A new `two solitudes' in the age of COVID
A divide is opening up between the public and the health system, Lawrence Rudski says.
In Quebec, we all know what “two solitudes” means. During this pandemic, I fear that we are creating another two solitudes: members of the public versus the healthcare workers and institutions that care for them and their loved ones.
I'm well positioned to see both sides: a full-time clinician, an administrator in the CIUSSS du CentreOuest-de-l'île-de-montréal, a volunteer at Maimonides during the first wave and the son of a wonderful man who has called Maimonides home for the past 3.5 years.
We are in the midst of the second wave — compounded by a cyberattack — and things are heading south, again. Family members are concerned about their loved ones; health-care workers are working overtime, with needs increasing and the pool of healthy workers declining; and administrators are acting to ensure that all ministry directives and best practices are being applied.
And yet despite everyone's best efforts, people are getting sick and dying.
I remember during the first wave as cases at Maimonides mounted, going through the painful process of deciding whether to take my father out to “protect” him. We decided that he should stay. My father did not escape infection. Although thankfully he survived, it was not without significant psychological effects related to both the virus and the attendant isolation from family members.
I understand fully what families with loved ones in CHSLDS are going through right now, their concerns and their frustrations with administrators seemingly not doing enough to halt it. Accusations in the press are made about staff movements between hot and cold zones, lack of mandatory testing of visitors, caregivers and health-care workers. These issues are not black and white. They require balancing acts between what resources are available and what Quebec law, the ministry, the health-care workers and the families require, permit and will accept.
Differing perceptions of a photo published in the Montreal Gazette Nov. 25, showing a head nurse coming out of a hot zone, illustrate the great divide: I thought this demonstrated the enormous precautions put in place. A family member saw the photo as showing a “nurse going from the hot zone to another zone.”
The nurses, PABS and all other health-care workers are working extremely hard and are devoted to their patients. Nurses now work 12-hour shifts, an exhausting task that I have witnessed in my own critical care unit, where they even work 16 hours when we are short. I fully sympathize with them and their exhaustion. Sadly, this is what is needed right now, and we all hope that it will be very temporary.
As the director of a clinical department where people live or die based on both application of basic fundamentals, as well as advanced technical platforms, I know that people cannot have the same 99.99 per cent uptime of computers and mechanical systems. When people are tired, they make mistakes. Team leaders and head nurses constantly reinforce best practices about hand hygiene and PPE, but we are only human.
I have worked closely with senior CIUSSS and CHSLD administrators. I can assure you that they are doing everything they can, being guided by the ministry and leading international experts in the field. There are many talented, experienced and creative people trying to solve this unsolvable problem. Some are working 18 hours a day seven days a week.
Communication and as much openness as possible will mitigate accusations and enhance understanding. Family members' suggestions (including some of my own) have been adopted, but one must recognize that not all family members advocate the same approach — even members of the same family.
Everyone is trying their best, giving it everything they have. During this unprecedented pandemic, let's all pull together and support each other, for the sake of our families, ourselves and our social fabric.