As British Columbians cope with the second wave of COVID-19, front-line medical staff chronicle their experiences during a long winter, with the hope and challenge of a vaccine having arrived.
The journal entries that follow recount their observations through November and December.
The diarists Dr. Jeevyn Chahal, family physician in Kamloops Jayne Hamilton, advanced care paramedic, Metro Vancouver Dr. Tiffany Lee, locum critical-care physician, Surrey Dr. Cyrus McEachern, consultant anesthesiologist, Vancouver Acute Department of Anesthesiology, Vancouver General Hospital and UBC Hospital Rachel Mrdeza, emergency-trained registered nurse, St. Paul’s Hospital, Vancouver Dr. Steve Reynolds, specialist in infectious diseases, internal medicine and critical care; ICU physician and site medical director at the Royal Columbian Hospital in New Westminster Shane Sander, primary care paramedic, Surrey Previous instalments
From April: Seven weeks of COVID-19, as seen by six health professionals
From July: B.C.’s lockdown is relaxing, but front-line health workers aren’t
The diaries Dr. Tiffany Lee, Nov. 13
I spend the afternoon meeting ICU patients’ visitors. Just as I thought the day was going to come to a smooth conclusion, the team gets called to intubate a COVID-positive patient on the ward – now. We are in second-wave mode now, moving with resigned efficiency, an entourage of respiratory therapists, nurses and so many carts on wheels. I put my trust completely in this team I met only a day ago, and we implicitly know that “we’re in it together.”
An hour later, with a breathing tube, blood-pressure monitoring line in the wrist and drips going in a large IV in the neck, the patient is calm and stable. I pick up the phone to arrange transport to an ICU that accepts COVID-positive patients.
Dr. Lee, Nov. 14
I’m with the social worker who has arranged a phone conference with multiple family members on the line. They have questions. They tell me no doctor has spoken to them all week.
My intensivist brain reflects on what happens when we put a frail, sick-even-before-COVID person on a ventilator in the ICU. The weeks spent alone on a ventilator. The poor likelihood of surviving to leave hospital, let alone having functional independence. The burden of suffering.
My palliative-care brain reminds me to hold space for grief, hope and spirituality. To understand that dignified end-of-life care starts with decisions made long before the moment of death.
My daughter-of-Chinese-immigrants brain says, “You are talking to elders. Aunties and Uncles. Remember their stories. We are survivors. We are people of sacrifice. We would do anything to keep those we hold close alive.” And so, I start:
“His breathing has gotten much worse over the last 24 hours. The doctors and nurses have done everything right – antibiotics, steroids, but COVID can be so aggressive when a person has been living with many medical problems before they got sick.” It breaks my heart to tell them that the machines in an ICU cannot restore their particular loved one to health. We talk about hope, miracles, dignity and comfort. I get asked what I would do for my parents. I want badly to tell them that I thought about my own parents the minute I walked into their parent’s room.
This is the third call today.
Darryl Dyck/The Canadian Press
Dr. Cyrus McEachern, Nov. 16
I’m troubled by how many tragic cases of young, homeless, fentanyl-addicted men I’ve cared for recently: overdoses, stabbings, suicide attempts, a broken neck and paralysis from dumpster diving, one beaten and left for dead in a park. The saddest to me are those who catch fire trying to stay warm with candles or camping stoves.
I ask an ICU colleague if my impression is true. “Diseases of despair,” he replies gravely, dark circles under his eyes, “We saw a huge surge of them after the first wave of COVID settled. I try not to think about it too much, to be honest.”
Another colleague well-versed in the subject insists that if we could just house the homeless, most of the drug addiction would resolve. I think it’s more complicated than that, but at least it sparks within me a glimmer of hope.
By the end of October, 258 people had died of COVID in B.C., but 1,386 had died from illicit drugs in the same time frame, the vast majority from fentanyl. We are clearly suffering from two deadly crises in B.C., and I think an insidious third crisis ties them both together: despair.
Jayne Hamilton, Nov. 17
I am struggling with how best to describe the reality of working in paramedicine as we become firmly entrenched in the second wave of this pandemic. There are many analogies that come to mind – a marathon? A war? Neither quite fit, but we know that it’s long, painful and far from over.
In the spring, we were terrified but determined; it was the honeymoon phase of a disaster we were just beginning to understand, and while overwhelmed, paramedics rose to the challenge.
Just as we have hit our absolute limit in maintaining vigilance, the case numbers are rising every day and we are now met with an onslaught of COVID-positive patients every single shift. I remember when this all started, allowing a moment for myself to cry because I wouldn’t have the time or capacity to do so later – well, this is the later. I’ve activated an emotional triage that’s necessary not only to be effective in my job, but to prevent the core of my own humanity from eroding under the never-ending onslaught of this epidemic – or so I hope.
I don’t think that patients deserve less just because I’m tired, and I know that sentiment drives my colleagues through this too. I see people who are terrified of the COVID-positive test result they’ve just received and don’t know where else to turn – and from behind the safety of my respirator, I need to try to reassure them. I see patients who don’t survive this virus during their time with me and I have to try to reassure myself. I don’t think I’m alone in wondering if I’m getting this right, but there’s nobody else to ask.
Rachel Mrdeza, Nov. 19
While clutching her chest and breathing hard, my patient tells me she is having chest pain. She presents as young and in good health, so I ask about her medical history, looking for a link to this presentation of symptoms. I ask if she’s had any recent stressors in her life, and she breaks down crying, explaining that her dad recently died of COVID. I asked when she last saw her father, and she says not for years, since he lived in Iran.
COVID continues to rob our community of the opportunities to properly grieve the death of loved ones. Its greedy hands go so deep beyond the surface, and I’m reminded daily of the sacrifices people are making to survive.
Darryl Dyck/The Canadian Press
Ms. Mrdeza, Nov. 26
Walking out of the emergency department, I receive a message from a family friend regarding an “alliance for COVID health professionals.” I click on the link, thinking it pertains to an international response team, and am deeply disappointed to read an article with baseless information claiming COVID wards are empty, herd immunity has been reached, and the lockdowns need to end. After a long shift of trying to find space for acutely ill patients and attempting to isolate COVID-like presentations, I am angered by this petition.
People so far on the peripheries of the COVID universe seem certain they know what is happening at the core. As they orbit around a blaze, untouched by flames, they accuse the people burning of falsified information and “fake news.” I’m saddened by this disrespect to front-line workers and try my best to find the strength to help the people who need it most.
Dr. McEachern, Nov. 27
It’s my third night shift in a row, and I make the mistake of getting my hopes up for a restful night.
A code stroke is called and I race down to the emergency department. The patient can’t speak or move half his body because of a blood clot blocking oxygen from half his brain. For us to surgically extract the clot, he must remain perfectly still, so I need to anesthetize and intubate him.
He can’t answer the COVID screening questions, so we have to presume he could be infected. I intubate him in a negative-pressure isolation room, then wheel him down 50 metres of hallways and four doorways to the stroke suite. This is what COVID has done to health care – it complicates everything.
During the clot extraction, I receive a flurry of calls from the cardiac surgery ICU: two patients’ kidneys are failing and need dialysis; one patient’s leg has lost blood flow; and another has developed paralysis from spinal cord ischemia. I manage it all remotely over the phone, then transfer the stroke patient up to the ICU.
I exhale a sigh of relief as I change out of scrubs at 3 a.m. – but then the phone rings. An aortic dissection is coming by ambulance, arriving in about 20 minutes. I’m not going anywhere. I’m so tired.
He could also have COVID. Mask on, gown up, face shield down. While suturing IVs into his neck, I stick my thumb with a bloody needle. It’s my first needle stick injury since junior residency, eight years ago.
Once he’s safely on the heart-lung machine, I trudge back down to the emergency department, this time as a patient to get my own blood drawn, before rushing back up to the OR to continue the case. I hope he doesn’t have hepatitis B or C, or HIV.
Darryl Dyck/The Canadian Press
Shane Sander, Nov. 29
It’s a dreary night. The rain and wind are vigorous and defiant, practically knocking us to the ground outside the home we’ve been called to. Our face shields become covered with raindrops, distorting our visibility and saturating our droplet-protectant blue gowns that can practically be seen from space.
Inside is a man who, before his recent diagnosis of COVID, was previously healthy. As he struggles to get air into his nearly silent lungs, and with his oxygen saturation deathly low, his eyes tell us how petrified he is in this moment. He asks us slowly between breaths: “Am I dying?”
His family is anxious as they grip the doorframe of the bedroom, frightened to take another step closer. His wife sheds tears, wondering if her husband of 20 loving years will ever come home again as we frantically attempt to stabilize him. As we load the man into the ambulance, his children yell out from behind their tears, “We love you, daddy!”
Dr. Steven Reynolds, Dec. 2
She was a colleague. Young and fit. Terrified. I watched her through the glass door as the resident told me the details of her COVID diagnosis. I caught her eye and smiled, but for the thousandth time realized that was a wasted effort, so gave her a slight nod instead. I tried to embody a quiet sense of purpose that I was here for her, the team was here for her. We would stand watch and be ready when she needed us.
Had a few gentle words with distraught colleagues, and off I went to gather equipment as I knew there was a reasonable chance that she would need life support with a mechanical ventilator.
In my office, my angst caught me in a quiet moment, ambushing me while I bent down to tie my shoes. She was one of us. Health care workers are three and a half times more likely to get COVID than the rest of the population. That is what we live with, the unquestioning risk we take. In the moment, that can be pushed away. The fallacy that tragedy happens only to others helps to protect me, maintains a distance that allows me to function. There are times when that armour falls and the existential dread can be deafening.
I paced and rode the wave of emotions. I breathed, settling myself, and gathered my equipment. I had done this before. This is what we do. This is the way.
I walked back to the ICU to see my colleague. Checking multiple times over the course of the evening, I saw that she settled after she had spent some time lying on her abdomen. She stabilized.
I reflected on the sentiment that this COVID pandemic is overblown, or that some people feel that they have the right to ignore measures for our collective wellness. One small party must be okay – after all, how could you skip a child’s birthday, Thanksgiving or Christmas? I no longer felt frustration, merely sadness – after all, I also yearn for the same things.
Chad Hipolito/The Canadian Press
Ms. Hamilton, Dec. 3
As I leaned in and put my hand on the arm of an overdose patient I had resuscitated, quietly telling them, like I always do: “You’re safe, you overdosed,” they nodded – and, very suddenly, coughed.
I could see the tiny droplets on my visor glistening in the light and could see that their colour hadn’t come back the way I would expect. This didn’t sound like a regular cough – it sounded like a jet engine ready for takeoff, and I was suddenly very aware of how hot their skin was through my gloves.
I didn’t need to wait for confirmation later to know COVID was in the room with us. I’ve learned that this virus hitches a ride on all kinds of calls – in the past week, it tagged along with the elderly person having a stroke, and before that it was the middle-aged parent who’d been in a fender-bender on the way to work.
A vaccine can’t come soon enough. This mantra crosses my mind a hundred times a day whether I’m at home or at work, and nothing in the comments section of Facebook news threads can sway me. I’ve seen enough to know this virus doesn’t care who you are or what you do or what you think about it one tiny bit. Witnessing one sad story after another for nine months is more than enough for me to want the vaccine available for everyone already.
Dr. Jeevyn Chahal, Dec. 4
The second wave is here in the B.C. Interior – a sudden increase in COVID-19 cases, in rules, in fear.
Usually, a patient shows up at the locked door of my clinic. My masked assistant goes to the door with her clipboard of COVID-screening questions and forehead thermometer. If the patient doesn’t have a mask, we give them one. The patient usually scores 100 per cent on the questionnaire and is allowed to enter.
They are escorted directly to a room – unless the two exam rooms are already occupied. In that case, they stay in the waiting room, which features a hand-sanitizer dispenser and an artificial Christmas tree.
Frequently we see the COVID dance – as patients move around in the waiting room, they try to keep their physical distance from each other. The scent of disinfectant is in the air – another new reality of the COVID era.
I am seeing approximately 15 to 20 patients in the office each day and calling another 20 to 25 patients – videoconferencing appointments have not caught on.
I see the daily parade of emotions: frustration, fatigue, anxiety, anger and resignation.
It is so hard not to hug my patients I normally would have embraced after their cancer diagnosis, pregnancy news, or to help them with loss or depression. I look away sheepishly from child patients who await the usual treats (toys or books) at the end of their checkup. No treats.
The once cheerful telephone visits in the summer of 2020, full of reports of successes in diet, exercise, gardening and baking, are now met with resignation. Patients are disinterested in checking their blood pressure or blood sugar. They don’t deny their lack of exercise, increased consumption of drugs and alcohol. They have given up.
Projections of full vaccination by next fall do not instill confidence. They worry about enduring another nine months of what they are now experiencing.
The system is overwhelmed. Some of us are able to dig deep and find reserves and usually have support, but some have nothing left. Every once in awhile, I feel the pressures we are all facing and gasp out loud.
Darryl Dyck/The Canadian Press
Mr. Sander, Dec. 7
“I can’t hear you!”
“Take your mask off!”
“I can’t breathe – I need to take my mask off!”
We hear this almost daily on the frontlines. PPE is a necessary precaution, but one that I’ve found can be discomforting in the eyes of patients. Nowadays your friendly neighbourhood paramedics are donning respirators that muffle our voices, face shields that blur our facial expressions, and blue evening gowns that will never be seen at a MET gala.
I sometimes wonder to myself if the empathy in my voice can still be heard, or if the concern on my face can still be seen. The grandmother in the care home that’s calling can’t see it, but a smile is still on my face as I ask questions. Sometimes it means that comforting smile is replaced by holding her hand for a moment or two to reassure her that everything is going to be okay. Maybe it’s how I adjust my body language in how I stand or kneel in front of someone to appear less frightening with all this PPE on.
When I scroll through social media and read comments from anti-maskers or COVID conspiracy theorists, I’m tempted to be baited into a battle behind the keyboard. But I step back and try to give myself some perspective. They might not understand the reasons, but I’m not wearing all this PPE for them. I’m wearing it for the grandmother in the care home who’s immunocompromised and could become gravely ill if she were to get COVID. I’m wearing it for the guy in the grocery store who’s anxiously trying to get in and out because he has kids at home that he wants to protect.
With the vaccine now here, I know there’s finally light at the end of the tunnel. But for now, I’ll still be smiling from behind the mask – even if no one can see it – while finding other ways to comfort the patient in front of me.
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