A new 3D mammography machine in the Central Oregon Radiology Clinic at St. Charles Madras will be a “game-changer” for breast cancer screening in Jefferson County, says mammography technologist Stefanie Brown.

“The statistic that always jumps out at me is that one in eight women will develop breast cancer in her lifetime,” said Brown, who has worked at the Madras hospital since 2018. “In my family, we have at least eight women, and so I look at them and I know the odds are one of them will get breast cancer. As a family member and as a caregiver, I want them to get 3D mammograms.”

Until late April, Madras had a 2D mammography machine, which produces a flat image of the breast. Now, it has a 3D machine – made by the medical technology company Hologic – that creates 50 to 80 1-millimeter “slices” providers can flip through like the pages of a book. This gives providers a much clearer, more comprehensive look at the breast, which means they have a chance to catch cancer earlier, said LeeAnn Ford, mammography supervisor with Central Oregon Radiology Associates.

And with breast cancer, early detection is key: Women who are diagnosed early have a 98% or higher survival rate in the first five years.

“With a 2D image, you have a lot of superimposed breast tissue, so you’re kind of just watching for shadow changes,” Ford said. “With 3D, you’re actually seeing inside the tissue, so you can see little things hiding in there.”

Brown offered an analogy: “Imagine you have a big cotton ball and you put a Skittle in the middle of it, and that Skittle is the cancer. You can take a picture of the cotton ball and you won’t see the Skittle. But if you cut the cotton ball into thin slices, you’re going to find that cancer.”

In addition to earlier diagnoses, the 3D machine’s more detailed images mean more certainty for providers and fewer false positives, which translates to more peace of mind for patients. Patients with an inconclusive 2D mammogram may be asked to schedule a follow-up 3D mammogram, Brown said, and the wait between those appointments can be fraught with worry.

“For two weeks, they’re saying, ‘What is going on with me? Do I have cancer?’” she said. “There’s all this anxiety, when really it was just a clump of tissue that might’ve been more easily seen in a 3D image.”

Many women in Madras, Warm Springs and the surrounding areas have been driving to Redmond or beyond for 3D mammograms. The new machine means they can get the care they need closer to home, and it greatly reduces a barrier to breast cancer screening for people with transportation issues.

“3D technology has completely changed the world of mammography for the better, and I am so pleased that we are now able to offer this tremendous resource to our community with the partnership of our friends at Central Oregon Radiology Associates,” said David Golda, vice president and hospital administrator at St. Charles Madras. “I know we have people in the area who have been driving out of town for their mammograms, and I hope they’ll start coming to St. Charles Madras.”

To be clear, the patient’s experience doesn’t change much in the move from a 2D to a 3D mammogram, Ford said, although Madras is getting the “latest and greatest” technology with its machine: Hologic’s SmartCurve™ system, which conforms to the unique shape of a woman’s breast and replaces the flat plastic paddles of yore. “We still have to compress the breast. Compression is necessary to get the best results,” Ford said, “But this new system should provide a little more comfort.”

More comfort. Less travel. Clearer images. Earlier detection. Peace of mind. There are plenty of good reasons for people to get 3D mammograms in Madras. Brown performs them Mondays through Thursdays, and she hopes her schedule fills up soon.

“My aunt is a breast cancer survivor, and her story fuels my passion for this industry,” she said. “So the fact that we’re literally now offering the best care to our patients, I’m just so excited about it.”

Gene Costanza has been through more than his share of life-changing experiences.

A police officer for more than 25 years, he has saved lives, watched people die and was nearly killed on duty — multiple times.

So Costanza, 66, knows how important it is to stay calm in a chaotic situation. And on May 14, 2020, it took everything he had to do exactly that.

“I woke up that morning and felt great for about five minutes. And then I started feeling a weird pressure in my chest, a bit more acutely than I’d been feeling a couple days before. I woke my wife up and jumped in the shower, and that’s when it really started to cook,” he said.

“It wasn’t long before I was seriously concerned that I was not going to live through this,” he continued. “I was doing whatever I could to stay calm and breathe. I was just trying to stay alive.”

Fortunately for Costanza, good help wasn’t far away. After arriving at St. Charles Bend, he was quickly taken to the Emergency Department, and then whisked away to the Cath Lab, where he could hear interventional cardiologist Dr. Nicholas Buss and his team of caregivers talking, both to him and to each other.

‘I WAS A PERSON’

“The way they were speaking to me, it wasn’t like I was a product. I was a person. They were speaking to me, the guy at the other end of this emergency,” Costanza said. “They’d ask me questions that needed to be answered. They’d tell me where they were going and what they were doing. I didn’t care what they were doing, but looking back, I certainly appreciate the level of communication and interaction, especially in an urgent environment.

“The teamwork that I could hear happening,” he said, “was incredible.”

The Heart One program at St. Charles Bend’s Heart and Lung Center is a coordinated effort to bring physicians, area hospitals and emergency responders together to ensure people who are having a heart attack receive care as quickly as possible. The Bend hospital has the lowest mortality rate for heart attack patients of all the hospitals in Oregon, in part because the time it takes for a heart attack patient to receive a stent once reaching the hospital — known as door-to-balloon time — is better than national averages.

The next thing Gene Costanza remembers is being wheeled out of the Cath Lab and being struck by the “everyday hero” nature of what he’d just experienced.

“I looked up at them and I said, ‘You guys just got up this morning, had breakfast, came into work and saved my life,’” he said. “How cool is that?”

The quality of care continued beyond the ED and Cath Lab. Costanza had great nurses, he said, and he struck up a conversation with the Environmental Services caregiver who cleaned his room.

“She loved working at St. Charles,” he said. “I left the hospital thinking, ‘Man, am I too old to go back to school and become a nurse?’”

LEAVING SOMETHING BEHIND

As a kid, Costanza started drawing as a way to avoid paying attention in school, he said. But he left art behind as he entered adulthood and started his police career, only to have his long-dormant passion reawakened one day at a conference in Arizona.

“I was in Scottsdale and I walked into an art gallery and came face-to-face with a massive painting of the Grand Canyon,” he said. “I went, ‘Oh no … I’ve got to learn how to paint. I’m disciplined enough now that maybe I can do this.’”

That was in the late 1980s. Since then he has spent much of his free time creating contemporary realist paintings of traditional subject matter, with a primary focus on natural landscapes. (You can see his work at genecostanza.com.)

So last year, when he got home from St. Charles and wanted to find a way to thank the people who cared for him, he turned to his art. Using his “broken top” of a heart as inspiration, he started working on a 30-by-60-inch oil painting of snowy Broken Top towering over brownish-green trees, a glistening creek and rustic fence posts.

He is finishing and framing “New Morning on Broken Top” now, with plans to mark the one-year anniversary of his heart attack by donating it to the St. Charles Foundation for placement in the Bend hospital.

“Me and a good buddy of mine spend hours talking about art and philosophy, why we’re driven to create, and about giving back and leaving something behind,” Costanza said. “The people who took care of me went above and beyond, and my hope is that this painting can hang there long after I’m gone.

“If I can do something that will raise the spirits of people who are sitting there waiting for a loved one or just passing by, I’d feel pretty good about that,” he continued. “Maybe even someone from the care team might notice it and remember saving my life. That’d be pretty cool.”

A few weeks ago, I sent out a message explaining that we were in a race to vaccinate as many people as possible against COVID-19 before the new variants of the virus could catch up with us.

Unfortunately, as of this moment, it feels like we are losing the race.

Recently, Deschutes County recorded the highest number of positive COVID-19 cases in one week since the beginning of the pandemic. Nearly 600 new cases were reported in the tri-county region from April 18-24 – many of them in children and young adults.

At the same time, hospitalizations are increasing as well. Late last month, we had 36 COVID-19 positive patients in the Bend hospital. Because we have done such a great job of vaccinating our older population, the average age of our hospitalized critically ill patients has dropped by about 13 years. Unfortunately, with this recent wave of spread, and perhaps related to new variants, we are now seeing people in their 20s, 30s and 40s who are very sick with this virus and in need of intensive care.

We are once again faced with canceling some elective procedures for patients because we are simply out of hospital beds and staff to provide that care. These are patients who have already waited for months in many cases. They are in pain and suffering. We don’t want to delay their care – but the resurgence of COVID-19 cases means our resources are tapped.

Our St. Charles team of caregivers and providers started all but four days in the month of April with the Bend hospital at 90% capacity or higher. We have nurses, doctors, respiratory therapists, environmental services, food services caregivers and so many more who are working very hard to care for our community.

This is not the time to give up. We have tools that will give us that boost of energy to pull ahead in the race. Masking, handwashing and distancing remain absolutely critical – perhaps now more than ever.

And, the most important thing you can do today is get your COVID-19 vaccine. I know many of you already have taken this step, but we still have a long way to go to reach herd immunity. This is especially true in Jefferson and Crook Counties where vaccination rates are hovering around 30% of the population. Deschutes County is doing slightly better with about 43% of the population vaccinated.

But we are now at the point where we have more vaccine appointment slots available than we can fill. You can still visit www.centraloregoncovidvaccine.com to make an appointment at the tri-county mass vaccination clinic at the Deschutes County Fair & Expo Center. You are now able to pick a time that's most convenient for you – no more pre-registering or waiting to receive a link in an email. Just schedule and go. It's that easy.

If you have been hesitating, now is the time to get vaccinated.

Be a part of the solution. Help us win the race.

Sincerely,
Joe

As more Oregonians become eligible for the COVID-19 vaccine, it is important to provide clear guidance on how to get an appointment.

With that in mind (and with help from our partners at Deschutes County), we've compiled some FAQs on getting the COVID-19 vaccine in Central Oregon. Please feel free to share this with your friends, family and social media circles to help us spread accurate information and get shots in arms as quickly as possible.

WHO IS ELIGIBLE?

Through April 18, everyone in Phases 1A and 1B of the state's vaccine sequencing plan is eligible to receive a COVID-19 vaccine. This includes frontline workers as defined by the CDC and their family members who live with them, people living in a multigenerational household and everyone age 16 or older who has one or more underlying health conditions with increased risk. Many more details are available here.

Effective April 19, all Oregonians age 16 and older will be eligible for the COVID-19 vaccine. This is two weeks ahead of the state's original schedule because, as Gov. Brown has said: "We are locked in a race between vaccine distribution and the spread of variants."

WHAT SHOULD I DO RIGHT NOW?

If you want the vaccine, go to centraloregoncovidvaccine.com today and pre-register, whether you are currently eligible or not. Pre-registering saves your spot in line for the vaccine and ensures you'll receive it as soon as there is a shot for you. When you're eligible and we have a dose for you, we'll send you a unique link to schedule your appointment. It's that simple.

NOTE: If you previously filled out this form, you still need to pre-register at centraloregoncovidvaccine.com. If you filled out a form but you’re not certain which one it was, go ahead and pre-register at centraloregoncovidvaccine.com to be safe.

WHAT IF I CAN’T (OR DON’T WANT TO) PRE-REGISTER ONLINE?

The easiest and fastest way to pre-register is online. If you need to pre-register by phone, call 541-699-5109. That number is staffed from 9 a.m. to 5 p.m. on weekdays and 9 a.m. to 1 p.m. on weekends. Please be prepared to wait on hold or call back as this line is experiencing high call volumes. If you pre-register by phone, you’ll receive a call to schedule your appointment when a vaccine is available.

WHAT WILL HAPPEN AFTER I PRE-REGISTER?

First, you’ll receive a confirmation message that looks like this. (You will NOT receive a confirmation email.) Your name will be added to a database of people who have pre-registered through the site. As we receive doses of vaccine from the state of Oregon, we will email personalized, one-time scheduling links to as many people as we have doses available. This email will come from the address [email protected]. Keep an eye on your "spam" or "junk" folders in case it shows up there.

If you receive a scheduling link, use it within 48 hours to schedule your appointment.

I PRE-REGISTERED. WHY HAVEN’T I RECEIVED A SCHEDULING LINK?

Many people are eager to get vaccinated, and we are excited to offer the vaccine as quickly as possible. There are thousands of people in the pre-registration database waiting for their appointments. The system is set up to contact people based on eligibility group in the order they signed up. That means someone who is younger than you - but is in your eligibility group - may receive their appointment link before you do. This is normal. Again, there are many people in line waiting for their shot, and we will get to every single one as we have the doses. Your patience and understanding are very much appreciated.

WHERE DO I GET VACCINATED?

Deschutes County and St. Charles Health System are operating a large-scale vaccination clinic for all Central Oregon residents at the Deschutes County Fair & Expo Center, located at 3800 SW Airport Way in Redmond. If you schedule an appointment through your personalized link that was emailed to you, that’s where you should go to get your vaccine. NOTE: We have made every effort to make the clinic as accessible as possible, including golf carts that can shuttle individuals with limited mobility from their car to the front door. There are also language translation services onsite for non-English speakers.

Vaccines are also available through many local pharmacies. Appointments may be found through vaccinefinder.org.

IF I GET THE MODERNA OR PFIZER VACCINE, HOW DO I SCHEDULE MY SECOND SHOT?

The Moderna and Pfizer vaccines require two shots a few weeks apart. If you receive one of these vaccines for your first shot at our large-scale vaccination clinic at the Deschutes County Fair & Expo Center, you will get an appointment for your second shot before you leave the clinic. You don’t have to do anything else. Your second shot is secured and scheduled.

NOTE: At the direction of the federal government, the fairgrounds vaccine clinic is not currently administering the Johnson & Johnson vaccine. Only Moderna and Pfizer are available at this time.

A message from St. Charles President and CEO Joe Sluka and La Pine Mayor Daniel Richer:

When St. Charles opened the doors of its Family Care and Immediate Care clinic in La Pine in May 2018, it did so to bring health care services closer to home for people who live there and in other medically underserved areas like Sunriver, Gilchrist, Chemult and Christmas Valley.

The project was years in the making and made possible in large part by the La Pine community. Individuals, foundations and businesses came together to see health care expanded in the south county area and contributed more than $1 million to fund the clinic, which houses primary care, immediate care, radiology, lab, occupational and specialty services.

Demand for services in La Pine is high. In 2020, more than 20,000 patients visited the clinic, 7,000 of whom were seen in Immediate Care alone. And as more people are seen there, more are referred to St. Charles' Bend hospital for medical emergencies that warrant a higher level of care than what the clinic can provide. In 2020, 715 patients were referred to the Emergency Department, 95 of whom went by ambulance. 

The decision to activate 911 is made with the safety and well-being of patients top of mind. That’s why we became deeply concerned when the La Pine Rural Fire Protection District (LPRFP) enacted an ordinance—Ordinance No. 2019-03—attempting to charge care providers like St. Charles and the La Pine Community Health Center for what the LPRFP claimed were non-emergent ambulance transports. But these “non-emergencies” were patients with potentially life-threatening problems like heart attacks and strokes.

Recently, the fire district decided to review this ordinance and invited public comment. It received overwhelming opposition to the fire district’s fee-based model. This outpouring of resistance to the ordinance included submissions by the Central Oregon Independent Practice Association (COIPA), a group that represents independent providers in the region, the La Pine Community Health Center and one of the co-authors of this piece, La Pine Mayor Daniel Richer.  

You can read the public comments here.

This Thursday, the fire district board is scheduled to review and vote on a replacement ordinance, 2021-01. The proposed new ordinance would direct the fire district to bill care facilities for all 911 activations— not the patient’s insurance, as is standard practice. We strongly oppose this new ordinance, as we believe it could place La Pine health care services at risk.

While the clinic sees thousands of patients each year, it operates at a significant financial loss and has been subsidized by St. Charles as a service to the community. Sadly, if St. Charles is forced to pay for ambulance transports, the increased losses to provide care may prove so challenging that the health system will most likely be unable to keep the clinic open. 

St. Charles cares about the La Pine community and wants to continue to do our part to serve it. The people of La Pine deserve access to the health care services they need, which is why we think the fire district board should reject this ordinance and stop the harmful practice of billing care facilities for transports instead of patients’ insurance. The fire district has many means to fund itself that do not endanger community residents. It’s time they explore those other options.

If you live in one of the areas served by St. Charles' clinic and the La Pine Rural Fire Protection District, we encourage you to attend the fire district board’s next meeting on Thursday at 9 a.m. The meeting is virtual, and you must send your request for the Zoom link to [email protected] before 3 p.m. on Wednesday. 

We think your health is too important to jeopardize over a fire district funding issue.

Joe Sluka
President and CEO
St. Charles Health System

Daniel Richer
Mayor of La Pine

In a world of their own: Caregivers use virtual reality technology to train for medical emergencies

Janice Schmidt is in another world.

The St. Charles Bend operating room she’s in isn’t prepped for surgery—equipment is shoved to the side and sitting idle—and no one else is there.

But in her virtual reality, the operating room is hopping as a team of doctors and nurses quickly react to what could become a catastrophic disaster.

With a headset strapped to her face and paddles secured to each of her hands, the clinical practice education coordinator is racing to extinguish a fire that erupted when a laser (used to repair the trachea of a patient) ignited a dangerously high level of oxygen. Schmidt has mere seconds in this timed scenario to reach for a bowl of water, extinguish the burgeoning blaze and peel back the patient’s surgical drape before it’s engulfed in flames.

This heart-thumping scenario is all too real—which is exactly the point

“We don’t want to just read a book,” she said. “We want to see it, do it, feel it. Virtual reality is a game-changer for reduction in fire risk.”

That’s why St. Charles Health System is joining the ranks of other West Coast health care providers like Stanford Health and UCLA Health that are using virtual technology to improve the quality of the clinical training they provide. Since January, more than 100 St. Charles doctors, nurses and technicians have completed their annual Joint Commission-required education on fire prevention via Health Scholar’s Fire in the OR virtual reality simulation.

In operating rooms, fire is an ever-present danger, said Sherie Ponting, interim perioperative educator. That’s because the three components of fire, known as the “fire triad,” are present in nearly all surgical procedures: an oxidizer, like oxygen or nitrous oxide; an ignition source such as a laser or electrocauterizing tool, and fuel, which can be anything from surgical drapes to gauze.

Through virtual reality training, Ponting said caregivers realize just how fast a fire can happen and how quickly they must respond.

Operating room fires are rare events—about 550 to 650 are reported each year in the United States—but surgical teams must be ready to quickly communicate and react to minimize harm to patients and themselves.

An operating room fire can be a “horrific error,” Ponting said. “A patient’s future care and ability to survive it is based on how fast you can react.”

While virtual reality is a cost-effective way to offer training, it’s also highly effective. Learners who use virtual reality fire simulation training performed 250% better than those who only had traditional didactic teaching methods, according to research cited by Health Scholars.

“It was awesome,” one St. Charles caregiver wrote in their feedback form after taking the Fire in the OR training. Another offered, “I truly felt stressed and recognize how quickly a fire can get out of control.”

Schmidt and Ponting said the response from caregivers has been so overwhelmingly positive that the health system plans to soon offer additional virtual reality simulations for other kinds of scenarios such as when a patient experiences malignant hyperthermia (a kind of severe reaction to drugs used for anesthesia) or precipitous delivery (the rapid delivery of a baby).

“If I save one life, one patient from being harmed, that’s enough,” Schmidt said.

(NOTE: According to caregivers familiar with his case, there is zero evidence linking Dale Cheney’s medical incident, described below, to the COVID-19 vaccine he received earlier in the day. He just happened to be at the vaccine clinic when the incident occurred.)

Thousands of Central Oregon seniors have gone through the switchbacking vaccine line at the Deschutes County Fair & Expo Center over the past several weeks.

“Most days, it’s pretty uneventful,” said Dr. Matthew Slater, a cardiothoracic surgeon with St. Charles and one of many physicians who have volunteered to provide medical staffing for the fairgrounds COVID-19 vaccine clinic. Their job, typically, is to keep an eye out for people having trouble standing or moving through the line, to answer questions prompted by a pre-shot screening process and to respond when a patient has a reaction to a vaccine.

“That’s 99.9% of what we do there,” Slater said, “and then the rest is true medical emergencies.”

Medical emergencies have been rare so far, but they’re certain to happen, given the sheer number of people expected to be vaccinated at the clinic over the next few months, said Bo Miller, St. Charles’ medical director of provider informatics.

“We want to vaccinate as many people in Central Oregon as possible in the clinic,” he said. “When you have thousands and thousands of people, many of them elderly or with pre-existing conditions, the probability of a serious medical event unrelated to the actual vaccine is very real. We accounted for that and have a system to handle emergencies, no matter how uncommon they are.”

To date, St. Charles has spent around $250,000 on the vaccine clinic, Miller said, stocking medical supplies, upgrading the WiFi, paying for interpretation services and incurring other expenses to ensure patients are as safe as possible during their visit.

“We want people to be confident they can come here, get their shot and go home, and we’re watching out for them every step of the way,” Miller said. “If something goes wrong, we’re as prepared for it as we can be.”

DALE’S STORY

Dale Cheney of Redmond was scheduled to get his second dose of COVID-19 vaccine at 8:30 a.m. on Feb. 18. But he was up and ready to go by 7 a.m.

“I told him he should go ahead and go if he wanted to,” said Dale’s wife of 63 years, Judy. “So he left, and he had his cane with him because his back always bothers him if he has to stand for a while.”

Judy, 84, didn’t think anything of sending Dale to his appointment on his own. “He was in excellent health,” she said.

Dale, 86, arrived at the fairgrounds to find a line of about 50 people waiting to enter, Judy said, but a man near the front of the line saw his cane and invited him to jump in ahead of him. Once inside, Dale was escorted past the switchback section of the process and taken directly to a vaccination table, where he received his shot, she said.

From there, Dale walked to the respite room and took a seat to wait 15 minutes to make sure he didn’t have a reaction to the vaccine. After about five minutes, he looked up, Judy said, and made a mental note of how long he’d been there.

And that’s when Makena Forestell, a combat medic with the Oregon National Guard and a pediatric medical assistant at Mosaic Medical in Bend, heard Dale’s cane hit the linoleum floor.

“It drew our attention to him as he collapsed,” said Forestell, who was standing just a few dozen feet away. “We ran over to him, and when I saw other people initiating First Aid and blood all over his face, I went to grab gloves and gauze.”

Cheney had suffered a heart attack — unrelated to the vaccine he’d just received — and tumbled forward out of his chair, landing on the floor and breaking his nose. The first people to reach him were Forestell and Tiffani Soliz, a combat medic with the Guard and a medical assistant for Mosaic Medical in Redmond who, according to Forestell, “took charge of the situation immediately” by starting CPR and calling for an automated external defibrillator (AED) when she couldn’t get Cheney’s pulse. Soon, they were joined by paramedics from Redmond Fire & Rescue, as well as Slater, who immediately recognized Cheney’s affliction.

‘HE WAS DYING’

“I’ve seen a lot of dying people, unfortunately, in my career, and he was dying,” Slater said. “He was grey. He was struggling to breathe. He was clearly having what I thought was a cardiac event.”

The group worked to clear Dale’s airway and administered CPR while Forestell attached the AED to his body. After one shock and more CPR, a second shock — combined with a dose of epinephrine — brought Dale back to life, Slater said. He was then transferred to St. Charles Bend for further evaluation and treatment.

A week later, all involved were quick to credit others for the save. Soliz said a sheriff’s deputy did a good job of keeping onlookers away and helping to protect Dale’s privacy. Slater praised the “spectacular” work of the Guardsmen and the Redmond paramedics. Soliz also said the impromptu team worked incredibly well together. “I’ve seen established ER teams that didn’t work together as well as we did,” she said.

“Thankfully, this happened in a place surrounded by doctors, medics, paramedics, EMTs and nurses,” said Forestell. “We were able to get to him quickly and it worked out alright.”

For Judy, her husband’s good fortune started earlier in the day.

“The way it all came together — that he went an hour early, the man who called him to the front of the line — it all led to him being in that chair at that moment,” she said. “Had it been just a minute’s difference, he could’ve fallen while he was walking. He could’ve had it in the car. He could’ve died at home.”

THE SYSTEM WORKED

Besides staffing the clinic with the right people and positioning them effectively, Miller and a group of St. Charles caregivers worked diligently before the clinic opened to make sure the right equipment, the right medications and the right protocols are in place and ready for the most likely medical emergencies. They brought in a fleet of golf carts to transport mobility challenged people from the parking lot to the front door, and they placed wheelchairs strategically throughout the facility. They even closed half the bathrooms to give people less space to roam between their shot and the respite room.

Not all of those factors directly affected Dale Cheney’s incident, but it’s that kind of planning and attention to detail that put him in the right place at the right time and surrounded him with the resources that saved his life.

“It’s never a good day to have a heart attack, but if you’re going to do it, it’s best to do it in front of a system designed to rescue you,” Slater said. “The system is designed to give us the best chance of saving somebody, and this is evidence that it worked.”

EPILOGUE

Dale Cheney was discharged from the hospital a week after his heart attack and had a few days of feeling good at home, said Judy, his wife. But then he stopped eating and started losing strength, and on the first day of March, he went back to the hospital, where he was diagnosed with pneumonia.

He passed away late in the evening on March 5.

Judy is devastated, and she is also grateful to the people who cared for her husband that day at the fairgrounds. She’s thankful that their life-saving efforts gave her a couple more weeks to talk to Dale and take care of him.

She said she has asked God why He saved her husband only to take him a short time later, and she thinks she knows at least part of the answer.

“What happened to him that day was a miracle,” she said. “And we need to tell people about it to let them know that miracles do still happen.”

A tiny seed is having a big impact on breast cancer care.

In partnership with Central Oregon Radiology Associates (CORA), St. Charles Cancer Center has begun using Magseed—a tiny, iron oxide “seed” that is implanted in a cancerous breast tumor to mark its location for surgery. Equipment needed to use Magseed was purchased with money from Sara's Project, a St. Charles Foundation fund dedicated to easing the challenges of breast cancer for people in Central and Eastern Oregon.

The Magseed is a substantial improvement over the metal wires that were formerly used to guide surgeons to tumors that are otherwise too small to find, said Dr. Kelly Hewitt, a University of California San Francisco fellowship-trained breast surgeon who joined the Cancer Center in October.

“As you can probably imagine, that can be fraught with issues,” said Hewitt, who prior to her fellowship worked as a general surgeon in Newport, Ore.

The thin wires, which usually had to be placed the day of surgery, could sometimes become dislodged when the patient traveled from the radiologist’s office to the hospital, or in the operating room, she said. And because the wires could be unwieldly, they had to be taped to the patient’s breast until she was in the operating room.

“From a system standpoint, it’s also a scheduling nightmare because they have to put the wire in at a certain time and coordinate it with surgery, etc.,” she said.

Placed by a radiologist in the breast tissue, the radiation-free Magseed marker won’t move or break, and can be placed days, weeks and even months ahead of surgery, Hewitt said. During surgery, she waves a wand-like localization device over the breast that guides her to the seed, targeting where the incision needs to be made.

“It really lets me pick my incision based on aesthetics and safety,” Hewitt said. “Sometimes the wire can kind of dictate where you have to go, but with the seed, it gives you more flexibility.”

Hewitt said she has even implanted the Magseed—which is so small it can’t be felt by the patient—in lymph nodes that need to be removed as well.

The only fellowship-trained breast surgeon in Central Oregon, Hewitt said she is excited to be able to use this new technology to improve care for patients.

“It’s all about perfection and doing something that is both oncologically safe—so, getting all of the cancer out—but then also making it look as nice as possible,” she said. “So, having the best aesthetic outcome in combination with the best oncological outcome.”

Heads up: Dr. Kelly Hewitt will present "Breast cancer in 2021: Diagnosis to survivorship" at our next installment of Doc Talks on March 29.

In recent weeks, media outlets, health care organizations and others around the world have been marking the one-year anniversary of COVID-19’s unwelcome arrival into our lives.

What a year it has been.

When I think back, I cannot remember when or where I first read about this new novel coronavirus, which started in China in late 2019 and spread to the United States in January of 2020.

What I can remember is the day the first presumptive positive case of COVID-19 was confirmed in Central Oregon: March 11, 2020. I remember attending a hastily organized mid-day meeting, where the overriding mood was not one of worry or panic, but of confidence and resolve. We had been preparing for that moment for months, and we knew that while the disease was unpredictable and the future was uncertain, our health system was ready to handle it.

I also remember watching my colleague, Dr. Jeff Absalon, and other local officials speak at a press conference that afternoon. “This,” said Dr. Absalon, St. Charles’ chief physician executive,  “is what we do.”

To be clear, he was not talking about holding press conferences. He was talking about caring for people who are sick.

That is what we do here at St. Charles, every single day. It is our commitment to ourselves, our commitment to each other, our commitment to our communities and our commitment to you.

Of course, there have been tough stretches over the past year. Preparing for and responding to COVID-19 has been a massive operational undertaking for our health system. It has dealt a financial blow to our organization. It has changed the way we do just about everything, from the bedside to the board room and all points between. And it has certainly tested our frontline caregivers and our first responders.

Have there been uneasy moments? Definitely. We are human beings, after all. But again and again over the past year, I have seen our people rise to the challenge, whether that challenge is figuring out how to quadruple a hospital’s patient capacity without expanding its footprint or how to give a dying woman the birthday celebration she deserves, even in isolation. Now, they’re heavily involved — alongside Deschutes, Crook and Jefferson counties and the Oregon National Guard — in the complicated regional effort to end this pandemic by vaccinating as many people as possible as quickly as possible. And they’ve done it all during a time of unprecedented upheaval in both their professional and their personal lives.

I have said it before and I’ll say it again: I feel incredibly proud and fortunate to lead the 4,600 caregivers who make St. Charles Health System such a great place to provide and receive care. Through a year of dizzying ups and downs, they have been a steadying force every step of the way.

Sincerely,
Joe

Rachel North was on the other side of the parking lot lane at the Deschutes County Fair & Expo Center when an elderly woman started shouting questions at her.

“How am I supposed to get in this thing?” the mobility-challenged woman barked as she tried to maneuver into a golf cart. “I can’t get in this thing. I need a wheelchair!”

Her tone was either impatient and mean or simply firm and direct, probably depending on the disposition of the person to whom it was directed. In North, she had found the perfect recipient.

“We’ve got wheelchairs,” North said gently, with a big smile on her face. “You get back in the car and wait, and I’ll make sure we get a wheelchair out here to you.”

As she pulled away from the woman’s car, North laughed good-naturedly at the exchange. “I work for the Transportation Security Administration (in the Redmond Airport), and that can be a little rough, you know?” she said. “I’ve been seasoned. I’ve got days and days of stories. This is a piece of cake for me.”

It was a Saturday morning at the fairgrounds, and hundreds of people age 75 and older were arriving to receive their first dose of the COVID-19 vaccine. The weather was cold and unusually blustery, and patchy snow and ice on the ground made access to the large-scale vaccine site inside — operated by St. Charles and Deschutes County, with help from the Oregon National Guard — particularly tricky.

That’s where North and her fellow golf-cart drivers came in. Their mission was simple: Crisscross the parking lot looking for cars with their hazard lights blinking. That was a sign that someone inside (or standing nearby) needed assistance.

“Sometimes,” she said, “they might be waving their arms or honking their horn.”

North is just one of “several hundred” volunteers who have helped make the fairgrounds vaccination site a success over the past few weeks, said Trevor Janeck, a talent acquisition manager at St. Charles who is helping to oversee the volunteer effort. In addition to ferrying people from the parking lot to the door, volunteers are greeting people as they enter, registering patients and helping guide them through the process, among other jobs.

Their efforts have not only been a vital part of the operation so far, they’ve been inspiring, Janeck said.

“The response from the community on this has been incredible,” he said. “Everyone who has volunteered has been so kind and so willing to do whatever it takes to make this place work as smoothly and efficiently as possible. And almost every one of them says more or less the same thing: ‘It’s just so important that we get this vaccine to people, and I want to help however I can.’”

More than 1,000 people have signed up to volunteer at the St. Charles website and at Deschutes County’s website, which is more than the fairgrounds site can even use.

“We’ve had to turn people away,” Janeck said. “It’s just been overwhelming.”

One of those volunteers is Teague Hatfield, owner of the Birkenstock store in downtown Bend. On a recent weekend, he was stationed just outside the clinic, greeting everyone who walked by and funneling people toward the check-in area. He said he signed up after a co-worker volunteered and encouraged him to do so.

“I came out a couple days ago and, honestly, it was just a ball,” he said. “People were in good spirits and it felt like it was helpful, so I came back to do it again.”

Hatfield said he was impressed by the operation and planned to take a shift per week as long as volunteers are needed.

“We’ve all been sitting around waiting for something to happen, so this is exciting that it is happening,” he said. “And being out here, like 99.9% of the people have been friendly and appreciative and the whole bit. This is what I’ve done my whole life, just talked to people.”

On the other side of the clinic, Wendy Worstell stood near in the hallway between the vaccination area and the recovery room, where patients are asked to wait for 15 minutes to make sure they don’t have a reaction. Her job? To make sure no one wandered through without getting their shot.

Worstell is a retired registered nurse with a daughter who teaches for Bend-La Pine Schools. She is currently splitting time between Central Oregon and Eugene and said she came to the fairgrounds to do whatever she could to help.

“I just think it’s hugely important that when we have a pandemic like this, that whoever can step up steps up and helps get the vaccines out there,” she said. “This has been wonderful. I’m so impressed.”

Back out in the parking lot, North dropped off one woman at the front door and started backing her golf cart up to make another run into the sea of blinking hazard lights. With her knit hat pulled down to her eyebrows and her mask up over her nose, she looked like she could’ve been warmer at home. But that really wasn’t an option, she said.

“I volunteer for the Assistance League of Bend. I volunteer for the Nature Center in Sunriver. It’s what you do when you live here,” she said. “I just had the day off and I could sit inside and watch Netflix or I could come out and do a nice thing for people.”