‘The well is starting to run dry’: Emergency department physicians speak out
Two years into the pandemic, health-care workers have been worn down again and again by a virus that clobbers health-care systems lacking surge capacity. Even as cases and hospitalizations from COVID-19 decreased, there has been very little opportunity to reflect and take stock before bracing for impact of yet another wave.
Representatives of Toronto Women in Emergency Medicine, a group of emergency physicians working in hospitals in the Greater Toronto Area, were asked to reflect on their experiences of the most recent wave and what health-care systems can do to survive the next one.
“It is not news that this pandemic has exposed the precarity of many people’s lives – how they negotiated the cracks to just get by in ‘the before times.’ Perhaps it will be labeled dramatic, but I am going to say it anyway – In a society where the last social safety net seems to be health care, and the last safety net in health care seems to be the emergency department, it is morally distressing to be the one at the very end of the line to say yet again, ‘Sorry, we can’t solve this here.’ Increasingly, I find that the most therapeutic thing I have to offer someone is my time; to acknowledge and be with them in their suffering. My wish is for us to use the lessons the pandemic has taught us about our collective need to build robust inclusive social systems so we can truly be ‘all in this together.’ ”
“Omicron has uncovered the cracks in our health-care system, and within our social safety net. At work, I regularly care for people who are experiencing homelessness. I believe this segment of our city needs excellent health care, almost more than anyone else. But we are not doing them justice, and watching their struggle is painful. When they get COVID, they can no longer stay at their shelters. So, they head out to the streets in the bitter cold of winter. This leads them frequently to their closest emergency department, where they may need warmth and food and shelter more than anything else I can offer. I don’t need my 14 years of post-secondary education for this, I just need a moment of common kindness. Why are shelter budgets constantly getting slashed? We don’t save money as a system when we are forced to use hospitals as housing. This happens every single day, and it is beneath us as a city to treat our own so poorly.”
“I regularly care for people who are experiencing homelessness… we are not doing them justice, and watching their struggle is painful.”
“As a mother and emergency physician working in a community teaching hospital, I can tell you that most of my days and nights are spent caring for others. They warned us at the start of the pandemic that this will be a marathon and not a sprint. The pandemic has been a two-year sprint, and the finish line is still not clearly in sight. We need to care better for our most precious resource: the human beings who uphold our health-care system. All of us who work in emergency medicine signed up for hard work. We provide health care to vulnerable and deserving people in the midst of staff shortages, departmental overcrowding, homeschooling our kids and caring for our elderly throughout this relentless pandemic. I often read the book, How Full is Your Bucket (for kids) by Tom Rath and Mary Reckmayer, to my daughters. In order to sustain the health-care system and emergency departments for the communities we serve during this wave, we need to fill the buckets for those who care for others. It appears the well is starting to run dry.”
“As an emergency physician in a community hospital in the Greater Toronto Area, each wave has brought different challenges. The biggest stressor of this wave is that it has exposed the perpetual strain that our healthcare system is under: the sheer number of patients presenting to the hospital for care, the lack of hospital beds, and long wait times for care. This led to a frustrating and distressing experience for both patients and health-care workers. After two years of this, the imminent threat to the health-care system is the health of people doing the healing. Burnout has reached epidemic proportions. Nurses are leaving the profession in droves. Governments need to address retention of health-care staff especially nurses, home-care workers and personal support workers by increasing their pay and improving their working conditions. If we do not address this, we will be in a critical shortage of these vital components of the health-care system. While this pandemic will eventually end, we are on the precipice of the “silver tsunami” – the aging of our population that will put a further strain on our health-care system. My sincerest hope is that the public and all levels of government understand the toll this pandemic has taken on health-care staff and that we all work to rebuild a more robust system. We need to create the conditions to bring back joy to this profession so that the healers can go on healing.”
“The biggest stressor of this wave is that it has exposed the perpetual strain that our healthcare system is under.”
Emergency Medicine Resident Physician
“Two years into the COVID-19 pandemic, I am constantly amazed at the tenacity and strength of my colleagues who continue to pour their hearts and souls into the work of keeping our patients and communities safe. It’s been a long and tiring two years full of difficult decisions and heartbreaking situations. This wave of the pandemic has come with its own unique challenges. Not only are the sheer number of COVID positive patients higher than ever, but our emergency departments are simultaneously facing critical nursing shortages. Burnout and brutal working conditions combined with chronic shortages preceding the pandemic have all contributed to the situation we find ourselves in. I hope that health policy-makers will listen to our nursing colleagues who are fighting for fair wages and better working conditions. We need to invest in our health-care workers in order to continue fighting the pandemic and sustain our health-care system long term.”
“I don’t want to talk about COVID anymore. I want to boycott the name. Patients in emergency departments are sick, so so sick, and not all necessarily with COVID. In emergency departments, there are not enough beds for patients, and while health-care providers are not being told to triage (with the Big ‘T’), emergency physicians feel forced to compromise given limited space and staff. Nurses are leaving in droves, and they are the backbone of emergency departments. They are who make things work and keep us going. Without them, as physicians we are nothing. We work as a team – from the janitorial staff to the medical trainees, social workers, occupational therapists, physiotherapists, unit clerks, nurses and physicians – we all need each other. So, when people cannot come to work because they are sick, or their child or loved one is unwell, we all suffer. The hardest part is that no one feels they can take a day off for their own mental health because we are all empty, we are all at our last effort. So, what do we do? We come to work, we push our needs aside, again, for the umpteenth time. We do not see a light of hope. We see cancers being missed, lifesaving/altering surgeries perpetually delayed, mental health and social crises being ignored. I want to shout at the top of the rooftop, ‘Who will take care of them?’ The only answer I have is, ‘We will.’ ”
“Nurses are leaving in droves, and they are the backbone of emergency departments. They are who make things work and keep us going. Without them, as physicians we are nothing.”
“We’ve been stretching ourselves thin for years – way before the pandemic – to plug the holes in our imperfect health-care and social-security system. We have ‘MacGyvered’ our way through, found creative, band-aid temporary solutions, which then become permanent, imperfect solutions. We know this ultimately is a disservice to our patients, who end up falling between the cracks. And we, as frontline emergency providers, bear the brunt of anger from patients and families when the system fails them. The emergency department is where people end up when they can’t get a timely appointment with their primary care provider or their specialist. It’s where they end up when they’ve waited for months with no response from the specialist they have been referred to. It’s where they end up when their families can no longer care for them at home due to the complexities of their medical issues. During the most recent waves, many specialists and primary care providers have pivoted to virtual care. While this may have allowed some convenience and an extra buffer between COVID and patient and COVID and provider, it still ended up bringing the patient to the emergency department when they needed a physical exam. Though there may be a role for virtual care in some specialties for stable follow ups, virtual care will never be able to replace primary care.
In the emergency department, we never turn patients away, no matter if the issue is a physical ailment; a housing or food insecurity issue; mental health, addictions; if you have COVID symptoms or are unvaccinated. Yet, as we plug the holes in the health-care system on each and every shift, we ask ourselves, ‘Could this visit have been prevented if the system hadn’t failed our patient?’ We are no longer treating your heart attacks; we are treating the effects of a dying health-care system. We are tired of trying to prop it up. It’s time to re-evaluate the broken system we’ve been carrying on our backs for years.”
“The Omicron wave coincided with the medical residency application season, a time when medical students seek career advice. I tried to honestly answer questions about what I enjoy the most about my job and what I find most challenging. My love for emergency medicine is still there despite two years of COVID. We have the privilege to help others when they are most vulnerable or scared and to make a difference in the lives of marginalized patients, who often have no other place to turn to. With Omicron, the biggest challenge I encountered and the most significant source of burnout I see in my colleagues across all professions has been the inability to do our best for patients. The hospital and the emergency department operated in a slow-motion Code Orange, a perpetual disaster state, with shortages of staff and space that greatly impacted patient experience. For an allegedly ‘mild’ illness, Omicron had an incredible ability to disrupt the fragile equilibrium of a health-care system already on edge and to affect the care we can provide. We worked harder, longer hours, covered last minute shifts; as always, the lights stayed on in the emergency department 24/7. But we have yet to recover from the emotional impact of not being able to provide everyone with the care we know they deserved, as well as from the loneliness of that experience in the face of an increasingly divisive public discourse.”
“We have yet to recover from the emotional impact of not being able to provide everyone with the care we know they deserved, as well as from the loneliness of that experience in the face of an increasingly divisive public discourse.”
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