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Sharma Vaughn, RN, MPA
Executive Director, Community Care Alliance
Western Healthcare Alliance
April 10, 2020


Counting …

The patient’s blood pressure was dropping.

One, two…

Along with no IV pump, there was no EMT that night to take the ambulance call.

Three, four…

Not generally a place you find an RN, yours truly was conscripted into riding the ambulance – again.

Five, six…

Honestly, I cherish those memories in the back of the ambulance.  This one, all the more potent for the fear, the scarcity, and for all the counting I did that night.


I counted everything.  I counted how many drops of dopamine would fall in the drip chamber in 15 seconds.  I learned I could count on my nursing school instructors who had insisted that I learn this archaic skill.  I would re-count the drops, lengthening the time to a minute to make sure I got it right.  We couldn’t afford to get it wrong, not me or the patient.

I counted the minutes between blood pressure checks, anxious to see if the dopamine was helping.

Mostly, I counted down the 19 miles it would take to get this patient back to the hospital, to the help he needed.  That was the longest countdown, longer than the time it takes to hold your breath through the Eisenhower tunnel.  Could he make it through?

Ten years later, I find myself counting along with the rest of the nation.  CFOs are counting the days of cash on hand.  Store clerks count toilet paper at checkout.  Children count the number of homeschool assignments, while their mothers take a deep breath and count to 10… repeatedly.

We also count the rising number of infected and the death toll.  Then we recount the amount of hand sanitizer, the supply of N95 masks, and the countdown of days until the surge of COVID-19 patients hits our hospital doors.  We count on this ending too, in May, or June, or August.

Hospitals are counting on their communities.  We count on them to see our value.  We depend on them like we depend on life-saving personal protective equipment.  While we’re counting, we know the community is too.  They count the lives of the healthcare workers like they count the lives of those precious to them.  One makes a difference for the other.

In Lamar, Colorado the community counts how many surgical gowns they can sew from the operating room towels in an urgent rush to make enough.  Can we make it through?  Keep counting.

Montrose and Rangely are counting the current and retired healthcare professionals in town that could help us meet the rising tide.  We count on our community to survive, and we keep counting.

Other hospitals are doing everything they can to keep their employees on the payroll.  Usually increased business means more funding for staff.  COVID-19 shut down all outpatient services, and suddenly the world is on its head.  So far, though, we count as the staff come back in the door. We count how high their temperature is, and we keep counting.  We count on them to show up.

This isn’t new though.  The resolve of the hospitals to stand in the gap between their community and catastrophe is not new, whether the catastrophe is a car crash or COVID-19.  People are valuable.  Also not new is the vital awareness that the community’s support of the hospital makes it possible for the hospital to stand.  It’s not new; it’s just more obvious during a crisis.  It was always the case, that the community needed the hospital, and the hospital needed the support of the community.

Rural hospitals have been closing.  Ironically, so many closures have occurred that it’s been called an epidemic.  For many of those hospitals, political agendas disrupted community support, positioning the hospitals as the culprits, overspending and overcharging.  Years later, beaten down from the lashing of caps, sequesters, and delays in funding, COVID-19 emerges.  Amidst a pandemic, rural hospitals on the brink of closure are leading the charge.  We have remembered who it is we count on – each other.

So, we count again.  We count the days cash on hand, the census, the staff, the hand sanitizer, and the supply of Personal Protective Equipment.  We count how many staff will still need masks.  We count the number of days until the patient surge hits, and we will count our blessings if it doesn’t.

Later though, when we’ve counted these days gone, when there is no homemade uniform donned by our doctors and nurses to remind us, we will still be counting.  We will continue to count on the community to remember and to remind us: we are essential.  You are essential.  We don’t survive without believing in one another, supporting one another.

As the number of rural hospital closures climbs, we hold our breath that the next one won’t be the one in our own community.  Will we make it through?  We must.  Our community is counting on us.

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