out-of-state who happens to be a spine surgeon.
Pete Engle: It took us a few days, maybe almost a week just for me to get the MRI information to him and for him to have a chance to look at it. And he looked at it and called me and he said, “Yeah, we call this an ‘Oh shit MRI.’” As in, “Oh shit, we have to get that guy into surgery right now.”
And I called my doctor’s office again and said, “Look, I’ve talked to an out-of-state spine surgeon, looked at the MRI, and I need surgery right away. What can we do about this?” And my doctor’s office basically said, not much. They said, “We’ll call Dartmouth for you to see if they can get you in any sooner.” And of course, Dartmouth can’t get me in any sooner either.
Pete said if he wants to get this surgery in Vermont, he’s been told he has to wait until at least February to talk to a specialist. Not to get the surgery — just to talk to a doctor about scheduling a procedure.
Pete Engle: Because right now, none of the Vermont hospitals — again, UVM and Dartmouth are the only two that could even consider doing the surgery. And neither one of those are accepting any, any non-emergency surgeries right now. So it’s basically heart attack and stroke. And anything else, you just got to live with it.
A spokesperson for the University of Vermont Medical Center told VTDigger last week that roughly 200 to 250 patients have been impacted by delayed procedures. But that number doesn’t include patients like Pete, who haven’t even started planning their surgery with a doctor. Dartmouth-Hitchcock Medical Center has also announced that some procedures have been delayed, but they didn’t respond to questions about how many.
Hospital officials have said there are multiple factors causing their capacity problems. There’s a shortage of qualified doctors and nurses to staff hospital beds right now. More and sicker patients are coming in after putting off care during the pandemic.
But one major factor is the influx of patients with severe Covid-19. Vermont’s Covid hospitalization rates have been climbing throughout the fall, peaking about two weeks after Thanksgiving. But they’re expected to start climbing again after the New Year, when the more contagious Omicron variant takes hold.
Other patients told us they’ve had their first cancer treatments delayed. One said she had taken a month off work to have a hysterectomy only to have it canceled with two weeks’ notice. Experts say that until the region gets Covid transmission under control, this pattern is likely to continue. People like Pete are hearing that message, too.
Pete Engle: If people would be a little bit responsible and wear a mask and get vaccinated, it would help the whole system move forward a little bit better.
When we come back: what an overcrowded hospital actually looks like.
Riley, thanks for jumping on.
Riley Robinson: Hi, Mike.
Earlier this month, our reporter Riley Robinson visited the Southwestern Vermont Medical Center in Bennington. At the time, Bennington County was reporting the highest rate of new Covid cases in the state.
Riley, I have to imagine that people have some ideas and assumptions in their mind when they hear about hospitals being at capacity. And I wonder if you could describe what it actually looks like. Where are the patients when you go into this building?
Riley Robinson: I’ve watched an embarrassing amount of Grey’s Anatomy. So when I walked into the emergency department, I expected blood and guts and people yelling at each other and people looking very stressed. It was actually very calm. It was very quiet.
Trey Dobson: What you’re seeing here is that’s out into the waiting room, the ED, and this is triage. So they need a nurse to discuss what the issue is before they’re admitted. Here on this side, there’s a couple of nursing administrator offices here to our right …
Riley Robinson: We met up with Dr. Trey Dobson, who’s their chief medical officer there. He’s also an emergency medicine physician.
We started in their regular emergency department. It’s set up in a circular space. The center is, I guess, like the central command. You have all these computer monitors and nurses and doctors, and you didn’t really see a lot of patients. They were in either walled off or curtained off rooms. It’s not like there’s people in gurneys down the hallway. That’s not what was going on.
At Southwestern, because they’re doing construction, they’re trying to adapt to this capacity issue. Before the pandemic, they had four negative pressure rooms. And they now have 55 that they’ve put up, and it’s kind of adapting to this temporary space. Some of these negative pressure rooms are sealed off with blue painters tape. Because they’re also in the process of building their new ED.
Trey Dobson: Now you can see how many Covid patients — so back when the surge was not happening here, we didn’t have every single room ready to roll here. We just put some Covid patients here. But now, on any given day, we can have more than half the patients in the emergency department with Covid, or at least being ruled out for Covid…
What are the doctors and nurses doing? What do you see in terms of the actual movement and flow of people through the space?
Riley Robinson: Before they go into a room, there’s a checklist, either flipped out or flipped in, to tell them whether they need that higher level of PPE to go see a Covid patient.
Trey Dobson: All this stuff on the walls and all this — all pandemic stuff, telling you, I can’t go in there without being fully PPE’d.
Riley Robinson: There’s a lot of taking off and putting on gowns and these helmet-like respirators, and pushing carts of supplies. We see doctors just in there talking to patients. And, again, not all the patients in the ED are there for Covid.
When you talk about it being sort of a quiet atmosphere — I wonder, in this moment that we’re in right now, why might that be kind of surprising?
Riley Robinson: When I tried to imagine what it would be like to be a provider right now, it seems like you’re always running around, needing to coordinate with lots of people on the team. Things are urgent, yelling. But it wasn’t like that. People spoke to each other quietly. They’re quietly putting in patient information, files.
The quiet really stood out in the ICU. That’s really where it hit me. It’s almost like an office except for the beeping.
Riley Robinson: What’s the alarm we just heard?
Trey Dobson: What’s the alarm we’re just hearing right now? So there’s a couple. One is a bed alarm, meaning that the patient has adjusted themselves in the bed and they want the nurse to know that that’s happened. This person here has an alarm going off because their oxygen is really low. And I can see that.
Riley Robinson: Because of his training, he can pick out each of these different beeps in this jumble of sound, and he can tell me, this is because somebody’s oxygen level is really low, or this is because of someone’s heart rate, or that’s an alarm for when somebody adjusts in their bed or something else has happened. But it’s just a constant beeping. And other than that, there’s not a lot of human sound.
What kind of condition are these patients actually in?
Riley Robinson: It depends. As I walked around with Dr. Dobson, he pointed out, some people are on ventilators, some people were not. But there were several patients in the ICU that, he noticed, their blood oxygen level was really low.
Trey Dobson: So you can see we have one bed open. This person here can’t breathe on their own due to Covid, so they’ve got a tube down. And you can see this oxygenation is actually still not great. You should be at 100% oxygenation if a tube’s down there.
You can see this woman’s oxygenation is not good. That woman’s oxygenation is not good. That is a rhythm strip that is — so the person’s heart right now is beating too fast, so it’s alerting the staff. But you can see all these people’s oxygen is low. They’re on oxygen too. So she’s got oxygen in her nose and still — you should be at 100%, and both these people are 90%.
What did Dr. Dobson tell you about why this moment feels different from what they’ve experienced in the past?
Riley Robinson: Bigger picture, obviously, more Covid patients, but also more non-Covid patients. And he said, there’s always sort of a cyclical nature to this — it could be from flu, it could be anything else going on in the world. But now, it’s the combination of Covid plus these other things.
Trey Dobson: What’s happened over the last three to six weeks is just, volume has increased. And it’s both with both Covid patients and non-Covid patients. And the problem with that is, we anticipate fluctuations with non-Covid patients. Sometimes it occurs with the seasons. Sometimes it occurs with diseases like influenza. Sometimes it just happens, like you don’t even have any idea why. But now with the unvaccinated Covid patients coming in, it’s really inhibiting our ability to take care of others. And that’s a sentiment that’s unfortunately become pervasive over the past several weeks among health care workers in New England.
Riley Robinson: Plus, at Southwestern and at hospitals everywhere, it’s people who, if it were not for the pandemic, would have gotten care earlier. They would have gotten that routine colonoscopy, they would have gotten that weird whatever-it-is checked out. So they’re seeing patients who are sicker. Now, that issue has become more severe. And now they’re in the emergency department. And now they need that higher level of care.
For doctors and nurses, they’re seeing a lot more patients. It was 11 o’clock in the morning, and they already had people waiting outside to be seen, which he said normally wouldn’t happen until 6 p.m. Because people come in faster than that they can clear them from the emergency department or faster than they can be seen. So their daily rhythm is, things sort of compound over the day.
There was a moment when Dr. Dobson looked up at the board and he looked up at this electronic screen that shows you how many people are waiting to be seen. He goes, This is too early. This is too many people for this early in the day.
Trey Dobson: It’s very early, and we don’t normally have as many patients this early in the morning. We don’t normally have this many staff. This is all due to Covid and the increase. And it looks very calm and relaxed. But if you think about it, there are two doctors trying to take care of all of these patients right now.
Riley Robinson: There’s burnout. We talked a bit about anger. The feeling of, “It doesn’t have to be this way.” Most people who are showing up in the hospital really, really sick with Covid are unvaccinated. There’s a feeling of anger around people weighing their individual rights over the impact that it has on everyone around them.
Right — we know that the vast majority of people in the ICU in Vermont are unvaccinated. And even for hospitalizations more generally, that’s also true. And they’re saying, “This is a preventable situation.”
Riley Robinson: Yeah. And I think it’s also, how do you keep going, especially when we thought that it would be better? Maybe it didn’t have to be like this. But now there’s Delta, and now the holidays, and what if these pressures continue to grow?
Trey Dobson: Morale is very low among healthcare workers. And that happens when they get to a point where they feel like they can’t deliver the care to patients. The reason they went into health care in the first place — so people go into health care to limit suffering and provide treatment. And when they can’t do that, the morale drops.
The morale drops also when they just are exhausted, at a certain point. And unfortunately, that’s what’s happening. And I fear that people will begin to lose their compassion. And by that, I mean, the desire to provide the care. When you lose your compassion, that’s called burnout. And that’s how people leave the field.
There’s some anger developing. They’re angry at people not vaccinating, choosing what they believe to be their own individual self right, not recognizing the impact on the rest of the community in that regard. So for example, having all the patients come to the hospital means that we’re going to be past capacity. The increase continues, we’ll be past capacity, won’t be able to take care of everyone. And that’s very scary, and that’s very anxiety provoking, for a doctor or a nurse. To know that you — they’ve never, most anyone here has never been faced with that unless they served in the military. Or they really went through a major, traumatic event like 9/11.
Riley Robinson: Have you personally had to work through anger, burnout? How do you deal with that?
Trey Dobson: I have. I think everyone has. I think that’s part of being human. I try to be aware of when I’m having those feelings, and step back and ask myself why I’m having that feeling and what I can do to address it in the moment.
I think the big question, the more we hear about the strain on the health system right now, is, how much longer can this go on for? Did you come away with a sense of what the longer term outlook is for these doctors and nurses and hospital staff who are dealing with all these different stressors, and how much longer they can keep even providing this level of care?
Riley Robinson: I don’t know. I don’t know what that timeline is. Because we don’t know how bad it will be and how long this will continue and where that light at the end of the tunnel will be.
Living in the U.S., I think there’s an assumption that if you need medical care, capacity won’t be an issue. There are definitely all these other barriers to getting health care — it’s expensive, you might have to drive. But it’s there in times of true emergency.
That’s what doctors and nurses want to do — they want to give people the best possible care and the best possible outcomes and all of the resources we can throw at people who need it. But also, they’re living with the reality that there are only so many nurses, there are only so many doctors. There are only so many hours in the day. At some point, those are finite things.
Last week, President Joe Biden announced that the federal government was sending reinforcements to hospitals experiencing surging patient volumes in six states. One of them was Vermont. In addition to 20 paramedics and EMTs deployed to UVM Medical Center, 10 medical workers were headed to Southwestern Vermont Medical Center. The emergency teams were scheduled to remain at least through the end of the year.
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