Front Burner - The 'agonizing' front lines of Edmonton's 2nd wave

Episode Date: December 9, 2020

New restrictions have been announced in Alberta as the province struggles with the highest rate of new coronavirus infections in the country. As hospitalizations rise, we check in with two Edmonton doctors on the front lines of the pandemic, to hear about the impact they're seeing the virus have up close: Dr. Darren Markand is an intensive care unit physician, and Dr. Shazma Mithani is an emergency room physician and the spokesperson for the section of emergency medicine within the Alberta Medical Association.

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. yeah I would say I'm hanging in there it's um it's been tough the the shifts are getting more challenging and more tiring and so I'm really just trying to take the time between shifts to recover as much as possible that's Dr. Shazma Mathani she's an emergency room physician in Edmonton and I just asked her how she was doing. Because though the nightly banging of pots and pans has mostly stopped, the pandemic, it rages on.

And Alberta in particular is getting hit hard. I asked Dr. Darren Markland, who works in an Edmonton intensive care unit, the same question. Well, as long as I don't think about tomorrow, I think I'm pretty good. It's all about focus right now. And yeah, the forecasts are a little concerning. Today, as Alberta grapples with more active coronavirus cases than Ontario, despite having only a third of the population, A conversation with two Edmonton doctors on the front lines about the impact they're seeing this virus have up close. I'm Jamie Poisson and this is FrontBurner. I wonder if you could start, Dr. Matheny, by telling me a bit about what a day in your hospital ER is like at the moment.

I would say it's busy. The patients that are coming in are definitely sicker, and that's both COVID patients and patients who have other medical conditions. We, as healthcare providers, are more stressed, we're more anxious, just knowing that the numbers are climbing and knowing that that directly translates to more COVID patients coming into hospital needing to be admitted. And so we're kind of always on the edge of our seats, wondering what's going to come in the door and whether we're going to be able to adequately manage the patients that are coming in with the resources that we have available. You mentioned all patients are sicker. Why are you seeing non-COVID patients who are sicker right now? Yeah, Jamie, that's a great question. What we have been noticing, we noticed this back in the spring and we're starting to notice it again right now, is that as the case numbers are starting to climb, people seem to be scared to come into the hospital because of COVID, because they're worried of catching COVID.

Which is, you know, for patients that need the emergency department, we're here, we're always around and they should be coming in when they need help. And so what we're noticing is that patients are staying at home longer than they should with their medical condition and then coming in much sicker than they would have if they had presented earlier in their illness. And Dr. Marklin, if I could put the same question to you about your unit, the ICU, what's it like there at this point in the pandemic? what's it like there at this point in the pandemic? We start our day at seven. Of course, I'm up much earlier. And the first thing I do is kind of check out the news cycle to prepare myself emotionally for what I'm going to see. And then I kind of look at the projections.

And when you walk into the unit, it's always during handover. And there is this intensity, partially because there's so many more nurses and allied health care staff. We're much fuller than we used to be. And every bit of physical space in what we used to have our unit is now full of patients. And we've spread now physically into other parts of the hospital. So, you know, what used to be kind of almost an autonomic experience now is much more cerebral. I have to figure out where everything is. I have to figure out where the new patients have come in. There's new staff that I've never seen before because AHS has done a remarkable job of bringing in resources and staffing, but it's a different place now.

and resources and staffing, but it's a different place now. This sounds like such an intense and stressful environment. I'm hoping we can talk a little bit today about the COVID patients that you're seeing and what toll the virus is taking on them. And so let's start with the ER, Dr. Mathani. The COVID patients you're seeing come in, what state are they in when they come in? Dani, the COVID patients you're seeing come in, what state are they in when they come in? Typically, when they're coming in to see us, they're about a week into their illness. And that's normally when we see the symptoms start to worsen if they are going to worsen. And so the most common complaint that they're coming in with is difficulty breathing. And so these patients are often really struggling to breathe. Their oxygen levels in their blood are lower, much lower than what we

would normally expect. Often they are just run right off their feet, like they're exhausted. They typically have quite high fevers. And you can tell just by looking at them that they're not well, they're sick, and they're really struggling from a breathing standpoint. It must be so awful, this feeling that you can't breathe, hey? It must be so awful, this feeling that you can't breathe, hey? Absolutely. I mean, I was trying to think of an analogy of this the other day. And the first thing that came to mind is, you know, when you're swimming and you choke on some water and that there's that period of, you know, 10, 20 seconds where you're

just really struggling to catch your breath. And, you know, that feeling is horrible. But imagine feeling like that all the time. I can't even imagine. It just really would be the most terrible sensation to have, I think. And Dr. Markland, of course, the very nature of being in an intensive care unit means that your patients are very sick. And can you tell me about what your COVID patients are going through? Where intensive care physicians have a different approach than emergency physicians is that, you know, often we come in at the time when the tubes go in.

But with COVID, that's not the case. We'll bring the sickest people and we will try everything we can to avoid putting the tubes in because we know that that gives our patients the best chance of surviving the illness. But during that time, we've become very close to them. We become kind of their emotional surrogates because the other thing that this disease has done is shut down the hospital to visitors. And so the important emotional support that you get from family and friends isn't there. These are the things that we are now providing as well. And when the time finally comes and they no longer have the reserve to bear this sensation of drowning,

is when we literally have to have this conversation about where do we go now, knowing that after that happens, we take away their conscious participation, and maybe they may not come back from this experience. Dr. Bethany, I know you also have to do these intubations in the ER, and what do you do to help prepare a patient for what they're about to go through to help them cope? As Dr. Marklin just mentioned, this idea that they may not come back from this. Yeah, I'll echo what Dr. Marklin said there. I mean, that part is the most heartbreaking part of this.

Now we are not allowing any visitors in because of the risk to everybody. any visitors in because of the risk to everybody. And, you know, like Dr. Mucklin mentioned, when we put these breathing tubes in, we have, we take away the patient's ability to talk, we take away their ability to be awake and aware of what's around them. And we have no idea if that breathing tube is going to come out. And so if in situations where I have put those breathing tubes in the emergency, in the emergency department, I will talk them through it, let them know why this is happening, why we're doing this. And I have now made it my practice to ask them if I can help them call or FaceTime a family member

before we put the breathing tube in, if there's the ability and it's safe to do that. I ask that now every single time, knowing that they may not be able to talk to their family member again for some time or ever again. Dr. Marklin, I can't imagine how hard those calls must be to make these decisions for you right now. It's getting harder. We before had the leisure of going for the long shot the patients who were the sickest and had the most issues that might complicate their stay but now as resources are becoming scarcer we have to make more informed decisions about who's really going to benefit from this aggressive type of care.

And that weighs very heavy, I think, on everybody who's involved in this. As a physician, you want to save everyone. It's rare that we have to actually make these decisions, but it's becoming more and more relevant as numbers, the sheer numbers increase. Is it fair for me to say what you're talking about here is ventilators? Like you may not have enough ventilators. The ventilators are actually the least of our issue. Very early during the pandemic, we procured ample equipment for these kind of things. We procured ample equipment for these kind of things.

The challenge really now is staffing and coordination of a system that is so much larger than it used to be. Our nursing ratios, physician to patient ratios are all affected under pandemic surge circumstances. Wow. Dr. Mucklin, are you seeing patients die from COVID? Yeah, yeah. And the challenge about it is just as the progression to requiring intubation is gradual, and there's no defined moment where you have to put a tube in, dying from COVID in the intensive care is also a spectrum too. People don't just suddenly pass away. They fail to get better or they accrue complications along the way or their odds become progressively diminished as they get weakened for other reasons. It's agonizing and the challenge too then is delivering this type of news to family members who have never experienced this type of protracted grieving effectively. Hmm.

I feel like we hear these statistics, like last week, we heard a 10% positivity rate in Alberta. These numbers, like record-breaking 1,879 new cases on the weekend, 20,000 active cases reported in the province. But I wonder what these kind of sterile figures actually mean for you on the front lines of this. And Dr. Matheny, I'll start with you. Thanks for mentioning that. I mean, it's hard. It's easy to just become sensitized or desensitized, I should say, to those numbers where it just, it's another day of over 1,500 cases, right? And so to put that into a bit of context, in just in the last week of cases that we've had here in Alberta, we would expect from just that week of cases to have over 400 more

hospitalizations, over 70 more ICU admissions, and over 100 people dying just from one week of cases. And so I hope that helps put that part into perspective. And then we have to remember that the stress on the hospital system is not just from COVID patients. These are patients that are going above and beyond what our typical capacity is. And when you add this extra surge of patients, it affects everybody. It's not just the patients who are coming and requiring admission or breathing tubes from COVID-19, it's every patient that's going to come in with an appendicitis or a car accident or a heart attack or a stroke or a broken ankle even, right? And so if our operating rooms are not functioning at

full capacity and only functioning at emergency capacity. If our ICUs are full, that means our emergency departments are full as well, because we can't send patients upstairs. And that means that people are waiting longer for these critical conditions that are not COVID. Dr. Marklin, if these numbers don't go down and fast, you know, what will that mean for hospital capacity? At the beginning of the interview, I told you you I don't like to look at the future. If you follow, you know, if you follow the things that experts in this field have been saying from the beginning, infectious disease doctors, epidemiologists, intensive care physicians, emergency physicians,

people who have done this since the Spanish flu epidemic, this is predictable. These things are known to happen and the measures to treat them are known. We know where we're going with this because we haven't followed expert advice and expert experts in these matters even if we lock down right now given the numbers and the logarithmic nature of it we will still have a significant crisis to deal with in the coming weeks before things turn around. Why do you think it's gotten to this point? Are you asking me? Yes. I think everybody knows why it's gotten to this point.

This isn't about science anymore. This has become very politicalized. And politics works very well in certain circumstances. But when you're dealing with natural phenomena, opinion just doesn't pan out in controlling an infectious virus. It must be hard to feel like, in a a way you saw this all coming. Well, you know, I think we were talking about the things that keep us sane. And so Dr. Matheny and I both have hobbies. One of it is I love to read.

And there's this great story about mythology about Cassandra, who's a concubine of Apollo. And she was a strong woman who did not succumb to his charms. And as a result, she was given the gift of prophecy, but the curse that no one would ever believe her. And I think that's what a lot of people in the healthcare field feel like. We've been saying these things as loudly as we can, and sometimes as loudly as we can and sometimes as loudly as we're allowed to say, often at great personal risk. And yet these things have been minimized in the current environment

and to the harm of our patients. Dr. Matheny, at this point, what do you think needs to be done to help prevent the cases from continuing to rise and all the suffering and consequences that could come with that? And, you know, everything you're already seeing right now, I know it sounds like further restrictions could be coming. There are also reports today that the military could even be sent in to help with the response. I think that it's time to put our healthcare system first. I agree with Dr. Marklin that, you know, it's that this whole thing has been politicized. And I certainly understand the balance of the economy, but we're at the point now where our healthcare system is breaking. Even if we lock down tomorrow or today, our health care system is still at high

risk of breaking and not being able to cope with the cases that we've had up to now. And so it's time to put the health of Albertans and our health care system first. And the only way forward is a lockdown. We need to stop all non-essential services and really just give the hospitals and health care system a chance to catch up, to give our contact peers a chance to catch up. We're so close to the finish line. The vaccine is just around the corner. So we really need to get this under control in an aggressive way so that our healthcare system can continue to function until everybody is vaccinated. Dr. Marklin, does the prospect of a vaccine offer you hope right now? Oh, absolutely.

I mean, it's one of the greatest achievements of science ever. The fact that this was a global initiative, that regular barriers were taken down, that money was put forward so this was low risk for companies to develop this. This is an achievement that's worthy of a Nobel Prize. And these vaccines work. In fact, independent evaluation of all three of the current vaccines has demonstrated efficacy and safety. This is tremendous hope, as long as we take politics out of the whole idea of vaccinating our population. Dr. Marklin, before we go today, is there any final thought that you might like to leave us with, leave our listeners with today? I know we did this the first time. I know we're all tired. I've slipped out of my silo on several occasions and the relief was so palpable.

From us saying the same thing over and over because we see the worst is obviously something that nobody wants to hear and in fact probably mutes. But the honest fact of the matter is that if our hospitals no longer function, everybody out there is walking a tightrope without a net, and nobody should be put at that type of risk. With vaccination and with good care and doing the right things like we did the first time, we can get control of this. Yeah, I agree 100% with Dr. Marklin. We were so close now. We did such a great job during the first wave. I know that everybody is tired.

I'm tired. We just need to do the right thing and to just hang on a little bit longer to lock things down so that we can protect our healthcare system and protect Albertans and just get to the end of this. There's a light there now. We just have to get there. I want to thank you both so much for taking the time out of your very busy schedules to talk with us today. You know, I know we mentioned in the conversation, it's so easy to look at these numbers and just see numbers and just feel tired with this all. And so I want to thank you all for reminding us about the human cost of this. Thank you very much for having me today.

Yeah, it's my pleasure. 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. Hi, it's Ramit Sethi here. You may have seen my money show on Netflix. I've been talking about money for 20 years. I've talked 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 Cops. So after the interview ended, I asked the doctors if they felt like I'd missed anything in our conversation. And here's what Dr. Marklin wanted to say to his colleagues in Alberta Health Services. conversation. And here's what Dr. Marklin wanted to say to his colleagues in Alberta Health Services. I think it's just really important to acknowledge, you know, all the people in AHS who have been keeping our heads above water. We get a lot of, you know, we get a lot of gratitude from people

because we're frontline workers. But the reason we get our job done is all the people behind the scenes who have been working under incredible circumstances to keep us, you know, supplied with resources, beds and stuff. Shortly after we recorded the interview, the Alberta government announced new restrictions to tackle the spread of COVID-19, including the closure of all casinos and gyms, a ban on dine-in service in restaurants and bars, and a province-wide mandatory mask rule. Until yesterday, Alberta had been the only province in Canada without one. That's all for today. Thanks so much for listening to FrontBurner.