From today's Washington Post:
STILLWATER, Okla. â
The covid patient in Room 107 was bleeding internally and near death.
So Robin Pressley, transfer coordinator at Stillwater Medical Center, was working fast to try to find an ICU bed at a larger hospital for Johnnie Novotny, a 69-year-old retired gas plant operator who had developed a hematoma and needed more specialized care than doctors at this modest rural hospital could provide.
Pressley knew that other hospitals in the region were already choked with covid patients due to a summer surge driven by the highly infectious delta variant and the stateâs large numbers of unvaccinated residents, like Novotny. But she also knew that Novotnyâs life depended on her success.
After 34 years in nursing, Pressley had developed ways to deal with the stress of her job. So, on this August day, she loaded her diffuser with calming lemongrass oil and pulled out a piece of putty she uses as a makeshift stress ball and began squeezing. Then she fired up her two computer screens, picked up one of her three phones, and started dialing.
A piece of putty becomes a makeshift stress ball for Stillwater Medical Center transfer coordinator Robin Pressley. The stress of Pressleyâs job is sometimes so great that she stops in a parking lot to catch her breath before going home to her husband, with whom she never talks about work.
12:26 p.m.: Hillcrest Medical Center in Tulsa, Okla. No ICU beds available.
12:29 p.m.: Oklahoma State University Medical Center in Tulsa. At capacity.
12:37 p.m.: St. Anthony Hospital in Oklahoma City. No beds available.
Pressley tried not to get discouraged. Surely, someone was going to take him, she thought. But she was rapidly running through the Oklahoma hospitals on her list. She called the stateâs medical emergency response center for help, and a coordinator there agreed to call hospitals in Missouri and Arkansas.
Pressley went back to her list.
12:39 p.m.: St. Francis Hospital in Tulsa. No covid beds available.
12:55 p.m.: Ascension St. John Medical Center in Tulsa. At capacity.
12:59 p.m. Ascension St. John Jane Phillips Hospital in Bartlesville. At capacity.
Itâs just a matter of getting the right hospital, Pressley told herself and kept dialing.
[
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Nurse Robin Pressley, 61, hangs her head in sadness Sept. 20 as she looks at the list of hospitals she called the previous month in a vain attempt to find a place for Johnnie Novotny, a covid patient whose needs were more than Stillwater Medical Center could accommodate. âYou are just constantly thinking, where could I call, what can I do, who will take this patient for the procedure?â she said.
Oklahoma was on the cusp of a summer surge that would peak Aug. 30, with new cases averaging about 2,800 a day. Intensive care unit admissions soared to an all-time high during the first two weeks of August, at a time when the average length of stay for a covid patient increased significantly, overwhelming ICUs, according to Dr. David Kendrick, chairman of the Department of Medical Informatics at the University of Oklahoma. More than 1,500 Oklahomans died of covid in August and September alone as the stateâs pandemic death toll exceeded 10,600. More than half the state still is not fully vaccinated.
Gov. Kevin Stitt (R) did not institute restrictions for the latest surge, such as limits on gatherings or mask mandates. In fact, he issued
an executive order prohibiting state agencies from requiring vaccinations and masks in public buildings. A judge has temporarily blocked a state law
banning masks in public schools.
In Payne County, where Stillwater is located, only 35 percent of the population was fully vaccinated when Novotny became ill in mid-July, and the delta variant was spreading so rapidly that the mayor declared a state of emergency Sept. 3. Triage tents soon rose in the hospital parking lot.
Talk by city leaders of
reinstituting a mask mandate raised the ire of residents. Disinformation spread on social media: You wonât be able to
carry a concealed gun while wearing a mask, people warned; hospitals in Tulsa were turning away unvaccinated patients coming for care. Neither was true.
Shelves in feed stores were emptied of
ivermectin by customers who falsely believed that the deworming medicine cured covid. At least two people turned up in the Stillwater hospital emergency room after overdosing on the drug, the hospital said.
Yet no matter how bad things got, the staff had always been able to find a way to get their patients the care they needed, even if it meant moving them to another hospital. Theyâd never had to stand by and watch a patient die when they knew he or she could be saved.
Dr. Matthew Payne, 43, supervises his Stillwater Medical Center colleagues as they intubate a critically ill covid patient Sept. 17, 2021. Payne, who grew up in Stillwater, spends up to two hours every night calling the families of each of his covid patients.
The rare available bed in intensive care at Stillwater Medical Center is taken when a seriously ill covid patient arrives by ambulance Sept. 18, 2021.
Dr. Matthew Payne, holding his portable oxygen hood, walks the halls of Stillwater Medical Center with nurse practitioner Mirabel Forteh after doing rounds with covid patients.
The 117-bed community hospital was already under siege when Johnnie Novotny showed up July 24. It was overflowing with covid patients who were younger and sicker than those during the pandemicâs first surge, and they were staying longer, taxing the already depleted staff.
Pressley and her colleagues had never felt more isolated from the community of Stillwater, a town of 48,000 nestled under wide skies where life centers on the rhythms of Oklahoma State University.
The first round of covid âwore them slick,â Pressley said of her colleagues. They suffered nightmares, insomnia, anxiety and depression. One respiratory therapist was struggling through his own long-haul covid. Forty nurses had quit since the start of the pandemic and the hospital had 100 job openings.
âWe are broken,â said Grace Ferguson, 33, a charge nurse who grew up in nearby Pawnee, where her family owns the newspaper. âI never used to cry about work, but now I canât seem to talk about it without my voice cracking. Iâm wondering, when am I going to stop crying about this? Maybe never.â
Stillwater charge nurse Grace Ferguson, 33, was âlittle Gracie Fergusonâ in the elementary school reading class of Angelia Novotny. In August, as Angeliaâs husband, Johnnie, was suffering, Ferguson was helping the family cope.
Ferguson had known the Novotny family since childhood. Now she was part of the medical team trying to save its patriarch.
Novotny was in the hay meadow on the familyâs farm that July day when he started feeling sick. Heâd put up 200 bales before coming in and was in the shower when he started sweating and coughing, his wife, Angelia, said. She felt ill, too, but her symptoms were less severe, and she was able to do her chores â feeding their cats, chickens and seven peacocks.
But soon, Novotny was so listless that the family decided he needed to go to the hospital in Stillwater, 28 miles away. He was reluctant to go, even though his daughter-in-law Tara Novotny is a nurse there. The couple had been married for 48 years and heâd never been one for doctors, his wife said.
âAre you giving up on me?â he quipped. His oxygen saturation level was so low when he arrived in the emergency room that he was immediately transferred to the third-floor intensive care unit.
Once upstairs, his nurse pointed to her badge so they could see it was âlittle Gracie Fergusonâ who had been in Angeliaâs reading class as a second- and third-grader at Pawnee Elementary School.
âShe told me âGrace, we donât do anything. I canât believe he tested positive,ââ Ferguson recalled. âIâm thinking, âHow could you not believe thatâs what this is?ââ
The couple hadnât gotten vaccinated because they had misgivings about the shot and stay mostly on their farm â except for church on Sundays. Ferguson didnât argue with them.
In a 2017 family photo, Johnnie Novotny perches atop an off-road vehicle with his grandson Kanen. (Angelia Novotny)
âItâs too exhausting and heartbreaking to have to be like, âNo, you donât understand what I see every day,ââ Ferguson said. âI canât open that wound just to argue with somebody who doesnât want to hear.â
That wound was losing two to three longtime patients a week and having to shave one patientâs beard so his wife could see him on their final goodbye.
[
The delta variant is ravaging this Missouri city. Many residents are still wary of vaccines.]
Her work locker is still crammed with notes on her patients from the first surge that she canât bear to throw away â the one who loved gospel music, another who needed Garth Brooks played on repeat. She took a trip to Costa Rica when covid cases ebbed, in search of some normalcy, and for a moment it felt like she was going to find it. But now admissions were climbing again and her therapist was telling her that he needed a break during their sessions because her stories were so horrific.
âYou feel like youâre on an island, and no oneâs looking to send out search-and-rescue planes to save you,â said Matthew Payne, Novotnyâs doctor. âThe case managers are tossing messages in a bottle, and no one is there to pick those up.â
Payne, 43, grew up in Stillwater and spends up to two hours every evening calling the families of each of his covid patients. When he spoke to Angelia Novotny as July faded into August, things were not going well.
Johnnie Novotny was growing more anxious and scared each day, at one point ripping out his tubes and tearing the mask for his breathing machine. Angelia was the only one able to calm him, but visitor restrictions meant she could only stay a few hours each day. He told nurses he was lonely and missed human contact after days in a hermetic bubble.
âThat broke my whole heart,â said Ferguson, the charge nurse.
[IMG alt="Dr. Payne gets a moment of quiet at a home near Stillwater Medical Center that is availed to medical staff for down time.
"]
https://img.washingtonpost.com/wp-a...c/M767M2BFIEI6ZBZZLS3KXIYKGA.jpg&w=1800[/IMG]
Dr. Matthew Payne dons personal protective equipment Sept. 17, 2021, just before heading into the room of a critically ill covid-19 patient.
Dr. Payne gets a moment of quiet at a home near Stillwater Medical Center that is availed to medical staff for down time.
Dr. Payne leaves Stillwater Medical Center after having just finished a seven-day stretch of being on call round-the-clock.
âIâm sorry I was mean to you,â Novotny said to his wife one day, his voice muffled through his oxygen mask. Angelia was sitting at his bedside amid the chaos of wires and beeping monitors. The hospital room was papered with photos of the coupleâs 10 grandchildren and Colorado vacations.
Angelia laughed.
âMean to me? You werenât mean to me, for heavenâs sake,â she recalled.
They had been in love for a half-century, since he first saw her in her fatherâs wheat field and honked and waved from his blue â57 Chevy. He was never mean, she says, but he could be a perfectionist and short-tempered sometimes, like when he was trying to fix something and thought she was holding the flashlight or the screwdriver wrong. Was he trying to apologize for that, she wondered, or was he thinking he might not make it out of there and wanted to make sure she knew he loved her?
It was Ferguson who first noticed the spongy mass in Novotnyâs abdomen, the night of Aug. 6. âWas this new?â she asked. It was, Novotny said, and it hurt. She told him he would have to be taken downstairs for a scan to see what was wrong.
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âAre you coming with me?â he asked her, half-afraid, half-teasing.
The news was grim. Novotny had developed a hematoma â a collection of blood inside one of his abdominal muscles â that needed immediate attention. They needed an interventional radiologist, a specialist that Stillwater did not have, to perform a procedure to block the blood vessel and stanch the bleeding.
Without the procedure, Novotny would likely be dead in 48 hours, Payne estimated. They had to find him a bed, somewhere.
It was 1:42 p.m. on Aug. 7, when Pressley widened her search for an ICU bed to neighboring states and got her first real lead. Instead of a definitive âno,â she got a âmaybeâ from St. Lukeâs Community Hospital in Olathe, Kan., nearly 300 miles away. They asked for Novotnyâs medical and insurance information and for Payneâs cellphone number so the doctors could consult. Pressley briefly allowed herself a moment of hope.
Pressley has worked for Stillwater Medical Center for more than 30 years, including the last 16 in the infusion clinic. She switched to transfer coordinator â a job created during the pandemic â in part because she wanted a change. But the job has become so stressful that she sometimes stops in an empty parking lot to catch her breath and decompress before going home to her husband, Ken. She never talks to him about work: Why should they both be depressed?
She made a sign for her office that says âBreathe Deeply.â A colleague scrawled âInto the paper bag,â underneath it.
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Robin Pressley has worked at Stillwater Medical Center for more than 30 years. She took on the role of transfer coordinator, a job created during the pandemic, because she wanted a change. Now, with challenges such as her efforts to find a larger hospital that could help patients like Johnnie Novotny, she entertains thoughts of early retirement.
At 3:42 p.m., her hope evaporated when St. Lukeâs called back to say they were declining to take Novotny. No explanation was given. Pressley called Payne, who suggested a Hail Mary. Maybe they could convince one of the larger hospitals in Oklahoma City to take Novotny just for the hematoma procedure and then bring him right back?
âYou are just constantly thinking, where could I call, what can I do, who will take this patient for the procedure?â Pressley said. âWhat can we say to make them take him?â
At 4:07 p.m., the University of Oklahoma Medical Center in Oklahoma City said they wouldnât accept Novotny without having a bed to put him in if something went wrong.
At 4:19 p.m., Integris Baptist Medical Center in Oklahoma City said the same thing.
At 4:21 p.m. Mercy Hospital in Oklahoma City said Novotny was too unstable for transfer and, if he got there and crashed, they had no bed for him.
Pressley had to call Payne and deliver the news: She simply could not find a bed anywhere. Payneâs only hope at that point was that Novotnyâs condition would improve on its own.
Throughout the anxious night that followed, Novotnyâs blood pressure continued to drop; frequent blood transfusions were having little effect. The hematoma had swollen to the size of a volleyball, which was difficult for all to see. He was slipping away.
Early the next morning, Payne met with the family in a conference room near the intensive care unit, where Angelia, the coupleâs three adult children, their spouses and others crammed into the tiny space, hoping to hear a miracle. The conference room is next to what used to be a comfortable waiting room for families, but now houses spare ventilators sheathed in white plastic, like an army of ghosts.
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âThey were absolutely desperate, hoping against hope something might have changed,â Payne said. âYou basically have to be the dream-stealer and tell them this isnât working and, at this point, it is truly hopeless. We canât get him transferred out.â
Payne told the family they had tried 40 hospitals in at least four states and come up empty.
âItâs so hard. Nobody could fix him. He just had to lay there and die,â Angelia Novotny said.
She had never until that moment realized that her husband wasnât coming home, she said, and in the cramped space she was suddenly overcome by nausea. She raced out for the restroom. She made it as far as the hallway trash can.
An available bed has been a rare sight of late in intensive care at Stillwater Medical Center. This one became available when a patient being treated there died. It was very quickly filled when a seriously ill covid patient was brought in from a town about 90 minutes away.
Various tubes are attached to pumps that regulate the flow of medicine to a critically ill covid patient at Stillwater Medical Center.
A gown and sterile gloves lie at the bottom of a trash can just outside an intensive care room occupied by a patient with covid at Stillwater Medical Center.
One by one, family members went into Room 107 to say goodbye to Novotny, who had been put on a ventilator and was now unresponsive. âDad, you canât die. You never taught me how to drive a tractor right,â the family recalled daughter Michelle saying through tears.
âHe doesnât deserve this,â Angelia kept repeating.
Novotnyâs daughter-in-law, Tara, the nurse, arrived, and Ferguson helped tie a blue gown over her baby bump â the grandchild already named Johnnie Novotny III, to say farewell.
Ferguson had stayed over from her night shift to support the family, but she decided she couldnât sit and watch Novotny die. She gave Angelia a hug and slipped out of the room.
âIt was terrible to watch,â Ferguson said. âIt didnât matter that I knew them and heâs close to my parentsâ age. It shouldnât have happened. Thatâs what it boiled down to. It just shouldnât have happened.â
Novotny was on a dozen different medications to keep him alive, but it wasnât enough. His heart stopped just after 10:30 a.m. on Aug. 8.
Of the 76 covid-related deaths at the hospital through mid-October, his was the first that occurred because staff couldnât find an ICU bed at a larger hospital, Payne said.
Dr. Matthew Payne cared for covid patient Johnnie Novotny during Novotnyâs stay at Stillwater Medical Center. His medical needs were more than Stillwater could manage, and staff reached out to 40 other hospitals in at least four states for help, to no avail.
Payne called Pressley later that morning, and his voice cracked a bit when he told her Novotny had died. âThis one really got to me,â he said.
âYou could tell by his voice that this hurt him to the core, you know? And I felt the same,â Pressley said. âWe did not have a chance to save his life because of bed availability. We just didnât have that chance.â
Pressley went to the bathroom to collect herself. After her shift, she went home and went straight to bed, curling up with her three-legged pug, Pearl. Pressley, 61, had hoped to work until 65 but was now thinking she should retire early.
âI stayed in my room for quite a while because I needed to get my head on straight, because I was going down a dark hole thinking that maybe I should switch jobs, maybe Iâm not good enough at this,â she said. âItâs hard to have a patientâs death on your shoulders, and itâs not like itâs on mine 100 percent, but Iâm involved, and if I could have gotten him out of here, maybe he wouldnât have died,â she said.
She thought about it for a week and ultimately decided to stay. It felt selfish to leave when they needed so many hands. Why should she take away two of them?
A nighttime exposure from the vantage point of Johnnie Novotnyâs gravesite shows a vehicle passing through Highland Cemetery in Oklahomaâs Pawnee County. âYou know, you never think somebody is going to die,â said his widow, Angelia. âI thought he would have at least 20 more years.â
Novotnyâs family buried him on a hill in Highland Cemetery, just north of Pawnee, where a simple wooden cross marks the grave that is lit by a small solar panel and visible from the road at night. About 150 people came to the Aug. 14 graveside service, where the pastor read the 23rd Psalm.
The coupleâs 100-year-old farmhouse feels empty for Angelia these days, even with the two grandchildren she babysits there five days a week. Her son offered to fix up one of his rental properties for her in town, she said, but she refused. âI like to be in the country,â she said. âIâm not a town person.â
The namesake baby, Johnnie III, was born at Stillwater Medical Center on Sept. 6. The living room of the farmhouse is filled with photos of Novotny holding each infant grandchild. He had to be photoshopped into one with the new baby.
âYou know, you never think somebody is going to die,â she said. âI thought he would have at least 20 more years.â
Johnnie and Angelia Novotny are seen in a 2018 family photo. The couple fell in love over 50 years ago, on a day Angelia was in her fatherâs wheat field and Johnnie honked and waved at her from his blue â57 Chevy. (Rae Lynn Payton)
She asked a neighbor who lost her husband three years ago if things ever get any better.
âI asked her, âDoes the loneliness ever go away?â â she said. âAnd she said, âIâd love to tell you, yeah, it does, but no, it doesnât.ââ
She has been beating herself up a lot lately. Maybe she should have taken him to a larger hospital in Oklahoma City or Tulsa in the first place, so that he would have had access to more specialists. Maybe she should have taken him to the hospital sooner.
Not on her list of regrets: her decision not to get vaccinated.
âI just have so many questions about the shot,â she said. âI donât know if Iâm persuaded. I guess you want to say I donât believe in it.â
On Aug. 14, the day Novotny was buried, Stillwater Medical Centerâs ICU was full again. In the back of the nurseâs station, taped to one of the cupboards, was a childâs drawing of an orange tractor and a tiny hay bale. âGet Well,â it says, with a heart. Itâs signed by two of Novotnyâs grandchildren. One of the staff had rescued it from Novotnyâs room and hung it up, the only remnant of the patient they knew how to save but couldnât.
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Annie GowenFollow
Annie Gowen is a correspondent for The Post's National desk. She was the India bureau chief from 2013-2018.
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