COVID surge forced rural Missouri hospital to build makeshift ICU for dying patient

For six days, Dr. Mohamed Nabeel Kuziez and his team at a small emergency room in southeastern Missouri did everything they could to keep a 67-year-old woman with severe pneumonia alive.

The day after Kathie Ganime was admitted on Jan. 12, Kuziez saw that her infection was so critical that she needed to be transferred from Madison Medical Center — a 15-bed hospital in Fredericktown — to an intensive care unit (ICU) at a larger hospital. 

But after calling 19 hospitals — in Missouri, Kansas, Illinois and Arkansas — the staff at Madison Medical Center couldn’t find a single open ICU bed due to the surge in COVID-19 patients. In just the first 12 days of the year, Missouri hospitals admitted 1,065 people with COVID-19, and new admissions were averaging 116 per day over the previous week.

Heavy mucus was building in Ganime’s lungs, and Kuziez knew if he didn’t take action soon she would die.

But his small hospital couldn’t afford a “percussion vest,” which doctors at an ICU would use to loosen the mucus clogging Ganime’s lungs and making it hard to breathe. 

“It was 7 o’clock in the evening,” Kuziez said, “and I said, ‘Let’s look at the website of Walmart to see if they have anything for massage.’”

He found a deep-tissue handheld massager for $29.98 on Walmart’s website and told the nurse to run out and buy it. 

The night nurse, a military veteran, stayed up all night massaging Ganime’s lung and alternating oxygen treatment.

The next morning, Kuziez took another X-ray and was “shocked” at what he saw. 

Ganime’s lungs had cleared.

“We were all jumping up and down,” Kuziez said.

The exuberance of Kuziez and his staff was tempered, however, by the fact that Madison Medical Center is still unable to find available ICU beds for patients.

And Fredericktown is far from the only rural hospital in this precarious situation. 

Larger hospitals are stretched thin, facing the highest COVID-19 hospitalization numbers of the pandemic at a time when they are also contending with staffing shortages.

Madison Medical Center is a critical access hospital, which is a designated facility in a rural area that stabilizes patients in emergency situations and then transfers them to ICUs in larger cities.

But because of the omicron surge, these hospitals are being forced to create their own makeshift ICUs, said Dave Dillion, vice president of public and media relations for Missouri Hospitals Association.

“We’ve had smaller hospitals throughout the state calling, in some cases, literally hundreds of other hospitals trying to effectuate a transfer of a patient,” Dillon said.

This includes people like Ganime, who tested negative for COVID but was still impacted by the surge in cases. 

“I just couldn’t believe that another hospital was not able to take her,” said Amy Richard, Ganime’s daughter who lives in Houston, Texas, and immediately drove to be with her family. “Up until now, you hear on the news that things are bad in hospitals, as far as staffing and everything, but I don’t think you realize how bad it is.” 

Ganime is now in stable condition in Fredericktown, and Richard said her family is so grateful for the entire team’s “amazing” work.

Recalling the intensity of the situation, Richard broke into tears. 

“I was like, ‘Oh my God, this is crazy. They’re gonna go buy something from Walmart?’” said Richard, barely able to get out the words.  

At one point, Richard remembers asking the nurse if she should just drive her mother to a nearby emergency room – because then they would have to take her in. The center is about 90 miles south of St. Louis.

The nurse didn’t think her mother would make it. 

“I didn’t want to risk that,” she said. “A chance there was better than no chance if I put her in my truck.”

The tide could be about to turn for Missouri’s hospitals, gauging by the state’s COVID-test positivity rate, Dillon said. Right now, 35 percent of people who are getting tested are coming away with a positive test, and that means transmission is extremely high in Missouri. 

When that number starts to trend downward, the hospital admission numbers will usually follow a week behind, Dillon said. 

St. Louis’ four largest healthcare systems are beginning to see a slow decline in hospital admissions, said Dr. Clay Dunagan, BJC HealthCare’s chief clinical officer who also leads the St. Louis Pandemic Task Force on Tuesday. However, it will likely still be until March that the hospitals are under “tremendous strain” to care for both COVID and regular patients, he said.

The work the smaller hospitals are doing is “every bit as heroic” as the life-saving efforts at Missouri’s large hospitals, Dillon said. 

“Often it is not only on a smaller scale,” he said, “it’s with additional difficulties, whether they be staffing difficulties, supply-chain difficulties – all of these components that can make it harder to provide care.”

While the Madison Medical Center is a small facility, it’s the kind of place where employees stay for 40 years and no one says, “That’s not my job,” said Beth Simmons, marketing manager at the center. 

“COVID been hard on everyone,” Simmons said, “but everyone jumps in and does what they have to do. And we are so thankful for them. We appreciate Dr. Kuziez and all the work that he did.”

One of the things Kuziez has loved most about serving at the center for the last six years is the way that everyone in town knows the doctors – and how their medical team is like a family. 

Kuziez, who immigrated from Syria in 1975, has practiced emergency medicine for more than 40 years. Previously, he was the director of the emergency department at St. Mary’s Hospital, one of St. Louis’ largest and busiest hospitals. 

In Fredericktown, there’s only one emergency doctor on the shift, which keeps him “on his toes,” he said, and every member of his team is crucial.  

“I give credit to all the staff in the hospital,” Kuziez said. “This has never been done in a small hospital of that size – open an ICU in the emergency room. We are very proud of it.”

This story has been updated since it first published.