Ophelia Ramirez was in some of the worst pain of her life — on par with childbirth, she said. The culprit was gallstones, hard deposits that formed in her gallbladder, the small organ that stores bile to aid in digestion.

Doctors told Ramirez, 71, that her gallbladder would have to come out. But they couldn’t be sure when.

Ramirez received her diagnosis as the Treasure Valley’s two major health care systems announced that they would pause or delay non-emergency surgeries and procedures. Her doctors had to weigh her gallbladder surgery against the other medical needs they were facing and decide who could wait.

“My doctors told me repeatedly this (surgery) was not a done deal, there was a big chance this might not happen,” Ramirez said in a phone interview.

Idaho’s latest pandemic surge has placed a huge strain on the state’s hospitals, a reality that is affecting even Idahoans who haven’t contracted COVID-19. Some doctors say they’re trying to continue business as usual, but others say delays created by the most recent surge are unequaled and will ripple into the future as patients avoid preventive care or delay early intervention.

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Last Tuesday, the Idaho Department of Health and Welfare announced that it had implemented crisis standards of care in two North Idaho health districts as hospitals struggled to handle a surge of COVID-19 patients. Health care providers must now triage patients based on who is most likely to survive.

Saint Alphonsus and St. Luke’s health care systems announced Aug. 31 that they would pause elective or non-emergent procedures as they focused on addressing COVID-19 needs.

Dr. Laura McGeorge, a physician at St. Luke’s in Boise, said that pause includes a wide range of procedures, including ones that will alleviate pain and discomfort for patients or prevent a condition from worsening.

“I had a patient yesterday who had been waiting months for her total knee replacement, preparing for it, doing exercises to prepare for getting medically stabilized for it, and (her surgery is) going to get canceled,” McGeorge said in a video interview earlier this month.

Ramirez, who lives in Boise, said her surgery was finally performed on Sept. 3, but she didn’t receive final confirmation until two days before the procedure. She waited about a week.

Ramirez said she was fortunate to have a care team that advocated for her to have surgery, but said she was “disconcerted and disappointed” — not at the health care providers, but at people who chose not to be vaccinated against COVID-19 and have overrun hospitals because they need life-saving care.

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“That was the maddening part,” Ramirez said. “That people like me who are in ridiculous pain and need surgery may not get it.”

Dr. Sheev Dattani, a colorectal surgeon at Saint Alphonsus in Boise, said he’s still performing surgeries on a regular schedule, though he said much of his work is typically urgent or an emergency, which would make it a priority in spite of the current restrictions.

He said the hospital is working to ensure that any surgery is completed in a timely fashion. But now, all surgeries are brought to a committee that decides the priority level of the procedure.

Ramirez said she was “intensely relieved” when the committee approved her gallbladder removal. Soon after, though, she said she worried she might take a bed from a patient who needed it more.

“So there’s relief, there’s gratitude and there’s a little bit of guilt,” she said.

McGeorge said patients who need care today are not the only ones who will feel the effect of the newest COVID-19 wave. She said some patients may delay care or struggle to be seen in a timely manner for preventative care as resources are diverted to urgent COVID-19 measures. Those patients could end up worse off down the road as a result.

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She gave the example of a patient who might be poorly managing a chronic condition such as diabetes. Without timely intervention from their doctor, their condition may worsen and lead to bigger problems.

“(Maybe a diabetes patient has) a little foot ulcer that, the next thing you know, it’s worse and worse and worse,” McGeorge said. “And down the pike, maybe they need an amputation of a toe or something more because it just didn’t get treated in time. So those are the kinds of things we’re really worried about.”

McGeorge also said she worries Idaho will see a rise in advanced cancer cases, as some cancer screenings have become a lower priority amid the resource crunch.

“Last year, we probably got behind by maybe three months of mammograms. How do you ever catch up on that?” McGeorge said.

Dattani said he has already seen more advanced cases of colon cancer, adding that Idaho was already one of the worst states in the country for colonoscopy rates.

“COVID has made it somewhat worse,” he said. “People are a little more scared to go for their screenings.”

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Dattani encouraged people to try to keep up with regular preventative health care, even though they may experience a delay.

“I don’t want our patients to think the hospital is shut down,” he said. “Urgent, emergent cases have priority, but these non-emergent cases are getting done.”

McGeorge also urged people to get vaccinated, practice social distancing and continue wearing a mask in public spaces. She said now is not the time to get sick with COVID-19 — or with any preventable condition.

“Whether you’re coming in with COVID or if you’re coming after a fall because you went on that hike, (you’ll find) the same thing,” she said. “It’s a big bed crunch right now, so just be safe. That’s my message to everybody: Just be safe.”

Navigating the pandemic
(Jennifer Luxton / The Seattle Times)

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