Front Burner - Intensive care on the brink

Episode Date: April 14, 2021

Dr. Shelly Dev and Dr. Alex Wong, two physicians in two different provinces, describe the desperate situation unfolding inside Canada's hospitals where a record number of COVID-19 patients are being admitted into intensive care.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hi, I'm Jamie Poisson. The situation in Canada's ICUs is the worst that it's been since the start of the pandemic, particularly in Ontario, where COVID variants are spreading beyond control and hitting young people really hard. Patients in the GTA are being moved to other hospitals without their consent.

My colleague Lauren Pelley was just in an ICU in Scarborough where she spoke to doctors and nurses and other hospital staff who are completely on the brink. This is very, very different. Most of us work in the emergency department because we like the adrenaline, but now after a year, we're almost at our limit. We're seeing all walks of life now. The ages are actually coming, even to the younger generation.

I put eight patients on mechanical ventilators overnight, and the hardest part of all of it was the conversations in those moments before you had to do so and seeing them say goodbye because we know that they're going to be on a ventilator for some weeks in a medically induced coma so we can provide effective ventilation. We know probably half of them aren't going to survive. Today, we're talking to two doctors, one here in Ontario and one in Saskatchewan, about how bad it's getting inside ICUs.

First, Dr. Shelley Dev. She's a critical care physician at Sunnybrook Hospital in Toronto. Hi, Dr. Dev. Thank you so much for making the time to speak with me today. Oh, thanks for having me. I appreciate it. So a year and a half ago, what did a day look like for you? Before all this changed, a day in the ICU is on average a really busy day. It's a pretty noisy place. There's a lot of talking, a lot of beeping and alarms from different types of machines.

We like to call it, I think, an organized kind of chaos where there's groups of people, different specialists, healthcare workers, coalescing around different bedsides of patients, talking about what to do, making plans about what to do. A very friendly environment, an environment made of people who feel like they're part of a community. They're very close with each other. You'll see moments of levity and laughter, just people helping each other get through the day. And how is it different now? You know, you lose a lot when you can't see each other's faces.

You lose a lot of what we take pride in in the ICU, which is creating a sense of it being a safe, protected space, especially for our patients and especially for their families. There's a lot of warmth and a lot of comfort that gets communicated in your face. Now it feels more like an environment of fear and an environment of foreboding in a lot of ways. I know that sounds strange because an ICU is not by definition, you know, a happy place by the nature of what's going on. But I think that when you kind of erase the faces of the people who work there, it loses the warmth that you need to have in a place like that to comfort people who need comfort the most. So it's a very sterile feeling environment. And it normally doesn't feel that way.

What effect do you think that that's having on the patients and then on the people that work there, people like you? It's painful. It's emotionally very painful. In the ICU, we have this culture of openness in the sense that we want families to understand that they are an essential part of their loved one's journey in the ICU and an essential part of providing these rooms, you know, where they're cordoned off away from any of those things that gives them their humanity. So when we learn about our patients in the ICU, I learn about them secondhand. I often can't talk to them because they're so sick, they're unresponsive or in comas, connected to mechanical ventilators, and they can't speak to me. So they can't communicate in the way that they would have if I met them in a clinic

setting or if they walked into the emergency department. So my reliance on their families is one where they create this person for me. And so now they're not there. So there's this absence of the life that's attached to that person. And that's so sad to me. That's so sad because that's often what motivates you to push yourself, right? Is that you don't, you have to see beyond what the ailment is. You have to see that this is a person who belongs to other people, right? This is a person who comes from somewhere. I'm a detour in that journey, and I want to get them back to where they were if I can.

Do you have a story or a moment that really sticks out to you that is indicative of that story that you just told? You know, what I do think is important for people to hear is that this is not just in the case of the COVID patients. It's also in the case of all the other patients who don't have COVID whose families also can't see them, right? I was taking care of a patient some months back who was a woman in her 90s and who she belonged to were, you know, two adult children and their families. And so this patient's grandchildren and how painful that was for them, how sad the idea that was of her leaving this life without them with her because she had been with them through

everything. Right. It's incredible to think about how much has been has been lost here. There's so much that has been lost. And I think that we look at grief in the context of someone dying or struggling with an illness. But the grieving is happening, you know, in a way for like all of us who've lost what we knew to be true about our lives, right? And you see that, you know, it's so magnified when illness is involved. But man, like I, you really realize how much you underestimated how essential it was that people get to be together in these really important moments, right? Regardless of how it turns out. So there are at least 600 people in ICUs in Ontario right now. You and I are talking on Tuesday afternoon. And there are projections that it could be 800 by the end of the month. And can you put that into perspective for me, Dr. Deb? What does that mean? That means that the workers who are already so strained, and strain is a word I'm using, you think of it physically, but it's very psychologically and emotionally so strained that this just catapulted into another category. And the category it

catapults them into actually is into the zone of it being an unsafe thing in terms of how we provide care. So what we, you know, I think there's been this absolute, you know, sometimes reasonable at times fixation on do we have enough of, and then fill in the blanks, right? Do we have enough beds? Do we have enough vaccines? Do we have enough at one point PPE or mechanical ventilators, right? And the concerns that we must have even above all that is, do we have enough people who can take care of our patients? Because you can have a billion mechanical ventilators in beds, but if you don't have the appropriately trained and skilled healthcare workers who are in good enough health mentally

and physically to take care of the patients who are in those beds health mentally and physically to take care of the patients who are in those beds, what is going to happen? Right? What will it matter that you have the inanimate resources when you don't have the essential human resources in the best shape possible to take care of the people they need to take care of. And that is what we don't spend enough time thinking about. Right. I saw a Toronto critical care physician tweet the other day about this. He said it took five doctors, four ICU nurses, four respiratory therapists, one perfusionist, and three critical care paramedics to save a 40-year-old COVID patient. And so I suppose the question I want to ask you is,

how worried are you that we don't have those people right now, that we're running out of those people, that they're burning out? I was worried about this before the pandemic. If we cannot take care of our patients properly, our patients are going to suffer. And what I mean by that has not anything to do with do I have enough syringes? It has to do with the worker who's administering the medications, who is there to be present, to be vigilant about what's going on. How okay are they? These are human beings who are at their core, good, decent, kind, compassionate people who are capable of losing the ability to perform in the way that they're required to second by second,

because they too are struggling. Can you tell me a little bit more than how you're seeing that on a day-to-day basis right now because of the influx of patients in the ICUs because of COVID? You see it in many different ways and it's kind of, you know, the ways in which we manifest our distress in medicine. I use the umbrella term of coping. You know, what I would say is when you're in a bad way, you're not at your best behaviorally, right? You know, what I would say is when you're in a bad way, you're not at your best behaviorally, right? And you often will make bad decisions. The worst part of that spectrum of coping, I think, tends to be apathy.

You know, this kind of resignation to what does it really matter? Dr. Dev, can you tell me a little bit more about what's happening with your COVID patients in the ICU right now? This, to me, is like its own separate illness from what we saw a year ago. This is different. So what we're seeing is people that run ages from their 20s to their 60s getting sick. People who do not have any health problems. Lots of essential workers who have to work in factories or warehouses or grocery stores. And their entire families are getting sick. I have really no idea right now how to determine who's going to be okay and who's going to become deathly ill. I just don't know that.

And a colleague of mine and I were talking about this and we said, it's as though after all these years of working and all of the patients we've seen in our lives, I don't have anything to rely on to say, I know this is going to turn out okay because. And that goes beyond uncertainty. It's just, it's profoundly scary and upsetting. And this is so largely an unknown still that, you know, just wrestling with accepting that is so hard. Yeah. And, you know, speaking of this unknown, I know that the provincial government is even considering bringing in a last resort triage protocol, which basically says doctors will get to choose who should get treatment first and in what order. that you might at some point in the near future be faced with this, especially considering what you just said, that it's so hard to know in which direction this could go. I don't know that I have the words to describe that kind of feeling

of that kind of foreboding. This is not how any of us really envisioned practicing medicine. This is not how any of us really envisioned practicing medicine. I am so afraid of thinking about how I could possibly live with that kind of decision. It's creating actually quite a bit of anxiety amongst me and my colleagues, nursing, physicians, all kinds of healthcare workers, that that is something that we'd have to be part of, understanding where that comes from. But it's just emblematic of truly how bad this is. Like this is how far this has come. Dr. Deva, I'm really sorry that you and your

colleagues are faced with this right now. I'm really sorry. I really want to thank you for taking the time. Thank you for having me. I want to just emphasize the fact that for everybody who is making the decision to distance and wear a mask and go along with the lockdown, I want you to know that we in our world of healthcare take this as an act of solidarity. And it means a great deal to us, and we're all so grateful for that. I'm going to millions of people and I have some startling numbers to share with you. Did you know that of the people I speak to, 50% of them do not know their own household

income? That's not a typo, 50%. That's because money is confusing. In my new book and podcast, Money for Couples, I help you and your partner create a financial vision together. To listen to this podcast, just search for Money for Couples. All right, so Ontario obviously isn't the only province struggling with the third wave. In Saskatchewan, things have actually gotten so bad that the provincial chief medical officer said the growing number of younger COVID patients in the ICU made her jaw drop. Dr. Alex Wong is an infectious disease physician from Regina, the epicenter of the province's battle against rising coronavirus variants. Hi, Dr. Wong. Thanks for being here. Hi, it's a pleasure.

So could I ask you, what is the current state of the ICU at your hospital in Regina? What is the current state of the ICU at your hospital in Regina? So our normal ICU capacity here in Regina is 28 beds. And we've currently expanded to 43 beds in order to accommodate the surge of patients that we've experienced over the course of the last couple of weeks. And, you know, there is planning in place to, you know, accommodate further surge and further capacity as required. further surge and further capacity as required. You know, COVID-19 patients make up around sort of 25 to 30 patients at any given time right now of those beds. And like we've seen pretty much everywhere else around the country, the demographic that we're seeing right now is much younger,

much more severe illness. A couple weeks ago when I was on call, I was walking past, you know, the ICUs and looking at the people in there. And I mean, it's multiple people sort of room by room by room who look exactly like me, about the same age, young families. And these patients are really sick. So they spend a lot of time in the ICU. Unfortunately, some of them deteriorate and pass away. Others just take a long time to recover. of them deteriorate and pass away. Others just take a long time to recover. So we don't have the same kind of turnaround as we do for a lot of sort of non-COVID patients where they're super

sick, but we can kind of get them better and get them out onto a regular hospital ward. When you say a long time, what are we talking about here? Could be weeks. And, you know, I think that takes a toll on frontline staff as well, especially the nurses and the respiratory therapists who are really doing the minute to minute care for these patients. It's just tough watching, you know, young, otherwise healthy people just stay so sick for so long with limited to minimal recovery. It just, it's just a waiting game. And it can take a long, long time. But again, when you have someone so young and otherwise healthy, you don't give up. So a lot of our frontline staff are, you know, working to the max,

and people are really, really feeling the stress. I want to come back to what this is like for you and your colleagues in one moment. But first, you mentioned the surge. Can you just explain to me what that looks like? Like what would need to happen? You know, at the beginning of the pandemic, it was more about sort of ventilators and all of the other sort of critical equipment required. That's a bit less of a concern now. I think the challenging piece is stretching the staffing because you need nurses and respiratory therapists and other very specialized personnel to look after this group of patients. And again, those people don't necessarily kind of grow on trees. So it is a challenging process. And as the numbers

continue to kind of push and increase, there are system planning in place to open slowly more and more beds as required. We've kind of been holding steady and kind of keeping our fingers crossed that we're not going to get pushed too much more. That still remains to be seen as variants of concern are spreading widely across the province now. How are you and your colleagues holding up right now? I know based on sort of all the discussions and feedback that I get from all of my critical care colleagues, physicians, nurses, pharmacists, dieticians, respiratory therapists, everyone's just really sick and tired of all of this. Everyone, you know, there's a degree of disappointment and frustration, no doubt. But at the same time, you know, everyone has a sense of

duty and responsibility, too. That's kind of why we all got into healthcare in the first place, was to help people and to serve and to do what needed to be done for patients and to provide the care that, you know, nobody else can provide. And so that's our job. And I think one of the most important pieces that, again, the general public can do to really support frontline healthcare workers and to make it easier for frontline healthcare workers truly and frontline workers in general is to just be completely diligent with regards to following the public health guidance. Dr. Wong, earlier we spoke with Dr. Shelley Dev at Sunnybrook Hospital in Toronto. She talked about the dread that she feels

around the discussion now that patients might have to be triaged. And I wonder if I could ask you as a final question today, is that a discussion that's happening in Regina? And what goes through your head when you think about the possibility that your colleagues might have to be making those decisions in the future? It's a horrible decision to have to make, to be able to decide between whose life is more savable and more,

I don't want to say valuable, but in the end when you're trying to make these really hard decisions, you're looking at a lot of different pieces and a lot of different considerations, like what's the likelihood that you're going to be able to save someone and hopefully have them have a good sort of meaningful outcome, you know, versus not. And again, I mean, those types of judgments are incredibly complicated and difficult, because essentially, when you make that decision, you're choosing who lives and who dies. And that is very hard. It's the type of decision that no physician, no health care provider wants to have to make,

especially in a place like Canada where, I mean, for goodness sakes, we've got all the resources in the world. We've got all of the capability in the world. And we had all the foresight to know that all this was coming. To allow for that type of situation to potentially be a reality would be tragic. And so we're not at a point here in southern Saskatchewan as yet where we've had to make those types of decisions. And again, the capacity exists to expand, but there are limits and we are definitely pushing those limits. And so again, there's much to, both from the general public as well as from our decision makers, around getting us through this third wave, you know, in a way that is less painful.

All right, Dr. Alex Wong, thank you so much for your work and also for making the time to speak with us today. No problem. Thanks. okay so before we go today for the first time canada is now recording more daily covid cases per million than the united States. And other countries are starting to take notice too. On Tuesday, Japan now fighting off its fourth wave, tightened travel restrictions on anyone from Spain, Finland, and the province of Ontario. Meanwhile, back here in Canada, the return of the Atlantic bubble has been delayed until early May. This is tough, I know, but it's necessary given what we are seeing across the border and in several other provinces where the cases are increasingly rapidly because of the presence of variants. This is what we want to avoid here,

an outbreak resulting from the more contagious spread. That is all for today. Thank you so much for listening to FrontBurner. I'm Jamie Poisson. We'll talk to you tomorrow.