The emergency room is bustling when I arrive. Patients are in beds in the hallway because the rooms are full. I used to love the bustle of the Emergency Department — the sound of the monitors, the sense of purpose — but lately things have been hard. I check the board: four patients waiting to be seen … shortness of breath, cough, fever. All likely COVID.

I put my N95 mask on, my level-three mask, my gown, my gloves, my shield and enter my first patient’s room. I strain to hear them over the filter in their room and in-between their coughing. They look unwell, but their oxygen saturation is 95 percent, an acceptable level; they will likely go home. They are not vaccinated.

I remove my shield, gown, masks, gloves, wash my hands, and prepare to see the next patient.

I walk in, again with mask, shield and gown, this patient’s oxygen level is less than 90 percent, which means they require oxygen and will need to be admitted. They are in their 50s, otherwise healthy. They are unvaccinated. They tell me they were scared of the vaccination but now tell me they are really scared. They feel so sick and so alone, since they are unable to have visitors. We will do everything we can to take care of them.

There are several ambulances out, one sounds like COVID, one sounds like a stroke. The waiting room is starting to fill up.

In my head, I hope the patient who likely has a stroke is OK, that they will not require transfer to a larger hospital. I know all too well there is likely no bed available nearby, if at all. I know their only option, if we are lucky, will be to find a bed hours away from their family. In the past, I have called 28 hospitals before finding a bed; I hope it does not come to that. They will be here in five minutes. We will just have to wait and see.

This is the day. This is every day as of late. It is nonstop. The ICU is full.

Hospitals throughout New Hampshire are full, as they are in the surrounding states. You just have to ask those in the ER or hospital medicine: Things are not OK.

This is the worst it has been for Cheshire County, my home, since the onset of the pandemic. The majority of people who come to the emergency room and require admission are not vaccinated. They are sick, and they need help. However, there is no pause button for the normal emergencies: someone’s dad having a heart attack; someone’s grandmother having a stroke; a trauma from a car accident. Because of the growing number of COVID cases, these patients may not have appropriate resources to care for them. This is now our reality.

We keep working. We will keep trying We keep showing up. We are always open, and we will always do what is best for our patients. We have been placed in an impossible position with too many sick people, with nowhere for them to go. The weight of this has been on our shoulders, and we are tired.

So I beg of you all: Please wear your masks and please get vaccinated. We know these things work. Please trust the science and please trust your medical providers. Please put politics aside and help protect your neighbors and friends. Your choices and actions do matter. We care about you and your family members. Please help us, so we can help the community.

We are doing our very best, but we are drowning, and I am asking you, please do your best, too.

Amy Neal, PA-C, MPH, is a physician assistant in the Emergency Department at Cheshire Medical Center in Keene.

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