The front lines of critical care during the COVID-19 pandemic have been a stressful spot since last March, but no more than right now, admit those who are seeing it first hand.
“We’ve been asked to take on not only our own community in terms of acute care needs, but we’ve also been asked to help out our neighbours and friends to the south. The GTA hospitals are overwhelmed,” said Dr. Christopher Martin, an emergency and intensive care physician, as well as chief and medical director of critical care at Barrie's Royal Victoria Regional Health Centre (RVH).
“It is exhausting and we don’t know when it will end," he added.
Doctors and nurses are all trying to pace themselves while also keeping up the intensity to take care of the increasing number of patients.
“We are trying to do what we can to help out down south because we know this is a provincial problem. We have to do our part and we’ve done our part,” he said.
RVH is one of the hospitals in the province taking the most critical care patients from the GTA, Martin added.
Overall, he said, the feeling for many who work on the front line is that of fatigue, but also that the last year has been a test of resilience.
“My emotions have been everywhere from exhaustion — mentally, physically — but also very proud of my team. We’ve stepped up like I couldn’t have imagined. We’ve had great leadership and great people volunteering. We’ve shown we can step up… and hit above our weight class,” he said.
They’re also trying to maintain this level as well as prepare for more patients.
“We’ve increased our capacity, but it’s a challenge with staff because critical care is such a specific, highly trained area and our professionals are so good, you can’t just replace them or bring in more. It’s a finite resource," Martin said.
“We are working hard to make sure we can manage the capacity locally (and) continue helping out provincially and (that we) can do that on a prolonged basis because this could be months.”
Most challenging year of their careers
Lauren Gallagher, who has been working as a registered nurse in RVH’s intensive care unit (ICU) for six years, says this has been without a doubt the hardest year of her career and the hardest year for her team.
She is also eight months pregnant, which she admits has turned what should be the happiest time of her life into one riddled with anxiety, fear and stress.
Her team, she continued, is also overwhelmed with exhaustion.
“At the beginning, our first wave was just fear of ‘what is COVID, how would it play out and for how long?' Now, a year later, we are just at that breaking point where we've been working and running around with double the patients that we’ve ever had before,” she said, noting the nurse-to-patient ratios are just overwhelming staff.
“The expectations are so much higher as ICU critical care nurses. We are trying to train people as quickly as we can at the bedside, but it’s not the same as having ICU staff that have been here and know policies and can take a patient without strain. It’s a completely different environment," Gallagher said.
That fear, stress and anxiety follows them home, too, she added, noting it’s hard to leave the emotions of the day behind at the end of a shift.
“Being pregnant, I have additional fears of 'is this the day I bring COVID home? Am I short of breath because the baby is getting bigger, or am I short of breath because I have COVID?' It’s a lot of emotions right now and a lot of bringing it home to our families.
"I know I dream of work, I am thinking of work and wondering what it’s going to be like the next time I step foot.”
Fearing the unknown
Their patients are also facing the fear of the unknown, and staff do their best to offer comfort, but Gallagher admits it’s hard not to be able to give them the answers they need.
"I can’t imagine the fear they’re feeling. Becoming more and more short of breath, requiring ICU admission, seeing faceless nurses with masks on and we are the ones holding their hands while they’re being sedated and intubated," she said. "They don’t know what the other side of it is. We honestly don’t know, either.
"Are they going to survive or not, or what their lives are going to be like after,” Gallagher added. “We are the ones FaceTiming the family saying this is it, tell them that you love them because we don’t know if it’s days or weeks of sedation or what they’ll be like at the end. Who knows what that patient’s trajectory is... then the next day we have three more come in and do it all again.
"It’s a lot of weight to bring home.”
It’s that unknown — how the disease can impact each individual in very different ways — that has both Gallagher and Martin pleading with the community to be responsible and follow the public health guidelines.
“If you walk in the doors of this hospital right now, because there’s no visitors (allowed), clinics are closed and there are no non-emergency surgeries, it looks somewhat quiet," Martin said. "But, if you go to the COVID wards, or you come to the ICU, you see a wide range of people who are struggling to breathe, in isolated rooms by themselves, and can’t leave their rooms to go for a walk even if they’re on lower levels of oxygen because of the infection risk, and they’re scared."
Currently, the youngest patient in the ICU is 38 years old. They’ve also treated many patients who are in their 40s and have had to send patients in their 40s for extracorporeal membrane oxygenation (ECMO), a machine procedure which pumps blood from the patient's body to an artificial lung (oxygenator) that adds oxygen to it and removes carbon dioxide. It ultimately replaces the function of the person's own lungs.
“It’s almost like Russian roulette where one person may get zero symptoms… and another can end up dying from it. I think that uncertainty in younger people is what the fear is and why people should get vaccinated. We can’t predict it,” Martin said.
The doctor says he wishes he could wear a body-cam during rounds to show everyone what life in the ICU is truly like.
The addition of multiple variants and the rate of how quickly patients are getting sick is throwing medical professionals for a loop as well.
“They are getting sicker not over the course of a couple weeks, but a couple days.”
Facing the truth
Martin wants to reassure those who are uncertain that the disease, and its impacts, are in fact real.
“There are people who are uncertain of how bad it is, and there’s obviously a category of people who are conspiracy theorists… and those people you aren’t going convince,” he said.
“If I could go up there (during a protest) I would say ‘Here is the situation… no other agenda. They can incorporate that into their decision-making and what they do. That’s all we can do. I am not a policy maker. All I can tell them is the stress it’s put on the system and the risks it has to both current and future patients.”
