On the weekly Boston-area hospital network calendar, the color-code for CHA Everett has been bright red for weeks – meaning they have been jam-packed with patients seeking treatment for COVID-19.
For the last several days, that color-code has moved down to orange and now yellow, meaning they have seen less volume. They hope one day soon it will be green – meaning they have space and the rush has eased.
For now though, yellow means restrained joy.
Dr. Melissa Lai-Becker, chief of the Emergency Department at CHA Everett, gave the Independent her bi-weekly report from the front lines of the hospital on the hill this Monday, and said they are cautiously optimistic about some slowing down they’ve seen there in the last seven days.
“The first part of the last two weeks were very much the same as we had been seeing,” she said on Monday. “I can say with cautious optimism that exactly six days ago there was a noticeable change at last in the Emergency Room…We’re cautiously optimistic this seems like a kind of plateau. We’re very hopeful we are cresting over the flattened curve.”
Lai-Becker said they had encountered so many obstacles over the last several weeks for simple, non-virus emergency surgeries, such as an emergency appendectomy that had to be done some weeks ago. Because CHA Everett was full, those procedures were to be done at the Cambridge Hospital, yet – it too – was full and the post-surgical recovery room had been converted to an ICU for COVID-19 patients. There just simply were not beds or places for the patients, but this week she said that kind of situation has eased up.
“It just feels like that is the kind of thing we’ve been doing for so long,” she said. “It’s been like a game of Tetris where the…shift manager was investing so much time and effort in completely maximizing every resource we have. Then suddenly on Tuesday (last week) it was like night and day. Suddenly every admitted patient had a bed. The ICU’s are still entirely beyond capacity, but there was good work being done there…We have our rhythm down. For the past six days now we’re at a place where we don’t need to do these acrobatics to squeeze every patient into every spot and slot. That’s been nice.”
With more of a silver lining on things – and a detectable uplift in the spirit and voices of those working in the ER at CHA Everett this week – there has been a new protocol established. With more people now coming off ventilators and more people recovering from COVID-19, the hospital needed some music.
“We now have a patient discharge song,” said Lai Becker. “When a patient is discharged, we play ‘Here Comes the Sun’ over the loudspeaker. Last Friday was the first time we all got to hear it.”
That has been a welcome break for those working in the ER at the Everett hospital, as they have also noticed that they are treating things other than just COVID-19 cases.
“For a long time, it seemed like there was no way anyone could show up here with anything other than symptoms of COVID,” she said. “I worked over the weekend and for the first time in six weeks, I felt like I actually had a couple of patients that really were just having back pain. Or there was someone with simple abdominal pain and it had nothing to do with COVID-19. That’s a good thing to report.”
The slowdown for the last several days has been a wonderful and necessary relief, said Lai-Becker. She said it will give their supply chain time to get sorted out so they can potentially get in new supplies.
The hospital has been out of the small size of N95 masks for weeks, and they have had to refill cartridges of hand sanitizer in the wall dispensers. While they have plenty of sanitizer, they have run out of the cartridges – oddly enough. Yet, they have innovated by simply re-filling the old cartridges – which would normally be thrown out – and placing them back in the wall units. They also have run out of disinfectant wipes, which they have overcome by using a clean cloth and disinfectant. The wipes, she said, are more of a convenience issue.
“It’s like diaper wipes,” she said. “They’re easier, but you can always use a wet cloth.”
Yet, at the same time, it doesn’t mean they are in any sort of safe zone, or that people should relax their restrictions in the community. Still, Lai-Becker said they will suddenly have two hours during a shift that are absolutely off the wall.
“There will be a steady stream of patients for most of the day and then we’ll have two hours where everything happens,” she said. “We’ll all the sudden have two or three critically ill patients in the ER, but then we’ll admit them, or move them or get them to the ICU. Then it’s back to a very steady inflow. The thing is no one has any idea when those two hours will come.”
• Thanks to the Community
An ongoing joke among doctors and health care workers over the last six weeks is that they will have to remember how to go out and get lunch or dinner when the COVID-19 pandemic is abated, as so many in the communities have stepped up to feed them and bring food to the hospitals during the crisis.
It is no different at CHA Everett, where staff and personnel are tremendously grateful to the community for feeding them, and for adhering so greatly to the restrictions put in place.
“The community restaurants have been so generous and so many have been sending us food,” she said. “Some, if not all, have even gone to the painstaking lengths of making sure each meal is individually packaged. It’s practically every day…The generosity is amazing.”
Also, she said by the communities adhering to social distancing and quarantines, it has given them the time they needed not to be overwhelmed, and continuing those measures only gives them more time to make sure the hospital doesn’t experience another surge.
“I give props to the community for flattening the curve and buying us time to develop a vaccine and plan for a re-opening that will continue to preserve our capacity to help as many people as possible,” she said. “We’re at a moment where we can say we don’t have to invoke measures to decide who gets a ventilator.”
• CHA Gets Abbot Testing Machine
The CHA network has also taken delivery of the now-famous Abbott rapid testing machine, which can give the results of a swab test in 15 minutes. It was an innovation that came at the outset of the surge, but the demand for the machine to process the swabs was so great that there was a giant waiting list. In the last week, CHA’s number has come up on that list.
Right now, the one machine in the network is being kept at Cambridge, but can be used by patients throughout the network for a quick result.
“That’s a really big deal for a community hospital to have access to that,” said Lai-Becker.
• Open for Non-Covid Visits Too
There is no evidence that patients with other conditions are not reporting to the hospital for things like heart attacks, chest pains and strokes – though some hospitals have reported that is happening. With COVID-19 so prevalent in the treatment triage at most hospitals, some are wanting to avoid hospitals at great risk to their health.
Dr. Lai-Becker said she usually sends three or four patients for treatment of chest pains per week, but has not done so for the last six weeks. She said that doesn’t mean they are putting off care, but the ER will be looking at EMS data for the last seven weeks to see if there are reports in the field of such issues.
“It’s very possible, and anecdotally I can concur with those observations that there is a mystery as to where all those patients have gone,” she said.
She said they encourage people to come to the ER if they are having chest pains or have medical concerns. Though they are treating COVID-19 in large part, they are available to treat all medical concerns.