WORCESTER — In the bay outside the crowded emergency department of UMass Memorial Medical Center, the ambulances keep coming.
Just inside the doors, a pair of paramedics wait with their patient, an elderly woman on a stretcher.
Eventually, they take the patient to a room where a nurse checks on her. But many others are not so lucky. Sick and distressed, they lie in beds in the hallways, bright lights overhead, alarms beeping, doctors and nurses rushing past. There are more patients here than beds or medical staff to care for them.
Here and across the state, hospitals are busier than at any time during the pandemic. In the emergency department at Massachusetts General Hospital, every bed and hallway are often full and dozens of patients wait to be admitted — a situation known as “capacity disaster.” Hospitals in the Beth Israel Lahey Health system are postponing some scheduled surgeries to open beds for patients with more urgent needs. In many hospitals, patients are staying longer because they are sicker.
Little of this surge is driven by COVID infections, even as cases rise across the state. Instead, patients are flooding hospitals with every kind of problem — heart attacks, strokes, drug overdoses, suicidal thoughts, broken bones, infections, and COVID. Many had put off medical care during the pandemic and came to the hospital only when they could no longer bear to stay home.
As much as hospital leaders had strategized and prepared for the pandemic, they didn’t foresee this.
“We didn’t quite appreciate how much the delays of care would impact the acuity of illness for patients now,” said Dr. Ravin Davidoff, chief medical officer at Boston Medical Center. “We probably underestimated the magnitude of that impact and the volume that we’re seeing now.”
The soaring need is putting unprecedented stress on hospitals and health care workers who have been contending with the pandemic for 20 months and are already suffering from staffing shortages.
“Virtually every stage of patient care delivery is stressed or near collapse,” said Dr. Richard Nesto, chief medical officer at Beth Israel Lahey Health.
A combination of factors is fueling the crisis. Many patients had to skip routine medical appointments during the pandemic, and their chronic illnesses, such as heart conditions and diabetes, have worsened. Some were scheduled to have surgery in 2020 but were forced to wait in pain because hospitals canceled their procedures to free up beds for the surge of COVID patients. Some have avoided going to the hospital even with a heart problem, because they’ve been afraid of exposure to COVID.
Mary Nzuki of Worcester was scheduled to have spine surgery at Brigham and Women’s Hospital in April 2020. But her procedure, along with many others, was canceled as hospitals focused on the still-new coronavirus. Bad memories from a previous bout with a life-threatening respiratory infection at first kept Nzuki from rescheduling.
Eventually, the pain in her back became so bad that she could barely get out of bed. She called the Brigham and finally had surgery in August — a year and a half after she had initially planned it.
“I was actually well on my way to paralysis if I didn’t get the surgery at that point,” she said.
The long delay hampered her return to good health, she said. She has resumed activities such as cooking, but has to sit to chop vegetables and needs help lifting heavy pots off the stove. Walking can be difficult.
“I’m still limited,” said Nzuki, 55. “It’s a long process.”
Hospitals are also seeing record numbers of adults and children suffering from mental health conditions — a crisis that worsened during the pandemic — and hundreds are waiting in emergency departments for psychiatric treatment beds.
The rise in very sick patients is putting as much or more stress on hospitals than the COVID surges, said Nesto, of Beth Israel Lahey. “What we’re going through now is something that’s not going to go away,” he said.
Dr. David F.M. Brown, president of Massachusetts General Hospital, sees two concerning trends among patients now coming to MGH.
One is that some patients who suffered serious health problems, such as heart attacks, initially avoided seeking care because of fears about COVID. These patients survived, but they’re living with weaker hearts. So if they face another illness now —for example, pneumonia —their treatment may be more intense and recovery more complicated.
Also, because many patients delayed seeing doctors until only recently, they are being diagnosed with illnesses such as cancer that are at more advanced stages, or their chronic conditions have become worse.
“These things were all put off for months and months, and some of them we’re still catching up on,” Brown said. “As a result, the burden of disease on the population is a little higher. The patients are just sicker than they were two years ago, pre-pandemic.”
During the initial wave of the pandemic in the spring of 2020, hundreds of COVID patients filled MGH’s beds. Now, the number is just a fraction of that. But, Brown noted, “It’s not a small number when that means an entire floor of the hospital is dedicated to taking care of a disease that two years ago nobody knew existed.”
Because patients are coming to the hospital sicker, they often stay longer. The average length of stay for MGH patients has increased over the past two years from about seven days to about eight days. This is creating bottlenecks; when one patient stays an extra day, other patients must wait longer for beds.
Dr. Ali S. Raja, interim chair of the emergency department, said patients sometimes wait two or three days in the ER for an inpatient bed. Many spend hours in hallways. There are few opportunities to transfer patients to other hospitals because they, too, are full — or close to it.
“We just don’t have any other place to put them right now,” he said.
Dr. David C. Ayers, orthopedist-in-chief at UMass Memorial, said several patients have delayed joint replacement surgeries, reluctant to come to the hospital because of worries about the Delta variant. Now when they do come in, they are in more severe pain and have limited mobility. In one day earlier this month, Ayers operated on two patients who originally planned their procedures for the spring of 2020.
“Some people are still quarantining,” Ayers said. “Many people say, ‘This is my first time out.’”
He warned that patients shouldn’t wait too long to have surgery. “If you’re in so much pain that you stop doing things, that can affect your recovery,” he said.
Doctors and hospital leaders don’t yet know when this rush of sick patients will begin to subside.
In the emergency department at UMass Memorial, even with help from temporary workers, the staff is struggling to keep up.
Nurse Nicole Kariko arrives at 7 a.m. for her 8-hour shift, but at least once a week she stays an extra four hours because her colleagues need the help. She eats her lunch quickly while working at her computer, before going back to her patients.
“There’s really no breaks here,” she said. “You’re on your feet for the entire shift.”