Quebec doctors describe the emotional battle of treating the province's COVID-19 patients

Anger. Fear. Frustration. Ten months into Quebec's battle with the COVID-19 pandemic, several doctors told CTV News they are fighting battles with their emotions as patients continue to steadily stream into emergency rooms.

“My exposure to COVID comes from one source; it comes from working,” said Paul Warshawsky, head of the Jewish General Hospital's Intensive Care Unit. “It's an altruistic act, where I go out and deliberately put myself at risk every single day in order to take care of people. When the people I take care of got into that situation because they didn't limit their activities, that's very frusterating.”

One doctor who works in a COVID-centre emergency room said one of the most stressful parts of their job during the second wave “is navigating the portion of the public who don't believe it's real, don't believe it's true, think it's overblown, anti-maskers. People who flagrantly disregard the rules and are very open about it. That part? Honestly, that's the hardest part.”

To this point, doctors have been able to offer medical treatment to all who need it. But that could change if the number of new cases per day doesn't drop. The ER doctor, who asked to remain anonymous as they did not have authorization to speak to media, said they believe if that doesn't happen, doctors may be forced to make decisions on who receives care and who is left to die.

“I think 100 per cent that's a legitimate concern,” they said. “It's my biggest fear to have, to have to turn someone away who needs it. 'Sorry, I have no ventilator for you.' Because if I have no ventilators, I can physically intubate you, the tube is a cheap piece of plastic. But if I have no ventilator, then there's nothing I can do for you. And it happened in Italy, a first world country six months ago. It would be naive, when we're almost hitting 3000 cases a day, to think that it can't happen here.”

As an example of how bad things can get, Warshawsky pointed to New York City ICUs during the first wave, where mortality rates in ICUs hit 85 per cent. The mortality rate at the Jewish General's ICU during that time was 20 per cent.

“We're all looking at how to increase capacity to take care of the non-stop wave of patients coming to our emergency rooms,” said Warshawky. “Particularly in Montreal, we're not sure we're going to have the capacity to take care of all those people. We're very worried about that.”

Nurses, respiratory therapists and other support staff have been forced to cancel vacations. Union representatives have warned that many nurses are nearing their breaking point. Warshawsky said the idea of doctors taking a break is “inconceivable,” resulting in a situation that is “unbearable.”

Along with the sheer workload is the mental strain of trying to stay healthy when surrounded by a highly infectious disease. The ER doctor said there is a constant nagging thought that they may get infected at work, come home and get their family sick.

“What I've told all the staff is, every patient is COVID positive, even with a negative test,” said the ER doctor. “And from that, I mean, you have to wear full PPE to every patient. Don't let your guard down because that's when mistakes happen... There are studies that show that doffing the PPE, when you take it off, is a high risk infection point.”

“Nursing burnout is tremendous, tremendous, tremendous,” they continued. “They've been overworked and not properly structured for a long time. Then you throw a pandemic into the mix... They're done. They're fried. There's been no reprieve.”

The ER doctor estimated that, currently, around half of the patients they're seeing each day are coming in COVID-related symptoms. During the summer, that number was closer to 10 per cent.

Warshawsky said one silver lining in the second wave is that, unlike the first wave, when many of the cases coming to hospitals were highly-vulnerable seniors and CHSLD residents, the people coming in now are “a little more resilient.”

“For every 100 people diagnosed with COVID, less of them are ending up in the hospital and the ICU. But the total number is much higher.”

That higher level of community transmission has also left healthcare workers more vulnerable.

“Healthcare workers, generally speaking in the first wave, their only exposure was in the hospital where we know how to protect ourselves,” said Warshawsky. “If you look at the outbreaks in healthcare institutions are seeing right now, a lot of is coming from healthcare workers exposed in the community who bring it to work.”

There is hope on the horizon. Warshawsky pointed to Quebec's vaccination program, underway since Dec. 14, as meaning “the end is in sight.” But with the province months away from having vaccination levels at a point that would make a real difference, he said it is ultimately up to Quebecers whether the healthcare system will continue to function.

“Some people are flagrantly disobeying the instructions. Others are doing things they just didn't think would put them at risk but were technically violations of what they're supposed to be doing,” he said.

“If people keep going with this insane notion that this doesn't affect them and they don't need to worry about it, we're going to see more deaths.”

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