Dr. Jason Laney sat at a desk in his 25-bed hospital in South Georgia, on the phone to a doctor at one of metro Atlanta’s powerhouse health systems 200 miles away. They were both crying.
Laney needed the Atlanta doctor to accept his COVID-19 patient for a bed with an artificial lung machine called ECMO.
He and nurses at Jeff Davis Hospital in Hazlehurst had already called scores of other hospitals and medevac companies across the Southeast for that patient, the county’s high school principal.
But the Atlanta doctor had scanned the situation at her own packed ICU and said she was sorry. She couldn’t.
If his patient that day was special, the situation was not. Such calls have rung across Georgia in the last two months amid the delta surge, as the state’s system for sharing resources among hospitals has collapsed.
The attempt to save just one patient shows why. It involved dozens of caregivers working around the clock —not for hours, or for days, but for weeks.
And the work is more than the usual strain. Workers’ attention is focused second-by-second on the body functions of a critical patient, tweaking machines and medicines, staff ready to pounce if something goes south. For all that, patients still die: COVID-19 has claimed 38 lives at Laney’s small hospital alone.
In normal times, Laney would probably have transferred a patient as sick as the principal, Greer Smith, to Savannah’s Memorial Health, a 645-bed hospital with ECMO and a top-tier trauma center. But Memorial, like Laney’s small hospital, was overflowing and refusing other facilities’ ICU COVID-19 patients.
So when Smith, a 38-year-old married father of two, little league football coach and Jeff Davis High School principal, showed up the last Wednesday in July with sinking oxygen levels, he was in more trouble than he knew.
Credit: HYOSUB SHIN / AJC
Credit: HYOSUB SHIN / AJC
Within a day, Laney was convinced Smith was in grave danger. He tried to keep the full depth of his concern from the family but what he said was bad enough.
Smith needed to fly out.
The problem was where he could go.
Out of options
Smith thought he had a sinus infection. Then his doctor made him get tested. He first knew he was in trouble when a headache set in so bad that he couldn’t stand up.
He started testing his oxygen levels on a home oximeter device. That Wednesday his oxygen dropped dangerously low. He was delirious at times, his brain starved for oxygen, a symptom that can appear in severe COVID-19.
His wife, Stephanie, took him to the hospital.
Credit: HYOSUB SHIN / AJC
Credit: HYOSUB SHIN / AJC
Laney put Smith on an oxygen pump, but his levels were stubbornly low. Turning him over, a surprisingly powerful treatment for COVID-19 pneumonia, didn’t help. Laney decided Smith was more likely to die than not if he couldn’t get on an ECMO machine. Unlike ventilators, which force air into the lungs and make the lungs breathe, ECMO machines let the lungs rest, and, hopefully, heal. The machine acts for the lungs, filtering the blood, putting in oxygen, and pumping it back into the body.
To qualify for a coveted ECMO spot, Greer Smith needed first to be intubated — put on a ventilator in a coma — and fail at that. To Smith, though, going on a ventilator was a death warrant.
Laney tried to convince him. Smith was in trouble already. His oxygen settings were maxed out. He was on every accepted medication. Privately, Laney thought that if Smith stayed in Hazlehurst, even on the ventilator, he might have a 30% chance of staying alive.
He came in Smith’s room and stood at his bedside. Smith sat at the edge of the bed, looking at his wife.
“I’m just confused that my bloodwork looks good or a little better,” Smith said, his oxygen monitor in the background sounding an alarm. How could most indicators look so good but the lungs be bad?
“If I had the answer to that, man—” Laney said. “I mean, I can’t tell you how many times I, everything’s looking OK, and then the lungs just won’t work.”
Smith agreed to go under. He wanted to see his children — son Kellan, 10 and daughter Emerson Rose, 4 —again.
“I just want to live,” he said.
Within an hour and a half, he was on a ventilator. It wasn’t a success.
Video: Dr. Jason Laney and his patient discuss going on a ventilator
No room to spare
Like many small rural hospitals, Jeff Davis serves communities where vaccination rates are staggeringly low. Surgo Ventures crunched CDC data as the delta variant ramped up in July and named Jeff Davis County one of the 20 most dangerous counties in the nation. Its vaccination rate remains about 10% of all eligible people, according to the CDC.
And like many rural hospitals, Jeff Davis isn’t staffed or equipped for a tidal wave of patients. In the days and weeks following Smith’s admission, the hospital’s four ICU beds weren’t enough for all the patients who needed critical care. Two makeshift ICU beds sprang up in the ER, then three. Plastic sheeting was hung in a hallway in case regular rooms need to be turned into sealed-off negative pressure rooms for new virus patients.
Credit: HYOSUB SHIN / AJC
Credit: HYOSUB SHIN / AJC
To help care for the patients, the hospital had put in a request for temp workers when the state announced it would fund more, but Jeff Davis didn’t make the cut.
Hospital CEO Barry Bloom went on scavenger hunts for equipment. Bloom drove 150 miles in his Chevy Silverado to borrow a ventilator. Just as he had in a previous wave of COVID-19.
Jeff Davis also lacks a specialist in intensive care.
So in each surge of the coronavirus, Laney, an internal medicine doctor who happened to get some critical care instruction when he trained at Emory, becomes the hospital’s point man on critical care. As beds fill up, he shuts down his regular patient hours and takes over the ICU, all shifts.
Credit: HYOSUB SHIN / AJC
Credit: HYOSUB SHIN / AJC
That’s what he did as the delta-fueled surge hit. Many nights, Laney slept only three or four hours, getting up first thing to do patient rounds, or checking texts and emails for the 10 p.m. lab test data and responding with treatment orders.
And he bore the weight of each patient.
Before Smith was ventilated, Laney had already started making calls, trying to find a hospital with ECMO that would take him. Georgia has no state routing center that helps doctors find such openings. And if there was, with delta hospitals would likely have hoarded them, not posted them publicly.
So Laney got on Google and typed in “ecmo availability.” Then he and other staff called ICU doctors person-to-person, hoping to strike at a moment when a hospital’s patient had been discharged and no one had yet filled the bed.
They encountered brick walls.
“I just want to live."
Georgia hospitals were reporting spikes in COVID hospitalizations, with numbers they hadn’t seen since the pandemic peak in winter. Hospitals were on diversion around the state, turning away ambulances from emergency rooms, ICU beds or both.
When Laney intubated Smith, he thought they had secured a bed at Wellstar Kennestone. Then weather delayed the transport helicopter. When the weather cleared the next morning, the bed was taken. Laney and the team got back on the phone.
Talking to a doctor at Piedmont he knew from Emory, Laney learned that Northside Hospital had a new ECMO program. He called and talked to Dr. Allison Dupont, an interventional cardiologist who came to Northside Hospital Gwinnett to start an ECMO program. She thought she had a bed.
Credit: HYOSUB SHIN / AJC
Credit: HYOSUB SHIN / AJC
When she called him back to confirm, though, she said no. The hospital had its own patients so sick they would probably need it.
Laney broke down, wept and begged.
“Listen, this is my high school, our high school principal,” Laney recalls saying. “My kid goes to his high school. I coach with him. So I, I can’t, I can’t do it.
“I can treat all these other people, that’s fine,” Laney said. “You have to take him. Please.”
“Please take him.”
Dupont began to cry, too. “Hold on a second,” she told him.
She didn’t want to make a completely emotional decision. It had to be rational. She got back on the phone to Laney along with her critical care colleague. They were all in tears.
Dupont told Laney, “We’ll take him, we’ll take him.”
Another setback
It wasn’t over. The Hazlehurst team had trouble finding air transport. Finally they got a helicopter company to come.
When it arrived, though, the crew told Laney they didn’t think Smith would fit. They took measurements of the 6′3″ former football player. They were sure of it. They wouldn’t take him.
Laney told Smith’s wife, in her usual seat on the floor in the corner of Smith’s tiny ICU room, to leave him and the crew to speak alone. “I was like, ‘Man, listen. He’s going to fit. That’s all there is to it.’”
The transport company tried calling other companies, and hours went by. Northside called for a status update, and Hazlehurst assured them Smith was getting ready. Northside called again; they needed the bed for their own patient now. Laney told them Smith was being wheeled out the door.
He wasn’t.
Smith’s wife, Stephanie, heard most of it. She heard the helicopter crew relent and agree to let Laney try. The process of transferring Smith to the travel ventilator and drips took more time. Now weather was coming in.
They made it outside but had more trouble at the helicopter. Finally, Laney stepped away and gave Stephanie a thumbs up. The helicopter took off for Atlanta.
Clinging to hope
ECMO didn’t save everyone at Northside. But it saved Smith.
He spent 20 days at Northside.
While he was on ECMO, two nurses cared for him 24/7. They took care of the pump. They administered drips of medications. They constantly monitored him.
When he came out of his coma, he was able to sit up. The doctor wanted him to lie back down, but Smith wanted to stand. He did.
The Northside staff erupted in a cheer.
Credit: Handout
Credit: Handout
Workers kept coming by to “check on” him, to hear how he was doing. They learned he played guitar and someone brought one to watch him play.
Some weren’t part of his treatment team. Some didn’t work with patients at all.
“And every one of them said the same thing,” Smith said. “They thanked me. For being able to get through it, I guess.”
At night, Smith could see through a crack in the curtains as body bags were wheeled by. He understood.
It’s the same for the staff in Hazlehurst. They love to hear about Smith. Laney this week got a text from an outpatient lung doctor, randomly asking how Smith is.
Credit: Handout
Credit: Handout
Laney put together a video composed of photos of Smith, from the gurney at Hazlehurst to his coma on ECMO, to his reunion with his kids. Dupont watches it, again and again, perhaps 50 times by now.
“Every day is tragedy with COVID, and having to call families and tell them that their husband or wife or father or mother is not getting any better and we’re on higher oxygen is very depressing,” Laney said.
“We’ve got to cling to it”—the success story—”or else I’ll go crazy.”
Back to life
Last Monday morning in Hazlehurst, it was a strangely normal day.
As students returned to Jeff Davis High School, Greer Smith was back, too. He was cleared to work, off of oxygen and almost over his physical therapy, regaining strength faster than expected.
As Smith did lunch duty with his friend and assistant principal Doug Alexander, he gave hugs and back slaps to students passing by.
“How’re you doing, man?”
“Your granddaddy doing good?”
When Smith had returned from Atlanta, the town greeted him with a parade, complete with the sheriff and deputies’ flashing lights.
“We’re a small town,” Alexander said. “We only have one high school in the county. This is common ground for the whole community.”
If Smith hadn’t made it back?
“I don’t know that it would have been something we would have recovered from quickly or at all,” Alexander said. “I don’t want to think about it.”
Smith is a man of faith, and he considers what happened to him a miracle. He and Stephanie are trying to repay the doctors and nurses by encouraging people to get vaccinated.
Credit: HYOSUB SHIN / AJC
Credit: HYOSUB SHIN / AJC
The couple had chosen not to get vaccinated, reasoning they were young and healthy. They’ve changed their minds, and Stephanie has had her first shot.
At Jeff Davis Hospital, over the weekend some patients died and several patients were discharged, but fewer showed up to take their place. The hospital Monday had open beds again.
Laney, the optimist, hoped the tide had turned. Emergency Department nurse and manager Justin Griffin said no way. “We’ve had this a couple times,” he said. “It’s kind of like a cycle that repeats itself.”
In the ICU, all four beds were full. But the charge nurse, Sarah Spell, could take a minute to speak to a visitor. “If you don’t work in the hospital, you don’t understand,” she said. “I don’t think anything could really prepare you.”
Later, Laney took a moment, too. He’s had to call family after family with grim updates. Watched so many loved ones say goodbye. He recently admitted his youngest patient on full oxygen. So he loves getting queries about Smith.
“You have to remind yourself why you still push,” he said, “and give everything you’ve got.”
