Daniel Bear lives in Kenilworth, Utah, a small community of around 200 people between Salt Lake City and Moab. Earlier this year, Bear suffered a woodworking accident that involved his hand and a tablesaw. It was messy.
"It cut through the bones on the backside of my hand," Bear said. "But it didn't like cut - which I'm super grateful for - didn't cut like down those tendons on the bottom of the hand."
It was clear that Bear would need surgery, but scheduling the procedure wasn't easy, partly because Salt Lake City is two hours away. The pandemic proved to be the bigger obstacle, though, because it prompted hospitals to postpone elective surgeries. Bear's surgery got pushed back about six weeks.
"At this point, physical therapy is going to be a little harder just because my fingers have been in a certain position for longer," Bear said in early June a few weeks after his surgery. "So I'll definitely have to do extra work."
Patients all over the country have been in the same boat. The pandemic put elective surgeries - from knee replacements to Lasik eye surgery to hernia repairs - on hold. In parts of the Mountain West, the situation highlighted long-standing barriers to health care.
Eric Quallen is transgender and had long been preparing for a double mastectomy and reconstruction surgery for a male chest.
"My chest is really the last part of me that is reminiscent of this person that I was trapped as being, you know, for 24-odd years," he said.
Quallen lives in Laramie, Wyoming, where he found it difficult to make the gender confirmation surgery happen in the first place.
"There are a lot of hoops you have to jump through to make sure that your insurance will approve," he said. "You need to get referred by your other doctor and in my case, I have multiple doctors, and most of them are in Denver because I can't actually get - you can't really get transgender healthcare in Wyoming."
Plus, Quallen's a PhD student with an intense fieldwork season that requires lifting heavy things and hiking across large landscapes - things you can't do while recovering from surgery.
"It took a lot of planning and it really threw a lot of things off," Quallen said.
When hospitals started performing elective surgeries again, Quallen's could only give him a tentative date, because the backlog of elective surgeries piled up fast and created a bottleneck.
"Once we reopened, a lot of those health care providers just really wanted to get those patients taken care of and meet their needs," said Kyle Cameron with the Wyoming Department of Health.
The hospitals also had a significant financial incentive. Most of them rely heavily on elective surgeries for revenue. But from the patients' experience, the resulting congestion at hospitals worsened existing health care barriers.
"You live in this small town, but there's not health care available for you, so there's that disparity of traveling 35 miles to get the kind of healthcare that you want," she said.
This is a long-standing problem in small towns across the Mountain West.
"They don't have a specialist," Cameron said. "And honestly, in a lot of these small rural communities, they have a hard time even attracting a primary care physician."
Both Daniel Bear and Eric Quallen have been able to schedule and complete their surgeries. But if the current surge in COVID-19 cases forces hospitals to again delay procedures, those procedures will pile up, causing long wait times for patients already at a disadvantage, and dealing hospitals another financial crunch.
Have a question about this story? Contact the reporter, Maggie Mullen, at firstname.lastname@example.org.
This story was produced by the Mountain West News Bureau, a collaboration between Wyoming Public Media, Boise State Public Radio in Idaho, KUNR in Nevada, the O'Connor Center for the Rocky Mountain West in Montana, KUNC in Colorado, KUNM in New Mexico, with support from affiliate stations across the region. Funding for the Mountain West News Bureau is provided in part by the Corporation for Public Broadcasting.