For all of us, the arrival of COVID-19 — and the threat of its insidious spread — has upended daily life.
In hospitals, the upheaval is particularly pronounced, with extraordinary measures to protect patients and staff from the virus impacting all aspects of patient care.
Six weeks after Ontario declared a state of emergency, the Star checked in with three health workers on the front lines at Toronto’s Sunnybrook Health Sciences Centre: A surgical oncologist, who has postponed most of his patients’ surgeries, a nurse practitioner at the hospital’s COVID-19 Assessment Centre and the emergency room’s supervisor of equipment and supplies who lies awake at night worrying about his stock of personal protective equipment (PPE).
Here, each tells us in their own words how their job has changed during the pandemic and describes the challenges and fears they’ve faced at home and in the hospital.
Dr. Shady Ashamalla is a surgical oncologist and head of Sunnybrook’s division of general surgery. An expert in minimally invasive colorectal surgery, Ashamalla usually performs between 20 and 25 colon and rectal cancer surgeries a month. Because of COVID-19, he’s had to postpone most of his patients’ surgeries scheduled for the last half of March and for April and May. He says telling patients their surgeries are on hold were among the most challenging conversations of his career.
Every cancer patient has a journey, and surgery is only one part of the journey. Many of my patients need radiation and chemotherapy — with pauses in between treatments — to prepare for their cancer surgery. Patients who were scheduled for surgery in March, April or May likely found out six months ago they had cancer, and those months were spent preparing for a surgery that is now postponed.
On March 12, when the country pivoted to contain the virus, that’s when our hospital’s pandemic plans went into motion.
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Normally, on any given day, Sunnybrook has up to eight operating rooms open, running simultaneously, for cancer surgeries. For our pandemic plan, that has decreased to one for cancer.
Now, every day, the hospital’s oncology group meets virtually to review our entire list of cancer patients and we triage those that are at highest risk. Anyone who is at risk of their prognosis changing in two to four weeks, or if there is an immediate risk to their life should they not have surgery, is triaged to have their operation.
In March, everyone’s cancer surgery dates were postponed. I had that conversation with between 55 and 60 patients. I wanted to make sure they understood what was going on, to explain the process, and try my best to control their tension and anxiety.
These conversations were in parallel to the anxiety and fear all of us were already experiencing, just being a part of this pandemic. To layer cancer anxiety on top of what they were already feeling … having those conversations was both humbling and profound.
You’re never, ever ready to take away a curative operation that your patients have been planning for. Telling people we needed to postpone their cancer surgeries — that is the exact opposite of what I’ve been trained to do.
As a cancer surgeon, dealing with COVID-19 has created multifactorial levels of anxiety. There is the anxiety for my family — hospitals are one of the epicentres of the disease — and I worry very much about bringing the virus home to my family. Then there is the anxiety of getting sick myself. And day to day, I have anxiety for my patients who can’t right now have what they need to have. That is huge.
Initially, almost every patient was very afraid when I told them we had to postpone their surgery. Then as they listened to how we are changing their cancer pathway, and how we triage their care and what that structure would look like, they said: ‘We trust you.’
If you think about what a patient has to do to consent to surgery in the first place, they have to trust you to cause harm in order to cause good. That trust definitely came into play when we shifted gears in the pandemic. Everybody knew the gravity of what was happening around them and they accepted the situation. In the end, everybody kind of said the same thing: Thank you, doctor. Stay safe.
It was this very touching moment to think — despite everything they are going through — they are still thinking of me. For me, it really resonated the idea that we are all in this together.
In recent days, I am feeling hope and relief that we are increasing the number of operating rooms needed to safely treat our cancer patients, and that we are finding a new normal at Sunnybrook to keep all our cancer patients safe.
Daria Gefrerer is a nurse practitioner who helps oversee Sunnybrook’s COVID-19 Assessment Centre. Up until March 16, Gefrerer was a nurse in the hospital’s birthing unit, taking care of mothers and families during labour, delivery and their postpartum stay. Though she loved her nine years in the birthing unit, Gefrerer wanted to step up to the front lines during the pandemic and applied for a leadership position at the Assessment Centre. This marks the end of her seventh week in her new job.
I knew I was the right fit for this role. Many of my nursing colleagues have young families or older parents and they’d find it hard to be on the front lines of the virus. For me, I don’t have those same ties. I live close to Sunnybrook, I have a supportive husband and I don’t have children. To do this job, I wouldn’t have to make the difficult decision to live apart from my family. I also thought of it as a challenge that I was ready to take on.
When we first started, all the staff at the assessment centre were a bit hesitant. We didn’t know what to expect with the virus or how the screening process would look. It was all unfamiliar. But once the first flow of patients went through our clinic, it eased our worries. Now we feel safe; our small team has really come together to support one another.
When our clinic opens for the day, we often have a line of patients just outside our door. We screen them one at a time and we assume everyone who comes is COVID-positive. Each day, our team double checks we are on the same page for the current testing criteria so we know the patient population we should be swabbing.
At first, the testing criteria included someone’s travel history. Within weeks, it didn’t matter that someone travelled; it was clear you could pick up the virus at the grocery store.
We have a fair number of people who come to us with “typical” COVID symptoms: fever, cough, breathlessness. But we also have people show up with just gastrointestinal symptoms, such as diarrhea, and nothing respiratory in nature. It’s been interesting to see all the symptoms presenting with the virus.
Every now and then we need to turn away someone from getting a swab. It’s a hard thing to do. It’s human nature to want to know if you have COVID-19.
Some people are very persistent in wanting a swab after we tell them they don’t fall into the testing criteria. Having to tell them ‘no’ is very challenging. A lot of education goes into those explanations, but it’s still hard to be the bearer of bad news and sometimes we’ve had to get security involved with people who really want a test and can’t have it.
We do see patients who come to us that truly look unwell. I think it goes back to nursing intuition, that gut feeling a lot of nurses have, where someone comes into the clinic and you just know they don’t look right.
Almost every day, we ask someone to go to Emerg. And there are times we physically put someone in a wheelchair because they are unstable and we accompany them to the emergency department ourselves. We just had to do that today with a woman who came in very short of breath. We didn’t swab her because she needed more acute care then we could provide; we took her straight to the emergency department.
It’s those times that I feel thankful for this opportunity. As a nurse, it’s ingrained in you to want to help people and that’s what I think I’m doing during this tumultuous time.
Ray Joseph is Supply and Equipment Supervisor for Sunnybrook’s emergency department and trauma centre, the biggest in Canada. Joseph has worked in hospitals for 39 years and has been at Sunnybrook since 2000, working his way up to the supervisor role. The COVID-19 pandemic has brought extra pressures to his job of sourcing supplies and maintaining all the equipment in the emergency department. Since March 20, Joseph has been living in an Airbnb to ensure he doesn’t bring the virus home to his wife of 30 years.
Our hospital has a contract for most of our supplies. But when we need big ticket items, or something specialized and outside the box, that’s when it falls on me. Right now, it’s me against the world. Everything I want, the entire world wants it, too. And things I could normally get within a couple days, it’s now taking two or three weeks with no ETA.
I’ve seen a lot in my career. I was working the day of the van attack on Yonge Street (that left 10 dead and 16 injured). I remember the Charge Nurse telling me after I came off break at 1:15 p.m. that she was going to activate a Code Orange — that’s the code for an external disaster. The way she looked at me, I knew she wasn’t kidding.
That day was the first time I saw all three trauma bays being used at the same time. My role was to get the clinicians the supplies they needed. But I don’t really remember what I did; it was go-go-go, just non-stop. What I do remember from that day is how quickly we go through equipment and supplies when there is a major rush of patients.
The trauma team is always training for potential mass casualties. We actually had one of the surgeons who treated victims of the (2017) mass shooting in Las Vegas (that left 58 dead and hundreds wounded) come to the hospital for a town hall. He told us they were seeing patients every seven minutes in a constant, constant rush. He told us the biggest obstacle they ran into was supplies. He said they could keep up with the patient flow but were running out of supplies. That fact stuck with me. We learned from the Las Vegas surgeon to have extra disaster carts with equipment available in the Trauma Centre, ready for mass casualties.
In terms of COVID, my worst fear is not having enough of what the clinicians need to preserve a life, to do what they are trained to do.
I’m always worried about PPE. We have enough right now. But you don’t know what’s going to happen in the future. Like, how many people are going to walk into our emergency room tonight? We are a trauma centre; on top of COVID, we are still getting traumas.
I went through SARS and going through that has helped me. Some of our nurses didn’t go through SARS and for them, this is scary. I can see it in their eyes. I try to reassure them and say: Don’t be afraid of not having PPE, we will have it for you. I tell them: ‘You think about what you’re trained to do and all the other stuff, that is for me to worry about.’
My typical eight-hour days are turning into 10- or 11-hour days. Even when I go home, everyone here knows I’m just a call away. If they need me, I’ll come back. If there is a crush of patients, I’ll come back.
I’ve been living in an Airbnb since March 20. My wife has underlying health issues and our daughter, a nurse, is taking care of her. To keep her safe, I can’t go home. I miss my family, dearly. Living apart is the worst thing about all of this. I’m used to going home to a rowdy house full of family. Now, I go home to a quiet house.
These interviews have been edited and condensed for length and clarity.
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