/As COVID-19 cases rise, hospital workers (and their patients) enter a grim new reality

As COVID-19 cases rise, hospital workers (and their patients) enter a grim new reality

Dr. Kent Stock dashes into a hospital unit for patients who are coming and going from intensive care. Its 10 patient rooms, wrapped like a horseshoe around a cramped nurses’ station, are full this morning, their doors closed. Every patient inside has COVID-19.

A week ago, the unit had only three.

Bon Secours St. Francis is not one of the first hospitals within its larger system to get COVID-19 patients. When they come here, it means the others are filling.

Stock, an infectious disease doctor and COVID point man, stands outside a patient room to begin the morning’s rounds with a team of masked doctors, nurses and respiratory therapists. It is Aug. 5, a Thursday.

In Room 211, an otherwise healthy 69-year-old was admitted the previous day. He is unvaccinated.

Next door, an 84-year-old man was admitted Tuesday. His wife, daughter and daughter-in-law all tested positive. He is unvaccinated.

Nearby, a 61-year-old is maxed out on the oxygen he can get without going onto a ventilator. He caught the virus from a friend. His friend is fine; he is not. His friend got a vaccine; he did not.

“He’s struggling,” Stock says.

As the team moves along, they discuss how the delta variant is propelling a wave of patients who don’t look like the previous ones. Delta is more aggressive and more virulent. And it’s striking younger, healthier people. Stock says he has seen more COVID-19 patients in the 40- to 65-year-old range, including those who die.

Across town, in a lab at the Medical University of South Carolina, researchers have been testing positive cases to see what variants are showing up. Delta, which appeared in their data in mid-June, now accounts for more than 92 percent of all positive tests.

“At the bedside,” Stock says, “we are definitely dealing with a different animal.”

Yet, this unit did send a patient home during the week. She was 80, had cancer and was on chemotherapy, a prototype of who COVID-19 used to kill.

The difference? She is vaccinated.

In room 215, a corner room, Brenda Langley is not.

Registered nurse Kristen Moody checks on Brenda Langley, who is receiving treatment for Covid-19 in the progressive care unit at Bon Secours St. Francis Hospital on Friday, August 6, 2021, in Charleston. Gavin McIntyre/Staff

‘All the vulnerability’

Before entering Langley’s room, nurse Kristen Moody wraps herself in seemingly every form of plastic and latex, then slips inside quickly.

The room is cramped, the window hazy with humidity. The Golden Girls plays on TV as the 69-year-old patient lies on her stomach to help expand her lung function. Although her family and boss reach out often, she spends the long hours of every day feeling scared and lonely.

Amanda Snipes, a respiratory therapist, arrives to examine a high-flow oxygen nasal canula that delivers substantial amounts of oxygen, which so far is keeping her off a ventilator. Going on one is Langley’s biggest fear, aside from dying.

“I’m not going to give in to this,” she says. “I’m going to whip it.”

She adds, “And then I’m going to get a vaccine.”

Langley arrived here three days ago after languishing all weekend in the emergency department at Roper St. Francis Berkeley Hospital in Summerville. Beds for COVID-19 patients had become, very suddenly, full.

On Sunday, while she waited for one, Gov. Henry McMaster went on FOX News. He called COVID-19 concerns an “exaggeration.”

“I believe a lot of our national experts are engaging in frightening hyperbole,” McMaster said. He acknowledged that rates were rising but assured, “The house is not on fire again.”

The governor urged vaccinations, adding that they aren’t for everyone.

Langley had thought the same thing.

Throughout the pandemic, the Summerville resident worked full-time at Publix. She figured that if she hadn’t gotten COVID-19 yet, after all those months on the frontline of a grocery store, she was pretty safe. She also has Hashimoto’s thyroiditis, an autoimmune disorder, and worried the vaccine’s effects might be worse than catching the virus.

Her doctor highly recommended getting the vaccine.

Langley procrastinated. 

About a week ago, she started sneezing, then coughing. After testing positive, she arrived at St. Francis with a diagnosis of pneumonia. 

She tells Moody, her nurse, that she is now urging everyone she knows to get a vaccine — and plans to get one herself.

“Hopefully, we won’t grow tails!” she laughs. And coughs.

Moody smiles back. “I haven’t yet.”

For medical workers like her, it’s hard to hide the frustration. Langley is like so many in this new surge of cases. They arrive unvaccinated, get very sick, and then become vaccine champions.

Much convincing remains. South Carolina ranks 46th in the nation for vaccinations. In the tri-county area, which feeds patients to St. Francis, only 43 percent of residents are fully vaccinated.

Langley tears up explaining the vulnerability, the fear of death, the shock at being here fighting COVID-19.

“Put the fear away, and trust the system,” she says. “Trust God that He is in control, and He gave us medicine for a reason. He gave us this vaccine.”

As her voice quivers, Moody set a hand onto hers, a reassuring gesture, one wrapped in two layers of purple latex.

Registered nurse Mike Benson (left) and registered nurse clinical specialist Mary Jackman discuss a patient receiving treatment for Covid-19 in the intensive care unit at Bon Secours St. Francis Hospital on Friday, August 6, 2021, in Charleston. Gavin McIntyre/Staff

Hope unrequited

Across the country, new daily hospital admissions for COVID-19 patients shot up 40 percent over the past week to more than 7,700 new patients a day, according to the Centers for Disease Control and Prevention.

Those big numbers become real, individual people in local hospitals. Over the past two weeks, the Roper St. Francis Healthcare system went from 25 to 65 patients with COVID-19.

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At St. Francis, it started a week ago, mostly with patients arriving from rural areas of Dorchester and Berkeley counties, which have lower vaccination rates.

It can seem like a vague and generalized threat. Unless you are someone like Dr. Stock, once again rounding in units filled with COVID-19 patients. 

There was a time this spring, when the air warmed and the azaleas bloomed and Stock got the vaccine, and he and his colleagues felt so hopeful. Instead, last week, a man screamed at him in his office. 

You can’t tell me what to do.

I don’t trust the government.

There’s not enough safety data.

The vaccine will make me sick.

Stock finishes rounds and heads for the intensive care unit.

A multidisciplinary team of medical professionals discuss the conditions of two Covid-19 patients in the intensive care unit at Bon Secours St. Francis Hospital Friday, August 6, 2021, in Charleston. Gavin McIntyre/Staff

‘Anger is the best word’

As he speed-walks to the ICU, numbers veer through Stock’s head.

A day earlier, about 300 people in the tri-county area had tested positive for the virus. He’d read a study that showed at least 15 percent of infected people will get sick enough to require hospital care. 

That’s 45 new patients coming down the pike to local hospitals from one day’s new cases. And each day, the number is rising.

As a result, St. Francis has become a microcosm for what is happening here and across the country.

The ICU is full.

It has three COVID-19 patients, and its other beds are filled with its usual types of critically ill people. Normally, the hospital keeps one room open for an emergency need. But not now.

On this shift, the unit also is short two critical care nurses. Nationwide, the nurses have come under enormous demand, their ranks burned out from prior COVID surges and thinned by the bigger money they can make as traveling nurses elsewhere.

A team discusses staffing at Bon Secours St. Francis Hospital on Friday, August 6, 2021, in Charleston. Like hospitals nationwide, St. Francis is grappling with a shortage of critical care nurses. Gavin McIntyre/Staff

As a result, two nurses working today have three patients when the level of care typically demands only one or two per nurse. Even the rapid response nurse, who normally rushes to emergencies around the hospital, has a patient.

Stock greets fellow physician David Handshoe, a pulmonologist whose partner has been working at Summerville Medical Center, a hard-hit hospital. In just the past week, two of her patients with COVID-19 died — one was 28 years old, one 27. 

Neither were vaccinated.

The doctor, Leslie Wilke, recalls that when COVID-19 patients died last year, she often spoke with distraught children of the elderly patients. This time, she is talking to parents of younger adults, and there is something so different about a parent burying a child — “especially from something preventable,” she says.

Like many doctors, she feels like a broken record playing music in the background of everyone else’s back-to-normal lives.

“Anger is the best word, honestly,” Wilke says. “That’s been the overwhelming theme among staff in the ICU this week. I don’t want to sound crass, but if they had all been vaccinated, we wouldn’t be dealing with this.”

Handshoe heads into a large ICU room with two beds. Both patients have COVID-19. Both are on ventilators.

One is a 64-year-old woman. She was vaccinated back in April but takes medications that block the same receptors the vaccine tries to reach. Her husband sits alone outside the glass windows to the room, wondering if someone who isn’t vaccinated gave it to her.

Beside her is a 36-year-old man. He isn’t vaccinated.

Next door, neither is Bernard Scott, who is 33.

Brandon Scott, 33, inhales with an incentive spirometer held by registered nurse Shawn Mayle to help his lungs as he receives treatment for Covid-19 in the intensive care unit at Bon Secours St. Francis Hospital on Friday, August 6, 2021, in Charleston. Scott is currently on maximum oxygen, a step away from a ventilator, but has seen an improvement in his condition. Gavin McIntyre/Staff

Message from the ICU

Scott didn’t get vaccinated because he figured he was young and healthy. If he caught the virus, surely he wouldn’t get very sick.

He arrived at St. Francis last weekend short of breath, then deteriorated rapidly. His oxygen needs escalated, although so far, he has avoided going on a ventilator and today appears stabilized. 

On Tuesday, crews navigated him into this ICU room, alone, away from his family. Visitors can only come when someone is dying. Even then, they must wear full protective gear, rending them something like an astronaut stepping into the strange space of their loved one’s hospital room.

The two TVs in his room sit dark and quiet, turned away from him, toward the room’s only window. The silence, the seclusion create a womblike atmosphere. When Scott rouses, one hand feels around the spaghetti pile of tubes across his chest, and he tries to speak. A plastic mask muffles his words.

“Just get it,” he says in a whisper.

He stops, laboring to inhale. 

“I wish I had got it.”

“Do the right thing.”

Before closing his bloodshot eyes, he manages to thrust out a few more words. 

“Do what you’ve got to do. Get that shot.”

His nurse, Mike Benson, quietly moves around the room. He wears a camouflage scrub cap and normally sports a beard. But to get an N95 respirator to fill snuggly enough to protect him, he arrives in Scott’s room freshly shaven.

He jokes that he feels like Punxsutawney Phil, the groundhog, because with every COVID-19 surge, he has had to nix the beard.

“When you see my chin,” he says, “it means six more weeks of COVID.” Benson chuckles then at the dark humor, so common here because it sure beats crying.