Overwhelmed by COVID, Quebec hospitals face tough choices in scaling back surgeries

François Shalom finished cancer treatment only weeks before the COVID-19 pandemic descended in March 2020.

At the time, Shalom felt like he'd dodged a bullet. Surgeries and medical procedures were postponed in Quebec in the weeks that followed to prepare for a rise in hospitalizations.

But last summer, the 67-year-old from Pierrefonds, Que., learned he had a congenital heart defect. He was told by doctors his main heart valve is leaking and needs to be replaced.

Shalom was scheduled to have surgery at the end of January at Montreal's Royal Victoria Hospital, but learned this week it had been postponed indefinitely.

"It's absolutely petrifying," he said in an interview. "My life is at stake here. This is not a facelift that I'm waiting for. This is surgery to save my life."

Faced with a surge in hospitalizations, Quebec and other provinces, including neighbouring Ontario, have once again issued directives to cut back non-urgent surgeries to free up beds and staff. 

This week, Quebec reported more than 2,000 patients in hospital with COVID for the first time since the start of the pandemic.

'They're living in pain'

Dr. Liane Feldman, director of surgery at the McGill University Health Centre, which oversees the Royal Victoria Hospital, said the teaching hospital has been forced to make difficult decisions on which patients to prioritize for surgery. 

"I'm worried about the thousands in our own hospital, tens of thousands in our province and hundreds of thousands in our country of patients whose surgery has been postponed over and over again, delayed, postponed, cancelled," she said.

"They need their operations, they're living in pain."

In a statement, MUHC spokesperson Annie-Claire Fournier said the situation "regarding reduced surgical activity is not unique to the MUHC, but affects all establishments in the province."

"Activities are limited to free up staff to treat COVID patients and also because we have staff in quarantine," she said.

Dr. Paul Warshawsky, head of the intensive care unit at Montreal's Jewish General Hospital, said the number of ICU patients has been increasing steadily over the past few days. He said the hospital can find more room, but will have to postpone more surgeries to do so.

"Right now, if you need cardiac surgery, you're very likely not to get it. If you need other major surgery your surgery is going to be delayed," he said.

Warshawsky said hospitals had already been forced to prioritize surgeries, but up until recently were catching up on the long list of surgeries delayed by the first months of the pandemic.

"Every time we have to shut down our operating rooms again, those wait lists get longer, and people waiting for surgical interventions, they are being very unfairly treated by this pandemic," he said.

Growing staff shortages add to strain

According to Quebec's Health Ministry, about 20,000 workers are absent due to the coronavirus, putting an even heavier strain on hospital services that have been put to the test for nearly two years.

Shalom is trying to stay calm, but is worried his symptoms may get worse or he may have a stroke while he waits for surgery.

He turned to his surgeon for reassurance, but his surgeon fell sick with COVID-19 himself this week and is in isolation.

"I don't know how much of my fear and anxiety is overblown and how much of it is real," said Shalom.