Richard Danca was pulling on his shoes at 5 a.m., getting ready to leave for the hospital and his long-awaited spinal surgery in November when he got the phone call: His surgery was being postponed amid the crush of COVID-19 and other critically ill patients at Boston-area hospitals.
Two months later, there’s still no word on when his surgery at Beth Israel Deaconess Medical Center can be rescheduled. Meanwhile, the narrowing in his spine is so intense, his left leg feels like a lump of wood and it’s getting increasingly tough for the 75-year-old Brookline resident to get around.
“I live a half-mile from Coolidge Corner and I used to be able to walk there and back,” Danca said. “Now I can barely walk to the corner.”
Even as the number of new cases in the latest COVID-19 surge eases in Massachusetts, much of the health care system remains overwhelmed, and many anxious patients, some coping with chronic pain and worsening conditions, are facing substantial delays in surgeries and other medical procedures.
At the end of December, nearly a month after Omicron was first detected in Massachusetts, state data show roughly 90 percent of hospital beds here filled with patients, including many not being treated for COVID. The numbers have just kept climbing and as of Monday, 92 percent were full.
Mass General Brigham, the state’s largest health care system, last month slashed thousands of surgeries as it strained to stay ahead of the tsunami of patients pouring in. Other hospitals took similar actions, and administrators say they hope soon to start rescheduling the considerable backlog, which has been mounting since the state ordered overflowing hospitals in November to start reducing non-urgent procedures and in late December ordered a halt to all such procedures requiring a patient to be admitted. A review of that action was promised by the state no later than Jan. 31 — Monday.
A spokeswoman, however, said Monday she had no updates to report.
At the time of those orders, hospitals were already contending with a flood of patients who were acutely ill after delaying care earlier in the pandemic, prompting more intensive and time-consuming treatment.
Now the pent-up anxiety is palpable as legions of patients call and e-mail their health care providers trying to get their surgeries, scans, and other procedures back on track, from those coping with aching pain from worn-out joints, to cancer patients nervously waiting longer than usual for screenings and test results to learn whether their tumors have returned.
“It’s heartbreaking. I know that patients are suffering with symptoms and uncertainty,” said Dr. Saul Weingart, former chief medical officer at Tufts Medical Center and now president of Rhode Island Hospital. Rhode Island’s health care system is contending with challenges similar to those here. Its largest hospital has been so strained and backlogged that Rhode Island became one of six states to which the White House earlier this month deployed military medical personnel to help alleviate the crunch.
Weingart and experts in Massachusetts predict the current surge in hospitalizations will ease enough by the second week of February that hospitals can gradually start rescheduling delayed surgeries and other procedures.
In the early days of the pandemic, all but the most critical care in Massachusetts and Rhode Island was halted for a longer period. After hospitals eased those restrictions, patients, fearful of getting infected with COVID, stayed away from doctors’ offices in droves even as their conditions worsened. That fueled the backlog of acutely ill patients awaiting surgeries and treatments that hospitals were still digging out from under when Omicron hit in November.
“In March, I suspect we will go back to the “old normal” that we had in November, which was not a pretty place, but it was tolerable,” Weingart said.
While hospitals are planning to reschedule surgeries more quickly than after the shutdown early in the pandemic, they are contending with an unprecedented shortage of staff, from COVID infections, burnout, and resignations. Because of that, patients like Danca who are waiting for more complicated surgeries may be waiting longer than others, because such surgeries require several days of hospitalization, Weingart said.
For those kinds of procedures, “we will need to be more fully staffed for inpatient beds,” he said. “There aren’t enough contract nurses around to help manage the supply.”
Alisa, a 49-year-old Hyde Park resident, remains in limbo, too. Alisa, who didn’t want her full name used to protect her privacy, has been waiting weeks for doctors to schedule surgery for fibroids that have swollen her uterus to twice its normal size.
“If I bend down or raise my knees, I can feel them,” she said.
The fibroids have also caused continuous bleeding, almost as if she has had one nonstop menstrual cycle. Now, Alisa said, doctors are trying different types of medication to stop the bleeding as she awaits word on a surgery date.
“I would just love for it to be over, and resume a normal life,” she said.
The significant backlogs and their toll on patients extend to every corner of the health care system, from swamped hospital emergency departments to primary care doctors’ offices.
In Brighton, 29-year-old Michelle Furlong said she is leery of hospitals after a harrowing series of trips to the emergency room. Her ordeal started last month when nearby urgent care centers were too backed up for her to get in. Struggling to breathe, she headed instead to the emergency department at St. Elizabeth’s Medical Center. Documents indicate she was sent home from the ER with a diagnosis of COVID pneumonia and a prescription for dexamethasone, a powerful steroid that federal guidelines recommend against using on COVID patients without close monitoring because of a lack of safety and efficacy data for outpatient use. (A hospital spokeswoman declined comment on Furlong’s care, citing patient confidentiality.)
Furlong said she went downhill the next night, struggling to breathe as her partner pounded on her chest and dialed 9-1-1.
“That was terrifying,” she said. “My lung [felt like it was] spasming. I didn’t know what was happening.”
After two more hours-long ER trips, in which, she said, staff seemed overwhelmed at the relentless flood of patients, she said her parents drove down from New Hampshire and brought her back north for medical care. Furlong is now recovering at home.
“These are trying times and sometimes you are doing the best you can with what you’ve got,” said Dr. Kathleen Kerrigan, president of the Massachusetts College of Emergency Physicians.
Kerrigan, who had been working as an emergency room doctor at Baystate Health in Springfield, recently encountered two men, one in his 20s, the other in his 40s, who came to the emergency department with abdominal pain they had pushed off for a while. Both were then diagnosed with gastrointestinal cancer.
“Hospitals are still full and still in for a world of hurt, even though COVID case numbers are going down,” she said.
Dr. Alain Chaoui, head of Congenial Healthcare, a North Shore family medicine practice with 25,000 patients across five locations, said they are still encountering patients who are putting off breast and colon cancer screenings, and ignoring chest pains because they are afraid they will catch COVID in medical settings.
“People are calculating it in their heads, thinking if I go now [to the hospital] maybe I will get something worse than I already have,” Chaoui said.
At the same time, he said, his practice is beefing up its telemedicine capacity to help as many patients as possible who may be facing delayed care.
“I am encouraging patients to communicate with their doctors to help them make their decisions,” Chaoui said. “Your doctor may be able to help you navigate a system that is completely clogged up right now.”
Alisa, the Hyde Park woman awaiting fibroid surgery, could use help like that right now. She is still hoping doctors can perform minimally invasive laparoscopic surgery, using small tubes and tiny incisions to remove her uterus, rather than slicing her open. But if her uterus grows another inch as she is waiting, she said, doctors have told her minimally invasive surgery may not be an option anymore.
“I am praying for the best,” she said.
Meanwhile, Danca is trying to stay upbeat, as he sends repeated messages to his doctors, seeking an update on his spine surgery even as he increasingly needs to rely on a walker.
“My left upper leg ... it feels like I am hauling it around with me,” he said. “But what can you do? At least I am on this side of the dirt.”