16 minute read
ON THE COVID-19 FRONT LINES
BATTLING COVID-19 ON THE FRONT LINES
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| BY VAWN HIMMELSBACH
It takes a team of health care workers to help recovering COVID-19 patients who often take months to get better
As the fi rst wave of the pandemic escalated in spring, Markham became York Region’s hot spot with 22 per cent of the Region’s COVID-19 cases. And some of Ontario’s highest numbers of COVID-19 patients were treated in MSH’s Intensive Care Unit (ICU).
MSH responded by opening an on-site COVID-19 Assessment Centre. Up until October 13, the hospital had tested over 40,000 people, confi rming 1,240 positive cases and admitting 126 patients. Of those, 30 per cent were sent to the ICU; 28 per cent of admitted patients were intubated, spending an average of 19 days on a ventilator.
Some patients, however, spend much longer rehabilitating in hospital — and their recovery process
is still far from over. One of those patients is Frank Scali. In midMarch, Frank’s wife and one of his sons began experiencing symptoms of COVID-19. Shortly afterward, Frank came down with a fever, accompanied by body aches. A few days later, he was drying off after a shower when his legs gave out and he fell to the fl oor.
“I remember coming out of the shower and within seconds I fell to the fl oor. I had no strength in my arms or my legs to lift myself up, and I was lucky that my wife and one of my sons were here,” says the 75-yearold Markham resident. His wife, Alfonsa, immediately called 911.
“I remember talking to the ambulance attendant and I remember being taken into the hospital —
Frank and Alfonsa Scali
and that is all that I remember,” says Frank. The next month and a half are absent from his memory.
Frank tested positive for COVID-19 and was admitted to MSH. Three days later, he was put on a ventilator, yet the virus continued to wreak havoc on his body. “Frank’s doctor called and told me he was very sick and they might have to intubate,” Alfonsa says. “It was the only thing they could do to save his life.” His blood pressure plummeted, his kidneys shut down and he was put into an induced coma.
“It was scary, the uncertainty,” she says. “We didn’t want to lose hope, but on the other hand, doctors were telling us to prepare for the worst.” And because of new safety protocols at the time, she wasn’t able to visit him in hospital. “My biggest fear was that Frank was going to die alone and we wouldn’t be there to say goodbye.”
Frank was briefly sent to a GTA hospital, returning to MSH 10 days later. He was still intubated, but his blood pressure was increasing and his kidney function improving.
Gradually, after being intubated for three-and-a-half weeks, his doctor decreased his sedation and took him off the ventilator.
“That was a roller coaster that was going more down than up,” says Alfonsa. “Even before they took out the tubes, they started the medication to wake him up [from his induced coma] and it took two weeks.”
Frank spent the majority of his time in the complex continuing care (CCC) unit, cared for by a team of nurses, personal support workers and rehabilitation staff. “Having him in that unit was wonderful,” she says. “He was in a room on the first floor and the staff would bring his bed close to the window. Even though I couldn’t be with him in person at least I could see him.”
No two COVID-19 patients seem to be alike, so health care professionals are continually learning on the job. Patients in the CCC unit tend to be so profoundly weak that they require more than ‘typical’ rehabilitation. Complications often arise, such as limited endurance, shortness of breath, severe muscle weakness, neuropathic pain and critical illness myopathy. “COVID-19 patients — and especially the ones who have been intubated — tend to be impaired on so many levels. They’re dealing with heart issues, oxygen saturation, dizziness and pain,” says Tammy Hibbert, an occupational therapist at MSH. “Some have had strokes as a result.”
The role of occupational therapy is to assess and facilitate a patient’s independence in activities of daily living, from getting out of bed and managing personal care to cooking meals, driving a car and returning to school or work.
“The biggest difference from a regular rehabilitation program is that COVID-19 patients are dealing with so many subtleties or medical surprises that they’re recovering from all at once,” says Tammy. “There’s a need for close monitoring, since they can take two steps forward and then one step back. So we take it day by day and reward
the small steps.”
When Frank was admitted to the CCC unit, he was so weak he could not walk, sit up on his own or even feed himself. He didn’t even have the strength to open a juice box. “Individuals like Mr. Scali have very low endurance and can’t tolerate much therapy,” says Joyce Tan, an MSH physiotherapist who worked directly with Frank.
But as the weeks passed, he was finally able to get out of bed on his own. The first time he stood up by himself, without assistance, he thought, “this is a miracle.”
He finally left the hospital on July 7, with a long line of caregivers in the hallway clapping him out. “Everyone was there,” Frank recalls. “It was very emotional. It should have been me clapping for them.”
Frank is happy to be home — as is his family — but he still has a long road ahead in his recovery process. “I can’t imagine the stress my wife and family experienced,” he says. “We weren’t prepared for this but thankfully our hospital was. With my age and health issues, it would have been so easy for the staff to give up on me but they never did. I’m here today because of them.”
Rehabilitation staff like Joyce and Tammy worked with Frank to improve his physical function and mobility so he could safely transition back home. However, because recovery typically takes longer, it will continue at home.
“Once a patient is at a level that is safe to go home, we typically put in community supports if we feel there is still room to improve,” says Joyce. MSH provides everything from personal support workers to nurses and therapists as needed to support a patient’s recovery.
Months later, Frank continues to work on his recovery and deal with the after-effects of COVID-19. A nurse visits every morning and a physiotherapist twice a week. He’s still weak, his concentration isn’t
The team of nurses, personal support workers and rehabilitation staff who helped Frank recover
fully recovered and he still requires a walker to get around.
“It’s going to be a long process. I really don’t know how long it’s going to take before I’m 90 per cent of where I was before I went to the hospital,” says Frank. “I cannot go up the stairs to take a proper shower, but the way I look at it is, I’m here, I’m with my family, I’m talking to my friends on the phone. I’m very thankful to MSH for all they did and are still doing.”
Since the launch of its COVID-19 Relief Fund, MSH Foundation has raised $2.5 million, with a goal of raising $3 million. Money raised through this relief fund is being used to purchase life-saving equipment, PPE and other emerging and essential needs to help combat COVID-19 in the community — and help patients like Frank.
To date, MSH has purchased 20 ventilators and acquired an on-site PCR testing unit (Polymerase Chain Reaction Analyzer), thanks to donor support. As COVID-19 is an ongoing health emergency with no finish line in sight, funds for these types of equipment are critical.
“Two weeks before I got hit by the virus, I remember talking to my son and saying, ‘If I get the virus I wouldn’t survive it,’” says Frank. “But somehow here I am. The team at MSH didn’t give up on me, so I’m here. I owe my life to the hospital.” Community members can support COVID-19 relief efforts through the MSH Foundation at helpmsh.ca.
CANCER CARE CARRIES ON, DESPITE COVID-19
As the world deals with a global pandemic, MSH’s cancer clinic hasn’t missed a beat
| BY VAWN HIMMELSBACH
In 2015, after visiting her doctor about a pain in her side, Eileen Russell was diagnosed with Stage 4 breast cancer that had metastasized to her bones. At the time, the diagnosis was grim: her cancer could not be cured. But it was treatable — so long as she continues to have chemotherapy every three weeks for the rest of her life.
As cancer treatments improve, so does the quality of life for patients. “It definitely is an incurable cancer but I’m so happy it’s treatable,” says Eileen, who has responded well to treatment and lives a relatively normal life.
Even a global pandemic has not slowed her down, since she’s been able to continue to receive firstclass care throughout the pandemic at The Shakir Rehmatullah Cancer Clinic at MSH.
“The number one thing for me was the fact that they did not cancel any of my treatments [because of the pandemic] — not one,” says Eileen, a former MSH employee who was hired in 1989. She was the hospital’s manager of communications when she retired in 2013.
Because of COVID-19, Eileen has not been able to visit with former colleagues while she’s in the hospital for chemotherapy. She misses that, but she was delighted to be able to continue regular treatments with oncologist Dr. Henry Solow and her nurses, Debbie, Heather and Sinny.
Patients like Eileen who require ongoing care through The Shakir Rehmatullah Cancer Clinic become “like family,” says registered nurse Debbie Mahoney, who has been one of Eileen’s nurses since the initial
Eileen Russell, grateful patient
cancer diagnosis. “So that part hasn’t changed [because of COVID-19].”
What has changed is that Eileen’s husband Jim (or any other visitors) cannot sit with her during treatment, due to safety protocols at the hospital. “Prior to COVID-19, Jim came with her every single time,” says Debbie. “We would have a nice chat. It’s a small clinic and it’s very personal, so you get to know the patients and their families. We exchange Netflix options and talk about travel; it’s a family kind of feel in here.”
At The Shakir Rehmatullah Cancer Clinic, MSH’s oncology nurses help patients through each step of their journey. The clinic includes the innovative pain and symptom management clinic, which is expanding its services thanks to donor support. Through an integration of acute and palliative care, patients receive treatment that goes beyond their cancer diagnosis, encompassing related complications as well.
During the pandemic, oncology nurses are doing whatever they can to
ensure vulnerable patients continue to receive the safest, most effi cient care possible. For example, there’s now a separate entrance for oncology.
“It’s been amazing. You get screened there, you get your hand sanitizer and mask and temperature taken,” says Eileen. “Everything is done right at that entrance so it’s an extremely safe environment.”
MSH’s oncology program — which includes the Breast Health Centre, chemotherapy clinic, pain and symptom management clinic, colon health services, clinical trials and radiation consultative services — was created in response to demand from area residents who want cancer treatment close to home, in their own community.
“Oncology is an essential service, so plus or minus COVID-19 we forge ahead,” says Cheryl Osborne, patient care director of emergency services and ambulatory care. But dealing with a pandemic brought with it extra challenges for oncology.
“It takes longer to provide care when you’re donning PPE and disinfecting surfaces in between patients,” says Cheryl, “and that will remain a challenge until we’re past the pandemic.”
There’s also a backlog of patients who did not come in for checkups during the height of the pandemic. “They’d only come to the Emergency Department if they were really sick,” says Debbie. “So the patients we’re getting now are really sick, and they’ve been sick for a while.”
But the pandemic is not the only challenge. As the community continues to grow, so too does the need for cancer treatment and support. MSH has been experiencing a 12 per cent annual increase in new oncology consults within recent years, currently treating upwards of 30 chemotherapy patients daily. Most days every consult room and all 14 chemotherapy treatment chairs are full, and the clinics are operating at capacity.
This is not expected to slow down anytime soon, even when the pandemic is over. Indeed, nearly one in every two Canadians is expected to be diagnosed with cancer in their lifetime.
In its 2020 research, Cancer Care Ontario predicts an estimated 91,946 new cases of cancer in Ontario this year — that’s 252 new cases every day. The most commonly diagnosed cancers will be breast, followed by lung and prostate cancers. As Ontario’s population grows and ages, the annual number of new cancer cases is predicted
to increase by 25 per cent in the next 10 years (or by 23,000 cases).
While more people are being diagnosed with cancer, more people are surviving and requiring follow-up care, sometimes for the rest of their lives — like Eileen.
There are dozens of chemotherapy drugs available and many more being developed. Eileen, for example, is being treated with two types of chemotherapy drugs as part of her maintenance plan. This does not ‘treat’ the cancer, but blocks it from spreading.
“New drugs are coming out all the time — it’s not necessarily a death sentence anymore, it’s almost like a chronic illness,” says Debbie. That’s one of the reasons why MSH is quickly outgrowing its current space in the cancer clinic.
In the near future, there will be a growing need for consults, acute patient care and longer-term palliative care.
“The clinic space for now is adequate to meet our needs, but we’re going to be pretty tight [as going to be pretty tight [as it grows],” says Cheryl. it grows],” says Cheryl.
Cheryl Osborne, patient care director
“Another four to five chairs will be needed within the next few years. Right now, we have to be creative with our schedule to ensure we can book the maximum number of patients, and while maintaining our COVID-19 practice and safety principles.”
Aside from more chairs, Cheryl expects they will need more infusion pumps and treatment room space, as well as the infrastructure required to support those additional spaces. She would also like to hire another nurse practitioner, as well as a second nurse navigator
THANK YOU FOR MAKING TRIPLE THE IMPACT
Although we were unable to hit the links this year, thanks to our generous matching donors, Ballantry Homes and David Milovanovic, your gifts were matched $1 for $1 and raised over $77,000. This helps ensure our frontline team is well prepared, in any scenario, to provide life-saving care and treatment to every patient who turns to us. With every dollar raised, you help enable the continued provision of exceptional patient care even in the face of unprecedented crisis. LEAD DONOR
2020 SUPPORTERS
Bill Bachra Tamara Brown Francis Chan Cisco Systems Canada Co. Friends of MSH Foundation Markham District Energy Inc. Mattamy Homes Minto Communities Patrick Molloy Brad & Lara Morris
Allan & Kathryn O’Dette Paladin Security Group Ltd. Precise ParkLink Inc. Schaeffer & Associates Ltd. Frank & Freda Spain The Raywal Limited Partnership Dr. Michael Virro David Wang Peter Zukow
(someone who patients can contact when they need support).
“I would love to see an environment that’s more soothing and less institutional,” says Cheryl. “We’re doing that in the Breast Health Centre; there will be wall-to-wall graphics of nature scenes.”
In an eff ort to improve the overall patient experience including effi ciency and patient fl ow, the Breast Health Centre relocation and cancer care expansion are now underway. The current Breast Health Centre space is shared with the chemotherapy clinic, so the relocated site will house larger assessment spaces and therapeutic intervention rooms.
The waiting room will also be segregated, providing patients with privacy and supporting best practices recommended by Cancer Care Ontario. Donor funds made the addition of specialized beds possible, as well as provided the furniture to support a more therapeutic and comforting environment.
Creating more dedicated space for surgeons at the Breast Health Centre will also allow for a much-needed expansion of the chemotherapy clinic, the symptom management program and the clinical trials program, as well as provide space for the radiation oncologist. With the acquisition of a tissue microarray processor for the lab — also thanks to generous donor support — MSH is well-positioned to grow its clinical trials program, particularly breast cancer trials.
“We’re anticipating by the end of spring we should be able to move into this new space,” says Cheryl. “We’ll be able to standardize practices across providers, so everybody’s experience will be similar in terms of intake and how we deliver services, allowing us to provide a better patient experience.”
As cancer treatments improve and more people live longer lives with cancer as a chronic illness — rather than a death sentence — there’s also a need for enhanced long-term support programs close to home.
Eileen is one of those patients who will benefi t. However, in the meantime, while the world deals with a global pandemic, she has found that patient care at MSH has
Eileen with oncology nurse Debbie Mahoney
not missed a beat.
“As a patient I’m not really aff ected. I get my juice and cookies, and all the friendliness of the staff — apart from not getting my hugs,” she says. “[My husband] Jim is missing it big time because he’s the one who gets more hugs than I do, and they’re missing him too. It’s such a comfortable feeling, I kind of forget why I’m there.”
