A glimpse inside the ER during the pandemic's 3rd wave
Dr. Justine Amaro gives insight into the challenges posed by COVID-19
As Ontario's hospitals prepare for the possibility of triaging life-saving care in the event COVID-19 cases further overwhelm resources, one Ottawa doctor says she's not emotionally prepared to make such choices.
"I don't think any of us thought we would need to make these decisions when we entered medicine," said Dr. Justine Amaro, an emergency room physician at The Ottawa Hospital.
Amaro said a sense of "foreboding" has blanketed the emergency room as she and her colleagues watch hospitals in the Greater Toronto Area (GTA) exceed their capacity to care for critically ill patients.
As of Saturday, there were approximately 100 patients on ventilators in intensive care wards across the nation's capital, according to Dr. David Neilipovitz, head of critical care at The Ottawa Hospital and is also leading the critical care effort in eastern Ontario.
Of those patients, more than half are people who've been diagnosed with COVID-19, Neilipovitz told CBC. Three out of four COVID-19 patients are on ventilators, he added.
There has been a slight plateau of some key COVID-19 indicators in the city, however, and on Saturday, Ottawa Public Health reported the lowest one-day case total in more than three weeks.
The Ottawa Hospital also said in mid-April that it was not close to deciding who gets life-saving care.
But if the availability of ICU beds or staffing reaches a critical point, doctors will follow a provincial triage protocol based on mortality risk.
Critically ill patients who have the best chance of survival one year later would be prioritized under the protocol.
Changing concerns in ER
When COVID-19 first arrived, Amaro said there was a lot of fear as people didn't know how it spread or how dangerous it was. At the time, hospital staff were primarily worried about shortages in personal protective equipment.
In fact, ER visits declined during those early days — a sharp contrast to what's happening now.
By last fall, Amaro said she started to notice a new trend: more patients coming in with late stages of diseases, suggesting they had put off seeking medical attention.
Amaro said she saw patients come in who'd already had heart attacks and strokes, as well as people with metastatic cancers that had spread. In one case, she recalled a patient going into septic shock due to a gall bladder infection.
"He was dying of a life-threatening problem that, had he presented himself earlier, it could have been dealt with," said Amaro.
Parents, front-line workers among younger ER patients
In the past two weeks, Amaro said she's seen a greater number of patients in their 20s, 30s and 40s with COVID-19.
Sometimes, entire families or multiple members of a family are infected. In one case, Amaro recalled two parents who were both admitted to hospital with no one to take care of their young children.
The doctor said she's also seen cases where grandparents are filling in the child-care void.
"I've also had patients where a parent is too sick to go home but they choose to leave the hospital and go home anyway because they have no other option," said Amaro.
Among Amaro's younger patients are essential front-line workers, some of whom do not have the option to stay home. They also include people without paid sick leave who live in crowded spaces with large families.
'A huge toll'
Amaro said she's still haunted by one "heartbreaking case" involving one of her older patients.
"I've literally sat with an elderly person who has begged me to please provide them with medical assistance in dying, because they would rather die than continue living in an isolated way," she recalled.
"It breaks my heart to watch people literally feeling they would rather end their life than they would continue to live on in a way where they are alone."
In the 17 years she's worked in emergency medicine, Amaro said she's never seen so many patients suffering from deteriorating mental health.
"The social isolation," she said, "has taken a huge toll on all of us."
- A previous story incorrectly stated that roughly 75 per cent of patients in ICUs across Ottawa have been diagnosed with COVID-19. In fact, more than half of those patients have been diagnosed with the illness.Apr 27, 2021 6:55 PM ET