And then came the COVID-19 vaccines. Our Pandemic Diaries series, in which health care professionals in British Columbia have told their stories of working on the front lines, concludes with the hope that’s arrived along with the shots – tempered by the continuing challenges of treating affected patients during the pandemic.
- Dr. Terri Aldred, family physician from Tl’azt’en Nation, who lives and works on the traditional Lheidli T’enneh territory otherwise known as Prince George
- Dr. Jeevyn Chahal, family physician in Kamloops
- Jayne Hamilton, advanced-care paramedic in Metro Vancouver
- Dr. Tiffany Lee, locum intensive-care physician at the University Hospital of Northern British Columbia, Prince George
- Dr. Inderveer Mahal, family physician at Vancouver General Hospital and the Downtown Eastside
- Rachel Mrdeza, emergency-trained registered nurse at St. Paul’s Hospital, Vancouver
- Dr. Steve Reynolds, specialist in infectious diseases, internal medicine and critical care; ICU physician and site medical director at the Royal Columbian Hospital in New Westminster
- Shane Sander, primary-care paramedic in Surrey
Dr. Tiffany Lee, Dec. 31
We are now familiar with the relentless suffering COVID inflicts on our sickest patients. First, the exhausted gasping on 100 per cent oxygen. Then, a breathing tube. Eight hands flipping a body supine, hoping the lungs will finally want to work right side up.
Day 7: The family still calls during every shift, and we have nothing new to share, except for the new infections pummelling through a worn body.
Day 14: We have enough hope to press on with the machines, so it is time for a tracheostomy – a hole through the neck, the breathing tube going directly into the windpipe.
We finally let the patient emerge from the haze of drugs. What was the last thing they remember? The panicked gasp for air? The pressure of plastic pushing through yet another orifice? The delirium sets in now – sometimes in an anxious, boiling rage, sometimes in a quiet, icy withdrawal. Then – because it is true, and because there is no other choice – we harden our hearts and say: “If you want to get out of here, we need to get you out of bed today.”
Dr. Terri Aldred, Jan. 1
On New Year’s Day, I received the first dose of the Pfizer vaccine. I felt a mixture of relief, anxiety and hope. Relief because rural and remote Indigenous communities, and the care teams that support them, are a priority to receive the vaccine. Anxiety because due to colonialism, COVID is disproportionately affecting Indigenous people – and due to the legacy of colonization, many Indigenous people lack trust in the health care system. This has made some fearful about the vaccine and reluctant to receive it. I am hopeful, though, that getting the vaccine will set a good example for my patients and inspire others to follow suit.
Following the teachings of my elders, when I pick and prepare traditional medicines, I should do so with a good heart and a good mind. This is done through ceremony.
Remembering these teachings, I made sure I prepared my spirit to receive the vaccine by smudging and praying. I prepared my body by eating healthy foods and resting. I prepared my mind by learning about the vaccine and asking any questions. And I talked to my husband and family and received their emotional support. Taking these steps help my whole being prepare to receive the medicine.
I cried – for all those who are sick, all those we lost, and all who will benefit from the vaccine. Thankfully, I had minimal side effects – I was tired on the first day, had a sore arm the next day, and then I was fine.
The vaccine is good medicine – a gift I humbly received.
Rachel Mrdeza, Jan. 6
Walking into the trauma room today, I flashed back to a recent case of a young woman acutely ill with respiratory failure, who ended up being intubated. Her frightened face and audible gasping were etched in my mind, but most memorable of all was her resistance to treatment. Her oxygen saturations were crashing, with all other vitals becoming more unstable. But it wasn’t until after much convincing and a decrease in her level of consciousness that she allowed us to help.
After a quick discussion with a colleague, I found out the patient had passed away in ICU despite the team doing their absolute best to keep her alive. I remember the ICU doctor stating immediately after we intubated that her condition was most likely caused by COVID-19.
I reflected on how impossible it is for many of our more marginalized patients to self-isolate from one another. I am overwhelmed with the reality that many of the basic elements that help prevent COVID-19 are a luxury not accessible to everyone in our society.
Shane Sander, Jan. 8
A text message told me to check my e-mail. I filled out an online form on which the words “limited seats available” flashed atop the page. I raced across town, went into the wrong part of the building, but was thankful I had planned ahead by leaving 15 minutes early. It was an important appointment – in a basement at the address, paramedics were receiving COVID vaccination shots.
As I sat down for my shot, I thought about what this meant to us. As physically demanding as the front-line battle had been on our health care brethren, the mental anguish some of my colleagues have undergone was something I hadn’t seen before in my career. Burnout rates, shift vacancies, and a call volume all at an all-time high – the pandemic paired with an overdose crisis have really done a number on paramedics in this province. Seeing these vaccinations come to fruition was a monumental moment.
Now, I hope to see normalcy. I am hopeful that I’ll eventually be able to go to hockey games in an arena, concerts with friends, to see loved ones get married – and, most importantly, take a much-needed vacation or two with my wife.
Jayne Hamilton, Jan. 16
I had imagined what getting the vaccine would be like for 10 months before the time I was able to book an appointment. Every scenario I had envisioned – particularly when I daydreamed about it at 3 a.m. in the back of the ambulance while drenched in my own sweat underneath all the PPE – involved some version of feeling overwhelmed with relief and tears.
But on the day, as I stood in line edging my way closer to the check-in table, I realized I hadn’t considered that I might feel how I did in that moment: guilty. Deep, gut-wrenching guilt. I had noticed it the instant I had confirmed my appointment three days earlier, but hadn’t wanted to acknowledge it.
The paperwork and questionnaires were a blur, and when it was finally my turn, I numbly stumbled to a chair and sat down. As I felt the mild sting of a needle in my right arm, I thought about all the people who need and deserve the vaccine but haven’t gotten it yet – a thought that carried me out to the waiting room where I was asked to remain for 15 minutes to make sure I had no serious reaction. The tears and relief I expected never came, but as I sat staring at my vaccination card, I felt another thing I hadn’t counted on, either – hope.
Dr. Lee, Jan. 25
Heroes get placed on a pedestal – we mock their weakness when they fall. I care too much about the people I work with to use the word “hero.” All I know is that they are somehow there to help me laugh at myself in the darkest hours of the bleakest night shifts. That is the magic and joy of the ICU. When we burn out, though, we burn out together.
Burnout is questioning whether we can feel anymore. We are numb until a particularly traumatic death happens. We grieve together for a moment, collectively thankful that we still have emotions. By tomorrow, this will have been “yet another bad day.” Burnout is thinking that you are indispensable to a system that that treats you as dispensable. You pick up another shift, because you care about those who are more burned out than you are. Then you go home to your partner (kids, dogs, cats, etc.) and stare at Baby Yoda (or Yellowstone, or Bridgerton or whatever) for a few hours before you do it all again.
Our professional schools trained us to be good soldiers. To build careers out of people’s worst crises. To function on a heady brew of adrenaline, cortisol and Tim Hortons coffee. Good soldiers go to wellness workshops and do not complain about the schedule. They cry only in bathroom stalls, so the flushes drown their whimpers. We will be ready to work tomorrow, mining our reserves of hope.
Dr. Inderveer Mahal, Jan. 27
A Microsoft Teams notification appears on my phone from the staff at our Downtown Eastside clinic.
“Your 10:30 patient just called to say she can’t come in. Can you call her instead?” My watch reads 10:57 a.m. and I text back a quick “yes.” When your patients are struggling with two public health emergencies – the overdose epidemic and now COVID-19 – there’s a general understanding you don’t turn them away.
She’s one of my newer patients and with the help of methadone has almost stopped using. She had been so proud of her progress during our last visit. I call and hear a loud sob through the phone. She’s been exposed to COVID and needs to self-isolate in her single-room housing. Her voice is frantic: “I can’t miss my methadone – I’ve been doing so well!”
Together we come up with a plan. We’ll find a pharmacy to deliver her methadone and our nurse will call regularly to check in on her. But her anxiety is still palpable through the phone. She tells me she’s still using fentanyl regularly and the isolation is only worsening her cravings. I prescribe hydromorphone to try and curb the cravings and replace her fentanyl use. For what has to be the hundredth time since the start of the pandemic, I silently give thanks for the ability to do this. It makes me feel useful, like I’m helping in some way.
At the end of our call, she says: “My friends keep overdosing and my family is dying of COVID. I’m so scared I’m going to be next.” I say nothing for several seconds. Her despair is overwhelming. I’m scared for her, too.
Dr. Mahal, Jan. 29
Between the many e-mails from staff asking for a shift reprieve and an update on a hospital-ward outbreak, there’s a flash of hope. It reads: “Vaccine clinic tomorrow for people living in the Downtown Eastside.”
You can feel the mood shift at work today. There’s an excitement like something special is happening. It’s a glimmer of light after almost 12 months of fear, despair and death.
I call one of the pharmacies located across the street from the vaccine site. With telehealth, I can’t physically hand patients their prescriptions any more, so I often end up calling their pharmacy. There’s a familiar collegiality that has developed that I find comforting.
“Any news on how the vaccination clinic went?” I ask.
“Well, even with the rain, there was a lineup outside the door and around the corner. News spread pretty quickly through word of mouth and uptake seems great. I think people are looking for a reason to be excited, and this is it.”
I hang up and dream of a post-pandemic world. It’s close – yet still so far.
Dr. Steve Reynolds, Feb. 7
“So, seven out of nine days on skis, skiing again this morning, riding Seymour this afternoon…”
I looked at the text from a friend and my heart sank. I put my phone down and signalled to the nurse to give me a few moments before she gave me the report on the next patient.
When I was growing up, I wanted so badly to contribute, to build up those around me, and be valued. Medicine was the right fit – challenge, service and meaning, all together.
I remember the moment when my life shifted from an adventurous youth to a lifelong commitment. I sat on a black sand beach on the island of Makira in the Solomon Islands and watched the sun rise. Even then, I knew those days were limited.
Now I’m at the cusp of 50, and I watch the consequence of those decisions. COVID is just one more set of sacrifices. I have contracted tuberculosis, received an HIV-positive needle-stick, and now spend days facing down this virus. Nights away from my family. Vitality spent in the early hours of the morning squinting through the fatigue, staring at a patient’s monitor trying to gather the sands of their breaking physiology in my hands. Sometimes pulling out a success – but too often I am unable to change the course.
COVID has meant sacrifice for us all. In small and big ways, we have all lost. Part of this loss is apparent to me in the text I received from my friend – what I have traded for my calling; what I continue to forsake in the deluge of work. What I feel most now is the many absences – of freedom, of the liminal release of vacation, of gathering with friends, of spontaneity, of rest.
But this is not the time for rumination. The team is waiting. There is urgency in the illness all around me in the ICU. Some days, I drown in the meaning that I’ve chosen – but I know I wouldn’t change it for the world. Not even for those halcyon days of skiing.
Dr. Aldred, Feb. 9
For the past seven years, my practice has included outreach to First Nations communities in my traditional territory. That looks much different this year.
Two weeks ago, the health centre staff and I were working hard to educate those who were vaccine-hesitant and who deny the existence of COVID. This week, I sit six feet away while my patients dressed in black mourn their family members who are sick and those who have already passed.
I try to provide comfort while I manage my own fears and anxiety. Then, I pack the few things I brought and start the commute home. Tired, alone, with a full and heavy heart.
Dr. Lee, Feb. 9
Having the privilege of working in the north pushes me to question my practice all the time. Is this the same-quality care I would provide an affluent white man down south? Have I shown compassion to the best of my ability? Have I been honest? Have I created connection with a community that has a justified mistrust of hospitals? I often fall short, and this weighs on me as I sit at home processing the past week.
Even when I can answer yes to these questions, I still recognize that I have been an agent of trauma. It is not lost on me that I took care of residential-school survivors who were separated from their families yet again in the last days of their lives. It is not lost on me that for two nights in a row, my nursing colleagues began their 12-hour shifts by moving bodies to the morgue.
I’ve stopped trying to find meaning and redemption in this suffering. All I can do is to go to the bedside and be present. Moment by moment, I am trying to prove that we can reach the other side of this nightmare with our humanity intact.
Dr. Jeevyn Chahal, Feb. 13
We are nearing the end of our self-isolation. My 6-year-old daughter got COVID-19. This came as a surprise as she was so careful to wear her mask at school, showered immediately when she got home, and the three of us were so cautious in our little bubble.
My husband and I tested negative. I felt a wave of relief wash over me when I got my negative result. There seems to be such a stigma with a positive COVID diagnosis – a positive result translates, to many, as being non-compliant with health orders. And we know that this is not always the case – we followed the rules and my daughter still got COVID-19. An experienced educator gave me this thoughtful insight: he said my daughter was the victim and not the perpetrator. Thankfully, she had very mild symptoms and recovered quickly.
Dr. Chahal, Feb. 20
Vaccine hesitancy is not an issue in my practice … anymore. Even those patients who scoffed at the influenza vaccine in the past are eager to receive the COVID-19 shot. There is a palpable sense of fear among my patients of all ages, and most are trying to get every vaccine they can.
Having received the first dose allows me to be an even more credible advocate for the vaccine, touting it as safe and effective. I can see the look of relief as it washes over my patients’ faces and the sound of hope that echoes in their voices on the phone when they find out that I did not experience any side effects. There are a minority of patients who are still skeptical and may not get the vaccine. It is my role to encourage discussion, listen to their fears and reasons for hesitancy, and respect their choices.
Completing a marathon has always been on my bucket list, but I wasn’t expecting it to come in this form. With ongoing perseverance, endurance and optimism, we continue our quest for the finish line of gaining back some of our autonomy.
Ms. Hamilton, Feb. 21
“So what do you think about the vaccine?” It’s a loaded question that many in health care are now bombarded with at the strangest of times by members of the public – one I heard recently as I was handed my food at a McDonald’s drive-thru. “Have you actually seen anyone with COVID?” a stranger at the pharmacy asked as I ducked inside in uniform to grab some hair ties. “Is it really that bad?” another motorist quizzed me while I was fuelling the ambulance one day.
Despite being a paramedic, I’m not always prepared or in the right head space for these discussions. Many people are genuinely curious, while others seem to see my uniform as an outlet for their frustration and fear. Either way, there is no option to simply shrug and say nothing, nor can I become emotional in my reply or it loses all credibility.
“Have you seen anyone die?” a stranger asked as I picked up my coffee in a local shop. I could feel my adrenaline surge and my face become hot as a horrible movie reel of memories flashed behind my eyes. I mumbled some quip about how I hadn’t seen anyone die that day and rushed out of the shop, back to the safety of my ambulance, heart pounding.
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