Exhausted. Helpless. Feeling like a failure. Some palliative care doctors and nurses say they’re burned out because more patients face incurable cancers. To cope, they’re supporting each other through COVID-19’s latest wave in Canada.
This week, a Leger survey for the Conference Board of Canada suggested 97 per cent of 200 doctors and nurses who provide direct patient care in hospitals reported fatigue and burnout have increased in their workplace. Most cited inadequate staffing levels resulting in stress from not being able to offer optimal care.
And those offering comfort care tell CBC they’re seeing more patients who are terminal at their first appointment than they did before the pandemic. Cancer specialists are in a prime position to observe the effects on patients, their families and each other.
For Dr. Gerald Batist, a medical oncologist and director of the Segal Centre Centre at Montreal’s Jewish General Hospital, the pandemic is the first time he’s seen burnout up close, in a colleague.
“We’re all clinicians. We should recognize what burnout means, right?” he said in conversation with Dr. Brian Goldman, host of CBC Radio’s White Coat, Black Art.
Batist’s team didn’t immediately recognize the burnout, which can be serious and may include emotional, physical and mental exhaustion and feeling hopeless and resentful, along with headaches and backaches.
Batist leads the cancer centre and says he felt stuck between physicians who were frustrated that their colleague wasn’t picking up shifts, and the colleague going through rehabilitation feeling hostility.
“We’re not used to dealing with our colleagues, our professional colleagues as … patients.”
Once the problem was recognized, the team’s solution-finding kicked in to help the person recover, he said.
Batist said colleagues who at one point were sniping at each other are now all determined to support one another, asking how one another is doing in a stairwell and commiserating in their shared experiences.
Doctors overwhelmed by tsunami of advanced cancers
As an oncologist, Batist sees the “tsunami” of advanced cancers that are less curable than if they’d been diagnosed at an earlier stage. He said it’s happening because:
Patients with symptoms feared coming to hospitals, which are taking precautions to reduce the risk of contact with COVID-19.
People missed preventative screenings like mammograms and colonoscopies.
There were cuts to operating room time during lockdowns, slower diagnostic tests and biopsies, and reduced intensive care unit staffing for surgical patients.
“It’s very hard to see people in increased numbers facing the end of their lives … sooner than they and we would have hoped.”
He recently saw a woman in the emergency department who was diagnosed with rectal cancer that had spread dangerously. She walked into the hospital for pain and recalled her leg had rapidly weakened over three weeks.
Batist said her cancer was treated. But irreversible damage happened because of the delay in coming to hospital. “That’s really hard to swallow, of course, for the family and the patient, but certainly also for the doctors trying to make life better for our patients.”
In Toronto, Dr. Irene Ying supports Batist’s observation of seeing patients with more complicated states of disease than before the pandemic.
She’s a palliative care doctor at Sunnybrook Health Sciences Centre, which means she works to make life better for patients by relieving symptoms such as pain and nausea to improve quality-of-life for patients with a serious illness, and their families.
Ying said when a disease like cancer makes someone frail, surgical options to reduce pain and other symptoms may no longer be open to them.
“There’s greater feelings of helplessness because we feel like there could have been more that we could have done to make their end of life more comfortable,” Ying said. “I think that takes an emotional toll over time.”
COVID protocols make comfort harder
Wearing masks, gloves and other PPE mean she can no longer offer the comfort of a warm hand when a patient’s relatives are trapped on the other side of the world or quarantined in the city. The loved one dies alone when she isn’t able to correctly predict how close death looms.
“It’s tough when you can’t get the kids to come in to see their mom or dad,” due to restricted visitor policies. “That adds an extra layer of an emotional sucker punch to the situation.”
Ying said she still feels lucky to work in palliative care with physicians, nurses and staff who have such compassion for their patients and colleagues.
Dr. Christian La Rivière, medical director of palliative care for the Winnipeg Regional Health Authority, also continues to see compassionate care delivered in homes across his city despite huge challenges.
Canadians often say they’d prefer to receive palliative care at home rather than in hospital. The demand is so high during this wave of COVID-19 that La Riviere’s nursing colleagues who offer home-based palliative care often aren’t able to take meal breaks and complete patient charts after their work day ends.
La Rivière said in an average year, 200 people in Winnipeg die at home. This year, it’s been more than 500, in part because families want to avoid hospital visitor restrictions at the end of life.
The result? La Rivière’s noticed his team members are no longer as upbeat and they’re all tired from a “constant barrage” of updates and directives from the region, province and media.
While exhausted himself, La Rivière sees a positive.
“My team still sees the patients with a smile on their face and supports patients regardless,” he said. “We will get through this.”