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Bedside Moments, Last Breaths. ER Docs Face Down ‘Nasty Beast’ Of COVID-19.

From Halifax to Yellowknife, doctors on the front lines of the coronavirus pandemic are experiencing the challenge of a lifetime.
Dr. Joe Vipond in Calgary, left, Dr. Nadia Alam in Halton Hills, Ont., centre and Dr. Marie-Renée Lajoie in Montreal have been working on the front lines of the COVID-19 crisis.
Dr. Joe Vipond in Calgary, left, Dr. Nadia Alam in Halton Hills, Ont., centre and Dr. Marie-Renée Lajoie in Montreal have been working on the front lines of the COVID-19 crisis.

TORONTO — Amid hectic and unpredictable days, Dr. Nadia Alam takes a moment to sit with a patient fighting the worst COVID-19 symptoms.

For the last week, Ezio “Armando” D’Agostino, 72, has been in the intensive care unit of a Toronto-area hospital, his lungs clogged with fluid, coughing, fatigued, struggling to breathe. With the exception of health-care workers, he is alone. His family cannot visit him or they would risk contracting the highly contagious disease.

D’Agostino has declined the use of a ventilator — the last-resort machine that would pump oxygen into his lungs through a breathing tube. It was a decision Alam, a family physician and anesthetist, tweeted about last weekend.

For D’Agostino’s family, knowing he has company for the briefest of times eases their anxiety, said his niece Virginia Mazzone-Ahou. She’s refrained from calling, wanting him to save his strength to talk to his wife and children.

“I thanked [Alam] a million times,” she said. “I shared [the tweet] and cried. It gave me a little bit of peace.”

Like many other Canadians with loved ones suffering from the coronavirus, Mazzone-Ahou must trust the doctors and nurses will provide D’Agostino comfort as his bedside remains empty of those who, in different times, would hold him close.

HuffPost Canada spoke to five front-line doctors across the country about their experiences responding to the COVID-19 crisis — a challenge of a lifetime.

Alam said behind her mask, gown and gloves, she is striving to connect with patients in hospitals and long-term care facilities who are now “incredibly lonely” as social distancing continues in Ontario.

“All the kinds of things we used to do to comfort one another involve touching and we can’t anymore,” she said. “And there’s this fear, too, underlying everything.”

But when she sits with D’Agostino, worries about running out of personal protective equipment, or contracting COVID-19 melt away. “I sat down, held his hand and I hoped he felt more than just plastic — that he felt a human connection,” Alam said.

Ezio "Armando" D’Agostino, who lives in Brampton, Ont., is currently in hospital after contracting COVID-19.
Ezio "Armando" D’Agostino, who lives in Brampton, Ont., is currently in hospital after contracting COVID-19.

D’Agostino, who lives in Brampton. Ont., did not travel recently and his family does not know how he contracted the coronavirus, said Mazzone-Ahou. He first experienced cold-like symptoms that quickly worsened.

“He’s an amazing man,” said Mazzone-Ahou, whose childhood weekends included sleepovers at his house with her cousins and big family dinners. D’Agostino can be counted on at weddings to pop open the trunk of his car and hand out gifts and food, and call her mother everyday to check in, she said. “He has a giving hand and always makes sure everyone else is OK.”

D’Agostino is “amazingly” still alive without a ventilator, said Alam. He rests on his stomach from time to time to increase the amount of oxygen getting to his lungs, a method called prone positioning.

“Maybe he will turn out to surprise us all,” Alam said. “It would give me a lot of joy to be his family doctor.”

Watch: Vancouver nurses reflect on the impacts of the COVID-19 crisis. Story continues below.

As of Friday, Canada had more than 30,000 confirmed cases of COVID-19 across 10 provinces and two territories. About 1,200 people have died of the disease. Ontario is second hardest hit, after Quebec, with 9,000 cases.

In mid-March, when the World Health Organization declared COVID-19 a pandemic, Canadian public health officials became increasingly concerned hospitals would be overwhelmed with patients and face a shortage of ventilators. While they’ve so far staved off an unmanageable surge, it could still happen.

Last week, researchers warned hospitals may need as much as 13 times more critical care beds in the coming weeks than are currently available, as the number of cases are expected to peak.

HALIFAX

With decades of emergency medicine experience, Halifax doctor, Sam Campbell, is quick to admit that when it comes to COVID-19, “we really do not understand what we’re dealing with.”

Doctors around the world are relying on anecdotal evidence, piecing together what appears to have worked in China, Italy or New York City, and adapting day by day, he said.

What causes COVID-19 to transform from a mild disease to one that causes overwhelming inflammation in the lungs? Why does it kill some people and not others? What’s more effective to improve oxygen levels in a patient — inserting an invasive tube down their throat to hook up to a ventilator, or rolling them onto their stomachs so their lungs can take in more air?

Dr. Sam Campbell works at the Queen Elizabeth Health Sciences Centre ER in Halifax.
Dr. Sam Campbell works at the Queen Elizabeth Health Sciences Centre ER in Halifax.

These are questions Campbell and his colleagues are grappling with as they respond to COVID-19 cases in the emergency department at Queen Elizabeth Health Sciences Centre. So far, Nova Scotia has had close to 600 confirmed cases of COVID-19 — the most of any maritime province — and is expecting to peak at the end of April.

“An emergency doctor never wants to see a pandemic, but that’s why they were put on this earth. This is what they’re trained to do,” said Campbell. “It’s a time to be proud and take very seriously what the public is hoping you will do for them, and focus on what really matters.”

Right now, the department is quieter than usual. In fact, Campbell has not seen this many empty beds in years.

Health-care workers are treating about half the number of patients, either because people aren’t getting injured as often while social distancing, or they’re putting off going to the hospital out of fear of contracting COVID-19, he said. Cancelled elective surgeries have freed up beds and doctors are choosing treatments more wisely for those who are sick, cutting wait times in half.

“If you ask me again in three weeks time, I will probably be pining for these days,” said Campbell.

MONTREAL

In the emergency department of the Jewish General Hospital, many of Dr. Marie-Renée Lajoie’s COVID-19 patients live or work in nursing homes.

In Montreal alone, at least 50 homes have confirmed cases. One residence is under police investigation after staff fled out of fear of contracting COVID-19 and 31 people died in less than a month.

Staff and visitors walk past a sign indicating to wash hands on the elevator doors at the Jewish General Hospital in Montreal on March 2, 2020. 
Staff and visitors walk past a sign indicating to wash hands on the elevator doors at the Jewish General Hospital in Montreal on March 2, 2020. 

“The big tragedy in Quebec is in the long-term care institutions,” said Lajoie. “Our elders are in a very vulnerable position and health-care workers are, too.”

Lajoie struggles with the tough tough decisions she has to make — should a frail patient be put on a ventilator, which could risk irreversible damage? Should an elderly patient who doesn’t have severe symptoms be sent back to their nursing home where they may not receive proper care?

“They feel alone and scared,” Lajoie said. “These are all the emotions no one wants to go through towards the end of their life.”

Lajoie estimates that right now about 100 patients visit the emergency room at the Jewish General Hospital a day, and between a third and a half of them are assumed to have COVID-19 — a disease she calls a “nasty beast.” Quebec has the highest number of cases of any province at about 16,000 and hasn’t reached its peak.

Dr. Marie-Renée Lajoie is pictured in the ER at the Jewish General Hospital in Montreal.
Dr. Marie-Renée Lajoie is pictured in the ER at the Jewish General Hospital in Montreal.

“Our health-care system hasn’t been overwhelmed, yet, but how much resilience will we need to get through this?” She said, the COVID-19 crisis could be a reality in hospitals for years to come, long after the strict social distancing measures have been lifted. She hopes Canada recognizes this pandemic is not a one-off.

“As a society, nobody was significantly investing in pandemic preparedness and I don’t think we’ve realized how disruptive and impactful these global health events can be, and how vulnerable we are,” she said.

CALGARY

Health-care workers at Calgary’s Rockyview General Hospital are both pleasantly surprised a wave of COVID-19 cases hasn’t hit them and “extremely nervous it’s coming,” said Dr. Joe Vipond.

“It doesn’t take much for a wildfire to escape from our control and we have to be really cautious.”

Alberta has reported 2,158 confirmed cases of COVID-19, more than British Columbia, Saskatchewan, Yukon and the Northwest Territories combined. The province, however, implemented relatively strict social distancing and widespread testing early on in the crisis, and doesn’t face significant shortages of personal protective equipment, all of which are helping hospitals cope, said Vipond.

Premier Jason Kenney even announced that Alberta would be sending masks and other medical supplies to provinces facing shortages such as Ontario, Quebec and B.C. However, Vipond would like to see the equipment going to Alberta’s emergency responders, grocery store workers and the public, too.

“That’s what’s going to get us through this where we’re almost winning,” said Vipond.

He’s concerned about the long-term mental health impacts the COVID-19 crisis will have on society. He has chosen to self-isolate from his wife and kids and said it’s tough to be alone with his thoughts for most of the day.

“We’re such a social species,” he said. “For a lot of people, there’s only so many virtual hugs and Zoom interactions before you crave something a little closer and more personal, like coffee over a small table.”

Vipond is imploring people not to delay emergency medical care for conditions other than COVID-19. He’s seeing patients who are sicker than usual, having put off addressing chest pain or appendicitis and are now facing full-on heart attacks and burst appendices.

“If you have an emergency, we want to see you,” said Vipond.

YELLOWKNIFE

In the Northwest Territories, the tuberculosis epidemic in the 1950s and ’60s remains a vivid collective memory. At least one-third of Inuit in Canada were infected and thousands of Indigenous people died. To this day, many communities have no hospital or ventilators.

So, when COVID-19 cases began climbing in the provinces in March, communities took it seriously from the start, closing borders and enacting social distancing measures, said Dr. Courtney Howard, an emergency doctor at the hospital in Yellowknife.

Dr. Courtney Howard who works at the Stanton Territorial Hospital ER in Yellowknife, said communities there took precautions from the pandemic’s start.
Dr. Courtney Howard who works at the Stanton Territorial Hospital ER in Yellowknife, said communities there took precautions from the pandemic’s start.

“We know if it gets into communities here, it will really be a problem,” she said.

A month in, the Northwest Territories has had five cases, two of which have resolved.

The health-care system has undergone changes in a matter of weeks that medical professionals have been talking about for years, said Howard. They’ve expanded virtual care to check in on people in far flung locations. There’s a new shift at the hospital for a doctor to do only these calls.

“We know we live really far away and that we need to take care of one another, and it’s helping us,” Howard said.

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