‘Trying to keep our heads above water’: Inside the hospital bed crisis in rural Wisconsin

"Part One: The Beds" begins a series inside the ICU, ER, and inpatient facilities of SSM Health's Monroe Hospital, where staff say they're in a crisis unlike any other point in the pandemic
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Inside the ICU at SSM Health's Monroe Hospital (WISC-TV Photo)

MONROE, Wis. — It’s quiet inside the intensive care unit at SSM Health’s hospital in Monroe. There’s a calm, steady energy as nurses move about, huddled together at the center desk or sweeping curtains closed behind them as they shield a patient, mercifully, from the camera lens and the public’s eye.

Behind those curtains, the quiet belies the reality.

Serving rural communities across southern Wisconsin and northern Illinois, the hospital houses just six ICU beds. On Wednesday when a News 3 Now team spent nearly four hours inside the hospital, all six of them were filled with COVID patients.

“Very rarely do we see a vaccinated patient,” ICU nurse and weekend shift coordinator Janelle Jaeggi reflects. She’s worked in this ICU for fourteen years, and at no point has it been worse. “If they do survive, they have a very long road ahead of them.”

They will be there for days–weeks–maybe longer. The lucky ones who make it out of the ICU will have weeks and months more ahead, living a newer, harder life. Patients may need to spend weeks more in a lower-level bed, or waiting for a longterm care room to open up.

“Their bodies are very de-conditioned,” Jaeggi said. “They’ve been in bed for weeks, if not months. They’re getting fed through a tube in their stomach. They’re breathing through a hole in their throat.”

Her eyes are tired as she talks.

“This is 100% real. This is not fake,” she says with emphasis. “It’s patients in their 20s, in their 30s, 40s, and 50s. It’s not just patients who have underlying chronic conditions. It’s patients that come in with no past medical history. I mean, it’s hitting everybody.”

The ICU has been in that state for months. Nurses from other departments are helping out as they can. When there’s a crunch of patients needing intensive care, it can take 20 or 30 calls–or elaborate transfer agreements–to find another facility that can take them. And for Jaeggi and her colleagues, it’s taking a toll.

“It’s been a lot lately,” she said. “If you’re able to, please get vaccinated.”

Hospitals grapple with bed shortages across Wisconsin

Statewide, the Wisconsin Hospital Association reports COVID hospitalizations have spiked sharply in the last few months. It’s the highest it’s been by far in 2021; the number is rapidly rising to the heights hospitalizations reached briefly last December.

The Department of Health Services released data this week showing the unvaccinated are 12 times more likely to die of COVID than those who have received a vaccine. The likelihood of infection for the unvaccinated was also 3 times as high; the chances that a vaccinated person would die or need hospitalization was far lower than those who hadn’t received the shot.

Nearly 10,000 have died of COVID in Wisconsin since the pandemic began.

Jaeggi grows quiet for a moment when asked about what patients are saying when they reach a crisis point in the ICU.

“A lot of them know once they get on a ventilator, their chances of survival are slim,” she said. “Prior to going on a ventilator, there’s several of them that just say, ‘I wish I would have gotten my shot.'” Others, she says, don’t mention any regrets.

At no point in the pandemic has Monroe Hospital had to handle a surge like this, president Jane Curran-Meuli said. While larger hospitals have frequently been filled over the past 20 months, smaller hospitals like hers have still had the ability to send their critical or overflow patients out to other facilities for care.

RELATED: SSM Health suspending ‘non-urgent medical procedures’ at Monroe hospital due to patient volume spike

Now, those calls are coming the other way as they battle their own first surge of the pandemic.

“We’re probably fielding six to ten calls a day from other hospitals wanting to transfer in to us,” she explained. Rarely can they accept the transfers, amid their own dozens of calls back out.

“We’ve actually worked with our hospitals to do almost a three-way trade: This patient needs this level of care, so we’ll transfer them, but to do that we’ve got to transfer this person here, and we’ll take this patient from you.”

The hospital canceled nonurgent surgeries effective November 22, and since then, about 25% of inpatient surgeries have been canceled or rescheduled to try and conserve both staff and bed space.

While it’s COVID driving much of the surge, non-COVID patients are also coming in sicker, Curran-Meuli said. Combine that with COVID stays that tend to extend much longer than average already, an average hospital stay is up to 14 days from 3 days pre-pandemic. People are delaying care–and the results, she says, are deadly.

“I’ve seen patients who, normally, we would have caught a lung cancer–they come in at the final stages of lung cancer for the first time,” Curran-Meuli said.

Patients wait hours, days in ER for beds to open

Three floors down from the ICU in the emergency room, two non-COVID patients were waiting for hospital beds Wednesday morning. That wait could go on for 36 to 48 hours, EMS coordinator RN Mary Tessendorf said, with nearly half of their inpatient beds filled with COVID patients at that moment.

“We bring down a hospital bed out of the penthouse and get them as comfortable as we can,” Tessendorf explained. The two patients were waiting on standard inpatient beds; if it was a crisis and the need was for an ICU bed, the situation would be far different.

“We would have to wait till a bed opens up in the ICU and that can be days,” she noted.

That’s when the hospital must at times rely on creative or elaborate transfer solutions or simply sheer manpower as doctors make dozens of calls trying to place their patient throughout the state.

Coordinating beds across the hospital’s inpatient, family birth, and ICU facilities is part of Jaeggi’s job on the weekends, in addition to the ICU. When there’s a crisis, such as a car crash where multiple patients might need high-level care, the strain just increases.

“Having the ICU full of patients, you get someone who’s critically ill into the ER, and we’re trying our best to transfer them out,” she explained. But when the beds aren’t there–as they often aren’t–she’ll spend hours herself in the emergency room trying to provide the ICU-level care the patient needs while juggling her other tasks.

That was the case when a patient was brought in recently without a heartbeat. They revived him, but he needed a level of intensive care that ER staff aren’t trained to manage. Jaeggi spent several hours that day in the ICU, providing drips and infusions and managing his blood pressure while doctors called around the state looking for a bed.

Laurel Taylor has worked at the hospital for nearly 41 years, and in the ER since 2007. Never before has she seen this kind of inability to transfer patients or get their beds.

“Optimum care has been hard,” she explained. “Sometimes it may take 20 or 30 calls to get a patient to where they need.”

The days in the ER right now are taking a toll, she said. And some in the community don’t seem to understand.

“Some people are a little shocked. They ask, ‘Is that really happening here? In Monroe?’ Yes. It really is happening here in Monroe. What you hear on the news is true.”

‘This is nothing like flu season’

Upstairs, the 55-bed hospital includes about 40 inpatient beds in two wings. One wing’s 19 beds are entirely dedicated to COVID patients. Only one was open when we visited, and it was expected to fill later that day.

“We have had patients that have been here for two months,” Jeanette Williams said. An inpatient nurse and administrative supervisor, she’s worked at the hospital for six years since finishing school.

“This is nothing like flu season,” she emphasized. “Absolutely nothing like that. We’re kinda trying to keep our heads above water here.”

The good days are when somebody leaves–for home, not another facility. After weeks or months, nurses have often grown attached to their patients, and it’s a celebration for nurse and patient alike when they walk out a success story. But the feelings of defeat happen far too often, too.

“We have patients that come in that don’t do well, or patients that are just here for so long and take one step forward and two steps back every single day.”

It’s hard not to think about them when a nurse goes home for the day, Jaeggi said, wondering if they’re doing better or if they’ve had a bad turn. And when a patient gets worse or passes away, it’s hard to remember not to blame themselves.

“You think to yourself, ‘What am I doing wrong? Could I have fixed this? How could I have prevented this?'”

We ask everyone: what’s your message to the public? For many: it’s vaccines, masking, taking precautions. It’s about the common good, Curran-Meuli explained. It’s about trusting your doctor, and avoiding unverified information from the internet or untrained people, Taylor added.

For all, it’s a desperation to convey the daily reality of what they see on the job: the shortage, the suffering, the deaths.

“This is real.”

Photojournalist Brian Mesmer contributed to this report.

This is “Part One: The Beds” of a multi-part series inside Monroe Hospital. On Sunday at 10, “Part Two: The Staff “explores the staffing shortages, another facet behind the statewide hospital crisis.