Arizona was reporting the state had 175 vacant ICU beds, but Dr. Cleavon Gilman could not find a single hospital to accept ICU transfers from his overtaxed rural facility as he worked Sunday into Monday.
“Where are the 175 ICU beds?” the 41-year-old emergency medicine physician asked when he spoke to The Daily Beast on Sunday evening. “They say it’s 175 beds available. That’s not what we’re hearing. We’re hearing there are NO beds available.”
On previous days, when the need arose, Gilman had simply arranged to have a patient flown to another hospital just as he might have arranged a medevac when he was a combat Navy corpsman with the Marines in Iraq in 2004. But that was not an option when he arrived at work on Sunday.
Gilman was able to medevac one patient suffering head trauma—but only to another emergency room, until a neurological ICU bed opened up.
Otherwise, he and his fellow medical workers at Yuma Regional Medical Center coped as best they could. He began examining patients in the waiting area because of a perpetual backup at the emergency room from an increasing number of COVID-19 patients.
Gilman figured that the Arizona Department of Health Services (ADHS )—which did not respond to a Daily Beast request for comment—may have prepared its rosy tally of available ICU beds without taking into account a shortage of critical care staff in Arizona, along with the rest of the nation.
“An ICU bed without a staff is like a plane without a pilot,” he said. “What are we going to do with it?”
On Sunday, Arizona was in its 14th straight day of reporting more than 2,000 new COVID-19 cases. The holiday season loomed and Gilman saw a video posted online that showed a big crowd at Skyport International Airport in Phoenix on Friday.
“It’s just crazy how many people are traveling,” Gilman remarked.
A report released by the University of Arizona the same day makes a chilling prediction.
“Without additional public health measures, holiday gatherings are likely to cause 600-1,200 additional deaths from COVID-19 in Arizona by February 1,” it says.
The added precautions recommended by the report include “a state-wide mask mandate, preventing gatherings of more than 10 people, closing bars, and decreasing capacity restrictions at restaurants with effective enforcement.”
Arizona Gov. Doug Ducey has done none of these things.
Yes, Ducey has voiced concern about the continuing spike in infections and declared, “I want people to wear masks. Masks work.”
But just as the 175 ICU beds are, in effect, none at all, Ducey has done nothing that will actually curb the spread.
“We really need some leadership,” Gilman said “National leadership.”
Actual leadership in Washington promises to be coming soon, along with vaccines. But we still have Thanksgiving and Christmas to get through.
“The election is over, but the pandemic is continuing,” Gilman said.
And the holidays will be followed by the start of the season when the area surrounding Yuma becomes “America’s Winter Salad Bowl.” Thousands of migrant workers will arrive to pick one-third of the lettuce grown on earth.
So far, anyway, Gilman is not seeing an explosion of cases at the level he witnessed as a resident at an uptown Manhattan hospital last spring.
“This is nothing like New York with millions of patients coming to the ER and dying in there,” he said. “It’s more like a slow drip every day, every day, every day. It’s like a wave that never breaks, always filling up the room.”
That same drip, drip drip, has been filling other facilities across the state and nationally, as hospitalizations reached record numbers last week.
He said that when bed does open up in his hospital or in one that can accept an ICU transfer, it too often arises in the worst possible way.
“People die and it opens up a bed,” he said. “That’s how it works”
And as someone who started in medicine while witnessing carnage on the battlefield, he is horrified that so many people just shrug as the death toll from COVID reaches the point where a four-day total exceeds all the American deaths in our two longest wars, in Iraq and Afghanistan.
“We’ve got 2,000 people dying a day and nothing is being done,” Gilman exclaimed.
By that, he meant there is no national strategy guided by actual fact and science. He had seen first-hand the value of one on a local level when Gov. Andrew Cuomo addressed the huge outbreak in New York back in the spring. The absence of a nationwide one has led to the present surge.
“Would you have ever believed we would be in this situation?” Gilman asked.
Nobody can say that the health care workers are giving anything but their all at considerable risk. Gilman noted that this includes the custodians and that everyone on the front lines remains a hero even if they no longer hear the applause every day he did when he was in New York. He also observed that some 2,000 health care workers have been felled by the virus and they generally do not get the line-of-duty death benefits accorded police officers.
The hospitals as a whole are equally dedicated and largely do whatever they can to meet the need for ICU beds, converting entire floors into COVID-19 wards. One serious problem compounded by the widespread surge is that hospitals have great difficulty drawing health care workers from other locales that have their own pressing needs. Yuma cannot get intensive care nurses from El Paso when El Paso does not have enough of its own.
And staffing becomes ever more difficult as health care workers everywhere are getting sick.
Gilman is grateful that Yuma Regional Medical Center is proving as mindful of its workers' safety as it is of its patients’ well-being. Intubation remains hazardous despite the HEPA filter that is now routine on endotracheal tubes after many medical teams got sick in the early days of the pandemic without them. Gilman’s hospital further reduced some of the risk by purchasing a Powered Air Purifying Respirator (PAPR). The device feeds filtered air into a hood that has a large face piece so the doctor performing the intubation has less cause to worry about virus-carrying aerosols expelled from the patient.
“I used it the first time today for an intubation and it was a godsend!” Gilman tweeted on Nov. 17. “No fogging like goggles under high pressure situations. Thankful our ER made this investment to protect us!”
He ordered a PAPR himself, so another member of the team will be able to use the hospital’s device during the procedure.
“Just dropped $1,500 on my own,” he further reported. “Before they run out nationwide.”
His PAPR is due to arrive in time for Thanksgiving, so he will be ready for the future patients who become infected when they sit down with loved ones. He has recently been treating people who wore masks and generally observed the necessary precautions outdoors, but then let down their guard. Maybe they went to a birthday party. Or maybe a teenager brought the virus home.
“And then it sweeps through the whole family,” Gilman said. “It’s killing the grandparents. We’re seeing a lot of that.”
On Monday evening, Gilman was scheduled to work another overnight shift at the hospital. He was heading out when somebody texted him a news article reporting that New Zealand Prime Minister Jacinda Ardern had arranged for the incoming Biden administration to consult with the health official on how her nation had curbed the virus.
“Thank God,” Gilman responded as he came closer to the day of national thanksgiving.
