What first surprised Nathaniel Osborn when he and his wife took their son, Seth, to the emergency room this summer was the handful of attention he had in the waiting room for a Wednesday at one in the afternoon.
The Florida hospital emergency room was so crowded that there were not enough chairs for the family to sit on while they waited. And he waited.
Hours passed and Seth, 12 ,’s condition worsened, his body trembling from the pain shooting him in the lower abdomen. Osborn said his wife asked why it took so long to be seen. A nurse rolled her eyes and murmured, “COVID.”
Seth was finally diagnosed with appendicitis more than six hours after arriving at Cleveland Clinic’s Martin North North Hospital in late July. Around midnight, he was taken by ambulance to a sister hospital half an hour away who was better equipped to perform pediatric emergency surgery, his father said.
But when the doctor operated on early in the morning, Seth’s appendix had exploded, a life-threatening complication.
As hospitals across the country fill up and emergency rooms overflow with patients with critical COVID-19 disease, it is patients who are not COVID-19, such as Seth, who have become collateral damage. They also need emergency care, but the large number of cases of COVID-19 brings them together. Treatment has often been delayed while paramedics look for a bed that is hundreds of miles away.
Some health officials are now concerned about impending ethical decisions. Last week, Idaho activated a “crisis care standard,” which an official called a “last resort.” It allows overwhelmed hospitals to take care of the ration, including “in rare cases, it may be necessary to use ventilator beds (breathing machines) or intensive care units (ICUs) for those most likely to survive, while I will not be able to receive any patients who do not survive, ”says the state website.
The latest federal government data shows that Alabama is at 100% of the capacity of its intensive care unit, with Texas, Georgia, Mississippi and Arkansas in addition to 90% of the ICU. Florida is just under 90%.
It is the COVID-19 cases that dominate. In Georgia, 62% of ICU beds are now filled only with COVID-19 patients. In Texas, the percentage is almost half.
Having so many ICU beds put into service for a single diagnosis is “unheard of,” said Dr. Hasan Kakli, an emergency physician at Bellville Medical Center in Bellville, Texas, about an hour from Houston. “Approaching the Apocalyptic.”
In Texas, state data released Monday showed that there were only 319 ICU beds available for adults and 104 in a state of 29 million people.
Hospitals need to have ICU beds for other patients, such as those recovering from major surgery or other critical conditions, such as stroke, trauma, or heart failure.
“It’s not just a COVID problem,” said Dr. Normaliz Rodriguez, a pediatric emergency physician at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida. “This is everyone’s problem.”
While the most recent hospital crisis echoes previous pandemic peaks, this time there are worrying differences.
Previously, localized COVID-19 hot spots caused a shortage of beds, but there were usually hospitals in the region not so affected that could accept a relocation.
Now, as the highly contagious delta variant wraps low-vaccination states at the same time, it becomes more difficult to find nearby hospitals that are not hit.
“Wait times can now be measured in days,” said Darrell Pile, general manager of the SouthEast Texas Advisory Council, which helps coordinate patient transfers in a region of 25 counties.
Recently, Dr. Cedric Dark, a Houston emergency physician and assistant professor of emergency medicine at Baylor College of Medicine, said he saw a critically ill COVID-19 patient waiting in the emergency room. for an ICU bed to open. The doctor worked eight hours, went home and came in the next day. The patient was still waiting.
Keeping a seriously ill patient in an emergency room while waiting for a hospital bed to open is known as boarding. The longer the wait, the more dangerous it can be for the patient, according to studies.
Some research suggests that long bed waits will worsen your condition and may increase the risk of death in the hospital.
This happened last month in Texas.
On Aug. 21, around 11:30 a.m., Michelle Puget took her adult son, Daniel Wilkinson, to the emergency room at Bellville Medical Center, as a pain in her abdomen became unbearable. . “Mom,” he said, “take me to the hospital.”
Wilkinson, a 46-year-old decorated Army veteran who did two service tours in Afghanistan, was ushered into an examination room about half an hour later. Kakli, the emergency physician there, diagnosed biliary pancreatitis, a serious but treatable condition that required a specialist to perform a surgical procedure and an ICU bed.
Credit:
Courtesy of Michelle Puget
At other times, moving to a larger facility would be easy. But soon Kakli found himself in a frantic six-hour search to find a bed for his patient. Not only did he call Texas hospitals, but he also tried Kansas, Missouri, Oklahoma and Colorado. It was like throwing darts at a map and hoping to get lucky, he told ProPublica. But no one could or would want to make the move.
At two-thirty in the afternoon, Wilkinson’s condition was deteriorating. Kakli told Puget to go back to the hospital. “I have to tell you,” she said, “your son is a very, very sick man. If he doesn’t get this procedure he will die.” She started crying.
Two hours later, Wilkinson’s blood pressure was dropping, and he indicated his organs were failing, he said.
Kakli took to Facebook and posted a capitalized plea to groups of doctors across the nation: “REFUSED BY ALL TEXAS HOSPITALS Due to no ICU beds. PLEASE HELP. SEND ME A SHIPPING If you have a bed. THE PATIENT IS IN ER NOW. I AM THE DOC ER. HE WILL FLY ANYWHERE. “
The doctor tried for the second time Michael E. DeBakey VA Medical Center in Houston. This time he found a bed.
Around seven in the afternoon, Wilkinson, still conscious but in serious condition, was airlifted to the hospital. He was placed in a medically induced coma. Throughout the night and until the next morning, medical teams worked to stabilize him enough to perform the procedure. They could not.
Doctors told his family the internal damage was catastrophic. “We made the decision that we had to let him go,” Puget said.
Time of death: 1:37 pm August 22 – 26 hours after first arriving at the emergency room.
CBS News first reported the story. Kakli told ProPublica last week that he still sometimes does the math in his head: it should have taken 40 minutes from the diagnosis in Bellville to move to the Houston ICU. “If I had to wait 40 minutes instead of six hours, I firmly believe I would have had a different result.”
Another difference with the latest wave is how it affects children.
Schools were closed last year and children were more protected because most of them were isolated at home. In fact, pediatric hospitals were often so empty during previous climbs that they opened beds to adult patients.
Now, the families are out. Schools have reopened, some with mask mandates, others without. Vaccines are not yet available for children under 12 years of age. Suddenly, the number of hospitalized children increases, establishing the same type of competition for resources among COVID-19 young patients and those with other diseases such as newly-onset diabetes, trauma, pneumonia, or appendicitis.
Dr. Rafael Santiago, a pediatric emergency physician in central Florida, told Lakeland Regional Health Medical Center that the average number of children entering the emergency room is about 130 per day. During the close of last spring, that figure dropped to 33. Last month, “the busiest month in history,” the daily average of children in emergency rooms was 160.
Pediatric transfers are not yet as full as adults, Santiago said, but more calls are needed than before to secure a bed.
Seth Osborn, a 12-year-old whose appendix exploded after a long wait, spent five days and four nights in hospital while doctors pumped his body full of antibiotics to prevent infection from rupture. The typical hospitalization for a routine appendectomy is about 24 hours.
Nathaniel Osborn said the initial hospital bill for the stay reached $ 48,000. Although insurance was paid for the most part, he said the family still applied for loans against their home to cover the more than $ 5,000 in out-of-pocket expenses so far.
Although the hospital system where Seth was treated declined to comment on his case because of patient privacy laws, he emailed a statement about the tension the pandemic is creating.
“Since July 2021, we have seen a tremendous rise in patients with COVID-19 who need care and hospitalization. In mid-August, we saw the highest number of patients hospitalized with COVID-19 in the Cleveland Clinic Florida region, a total of 395 COVID-19 patients in four hospitals. These hospitals have about 1,000 beds in total, “he told ProPublica.” We strongly encourage vaccination. Approximately 90% of our patients hospitalized for COVID-19 are not vaccinated. “
On Sunday, the Washington Post reported that an Alabama hospital called 43 people from three states before finding a bed for Ray DeMonia, a patient with a critical heart condition who later died. In his wake, his family wrote, “In honor of Ray, get vaccinated if you don’t, in an effort to free up resources for non-COVID-related emergencies. … I wouldn’t want any other family to live. what he did. “
Today, Seth recovers mainly. “Twelve-year-olds bounce,” his father said. Still, the experience has left Nathaniel Osborn shaken.
The institute’s history professor said he likes to remain optimistic and apolitical in his reflections on social media, posting about preserving Florida’s wildlife and favorite books. But on September 7, he he tweeted: “My 12-year-old son had appendicitis. The urgency overflowed with unvaccinated covid patients and we had to wait more than 6 hours. While waiting, the appendix broke and he had to spend 5 days in the hospital. … So yes, your decision not to vaccinate affects others. “
It has been retweeted 34,700 times, with 143,000 likes. Most of the comments were friendly and wished their son a speedy recovery. Some, however, went straight to hate, seemingly triggered by their last line. He was personally attacked and accused of inventing the story: “Good proof with guilt, idiot.”
Osborn, who is vaccinated, as well as his wife and son, told ProPublica that he only shared Seth’s story on Twitter to encourage vaccinations.
“I have no ill will towards the hospitals or the care received at either hospital,” he said this week, “but if those hospitals hadn’t been so full of patients with COVID, we wouldn’t have had to wait that long and maybe the of my son the appendix would not have exploded ”.