BILLINGS, Mont. — It happened so fast, Joey Traywick missed it.
“I've been doing this for a long time” he said. “I know how much time I have.”
But not this time. Traywick, a 48-year-old registered nurse, had misjudged how acute his patient's illness was. By the time he returned to her room, she was gone.
She had died alone.
“And I thought, ‘I'm never going to let that happen again,’” Traywick said, choking back tears. “It snuck up on me, and it surprised me because it's so relentless. … I (no longer) miss it. If I have to stay late after working, if it means doing it on my day off. They're not going to pass alone on my unit. Again. None of them.”
Since then, Traywick said he’s personally held hands with 23 patients who have died.
“I never thought it would happen here,” he said. “I never thought we would be anywhere close to where we are now. ... I'm a good nurse — and the nurses I work with are good nurses — but we are broken.”
His experience is shared by health care workers across the country and increasingly in rural areas such as Montana. Billings has a population of more than 100,000, but St. Vincent Healthcare treats critical patients from across the state.
On Thursday, Montana reported its second-highest number of daily Covid-19 cases since the pandemic began. St. Vincent has now expanded to three Covid-19 units.
NBC News was granted rare access inside the ICU — with the permission of patients’ families — to document the virus’ devastating impact. One of the patients had just been taken off a ventilator.
"He is improved,” Dr. Kris Spanjian said. “But that doesn't mean he's out of the woods yet. He is still very critical."
Spanjian, a physician for 35 years, retired in 2017. Still, she rushed to New York City this year to help fight the pandemic there. Now, she’s back — and the virus followed.
"It's shocking to me how fast it's accelerated in the last few weeks," she said, adding the hospital was very close to capacity. “We can probably find beds, but it’s going to be at the expense of non-Covid patients.”
Health care workers are frustrated that many people are not following basic public health guidelines, such as wearing masks. This summer, Montana’s governor imposed a mask mandate, but it’s been difficult to enforce in many parts of the state.
As the winter and flu season takes hold, health care workers are most worried about staffing. What if they get sick? What if a relative gets sick, and they have to quarantine, keeping them at home for days? Will there be enough traveling nurses to go around as the virus surges simultaneously in several parts of the country?
“I would use the word ‘crisis,” absolutely,” said Michael Skehan, St. Vincent’s chief operating officer.
He said the facility is fortunate to have sister hospitals in Colorado that can help.
“We’ve implemented a number of elements of our surge plan including doubling the size of our Covid unit," Skehan said. "We have a couple of more levers we can pull, but ultimately we’re going to run out of options.”
The virus is clearly taking its toll not just on patients, but their caregivers. Traywick, the RN, has been self-isolating for months. He sleeps in his basement, away from his wife and three kids.
“Not only can I not hug the patients, I can't hug the nurses that are crying,” Traywick said. “It's bizarre. It has absolutely wrecked us.”
On Thursday, he was able to visit one of his patients who was in recovery and finally out of isolation.
“When he gets to get off of the Covid unit, on to a different floor where he can have a visitor perhaps, it's like we won,” he said. “That's one of the times that it dawns on you that there's hope.”