'A huge toll'

Emily Farness has been a nurse at Kootenai Health for seven years, with three in the intensive care unit.

What she’s experienced in the past weeks caring for COVID-19 patients has been perhaps the most demanding she has endured.

Wednesday at a press conference outside the hospital, she described a coronavirus patient who didn’t want to be on a ventilator and they had reached the ceiling as to what care they could provide given her wishes.

It was then a doctor told the patient, “We really need to start looking at that comfort care and making you comfortable.”

And it was then the patient knew she was facing death.

Too weak to write, she asked the nursing staff to write goodbye letters for her to her family.

“And so one of my co-workers transcribed 25 letters to different family members and loved ones with her goodbyes and whatever notes she wanted to add,” Farness said.

She said it was just one example of the trying times, particularly emotionally, for medical staff as they care for patients fighting the coronavirus.

Kootenai Health reported it had 105 COVID-19 patients on Wednesday, with 33 requiring critical care.

Panhandle Health District reported 277 new coronavirus cases on Wednesday, and reported there were 17 more deaths in the PHD — 11 in Kootenai County — over the past week attributed to the virus. That brings the total to 398 deaths in the PHD. Of those, 25 were people 59 and younger, and 373 were 60 and older.

Joan Simon, chief nursing officer, said they continue to have patients in the Health Resource Center that was converted to a 22-bed care center. She said in order to make room for adult COVID patients, KH has moved its pediatric department to its postpartum unit. Because those are larger rooms, it has been able to establish some double occupancy.

“I think that overall, we've been managing the situation well,” said Dr. Robert Scoggins, chief of staff. “It's still, I think, a surprising number of frustrations that we've seen, and especially the number of unvaccinated patients coming in.”

Scoggins said the COVID-19 patient count could could rise, as Kootenai Health hasn’t seen the effects of the recent North Idaho State Fair or the return of students to school.

“We're not seeing very many pediatric patients at this point,” he said. “But we know that usually it's a week or two before we begin to see that surge in patients in different populations.”

Scoggins said a concern is their ability to take care of critically ill pediatric patients because they have limited pediatric ICU beds in the region.

“If we get a large number of kids sick at once, there will be a certain percentage of those kids that will need hospitalization and then a certain percentage that will need ICU level care,” he said.

To prepare for that scenario, he said several of the KH staff have taken a pediatric-advanced life support course in the last week and they are developing protocols to stabilize and transfer young patients.

“Our concern is that the regional pediatric ICU capability could be overwhelmed and we'll have to take care of them here,” he said.

Farness said their practices have evolved as new research and evidence has come out, and they have also been called on to do more for patients.

“As nurses, a lot of our care has expanded to supporting these patients' emotional needs as they're isolated from family and friends and church support, school support, all of those communities. And that takes a huge toll on our patients,” she said. “And it also takes a huge toll on the staff to kind of go above and beyond in that way.”

Farness said they are seeing “younger and otherwise healthier patients" due to the delta variant of the coronavirus.

“It's strange to see patients that are our peers, and they could be our friends. And they're working jobs similar to ours, and just very normal people in our community,” she said.

If they’re able to talk, she said it’s hard to hear them say they didn’t think that it would be them in a hospital bed with COVID-19.

“I thought it was either all political or all a hoax, or just people who are in poor health or maybe don't take care of themselves as well who are getting this sick,” Farness said, referring to what patients have said. “And they often show us texts of them telling their families to take this seriously to get vaccinated.”

In Kootenai County, 66,487 have received at least one dose of the vaccine, 47% of the 12 and older population. In the PHD, 86,692, or 41% of those 12 and older, are fully vaccinated.

Farness said she and her fellow staff members at KH could use help.

“We really are asking our friends and family and the whole community to do what they can to protect themselves, but also look out for their neighbors who, maybe their children, maybe their elderly or immunocompromised, and maybe they're not as lucky and healthy as a lot of us are.”