The world’s darkest hour

As an emergency room doctor, I have seen many people come into the ER in their darkest hour. Yet never would I have imagined that the entire world would be gripped in the throes of a global pandemic and that we would, in essence, be witnessing our collective darkest hour together. We will all need to pull together to get through these unprecedented times.

Good team dynamics is integral in an ER, and I am fortunate to work with many amazing professionals — doctors, nurses, paramedics, allied health professionals, clerical and cleaning staff. I know that our front-line staff are committed and prepared as best as possible for the battle that has already reached our shores, and by most epidemiological models, stands to only intensify in the days and weeks ahead.

I can tell you that the vast majority of us front-line health-care workers are trained very well in dealing with sick patients and our years of experience have accrued battle scars to further steel our preparedness. In terms of the COVID-19 outbreak, we are the beneficiaries of having been a few weeks behind other areas of the globe and have been warned by our international colleagues about what to expect.

We have thus run mock simulation drills and codes multiple times in our emergency department to mimic the crush of COVID-19 patients we anticipate seeing. We have instituted a robust backup system for on-call emergency doctors and nurses who will inevitably fall ill (many have already) — as worldwide, up to 20 per cent of COVID-19 patients have been health-care workers.

We have a plan to redistribute physicians to other areas of high need within the hospital. The hospital has appropriately cancelled elective surgeries and clinics, in order to have extra acute care and in-patient beds available. We have tried our best to stockpile ventilators and personal protective equipment (PPE) in the face of worldwide shortages and high demand, though we still have considerable concerns about dwindling supplies.

Public health officials have done an amazing job of educating the public about how to prevent transmission and setting up assessment centres, while being vigilant about protecting vulnerable populations (those in shelters and the homeless). But for us on the front lines, how could we ever fully prepare for an event of this magnitude? How could we be ready for something that comes around once in a century and can be transmitted by asymptomatic carriers?

Although health-care workers have common qualities and traits that have led us to do the work we do, we still have our own set of concerns that only intensify when we undertake activities that are deemed to be “high contamination risk,” such as removing our PPE, or resuscitating or intubating a COVID-19 patient.

We are also very worried about bringing the coronavirus home to our families and elderly parents. We are worried about being

HOW COULD WE BE READY FOR SOMETHING THAT COMES AROUND ONCE IN A CENTURY?

asymptomatic and passing the virus on to the patients we care for. We are worried about staffing levels in our departments when — not if — our colleagues fall ill, or we succumb to this awful pandemic ourselves.

But what I worry about the most is the exhaustive psychological toll this will have on our front-line staff if our hospitals become overwhelmed, like they have in many other countries. I worry about having to witness an unfathomable loss of lives as our colleagues in Asia, Europe and some parts of the United States have experienced.

And I dread having to choose, even though it would be based on ethical principles, who lives and who dies, due to supplies having to be rationed. I worry about becoming numb to the lives lost on a daily basis.

As professionals, my colleagues and I must find a way to soldier on in these darkest of times and I have complete confidence that we will. This is a marathon and we must endure and, despite our fears, we will find solace in the service of others.

People often ask us how we move forward, day in and day out. Everyone has their own approach, but what helps me get through the gruelling shifts are three things that together come to inspire me to keep going and give my best to my patients.

First, routine, both at home and work, while practising social distancing, eating well, staying hydrated, sleeping well and making time for exercise, meditation, prayer and extensive social media breaks.

Second, practising gratefulness. For me, that means being grateful for all the resources I have, even in these difficult times, as we in North America are still better off than much of the world. Social distancing has reminded me of the importance of connecting as human beings and how being isolated can be detrimental to our well-being. Thus, being able to go to the ER and do what I love, when many Canadians are working from home, is refreshing and a reminder of why I feel that I have the greatest job in the world.

Finally, practising mindfulness and reflection has been very therapeutic for me, both while on shift and after. When I see very sick patients with COVID-19, I think of all my colleagues around the world who are dealing with the very same disease, have the same concerns as I do and have battled through it all. This is immensely inspirational to me.

It is nice to see the public outpouring of support for health-care workers worldwide. Yet the most important things people can do are to discuss end-of-life care goals with their families, quarantine themselves if they have symptoms or test positive, wash their hands often, sneeze and cough into their sleeves and be diligent about practising social distancing.

Although we are early on in this fight and the world seems dark, there will come a time when the sun will rise again and we beat COVID-19 together.