Pandemic ICU strain could mean life-or-death decisions. For this Ancaster surgeon, it calls up his past as a war zone medic
Field hospitals. Intensive care unit strain. Patients routinely transported via helicopter for treatment. Redeployed staff.
He is a long way from Syria, but when confronted with Ontario's crisis care levels at his daily hospital COVID-19 briefings, Dr. Anas Al-Kassem remembers harrowing scenes he witnessed as a war zone trauma surgeon.
Al-Kassem, chief of surgery at Norfolk General and West Haldimand General hospitals, travelled to Aleppo in 2014 with the Union of Medical Care and Relief Organizations, near the beginning of the Syrian civil war.
It is one of many medical relief trips he has made to underserviced areas and war zones, but it ended with a haunting memory.
He had begun treating a woman whose severe injuries called for a complex surgery when another patient was brought in with a better chance of survival, if treated immediately.
He only had one team, one nurse, one ICU bed. After an ethical assessment, they ultimately unplugged the surgery patient from the life-saving equipment.
I cannot even forget this day, when I had to make a decision of who's going to live and who's going to die," he said. Although, if I had enough resources in terms of staff, ICU staff and ICU equipment and ventilators, both [patients] should be saved."
Al-Kassem said one of the defining features of how Ontario is experiencing the third wave of the pandemic is the ICU picture and how it is affecting other hospital units, especially with the cancellation of surgeries for some patients. He sits on the surgical and procedures regional committees, which convene weekly to plan around COVID-19 capacities across Hamilton, Haldimand, Niagara, Burlington, and Brantford.
On March 18, Health Minister Christine Elliott said the province ordered 300 more ventilators, but did not make a clear staffing commitment to support the boost in medical supplies.
Prime Minister Justin Trudeau said Sunday his government was in talks with Atlantic provinces and across federal departments, including national defence and immigration, about deploying health-care workers to Ontario.
The latest science table modelling shows Ontario is poised to exceed 1,000 ICU patients by the end of April.
On Sunday, the province reported 18 deaths and 2,107 hospital patients, including 741 in ICU. Of those, 506 are relying on a ventilator to breathe.
The province has not yet activated its triage protocol shared with hospitals in January in a document called Adult Critical Care Clinical Emergency Standard of Care for Major Surge."
Whether a pandemic or not, this is unprecedented, the pressure on intensive care and the pressure on the physicians to treat a huge amount of ... ill patients in the hospitals," Al-Kassem said.
In addition to general and emergency surgeries, Al-Kassem also performs COVID-19 related procedures such as tracheostomies.
Like other Muslim health-care workers observing Ramadan, Al-Kassem is fasting for about 15 hours each day. With late evening prayers at home, and early mornings to eat before sunrise, it tends to mean less sleep for the next three weeks until Eid. He hopes to ring in the holiday with better hospital data.
We'll wait for that. Hopefully by the end of Ramadan, we'll see the sunshine."
-With files from The Canadian PressVjosa Isai is a reporter at The Spectator covering Hamilton-based business. Reach her via email: visai@thespec.com.