Kevin McKechnie is a family doctor in Nelson, B.C.
Nelson is the bucolic mountain town in the Southern Interior of B.C. where I’ve had the privilege of working as a rural family physician for more than a decade. My colleagues and I practise a vanishing style of medicine that allows us to look after patients of all ages, through all stages, in both the community and in hospital. The work is gratifying and richly rewarding, and I never thought I’d question my plans to live out my career here. Sadly, events of the past few weeks have left me wondering.
Until very recently, the pandemic largely spared our community. Owing to our remote location, and blind luck, case counts remained low. I had one patient who spent five weeks in ICU, but his case was an exception, and the scattered handful of local cases were generally mild and self-resolving. Our hospital was not overcapacity, our workloads not overly burdensome and a will to overcome the pandemic seemed to draw the community together. Then, a few weeks ago, everything changed.
Since the beginning of August, Nelson and its surrounding communities have seen an exponential upsurge in COVID-19 cases. Our ICU is overcapacity, our hospital is full, our emergency department is seeing record daily visits, and our testing site can’t keep up with daily demand. Worse still, modelling data suggest case numbers could continue to climb for the next four to five months. Almost all local patients requiring hospitalization for COVID-19 have been unvaccinated, and public-health data demonstrate that the continuing spread is perpetuated almost entirely through those who have chosen not to get vaccinated.
My work as a family doc in this town has consequently become much more challenging. Today, typical of most days this past month, I started early and finished late. In addition to countless other encounters, I attempted to get an unvaccinated 23-year-old woman with worsening COVID-19 to the ICU, but failed because all the ventilators are in use. I called a patient to tell her that her aneurysm surgery has been indefinitely postponed because the hospital has no more capacity. I started an ordinarily resilient and vivacious patient on antidepressants, because after 18 months of trying to remain optimistic about his future, he is sinking. I witnessed a member of our clinic staff being verbally abused by an irate and indignant patient, offended at our clinic’s mask policy. I was asked to write a “medical exemption” letter for a patient with no significant medical condition. I attempted to reassure a pregnant mother, terrified about delivering in our COVID-positive hospital. I cancelled a planned house call (for the second time) with a bed-bound stroke victim, who wanted to discuss Medical Assistance in Dying, because I got called back to hospital at the end of my clinic day.
I care deeply about this town and the people in it. I am committed to providing my patients the highest-quality medicine I know how to deliver. I’m careful not to let bias or differences of opinion affect the care I provide. I am prepared to work as tirelessly as necessary to help get this pandemic under control and restore our town to a semblance of its previous idyllic self.
Unfortunately, I’m finding it increasingly difficult to maintain my motivation. My non-judgmental approach is beginning to wane. I’m becoming exhausted and profoundly demoralized. The personal and professional toll on me, my colleagues and all those working in the health-care sector of our community is enormous.
We have, in vaccines, a tool to put an end to all of this. The data are irrefutable. Should a sufficient number of the unvaccinated get inoculated, we could get our surging local outbreak under control in a matter of weeks. Unfortunately, our town continues to have one of the lowest vaccination rates in the province, and opposition to a vaccine passport program is vocal and strident.
I implore the unvaccinated citizens of our community, and similar communities elsewhere, to step up and do the right thing. Denying the reality of what my colleagues and I are seeing daily is untruthful, demoralizing and harmful. Please prioritize the health of the people around you. Please put aside specious arguments about the erosion of civil liberties or the sanctity of personal health information until we’re at last free of this devastating crisis. We are not being asked to go to war. We are simply being asked to acknowledge real-life evidence, trust in proven science and take a shot in the arm.
Meanwhile, I’ll continue to plug away in our hospital and in my clinic, and do what small things I can to help those affected by this pandemic. I’ll remain hopeful that our town will get itself back on track, and that tolerance, respect and compassion will become the defining characteristics of our community, once again. I love my town, and I’d really like to stick around.
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