Stories from the front lines

This COVID pandemic has really affected how I practice medicine. I'm I'm hospital based, so as you can imagine, telephones kind of became our lifeline. Lots of the hospitals were able to get iPads donated so that we could set up video chats for the families to be able to see each other. We're not even just talking about COVID patients. I mean, these are patients that are in hospital for a cancer diagnosis or any type of chronic illness. They are affected by these visitor restrictions just as much as the COVID patients.

I think the the biggest challenge for me personally for providing care during this pandemic: we were isolating ourselves from our families. We would still share family meals together, but there was no hugging my family or anything like that. So, um, sorry. That was definitely hard.

I don't think there's anybody in this country that would disagree: the biggest gap in care that's been brought to light is long-term care. Unfortunately, what was all too obvious on in the in the news and the media were patients that were suffering in situations where they didn't have the adequate care that they should have had. They didn't have the staff that they needed there. Sadly, palliative care is not well integrated into a lot of these long-term care homes. I definitely think that needs to be a fundamental change within our system.

I'd say one of the heartwarming or inspirational situations that I've been involved with this year through this pandemic would have to be my involvement with the field hospital here in Windsor. A decision was made to move some residents from a local long-term care facility that was having a difficult time managing the outbreak, and they moved the residents to a field hospital that we had created.

As a team, we worked hard to really make that field hospital a home for them, and we would celebrate when their blood pressure got better, when their oxygen needs improved. We had impromptu bingo games when they all started to feel better. And then, you know, the celebrations that we had when all of the residents that were, um, they had recovered from COVID and they all got to go back to their, uh, long-term care facility. There was celebration and dancing in the hallways at this field hospital. So that was definitely a heartwarming experience, and I will always, uh, hold that kind of dear that we played that part in helping these patients.

Today's practice of medicine now, it's really dramatically changed with COVID. It's now a more of a dance between virtual and and face to face. Requires better coordination of our time and efforts, and the actual encounters that we do with our patients are now more focused. My responsibility for patient care hasn't changed. Safety is important. Patients come first. My relationship with my patients hasn't changed. My attitude hasn't changed.

So personally, the biggest challenge has been learning the virtual. It's a, it's a priority, and it's, I'm getting a lot better at it. Patients comment that I'm getting a lot better at it, but it, for me, is—there's a learning curve.

So the most heartwarming, and inspirational encounter may not seem like much, but it was a senior patient of mine, an elderly guy. He was about 80 years old, coming in for a flu shot after being isolated at home. I knew he was coming in, so I just went over to say hello to him. Patient was not only elderly, but blind. The moment he heard my voice, he broke down crying. Uh, he was so happy to be there, and I, I got emotional, too. So to hear my voice was just overwhelming for him. It speaks to what we do.

We need to recognize that history does repeat itself. We've had pandemics before. We've had millions of people dying. We need to be prepared. We need to be able to be more nimble and listen to to this. Hospitals and communities need to interact a little better. I think there needs to be a bit more transparency in the system.

What gives us hope is the vaccine. So we need to get our shots, and we need the majority of the population to get our shots. And we can't let of our, our fear of the unknown get in the way of what we do. We have to tackle the fear, move forward, and do the best we can, you.

Definitely. We have more virtual care. You know, in the past, when we would see a patient, you're saying, "You know, I'll see you in three months," or, "in six months." This time around, the next question is, "Can I see you in person, or can this be done over a phone or a video visit?" Patients have embraced that. We have embraced that. We are making it work, but it certainly is that one extra step that we have to think about. That emotional connection is still there; it just takes a few more steps to get there.

As much as we'd like to separate our professional lives from our personal lives, it does impact us. I'm always on my computer connected to my patient charts, more so now. So, I'm bringing work home. It does creep in slowly and truly into your personal life.

There's this one patient I remember—her partner had passed away, and so for her, it was really, really important to have the support of her family. Right now, women are still only allowed, for the most part, one support person when they're coming in to give birth. It meant a great deal for her to have the obstetrician on call be the person that she knew, that she trusted, and that she has built a relationship with over, you know, the whole pregnancy.

COVID has taught me that family is important. We were home, and we had meals together, walks together. That's the biggest piece I take away from it: allowing me to spend more time with my family.

We really need to strengthen the connectivity of healthcare across Ontario—have that infrastructure to really support more virtual care, to do telemedicine. The ability for patients to access their charts from home is a key; it's a big thing.

What I'd like to say to the public is thank you. Thank you for embracing the new way we're doing things in terms of our healthcare system. Thank you for understanding the changes that we have had to go through, and get your vaccine.

Things have certainly changed a lot over the last year. And probably the biggest change that we've experienced is the fact that we are delivering a lot of the care through a virtual mechanism. For the most part, that involves phone calls. Occasionally it's a video link with patients.

I think in some respects there are some certain positives with that in the sense that patients don't have to travel, they don't have to leave their house, they don't have to pay for parking, they can wait at home for the phone call. But I think there's probably also some important negatives that we are becoming aware of. And I think one of the biggest ones is the fact that it's not the same relationship over the phone as it is when you see the patients in person. When you're treating patients with cancer, I think having that close connection—actually seeing patients—really makes a difference.

I think the work-and-home lines got blurred. We're often calling patients from our houses and from our living rooms, and, you know, you're having these really difficult discussions, and you don't have that separation at all. And of course, sometimes you've got family members who are around or kids who are around, and that can be difficult.

There's many patient stories, many things that we'll remember over this period of time. One case is of a young woman who I looked after for many years with advanced cancer. She took every possible treatment, tried every possible clinical trial, and finally, you know, we weren't able to win, if you can say it that way. The cancer was progressing, and then she started to think about medical assistance in dying. And that was the right thing for her, the right decision for her.

What was meaningful was during the course of that, despite the pandemic, I was able to see her a few times in clinic, alternating that with virtual phone calls. And then finally, I was able to do a video conference with her just before the very end, and we were able to say goodbye. So that was very special. It was very heartwarming. I think it offered a little bit of closure, and I think that was important.

As we enter this vaccine phase of the pandemic, I think the biggest advice I have for Ontarians and Canadians and everyone is just to stay home. Keep the warnings. There are many people who are asymptomatic carriers, and we have to believe that, in order to get control over this virus, we really do need to stay home. So that's my big message for Ontarians and Canadians.

When the last 12 months has been one of the most challenging periods in our career, I've been doing this for about 30 years and certainly has changed a lot. One of the most dramatic change is actually taking care of patients virtually over the phone or over the video.

First of all, you know, lots of our patients that we take care for in Ontario are minority populations. In my particular case, have lots of patients who only speak Cantonese and Mandarin. When we start getting to the point where we have to review the medications, it becomes a major challenge, for example, you know, to pronounce the name of the drugs or what kind of drugs they're taking and the dosage, etc. So, we have to use many different innovative methods of helping ourselves to help our patients.

At a personal level, we have, um, to take care of ourselves, take care of our family. Tend to actually put on my mars when I'm close with my parents. When we eat, we do at home, make sure that we have appropriate distances to make sure that we are safe and our family is safe as well.

In many ways, COVID is a very bad thing. We are right now in the darkest hours where we have to keep our morale up, but at the same time, we'll open the bright future of how we take care of patients moving forward. We're gonna have much more immersive experience. For example, they can have blood pressure machines and virtual stethoscope or other different internet of things health devices where they can have a kit at home. Then as doctors, we can access these tools to be able to measure the vitals, different things such as blood pressure, heart rate, oxygen saturations, and other different parameters that we need to care for patients.

I strongly encourage all our patients to take time, you know, in the day to exercise, trying to get sunlight because that's important for our mental health. Stay healthy by eating healthily, not trying to overeat, because many of our patients have gained a lot of weight. And last but not least, look at the information about COVID vaccines. Try to get to know what they are, make a decision for yourself, strongly consider to take the vaccine. I think that's the best defence against, uh, COVID and also allow us to move forward so we can get back to our normal lives.

A major change for us, which is unprecedented, is the introduction of virtual care. And that's quite different from the practice from pre-COVID. The number of patients who prefer the convenience and safety of virtual care is kind of important to recognize and to comply with.

This worldwide epidemic has really thrown a huge weight onto everybody's lives. Unprecedented levels of stress are experienced by many people. The demand for care is considerably higher for psychiatric health or mental health care. There are challenges to meet that demand.

The danger that we may pick up the virus unknowingly, in spite of the precautions that we're taking, and we take it home to our families—to infect one's own family is a horrible thought. That is a major concern and a stressor in which I feel. The other thing is the necessity to pace our work differently than before. We need to take extra time for the protocols to keep our environment safe.

So, in terms of what I have found wrenching, an example of this would be a man who has a job which is not very satisfying and he lives alone, he has no family. We know that exercise is an antidepressant. I recommended that, even though he may be fearful of being outside. He also has a certain condition which does require him to have access to bathrooms, sometimes quite urgently, and he informed me that most of the public toilets in this city are locked. The limitations that this COVID infection is really imposing on a lot of people who otherwise are living fairly circumscribed lives, but at least they were able to go out and about without fear of having a urinary or bladder accident—so that to me was fairly heart-wrenching to realize.

I know these times are tough, yet it is important to live in a way that cultivates optimism and a positive attitude. You really have to strive to live mindfully and learn to enjoy the moment-to-moment experiences of our daily lives, and also to practice gratitude for the things we can be grateful for.

The way that COVID has changed the world from my vantage point is that it's probably giving a lot of our patients some hesitancy to come to the hospital. There's the stay-at-home orders, the fear that maybe people with COVID are going to be at the hospital. I think it's creating a new barrier to care that ends up being problematic. If you truly do have an emergency, you should come to the hospital. Nonetheless, the people are still as dedicated as ever to accomplishing what we need to get done to keep Ontarians safe and pick them up when they do fall down.

I would say that the biggest challenge personally is just that it's quite isolating, right? We have family, we have friends from all over. I usually travel quite a bit, and I mainly have Zoom as one way of connecting with the world. A lot of the personal connections that were best fostered by, you know, sharing a meal together or playing a round with board games—that's not possible. I haven't seen my family in a long time in person.

Professionally, one of the biggest challenges I think is that healthcare was already overtaxed and overburdened in so many ways. We were already running at 110%, and during the early phases of the pandemic, we saw drops in numbers. Now we're seeing more and more people coming back, which is good, but then at the same time, we're running out of space in the hospital. We still have quite a bit of time that we need to spend letting people get better, and that's definitely a challenge right now.

Looking to the future, I think one of the big things that we need to do is just really think about how we can archive the lessons learned, archive the wisdom that we've all gained during the systems change, and maintain the things that we think will continue to help us. Across the board, healthcare organizations are now communicating better within the walls and outside of the walls. We need to maintain that.

I think we've had a rise of a whole cadre and generation of young physician leaders that need to be fostered. We need to invest in them now that they've risen to the occasion now and shown potential. I think that the best thing we can do is really, truly invest in the future of the next generation so that we can make sure that they take with them the lessons learned from this environment and parlay it forward into future situations.

When it comes time for you to get your vaccine, please step up, roll up your sleeve, and literally just let us jab you in the arm a couple of times. It'll be amazing if everyone can do that because I think that it's going to take everyone rolling up their sleeves, literally, to make this happen and for us to be able to get back to life.

Apart from what everyone dealt with the pandemic, the isolation, the fear, the anxiety, the thing that I, I think was most frustrating was not being able to take care of people and having even those who needed care being so afraid of coronavirus that they wouldn't even seek care when they need it for other problems, such as vision loss. That was really, um, a big surprise once things settled down in the summer a bit, seeing people with more and more advanced problems seeking care at later and later stages.

A lot of physicians can do web-based medicine, we can talk to patients. For us, we require a lot of examination and our services very interventional. So for us, the biggest thing that changed was really seeing fewer patients and trying to navigate a way to see all the people that need to be seen with these new constraints.

One patient I saw actually early on just after the initial pandemic started, I saw him fairly urgently because he was having a lot of trouble with his eyesight. And he was inspirational because this man had developed a severe case of coronavirus, had respiratory complications, his kidney stopped working. This guy was in the intensive care unit for two months, his family was told he's not gonna make it. All he remembers from this whole two-month episode where he was basically in the intensive care unit unable to speak, unable to communicate, he remembers the story that you always hear about the pearly gates. And, and he says, "I saw this big tall building and I was trying to, you know, see if I get the door open and, and someone kept saying to me, 'It's not your time.'" And he goes, the next day I was awake and my family was there. What was really interesting about his story, after all this, his biggest concern is, "Doc, I can't see properly. What can you do for me? Help me, please." And again, we did his cataract surgery for him, we helped him see better, and through all this, and he was so grateful. He taught really how important is to have the right attitude.

I think the biggest thing I think we need to learn and do better is communicating and having clear guidelines and clear rules in place, because there's been a lot of confusion over the last nine months. And I think that we need to be better at understanding, whether it's a pandemic, an infectious disease, or other medical issues, how to, how to clearly deal with them, explain to patients, to the public what the rules are and make them clear.

The one thing I really want to share with everyone is to not lose hope. No matter how bad things are, no matter how difficult things are, they always get better. They will get better, they have to get better, and we all have to have faith.