Lauren Broussard walked into the only empty room in Ochsner Lafayette General Medical Center’s intensive care unit Wednesday afternoon.

“OK, so when’s the next COVID one coming?” Broussard asked. She paused, a thoughtful expression visible on her masked face. “That might have been my first COVID patient that — I’ve never had one get downgraded.”

Broussard’s patient, who’d just been wheeled off to a regular room, was admitted to the hospital for a reason unrelated to COVID-19 but tested positive for the virus upon arrival. Even though the circumstances were different than usual, this was a small victory for Broussard, who said she can’t remember another one of her recent coronavirus patients leaving the ICU alive.

“I didn’t really have time to even process it. I’ll think about it later,” Broussard said. “I’m just trying to get the room ready for the next one.”

ACA.olged.021.adv

An empty ICU room is prepped for the next occupant at Ochsner Lafayette General Medical Center Wednesday, August 11, 2021, in Lafayette, La. The visible duct is connected to a machine that sucks contaminated air out of the room.

A lullaby played a few minutes later over the hospital’s intercom, indicating someone on another floor had just delivered a baby. The same sound echoed in the halls four times over a four-hour period Wednesday — an audible reminder that coronavirus patients weren’t the only ones demanding care at the region’s largest hospital.

Ochsner Lafayette General administrators allowed an Acadiana Advocate reporter and a photographer inside the main hospital Wednesday, Aug. 11, to document what health care workers are facing during the fourth and worst wave of the pandemic.

ACA.olged.018.adv

Medical staff move an upgraded patient from the ICU to another room at Ochsner Lafayette General Medical Center Wednesday, August 11, 2021, in Lafayette, La.

When journalists arrived at Ochsner Lafayette General’s flagship hospital at 10 a.m. Wednesday, there were 75 coronavirus patients on the campus. The hospital was treating 77 patients by the time the journalists left at 2 p.m. Wednesday. By Thursday morning, the hospital’s COVID-19 census had reached 86.

“Everything is moving faster,” Broussard said. “Patients are coding and dying faster. What we’re doing now just isn’t working.”

The hospital is one of hundreds across Louisiana overwhelmed with COVID-19 patients, the vast majority of whom are unvaccinated, as the highly transmissible delta variant of the coronavirus spreads unabated throughout the state.

The Louisiana Department of Health has announced record-breaking hospitalizations nearly every day for the past two weeks.

The Acadiana region broke its own record for the seventh day in a row Thursday with 380 coronavirus hospitalizations. Prior to this month, the region’s record had been 304 hospitalizations on July 22, 2020.

Like a person who holds it together on the brink of a breakdown, a hospital can continue providing care when teetering on the edge of a crisis.

ACA.olged.054.adv

Respiratory Therapist Allison Lejeune looks into a COVID patient's room in the ICU at Ochsner Lafayette General Medical Center Wednesday, August 11, 2021, in Lafayette, La.

All 35 acute-care beds in the hospital’s emergency department were occupied Wednesday morning. Twenty-five of those patients were not actively being treated but instead were waiting for an available inpatient or ICU bed to open up. Six patients in the emergency department were being treated in reclining chairs behind curtained walls.

About a dozen people sat in the emergency waiting room. Others left phone numbers and waited in their vehicles until care was available to prevent overcrowding.

“This wave is definitely hitting the predominantly younger, non-vaccinated population,” said Dr. Foster Kordisch, medical director of the hospital’s emergency department. “Our average age for admissions of COVID patients has gone from the 70s and 80s to the average age of 53. It’s not uncommon for us to have 20-year-olds, 30-year-olds admitted with COVID which, in the first wave or two, that was almost unheard of unless there were significant, significant health issues.”

ACA.olged.028.adv

Candice Guidry-Card, RN, takes a phone call in the ER nurse's station at Ochsner Lafayette General Medical Center Wednesday, August 11, 2021, in Lafayette, La.

Because of that, it’s been difficult for emergency department staff to determine who to prioritize for immediate care during this wave of the pandemic.

“What’s been our biggest transition this go-round is that young ones that we used to be able to keep in the lobby and keep an eye on are now showing up with critical labs and we’re bedding them immediately,” said Candice Guidry-Card, a registered nurse in the emergency department.

ACA.olged.048.adv

Resident Physicians Jacob Clement and Victoria Bolgiano treat a COVID patient in the ICU at Ochsner Lafayette General Medical Center Wednesday, August 11, 2021, in Lafayette, La.

Kadie Castro, a nurse who manages the emergency department, said her team is not only having to provide emergency care for patients but is also having to provide critical and longer-term care to patients who are waiting for rooms to open up in other parts of the hospital.

There is typically one nurse for every three patients in the emergency room, but that ratio is closer to one nurse for every four patients these days. In the ICU, there is typically one nurse for every two patients — so those waiting for an ICU bed in the emergency department are receiving less specialized care.

“We’re trained as emergency room nurses, not as floor nurses,” Castro said. “So we’ve gone from dealing with patients for 30 minutes and moving them through to holding ICU patients for a day or maybe two.”

Coronavirus patients who require ventilation or breathing treatments that aerosolize the virus are housed in negative-pressure rooms.

More rooms were actively being constructed in the hospital as the volume of critically ill COVID-19 patients continued to climb last week.

“What we’re having to do is create spaces that don’t exist to handle the treatments that these patients need as their condition worsens from the impact of COVID,” said Jonathan Koob, a registered nurse and the hospital’s director of critical care. “We’re having to board those patients in the emergency room in negative-pressure spaces that we’ve created while we create inpatient spaces while we create ICU spaces to be able to move people through that continuum of care.”

ACA.olged.043.adv

Jonathan Koob, RN, director of critical care (ICU) at Ochsner Lafayette General Medical Center, talks about the hospital's fight against COVID Wednesday, August 11, 2021, in Lafayette, La.

Still, space hasn’t been as big of an issue as staffing.

The hospital was in the fifth stage of its pandemic surge plan last week without the ability to expand crisis care because of a shortage of nurses.

“Right now, we cannot move forward to the next phase of the plan because of staffing,” said Patricia Thompson, the hospital’s director of communications. “We have the infrastructure for it. We have created more negative-pressure rooms for full COVID units, but we don’t have the people to staff the beds.”

ACA.olged.068.adv

Medical staff work in the ICU at Ochsner Lafayette General Medical Center, August 11.

Top stories in Acadiana in your inbox

Twice daily we'll send you the day's biggest headlines. Sign up today.

On Wednesday, 119 people across Ochsner Lafayette General system’s 4,700 employees were out with the coronavirus. About 75% of those were employees who care for patients at hospital beds.

The Ochsner Lafayette General system includes the main campus on Coolidge Boulevard, University Hospital on Congress Street, an orthopedic hospital on Ambassador Caffery Parkway and a surgical hospital on Pinhook Road along with Abrom Kaplan Memorial Hospital, Acadia General Hospital and St. Martin Hospital in neighboring parishes.

Most of the sick employees are nurses at the flagship hospital, according to Ochsner Lafayette General Medical Center’s CEO.

“Today, we have six beds that we cannot put patients in because of staffing shortages,” Al Patin said. “And over the last three weeks, at any point in time, zero to 20 beds have been closed due to staffing.”

ACA.olged.019.adv

The entrance to one of the intensive care units at Ochsner Lafayette General Medical Center is pictured Wednesday, August 11, 2021, in Lafayette, La.

Help is on the way.

The federal government is sending a team of about 20 medical professionals to the hospital to assist with the recent surge in COVID-19 patients. The nurses, doctors and respiratory therapists are expected to arrive mid-week and stay for three weeks. The team will be able to staff a COVID unit of 16 to 18 beds, which would allow the hospital to operate at its maximum capacity.

The help won’t last forever. Hospitals in other states with low vaccination rates are also reaching their limits.

“On any given day in the past three weeks, we’re getting over 50 calls to transfer patients from outside of our region,” Patin said. “We’re getting it from Oklahoma, Texas, Mississippi, Arkansas, Alabama. Those are transfers that we immediately deny. There’s no beds.”

Even patients within Ochsner Lafayette General’s system of hospitals are waiting to transfer into ICU beds at the main campus.

That means rural emergency rooms grow even more overwhelmed with patients. Meanwhile, medics who bring in patients by ambulance have to wait for beds to open up at hospitals, and those who call 911 have to wait longer for an ambulance to arrive.

ACA.covidpresser.001.081221

Medics wait with patients on stretchers, who arrived by ambulance, in the intake area of Ochsner Lafayette General Medical Center's emergency department Wednesday, August 11, 2021, in Lafayette, La.

Others are waiting for vital surgeries that have been postponed in recent weeks to free up beds and reallocate staff for the growing number of coronavirus patients at Ochsner Lafayette General Medical Center. More than 100 non-emergency surgeries — including those for cancer, aneurysms and heart disease — have been canceled per week since July under the existing surge plan.

Some doctors’ offices in the Ochsner Lafayette General system switched to online visits to protect the health of staff last week, and more are expected to do so in the coming days and weeks. Some of those doctors and nurses may be asked to assist in the hospital.

It’s the final step in the hospital’s existing surge plan.

“After that, it’s uncharted territory,” said Dr. Amanda Logue, chief medical officer, during a Friday press conference. “We are thinking through all the levers we could pull but we’re getting close to being there already.”

ACA.olged.013.adv

Resident Physicians Jacob Clement and Victoria Bolgiano treat a COVID patient in the ICU at Ochsner Lafayette General Medical Center Wednesday, August 11, 2021, in Lafayette, La.

Broussard, the critical care nurse, said she’s seeing more people die per day from coronavirus complications in the ICU during this surge than she’s seen during any previous surge.

“They’re getting admitted quicker and sent to the morgue faster,” Broussard said.

“In ICU, you see death all the time, but you never feel this helpless. Death is natural but not at this high of a rate.”

ACA.olged.014.adv

Lauren Broussard, RN, looks into a COVID patient's room in the ICU at Ochsner Lafayette General Medical Center Wednesday, August 11, 2021, in Lafayette, La.

The nurse said she walks, reads devotionals and goes to church to care for her mental health. She tries not to think about work during her downtime, but the patients sometimes haunt her dreams.

"You clock out and you sit in your car and you just cry," Broussard said through tears. "You go through nursing school, and you learn what to do with these kinds of patients in general. But with COVID, we don't know fully everything yet, so it's just a giant educated guessing game. You're throwing all your resources into it, using everything you've learned about similar respiratory illnesses, but it's just not working."

Critical care nurses aren’t just dealing with the physical, mental and emotional exhaustion that comes with caring for patients who are younger and sicker during this wave of the pandemic.

They’re also experiencing far less support from the community than they once did.

ACA.olged.042.adv

ICU Tech Julia Gaudin puts on PPE before going into a COVID patient's room at Ochsner Lafayette General Medical Center Wednesday, August 11, 2021, in Lafayette, La.

In the spring of 2020, people donated catered meals to hospital workers and showed appreciation by displaying “healthcare hero” signs. They made masks to ensure frontline workers had enough protection at a time when supplies were limited. They largely listened to their recommendations to protect their health and those around them.

Now, when the situation is far more dire, many people are willfully ignoring the cries for help coming from public health officials and hospital leaders alike.

“There was a camaraderie then that’s been lost,” Broussard said. “But I’d much rather you get vaccinated than bring us a pizza.”

The nurse said her own parents didn’t get vaccinated against COVID-19 until their friends were hospitalized with the virus last month.

ACA.olged.066.adv

Lauren Broussard, RN, puts on PPE before entering a COVID patient's room in the ICU at Ochsner Lafayette General Medical Center Wednesday, August 11, 2021, in Lafayette, La.

Broussard said she no longer spends time trying to convince people to take precautions or get vaccinated. She’s become “angry and numb,” deciding that most people won’t believe the reality she experiences on a daily basis until it hits close to home.

“They’re going to start losing their parents, their siblings, their best friends,” Broussard said. “It’s going to take a lot of people losing someone close to them to get the shot. It’s so sad that people literally have to drop dead for somebody else to get the vaccine.”

COVID-19 tests and vaccinations remain free to anyone, with or without medical insurance. Find testing sites and vaccination clinics near you by visiting ldh.la.gov.


Email Megan Wyatt at mwyatt@theadvocate.com.