'We are getting overwhelmed': Edmonton doctor on working in the COVID ward

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Every day, Dr. Neeja Bakshi has to have gutting conversations with complete strangers about their loved ones who have died or are dying from COVID-19.

Bakshi is a doctor in the COVID ward at the Royal Alexandra Hospital in Edmonton, where she says staff are exhausted and overwhelmed. Alberta has seen COVID numbers of 1,000 a day since Nov. 24 and over 1,600 a day for almost a week.

On Monday, the province surpassed 20,000 active cases, with 609 people currently being treated in hospitals for the illness, including 108 in ICU beds.

Premier Jason Kenney has been reluctant to bring in lockdown measures, but his government announced new restrictions on Tuesday, including mandatory masks and the closure of dine-in restaurant service, casinos and gyms.

Bakshi spoke to As It Happens host Carol off on Tuesday, before the new measures were announced. Here is part of their conversation. 

Dr. Bakshi, what is the most difficult thing about arriving at work each day?

The most difficult thing is not knowing what we're going to walk into. Every night, we have countless medical admissions and now, more and more over the last couple of weeks, predominantly they are all COVID admissions.

And so when we walk onto the COVID ward, we don't know who the new patients are and we don't know how sick they are, along with how sick the rest of the patients might be from overnight.

Just give us, if you can, a snapshot of all the variables, all the things you might have to be called to do, even at the same time.

Anybody that works in in-patient medicine can tell you that it's always a different day every single day, even before COVID. But the difference now is that with COVID, patients are deteriorating quickly. So they can be on no oxygen or just a little bit of oxygen at 8:30 in the morning, and then by 10 o'clock, they are now on 70 litres, which is the highest amount we can provide outside of ICU. You may have more than one patient doing that at the same time. 

Along with that, we're trying to discharge our stable folks, our recovered folks, so that we can actually make room for new patients coming in. But as you're dealing with emergencies and disasters, you can't prioritize those discharges. So they get pushed, pushed, pushed later in the day. 

We are doing our best. We're trying to provide patients with all the same level of quality of care, every single patient. But we are running out of steam and we need help.- Dr. Neeja Bakshi, Royal Alexandra Hospital 

We were doing a lot of interviews in the spring from Italy and New York City, the way they were describing what was going on, the near collapse of things. And does it feel like you're getting close to that level of crisis?

It does. I mean, we certainly may look different. We don't have the ice trucks that are sitting outside of our hospital right now. But it certainly feels like in the hospital, that every day there's a new crisis on: Where are we going to place patients? Or who's going to look after the patients? And do we have enough physicians? Do we have enough nurses? Do we have enough respiratory therapists?

And it's not, I guess, just the mechanics of doing this. It's the emotions of it. Because you're dealing with people [who] come in, [and] you don't know how quickly they might collapse, or even if they'll recover. They can't have their families with them. They can't have support. How are you dealing with that? With the possibility and probability of death so often?

I think all physicians, especially those that work in acute care, are used to having to deliver bad news ... but not at the level that we're talking about with COVID patients.

I'm having palliative care conversations four, five, six times a day, often with family members who I've obviously never met. I'm only speaking to them on the phone. They may be provinces or countries away, and I may have only gotten to know their family member for six to 12 hours based on how fast they may have deteriorated.

And so it's very emotionally jarring for us as providers. And I think the last thing any physician wants to ever become is somebody that doesn't have empathy. And when you do these conversations over and over and over again, it becomes really hard on your psyche. How do you maintain that same level of empathy for every single patient you're talking to?

And how do you do that? How do you prepare yourself, or what can you possibly say?

I put myself in the family's shoes.... What would I want to hear if I was on the other end? And there's never a right answer. Everybody's different. 

I think the equalizer here is that anybody who's receiving this call about a COVID patient understands that there's not much more we can do. And it's very sad to have to say that. But typically, when we get to that level where we're having that conversation, I think the vast majority of the world knows that there's not much more we can do.

We've heard the testimonies of those who have had [COVID-19], the feeling of panic, the feeling of not being able to breathe. Then just this feeling that something is just taking over you physically. How do you comfort them? What are you able to do, given how much you have to do in any given moment? What can you possibly provide to those patients?

We don't want to give false hope or false reassurance, but I think it's taking it in that moment. And simple things like myself and the respiratory therapist might be at the bedside and just saying, "Let's take some deep breaths together. We're all here together. We're watching you very closely." And just trying to reassure them in that moment that we have it under control.

Given that they can't see their family members, what do they want from you?

The majority of patients who don't do well or who know that they're not going to do well, they often want us to talk to their families on their behalf and let them know that we have tried everything and that, you know, we're doing the best we can.

How often in a week do you do that, do you have to have those conversations?

Every single day, multiple times a day.

That's extraordinary.

I think the important thing about it is it has taught physicians, again, that communication is extremely important.

We were not taught about COVID medical school. We don't know what effects COVID has. And so I think being open and honest with patients about: "We are here to support you. These are the things that we've learnt along the way."

We are much, much better off now than we were in March, April and May ... but again, it's a communication piece of: "This is what's going on with you. This is what I suspect will happen to you. This is what your hospital course is going to look like."

And again, being honest with, "I don't know if you're going to recover from this."

What effect is it having on you?

This is something that I've never experienced before. I mentioned that this last week is probably the hardest week of my life in terms of my clinical care and my clinical practice.

It's exhausting emotionally, physically. The cognitive load is high because you're trying to make sure that you manage the patient medically, but also the feelings piece of it and making sure that their emotions are being tended to.

I think most health-care workers are working 24 hours at a time and living 24 hours at a time because that's all we can.

If you could have five minutes with Jason Kenney and his government, what would you ask for?

I'd ask them to come and see what is happening in the hospital. And that I recognize that making decisions on restrictions and lockdowns have many, many repercussions, and I don't claim for that to be an easy position to be in.

But we are getting overwhelmed. We are doing our best. We're trying to provide patients with all the same level of quality of care, every single patient. But we are running out of steam and we need help.

You posted on Twitter a picture of your husband and said that without him you couldn't be doing this. What support do you have?

My husband is my biggest support. 

Every time I need to get on a conference call about some sort of planning or I need to rush in because one of my colleagues is sick on isolation [and] I need to go fill in, he picks up the slack, he takes care of our children, he ensures everything at home is taken care of so I don't have to worry about that. And he puts up with the middle-of-the-night pages that I get about crashing patients in hospital.

So I think every health-care worker could tell you that without family, we would certainly not be here.

Written by Sheena Goodyear with files from CBC News. Interview produced by Chris Harbord. Q&A has been edited for length and clarity.