Kyle Green / AP
Last month Chelsea Titus, a 40-year-old mother in Boise, Idaho, had to undergo surgery to relieve the severe pain caused by endometriosis. But the hospitals there are so crowded with unvaccinated COVID-19 patients that doctors have told her she should wait.
Nearly one in five American households have had to delay care for serious illnesses in recent months, according to a new poll from NPR, the Robert Wood Johnson Foundation and the Harvard TH Chan School of Public Health.
Titus, who works for a tech company from the home she shares with her husband, daughter and a labradoodle named Winston, previously had surgery for endometriosis in which doctors removed her uterus and a ovary. When the condition flared up again in September, the pain was severe.
“Sometimes I feel like I’m in active labor,” she says.
Endometriosis affects millions of women in the United States when the tissue that typically grows inside the uterus also grows outside of it.
When the initial medication Titus received did not help, she contacted her doctor on call.
“He said, ‘If the hospitals weren’t in the situation they were in, I would have you operated on today,” “she recalls.
The safety net is gone
The situation in Idaho hospitals has become dire. The facilities are so full of mostly unvaccinated COVID-19 patients that many can no longer function normally. Several hospitals have had to ration care.
Chelsea Titus / Chelsea Titus / Boise State Public Radio
Jim Souza, general manager of Boise’s largest hospital, St. Luke’s, describes the high standards of care typical of his institution as the network that enables doctors to perform high-level medical acts every day.
But now, “the net is gone and people are going to fall off the thread,” Souza says.
Idaho has one of the lowest COVID-19 vaccination rates in the United States.
“As cancer clinicians we are really frustrated,” says Dr. Dan Zuckerman, medical director of St. Luke’s Cancer Institute.
Zuckerman says his staff have delayed surgery for some breast cancers that can probably be kept early and treatable with hormones.
“There’s just no guarantee with that,” he says, “and there will always be cancers that could biologically show up.”
Zuckerman now spends half his day in the hospital helping his overworked colleagues and says he can only see half as many patients in the clinic.
Across town in Saint Alphonsus, the slightly smaller Boise Hospital, another oncologist, Scott Pierson, says they haven’t had to postpone surgeries – yet.
But standard cancer screenings, like colonoscopies, have been pushed back.
“We’re already a state that, if you look at the statistics, is lagging behind in screening,” Pierson said.
Pulmonologists who usually do lung biopsies in Saint Alphonse, for example, are overwhelmed right now, he says, trying to treat severe cases of COVID-19 in the intensive care unit.
Strained health systems mean delayed care
Many Americans face delays like those in Idaho, says Robert Blendon, a pollster at the Harvard Chan School of Public Health.
“The numbers were a lot bigger than expected,” says Blendon, “and the delta variant changed what was going on.”
The survey he helped lead found that nearly one in five American households said they had not been able to seek treatment for a serious illness in recent months; most of them reported having had negative results on their health because of it.
“It’s the United States,” Blendon says. “You don’t expect people with serious illnesses to say they can’t be seen for care.”
These data, he says, show that health systems must increase their capacity before the next pandemic or a severe natural disaster.
As hospitals in the Boise area are teeming with COVID-19 patients, they have also seen an increase in demand for people who have already delayed care during the pandemic.
Pierson and Zuckerman say they have seen more advanced cancers than usual that could have been detected earlier; catching malignant tumors earlier would likely have given patients a much higher chance of survival, they say.
Pierson says he suggested to patients that they could take a less intense form of chemotherapy so that they are less likely to need a hospital bed if they have complications.
Meanwhile, although the immense pain that Titus was feeling from his endometriosis was overwhelming, she said she couldn’t have surgery anywhere in Boise to remove her remaining ovary.
Her brother took the extraordinary step of chartering a private plane to take her to the Bay Area of California for treatment instead.
“I guess I could have flown commercially, but it would have been really difficult and embarrassing because I was screaming in pain,” she says.
After landing, Titus went to an emergency room and emergency care clinic and spoke to several doctors before finding a surgeon in his insurance network with an open schedule.
Hotel rooms, a rental car, and her flight home totaled thousands of dollars out of her pocket – all for surgery she might have had in a hospital a short drive from home under normal circumstances. .
She recognizes that she has the privilege of having been able to afford everything she has done to seek treatment.
“It breaks my heart that most people in Idaho don’t have the capacity to do this,” Titus says.
And even so, it was almost two weeks after she first felt the severe pain that she was able to find relief.
“It’s amazing how much better I feel,” she said two days after her operation.
But the situation has left her wondering how much her friends and neighbors who have refused to wear masks or to be vaccinated against COVID-19 really care about their community – and if it has more of a place in it. ‘State.
“My husband and I used to say, ‘We’ll never leave Idaho,’” says Titus. “We love it here. It’s an amazing place to live, and we’ve looked at real estate in other states – because it’s just not right.”