Scott Matsuda’s cancer was worsening.
He was diagnosed with myelofibrosis — a rare type of leukemia — 15 years ago, and for the most part had been able to keep it from spreading too quickly.
In late 2019, however, it became obvious he would soon need a bone marrow transplant, the 67-year-old said.
“We geared up for it,” he said. He had a medical team at the Seattle Cancer Care Alliance. He found a donor. He and his family made arrangements to stay near the treatment center after the procedure.
“Then, in the beginning of March [2020], everything got shut down,” he said, recalling when schools, businesses and other workplaces began closing in an attempt to limit spread of a new, mysterious virus.
It was a disappointment, but he and his wife understood, said Matsuda, of Mountlake Terrace. They could be patient.
He started coming down regularly with colds, and he tired easily, sometimes being knocked out for 12 hours at a time.
“It wasn’t at a stage where it was dire, but it was getting there,” he said.
Matsuda is among thousands of Washingtonians whose medical procedures have been pushed back during the pandemic, as hospitals cleared space for a crush of COVID-19 patients. Delayed procedures vary widely, from colonoscopies to cancer care — anything that, if postponed, is not anticipated to cause harm to a patient within 90 days, according to a recent emergency order from Gov. Jay Inslee that paused all elective care.
Even now, exhausted health care workers are scrambling to catch up as patients with the omicron variant clog hospitals. Hospital leaders have said they expect it will take months, if not years, to work through the backlog of delayed procedures.
Yet getting a clear picture of just how many procedures have been put off is difficult.
Neither the state Department of Health nor the Washington State Hospital Association tracks the number of pandemic-delayed medical procedures, and several hospitals in the Puget Sound area said data wasn’t available.
But UW Medicine provides a glimpse of the enormity of the problem. More than 18,000 of the health system’s surgical and procedural cases had been postponed during the pandemic as of December, according to spokesperson Susan Gregg. UW Medicine usually does about 60,000 operations during a typical year.
Thousands more have been postponed at Providence’s hospitals, a spokesperson said in a statement, pointing in part to omicron’s rapid spread.
“We understand this is stressful for our patients and their families who are waiting for important medical procedures,” said Cary Evans, vice president of communications and government affairs at Virginia Mason Franciscan Health. “… We are committed to resuming procedures as quickly as possible and in line with state guidance.”
Still, many patients are left with few solid answers.
“I feel like I’m treading water,” Clark County resident Beth Erickson said in December, four months after her initial hip-replacement surgery date. “There’s nothing I can do about it and there’s nobody that seems interested in trying to help.”
Her procedure was finally rescheduled for early February. It went well, she said. Still, it’s hard to forget the long months of waiting.
“I know hospitals are full,” Erickson added. “But damn it, then what about us?”
On hold, again
Gov. Jay Inslee first put elective or nonurgent surgeries on temporary hold in March 2020, as hospitals filled up with the state’s initial wave of COVID patients.
The medical order was an effort to conserve both hospital space and personal protective equipment and at the time applied to all procedures not expected to “cause harm to the patient” if delayed for three months. It did not define “harm.”
The order expired in May 2020. Hospitals slowly returned to chipping away at their long list of elective surgeries. But some, on their own, paused elective surgeries during other COVID surges.
Then last month, all nonurgent health care services and procedures were again put on hold, per Inslee’s emergency order.
The proclamation, which remains in effect until Thursday, aims to help ease the burden on health care systems under strain from the massive number of hospitalizations brought on by the wave of omicron cases, Inslee said in January. It’s a necessary step, Washington hospital leaders have said, but it hasn’t been easy for patients — or their surgical teams.
“We surgeons see our patients and see the needs that they have and recognize the impact of the pandemic and feel empathy for them,” said Dr. Doug Wood, chair of UW Medicine’s department of surgery. “We feel advocacy for our patients, but also somewhat helpless in our ability to care for them.”
Hospital teams recently faced another challenge during the height of the omicron surge as a growing number of their coworkers became either infected or exposed and were unable to work.
“This is taking a huge toll on health care workers,” Wood said. “People are burned out. People are hurting and tired and demoralized.”
At UW Medicine — and in many hospitals throughout the country — surgeons use an acuity scale to help define the urgency of each procedure, though various factors can affect decisions to expedite or delay surgeries, Wood said.
The first tier of the scale includes procedures that are “truly nonurgent,” like hernia or weight-control surgery, which are important, but could be scheduled at a later time, he said.
Heart bypass, plastic reconstruction post-cancer, most carpal tunnel and cataract surgeries all usually fall into the first tier, he said.
The second tier includes surgeries that could be postponed for a short period of time, but not indefinitely, Wood said.
“Things that need to get done, but don’t need to get done this week,” he added.
Some types of cancer surgeries, for example, could fit into the second tier if the cancer is not aggressive, he said. Kidney stone removal, aneurysm repairs, gallbladder surgery, ovarian cyst treatment and most joint replacements are usually categorized as second-tier procedures.
Urgent or emergent surgeries make up the third tier. Most operations for cancer, transplants, burns or trauma wounds and appendicitis would fit into the third tier, Wood said.
Then, within each tier, UW Medicine surgeons categorize operations into three groups: those that can be done as outpatient procedures, those that can be done as inpatient procedures, and those that might require intensive care or a longer inpatient hospital stay.
“In some cases, we had the operating room for the operation, but did not have a bed for that person to then recover in if it was one of the operations that required an inpatient bed,” he said.
Under Inslee’s proclamation, UW Medicine is only performing third-tier operations.
“As demoralizing as it is, there’s an understanding that Gov. Inslee is doing his best of trying to help us meet the competing challenges of health care when we have thousands and thousands of COVID-positive patients and enough of them needing hospitalization that requires refocusing our resources,” Wood said. “Unfortunately, that refocusing of resources means some people are harmed.”
Frustrated patients
In July 2020, doctors decided Matsuda’s condition was declining. After about three months of waiting anxiously, he finally received a bone marrow transplant for his leukemia.
The surgery went smoothly, though the recovery process will take time, he said. He still can’t do yard work, and he’s not supposed to fly yet.
While Matsuda said he’s grateful to his medical team, he knows others might not be as fortunate.
Dani Frank, 37, of West Seattle, has been waiting almost two years for an endoscopy. She had developed an ulcer years ago and started feeling symptoms again just before the coronavirus arrived in the United States.
Her UW Medicine doctor prescribed medication but she never got a call back about scheduling her procedure.
“I put two and two together as I was watching the news unfold,” she said.
Waiting has felt long. In the meantime, Frank’s made significant changes in her diet and lifestyle to keep her discomfort at bay, but said they mostly act as “Band-Aids” while she waits for the endoscopy. Staying away from certain foods — spicy flavors, tomatoes or anything with citrus or acids — and working with a nutrition coach helps, she said.
“I feel the burn of the acid almost every single day,” she said. “It’s not as bad some days as it is on others. But I really try very hard not to stay in the space of worrying what the long-term damage is doing to my body.”
“People are hurting, I know,” Wood said. “Health care teams are hurting. … There’s a moral dilemma we also face of other patients that are not being cared for.”
But because there’s not a clear solution, many more Washingtonians will continue to wait, he said.
“It can be so isolating when you have a chronic condition or something you’re living with every day,” Frank said. “The biggest thing [I’d want to say] for other people going through this, is that I hope they know they’re not alone.”
