48 hours to live: An Oklahoma hospital's rush to find an ICU bed for a covid patient
STILLWATER, Okla. - 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 state's large numbers of unvaccinated residents, like Novotny. But she also knew that Novotny's 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.
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 state's 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.
It's just a matter of getting the right hospital, Pressley told herself and kept dialing.
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 state's pandemic death toll exceeded 10,600. More than half the state still is not fully vaccinated.
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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% 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 won't 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. They'd never had to stand by and watch a patient die when they knew he or she could be saved.
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 pandemic's 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 "wore them slick," 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.
"We are broken," said Grace Ferguson, 33, a charge nurse who grew up in nearby Pawnee, where her family owns the newspaper. "I never used to cry about work, but now I can't seem to talk about it without my voice cracking. I'm wondering, when am I going to stop crying about this? Maybe never."
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 family's farm that July day when he started feeling sick. He'd 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 - 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 he'd never been one for doctors, his wife said.
"Are you giving up on me?" 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 "little Gracie Ferguson" who had been in Angelia's reading class as a second- and third-grader at Pawnee Elementary School.
"She told me 'Grace, we don't do anything. I can't believe he tested positive,'" Ferguson recalled. "I'm thinking, 'How could you not believe that's what this is?'"
The couple hadn't gotten vaccinated because they had misgivings about the shot and stay mostly on their farm - except for church on Sundays. Ferguson didn't argue with them.
"It's too exhausting and heartbreaking to have to be like, 'No, you don't understand what I see every day,'" Ferguson said. "I can't open that wound just to argue with somebody who doesn't want to hear."
That wound was losing two to three longtime patients a week and having to shave one patient's beard so his wife could see him on their final goodbye.
Her work locker is still crammed with notes on her patients from the first surge that she can't bear to throw away - 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.
"You feel like you're on an island, and no one's looking to send out search-and-rescue planes to save you," said Matthew Payne, Novotny's doctor. "The case managers are tossing messages in a bottle, and no one is there to pick those up."
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.
"That broke my whole heart," said Ferguson, the charge nurse.
"I'm sorry I was mean to you," 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 couple's 10 grandchildren and Colorado vacations.
Angelia laughed.
"Mean to me? You weren't mean to me, for heaven's sake," she recalled.
They had been in love for a half-century, since he first saw her in her father's wheat field and honked and waved from his blue '57 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 Novotny's abdomen, the night of Aug. 6. "Was this new?" 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.
"Are you coming with me?" he asked her, half-afraid, half-teasing.
The news was grim. Novotny had developed a hematoma - a collection of blood inside one of his abdominal muscles - 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 "no," she got a "maybe" from St. Luke's Community Hospital in Olathe, Kan., nearly 300 miles away. They asked for Novotny's medical and insurance information and for Payne's 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 - a job created during the pandemic - 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 "Breathe Deeply." A colleague scrawled "Into the paper bag," underneath it.
At 3:42 p.m., her hope evaporated when St. Luke's 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?
"You are just constantly thinking, where could I call, what can I do, who will take this patient for the procedure?" Pressley said. "What can we say to make them take him?"
At 4:07 p.m., the University of Oklahoma Medical Center in Oklahoma City said they wouldn't 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. Payne's only hope at that point was that Novotny's condition would improve on its own.
Throughout the anxious night that followed, Novotny's 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 couple's 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.
"They were absolutely desperate, hoping against hope something might have changed," Payne said. "You basically have to be the dream-stealer and tell them this isn't working and, at this point, it is truly hopeless. We can't get him transferred out."
Payne told the family they had tried 40 hospitals in at least four states and come up empty.
"It's so hard. Nobody could fix him. He just had to lay there and die," Angelia Novotny said.
She had never until that moment realized that her husband wasn't 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.
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. "Dad, you can't die. You never taught me how to drive a tractor right," the family recalled daughter Michelle saying through tears.
"He doesn't deserve this," Angelia kept repeating.
Novotny's daughter-in-law, Tara, the nurse, arrived, and Ferguson helped tie a blue gown over her baby bump - 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 couldn't sit and watch Novotny die. She gave Angelia a hug and slipped out of the room.
"It was terrible to watch," Ferguson said. "It didn't matter that I knew them and he's close to my parents' age. It shouldn't have happened. That's what it boiled down to. It just shouldn't have happened."
Novotny was on a dozen different medications to keep him alive, but it wasn't 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 couldn't find an ICU bed at a larger hospital, Payne said.
Payne called Pressley later that morning, and his voice cracked a bit when he told her Novotny had died. "This one really got to me," he said.
"You could tell by his voice that this hurt him to the core, you know? And I felt the same," Pressley said. "We did not have a chance to save his life because of bed availability. We just didn't have that chance."
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.
"I 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 I'm not good enough at this," she said. "It's hard to have a patient's death on your shoulders, and it's not like it's on mine 100%, but I'm involved, and if I could have gotten him out of here, maybe he wouldn't have died," 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?
Novotny's 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 couple's 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. "I like to be in the country," she said. "I'm not a town person."
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.
"You know, you never think somebody is going to die," she said. "I thought he would have at least 20 more years."
She asked a neighbor who lost her husband three years ago if things ever get any better.
"I asked her, 'Does the loneliness ever go away?' " she said. "And she said, 'I'd love to tell you, yeah, it does, but no, it doesn't.'"
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.
"I just have so many questions about the shot," she said. "I don't know if I'm persuaded. I guess you want to say I don't believe in it."
On Aug. 14, the day Novotny was buried, Stillwater Medical Center's ICU was full again. In the back of the nurse's station, taped to one of the cupboards, was a child's drawing of an orange tractor and a tiny hay bale. "Get Well," it says, with a heart. It's signed by two of Novotny's grandchildren. One of the staff had rescued it from Novotny's room and hung it up, the only remnant of the patient they knew how to save but couldn't.
- - -
The Washington Post's Jacqueline Dupree and Alice Crites contributed to this report.
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48 hours to live: An Oklahoma hospital's rush to find an ICU bed for a covid patient
