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A Story from the Chief of Critical Care Medicine

Dr. Iyengar is the Chief of Critical Care Medicine at Queensway Carleton Hospital. If there was any doubt about the intensity in the Intensive Care Unit (ICU) and seriousness of COVID-19, he dispelled it quickly, โ€œThe first COVID-19 week was one of my toughest as an ICU doctor.โ€

Doctor at QCH

Dr. Iyengar describes the situation like this: If you are an intensive care provider, you face a difficult situation every day โ€“ and a certain level of fear every day. Normally the fear is balanced by knowledge, experience, courage and resilience. But recently fear took over.

 

Fear of getting infected. Fear of personal protective equipment shortages.

 

Fear of wearing the right personal protective equipment.

 

Fear of not knowing enough about the disease. Fear of not providing adequate care.”

 

 

“What I see happening now, is that those fears are being addressed with courage and resilience. Thatโ€™s something Iโ€™m very proud of our staff for doing.”

Intensive Care Unit (ICU) preparations started in early March at both the regional and hospital level. Here, at Queensway Carleton Hospital, it was decided that the existing ICU would be dedicated to COVID-19 patients. At the same time, a secondary ICU would be opened for non-COVID-19 patients in what is normally the post-anesthesia care unit, known as PACU.

 

Everyone in the hospital was mobilized to assist with the response to the virus. ICU physicians took on additional roles managing schedules, human resources, and virus education. Nurses with previous critical care experience were brought in from different departments while other nurses received additional training. There was expanded training for respiratory technicians, and new ones being hired. Mock intubations and code blues were run in order to train staff on what would be needed to support an incoming patient, start to finish, while also keeping staff safe.

 

Doctor at QCH

 

The challenges hospitals expected theyโ€™d face were clearly daunting. Countries such as Italy, Spain, and France had seen their COVID-19 infection numbers skyrocket in a matter of days and their health care systems became completely overwhelmed.

โ€œAll those countries that suffered, and are still suffering in many ways, published a lot of information that guided us in how to prepare for this. At the same time, we also knew that while a lot of preparation goes into this, you never really know what to expect and that preparation only goes so far.โ€

 

Even in normal times, the ICU is a challenging unit to work in. Being on the frontline of a global pandemic as the first patients started to arrive, the preparation stopped and training kicked in. โ€œI think these are challenges that often appear to be theoretical talk, in that itโ€™s never going to happen. Well itโ€™s happening and thatโ€™s something that our team has approached head on,โ€ said Dr. Iyengar.

 

In the early stages of the virusโ€™ presence in Ottawa, Queensway Carleton Hospital saw more COVID-19 positive patients than anywhere in the entire region, stretching from Cornwall to Scarborough. What makes the novel coronavirus so challenging is how it acts very heterogeneously, explained Dr. Iyengar. โ€œEven in the patients that weโ€™ve had, itโ€™s a different pattern in virtually every patient [โ€ฆ] It does not behave like other viral pneumonia.โ€

 

For people who are not in ICU seeing the impacts of COVID-19, it can be difficult to grasp the intensity of the virus on the body. โ€œWhat we know about these COVID-19 patients, worldwide mortality rate is above 50% once they reach the stage of mechanical ventilation and require ICU care,โ€ said Dr. Iyengar. Even with the best equipment and the best staff taking care of patients, recovery is not guaranteed when a patient gets to ICU. โ€œSo far, although patients have survived, unfortunately, weโ€™ve also had deaths in our unitโ€ฆ This is a bad disease. Just in the patients that weโ€™ve seen in the last 2-plus weeks in the intensive care unit on full life supportive measures, we see that it does not discriminate with age, it does not discriminate necessarily with pre-existing health issues or functional state before getting sick.โ€

 

โ€œThere will be tough times, so weโ€™ll work together. We will get through this! Weโ€™re going to help each other, and weโ€™ll be okay in the end,โ€ said Dr. Iyengar. โ€œThatโ€™s the message that weโ€™ve been stressing right from the beginning, despite all the fears and other stresses that everybody has. That is how weโ€™re going to get through it.โ€

A Story from a COVID-19 Survivor

Ralph Field is from Barrhaven. In late March, he tested positive for COVID-19 and spent three weeks in the hospital โ€” most of that time in the Intensive Care Unit (ICU) on a ventilator.ย 

COVID19 survivor

โ€œBut I actually beat it. Iโ€™m finally home.โ€

Ralphโ€™s story is a positive one and he eventually returned home to his wife of 30 years, Diane. In an interview with CTV news, Diane embraces him tightly in a hug. The reporter asked him what he missed the most. His answer? Cuddling.

โ€œMy weeks on the ventilator were very scary for everybody. My heart flatlined three times. My family had no idea if I was ever going to wake up again.โ€

Ralph was connected to a ventilator for 16 days. His kidneys also started to fail and he was put on dialysis.

But it wasnโ€™t working; instead of his blood thinning it started to clog, so doctors decided to stop dialysis. Once it was discontinued, Ralphโ€™s condition started to improve.

โ€œThey just decided to take me off it. We were all shocked when my body started to heal. My kidneys and my blood pressure and my heart all started to get better. And then they removed the ventilator. I was finally able to breathe on my own again.โ€ Field said.

Ralph and Dianeย are happy he has returned home and are in good spirits about the whole experience.ย 

 

โ€œI will never forget what it felt like to have an emergency doctor at my door, telling me how unbelievable it was for me to still be here. The doctor told me: This is why we do what we do.โ€

This is the message Ralph leaves to frontline staff:

โ€œTo the ICU team that saved my life: you are real life heroes. If not for these women and men, I wouldnโ€™t be here today to share this story. I am so filled with gratitude.โ€ย 

A Photo Essay from the Frontlines

From the moment a patient arrives, to the steps they take to leave, along the way they are met and cared for by such incredible healthcare workers. People, who in the face of some of the most challenging months of their careers have stepped up and banded together to battle through this crisis and deliver some of the best care in the world. Below we share some of our favourite photos of the wonderful women and men who have worked tirelessly to care for the amazing people of Ottawa and beyond. Please remember to leave them a message.

 

 

Before COVID-19, our Acute Care for the Elderly (ACE) unitโ€™s job was to help the elderly recover and return home. Because the layout of the ACE unit is the best available to provide the kind of care needed for COVID-19 patients, our ACE workers are now a dedicated COVID unit.

 

 

With the opening of the West COVID Care Clinic at D. Aubrey Intermediate School in April 2020, the number one priority of our QCH healthcare team is providing excellent care to our patients. Our team has gone to great lengths to ensure everything is clean and safe for everyone who walks through the door.

 

 

Our Acute Care for the Elderly (ACE) unitย team has worked hard and worked smart to completely change their workflow and model of care in order to provide for COVID-19 patients. They are doing a fantastic job caring for patients with respiratory illness โ€” many who are scared and isolated.ย  We are so proud of them.

 

 

Our Medicine Unit (C4) has been gearing up to become our next COVID unit. Theyโ€™ve been learning from their colleagues on our Acute Care of the Elderly (ACE) unit, Emergency Department (ED) & Intensive Care Unit (ICU).ย  And we must say, they certainly look ready! Loving those shirts.

 

 

The West COVID Care Clinic, operated by QCH in partnership with Ottawa Public Health, was the first of itโ€™s kind in Ottawa. With swiftness and agility, the clinic was fully operational by April 6, 2020 to provide treatment for people with symptoms of respiratory illness โ€“ cough, fever and cold-like symptoms โ€“ in need of medical attention.

 

 

There is a whole team involved in making sure QCH staff and physicians have enough supplies to keep them safe. They are literally doing everything possible to make sure we have enough personal protective equipment when we need it.

 

 

“You are part of an amazing team!” Motivation like this and like yours help during this challenging time.

 

 

Everybody is doing their part, however they can. Here is Shawna MacIntosh, a Patient Care Assistant from the Emergency Department who has been redeployed to screening.

 

 

As many surgeries have needed to be postponed, some surgical nurses have been deployed to different areas, such as Intensive Care Unit (ICU), Emergency (ED), Patient & Staff Screening, Long-Term Care (LTC), the West Covid Care Clinic, and the Fairfield Inn Kanata that is hosting our offsite Alternate Level of Care (ALC) department.

 

 

Whether itโ€™s coming to work at our West COVID Care Clinic, or shifting an entire unit, every member of the QCH team have come together and worked tirelessly to take on this pandemic โ€“ demonstrating an incredible amount of strength and resiliency.

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