They sat in their cars outside Stephens Memorial Hospital in Norway on Thursday afternoon, their engines idling to keep warm. At this very early stage of their encounter with the health care system, each was officially classified as a PUI – short for “person under investigation” for possible COVID-19.

“I think there’s four in their vehicles currently right now waiting to come into the emergency department,” Kevin Hodson, a nurse, said during a brief break inside the hospital’s nine-bed emergency unit.

And they were out in the parking lot because there was no safe place for them inside?

“Correct,” Hodson replied. “I don’t have any rooms appropriate for them” to await their diagnosis.

Down the hall in the 25-bed hospital, respiratory therapist Ashley Cude took a moment to reflect on her herculean responsibility in recent days – getting as much oxygen as possible into patients whose lungs have been ravaged by the virus now sweeping across rural Maine.

“I’ve had four different patients ask me today, ‘When can I go home?’” she said. “And I don’t know…but it’s a long road.”

A road that might end right here in a hospital bed?

“That’s exactly it,” Cude replied. “But how do you say that to someone?”

Kevin Hodson is an RN in the Emergency Department at Stephens Memorial Hospital in Norway. Gregory Rec/Staff Photographer

For many Mainers, last week’s announcement that the sprawling MaineHealth network was at its outer limit for coping with the pandemic was but another superlative at a time when the word “highest” seems to precede every grim update:

Highest ever number of cases reported in a day – 2,148 on Friday, obliterating Thursday’s record of 1,460. Highest ever seven-day case average – 982 as of Saturday. Highest need for reinforcements since the pandemic began almost two years ago – enter the Maine National Guard and a federal “surge team” of clinicians to help handle the ever-escalating load.

“We’re running out of straws. There are not a lot of great options left,” Dr. Andrew Meuller, CEO of MaineHealth, said during a Zoom press conference Wednesday, surrounded by a gallery of somber-faced executives and medical professionals from across the state’s largest health network.

Among them was Dr. Ryan Knapp, chief medical officer at Stephens Memorial. Two beds had just opened up at his small facility, he reported. The reason? Two more patients had died.

Knapp was speaking from his home, where he remained isolated last week after his 4-year-old daughter, too young to be vaccinated, contracted COVID-19. She’s doing well, he later said in a remote interview, but the implication was clear: As COVID-19’s delta variant surges in this region with low vaccination rates, safety has become an elusive luxury. And nowhere is that more evident than at the community hospital whose medical staff Knapp oversees.

“They’re struggling,” he said of the small cadre of doctors, nurses, physicians assistants and medical support staff now in the fight of their professional lives. “It’s an emotional toll to take care of such a level of illness day in and day out – something that they’re not used to doing.”

What’s happening at Stephens Memorial, one of a dozen community hospitals in the MaineHealth system, reflects the pandemic’s stealth-like assault on the population’s most vulnerable. Back when COVID-19 first hit in early 2020, the small facilities planned and prepared like everywhere else for what they thought would be a sudden onslaught of seriously ill patients.

But that wave never came. While more populated areas reeled from COVID-19 spikes early on, things stayed eerily quiet at Stephens Memorial, almost as if the storm had passed them over.

Not now. The ever-opportunistic virus goes where the vaccines aren’t – and with Oxford County among the four counites in Maine with full vaccination rates still below 60 percent as of Friday, COVID-19 has swept in with a vengeance.

One wing of Stephens Memorial is now sealed off for COVID-19 cases, which these days comprise roughly half of the hospital’s average daily census of 22 inpatients. Makeshift fans and ducts maintain negative air pressure in that unit, keeping airborne pathogens from spreading to other wards.

But in a facility this small, there is no escaping the pandemic and its myriad challenges. Out in the parking lot, in addition to those waiting to get into the emergency room, local residents line up at a drive-thru testing site. As many as 100 tests per day are being administered, with positivity rates exceeding 20 percent on three separate days last week.

Non-COVID-19 patients who stayed away from needed treatments early in the pandemic have returned in droves – and they’re sicker now for having stayed away.

Andrea Patstone is the president of Stephens Memorial Hospital in Norway, photographed outside the hospital on Thursday. Gregory Rec/Staff Photographer

Hospital staff members, under a “surge staffing” plan now in effect through the end of March, are being asked to work more shifts to help handle the heavier load. And even as they do, they worry that they’ll bring the virus home to loved ones.

Liz Michaud, a nurse in the hospital’s four-bed special care unit, gave birth to a girl in August.

“It’s not like when you go home, it’s gone,” Michaud said while waiting for a new arrival to fill an SCU bed that had just opened up. “You still have your family and friends talking about COVID, asking you how it is in the hospital. You’re just kind of like always immersed in it…you just get tired.”

Comments like that weigh heavily on Andrea Patstone, president of Western Maine Health, which includes Stephens Memorial. She took over as the hospital’s chief administrator in January 2020 – just weeks before the pandemic hit – and now faces a crisis unlike any she’s ever encountered in her career.

“I went to policy school – they don’t teach this in policy school,” Patstone said. “When you see your care team members who are stalwart, compassionate, never flagging and they break down for a moment in frustration or in exhaustion, that’s when I feel like I’m not doing my job. And I’m here to take care of them.”

It’s a tall order, given what’s happening only footsteps form her office. Wondered Patstone aloud, “Can you imagine trying to calm someone down who can’t breathe?”

RT Ashley Cude, left, and RN Liz Michaud work in the Special Care Unit at Stephens Memorial Hospital in Norway and care for patients with serious COVID-19 health complications. Gregory Rec/Staff Photographer

Hospitals, of course, are never easy places to work. But it’s the current degree of difficulty that has Stephens Memorial, like so many rural health outposts, so out of its element. Patients die from time to time, but never so many that, when asked about the pandemic’s local toll during last week’s visit, no one could come up with an actual count.

“We have had members of the same family in different beds on the opposite side of walls, both of them nearing the end of life – all of it preventable,” Patstone said. “And we spend our time trying to figure out if we can get them in the same room together for a few moments before it’s all over.”

She paused for a moment, then added, “And none of that has to happen.”

That realization, like the virus itself, is inescapable throughout this 64-year-old hospital that was never intended to hold back this massive a public health calamity. If only more people in these parts would get vaccinated. If only they’d wear masks. If only they’d keep more social distance. If only…

Knapp, the chief medical officer, knows better than most how unrelenting COVID-19’s grip is on unvaccinated Maine as yet another Christmas season approaches – right on the heels of the now-unfolding Thanksgiving surge. Each day, he participates in the “capacity call” with his peers throughout the MaineHealth system to determine who needs a bed, who has a bed, who might have a bed, who’s exceeding their capacity under a federal pandemic waiver. Some days, Stephens Memorial’s daily census has climbed as high as 30.

At the same time, Knapp spends countless hours on the phone with higher-level-care medical centers in Portland, Bangor, Boston – searching, too often futilely, for someplace that can take a patient whose needs exceed Stephens Memorial’s capabilities. The brutal alternative, which has happened, is to lose a patient who’s intubated in his emergency department, waiting for a transfer that never materialized.

“It’s sad, honestly. It’s sad to take care of folks who are very sick from this disease and they could have avoided it,” he said. “And I can’t tell you how many times – and my colleagues all have similar stories – where we’ve taken care of someone with COVID and they’ve said, ‘Man, I should have gotten the vaccine. This is so bad. I’m so scared. I can’t believe I didn’t do this earlier.’”

Dr. James Gallea, director of the Emergency Department at Stephens Memorial Hospital in Norway, speaks with a patient in the hall of the ED on Thursday. Gregory Rec/Staff Photographer

Some in these divided times see that as just desserts. You pooh-pooh vaccines, the reasoning goes, and you pay the price. But for Hodson, the emergency department nurse with four people waiting outside, that’s not an option.

“I’m going to be completely honest. I’m very non-judgmental,” he said. “The best way I can explain it is my role is to provide care once patients arrive here. What brought them here is predominantly out of my control, and so I just start treating and assisting as soon as they arrive.”

And if someone asks him about the vaccine or other prevention measures?

“Then I have all sorts of talk,” Hodson said with a smile. “The numbers don’t lie. Those that are vaccinated are at a much less risk of becoming hospitalized or seriously ill.”

As happens with so many crises of this magnitude, calling these people heroes no longer comes close to capturing what they’re going through. Just as calling the unvaccinated ignorant or uncaring extinguishes, in Hodson’s view “any hope of changing their outlook.”

So perhaps the best thing to remember during these dark days of December is that, even as more and more Mainers get sick and die, a small hospital at the center of the storm is doing everything humanly possible to save them.

“Yeah, there are days where you leave and you’re just completely drained – anybody who says they’re not is lying,” Hodson said. “There are multiple days – it’s not just days, there are multiple days – where you go home and you’ve got no words. You just take your shower, sit down and start over.”

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