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8 minutes ago, skategal said:

While this is a US perspective, I fear that our health care professionals may share similar experiences before we are able to flatten the curve with the COVID Pandemic.  I took this off Twitter so apologize for the lack of formatting.  It's a long read and heartbreaking.  

 

 

Kari Jerge, MD, FACS (she/her)

@kari_jerge

 

For months, healthcare professionals have been hanging on to the guardrails of the top deck of the Titanic. We have been screaming at the top of our lungs that there is an iceberg dead ahead and begging the captain to turn the wheel. We have had other passengers who are in the food hall and can’t see the iceberg from where they are standing mocking us accusing us of lying about the iceberg. “There is no iceberg. You’re seeing things” “Even if there is an iceberg it is smaller than predicted based on available models” “You’re getting paid to claim there is an iceberg.” We are on the ship too. So we are watching the ship approach an iceberg knowing full well that we are going down with the ship. Do we keep screaming? Even though nobody is listening? Do we jump ship and save ourselves? The water is freezing and we don’t want to desert our fellow passengers. Do we gather up the other passengers who can see the iceberg and form a human shield to take the impact on ourselves? Do we bum rush the captain and demand he turn? Or do we stand still, silent, frozen in a state of fight or flight? Paralyzed with sheer terror. Never in a 14 year career would I have imagined I would see this day.

How are we supposed to feel when a critically ill patient has survived cardiac arrest and needs emergency kidney replacement with a dialysis machine but there are no nurses left to run the machine? How do we explain that the hospital policy allows for 1 family member to come in for 1 hour only as we withdraw care so the family of 15 who has traveled for hours to be with their father/brother/grandfather as he leaves this earth has to sit outside and watch on FaceTime? What do we say when they beg us to make an exception to the hospital policy, exclaiming in tears that they don’t care if they catch COVID, they just want to be with him one last time?

What do we say to the patients’s wife when a patient who was fine 48 hours ago is now maxed on 4 pressors, too unstable to flip on his belly to help his lungs get enough oxygen? He is in his 50’s, maxed on full life support. How do I explain that despite all of the medicines and machines available, he is dying, in front of my eyes? And there is nothing we can do to stop it. She cannot see what I see. She cannot feel how helpless this feels. How should I respond when I have explained the above to his poor wife over the phone and she starts crying, begging the universe to help her understand how this could have happened to him when they had “stayed home for months and done everything to avoid getting the virus”?

What do I say to the APP from a rural area in my state who is calling to transfer a critically ill patient because they don’t have any ICU beds left when we don’t have any either? Does it matter that the patient has a very treatable condition? If we had a bed available, we could save this patients life. I am sure of it. But my hands are tied and we have to turn them down. I wonder often what happened to that patient.

I am a surgeon. I fix problems. When patients come in after having been shot and their heart stops in the ER, I am trained to open their chest, clamp the aorta, and buy enough time to get the patient into the OR where we can fix whatever is bleeding. I am not afraid of much. In the most chaotic and hopeless of scenarios, when patients come in near-dead, trauma surgeons pick up the bat and swing for the fences. We run large teams of healthcare professionals, coordinating care of our patients like Aaron Rodgers in overtime during a Super Bowl game. There is nothing that ruffles us. Nothing that scares us. No case that we won’t try to save. When any rational player would bunt, just to get on base, we swing for the fence deep center field. It’s who we are. It’s what we do. Surgeons take out cancers. We fix broken things. We save lives. We are used to big sensational grand slam home runs. We are used to winning in double OT. We throw the Hail Mary when we should kick. It’s who we are.

So when I tell you that there is very little in the scope of medicine that truly scares me, it is not hyperbole. And when I tell you that I am humbled and terrified by what I have seen in the COVID ICU, it is also not hyperbole. What is coming in many states across the country is akin to the Titanic. It is another Hurricane Katrina. This was predicted. It was preventable. So, you tell me... how do I tell a husband that his wife is going to die tonight when he can’t see the tears welling in my eyes? How do I express my sorrow to him without looking him in the eyes and gently putting my hand on his? How do I show him how much I care and how hard we tried to save her when he cannot see me or feel my warmth? He came in to see his wife as we transitioned her to comfort care. He was only allowed to stay for an hour. I never met him in person.  I never gave him a tearful hug. We made his wife comfortable and she passed away that night, pain free. I wanted to be there to meet him but one of my 30+ other patients was getting sicker and I needed to be with him. Do you want to know what this dear man said to me when I explained that his wife was dying? He asked me, a stranger on the phone, what I advised him to do so that she would not suffer anymore. When I explained what comfort care meant, he agreed immediately. She had had a very poor quality of life and she did not want to suffer anymore.  So without many questions and without ever having met me, this man trusted a stranger to help walk him through end of life decisions... on the phone. And then, he asked me to please please let the whole healthcare team know how grateful he was for all we had done for her. He said “nobody really thanks you guys anymore.” He made me promise to tell the whole team how grateful he was. Because as he was preparing to lose his wife, a woman he had loved for 50 years, it was the well-being of the healthcare team that was important to him. I made sure to pass on the message to the bedside nurse and the charge nurse as I ran upstairs to another critically ill patient.

Sometimes I wonder which of these situations will haunt me in 5 years. The hug that I missed? The patient who couldn’t transfer to us? The woman who couldn’t get  the dialysis machine she needed? Sometimes I wonder which of these nightmares will stick with me. But then I remember that I go back on shift in a few days. And I am finally home with my parents, celebrating a small delayed Thanksgiving after finishing my quarantine. I realize that if my mind stays at work with my patients and co-workers, it will keep me from enjoying a small slice of normal life in between shifts. And I won’t do that. There is not enough of this time and I can’t waste it.  For those who are wondering... I put my heart into this but in case you’re worried, I promise I am good. I’m taking good care of myself. It also is worth mentioning that I have very carefully worded this post to avoid any HIPAA violations. If any patients or families would read this thread, there are no identifiable details and I have purposely delayed writing this post with no stated time frame. Just reflections on past experiences. And I deeply and profoundly understand that while healthcare professionals are struggling, it is so so much worse for our patients and their families. This disease is harming so many and I am not trying to center this dialogue on myself. I just wanted to give folks a glimpse into the hauntingly persistent experiences that healthcare workers are having these days.

This actually made me tear up....

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23 minutes ago, skategal said:

While this is a US perspective, I fear that our health care professionals may share similar experiences before we are able to flatten the curve with the COVID Pandemic.  I took this off Twitter so apologize for the lack of formatting.  It's a long read and heartbreaking.  

 

 

Kari Jerge, MD, FACS (she/her)

@kari_jerge

 

For months, healthcare professionals have been hanging on to the guardrails of the top deck of the Titanic. We have been screaming at the top of our lungs that there is an iceberg dead ahead and begging the captain to turn the wheel. We have had other passengers who are in the food hall and can’t see the iceberg from where they are standing mocking us accusing us of lying about the iceberg. “There is no iceberg. You’re seeing things” “Even if there is an iceberg it is smaller than predicted based on available models” “You’re getting paid to claim there is an iceberg.” We are on the ship too. So we are watching the ship approach an iceberg knowing full well that we are going down with the ship. Do we keep screaming? Even though nobody is listening? Do we jump ship and save ourselves? The water is freezing and we don’t want to desert our fellow passengers. Do we gather up the other passengers who can see the iceberg and form a human shield to take the impact on ourselves? Do we bum rush the captain and demand he turn? Or do we stand still, silent, frozen in a state of fight or flight? Paralyzed with sheer terror. Never in a 14 year career would I have imagined I would see this day.

How are we supposed to feel when a critically ill patient has survived cardiac arrest and needs emergency kidney replacement with a dialysis machine but there are no nurses left to run the machine? How do we explain that the hospital policy allows for 1 family member to come in for 1 hour only as we withdraw care so the family of 15 who has traveled for hours to be with their father/brother/grandfather as he leaves this earth has to sit outside and watch on FaceTime? What do we say when they beg us to make an exception to the hospital policy, exclaiming in tears that they don’t care if they catch COVID, they just want to be with him one last time?

What do we say to the patients’s wife when a patient who was fine 48 hours ago is now maxed on 4 pressors, too unstable to flip on his belly to help his lungs get enough oxygen? He is in his 50’s, maxed on full life support. How do I explain that despite all of the medicines and machines available, he is dying, in front of my eyes? And there is nothing we can do to stop it. She cannot see what I see. She cannot feel how helpless this feels. How should I respond when I have explained the above to his poor wife over the phone and she starts crying, begging the universe to help her understand how this could have happened to him when they had “stayed home for months and done everything to avoid getting the virus”?

What do I say to the APP from a rural area in my state who is calling to transfer a critically ill patient because they don’t have any ICU beds left when we don’t have any either? Does it matter that the patient has a very treatable condition? If we had a bed available, we could save this patients life. I am sure of it. But my hands are tied and we have to turn them down. I wonder often what happened to that patient.

I am a surgeon. I fix problems. When patients come in after having been shot and their heart stops in the ER, I am trained to open their chest, clamp the aorta, and buy enough time to get the patient into the OR where we can fix whatever is bleeding. I am not afraid of much. In the most chaotic and hopeless of scenarios, when patients come in near-dead, trauma surgeons pick up the bat and swing for the fences. We run large teams of healthcare professionals, coordinating care of our patients like Aaron Rodgers in overtime during a Super Bowl game. There is nothing that ruffles us. Nothing that scares us. No case that we won’t try to save. When any rational player would bunt, just to get on base, we swing for the fence deep center field. It’s who we are. It’s what we do. Surgeons take out cancers. We fix broken things. We save lives. We are used to big sensational grand slam home runs. We are used to winning in double OT. We throw the Hail Mary when we should kick. It’s who we are.

So when I tell you that there is very little in the scope of medicine that truly scares me, it is not hyperbole. And when I tell you that I am humbled and terrified by what I have seen in the COVID ICU, it is also not hyperbole. What is coming in many states across the country is akin to the Titanic. It is another Hurricane Katrina. This was predicted. It was preventable. So, you tell me... how do I tell a husband that his wife is going to die tonight when he can’t see the tears welling in my eyes? How do I express my sorrow to him without looking him in the eyes and gently putting my hand on his? How do I show him how much I care and how hard we tried to save her when he cannot see me or feel my warmth? He came in to see his wife as we transitioned her to comfort care. He was only allowed to stay for an hour. I never met him in person.  I never gave him a tearful hug. We made his wife comfortable and she passed away that night, pain free. I wanted to be there to meet him but one of my 30+ other patients was getting sicker and I needed to be with him. Do you want to know what this dear man said to me when I explained that his wife was dying? He asked me, a stranger on the phone, what I advised him to do so that she would not suffer anymore. When I explained what comfort care meant, he agreed immediately. She had had a very poor quality of life and she did not want to suffer anymore.  So without many questions and without ever having met me, this man trusted a stranger to help walk him through end of life decisions... on the phone. And then, he asked me to please please let the whole healthcare team know how grateful he was for all we had done for her. He said “nobody really thanks you guys anymore.” He made me promise to tell the whole team how grateful he was. Because as he was preparing to lose his wife, a woman he had loved for 50 years, it was the well-being of the healthcare team that was important to him. I made sure to pass on the message to the bedside nurse and the charge nurse as I ran upstairs to another critically ill patient.

Sometimes I wonder which of these situations will haunt me in 5 years. The hug that I missed? The patient who couldn’t transfer to us? The woman who couldn’t get  the dialysis machine she needed? Sometimes I wonder which of these nightmares will stick with me. But then I remember that I go back on shift in a few days. And I am finally home with my parents, celebrating a small delayed Thanksgiving after finishing my quarantine. I realize that if my mind stays at work with my patients and co-workers, it will keep me from enjoying a small slice of normal life in between shifts. And I won’t do that. There is not enough of this time and I can’t waste it.  For those who are wondering... I put my heart into this but in case you’re worried, I promise I am good. I’m taking good care of myself. It also is worth mentioning that I have very carefully worded this post to avoid any HIPAA violations. If any patients or families would read this thread, there are no identifiable details and I have purposely delayed writing this post with no stated time frame. Just reflections on past experiences. And I deeply and profoundly understand that while healthcare professionals are struggling, it is so so much worse for our patients and their families. This disease is harming so many and I am not trying to center this dialogue on myself. I just wanted to give folks a glimpse into the hauntingly persistent experiences that healthcare workers are having these days.

That's how I feel everyday at school

Edited by stawns
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3 hours ago, Canuckster86 said:

 

The big area of need is care aides....There is a huge lack in that industry and companies don't seem to be hiring more staff 

COVID has also made it painfully clear that another urgent area of need in our society is universal child care.  Even if there are enough front (and second) line workers it'll still be a HUGE problem if 25-35% of them don't report to work because huge numbers of schools shut down due to outbreaks and the front line workers stay hm to look after their own children. 

 

I've said it before and I'll say it again - even though Dr.B vehemently denies it - schools are a ticking COVID time-bomb waiting to go off....yet government is happy to do nothing until it's too late seemingly.

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6 hours ago, Russ said:

Now imagine if we could just cut out Surrey out of the picture it wouldn't look to bad.  Its a good thing you always brag that Surrey is the future of BC and everyone wants to move there ;)

Everyone one actually is moving to surrey.  Fastest growing city in BC.   The most beautiful city in BC with such an amazing Park system.

People vote with their feet... and the feet are heading to Surrey.    I think Surrey is pretty much on par now with Quebec City, Victoria and Ottawa in terms of beautiful healty green cities to live in.   I thought about moving to  the sleepier....  Langley and saving a bunch of money with the low cost real estate there.... but i just give up the beach access and wonderful cultural activities we haver here. 

Edited by kingofsurrey
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2 hours ago, Amebushi said:

So schools are safe to remain open due to the unquestioned fact that children don’t spread the virus. A few people at a couple of universities seem to disagree. 
 

https://www.princeton.edu/news/2020/09/30/largest-covid-19-contact-tracing-study-date-finds-children-key-spread-evidence?fbclid=IwAR3J3vpOyHqreyFwDWgfg57W2Pci34biNqk4fces3sJ4ha3AmUp7zXEZlKU

 

I continue to be vigilant as do most, but please folks don’t just agree with everything our government says without critical thinking and personal thought

Anti Science Horgan and Dr. B are counting on the fact that most BCers get their information from social media sites... and not actual scientific articles...

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4 hours ago, Jimmy McGill said:

how so, specifically? where would you have put them, and still staffed our other healthcare needs? 

 

Good questions.

1.       Temporary hospitals just for Covid patients could be built, hotels can be used as temporary hospitals as well. Heck, a portion of  GM Place could be used for hospital.

2.       Aggressively hire  personal for covid care. You don’t need to be trained 4 years +4 years +1 year (as my son) to take care of covid patient. Use medical students, retirees, medical professionals from foreign countries who live here but can’t work in Canada , etc.

We we told by Government that we are at war with virus. Well, war time required a strong management from Government, and,so far I've seen none.

During WW2 Canada built over 5000 tanks. From 0 in 1940. And these days we have to wait until developed countries produce vaccine for their own needs and then sell us some. Why a production facility was not built  during this year? This is just one of many questions.

Yes, we all need to do our part, and I do my part- as a manager on my job and as a responsible person in everyday situations.  And I would like to see at least some smart actions from the Government. Lockdown and print money- cannot be the  only solution, it creates more problems going forward.

Just my opinion...

 

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5 minutes ago, Silent Man said:

 

Good questions.

1.       Temporary hospitals just for Covid patients could be built, hotels can be used as temporary hospitals as well. Heck, a portion of  GM Place could be used for hospital.

2.       Aggressively hire  personal for covid care. You don’t need to be trained 4 years +4 years +1 year (as my son) to take care of covid patient. Use medical students, retirees, medical professionals from foreign countries who live here but can’t work in Canada , etc.

We we told by Government that we are at war with virus. Well, war time required a strong management from Government, and,so far I've seen none.

During WW2 Canada built over 5000 tanks. From 0 in 1940. And these days we have to wait until developed countries produce vaccine for their own needs and then sell us some. Why a production facility was not built  during this year? This is just one of many questions.

Yes, we all need to do our part, and I do my part- as a manager on my job and as a responsible person in everyday situations.  And I would like to see at least some smart actions from the Government. Lockdown and print money- cannot be the  only solution, it creates more problems going forward.

Just my opinion...

 

hmm... its a pretty good one. I do know they at least planned to use some hotels if need be, but you're correct in questioning whether or not it should have been done anyway to ensure that the regular system could continue. Things would still be slowed in standard hospital settings due to enhanced cleaning, etc. but with proper staff screening maybe we wouldn't be 2 years behind in many surgeries. 

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It's interesting being part of an exposure to see how it all works.  Though the class was in my library, I did not have 1-1 exposure with the student longer than 15 mins (I didn't longer than 10-15 seconds), so I don't have to self isolate, just monitor for symptoms.

 

The entire class, teachers and EAs all self isolate until next tuesday

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1 hour ago, Silent Man said:

 

Good questions.

1.       Temporary hospitals just for Covid patients could be built, hotels can be used as temporary hospitals as well. Heck, a portion of  GM Place could be used for hospital.

2.       Aggressively hire  personal for covid care. You don’t need to be trained 4 years +4 years +1 year (as my son) to take care of covid patient. Use medical students, retirees, medical professionals from foreign countries who live here but can’t work in Canada , etc.

We we told by Government that we are at war with virus. Well, war time required a strong management from Government, and,so far I've seen none.

During WW2 Canada built over 5000 tanks. From 0 in 1940. And these days we have to wait until developed countries produce vaccine for their own needs and then sell us some. Why a production facility was not built  during this year? This is just one of many questions.

Yes, we all need to do our part, and I do my part- as a manager on my job and as a responsible person in everyday situations.  And I would like to see at least some smart actions from the Government. Lockdown and print money- cannot be the  only solution, it creates more problems going forward.

Just my opinion...

 

Wait where are we sending these people? And why would aquillini want covid people at his place when he wants to get hockey up and going? There's literally the government funded stadium right beside in BC place that is sitting completely vacant for who knows how long. 

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Some people still don't get it:

https://www.cbc.ca/news/canada/british-columbia/langley-church-fined-2-3k-for-violating-b-c-covid-19-gathering-restrictions-1.5821450

 

Langley church fined $2.3K for violating B.C. COVID-19 gathering restrictions

Church-goers say banning in-person services is against their charter rights

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40 minutes ago, Russ said:

Wait where are we sending these people? And why would aquillini want covid people at his place when he wants to get hockey up and going? There's literally the government funded stadium right beside in BC place that is sitting completely vacant for who knows how long. 

Yes, BC stadium is even a better option.

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9 hours ago, Jimmy McGill said:

the problem is we can't just create a huge amount of new capacity in our healthcare system. Its not like we can suddenly have 100s more people in isolation and ICU and also keep handling our normal case load, The hospital space simply doesn't exist, nor the staffing. 

 

2 hours ago, Silent Man said:

 

Good questions.

1.       Temporary hospitals just for Covid patients could be built, hotels can be used as temporary hospitals as well. Heck, a portion of  GM Place could be used for hospital.

 

 

2 hours ago, Jimmy McGill said:

hmm... its a pretty good one. I do know they at least planned to use some hotels if need be, but you're correct in questioning whether or not it should have been done anyway to ensure that the regular system could continue. Things would still be slowed in standard hospital settings due to enhanced cleaning, etc. but with proper staff screening maybe we wouldn't be 2 years behind in many surgeries. 

 

1 hour ago, Russ said:

Wait where are we sending these people? And why would aquillini want covid people at his place when he wants to get hockey up and going? There's literally the government funded stadium right beside in BC place that is sitting completely vacant for who knows how long. 

 

28 minutes ago, Silent Man said:

Yes, BC stadium is even a better option.

Of course, we conveniently forget that the Convention Centre already has hospital capacity set aside since the beginning of the pandemic for exactly this purpose...

 

https://www.vancouverconventioncentre.com/news/alternate-care-site-update

 

https://vancouversun.com/news/local-news/vancouver-convention-centre-to-remain-an-empty-hospital-for-foreseeable-future

 

:emot-parrot:

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Why are average BC citizens ahead of our BC government on limiting covid....... ??

 

 

1/3rd of kids with COVID are asymptomatic how can we increase safety in schools? Kids may not know they have it and may be spreading it. Sanitizer and hand washing don’t stop the spread of aerosols. A density reduction and masks may help. #bced #bcpoli
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