LAKE SAINT LOUIS — As one of the darkest years in recent memory inches to a close, Erika Jensen doesn’t mince words when talking about the toll on her staff.

“We are so tired,” the nursing director at SSM Health St. Joseph Hospital-Lake Saint Louis said. “I mean, it’s just death after death after death.”

Outside hospital walls, the pandemic grinds on and the public numbs to reports about hospitals near the breaking point.

Within hospital walls, the front-line fighters in ICUs and on COVID-19 units don’t have the luxury of looking away.

“It’s like a trifecta,” Jensen said. “I mean, it’s the COVID, it’s the volume of patients we’re seeing. We’re at max capacity every day. We’re in the middle of a national nursing shortage as it is. And so, it’s a lot.”

Hospitals across Missouri continue to operate in crisis as they bear the brunt of what they knew was coming all along — so much so that the state is partnering with a private company in Texas in the hopes of relieving some of the stress on the system.

Late last month, St. Joseph Hospital-Lake Saint Louis gave access to a reporter and photographer to provide an intimate look at how the hospital is dealing with a fall surge.

‘Every day is getting more severe’

Close to 3,500 Missourians are testing positive for COVID-19 every day. Around 20 percent of tests are coming back positive — and more than 50 percent in some rural counties. The virus is now killing an average of 30 Missourians every day, as the number of people hospitalized with the virus remains near record levels.

During Thanksgiving week, Jensen served both as an incident commander at the 216-bed hospital and a nurse caring for its sickest patients. And she’s not the only one taking on multiple jobs. With the hospital overwhelmed, each staff member’s role has become flexible. She prepares for situations ranging from snowstorm protocol to building COVID-19 surge plans.

On Nov. 20, the hospital stopped accepting visitors. The halls were mostly quiet except for the low hum of televisions visible through cracked doors, and the nurses and housekeepers attending to patients.

The hospital’s latest task includes expanding the ICU — which Jensen said has been full and in danger of overflowing at any moment — by repurposing various sections of the hospital.

Some of the fear factors in treating the disease are gone, Jensen said, but “the reality is, honestly, it’s everywhere.”

“Fifty-four percent of our patients are COVID or COVID-related, and they’re literally everywhere” she said. “We do have the two designated units downstairs still, but there are times when those are full, and we have to overflow into other units of our hospital.”

Throughout the state, hospitals are working to dedicate more space to COVID-19 patients, but this often comes at the cost of patients who need surgery or other services. When no hospital beds are available, Jensen said the emergency department fills up.

“I’ve seen (non-COVID) patients in our emergency department waiting for a bed upstairs and [we] don’t have a bed for them,” she said.

The hospital has started moving non-COVID-19 patients in the emergency department toward repurposed facilities like their endoscopy area, where the endoscopy team had to rework the way that they do things, Jensen said. The patients needing services like colonoscopies are now being shifted toward sister hospitals with room to take them.

“That is a huge deal,” she said.

‘It feels like we’re at war’ 

While some material supplies have increased since spring, humans are a fixed resource, and the skilled labor of an ICU nurse or a seasoned respiratory therapist is difficult to come by.

Maddi Evans is a charge nurse and knows how hard the job can be.

“It’s really hard whenever somebody’s dying, and their family can’t be there,” she said. “That’s the worst situation for anyone to be in, including us nurses, because we’re the ones there at the bedside.”

Evans added: “But to know, as a nurse, that you can have that conversation with family and let them know that it’s going to be okay; that you’re holding their loved one’s hands, and that the person that’s there is making them comfortable — it’s so important.”

Patients’ families and visitors often have a harder time believing the severity of the pathogen’s effects than the patients experiencing the symptoms, she said. Virtual video calls are an attempt to bridge their disconnect, and the hospital has purchased three more iPads to link patients with their loved ones.

Evans also knows that available beds mean nothing without qualified nurses. Because the virus is surging in multiple states, hospitals across the country are competing for the same personnel.

Staff are working more overtime, causing more fatigue, which will lead to more burnout, she said.

Evening candle-lit vigils hosted by the hospital’s pastoral care team surround the bereaved with the living, and the coffee breaks and self-consciously normal talk are all designed to keep the staff thinking in the present and looking to the future.

Elaine Stearn, the ICU manager at the hospital, pointed to a busy nurse donning a mask and protective goggles. “Like Natalie over there — with the yellow sleeves,” she said. “I think she had three shifts in a row where she lost somebody every shift.”

The emotional toll that takes is significant.

“I console my staff every day,” Stearn said. “Every single day.”

“I have two very different conversations about COVID,” she added. “The patients here are so sick that you have to remind the staff that people do get better, and what we’re doing matters. And then I go home and I’m explaining to the public, this is really bad.”

Stearn admits that the spread of misinformation can feel too great.

“Facebook isn’t the best place for people to get the facts,” she said. “I think it’s trying to balance like, let’s not scare everybody and cause a panic, but develop a healthy sense of responsibility.We need the public’s support right now.”

Evans echoed this sentiment: “There are grandmothers, grandpas, young people; all kinds of people that we’re losing and that are suffering. People are losing their jobs. I think that just having a little human decency and respecting one another — putting on a mask — is the least we could ask.”

“You want to make sure you can see grandma next near,” Stearn said.

The key to counteracting the virus’s spread is recognizing that no single step is perfect at preventing it.

On one thing in particular, Jensen, Evans and Stearn all agree: “We need statewide mandates.”

‘We were scared for each other’

Lauri and Dave Reape, 59 and 62, of O’Fallon, sat adjacent from each other in their dimly lit hospital room where they recalled the horrors of their experience with COVID-19, as well as the virus’s emotional and physical aftermath.

“We’ve been really, really diligent as far as wearing masks, washing hands and social distancing,” Lauri Reape said.

They felt like they did everything right. But it wasn’t enough.

Their son, who lives with them, tested positive after being exposed to a co-worker who had the virus. By Election Day, the Reapes decided to visit a drive-thru testing center after feeling an onset of mild symptoms.

“It was pretty rough,” Lauri Reape said. “Running fevers, and then after about five days I told my husband ‘You’ve gotta take me to the hospital, I can’t breathe.’ … It was scary.”

Dave Reape checked his wife into the hospital on Nov. 10.

Five days later, a severe cough and depleting oxygen levels forced him to also check into the hospital.

He spent the next feverish week gasping for air as nurses did what they could to keep him alive, including administering Remdesivir.

“I’ve been down miserable, but not like that…” He shook his head. “No B.S., man.”

“It’s been a long road,” Lauri Reape said, “but they’ve done really good here. They’ve treated us really well.”

“So many of the nurses come in and they’ve got their families — going through it just like you and everybody,” Dave Reape said in his gravelly southern drawl. “Just can’t imagine what they’re thinking. They can’t stop.”

A pair of oxygen tanks sit near the door, ready for the couple to take home, but the Reapes aren’t sure how long their recovery will take.

“People think it’s about taking away their rights,” Lauri said. “I think people are in denial.”

The chorus from The Beatles’ “Here Comes The Sun” wafted from the intercom, a sign that a COVID-19 patient had been released. It was a reminder — if only for a brief moment — that life exists past a dark winter.

“That was my song for our father-daughter dance last year, at my youngest daughter’s wedding,” Dave Reape said with a gentle smile, his eyes glistening. “Good song.”

Armond Feffer is a freelance photojournalist and a part-time photo editor for the Columbia Missourian. He graduated earlier this year from the University of Missouri. You can find him on Instagram (@armyfeffer), Twitter (@armondjourno) and email ([email protected]).