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For Chris Kline, a hip replacement isn’t a choice. 

Kline, 65, is on his feet hours a day as he cuts, colors and styles hair at a St. Paul salon. He’s been at it since he was 19.

“I don't think standing on a hard surface for 45 years does any good either,” Kline said. “So it's just to the point where they wear out and you’re bone on bone.”

Kline had his right hip done a few years ago and was supposed to go in for the left in December. But he was notified 24 hours before his surgery that it was off.

“They kicked me to the curb because they didn't have the staff,” Kline said. “And he [a care adviser for the hospital] said, 'We'll be getting in touch with you again.’ And of course, we haven't heard anything yet. So he said, ‘You might have to wait till April.’”

The reason for the delay? A surge in COVID-19 cases put hospitals in a bind. Many procedures got shelved to free up staff and resources.

What Kline is experiencing is also a phenomenon tied to national health care workforce shortages driven by the pandemic, said Kaiser Family Foundation researcher Krutika Amin.

“Not only do we have lower employment in the health sector than before,” Amin said, but there has also been increased demand for health care workers due to COVID cases and hospitalizations.”

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Delays in what are called elective procedures can be traced back to the early days of the pandemic when hospitals were ordered to halt them, said Johns Hopkins Center for Health Security infectious disease physician and senior scholar Dr. Amesh Adalja, but the nomenclature is misleading. 

“Lots of people have the connotation of ‘elective’ meaning a nose job or cosmetic surgery,” Adalja said. “But what elective means is that it has some scheduling flexibility. And it could be something as serious as an aortic valve replacement.”

The mandates that halted elective procedures aren’t around anymore, but hospitals are still digging out from the pile of work that started accumulating the moment electives were paused. And hospitals have had to pull back on procedures during wave after wave of COVID-19 cases that have clogged hospitals around the country, Adalja said. 

In the worst cases, delayed care has led to cancer being detected too late and cases of other preventable diseases. 

And delays in treating people for non-life-threatening problems are contributing to the already pronounced mental health struggles of those living through the pandemic, Adalja said.

“I would say that many people who have chronic problems do have psychological stress over it,” Adalja said. “When you add the uncertainty of the pandemic to that psychological stress, it's only going to compound it.”

Heidi Alexander of Maple Grove has been waiting months for a hysterectomy meant to alleviate near-constant vaginal bleeding that started last summer. 

Through the fall, Alexander tried a less invasive procedure to staunch the bleeding, but to no avail. She made multiple trips to the emergency room when she feared she was losing too much blood. Medication helped eventually, but came with additional health risks. 

For Alexander, 50, the toll it has taken on her and her family is far-reaching. 

As a single mom, it’s prevented her from finding a job in her field as a translator, and she’s had to dip into savings.

“I don't want to be starting a job, where, all right, I might have to take some extra time off if this bleeding reoccurs,” Alexander said. “I’m definitely going to have to take time off with the surgery.”

Alexander is scared to do some of the activities she loves most with her daughters for fear she will start bleeding uncontrollably — bittersweet as she considers her eldest, 17, will soon graduate high school. 

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The medication she took to control the bleeding has caused varicose veins that Alexander will eventually have to seek medical attention for.

For now, Alexander says her bleeding is under control, and her hysterectomy is scheduled in April after she takes her daughters on one final spring break vacation before her eldest heads to college. 

But Alexander worries about the imprint her experience has left on her daughters, especially her 10-year-old.

“It’s just really quite traumatic for my younger one because I had bled through on several occasions, in bed, my clothing, down my legs, wearing shorts and skirts in the summer,” she said.

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As for Chris Kline, when he forgets to take Tylenol on time, his pain causes nausea. 

“Pain does terrible things to you, you know, it changes your personality,” Kline said. “You don't think straight?” 

His wife Stephanie has learned to watch out for mood swings in her husband of almost 50 years, which can sometimes crop up when he’s playing with his grandkids.

“When he's with kids, I call him Herman to be careful because that's his crabby grandfather's name,” Stephanie Kline said. “So then he answers, ‘I don't want the boys to remember me as crabby grandpa.’ So he has to chill out a little bit.”

And the torture of needing a joint replaced has worn on his mental health — during the already trying time of the pandemic, Chris Kline said. 

A walk around the neighborhood is out of the question. Traveling even a few hours by car is too painful. 

Between his age, the loss of clients during the pandemic and his hip, he’s feeling pressure to retire.

“I wanted to do it on my own terms, and I think COVID has kind of taken over that. So I'm not going out on my terms,” Kline said, adding that it has taken a toll on his self-esteem.

Beyond the pain, Kline is angry that some people opted against being vaccinated, because they’re now straining the health care system, pushing out people who need routine procedures.

“I have to bite my tongue a lot. Because I have people that come in [the salon] who are anti-vaxxers,” Kline said. And they talk about their rights. The way I feel is that they took some rights away from me, inadvertently.”

As he waits for surgery, the Kline’s lives are on hold. 

They missed Thanksgiving with family in 2020 because of their own bouts with COVID-19 and skipped it last year to guard against it as his planned surgery approached. 

They’re vaccinated yet still vigilant. Kline worries one exposure could throw prospects of his hip replacement out the window again.

“And if I come into the surgery time with a positive test, I'll be chopped off,” he said. “You get put at the end of the line."

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Catharine Richert

Throughout the pandemic, hospitals pulled back on elective procedures periodically because of a rush of COVID-19 patients and staff shortages. Those postponed treatments will take months to reschedule after the latest COVID wave subsides, leaving patients to cope with the emotional and physical toll of delaying their care.

Delayed care during pandemic takes huge emotional toll

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