As William Kieler struggled to breathe, as he grew woozy and unresponsive, as they hooked him up to machines to shove air into his lungs, the worried staff at the small-town hospital in Auburn kept calling the big-city hospitals.
They called every hospital in Omaha. No room. They called Fremont. No chance. They called nearby out-of-state hospitals. No dice.
They called Bryan Health in Lincoln, where a nurse put Kieler on The List. It’s a blinking list of names on a computer screen, a digital documentation of ages and illnesses and notes. The List did not exist, in its current form, until last year. It’s grown longer as the latest waves of COVID-19 sicken and send mostly unvaccinated people to the Lincoln hospital.
William Kieler does not have COVID-19. He’s a retired tugboat captain from Peru, Nebraska, a man proud of a career spent piloting ships down the mighty Mississippi. He’s an 83-year-old with congestive heart failure. He’s the sort of patient who has always been quickly transferred from a small-town hospital to a big-city one. But not on Dec. 7.
Kieler was 20th on The List. The next day, 9th. Then 7th. Back to 9th, because too many people were coming into Bryan’s ER. Then 4th.
For a day, two days, three, the staff of the Nemaha County Hospital in Auburn, the people caring for Kieler, called and waited. The Bryan nurses – the keepers of the List – answered and waited. Kieler’s loved ones waited, and worried.
The horror of The List is simple. It’s proof that one the biggest, best hospitals in Nebraska is currently being forced to ration medical care – isn’t able to admit very sick patients it would normally admit – because its emergency rooms, regular rooms, intensive-care rooms, makeshift overflow rooms, waiting rooms and even hallways are packed with patients.
“Of course you are rationing health care when you can’t get in all the people who need it,” Dawn Isaacs, the hospital’s nursing director, told the Flatwater Free Press. “When we’re making decisions based on capability and capacity, on what we can provide and can’t…Yes, we are in a health care system that is rationing care.”
For years, that call from the Nemaha County Hospital to Bryan would have been routine.
Isaacs said the Lincoln hospital rarely turned down a transfer before COVID-19, and never delayed admitting a critically ill patient.
Now, every time a small-town hospital phones, there’s a short conference call with a doctor and the employee running “bed control.” The key question: “Do you have a bed?”
The current answer, almost always: Not yet.
On a recent day, 29 Nebraskans – almost all of them awaiting transfers from rural hospitals – sat on the waiting list, said Bob Ravenscroft, a Bryan vice president, at a mid-December briefing. He showed a chart with a gray line denoting a normal busy time at Bryan, and a red line illustrating the hospital at its surge capacity. Since August, Bryan has crossed that red line almost as many days as it hasn’t.
“Every time we pop above that red line that’s where there’s not a realistic place to put them,” he said of patients awaiting transfer to Bryan. “There’s a house supervisor on the receiving end of those calls, and they are going one-by-one, on who gets that next bed. So, obviously, this is heartbreaking for (the staff).”
Bryan staff has converted the gastrointestinal lab into a space to put hospital patients at night. They have placed patients in rooms meant for observing people who have undergone surgery. They have parked a dozen beds in the hallways of the emergency room.
“The ER looks like a war zone,” said Isaacs, the nursing director in charge of the ER.
They discharge people speedily. They send people to urgent care offices for broken bones. They plead with smaller hospitals to do “comfort care” for their patients near death.
Bryan doesn’t have beds for patients destined to die within the next 24 hours, they said. Bryan doesn’t have beds, period.
“Literally all our beds are used,” Isaacs said. “This is not a staffing problem. The staff are stressed, don’t get me wrong. But we have every area open.”
Nebraskans having heart attacks, strokes or other life-and-death emergencies still get immediately into Bryan, Isaacs noted.
But many patients fall into a gray area. They have internal bleeding. Or, like William Kieler, they are having serious trouble breathing. Those patients go onto The List.
It is one thing to hear that hospitals are full because of COVID-19. It’s quite another to know that your loved one is bearing the brunt of that “No Vacancy” sign.
Kim Kieler, William’s daughter, stayed close to him at the Nemaha County Hospital as he waited for a transfer on Dec. 7, Dec. 8, then Dec. 9. To her, he’s more than a number on a list.
He’s the man who worked a month on and a month off during her childhood. He steered ships down the Missouri River, the Ohio and the Mississippi, then returned to the house in Peru where he and wife, Beverly, raised four children.
William Kieler still lives in that house. He stayed even after his wife of 59 years died in 2017. He’s long been a healthy horse of a man who, despite two knee replacements, would still captain the occasional tugboat past age 80.
To Kim Kieler, he’s Dad.
She tried to stay patient with the Nemaha County staff, knowing they were trying to get him transferred. She tried to stay patient with the phone calls – she knew Bryan wanted to help her father, too. But she felt fear in her temples, her muscles, her bones.
“He needed to be in a place that could do more for him,” Kim Kieler said. “Is he gonna get there? Is he gonna get the help he needs? Is this delay gonna…is it going to make things worse?”
Finally, on Dec. 10, a Bryan employee called Nemaha County back. We have a bed, they said.
Then, another delay: The ambulance meant to speed Kieler to Lincoln was occupied by another, severely ill patient. Finally, around midnight, Kieler was rushed to Lincoln and admitted to Bryan with acute respiratory failure.
He had waited roughly 80 hours for a spot.
He stayed for nearly a week. He was released – probably too early, Kim Kieler said. He ended up being life-flighted back to Bryan last weekend after the carbon dioxide in his blood spiked. He’s now recovering at the hospital, as others wait their turn on The List.
“Some people simply don’t realize what this is until you’re in this position and you see how hard it is to get a family member into a hospital,” Kim Kieler said. “To get the care they need.”
Isaacs realizes the position that Nebraska is in. Bryan’s nursing director has had to tell anguished co-workers that their loved one can’t be admitted – they must go on The List like everyone else.
When she sees friends, she tells them to drive safe, because there’s no room for them at Bryan. “It’s a joke, haha, but it’s really not,” she said.
Bryan leaders have been sounding the alarm for months. They did so again at the December briefing.
“The middling vaccination rates in Nebraska are crippling the health care system,” Ravenscroft said. “The unvaccinated population, as we can see from the statistics, is continuing to occupy beds at an unsustainable rate.”
The List isn’t going anywhere. Hospital leaders are bracing for it to lengthen, thanks to a resurgent flu season and a potential COVID-19 surge tied to the Omicron variant.
The List was 10 names long when Isaacs began answering questions during a Monday morning phone interview. An hour later, it had jumped to 13.
“It will grow this afternoon,” she said before hanging up.