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Rural Wisconsin hospitals 'burning on the inside' with COVID-19 surge

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Staff prepares to rotate patient

Nurse Kristina Beidel and other staff at Aspirus Medford Hospital prepare to rotate a ventilated COVID-19 patient. Rural hospitals are especially feeling the strain of the latest coronavirus surge, administrators say.

The hospital in Medford, like others, is feeling the strain, with no end in sight.

MEDFORD — Leaders at Aspirus Medford Hospital gathered this week to assess their situation: 19 patients, double the regular load. Twelve with COVID-19, 11 of them unvaccinated. Three on ventilators, with another likely needing ventilation soon.

The small facility in north-central Wisconsin normally would send ventilated patients to the larger Aspirus Wausau Hospital nearly 50 miles away, but its critical care beds were full. In Medford, four emergency room patients were waiting for hospital beds. To open more beds, the hospital needs more nurses. They’re in short supply.

“We’re kind of burning on the inside, and nobody’s aware,” said Susan Moretz, a nurse who oversees outpatient services in Medford.

Hospitals around the state are overwhelmed by another surge of COVID-19 patients and an influx of people needing other care, and rural hospitals are especially stretched to the limit, administrators say. With flu season starting, holiday gatherings ripe for spreading illness and the emerging omicron variant of the coronavirus showing signs of unprecedented transmission, the situation could soon become even more dire.

“Last week was the worst we have ever seen in the whole pandemic,” said Lisa Schnedler, CEO of Upland Hills Health in Dodgeville. “We’re just holding our breath to see what happens next, particularly with Christmas, New Year’s and now this new variant.”

Keeling with hat, mask

"We're not OK," said Aspirus Medford Hospital nurse Amanda Keeling. "It's affecting me. It's affecting a lot of co-workers. We're just burnt."

In Medford, a city of 4,300 people where many jobs involve making windows, cheese or frozen pizza, hospital workers feel frustration from being in the county with the state’s lowest COVID-19 vaccination rate. Just 34.5% of residents in Taylor County had received at least one dose as of Friday, compared to 61.3% statewide and 79.9% in Dane County.

Amanda Keeling, a nurse who grew up in Medford and moved back after going to school in Oshkosh and working in Green Bay, said some friends and family don’t believe her when she says the steady stream of COVID-19 patients is wearing her and other nurses out. There’s little interest in discussing how more vaccination could make the situation more manageable, she said.

“Last year, we were heroes,” Keeling said. “This year, people don’t want to hear us talk about it. ... I don’t think people want to be told what to do.”

Pushing the limit

On Wednesday morning, when a Wisconsin State Journal reporter and photographer visited the Medford hospital, Keeling joined nine other staff for a task that has become all too familiar: They gathered around the bed of a ventilated COVID-19 patient who had been put on her stomach the night before to help her lungs get more oxygen.

As a respiratory therapist held the breathing tube and a nurse managed the feeding and sedation lines, four others stood on each side of the bed and flipped the large patient on her back. Several hours later, workers would gather to put the patient on her stomach again, a process carried out each day for each patient on a ventilator.

Rotating patient

Ten nurses and other staff at Aspirus Medford Hospital prepare to rotate a ventilated, unvaccinated COVID-19 patient. The hospital didn't treat ventilated patients until September, when it became hard to transfer them elsewhere because of the delta variant surge.

Before September, Medford didn’t keep ventilated patients. But as the delta variant surge of COVID-19 made it hard to transfer patients elsewhere, the 25-bed hospital took on a function it wasn’t set up to handle.

“We’re pushing the highest end of our skill level right now,” said David Warren, a respiratory therapist who cares for ventilated patients and others on high-flow oxygen. He has been working 50 hours a week or more.

Many of the COVID-19 patients in Medford are in their 30s, 40s or 50s, younger than during the surge a year ago, before vaccines became available and were widely adopted by older adults. Like elsewhere, the patients are treated with the steroid dexamethasone, the antiviral remdesivir or monoclonal antibodies, as appropriate, said Vickie Woelfel, one of the nurse practitioners who treats them.

For the ventilated patients, the Medford hospital uses UW Health’s eICU, getting help online from UW experts in Madison on how to manage intensive care needs.

“It’s saddening and frustrating to see so many people here who might not have had to be here if they had been vaccinated,” Woelfel said. “I personally haven’t had a person yet who says they wish they had been vaccinated. I’m waiting for that day.”

ER and rubber duckies

Aspirus Medford Hospital emergency room nurse Kari Rickert, right, tries to find phone numbers for family members of a patient, with medical receptionist Jennifer Walters. In a light-hearted sign of teamwork, each ER staffer has a rubber ducky, lined up atop two computer screens.

In the eight-bed emergency room, which is seeing 900 patients a month, up from the normal flow of about 600, staff put patients in nearby clinic rooms when needed. When those rooms are full, they hang sheets in the hallway around a chair or a cot, for a makeshift space.

The constant challenge “takes its toll,” said Kari Rickert, an ER nurse who has a 5-year-old daughter. “You’re just exhausted when you get home. ... Sometimes I don’t have the energy she deserves.”

Strain widespread

Hayward Area Memorial Hospital, about 110 miles northwest of Medford, is experiencing similar strain. Emergency room visits are up 47% this year, and inpatient volume last month was 59% higher than November 2020, said CEO Luke Beirl.

He is struggling to fill 60 job openings, many in direct patient care. “We thought last year was challenging,” Beirl said. “It’s nothing compared to this year.”

At Sauk Prairie Healthcare in Prairie du Sac, about 25 miles northwest of Madison, CEO Shawn Lerch pointed to another way to measure the impact: in blood gas kits, used to measure oxygen levels in blood, a key indicator of how coronavirus patients are doing. The hospital typically uses 20 of the kits per month.

“Right now, we’re using 20 per day,” Lerch said. “Our teams have gone to heroic measures to ensure that safety and quality is maintained, but it’s not sustainable. We are burning the candle at both ends, and then some.”

Aspirus Medford Hospital

Aspirus Medford Hospital, built in the early 1960s, has been expanded and remodeled through the years. Like other critical access hospitals, it has 25 beds. 

Schnedler, the Dodgeville hospital CEO, said all six of its COVID-19 patients as of Thursday were unvaccinated. A week earlier, there were more COVID-19 patients, along with many others, including seven in the birthing center and seven in the ER waiting for beds.

“We had zero beds available,” she said. “It was the perfect storm.”

Skepticism persists

In Medford, with no sign of patient demand slowing, Jessica Faude is trying to figure out how the hospital might handle an even larger load.

The hospital has a few double rooms, but COVID-19 guidelines say patients shouldn’t be paired when community transmission is high — which, in Wisconsin, is everywhere. For non-ventilated patients, one nurse typically cares for five people per shift. The hospital’s surge plan calls for going to six or seven, but that can cause even more stress.

Jessica Faude

"Everybody's exhausted, I think, because it's been going on for so long," said Jessica Faude, a nurse and interim vice president of patient care services at Aspirus Medford Hospital.

Faude, a nurse who oversees patient care services, has tried to hire contract nurses from agencies, but they are in high demand nationwide. “To get somebody to want to come to rural Wisconsin, in winter, is hard,” she said.

Like many employees at the hospital, Faude has lived in Taylor County her whole life. Like most, she’s been working extra shifts and is exhausted. Like the others, she wishes her community would take the pandemic more seriously.

Since the pandemic began, 26 of the hospital’s COVID-19 patients have died. As of Friday, 106 of the 137 COVID-19 patients at Aspirus’ 17 hospitals in Wisconsin and Michigan’s Upper Peninsula were not fully vaccinated, including at least 39 of the 43 in intensive care.

But Faude said many people in the area distrust health care workers. Some demand that their loved ones be treated with ivermectin, an anti-parasitic livestock pill that doctors say is not suitable for humans with COVID-19, she said. Skepticism of vaccination seems entrenched, she said.

Dale Hustedt

Dale Hustedt is CEO of Aspirus Medford Hospital.

“They feel like it’s this big hoax that the government is trying to push on people, and so they don’t trust where the vaccine’s coming from or the intentions behind it,” Faude said.

CEO Dale Hustedt also sees denial in the community. “They refuse to accept that COVID is here and that it’s real and that people are dying from it,” he said.

But vaccinated or not, Hustedt said patients with COVID-19 or other conditions will continue to get care as long as the hospital can handle them.

“You don’t know when it’s going to end, but you know you have to stay with it and keep working hard,” he said.

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