Alberta health-care providers face growing mental health toll as ICUs pushed to breaking point

With no end in sight to Alberta's unrelenting fourth wave of COVID-19, health-care providers are bracing themselves for even more heartbreaking scenes in the weeks to come.

Nurses and doctors — already exhausted and traumatized — say they're gutted that Premier Jason Kenney didn't announce further public health restrictions on Tuesday to relieve the mounting pressure in hospitals, despite growing and desperate pleas for a so-called "firebreak" lockdown.

As of Tuesday afternoon, 1,100 Albertans were being treated for COVID-19 in hospital, including 263 in intensive care units. Alberta ICUs have  ballooned to 184 per cent of their normal capacity. When factoring in extra surge beds added, capacity is at 86 per cent.

"It's heartbreaking," said Keri Price, a Calgary pediatric ICU nurse at Alberta Children's Hospital who was redeployed to care for critically ill adult patients.

"It's really sad to see all these patients with no families by their side. And alone. And dying alone."

These traumatic scenes are now routine in Alberta hospitals.

"It felt like a war zone," said Edmonton emergency room physician Dr. Shazma Mithani, who worked a shift in the ICU this week as part of her regular rotation.

"Every single person on the health-care team was just exhausted. There's literally no end in sight … because the government is not doing anything to allow this to end," said Mithani, her voice quivering.

"I don't know how we can continue to go to work every day and face these challenges not knowing is tomorrow the day [critical care] triage is going to start? Or am I going to see another 20-year-old that has to be intubated? Or am I going to have to tell another family that their loved one is dying?"

Alberta's COVID-19 crisis is always weighing on her mind, even when she's not at work.

"To be amped up like that all the time is exhausting. And, at some point, all of us are going to crash. And what will be left after that?"

Moral distress

Earlier in the pandemic, health-care providers had hoped the vaccines would pave Alberta's way out of the pandemic, according to Calgary ER physician Dr. Katie Lin.

"It was very crushing to find ourselves in this situation again — and in some ways in a much worse situation in terms of our ICU capacities and the load that's been put on our system. It feels like that hope got taken away a little bit by factors outside of our control."

As hospitals fill up, health-care workers are battling to reconcile their desire to provide the best care possible to each patient with the reality of dwindling resources, she said.

 "A lot of us are feeling a great deal of moral distress right now as we care for our COVID patients," said Lin.

"When you're dealing with the patient in front of you who is needing life sustaining care and who is in distress, you're trying to do everything you can to save their life. And it is very upsetting when we're dealing with the degree of denial in the rest of the community. And I think that is definitely feeding into the burnout we're feeling."

Emotional exhaustion

As a lung specialist at Calgary's South Health Campus, Dr Kerri Johannson treats a lot of COVID-19 survivors who are left with long-term lung disease and breathing problems.

"It's hard to see death and disability and people suffering when you know this didn't have to be the case," she said.

"There's an emotional exhaustion from when you are giving and giving of your compassion and your mental energy and your desire to help, that sometimes if feels like you don't have much more to give."

But Johannson says what keeps her going is seeing very meaningful signs of support when she least expects it.

"Every single one of those thank-you notes or somebody buying you coffee at a coffee shop when you have to stop off in your scrubs on your way back to work — it's enough to bring each of us to tears."

'Thank-you'

On Tuesday, Alberta's newly minted health minister, Jason Copping, acknowledged the strain on front-line health-care workers.

"Thank you. I offer my direct and sincere thank you to the thousands of health-care professionals who have given everything they absolutely have and so much more over the past 19 months," he said.

"I hear you when you talk about how exhausted you are, how the toll these many many months has affected your physical and mental health."

Copping said he is committed to increasing baseline ICU capacity and to preparing Alberta for future COVID-19 waves.

But the premier opted not to bring in further public health measures, saying the government would monitor the impact of those already in place.

In the meantime, there are growing concerns about the long-term mental health implications of this unrelenting fourth wave.

"I just don't know how this can get processed. I think we're going to need massive mental health and psychological supports for our workforce," said Dr. Sue Reid, physician health advocate and former member of the Alberta Medical Association's physician and family support program advisory committee.

"Whether it's an intensive care doctor admitting more and more patients — unvaccinated to the largest degree, which could have been avoided with the proper messaging and education. Whether it's a surgeon trying to balance out which breast cancer patient is going to make it onto their one list this week.… It's frustration, exhaustion, burnout," she said.

"Where's the end in sight here? It's just overwhelming sorrow."

Reid said that when the fourth wave finally does wane, the pressure won't end for health-care providers, who will be left dealing with surgical backlogs and health problems brought on by delays in care.