The hour-long drive home typically provides time for Emily Feldhaus to decompress, but sometimes it is not enough.

By the time Feldhaus returns home, she has been gone 16 hours and she is mentally and physically spent, but the sights and sounds from her shift as an emergency room nurse at Mitchell’s Avera Queen of Peace Hospital keep the adrenaline running.

As the COVID-19 pandemic sweeps through South Dakota and as hospitals scramble to find the manpower to care for the influx in patients admitted, it has become nearly impossible to compartmentalize work life and home life.

The hospital has roughly 20 patients currently admitted with COVID-19, but Avera says the number fluctuates by the hour. On Friday, the South Dakota Department of Health said 574 people are currently hospitalized and 741 people have succumbed to the virus throughout the state.

“You’re more stressed out, you’re more impatient with your family at home because your job is constant giving and doing the best you can,” said Feldhaus, a house supervisor who has been with Avera for 12 years. “Sometimes you don’t have a lot left when you get home.”

Hospitals and medical personnel have been preparing for COVID-19 surges since March and 75 to 80 percent of the planning remains in place. But although South Dakota was not significantly impacted until the fall, days have become chaotic for nursing staff members.

The state has seen 518 of its 741 COVID deaths since Oct. 1, including 304 in November. The state has seen 2,415 of its 3,993 hospitalizations since Oct. 1, with 1,272 this month as South Dakota continues to duel with North Dakota for the worst state in the country in cases per capita. As of Friday, South Dakota ranked No. 2 with 7,883 cases per 100,000 people is No. 1 with 2.2 deaths per 100,000 people.

Avera has shifted personnel from hospital to hospital, while nurses are being cross-trained to work in the emergency room or the intensive care unit. Avera Queen of Peace has eight ICU beds and numbers consistently hover around that number , but there is room for overflow within the hospital. The hospital has also brought on 30 additional staff members – with plans for five more in the next week – to help in the ICU, acute care, medical surge and the emergency department.

“Patients can improve and get worse quickly,” said Rochelle Reider, AQOP Vice President of Patient Services. “Every hour things are changing, especially with COVID patients. They have an unpredictable course of care. It’s kind of two steps forward, one step back, one step forward, two steps back.”

For months, local nurses watched and read stories of dire situations in hospitals in more densely populated areas of the country, but now the pandemic has engulfed local and rural communities. They are no longer viewing safely from afar and no longer wonder what it is like to be in the middle of a battle that has no timeline.

“In February and March, everything was on the coasts, it’s numbers and it’s hard to put a face to a number,” said Feldhaus, a wife and mother of three. “At work now, you have faces to these numbers and children you’re trying to comfort. It’s not a number in the newspaper anymore.”

Life inside a COVID wing

An hour east in Sioux Falls, Sanford USD Medical Center is also experiencing similar surges. Despite a staff of 7,300, there are shortages in COVID-19 care, which has led to nurses in pediatric and neonatal ICUs being reallocated to help.

Simple tasks such as delivering water to a patient can take up to 15 minutes simply due to the demand on the pulmonary floor. Confused patients rip at oxygen cords and frequently do not recall simple instructions.

Lunch breaks are often missed and sitting to take a break is a rare occurrence as nurses must constantly rush to check on patients whose oxygen levels are so low that raising an arm or moving two steps from a bed to a chair leaves them gasping for air.

For many of the Sanford nurses, each shift includes a trip to the hospital morgue.

“You walk out of the COVID unit and then a call light comes on,” said Matt Peterson, Sanford pulmonary unit critical care leader. “You had just been in there for an hour with all your stuff on and you’re sweating. You haven’t sat and you had to go to the bathroom a half-hour ago. You look at the call light, it breaks your heart and you put your stuff back on and answer the call light. That’s every shift, every hour.”

Patients with COVID-19 are placed in rooms with doors and no windows, which does lend to the somber mood that often lingers on the floor. Many patients experiencing complications did not initially take the pandemic seriously.

Peterson has not experienced any outbursts from patients or demands for a magic cure. Many of his patients grow quiet, knowing they could have possibly prevented sitting in a room hoping their oxygen levels do not continue to drop.

“They just know that this isn’t the place to have that conversation,” Peterson said. “Some of them are struggling to stay alive and it’s a hard realization in that moment. We’re in the midst of it all and we’re watching the news and they’re talking about how bad it is, and this patient is in the room watching this as they watch their oxygen levels go down and they know that they’re in for the fight of their lives.”

Early in the pandemic, hospitals did not allow companions or visitors with COVID patients, but AQOP and Sanford are allowing one visitor for patients deemed to be on the verge of death. Nurses are now frequently playing the role of go-between for doctors and patient family members and it is a relief when some of the burden is lifted.

“Usually there’s a person at the bedside that can filter that information out, especially when you’re dealing with the elderly,” Feldhaus said. “There’s usually a husband, wife, next-of-kin — they may be ill themselves and they don’t ask as many questions as a daughter or son would. So, it can be hard to relay information. Doctors want to have one contact to communicate. If you’re not in this field or have a history in medicine, it can be challenging.”

No mental respite

The thoughts and experiences from a long shift do not disappear on the drive home. Thoughts of what transpired throughout the day, while conversations with patients, colleagues and doctors are replayed on repeat.

Emotions and thoughts often burst like a dam, as nurses put them aside in their minds to completely focus on the tasks required throughout their shifts.

“There are times when I get an admission in the morning and they have passed away in my 12-hour shift because the virus advanced that quickly,” Peterson said. “I go home with some thoughts in my head that I usually did not come with prior to COVID. … The ability to have someone that you trust to cope is something that every nurse needs right now. It’s very taxing on your mental health to know that you’re going to see it again, over and over again.”

It becomes further complicated when consumed with all of these thoughts while attempting to spend an already limited amount of time with family members. Feldhaus often finds herself reminding her children of COVID-19 precautionary protocols that have been reiterated constantly during the past eight months.

She fears bringing the virus home from work, although she knows it is more likely to be contracted at the grocery store or a sporting event due to the amount of personal protective equipment worn at the hospital.

Feldhaus is helping plan her daughter’s wedding without knowing if it will take place on time and she also missed watching her son be inducted into the United States Army National Guard because of her work schedule.

“I don’t wear a mask because I’m fearful to get (COVID-19), I wear a mask so I don’t give it to the person next to me,” Feldhaus said. “... I’m more at risk at the grocery store than I am at work because we have the proper equipment. We know who has COVID, typically. We just assume everyone does in the emergency room because the symptoms are so varied and different for everybody.”

But even normal activities and enjoyment cannot always provide reprieve from COVID-19, as it has devoured family conversations and social media feeds for months. Peterson has no time to engage with those that downplay COVID-19 after seeing the damage it creates on a daily basis.

“I don’t have the energy, I don’t have the ability to argue with things that are just not true,” Peterson said. “It’s just not worth my breath anymore. I can’t do it anymore. People are dying, people are sick and the denial is a tough one for me to swallow.”