After 36 hours in a Scarborough hospital caring for COVID-19 patients, Dr. Martin Betts will get to go home to his 15-month-old son Max.
“My day started at 5:45 this morning when my son got up. I checked in with all three physicians that were on call last night to see how many patients were admitted … we have about 90 patients in the ICU between the three sites,” he said.
Betts, who is the corporate chief and medical director of the network’s critical care program, and his team meet with families of each patient virtually to provide them with daily updates on top of caring for new patients brought into the Scarborough Health Network’s (SHN) intensive care units. SHN consists of three sites: Scarborough General Hospital, Centenary Hospital and Birchmount Hospital.
He told Global News while the flow of the ICU is the same as before the pandemic, the volume of patients the team is managing and the complexity of those patients has increased significantly, resulting in a much higher number of consecutive workweeks.
“Typically our physicians would work somewhere around 20 weeks of service per year. I think most of us will be doing 40 to 42 weeks of service, so we’ve over doubled the quantity of work that we’re doing,” said Betts after checking in on a COVID-19 patient at the Birchmount site.
That patient’s name is Rodney Birjah and he’s been in hospital since December. He turned 70 while attached to a ventilator.
“Initially on December 9th, he developed a fever and a cough around the same time his wife did. Nine days later, he got sick enough to have to come into the hospital and he spent four days on increasing concentrations of oxygen in one of our medical wards before he came down to the ICU,” recalled Dr. Betts.
Because of how severe his lung injury was, Birjah needed to be intubated.
“He had really profound needs for oxygen, really stiff lungs, and required a prolonged course on the ventilator and he ended up requiring a tracheostomy,” he added.
Birjah is now able to breathe on his own with oxygen supporting him, and the team is working on helping him regain his strength.
Soon the tube will be removed and he will be able to communicate with his family for the first time in months. Birjah is a father of two and a grandfather to two young granddaughters.
While Birjah is unable to speak, Dr. Betts leans over, in full personal protective equipment as always, to get as close to him as possible to talk to him, to ask him questions, to update him on his condition.
Amanda Firth, manager of Birchmount ICU, also brings in an iPad so Birjah can see his daughter, who is at work, but wanted to say hello to her father and let him know she will visit later in the day.
“When we do have patients that improve and we get to see them move out of the ICU and do well I think it’s a really great reminder of the work we do and the impact that it can have, and that it’s not just about the loss and some of the hardships that we are seeing on a day to day basis,” said Firth.
Like in any other healthcare facility, the frontline staff at SHN are dealing with a lot of loss.
“At our last count we had a little over 320 patients that have come to our ICU with COVID, and we had a little over 75 that had passed away,” said Betts.
“Each of those patients had family members, partners and children, in fact, we’ve had multiple episodes of multiple family members being in the ICU passing away.”
He pointed out the deaths are especially difficult on both the staff and the families.
“It’s been difficult because when one family member gets ill often multiple do and many times they can simultaneously end up in ICU,” said Betts.
There are other challenges for the frontline health-care workers, he said, beginning with the very infrastructure of the hospitals he works in.
“We’re in hospitals that haven’t been updated in decades, but our staff are the critical resource that is stretched at the moment,” he explained.
“We have opened up beds outside of the ICU to do things on medical wards that we’re not used to doing and bringing some of our ICU staff outside of the ICU to some of the medical wards and partnering with the medical nurses to have the support of patients.”
Betts said he worries for his team of approximately 250 people.
“We’re a team of nurses, doctors, physiotherapists, respiratory therapists, dieticians, social workers, pharmacists and every medical subspecialist that we need to help patients .. and we know people are tired, we know they’ve given their all and really been there for every patient that’s ever needed us,” he said.
Dr. Norman Chu, corporate chief and medical director of emergency medicine at SHN, said he is also concerned for his team.
“We’re tired,” he said.
“We still show up every day to work knowing that we do good work and we help keep our community safe … and hopefully make a difference.”
The emergency rooms at SHN are extremely busy. As Chu explained, Scarborough has been particularly hard hit by the pandemic.
“We have a lot of residents who cannot work from home, the nature of their job, they have to be at work, they’re in factories, they’re doing deliveries, they’re out and we know that that’s a risk factor for catching or getting COVID,” he said.
Another contributing factor to a high number of infections is the many multi-generational households in the community.
“Many generations living under one roof and we often see entire families infected and in fact many members of the same family being admitted to hospital,” said Chu.
It has been such a busy time in the ER at Centenary Hospital that SHN built a satellite emergency room in the parking lot out of a double-wide trailer.
“We brought this trailer in because we really recognize that in our current infrastructure we didn’t have the opportunity to social distance our patients as they came in,” explained David Graham, executive vice-president and chief administrative officer for SHN.
“In order to provide as much safety as possible … we brought in a temporary trailer that allows them to distance and assess people who don’t necessarily need to be in the main part of the hospital and just allowed us to have better flow as we dealt with the crush of number patients.”
Chu estimated across the network’s three emergency rooms, the teams care for around 400 patients a day.
He pointed out the number of admissions of COVID-19-positive patients has been declining for the last few weeks. But once again, just like in the spring, Chu said he is bracing for what could come next.
“The variants from the UK, South Africa and Brazil … we really don’t know what’s going to happen with that,” he said.
“Right now, we’re on the downslope. Things are improving slowly. What we don’t know is whether these variants will take over … whether we’ll have increasing numbers over the next couple of weeks or months.”
Chu said he has worked “100 per cent more” this past year due to the pandemic than in previous years, adding he is in hospital all seven days a week.
“We chose emergency medicine and to work in the ER because we like the intensity, we like the adrenaline, and even with that type of personality … this intensity is getting to us … pushing us to the brink,” he said.
Dr. Lisa Salamon-Switzman, an emergency physician with SHN, said this past year is like none other in her entire career.
“While our total volume of visits have decreased and that’s because the lower acuity patients haven’t been coming in… what we’re seeing is a much higher volume of really sick patients,” she said.
“Patients are waiting too long to come to the emergency department. They’re waiting until they’re on the brink of stopping breathing or on the brink of their heart stopping … that is happening much more frequently than I’ve ever seen before.”
Salamon-Switzman acknowledged the emotional toll on frontline health-care workers is immense.
“After a lot of the shifts, I am really tired… it really is emotionally draining, physically draining, mentally draining,” she said.
When Salamon-Switzman isn’t on shift, she said she is spending time with her three children or advocating on social media for an equitable approach to the COVID-19 vaccine rollout.
“We need to look at what areas are highly affected with COVID patients,” she explained.
“I really feel it’s important to look at areas like Scarborough where I work, where we have had a high COVID burden both in the first wave and now in the second wave.”
Salamon-Switzman pointed out Scarborough has seen some of the highest numbers of COVID-19-positive patients in Ontario.
“I really think that it’s important for the government and the vaccine task force to look at us and be able to prioritize us and our patients … if we’re able to vaccinate our patients, then we can reopen all of our services and be able to continue to offer the amazing health care that we always had,” she said.
Salamon-Switzman said she is concerned about the current reopening plans across much of the province.
“As soon as we open up schools, businesses, we know from our experience that the numbers are going to go up and up and up. Now, give us the variants on top of this, and, you know, it’s frightening,” she said.
While she said she supports the need to reopen schools safely for students, Salamon-Switzman would like a pause of several weeks before businesses can also reopen.
“If we’re opening up businesses on the heels of opening up schools, then it will be much more difficult, particularly in Toronto, where we’ve had challenges with contact tracing, to be able to understand, are our numbers going up because of schools or are our numbers going up because businesses are opening?” added Salamon-Switzman.
Much like anyone else, the frontline health-care workers at SHN are dreaming of the end of this pandemic.
“I think a lot of us are looking forward to being away from the hospital a little bit so that we can recover,” said Betts.
“I think everyone needs a bit of a rest and we need replacements to come help relieve the group that’s been going hard at it for the last 11 months so we can make sure that our health system continues in a way that provides the care that we’re used to providing.”