At Stormont Vail, things could almost be normal.


A lullaby-like chime floats about the emergency department to proclaim the birth of a baby.


Nurses move from job to job, not showing signs of the wear and tear that months of picking up an extra 12-hour shift per week has brought.


And then it hits you: the chairs and curtains tucked into areas where they wouldn’t normally be.


Those spaces, including waiting rooms, trauma bays and even hallways, have been repurposed to cope with the rapidly increasing number of COVID-19 patients, as well as those with heart attacks, fractured hips and other ailments who still need care.


"We’re in an emergency," said Kevin Dishman, Stormont Vail’s chief medical officer. "We’re in the biggest challenge that I can honestly say I have faced in a 25-year career as a physician."


Extraordinary measures


Stormont Vail’s story isn’t unique to Kansas or the Midwest. Hospitals everywhere from Wichita to Denver are tapped out, unable to accept more patients.


First came the news Monday that the hospital was at its capacity for COVID-19 patients, who are held primarily in a ward redesigned to better support care.


But the siren Tuesday afternoon signaled the hospital was having to lean on its extraordinary plans, including those ad hoc areas in hallways and common spaces, which ebb and flow with patients throughout the day.


The situation was at its most dire yet in the Topeka community and became a dark sign for where the pandemic could be headed in northeast Kansas with the holiday season around the corner.


"The virus spread in the community is uncontrolled," Robert Kenagy, the hospital’s president and CEO, said in a statement Tuesday.


At one point, Stormont Vail was taking in COVID-19 patients from as far away as Oklahoma and Texas. Now it can only allow for those who come to the emergency room with the virus, and some patients are being sent elsewhere when it makes sense to do so.


And while the facility does have some remaining spaces that it can expand if it needs to, it is unclear whether the hospital will have the required staff to support even more patients.


Exposure, fatigue for staff


Nurses and support staff have been going all out for the past eight months, said Salena Gillum, administrative director of medical surgical and critical care at the hospital.


They have not hesitated, she said, in taking on more hours, even though the hospital won’t mandate that they do so.


Staff have been trying to outrun fatigue from the intensive care needed by COVID-19 patients, with two nurses needed per patient.


Gillum, who manages staffing at the facility, said she is up at 4 a.m. most days, ready to pounce on an ever-changing array of challenges. That could mean figuring out what a new treatment means for patients or ensuring there is enough personal protective equipment on hand to go around.


Staff haven’t been able to outrun the virus in the community, however, with 172 doctors, nurses and other staffers unable to come to work because of a positive coronavirus test or because they were potentially exposed, generally outside the hospital.


That means an "ongoing pivoting and reassigning" of personnel, even those from other departments, to cope with the demand.


"I keep thinking, ’After today the numbers will start coming back down,’ " Gillum said. "And it just hasn’t happened yet."


Nurses wear many hats these days.


In the COVID-19 ward, that means connecting with families of those infected, not just setting up a video call with an coronavirus-positive loved one but sometimes hopping on the line themselves to explain care if a person is unable to speak normally.


But too-frequent confrontations with grief and loss mean that they won’t always have answers on how to cope with the extraordinary scenes they are now part of on a day-to-day basis.


That leads to a tendency to lean on their colleagues.


"The greatest support they often give is for each other," Gillum said.


Trying to continue other procedures


The transformation of previously unused parts of the hospital wasn’t an overnight decision and came as part of Stormont Vail’s surge plan, or contingency planning, that was developed in recent months.


It took a couple of days, for instance, to put up the temporary beds in which surgical patients can stay before they head into an operation for needs not related to COVID-19.


The goal is to continue with as many non-emergency, or elective, procedures as possible. Something like a hip replacement still needs to happen quickly to prevent someone from developing other complications, Dishman said.


"Our real challenge is how can we meet the needs that COVID has added on top of that," Dishman said.


Still, patients often have to be held in the emergency room for upwards of several hours before an inpatient bed is free, a process known as "boarding."


The fear is that things will get worse before they get better. Hospital officials across the state say they noticed a spike in cases following Halloween, and the fear is that will become a deluge after Thanksgiving.


Canada, for instance, reported an acceleration of its caseload after its Thanksgiving holiday, which occurs in early October. Contact tracing linked many of the infections to family gatherings.


Stormont Vail is ready in the event things get worse, Dishman said, although he didn’t want to talk about the potential that doctors may have to ration treatment.


"We have providers and staff right now preparing for more patients, higher volumes and responding to the needs of our community," he said. "And we will continue to prepare every day for that eventuality and hope that we are completely wrong. The old adage is better to have and not need than need and not have."


But there is still time, Gillum said, to avoid that.


When she sees people in the community not wearing masks or social distancing while running errands, her first reaction isn’t exasperation or righteous indignation. Instead, it is more measured and focused on the reality she sees every day that the rest of the world doesn’t.


"I think they have an education need, and I want to bridge that and help them understand that COVID is real," Gillum said. "I always say that COVID can just be mean and it can end up a very sad story for a very many people ... I will beg them (to wear a mask)."