On a quiet morning at a southern Vermont hospital, staff manage surging patient volumes

Sadye Matula

A health care worker tends to a Covid-19 patient in the emergency department at the Southwestern Vermont Medical Center in Bennington on Monday, Dec. 13. Photo by Glenn Russell/VTDigger BENNINGTON — On the doors to the ICU, a laminated sign reads: “Quiet hospitals help healing.”  The Southwestern Vermont Medical Center […]

A health care worker tends to a Covid-19 patient in the emergency department at the Southwestern Vermont Medical Center in Bennington on Monday, Dec. 13. Photo by Glenn Russell/VTDigger

BENNINGTON — On the doors to the ICU, a laminated sign reads: “Quiet hospitals help healing.” 

The Southwestern Vermont Medical Center in Bennington. Photo by Glenn Russell/VTDigger

And generally, the place is very quiet — surprisingly quiet for a hospital that has been overwhelmed with patients for weeks. The overhead lights are dimmed. Even as staff check on patients and their tangles of tubes and wires, voices are quiet and the room feels still.

Except for the beeping. 

There’s a mix of different alarms: One if a patient’s oxygen gets too low, another if their heart is beating too fast, another if they adjust themselves in bed. It’s ceaseless. 

Then it’s punctuated by the squeaks of doctors’ sneakers down the hall as they wheel another Covid patient into an adjacent wing. In the gurney, there’s two oxygen tanks, one beside each of the patient’s legs. 

Health care workers wheel a Covid-19 patient through a hallway. Photo by Glenn Russell/VTDigger

This is a Monday morning at Southwestern Vermont Medical Center in Bennington, where the volume of patients — both infected with Covid and not — has dramatically increased over the past several weeks.

In the intensive care unit, Chief Medical Officer Dr. Trey Dobson walks the loop around the nurse’s station, looking in at patients through the sliding glass doors. 

“So you can see we have one bed open,” he says. “This person here can’t breathe on their own due to Covid, so they’ve got a tube down, and you can see, oxygenation is actually still not great. You should be at 100% oxygenation if a tube is down.” 

Dr. Trey Dobson at SVMC on Monday. Photo by Glenn Russell/VTDigger

He gestures to one of the monitors, with their rows of neon-colored numbers and pulsating waves. A large number in blue reads 90. 

He walks a bit farther, pausing in front of another patient’s room. An older woman on oxygen is hunched over in her bed, gazing out into the nurses station, straining to breathe. 

“All these people’s oxygen is low,” says Dobson, who also is an emergency medicine physician. “So she’s got oxygen in her nose, and still — you should be 100%. Both these people are at 90%.” 

“You can’t live really long below 90 and be an active, physical person.”

Downstairs, the emergency department is also busy — too busy for this early in the day.

“There’s people waiting already,” Dobson says. “Normally, this doesn’t happen until about five or six at night.” 

The waiting room is at capacity, and there’s a handful of people already spacing out in chairs across the lobby.  

“We have about 21 rooms. You can see we’re past that now, and it’s only 11 o’clock,” Dobson says. “So that makes everyone kind of anxious, because it’s just gonna build. People come in at a faster rate than we can discharge them.” 

In the emergency department, nurses go in and out of negative pressure rooms — some of them sealed with blue tape — grabbing personal protective equipment from yellow hanging racks on the back of each door. If the laminated PPE checklist is hung up face-out, the patient inside is Covid-positive, and they have to prepare with additional gear. 

PPE preferences among the staff have shifted over the course of the pandemic, Dobson says. Now, many staff opt for a “controlled air purifying respirator” — known as a CAPR, pronounced “capper.” Many find the bubble-shaped, space-suit-like helmet to be more comfortable than a mask and face shield, and it allows patients to see more of the provider’s face. 

Down the hall, an elderly couple sits for triage under a string of Christmas lights and a garland of smiling Santas. All of the nurses’ stations have some kind of decorations. 

They’ve been working hard to keep morale up, Chief Nursing Officer Pamela Duchene said in a phone interview later in the week. 

“That resilience is really important. Last night, I know that nurses brought in snacks for one another,” she said. “Technically we shouldn’t be doing that … but part of my resilience is I sort of looked the other way.”

A nurse tends to a Covid-19 patient in the ICU. Photo by Glenn Russell/VTDigger

In addition to her management role, and serving as a nurse practitioner at the Centers for Living and Rehabilitation, Duchene also has been picking up additional clinical shifts at the hospital, including one starting at 3 a.m. on Friday morning, when she had five patients. One was Covid-positive and was switching over to end-of-life care. 

As of Friday morning, they employed no traveling nurses, she said, only permanent nursing staff — a rarity in the region amid a nursing labor shortage. Eleven additional staff, all paramedics and EMTs, arrived from the Federal Emergency Management Agency early Friday morning to help care for Covid patients.

Photo by Glenn Russell/VTDigger

The FEMA staff came from as far as Florida, Kansas and Michigan, Duchene said, and will be staying for the next two weeks. She hopes it will help ease some of the strain on nursing staff over the holidays. 

While they’ve been able to maintain staffing levels, Dobson said it’s been a grueling time for his team. It’s not just the long days and high volume of patients, but having to watch patients endure unnecessary suffering. And anger is brewing, he said, as some people continue to forgo vaccination, “not recognizing the impact on the rest of the community.”

If the increase of patients continues, he said, the hospital will be past capacity and “won’t be able to take care of everyone.” With the exception of people who have served in the military or went through a mass trauma event like 9/11, most of his staff hasn’t experienced that.

“And that’s very scary,” he said. “That’s very anxiety-producing for a doctor or a nurse.”

Photo by Glenn Russell/VTDigger