DAYTON, Wash. — The state’s vaccination deadline for health-care workers was less than a week away when Shane McGuire called his HR department for another daily update. The CEO of tiny Dayton General Hospital listened to the phone ring as he squeezed a stress ball and straightened the sign he’d hung on his office door in the latest effort to unite a fracturing staff: “We Are One.”
“How’s it looking for us on the mandate?” he asked, when the head of HR picked up.
“You mean in terms of the emotional fallout, or just numbers?”
“Numbers. I can handle the numbers,” McGuire said, and a few minutes later he opened his email and studied the list that had been dividing this rural hospital in southeast Washington ever since the governor issued one of the country’s first vaccine mandates in August. Dozens of McGuire’s employees were still marked as unvaccinated. At least 15 were in the process of applying for religious or medical exemptions, a few had already quit in protest, and many more were facing termination unless they decided to vaccinate against the coronavirus in the next five days before the mandate went into effect.
McGuire liked to refer to his small staff as a family, and many in fact were family, but it had been splitting in two since the beginning of the year, when exactly 50 percent of the hospital’s few hundred employees chose to be vaccinated and 50 percent refused. McGuire had lined up for the first dose he could get, believing it marked an endpoint to the pandemic; his 25-year-old daughter, Jessica, an employee in the hospital clinic, decided she didn’t feel comfortable getting vaccinated for at least a year. His medical director told the staff that mass vaccination was “safe, wildly effective and absolutely necessary.” His director of nursing wrote that it was “government overreach and medical tyranny.” His two respiratory therapists were a husband-and-wife team, married 40 years, and now one was vaccinated and one was not.
McGuire had spent the last nine weeks gently pushing his staff to vaccinate by the deadline, because he feared parts of his hospital would have to close if he lost too many employees, and also because he believed vaccination was the right and responsible thing to do. He’d asked the pharmacist to send out mass emails with data about safety and efficacy. He’d consulted with a leadership coach, who spoke about the transformative power of treating everyone with kindness and grace, regardless of their beliefs.
“Let’s not jump on the slippery slope of judgment with regards to vaccination status,” McGuire had written to the staff in late August. “We are NOT the vaccinated and un-vaccinated. There is only one team.”
“It’s our intention to retain every employee who wants to be here,” he’d written in September. “Please come talk to HR before you walk away assuming there are no options.”
Now he twisted a paper clip in his hand and looked over the list of unvaccinated colleagues he feared he might soon lose: a nurse who did most of the drive-through coronavirus testing, swabbing a dozen patients per hour; an eldercare specialist who read books aloud to her patients to help keep them company; four health aides; three people in nursing; two in dietary; one each in finance and IT.
And then there was the only administrator on the list, Katie Roughton, director of nursing, who had managed to lead the hospital’s nursing home through the pandemic without suffering a single covid death. She’d trained new employees on infection control, declined her own pay raises to help the hospital save money and helped run the annual flu vaccination program, but now she was on the verge of leaving over a different shot.
“Kindness and grace,” McGuire reminded himself, and then he sent Roughton a message.
“I’m sure this final countdown is hard,” he said. “But I just want you to know how much we value and appreciate you.”
* * *
For most of the last 25 years, Roughton had been walking or driving a half-mile each morning from her house into the hospital she sometimes called her “real home.” She’d started as a nurse’s aide right out of high school, saved to put herself through nursing school, eventually risen into administration, and now she was standing at the front of a small conference room, teaching five aspiring nurse aides how to care for the patients she was thinking of leaving.
“How long does the state say you need to wash your hands?” she asked her students. Her voice was hoarse and her eyes were red. For the last week, she’d been having periodic breakdowns brought on by what she thought was “grief, stress, anger, frustration.”
“You have to wash for one minute,” a student answered.
Roughton stared back at him and cocked her head. “Come on. I might not be there on-site to correct you.”
“Good,” she said. “In health care, you either follow the rules or get cited.”
The bulk of her job for the last 18 months had involved learning and incorporating new state rules to prevent the spread of coronavirus. Nursing homes were the most regulated part of health care, so during the pandemic she’d demanded more masks for her staff and taken charge of the hospital’s hazmat team and disaster committee. She trained her staff to follow a dozen state and federal mandates, but as the initial weeks wore on, she began to question their value.
Her staff needed to wear N95 masks at all times, but many of their residents were hard of hearing and couldn’t understand what was being said to them.
Her residents were also supposed to wear masks, but some suffered from dementia, and they often forgot, or refused, or placed the masks over their eyes, or, in one case, started swallowing part of the mask and choking on it.
The governor banned all nonessential procedures, which meant postponing a gallbladder operation for a 90-year-old who started to lash out as his pain worsened, choking one nurse and biting another nurse’s finger down to the bone.
The residents were not allowed to have visitors, which meant some began to suffer health declines from what doctors said was loneliness and depression. Roughton and her staff took extra shifts to keep them company, threw them weekly parties and dressed in costumes to entertain them.
And for an entire year, it mostly worked. They kept covid out of the facility for longer than any other nursing home in the state and planned a party to celebrate. Then, on the day their “Covid Free!” T-shirts arrived, two residents tested positive. One had been vaccinated; one had not. The state required all residents to quarantine in their rooms for at least two weeks. Roughton was trying to explain the policy to a 102-year-old woman who was banging on her own door, begging to come outside, when Roughton got a call from one of the hospital’s doctors. “How do we handle infection control?” he asked, and Roughton felt herself snap. “Do you want my personal or professional opinion?” she asked, and before long she was prodding him about the breakthrough infection and the science of vaccines, and he was calling her “stupid,” and they were screaming at each other — doctor against nurse, liberal against conservative, no longer partners in patient care but adversaries staking out opposite sides in an ideological battle that Roughton had been fighting since.
Regardless of scientific facts or the vaccine data, she believed what she was hearing on her TV, her computer, the local grocery store, her own family dinner table: The vaccines were rushed and oversold, and worse yet the state mandate signaled the government’s latest attempt to seize greater control. It was an infringement on individual rights. It was socialism. Her father-in-law had taken an experimental anthrax vaccine before deploying for the Gulf War, and he blamed the side effects for making him permanently disabled. Four of her family members were being forced to quit their jobs over vaccine mandates, and they were encouraging her to do the same.
“If you’re going to make it in health care, this has to be more than a job,” she told her students. “You’ll work like hell. You won’t get rich. But you do it because you really care about the patients.”
She paused and cleared her throat, trying to hold off another breakdown.
“It has to be a passion, because there’s always that personal sacrifice.”
* * *
One coffee shop in town required masks; another displayed a sign encouraging “Freedom for your Face.” The local brewery instituted a vaccine mandate for employees; a pizzeria placed a job ad promising: “No vax, no problems!” It sometimes seemed to McGuire that covid protocols were splitting apart the school board, the business alliance and the entire town of 2,700 into two rival factions, and there was only one person left on the opposite side with whom he felt comfortable enough to have an honest conversation. As the deadline neared, he drove to a quiet restaurant to talk to his 25-year-old daughter.
“These are good nurses we're losing, and I still can’t totally understand it,” he told her.
“Some people just think differently,” she said. “They feel differently. It doesn’t mean you can just dismiss them.”
“We all care about the same things,” he said. “I have to believe there’s still a possibility of common ground.”
“Maybe,” she said. “But what if it's a wall?”
“Then it’s my job to climb over it,” he said, and for months he’d been trying, encouraging his employees to come directly to him with their concerns about the state mandate. He’d listened to false claims about how the vaccines implanted people with microchips, or made them magnetic, or infertile, or increased the spread of the virus, or fundamentally altered DNA. He’d read through a stack of applications for religious exemption and tried not to judge, but to empathize.
“It’s the mark of the devil.”
“It’s the equivalent of unclean food that causes harm to my conscience.”
“It’s a violation of the Nuremberg Code and a medical crime against humanity.”
He waited as some of his employees consulted with their own lawyers and posted disinformation on Facebook, and since data and facts didn’t seem to be changing their minds, McGuire decided to appeal to their common humanity. He asked one of his new nurse practitioners to talk to the staff about her experiences treating covid in rural New Mexico. She spoke about setting up a field hospital near a Navajo reservation where hundreds of people had gotten sick, including her stepbrother, a healthy young father who suffered a sudden inflammatory response and died at home before he could get to a hospital.
“If I wanted to listen to more propaganda, I’d turn on the news,” one nurse said to McGuire, shortly after that presentation. “That was insulting and manipulative.”
“Thanks for sharing that with me,” he’d responded. “I’m sorry you felt that way. It certainly wasn’t our intention.”
McGuire had come home each night and tried to burn off his frustration on a stationary bicycle as covid cases skyrocketed across rural Washington in early fall. Dayton’s emergency room filled. The patients got sicker. Sometimes, at the height of the surge, the closest ICU with an available bed for a transfer patient was in Texas or California, and McGuire wondered: How? How had the rate of covid cases in rural Washington doubled after the widespread availability of safe and effective vaccines? How had so many people on his medical staff seemingly come to distrust science and medicine? One day he was riding in the car with his daughter, trying again to understand. “I can’t logic this out,” he said. “Please, help me.” He’d listened as she explained that she didn’t like the politics of being forced to take a vaccine, that it was her body, that she was young and healthy, that she feared rare side effects, that she didn’t trust the government, that she wanted to see more data, until finally he couldn’t listen for a second longer. “Stop!” he’d shouted. “Stop talking about statistics. You failed that class three times!” And then she started crying and asking to get out of the car, and he started crying because he feared the wall between them had hardened.
She had surprised him a few weeks later by deciding to get vaccinated along with five other employees at the clinic, some of whom considered it such an act of political betrayal that they vowed not to tell their families.
“What changed for you?” McGuire asked now. “Did our conversations make a difference?”
She shook her head. “Nothing changed. I did it because I had to, but I still don’t feel good about it. I feel exactly the same way.”
“Could anything change that?”
She shrugged. “You can take a reasonable person and make them unreasonable by pushing them. Maybe just respect. Patience.”
* * *
But there was hardly any time left for McGuire’s employees to decide, and in the last hours before the deadline Roughton went to see a former co-worker who’d already made her choice official. Tiffani McGhee had spent 27 years as an EMT, a firefighter and nurse before quitting a few weeks earlier.
“How’s life on the outside?” Roughton asked.
“Lots of sadness, lots of anger, but I wake up each morning and I have my freedom,” McGhee said, and then she started to describe what she imagined her life of freedom would look like. She planned to move to a remote property in the hills outside town, away from the “mask shaming and the reach of big government,” she said. She was teaching herself how to can vegetables and stockpile enough food to be self-sufficient.
“I’m the kind of person that doesn’t like being backed into a corner,” she said. “Don’t tell me: ‘You have to do this.’ It’s against my rights.”
“That’s me, too,” Roughton said. “I’m a stubborn ass and proud of it. I don’t take the easy way.”
It was the reason she’d kept her baby when she’d become pregnant during her sophomore year of high school, and why she’d walked home from class every two hours to breastfeed even when classmates teased her, and why she’d clawed her way off welfare, and why she’d survived an abusive relationship and found her way into a happy marriage. She’d been thinking lately about an incident in high school, when one of her best friends was killed in a drunk-driving accident that devastated the town. Hundreds of people had packed into a memorial service, and the pastor had started an altar call, urging students to devote their lives to God in honor of their friend. Roughton thought it was a shameless and coercive tactic, but one by one the other teenagers started coming onto the stage in their grief. The pastor and other students began calling her name, pressuring her, until after a while she was one of the few students left in the bleachers, still anchored firmly in her seat.
“Sometimes you have to take a stand,” she said.
“You’re damn right,” Tiffani said. “I started tearing up this morning watching all these nurses walk out around the country on Fox News.”
Roughton frowned and shook her head. “You’ve got to give that up,” she said.
“Fox News. I heard they did their own mandate. I switched over to Newsmax.”
It was the latest piece of her life she’d surrendered on principle: Sunday afternoon football, after the players started to kneel during the national anthem; her Costco membership, after the store mandated masks; regular dinners with her parents, after she saw a Joe Biden sign in their front yard. During the last several months, she’d started talking to her husband about leaving liberal Washington and moving with their children and grandchildren to Montana or Idaho.
“Me and this place — we’re going in separate directions,” she said, which meant she knew what she wanted to do.
* * *
She packed a box of her supplies and drove to work at the hospital for the last time dressed in a shirt that read: “Born Free. Live Proud.” She walked into the nursing home without a mask and stopped to say goodbye to some of her staff. One nurse came up to her and confessed that she’d gotten vaccinated before the deadline because she couldn’t afford to lose her job. “I feel tainted,” she said, and Roughton squeezed her hand. Another aide said she’d been granted a religious exemption thanks to a letter written on her behalf by her uncle, a pastor in Florida.
“I caved,” she told Roughton. “I wasn’t as strong as you.”
“I don’t feel strong,” Roughton said. She smiled and waved at two of the residents, who were rolling their wheelchairs into the cafeteria for lunch. “I better get out of here before I lose it,” she said.
She walked out the door toward the administration building. McGuire was sitting at his desk, working his stress ball. He saw her T-shirt and he knew.
“So, this is it,” he said.
She showed him her set of master keys and dropped them on the nearby desk.
“We’re going to miss you,” he said.
“You could have made this a lot easier by being an a--hole,” she said.
“There’s always going to be a spot for you,” he said. “This isn’t the end of our story.”
She nodded, blinked back tears, and walked out to her car. McGuire watched her go and turned back to the list on his computer, checking the final numbers as the deadline arrived. Seventeen employees had been granted religious exemptions. Two had left to take health-care jobs across the border in Idaho. Nine more had either quit or chosen to be fired. But at least 50 employees had gotten vaccinated in the last weeks as a result of the mandate, and McGuire had retained more than 90 percent of his staff.
“There are no words to express how incredible this is, knowing how hard the decision has been for many of you,” he wrote to his staff.
He asked the HR director to post a few of the new job openings online. “I’m glad we got through it,” he told her, but then a while later McGuire looked beneath the postings at the comments, which pointed not to an endpoint but to a widening divide and the work still ahead.
“Stop firing good people in the name of socialism.”