I ran to the Code Blue: a woman, 60's, just diagnosed with metastatic cancer, was found unresponsive -- in other words, dead.
With seconds to act, somehow, we brought her back and hooked her up to life support. This was a rural Ontario hospital so we initiated the transfer process to a larger center with a full-scope ICU.
As I walked out, a doc caught my sleeve: "Don't go too far," he said, "I might need your help: mom of 2, thirties, generally healthy, bilateral influenza pneumonia and decompensating steadily."
A sick feeling settled in the pit of my stomach.
All around Ontario, doctors and nurses do what they can with what they have. More often than not, we simply don't have enough so we stretch resources to meet patient need. This holds true in glossy downtown Toronto hospitals as well as small community hospitals. With luck, grace, wit and grit, we get by -- but not always.
This particular hospital had two life support machines. Two ventilators. 99% of the time, two was enough. Until one of them broke. So, I faced a hard decision: who gets our one and only ventilator? The 67-year-old mom with metastatic cancer whose son requested more time? The 30-year-old mom with overwhelming pneumonia and two babies waiting at home?
I have been thinking a lot lately about physicians, Medicare, the government and the politics of rationing care.
In the podcast, "Playing God", journalist Sheri Fink discusses the concept of triaging. Her setting: a New Orlean's hospital during Hurricane Katrina. She speaks of doctors and nurses faced with hard decisions: the power's out, the back-up geni's going, who gets evacuated first? Who gets saved? Who is left to die?
Triage means you don't have the wherewithal to help everyone so a calculated decision is made to prioritize some over others. You serve the greater good even as you sacrifice the individual.
A John Hopkins physician posed this question to a group of volunteers. The setting: a hypothetical flu pandemic and limited ventilators. She didn't ask doctors or nurses. Instead, she asked regular people. Their reasoned responses mirrorred conversations I have with my colleagues on an almost weekly basis.
Granted, my setting is neither a pandemic nor an environmental disaster. But, I know that doctors and nurses on the front-lines across Ontario are forced to ration care each and every week.
Years of under-funding and mismanaging health care led to an obvious mismatch between available resources and overwhelming patient need. The sickest get the doctors, nurses, hospital beds, ORs, imaging and investigations. The rest wait -- many of whom become sicker, some of whom even die.
Access to a waitlist is not access to health care.
We simply do not have enough to give everyone the care they need right when they need it. In an ideal world, we would. That is the definition of timely, universal health care. But in real-world Ontario, we are forced to triage patients and ration health care. Too many people, too few publicly-funded resources.
Emergency Departments are a microcosm reflecting this system. No patient is turned away. But resources -- doctors, nurses, bed and equipment -- are finite.
People walk in with trifling concerns: hangnails, splinters, constipation. People walk in with non-emergent concerns: twisted ankles, cat scratches, months of stable back pain or abdominal pain.
People also arrive with horrible concerns: limbs accidentally amputated by table saws; heart attacks where the docs and nurses literally bring them back from the dead; 3-year-olds with broken faces from car accidents and improper carseat use; stabbings, gun shot wounds, burns, blood infections, drownings.
Their setting: tiny stalls crowded with ER stretchers where the curtains brush against the doctor's hip as they lean over to examine the patient. Machines beep. Patients moan. The smell of bleach and antiseptic mingles with vomit and blood. The nurses are run off their feet. The docs have no legislated breaks -- meals are skipped because the need is overwhelming. "Logged 8000-9000 steps each shift," texted a colleague.
They are some of the unsung heroes of our chaotic health care system.
Doctors try to focus on each patient's story, but they worry: the woman in trauma bay with a gaping head wound; the boy in room 4 with the dislocated shoulder; the 87-year-old woman with stomach pain; the 17-year-old who overdosed on Percocets. Then the ambulance arrives with more. They juggle such stories of pain, fear, trauma.
Nearly every hospital now faces a perpetual bed crisis. The downstream effect on the Emergency Department means sick patients line up in hallway stretchers, waiting for a ward bed. Last month, one doc counted 60 patients waiting for beds in an urban hospital ER -- far beyond capacity. They were farmed out to neighboring hospitals.
With such overwhelming need and insufficient resources, ER doctors make hard decisions: who to send home? Who to park in a waiting room chair for more investigations? Who to admit?
Wait-times are long, tempers are short. With no one else to blame, patients snap at those trying to help. And at least once a shift, a patient threatens lawsuit or complaint.
"We as a profession can literally bend over backwards to give people an awesome customer service experience in a broken system, and it doesn't matter," said an ER colleague, crying in the backroom, something she hasn't done in decades.
This is Ontario. Our system is broken. And all around, doctors, nurses and patients are breaking. We cannot hide from this frightening truth.
This conversation needs all of our voices. Not just politicians who manage health care at arms' length. Not just the highly-educated doctors and nurses who have to look patients in the eye.
Ontario must answer: too many patients, too few resources, how do we choose who gets what when we simply don't have enough?
Details in story have been altered to protect patient identities.
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