As Dr Shane Wilson makes the rounds at the tiny, 25-bed hospital in rural Missouri, many of his movements are familiar in an age of coronavirus.
Masks and gloves. Zippered plastic walls between hallways. Hand sanitizer as he enters and exits each room.
But one thing is starkly different. Born and raised in the town of just 1,800, Wilson knows most of his patients by their first names.
He visits a woman who used to be a gym teacher at his school, and later laughingly recalls a day she caught him smoking at school and made him and a friend pick up cigarette butts as punishment.
Another man was in the middle of his soybean harvest when he fell ill and couldn’t finish.
In November, Wilson treated his own father, who along with his wife used to work at the same hospital. The 74-year-old elder Wilson recovered from the virus.
The coronavirus pandemic largely hit urban areas first, but the autumn surge is devastating rural America, too.
The US is now averaging more than 170,000 new cases each day, with hospitalizations breaking records all too frequently, and it’s taking a toll from the biggest hospitals down to the little ones, like Scotland county hospital.
The tragedy is smaller here, more intimate. Everyone knows everyone.
Memphis, Missouri, is the biggest town for miles and miles amid the cornfields of the north-eastern corner of this midwestern state.
Agriculture accounts for most jobs in the region. The area is so remote that the nearest stoplight, McDonald’s and Walmart are all an hour away, the hospital public relations director, Alisa Kigar, said.
People come to the hospital from six surrounding counties, typically for treatment of things like farm and sports injuries, chest pains and the flu. Usually, there’s plenty of room.
Not now. The small hospital with roughly six doctors and 75 nurses among 142 full-time staff, is in crisis. The region is seeing a big increase in Covid-19 cases, and all available beds are usually taken.
Scotland county hospital’s doctors are already making difficult, often heartbreaking decisions about who they can take in.
Wilson said some moderately ill people have been sent home with oxygen and told, “If things get worse, come back in, but we don’t have a place to put you and we don’t have a place to transfer you.”
Meanwhile, a staffing shortage is so severe that the hospital put out an appeal for anyone with healthcare experience, including retirees, to come to work.
Several responded and are already on staff, including a woman working as a licensed practical nurse as she studies to become a registered nurse.
The hospital’s chief nursing officer, Elizabeth Guffey, said nurses were working up to 24 extra hours each week. Guffey sometimes sleeps in an office rather than go home between shifts.
“We’re in a surge capacity almost 100% of the time,” Guffey said. “So it’s all hands on deck.”