Anna Balcom, a rising star and former Nurse of the Year at Oregon Health & Science University, will leave the frontlines of the COVID wars in February.
A charge nurse in OHSU’s medical intensive care unit, Balcom’s already stressful job became untenable with the arrival of the deadly coronavirus. The 34-year-old Florence native will leave the ICU in February for a less stressful position in another ward.
“I feel so much guilt, I feel like I’m abandoning my battle buddies,” Balcom said. “But it all became too much.”
Co-workers were stunned. Balcom was their stalwart leader, a cheerful hard worker who had helped many of them care for the most challenging patients in the most extreme circumstances. Those awful moments have come more often in the COVID-19 era. Balcom’s unit helped deliver a stillborn baby to a woman severely ill with COVID-19.
Balcom had been thinking about a potential change before COVID. She had gotten married. Plus, the ICU could be a rough place. It often treated homeless people with substance abuse and mental problems.
COVID gave her the final push.
“I thought I was a lifer in the ICU,” said Balcom, who will join a day-surgery unit in February. “But it sometimes feels like we’re asked to do the impossible. We’re risking our lives but sometimes it feels like we’re beating our heads against the wall.”
From Portland to Medford, a similar dynamic is playing out. After nine months of battling the virus, many of Oregon’s frontline health care workers are burned out, stressed out and increasingly, some want out.
The timing couldn’t be worse. While news of several effective vaccines has provided a huge ray of hope for the future, Oregon must first deal with a giant jump in coronavirus patients – active COVID-19 hospitalizations reached 474 Tuesday, triple the number from a month earlier.
As infections, hospitalizations and deaths race to unprecedented levels, it seems clear the gravest battles of Oregon’s pandemic wars are still ahead. But the tip of the spear of Oregon’s COVID-19 army has been blunted by many months of hard labor, danger and anxiety.
Regional healthcare administrators have taken notice, pleading with Oregonians to help slow the spread of coronavirus by limiting social interactions.
“Our dedicated frontline health care workers continue to risk their lives to care for every patient who needs them,” said Dr. Renee Edwards, chief medical officer at OHSU, in a speech last week. “But we are perilously close to overwhelming them. Like many of us, they are tired, frustrated and grieving.”
It’s not just the virus. The year 2020 has offered a feast of ill fortune. There was the recession, the riots in Portland, an ugly political divide, wildfires and school closures.
“If you ask any of us if we feel emotionally drained and exhausted I think 100% would say, ‘Yes,’” said Dr. Kevin Ewanchyna, a Corvallis urgent care physician and president of the Oregon Medical Association. “As this frustration and burnout sets in, you’ll see more people leaving the profession.”
Many health care workers are also angry – with hospitals they consider to be tightfisted, with President Trump for consistently downplaying and politicizing the pandemic, and in particular with portions of the American public, who have failed to recognize the seriousness of the disease and refuse to take basic precautions.
“The situation right now is that we’re facing a mountain of cases,” said Dr. Jamie Grebosky, chief medical officer at Asante, a Medford-based company that owns three hospitals in Southern Oregon. “What bothers me is that we know how to limit the spread. It’s masking, it’s social distancing. This is a preventable disease.”
Teetering on the brink
The emergency room physician was bursting with indignation.
Forecasts that Oregon so far has enough hospital space to accommodate an expected surge of coronavirus hospitalizations don’t appear true, she insisted, based on what she’s already seeing.
“We boarded 17 patients last night,” said the doctor, who requested anonymity because she wasn’t authorized to speak about the Portland-area hospital. “That’s insane. That just doesn’t happen.”
Emergency rooms are typically the front door for Oregonians who need urgent care, from broken bones to COVID-19 treatment. And hospitals are forced to “board” emergency room patients when they don’t have beds ready to accommodate them. Patients must wait, sometimes for hours in spare rooms or hallways, for a room to become available.
“Everyone is full,” the ER doctor said. “We can’t admit patients. By evening there are no beds in the city.”
State leaders have warned of a potential hospital crunch, but data shows there are hundreds of surplus beds outside of emergency departments, with contingency plans in place to accommodate the looming surge. Emergency departments reveal how the system is wobbling right now.
Last Friday was just another day of the new normal.
OHSU’s emergency room was operating at 95-99% of capacity, said Dr. Mary Tanski, clinical director of the department. It had been on “divert” for 24 hours, meaning it was too jammed to accept new emergency patients, forcing ambulances to take patients to other hospitals.
“I can tell you it’s very busy in the ED,” Tanski said. “We’re seeing a lot of patients, a higher percentage of them have COVID. Knowing how full we are, my biggest concern is figuring out what happens when we get this enormous volume of COVID patients.”
OHSU’s emergency department is one of the largest and most sophisticated in the state. It is a trauma center, meaning it accepts the most grievously injured.
Doctors in the 35-bed facility typically see around 120 to 130 patients daily. Lately, nearly 20 patients a day are being boarded.” That’s a big number,” she said. “It backs things up and that backup can remain for 24 hours.”
Fear of COVID-19 and a temporary ban on elective surgeries emptied out Oregon hospitals last spring. But bed usage has recovered quickly.
About 88% of the state’s 4,500 non-critical hospital beds were in use as of last week. In the Portland area, that number was 92%, according to state officials. The state’s ICUs, which generally house the seriously ill COVID-19 patients, were running at 92% of capacity.
According to a newsroom survey of the Portland region’s five major hospital networks, their comprehensive surge plans have identified hundreds of beds that could be used for COVID-19 patients.
But some question the state’s actual readiness.
“This is like a slow-motion train wreck,” said another emergency doctor, who also requested anonymity because the physician had not been authorized to speak publicly.
Tanski is more circumspect. But it’s clear, she said, the system is stressed.
“We’re already teetering at a tipping point.”
After 20 years as a registered nurse, Cooper Tanner thought he’d seen it all.
But when COVID-19 came to Legacy Mt. Hood Medical Center last spring, the 46-year-old Gresham native admits he was shaken.
The hospital’s ICU was jammed with coronavirus patients, many of whom were in crisis. The staff tried to help. But the virus was brand new to them. Little they tried seemed to make a difference.
To make matters worse, the hospital had adopted a no-visitor rule as part of efforts to limit the virus’ spread. Tanner and his co-workers had to deal with pleas from increasingly ill patients that they be allowed to see family.
It fell to the ICU nurses to comfort the dying patients.
“It’s one of the beautiful things we do,” Tanner said. “But this was incredibly hard.”
Half-a-year later, the disease remains incurable and deadly to some. But Mt. Hood has made one policy change Tanner said is good for everyone: The hospital now allows dying patients to see family.
Meanwhile, doctors must deal with some people who are convinced the coronavirus is a devious political invention by anti-Trump activists.
Grebosky, the executive at Asante in Medford, said he didn’t believe anyone could seriously subscribe to such a notion. That is, until a co-worker called needing help with a COVID patient. The patient was suffering severe respiratory distress and they needed to intubate her – essentially shove an air hose down into the trachea to help her breathe.
The woman refused to cooperate. The virus doesn’t exist, she yelled.
As of Tuesday, 847 Oregonians with COVID-19 have died, according to the state health authority. More than half of those fatalities have occurred inside hospitals.
“It’s hard to watch a person die,” said Jana R. Bitton, executive director of the Oregon Center for Nursing. “Even for a person who deals with life and death every day, it’s a hard thing to watch.”
That sense of helplessness will likely lead to a mass exodus of some of the most skilled nurses, Bitton warned.
“These people are quitting,” she said. “They’re quitting the profession they paid thousands of dollars to get trained for and they’re taking their expertise with them.”
The thought of quitting has crossed Erin Boni’s mind. An OHSU nurse and co-worker of Balcom’s, she cut her hours to spend more time at home with her two kids. There are other moments when she wonders whether the roles of ICU nurse and mother are compatible.
“When you’re in it, you just deal with it,” Boni said. “The adrenaline is flowing. You’re hyper aware. And then you get home, you’re alone with the kids. They’re shouting. I just have to step back and take a deep breath. There have definitely been times when I’ve asked myself, is this the best thing for me and my family?”
It’s not just nurses making career changes. Doctors are as well, said Dr. Marianne Parshley, a Portland internist who works with the Primary Care Collaborative, which is closely tracking COVID’s impact on the medical profession.
“Across the country, doctors are quitting, many more are considering it,” Parshley said. The reasons range from pandemic fatigue to financial troubles.
The COVID stress has led to labor tension at Providence Portland Medical Center.
On Oct. 15, about 25 nurses left the facility and staged a real-life labor demonstration to send a clear message to management they aren’t happy.
After months of negotiations, the two sides are still trying to strike a deal over, among other things, benefits tied to coronavirus exposure. Providence argued it’s been providing an assortment of generous leave options for employees, who in turn say they’re on the hook to first burn through vacation time if they get sick.
The days when people staged impromptu parades or sang from balconies as kids banged pots and pans in honor of health care workers seem long gone.
“At the beginning of the pandemic, I was the toast of the town,” said one union organizer in a message to the rank-and-file. “Now I’m just burned toast.”
Kevin Mealy, an organizer with the Oregon Nurses Association, said the tense relationship between workers and their hospitals will lead to more COVID caregivers getting out of the business.
“Nurses are exhausted,” he said. “They’ve been asked to sacrifice again and again through a pandemic. But it’s hard to continue sacrificing when you’ve got nothing else to give. And that’s the point we’re approaching.”
And for some, like Balcom, the ICU nurse at OHSU, it’s the point they’ve already reached.
“So many of the seriously ill COVID patients don’t get better,” she said. “We’re putting them on breathing machines, we’re putting them on their stomachs in hopes they will be able to breathe better. And sometimes it doesn’t lead to any improvement. It’s scary and discouraging.”