VANCOUVER -- The public is finally getting a closer look at life on the frontlines of the COVID-19 pandemic at the ICU and “red zone” in one of the province’s busiest hospitals, and the stress, exhaustion and emotion the healthcare workers are dealing with is striking.
For weeks, CTV News has been working with Providence Health Care to tell the stories of the work behind closed doors. On Tuesday, the health authority provided powerful visuals and facilitated interviews with staff at St. Paul’s Hospital in downtown Vancouver, who painted a vivid and heart-wrenching picture of the effort to keep the sickest patients alive – a battle they’ve been quietly waging for months with fatigue and loneliness now deeply established.
“Everything has become focussed on the minute to minute prevention of any contamination or infection but it’s taken away a lot of the humanity and the stress has built,” said intensive care doctor John Boyd. “What impresses me every day is people still come to work. We are getting through it and we want everyone to stay safe but the work itself has just become kind of lonely almost because you’re always inside the mask.”
From nurses to doctors, respiratory therapists to maintenance staff, every person in the ICU and COVID-19 wards is layered in PPE, but the most treacherous and stressful procedure is the one that exposes staff to the highest concentration of the virus. Intubation is high-risk, but is also the measure most important in keeping the sickest patients alive.
"It's semi-chaotic up until that time, the patient is losing their ability to breathe and there’s time pressure because we have to take over their breathing sooner rather than later or they'll stop and that's the risky time we call an 'aerosol-generating procedure' – when a tube goes through your vocal chords directly into your lungs, which has the highest count of virus, by far," explained Boys.
“That can spray everywhere in the room and that's why we do these procedures in a highly negative pressure room…We used to think that more people in the room was safer, documenting the drugs we were giving and to stay on track like you would on an airplane with a checklist, and we had to unlearn that kind of thinking because the more people we had in the room, the more people we had at risk.”
Related: Inside a Vancouver COVID-19 ward as B.C. hits hospitalizations record
That’s why the standard procedure now includes the minimum number of staff per procedure and multiple tasks carried out by each person. When they leave, they have to remove much of their PPE, sanitizing their hands as they remove each item; they avoid touching anything inside the patients’ rooms and work under the assumption everything is contaminated by the virus.
The process is so time-consuming, doctors in the ICU have binoculars for a quick visual observation of patients to see how they’re doing and determine if and when they should enter.
Unit 7B divided between Yellow and Red Zones
When a person shows up to St. Paul’s with COVID-19 symptoms, they’re quickly moved to the designated ward in Unit 7B, where a clear line divides the Yellow and Red Zones.
They stay on the Yellow side while they await test results, but are treated as if they tested positive. A confirmed diagnosis and they’re moved to the Red Zone; there’s no connection between the two sides and the teams work independently.
“We're in the room for a short amount of time. It's very hard to be in the room with PPE, it's very uncomfortable,” said Julia Pavlova, a dedicated “red nurse.”
She’d graduated only a few months before the pandemic and was still a rookie when Providence Health Care invited staff to step up for work in the riskiest areas of the hospital. She has now been nursing for exactly one year.
“I volunteered, nobody pushed me into this position. It was scary (at first) but it's baby steps," said Pavlova. "I never allow myself to relax and to forget that pretty much we view that everything is covered with the virus."
The mother of two teen girls also supports her elderly high-risk mother, and like many frontline workers at the time, moved out of the family home for two months as the pandemic began to avoid exposing them to the virus. So when CTV News asked Pavlova how she sees anti-mask protestors and COVID-deniers, she grew very emotional.
"I wish you never have to hold a patient's hand who's dying. I wish you never have to go into that room for that last phone call -- when you hold that phone and the person says a last final goodbye and the whole family is just shattered and they cannot be there," she said, addressing protestors directly. "You hear about people who are protesting and insist they have the right and they don't want to cover their faces and it's about their freedom and I'm thinking, how about the right of that person to live? How about the right of that person who had so many years to live and to enjoy life and them being robbed from their family and their family being heartbroken?"
Fearful of what could be coming
While the federal and provincial governments have been sourcing new ventilators since the spring, Boyd points out the machines don’t run themselves. While there’s physical capacity for ventilators, the manpower is a different story and training a doctor or nurse to care for those patients can’t happen overnight.
Our healthcare workers are now bearing a heavy burden, not only experiencing the same social restrictions and stressors the rest of us do, but with the ever-present risk of the virus haunting their every move.
“It’s tremendously isolating,” said Boyd, adding that it's had an immense impact on their dealings with patients' families as well.
“We sometimes have to communicate the most difficult news by telephone or Zoom ... you just want to sometimes give them a hug or a touch gesture, and that was so right before and it’s so wrong now.”
