COVID-19 has presented physicians across our hospital with unprecedented challenges. This pandemic has also offered a complex and demanding opportunity to provide special care for COVID patients, to learn, to teach, to innovate and to study.

We asked four of our front line COVID-19 physicians to take a moment and reflect on the current state during this unprecedented time. Here's what they had to say.

Dr. Waleed Alhazzani, Associate Professor - General Internal Medicine, Gastroenterology and Critical Care, St. Joseph's Healthcare Hamilton

What would you say is your greatest contribution to the COVID-19 preparations and response at St. Joe’s?

I would say my biggest contribution is leading an international guideline on the management of COVD-19 in the Intensive Care Unit (ICU). The surviving sepsis campaign COVID-19 guidelines included more than 36 experts from 12 countries and was endorsed by the largest critical care societies in the world. The guideline experts used a state-of-the-art methodology to produce these guidelines and kept it up-to-date. We issued more than 50 recommendations on the management of the sickest patients with COVID-19. These recommendations were used to help formulate the US government guidelines on the management of COVID-19 patients in the ICU, and are used by many doctors around the world. The guidelines contributed to the formulation of some local policies on the management of COVID-19 patients. The team developed a process under the umbrella of the Guidelines in Intensive Care Development and Evaluation (GUIDE) Group here at The Research Institute of St. Joe's Hamilton to continuously search for, and update, the evidence on a daily basis to help clinicians around the world use evidence-based recommendations in their daily practice of caring for patients.

I would also like to highlight that looking after sick patients with COVID-19 in the ICU is a duty and a privilege. Families and patients put their full trust in us to help them during these difficult times.  

To date, what image, experience, exchange, discussion, memory or moment has been most impactful for you during this pandemic?

The smile and the kindness of doctors, nurses and health-care workers on my first day of working in the ICU during the pandemic was touching and heartwarming. Despite physical distancing, everyone remained kind to each other and willing to help.

I also have an opposing memory of calling a loving family, who I had never met, about their loved one who they couldn’t spend time with in the ICU due to the strict (and crucial) infection control measures implemented everywhere during the pandemic. This was one of the most difficult moments in my career. Not being able to support families the way we usually do was heartbreaking.

What’s one piece of advice you would give to future physicians on how to prepare themselves to work in a pandemic?

In order to be able to effectively look after patients, you need to look after your well-being. During a pandemic everything changes, everything becomes more stressful, but our compassion and dedication is higher. Remember that taking time to rest, and finding ways to reduce stress and anxiety are crucial for your own health and for your patients.

Dr. Gregory Rutledge, Chief of Emergency Medicine, St. Joseph's Healthcare Hamilton

What would you say is your greatest contribution to the COVID-19 preparations and response at St. Joe’s?

Luckily, I work with a great team who are willing to step up. With their support, my greatest contribution has been coordinating emergency responses to ensure our protocols and flow patterns are in place for an impending surge.

To date, what image, experience, exchange, discussion, memory or moment has been most impactful for you during this pandemic?

The opportunity to draw teams from our Urgent Care Centre, Emergency Department, and partners at Hamilton Paramedics for a successful simulation of providing critical care to a presumed COVID-19 patient has been impactful. All these people came together on their own time to ensure we have the best processes in place.

What’s one piece of advice you would give to future physicians on how to prepare themselves to work in a pandemic?

The greatest piece of advice is to set apart some downtime. With social media and the news, there’s 24-hour access to various charts, projections and stories about the pandemic. It’s important to find time to balance being prepared, and having the knowledge to be safe and care for your patients, with taking time to unwind, regroup and refocus.

Dr. Susan Ellis, Chief of Obstetrics/Gynecology, St. Joseph’s Healthcare Hamilton 

What would you say is your greatest contribution to the COVID-19 preparations and response at St. Joe’s?

The Women’s and Infants’ Leadership Team very quickly came together to develop workflows in our maternal and newborn inpatient and ambulatory programs. Our well-established culture and passion for in situ situations allowed us to quickly identify safety threats for staff and patients and build these into all of our protocols.

To date, what image, experience, exchange, discussion, memory or moment has been most impactful for you during this pandemic?

Speaking with our pregnant moms about their commitment to staying safe and responding to their fears and anxieties by sharing information on our website, including a wonderful video about giving birth during COVID-19 created by our team.

What’s one piece of advice you would give to future physicians on how to prepare themselves to work in a pandemic?

For our team, simulation and building on what we learn helps us to know everyone is dedicated to keeping our patients, their families, our staff and their families safe while providing compassionate care.

Dr. David Fudge, Medical Lead, Psychiatric Emergency Services, St. Joseph's Healthcare Hamilton

What would you say is your greatest contribution to the COVID-19 preparations and response at St. Joe’s?

My greatest contribution has been the act of stepping up. Some of my colleagues had to take time off because of pre-existing medical conditions, age, or being quarantined. That left a lot of clinical work to be done to help my colleagues out. This was satisfying and rewarding, while also allowing patients to continue being treated and given the help they need at this time.

To date, what image, experience, exchange, discussion, memory or moment has been most impactful for you during this pandemic?

A patient I treat had a family member contract COVID-19 while my patient was in hospital. Tragically, the family member died. I have been helping my patient through their psychiatric illness and their grief, and the challenges posed by not being able to engage in rituals of grieving that we typically do. The patient wasn’t able to see their loved one while they were sick and dying, wasn’t able to be in contact with family, hug somebody, or have a funeral –actions that mark death and are part of grieving. It’s been a huge challenge for the patient, and for me to help during this difficult time.

What’s one piece of advice you would give to future physicians on how to prepare themselves to work in a pandemic?

Worry upon itself doesn’t change outcomes. I’d advise people to be mindful of their anxieties, make safe decisions based on the best evidence, and have flexibility. For physicians, the expectations have varied widely. Those who are able to cope with those expectations have some flexibility to do some additional clinical work, step back, and take on something they may have not done before.