A nurse tends to a patient in intensive care in Saint Alphonsus Medical Center in Ontario on Thursday, Sept. 30. (Malheur Enterprise/LILIANA FRANKEL)

ONTARIO - Signs of the pandemic are everywhere at Saint Alphonsus Medical Center in Ontario.

Carts filled with personal protective equipment are stationed at places throughout the floors.

Ping-pong balls floating in glass chambers in the wall indicate which rooms are negatively pressurized to control the spread of airborne illness. 

And in the emergency department waiting room, a divider separates the rows of chairs in two groups: patients with and without respiratory symptoms.

Since July, Covid cases across Oregon have skyrocketed in the largest surge since the beginning of the pandemic.

Malheur County, with a vaccination rate under 50%, is especially vulnerable to the community spread. 

Its single hospital connects the county to a healthcare system based in Boise which initially took charge of most Covid patients, but which has been increasingly overwhelmed by the surge. 

As Saint Alphonsus locations in Boise and Nampa are taxed by Idaho’s descent into crisis standards of care, the Ontario location has had to take on more Covid patients. 

To ensure care for those requiring hospitalization, surgeries that aren’t urgent or time sensitive and which would normally require an overnight stay have been paused since Sept. 20.

To get a sense of the current state at the Ontario hospital, Saint Alphonsus provided access to a reporter for the Enterprise. 

Though hospital leaders and medical staff said they were exhausted, their determination to care for each and every patient is what shines through.

“It’s an honor now that we get to keep them here because our patients don’t want to leave the local community,” said Dina Ellwanger, president and chief nursing officer at the Ontario hospital. “The patients like to be closer to their families.”

The numbers of Covid patients being admitted to the hospital on a daily basis have increased by up to 100%, said Ellwanger. The hospital maintains an average daily census of about 18 patients a day, and many if not most of those will be Covid patients. 

All patients in the emergency department are treated as potentially Covid-positive until a test rules that out. 

In the past, Covid-positive patients with severe symptoms would be sent straight to Nampa or Boise. Saint Alphonsus’s strategy as a healthcare system was to cluster patients there so that health care staff could develop a special expertise in treating them. 

Now, with limited bed availability at those locations, local patients are often kept in Ontario. For those hospitalized with Covid, visitors are limited to no more than three – and only one a day.

A divider separates the emergency department waiting room in Saint Alphonsus Medical Center in Ontario into patients with and without respiratory symptoms. (The Enterprise/LILIANA FRANKEL)

For non-emergency Covid patients, the hospital has been using a strategy called valet triage, where instead of having the patients wait in the waiting room, where they might infect others, they wait in their car.  

Hospital leaders said because of the surge, staff have been very busy.

“People in the emergency department have had no downtime at all,” said Anna LaRosa, executive director of operations and patient care services at the Ontario hospital. 

“As the leadership team, we know our staff will never give up,” said Ellwanger. “But if leadership is exhausted, I can’t even imagine the bedside staff.”

Ellwanger highlighted the role of traveling nurses sent by the state and federal governments in relieving her staff. 

“They came in and they’ve been absolutely fabulous about helping all of us out in the hospital,” she said. 

Dajanay Ash, a traveling nurse from Cleveland, Ohio, said that Saint Alphonsus felt “close knit.”

But it’s not just the new nurses who are helping out. Other hospital employees have volunteered from different areas of the hospital, including registration and environmental services, to serve as patient sitters. 

Similarly, a small crew of National Guardsmen have been helping out with nonclinical duties that take nurses away from patient care, like food service, emergency department transport, running labs, and turning over rooms. 

The logistical challenge of caring for Covid patients was a theme in interviews with staff, with frustrations about cumbersome personal protective equipment front and center. 

LaRae Findling, a registered nurse in the ICU, said that she had recently needed to attend a Covid patient at their bedside for five hours in full personal protective equipment while they waited for a flight to the hospital in Boise to arrive from Walla Walla, Washington. Nothing closer was available because of the surge. 

“It’s hot and sweaty and uncomfortable,” said LaRosa of the equipment. 

Findling said that her workload had increased because of the surge in Covid patients, who require special care such as titrating their oxygen and proning, or laying them on their bellies. 

Proning can be a complicated process involving up to five people – two on one side, two on the other and one managing the patient’s airway – and multiple pillows and sheets to flip the patient, who may be unconscious. 

But the effort is worth it, said Findling and LaRosa, for the benefit it provides to patients. 

“The surface area of the back of the lungs is bigger,” said Findling. 

As such, explained LaRosa, “it really helps the lungs, there’s more oxygenation.” 

Covid also creates emotional challenges for the hospital staff. 

“I think that it’s a new type of care that is slightly more emotionally draining because the Covid disease process is fast, expediated,” said Ellwanger. “The patients can change so fast. We can give the best care you can possibly imagine, but the disease process is the disease process.”

LaRosa said that in addition to managing families’ grief over their relatives’ illness, staff are also at times confronted with anger by people who don’t believe in the science behind Covid. That adds to the difficulty. 

“Our job as health care professionals is to take care of everybody,” she said. “That’s what we want to do. But it’s very emotional. Sometimes we get yelled at. It’s taxing on the nurses.”

“I think most of staff is completely exhausted,” said Dr. Shane Marshall, an emergency room doctor. 

“We’ve probably lost a third of our nursing staff since the pandemic started” across the Saint Alphonsus health care system, he said.

Ellwanger said that she was confident that attrition would not be overly exacerbated by Oregon’s vaccine mandate, which goes into effect Oct. 18. 

“If we lose any of our staff, it’ll be a very small percentage,” she said. “We have not lost a nurse yet to this date. We have lost some certified nursing assistants.”

Marshall said that in moments of burnout, his faith is what gives him the strength to go on. 

He said that he tried to be understanding with friends and neighbors who did not want to take the vaccine, remembering the biblical mandate to love one’s neighbor as one’s self.

“What inspires me is I try to look at people and pray that God would let me see them through his eyes,” he said. 

“It’s hard,” said Findling. “A couple weeks ago I had a gal begging to me not to let her die. Of course, she didn’t make it. But I’ve still got to do my job and help the people I can save.”

Hospital leadership said that they are doing everything they can to help the people in their care. Last week, none the patients in the ICU had been vaccinated, but they receive the same care and treatment as everybody else. 

The leaders also said that conspiracy theories about a secret cure supposedly being hidden from the public were not true.

“If there was a secret cure, we would be using it to take care of patients and save lives,” said LaRosa. 

News tip? Contact reporter Liliana Frankel at [email protected] or 267-981-5577.

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