As chief of the criticalcare program at the Scarborough Health Network, I oversee one of the largest ICUs in Canada. It was also one of the hardest hit

At the Scarborough Health Network, I oversee one of the largest ICUs in Canada. During the second wave, it was also one of the hardest hit

I grew up in Coquitlam, B.C., and came to Toronto for medical school. I never left. After I graduated, I joined Scarborough General Hospital. There, it was clear that every decision was about what was best for patients. Many organizations say they do that, but in Scarborough, it actually happens. Now, as ICU chief, I oversee a team of 250 people: physicians, nurses, respiratory therapists, physiotherapists, occupational therapists, social workers, pharmacists, dietitians and more.

Pre-pandemic, I worked one week on, one week off. During Covid, however, there’s no such thing as a week off. The other critical-care physicians and I can go two or three weeks in a row before getting a free day or two. We’re not the only ones. Most hospital staff have worked every single day since February 2020 to make sure our community gets through this thing.

Late last year, we tipped into a frightening new phase of Covid. Cases were spiking, and things were heating up in the ICU. Normally, we have 62 critical-care beds across our three sites—Scarborough General, Birchmount and Centenary. In December, we had to open up another 18 beds: eight in a room just down the hall from one of our ICUs, and the other 10 in a medical ward that has special isolation features because it was built just after SARS. We used Bluetooth to monitor those patients’ breathing and oxygen levels from the ICU.

By early January we were officially beyond capacity. Scarborough was hit particularly hard by the pandemic: it makes up about five per cent of Ontario’s population, but at times our ICUs were treating more than 30 per cent of the province’s critically ill Covid-19 patients. Many of our patients were essential workers. A lot of them were first-generation Canadians. Our community has high levels of existing medical conditions—diabetes, hypertension, chronic kidney disease—that predispose them to develop severe Covid-related illnesses.

Physicians throughout the hospital tried to help, telling us when they had open beds that could take critical-care patients. But we were limited by the fact that our hospital is from an older generation of health care. Although our ICUs have negativepressure rooms that keep Covid patients isolated, not every room in the hospital has the required ventilation or technology.

Eventually, we started transferring patients to other hospitals as far away as Kingston and Peterborough that had available critical-care beds. I was in touch with my colleagues across the province on a minute-by-minute basis. Around 3 a.m. one day, as I was waiting for an X-ray of a recently intubated patient, I tallied up all the communications I’d sent and received that day: 92 calls and more than 250 texts to 42 different people or groups.

A lot of our critically ill patients came from multi-generational homes. I heard so many stories about entire households getting infected. One couple developed Covid-related critical illnesses and entered the ICU, leaving their 18-year-old son at home to look after his 10-year-old sister. Our nursing team and social workers talked to the kids every day to make sure there was food on the table, that they were keeping up with school. It wasn’t looking good. Both parents developed lung injuries so severe that we had to send them to Toronto General Hospital for extracorporeal life support—that is, replacing their lung function with a machine. They were in hospital for three months. But it’s a good news story: both of them survived.

Many others didn’t, and much of the care we provided became end-of-life care. Once, a single father was admitted to our ICU. His wife had died six years earlier from another illness, and he contracted Covid working double-time to pay for his 18-year-old daughter’s university tuition. As his health deteriorated, I called his daughter regularly to update her on his condition. She carried some guilt because she knew her father got sick working for her future. It was heartbreaking when we realized he wouldn’t make it and she would become an orphan. Before he passed away, we were able to arrange an in-person meeting so she could say goodbye.

The last year has been one of the most challenging periods I’ve ever experienced as a health care provider. My wife is also a physician, but luckily, she has a community practice, so she doesn’t see Covid patients. We had our first child, a little boy, in November 2019. Our extended families live out west, and they haven’t seen our son since Christmas of that year. We knew Christmas 2020 would be different. My wife and I celebrated with just our son. I’d seen too many people admitted to the ICU who got Covid from what they thought was an innocent visit with a loved one.

Even though, as I write this, the second wave seems to be waning, my biggest fear is that we will let our guard down too early. We have to keep wearing masks and distancing. I know people are suffering in many ways because of this pandemic. It’s not just illness. But when I hear people talking about the frustrations of lockdown, well, I think most health care providers can’t wait for all of this to be over so we can lock ourselves down for a while.

During the pandemic, there’s no such thing as a week off