JAMESTOWN, N.D. — "Coughing and beeping and nothing else."
Those are the sounds Katie Ryan-Anderson remembers hearing as she walked through the dark inpatient wing of Jamestown Regional Medical Center on a particularly haunting November morning. Behind closed doors, patients sick with COVID-19 lay in their rooms alone — isolated from those still uninfected.
“It’s a small town, so there’s a good chance the people in there are people you know," said Ryan-Anderson, the hospital's marketing manager. "It was just a sad time."
A month later, the same corridor has got its pre-pandemic rhythm back. Sunlight shines through open doorways as a TV playing an old sitcom hums from a patient's room.
The hospital in the city of 15,000 has 25 beds and not one of them was occupied by a COVID-19 patient on Wednesday, Dec. 23. It's a remarkable turn of events for a facility that cared for 10 patients with the virus as recently as Nov. 13.
North Dakota has seen a favorable month and a half since a worst-in-the-nation outbreak of the virus decimated communities across the state. Active cases and virus-related hospitalizations have fallen sharply, and the arrival of a first wave of COVID-19 vaccines means health care workers and nursing home residents may soon have immunity to the deadly disease.
November's pandemic peak left doctors and nurses at rural hospitals with mental scars and a feeling of exhaustion, but a new sense of hope has brought morale up just in time for the holidays.
“Once we heard about the vaccine coming, I think everybody’s attitude kind of brightened a little bit," said Muffy Weisz, who works at the front desk in admissions for the Jamestown hospital.
Weisz was so elated to be the first staff member to get the vaccine on Wednesday that she did a little dance and shared a few hugs with co-workers.
"It was just a happy day," she said.
Heartbreak and fatigue
Nowhere in North Dakota was hit harder by the fall surge in COVID-19 cases than Dickey County. At 32 virus-related deaths, the county in the southeastern part of the state suffered more casualties per capita than anywhere else.
The persistent staff at CHI Oakes Hospital, the county's only medical center, worked tirelessly to save as many lives as possible, said director of nursing Kayla Kale. With the virus so pervasive in the community in late October and early November, some nurses and doctors were sidelined by quarantine and isolation, leaving the staff shorthanded and overwhelmed with high case loads.
“It was very hard seeing people struggle to breathe," Kale said. "It was hard knowing there weren’t beds available and trying to do the best we could. It was heartbreaking, and you didn’t think it was going to happen in our little town."
Long shifts in full protective gear left Kale and her colleagues "drained," and for some, the job came with the added emotional tax of watching friends and family fight for their lives against the virus, she said.
“Some of our nurses have known these patients since they were little and just seeing the defeat and not knowing the outcome — Are they going to live? Are they going to pass away? — it was very tough,” Kale said. "I know a lot of our nurses would constantly check the obituaries, and you know, we're just sad at all of those who passed away."
In Jamestown, which had a severe outbreak of its own in early November, supervising nurse Jess Skjeret said the workload was a heavy lift. During the worst of the surge, nurses were taking up to seven patients each — more than double the normal amount.
And even while the Jamestown hospital managed to avoid COVID-19 infections among staff, all nurses were required to pick up an extra shift and some volunteered to come into the virus unit on their days off.
More than anything, workers from all over the hospital recall the breakneck pace of work on those difficult days in November. Skjeret said she felt exhausted even before her shifts started knowing she would have to run much of the time. She said nurses joked about needing roller skates to get around faster.
Dr. Steve Inglish, who works in the emergency room, recalls Nov. 22 as the hardest day of his career in medicine. He said "it seemed like we were getting attacked from both sides" with COVID-19 patients walking in the door and arriving in ambulances as other noncoronavirus patients in critical condition demanded the staff's attention.
In the last month, the cadence of the hospitals in Oakes and Jamestown has returned to near normal as the flow of COVID-19 patients subsided.
Inglish said he got to start Wednesday with a cup of coffee instead of suiting up in protective gear and launching into a full day of nonstop care for sick and injured patients.
Still, Jamestown's health care workers aren't lowering their guard against the virus. They note that large family gatherings at Christmas and New Year's celebrations could undo much of the progress the state has made in slowing the spread.
"We’re probably thinking that we’ve passed the worst of it, but there’s always that (thought) in the back of our mind, ‘When’s the next (COVID-19 patient) coming? When’s the next surge coming?'" Skjeret said.
The path to immunity
For many in rural health care, receiving the COVID-19 vaccine relieves the stress of fearing the virus will put them in the hospital. For others, it's a moment of pure joy. For a few, it doesn't mean much until enough of the population has been vaccinated to establish herd immunity.
Weisz, the Jamestown front desk worker, said receiving her first of two shots gives her peace of mind. She said she has seen the unpredictability of COVID-19 firsthand, and she knows if she gets it, there's no guarantee she would survive.
Inglish points out that the vaccine is "not a cure-all, end-all" because it doesn't necessarily stop the spread of the virus. Rather, it prevents those with immunity from suffering an illness, which means they could still be unknowingly transmitting the virus.
The doctor said getting his first dose won't affect the precautions he takes, like mask-wearing and social distancing, adding that vaccinated members of the public should continue making efforts to keep the virus in check. Inglish said he's prepared to hunker down for another year as he waits for the country to reach herd immunity. Most health experts say 70-80% of the population must have antibodies for COVID-19 to reach the all-important threshold.
But in Oakes hospital, the shipment of vaccines couldn't have come soon enough. To Kale, the vaccine represents hope that the nightmarish pandemic could have an end in sight.
“I’ve never been excited for a shot, but yesterday was just amazing,” Kale said. "Everyone was just so overjoyed. There were lots of smiles and some happy tears."
Dr. Katie O'Brien, a physician at Oakes, said she was initially on the fence about getting the vaccine so soon, but after reading about the vaccination and seeing firsthand the death COVID-19 can cause, she said she was happy to be at the front of the line for the jab.
"It was a very wonderful Christmas present," O'Brien said.