BISMARCK — Hunter lay sideways on the floor of the emergency room waiting area, his eyes rolled back in his head, with a plastic bag over his mouth to catch the vomit that violently emitted from his stomach.
His kidneys were shutting down.
Delirious with pain, he screamed to his mother “I can’t breathe!” Tammy Berger could only watch in horror as the color faded from her teenage son’s face.
Receptionists at Sanford Medical Center in Bismarck told Berger they couldn’t admit Hunter because there were no open beds. She pleaded with them to no avail.
About two agonizing hours later, Berger carried her still-heaving son out of the waiting room and called CHI St. Alexius, the other hospital in North Dakota’s capital city. They were full, too.
“I was terrified. I was scared. I could see my son going downhill, and I was looking for somebody — anybody — to help him,” Berger said. “This is America, a developed country, and I’m running around with my son looking for somebody to help.”
Hunter was lucky. He lived. But the wait for a hospital bed nearly killed the 19-year-old.
The nightmarish episode that Hunter barely remembers and his mother wishes she could forget played out earlier this month as the strain on North Dakota hospitals grew increasingly more dire.
Like many health care professionals, Berger sees the state’s worsening COVID-19 outbreak as the straw that broke the camel’s back for hospitals that struggled with staffing concerns even before the pandemic.
Only about 15% of beds in the state are taken up by COVID-19 patients, but the pairing with high non-coronavirus admissions, like Hunter, has pushed most major hospitals to their limit.
The state’s hospitals reported having only 22 available intensive care beds and 247 regular inpatient beds as of Saturday, Oct. 24.
Fargo’s three hospitals had a combined nine ICU beds and 27 inpatient beds, while Bismarck’s two medical centers had two ICU beds and 15 inpatient beds between them. The number of available beds can fluctuate by the hour, according to hospital administrators.
Hunter declined to be interviewed for this story, and his last name has been omitted for privacy reasons.
'Whatever you have to do'
Berger believes an increasing number of seriously ill patients in Bismarck are sitting through long wait times to be admitted to the hospital, but Sanford Bismarck president Dr. Michael LeBeau said he’s confident the number of beds and staff on hand can deal with the rising hospitalizations.
LeBeau said he couldn’t speak to specific cases but characterized it as unlikely that a patient wouldn’t at least have a bed while waiting in the ER. However, he noted that the hospital is “experiencing very high demand” like most other medical centers, and patients are being “triaged,” meaning they are evaluated individually and admitted to the hospital in an order determined by the severity of their condition. LeBeau said there could be “very short stays” in the ER where a patient is given only a chair while being held there.
Berger said Hunter was never offered a bed or any medical attention during the roughly two hours they spent in the waiting room on Oct. 15. Hunter lay on the floor because he was too weak to sit up in the chair provided, she said.
After they left Sanford, Berger took her son to a walk-in clinic, where a doctor told them Hunter badly needed fluids and the kind of medical care he could get in the ER. An exasperated Berger explained that no such beds were available in the whole city. The doctor prescribed Hunter anti-nausea drugs but couldn't offer anything else.
Berger took Hunter home where he continued to vomit throughout the night. In the morning, Berger said her son “looked half dead.”
That morning, she took Hunter back to Sanford, where he was admitted to the ER almost right away. But that’s where the good news ended.
“The doctor comes into the emergency room and says, 'Your son is in full-blown kidney failure. If he quits breathing, would you like us to do CPR?’ ” Berger said. “I honestly felt like I left my body .... I just looked at him and said, 'He’s 19 years old. Yes, give him CPR or whatever you have to do.’”
Hunter was finally admitted to an inpatient bed after six hours in the ER, his mother said.
At the hospital, Hunter weighed in at 104 pounds fully clothed, down from about 145 a few months prior. His white blood cell count was more than twice the normal level, and his kidneys didn’t return to full function until the day after he was admitted.
“He could’ve easily died in my home had I not taken him back,” Berger said. "If I would’ve been able to get him into the emergency room ... he would not have gone into kidney failure. It was because of severe dehydration."
Berger had nothing but praise for the doctors and nurses at Sanford, whom she credits with saving her son’s life.
Her only complaint is that the staff, through no fault of their own, couldn’t make it to Hunter’s room in a timely manner when he pressed his buzzer for help because of how short-staffed the hospital was.
“I don’t blame them one bit,” Berger said. “These nurses are working their butts off trying to take care of all these people, and there’s only so much to go around.”
Hunter found temporary relief from the nausea and pain in hot baths, but his mother said the nurses wouldn’t allow it because they didn’t have the staff to monitor him. His mother had to step in to empty bags of vomit and cleaned Hunter up because the nurses “couldn’t get down there.”
“I was scared to leave him that if he pressed his buzzer nobody would be able to help him,” she said.
Her fear became a reality at 1:30 a.m. on Oct. 18, when Hunter started vomiting again and called his mother on the phone because no one would come to his aid.
Berger said it felt like hospital staff pushed to discharge Hunter later that day and free up his bed even though he would have stayed longer under normal circumstances. Berger added she was worried about bringing her son home because if he started vomiting again, they might not be able to get him back into the hospital.
But Hunter wanted to go home, and the doctors said there was no more they could do. Hunter was eventually diagnosed with a rare condition that causes severe nausea and vomiting.
His mother said he started off on a miraculous path to recovery after he was released from the hospital and feels much better a week later.
Hospitals on the edge
Berger said she has never heard of long waits at the ER in Bismarck, noting that Hunter was admitted almost immediately in August for a less intense vomiting episode.
The burden on hospitals in the state is a problem that has compounded since the beginning of the pandemic.
Hospitalizations from COVID-19 reached an all-time high in the state last week, and health care professionals say patients with the virus often demand more of the staff’s attention than the average patient.
LeBeau noted that many North Dakotans deferred health care earlier in the year and now have more serious medical issues. He encourages patients to keep coming in despite the strain on staffing and beds because kicking the can down the road just means sicker patients in the long run.
The doctor acknowledged that staff at his hospital are tired after more than six months of working at the pandemic pace. He said the hospital continues to hire nurses when it gets the chance.
LeBeau added that hospitals are working with the state to establish new surge plans to implement if the crunch on the health care system further intensifies.
On Friday, Oct. 23, the state Emergency Commission approved giving about $10 million in federal funding to hospitals in Fargo, Bismarck, Grand Forks and Minot to encourage staff retention and attract flex nurses from out of state. The funding, which will be distributed through the state Department of Health, still must be approved by the Legislature’s Budget Section.
Berger points the finger at Gov. Doug Burgum, saying he has failed to implement effective COVID-19 mitigation strategies and understated the state’s lack of available hospital beds. Earlier this month, Burgum said hospital capacity had “not been a problem” in North Dakota.
“As our leader, he should be taking the lead, and he’s not,” Berger said. “We are not fine.”
The Bismarck resident said she’s in favor of Burgum issuing a statewide mask mandate and using stimulus money to incentivize small businesses to shut down so that the state has time to recover from the COVID-19 outbreak and replenish its hospital capacity.
Burgum said on Friday the state is working to find a way to balance the needs of patients with COVID-19 and other ailments. The first-term Republican said he’s confident the state can manage the challenge on bed capacity “within the walls of the hospitals.”
LeBeau, Berger and Burgum come at the issue from different perspectives, but they agree the stress on the state’s hospitals could be alleviated if more residents take steps to prevent the spread of the virus by wearing masks, social distancing and washing their hands.
“If you’re worried about hospital capacity … your individual actions can help,” Burgum said. “We’re all in it together, and there’s actually something that each of us can do.”