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A registered nurse in Montana has spoken of the toll the pandemic has taken on rural healthcare services.
Joey Traywick, 48, told National Public Radio he arrives at work every morning with an "ominous feeling".
"You start realizing you're kind of going into the heart of the beast," he said.
Traywick works in the coronavirus unit at St. Vincent Healthcare in Billings.
The facility, which has three COVID-19 units, treats the local population of more than 100,000, along with critically ill patients from across the state.
Traywick has worked in one of the units since February.
In recent months, he has given interviews to national and local media, describing how the pandemic has pushed rural healthcare to the limits.
Traywick, who has 15 years' experience as a nurse, said he thought Montana would "dodge a bullet", with the state not seeing many of the virus' effects.
"We're not overwhelmed, but we're in it," he said.
"We're not dodging the bullet. We're absorbing it, we're tolerating it and we're able to treat the patients.
"We do the best we can. We're rural medicine-500 miles (804 kilometers) in any direction, we're it. We like to say that we have more cows than people in Montana."
In addition to the impact the virus has had on patients, it has affected their caregivers, with Traywick himself experiencing a bout.
He said he misjudged just how serious the condition of one of his patients was. By the time he returned to her room, she had died alone.
"I thought, 'I'm never going to let that happen again'," he told NBC News.
"They're not going to pass alone on my unit again. None of them."
Since that incident, Traywick said he has held hands with 23 patients who died.
"I never thought it would happen here," he said. "I never thought we would be anywhere close to where we are now.
"I'm a good nurse-and the nurses I work with are good nurses-but we are broken."