fear, fatigue and hope: what hospital workers are feeling

when the call about a covid-19 vaccine came on new years eve, respiratory therapist marilyse dufresne-cater experienced something she hadn’t felt in a long time: hope.“twenty-twenty was ending and it felt that there was finally a shining light coming in 2021.”for front-line health-care workers at queensway carleton hospital, the past year has been marked by fear, fatigue and steep learning curves. hope is something new. but it is not over yet.while many of us are experiencing the pandemic from our homes and sheltered routines, front-line health-care workers have been living the timeline — powering through every wave, working to keep struggling covid-19 patients alive and waiting anxiously for a vaccine.as ottawa begins the second year since the beginning of the pandemic, dufresne-cater, 41, and critical care nurse campbell toohey, 54, provide a peek inside their worlds, through video diaries and interviews with this newspaper. they are among front-line workers who have treated some of the sickest covid-19 patients at queensway carleton during the pandemic.the nurse and the respiratory therapist both work long shifts and have experienced frustration and even fear — especially in the early days — along with the satisfaction of playing key roles in the pandemic response. they are both vaccinated now, but they are still living the pandemic timeline.and, with a third wave beginning, there are new challenges with variants expected to hit younger people harder and hospitals already more crowded than during either the first or second waves.dufresne-cater and toohey hit the ground running when the pandemic began in ottawa last march and have barely stopped since then.queensway carleton treated its first covid-19 patient on march 12, 2020. for a time, it had more covid-19 patients than any hospital in the region. health workers had seen the chaos covid-19 had caused elsewhere and didn’t know what to expect.“at first, there was this panic of not knowing what we were dealing with and being terrified it was going to sneak into our masks,” said toohey, a registered nurse in the intensive care unit at queensway carleton. he changed his clothes and showered before and after work to make sure he didn’t bring it home to his family. he even considered parking a trailer in his driveway to live in, but, instead, isolated in a room in his house at the beginning of the pandemic.“i was scared at first.”dufresne-cater said she was “running on adrenaline,” at the beginning of the pandemic. “we were scared and overwhelmed.”as the months progressed, front-line health staff became more comfortable doing their jobs amid an unprecedented pandemic. they have also become more comfortable wearing their ppe all of the time and trusting it, said toohey.“at first, it was kind of a nuisance.” but a year later, toohey knows it has helped keep him safe. he has not been sick or passed covid-19 along to anyone. the few employees who have tested positive for covid-19 did so because of contacts outside of the hospital, he said.“i really praise our ppe for keeping us safe.”that gave health workers a growing sense of confidence as the pandemic progressed. but it didn’t make some of what they experienced — including deep fatigue and grief — any easier.

in one of her video diary entries at the end of a 12-hour shift, an exhausted dufresne-cater talks about a “very frustrating shift,” saying she is anxious to sign off.respiratory therapists are the “firefighters” of the hospital, she says. they support, monitor and treat patients with respiratory disorders and assist with intubations, which are among the riskiest procedures during this pandemic because of risk of aerosol transmission and complications.“we have very unpredictable jobs. anything can come through the door at any time.”some of those patients will need increased levels of oxygen and other treatment, some will need to be on ventilators in order to breathe.and there are times when all the intervention of medical staff will not be enough.dufresne-cater remembers a severely ill patient whose family had been able to come into the hospital on compassionate grounds. even as the family thanked her for all the work she was doing, she knew it was not going to be enough and that patient would not make it.all patient deaths are felt by health-care workers, but it is the deaths of the younger patients — those in their 50s and younger — that have stayed with dufresne-cater.“when you see someone in the prime of life losing their life and you are doing everything in your power to get them better — those deaths stick with you,” she said. “it is after the fact that this stuff bothers you, when you have time to think about it.”she is one of 20 respiratory therapists at the hospital. the pandemic has drawn them closer together.“we have always been close, but with covid-19 my coworkers have been a sounding board for my concerns and stresses,” she said.at the end of one shift, during which she worked on a difficult intubation, she talked to her coworkers for support.“we have all lived through something really stressful together. i don’t think anyone understands it as well as the people you work with.”

toohey is also conscious of the impact the pandemic is having on his coworkers.“we try to look out for each other.”nurses often get to know the most seriously ill covid-19 patients well because they can be in the hospital for a number of days before taking a sudden turn for the worse. during the pandemic, 35 of those critically ill patients at queensway carleton died from covid-19.“every time you come to work you ask: are they still there? did they make it?”efforts are made to bring family members in when a patient is hospitalized and seriously ill with covid-19, but that is not always possible. sometimes, family members are also sick with covid-19.toohey has organized video chats with families so they can see their loved ones, sometimes for the last time.over the past year, toohey has volunteered to work many overtime shifts because of staff shortages.“i just feel that if i can’t be there, my coworkers will have to work harder.”but he worries what the fallout will be on front-line staff when it is finally over.toohey, who has been a nurse for 35 years, says walking and hiking during his days off helps him to turn his work off and rejuvenate. “being stressed out doesn’t help my team.”but he believes some health-care workers will suffer long-term effects after the pandemic. “right now, we are still in the battle.” burnout will likely show up later.

fifteen years into her career as a respiratory therapist, dufresne-cater hopes she never sees another pandemic of this magnitude again. but she concedes “we have learned a lot from it.”among techniques frequently used on severely ill covid-19 patients is proning. placing patients in respiratory distress on their stomachs can help increase oxygen absorption in their blood. some research suggests it helps prevent more invasive treatments in some patients.it is a technique that has long been used for patients on respirators with severe respiratory distress syndrome. but its use was not common at queensway carleton until about five years ago, said dufresne-cater. the pandemic has made it a frequent treatment with as many as five patients being proned in one day. but it is labour intensive and potentially risky if not done properly.dufresne-cater said turning an intubated patient onto their stomach requires four nurses and two respiratory therapists as well as one doctor nearby. it used to take between 35 and 40 minutes to prepare for the procedure, but it now takes about 20 minutes, she said.“we are a lot more used to it.”still, the stakes are high. complications, including cardiac arrest and intubation, can be “catastrophic”.for toohey, who worked at cheo during the sars crisis, covid-19 has been a greater challenge because of the many ways it can attack the body.“with covid-19 we are challenged with a virus that does not respond to treatment. complications of the virus means we are not just dealing with a respiratory illness, but a full systemic attack on the body including the heart and organ failure.”many survivors are dealing with long-lasting effects of covid-19.

toohey routinely walks 16,000 to 17,000 steps during a 12-hour shift. according to his activity tracker, he often climbs 15 or more flights and remains on his feet for 12 hours.nursing is both physically and emotionally exhausting, he says.“our job is to save lives. when we can’t, despite all efforts, it wears us out emotionally,” he says.“the many lives lost have definitely affected our lives.”toohey, too, is relieved to have been vaccinated. but the pandemic is not over.and when it is?“i just want to go to the pub and have a beer, just be with friends again. i miss my friends.”