What it means to take leave in medicine -
As we continue to see the decimation of healthcare in AB, we should anticipate more and more physicians needing to take leaves due to stress and burn out.
Trigger warning: COVID death.
Hi Jane. This is Dr. Bakshi calling from Edmonton. I am not sure if you're aware, but your mom Anne was admitted to the COVID ward about 2 hours ago. I'm calling because she is not doing well, and will likely not survive the day."
A very long - Long COVID thread.
Our Long COVID program has been open 10 months now. I've seen over 150 patients in that time, with new referrals booking well into February 2023.
Long COVID.
It's been 11 weeks since my outpatient team and I opened our Long COVID clinic. In that time, I've had the privilege to meet so many people with such powerful, sad, and gut-wrenching stories.
14 months in, we are that point where COVID deniers are coming in with severe infection, openly admitting participation in freedom and anti-mask rallies. /1
Today, another 34 families went through this just from COVID. How may others went through this over the last 4 weeks since surgeries have been cancelled? How many deaths will be acceptable,
@jkenney
@JasonCoppingAB
before we see a
#FirebreakAB
She closes her eyes. Jane asks me to stay with her mom, and wishes to remain on the iPad. We sit in silence for 30 minutes, until Anne takes her last breath.
This is one story. Of so many I re-live often. Of COVID robbing families of good byes.
She points to her lips, and then to her belongings. I walk over and find hot pink lipstick in her bag. I bring the lipstick to her, and she pulls off her oxygen mask and says, in gasping breath:
"If I'm dying today, I'm dying beautifully, with my lipstick on. Hand me a mirror."
Calling all essential workers. Show us what it looks like to be
#RunningOnEmpty
Our leaders cannot continue to turn a blind eye to the truth.
I'll start.
Post COVID Unit Shift this weekend.
RT and share.
Unless you're living with Long COVID or treat LC regularly... Please be mindful of how you speak about long COVID.
It is real. It is devastating. And it is not psychosomatic.
Saying it again for policy makers, naysayers, and unfortunately, some of my MD colleagues.
#LongCovid
On my 12th hr on
#yeg
COVID unit, the bridge of my nose raw from N95 due to extremely ill patients, exhausted is no longer enough to describe this feeling. Patients fine 1 minute, then unpredictably crashing.
@jkenney
@shandro
what more evidence do you need to act?
#COVID19AB
Received handover for the COVID unit I take over tomorrow. What stuck out (besides how young patients are), is how much ICU level care we are providing on a non-ICU ward.
So when you hear ICU numbers tomorrow, add another 25-30%, and that'll let you know how truly dire it is.
In a particularly sad case recently, a patient said to me- "I didn't think COVID was anything more than a cold. I laughed at masks. Now I'm here. And my dad is dead. And my mom is in an ICU. This isn't a cold."/3
Through her tears, Jane responds: Yes. I'm so sorry for hanging up on you. I was shocked. I didn't even know she wasn't well, I spoke to my mom two days ago. I am in BC. I won't make it in time, will I?
"I don't think so, Jane. I am so sorry.... Jane, tell me about your mom."
Jane takes a deep breath: Mom is a fierce and spunky 75 year old with the spirit of a 30 year old. She loves to dress to the nines and is always laughing. And always told us she wanted to die on her own terms.
...deafening silence....followed by a chilling shriek.... Tears... Gasping for air trying to form words... Phone clicks. 5 minutes pass, and I call again.
"Hi, Jane. I know that was a lot to take in."
This last week and the two years upto this has been a lot.
After talking with my family, it's time to take a Twitter/advocacy sabbatical. I've loved my role here, but my mental health comes first.
Stay safe everyone. Much love. ❤️
In an interview this morning, I was asked how I was coping with yesterday's announcement.
I cried.
I walked down the hall of my clinic to check in on my docs. No one is well. No one has slept. We have gotten to "acceptable loss of life."
We are not okay.
#covid19AB
The divisiveness of this pandemic is ugly. Brings out the worst in so many.
But at the end of the day, the human suffering is deafeningly unifying.
#covid19AB
When you tell me that "those vaccines are killing people," I see you.
When I explain that we are giving you steroids, oxygen, antibiotics and monitoring you very closely, I see you.
"Jane, your mom is awake, and as fierce as ever. But her oxygen saturations are down to 80%, and we have her maximal oxygen. She does not wish to be placed on a ventilator, and this sounds consistent with what you've told me about mom. Would you like me to arrange Zoom?"
Moments later, her oxygen dropped, and so mask went back on, and Jane came through the screen to say goodbye to Anne. Through the hissing of the machines, and the ziplock bag covering the iPad, Anne couldn't hear her daughter. So, I yell-translated.
We have normalized trauma. We have normalized working beyond our capacity. We have normalized unsafe work environments in the name of healthcare martyrdom.
This is the face of defeat. And anger.
We care deeply for our trade. For being able to provide standards of care to our patients.
Right now, we can't do that. Because
@jkenney
puts self-preservation over the health and wellbeing of this province.
My colleagues, I see you♥️
We find the iPad, get it connected through a blurry screen, and don PPE. I go in to talk to Anne about her condition before I connect Jane. With the high flow oxygen + non rebreather mask we have on Anne to give as much support as we can, I have to yell so she can hear me.
My wish. May you never have to tell someone, who is fully mentating, holding your hand, that there is nothing left to do, that this virus has won, and that it is a matter of hours. I will never forget the eyes of these patients. I have never hated an illness so much.
#Covid19AB
After 2.5 years, we have only begun to scratch the surface of Long COVID, and understand its impact on individuals. I fear we will continue to underestimate its impact on our province, our nation and truly the world.
#LongCovid
None of us have the answer. But if you've heard that the system has survived a stress test and "it's not that bad"- please know that this is not the truth. Ask any one who has a role in healthcare what their definition of collapse is. Then ask them if they're currently living it.
What I've learned... There are definite patterns. Dysautonomia/POTS. Cognitive dysfunction and brain fog. PEM (post exertional malaise). Unexplained rashes. Muscles feeling like cement. Migraines. Chest pain. So much chest pain. Shortness of breath.
Who I've seen.... Humans of all ages. 21 through 87. All demographics. Previously healthy. Previously not healthy. Teachers and healthcare workers. So many teachers and healthcare workers. Athletes. Non athletes.
It's non-discrimnatory.
Barriers I've discovered - insurance. Insurance. Insurance. Insurance.
Pages and pages of forms, minimizing my judgement, experience and clinical knowledge.
Tonight is a night worth breaking my twitter-hiatus. Growing up in a rural Pennsylvania town, I would have never imagined an East Indian Mayor. Let alone two in the same province.
@AmarjeetSohiYEG
and
@JyotiGondek
- congratulations! This POC feels so seen tonight ♥️😭
Omicron and messaging. Can we PLEASE stop perpetuating that it is "mild?" It underplays severity and invalidates experiences.
Signed,
A COVID+ person who does NOT have mild symptoms.
#covid19AB
Fighting tooth and nail to have claim adjusters understand that "pushing through" and excessive functional assessments for the patient is contraindicated in patients with long COVID and ME/CFS.
"They're the most discriminated against group that I've ever witnessed in my lifetime."
Danielle Smith says unvaccinated people have suffered greater discrimination than those based on race, gender, sexuality and other.
#Yeg
#Yyc
#ableg
"it's just the flu." "We have this many in ICU this time of year anyways." "They have comorbidities, can you really blame covid for their death?" Having worked a decade at RAH, I can tell you I've never cried as much as I did today while seeing COVID patients.
#COVID19AB
But the vast majority of Long COVID patients are in this purgatory. Not knowing which way their life is going to go. Is this the best it's going to be? Am I one illness away from going back to where I started? Will I be able to work again?
Will I feel normal again?
For this is often the 1st time they've realized that: It's Not. All. In. Their. Head.
And 180 patients later, this still catches my breath each & every time.
Thank you to the LC community for working w/ me, having patience as we learn together, & trusting me along the way.
Post call delirium is setting in, so while I'm still slightly coherent, I wanted to share my observations of the last 24-36 hrs-- much of which isn't going to be new information, but definitely underscores the ongoing slow decay of our healthcare.
A thread. Day in The Life of a COVID ward doctor.
Wake up, anxious of the unpredictability of the day. Start day, 7:30am. Survey ward, check how many new admissions, ward transfers, and deaths occurred overnight. Receive handover from overnight covering doc. Ensure PPE in check.
Someone asked to speak to my boss, who surely would be a non-minority, non-woman doctor, unlike me.
My boss is a proud minority woman.
So is her boss.
All the way up to
@dryiu_verna
😁
Now what? 🤷🏾♀️
For the patient, it's not getting timely testing, timely results or having a family physician. It means waiting in the ED waiting room for 36 hours before being seen. It means being subjected to procedures and patient care in the middle of the hallway with no privacy or dignity.
To my physician colleagues - I say this with the utmost empathy.. but...
Can we please (PLEASE) stop labeling disease entities that we don't understand or have enough evidence for as psychosomatic?
And through all of this, trying to manage my own long COVID experience. Which has required pacing, reinvention of my chart note template to help cue the next question I was supposed to ask.
@drdagly
❤️sending you love, Darren. In the past 2 mo. alone, I've been pushed against the hospital wall, called slurs, told to bleach my skin, been told I know nothing as a non-white woman doc. Showing up is getting harder to do. I stand with you. But we will have to have our limits too.
For the nurse, it's being asked to work a 16 hr shift only to be back 8 hours later because there's not enough staffing. It's having patient to nursing ratios so high that you don't get to each patients care plan on time.
We added this because over 50% of patients I've seen so far have had to go on modified duties or short term disability due to severe brain fog, fatigue, or shortness of breath / chest pain.
We've talked about healthcare collapse a number of times over the years and I think it's important that collapse looks and feels different depending on where in the puzzle your piece fits.
Dear
@jkenney
-
Do Something. Anything.
Before your inaction forces physicians into making decisions we will never recover from.
Begging and pleading. On behalf of all Albertans.
#COVID19AB
If you're happy with
@ABDanielleSmith
and the UCP outcome, or don't think it will actually impact your life.. you are living in the worst kind of privilege-- ignorance.
10 months in, some of my patients have been able to be discharged, feeling almost close to pre -COVID health. Some have gotten COVID again, which worsens their symptoms and we start everything from scratch.
I let my patients know at the beginning of their long covid assessment, that the 90 minutes allotted is not only for them, but for me... As I will undoubtedly require the time and space to fully stay on task.
I am on my break. I swear. And will return to my break.
But. My daughter just said "If he doesn't want people to get sick, why is he telling kids to not wear masks?"
........
These are the # of referrals I've received today between 10am-4pm.
It has been like this for weeks. I'm booking months out, & unlikely to be sustainable (unless I just move into my clinic).
We need more resources and more LC clinics. We need our gov't to talk about it.
Being a physician right now in AB - where being yelled at daily by patients while advocating for faster access to tests and other specialists for the same patients has become the norm.
We are tired.
Replacing AHS leadership and those with institutional knowledge.. at a time where we are actively imploding in both acute care and primary care.. seems like a poorly thought out plan,
@ABDanielleSmith
....
Comprehensive educational documentation with personalized recommendations for each patient as info is often overwhelming, esp with brain fog.
Treatment aimed at both "Band-Aid toolbox" to help quality of life and "Root cause" looking at immunomodulation, anti-inflammation.
Security from scarcity is a key social determinant of health, and unless we begin to truly acknowledge the widespread impact long COVID will have on micro and macro systems- we will continue to see negative health outcomes for generations.
For the physician, it's not being able to provide safe patient care because you've got 25 acutely ill patients all needing your attention at the same time. It's being called from every angle to admit, transfer, accept when there's no space to even evaluate the patients.
This is MY hero. Because of him, I don't have to worry if my kids are looked after when I'm on the unit. Because of him, I am able to focus my attention on my patients. HCW families are equally heroic these last 9 months, unconditionally supporting us. Couldn't do this w/o him.
Albertans deserve equal access, affordable care, and to be able to sleep at night knowing that they won't have to choose between rent and a life-saving operation.
There is a bittersweet moment in the initial long COVID assessments I do with patients where this "a-ha" moment happens, and they tear up and say:
"So this isn't in my head. I'm not imagining things."
But. Universal and public health care is STILL the most equitable and inclusive way to deliver care. Instead of looking at privatization options, lining pockets of corporations and the 1%, our government must invest in the public system.
How did we go from "banging pots and pans in support of healthcare workers" to "please do everything to not identify as a healthcare worker for your own safety?" 1/2
BREAKING NEWS!
(No, COVID isn't gone. Yes, the hospital system is in disarray. No, our government hasn't suddenly decided to lead).
MY NEW VELOUR TRACKSUIT ARRIVED.
(I may have a problem. 😁) It's the small things ❤️
#selfcare
#RunningOnEmpty
Nursing and physician check ins. Regularly. Reflective listening, validation, and commiseration. Continuously reading, searching, hoping to find next breakthrough or tool that can be used.
The 15 minute buffers I have to place throughout my day to regain the line of questioning and follow through needed that comes with each individual's Long COVID story.
When we see the hospital numbers today and think "Well ICU is holding steady, that's good news."
This is normalization of trauma... Because in reality, things are not okay. Surgeries are cancelled. We are into more surge space than we have ever been, ICU and non-ICU.
I just finished 14 days in a row of acute care inpatient service - and besides the incredibly complex & sick patients I cared for, I also was gifted with the following statements:
How my clinical process has evolved.... Pre-appt screening tests, quality of life scores, functional assessment scores. During appointment visual aids to help understand possible pathophysiology.
The sheer volume of population that will be affected by this is incredible, and highlights the need for physicians, employers, and insurers to take this seriously.
Not being able to work due to brain fog and cognitive delays. Not being able to complete the 6 minute respiratory walk test due to fatigue, high heart rates, and chest tightness.
Dear patient,
I know you are scared, worried, and even frustrated. You either have a diagnosis and are waiting critical treatment, or you are still waiting for the specialist/tests/procedures that can give you those answers. The wait is excruciating. 6-12 months. Of uncertainty.