Trigger warning: COVID death.

Hi Jane. This is Dr. Bakshi calling from Edmonton. I am not sure if you're aware, but your mom Anne was admitted to the COVID ward about 2 hours ago. I'm calling because she is not doing well, and will likely not survive the day."
...deafening silence....followed by a chilling shriek.... Tears... Gasping for air trying to form words... Phone clicks. 5 minutes pass, and I call again.

"Hi, Jane. I know that was a lot to take in."
Through her tears, Jane responds: Yes. I'm so sorry for hanging up on you. I was shocked. I didn't even know she wasn't well, I spoke to my mom two days ago. I am in BC. I won't make it in time, will I?

"I don't think so, Jane. I am so sorry.... Jane, tell me about your mom."
Jane takes a deep breath: Mom is a fierce and spunky 75 year old with the spirit of a 30 year old. She loves to dress to the nines and is always laughing. And always told us she wanted to die on her own terms.
As Jane begins sobbing again: Doc, there's really nothing you can do? Can I see her? What will I say to her? Is she awake?
"Jane, your mom is awake, and as fierce as ever. But her oxygen saturations are down to 80%, and we have her maximal oxygen. She does not wish to be placed on a ventilator, and this sounds consistent with what you've told me about mom. Would you like me to arrange Zoom?"
Jane: Yes. Please. I need 10 minutes to get myself together. Do I have 10 minutes?
We find the iPad, get it connected through a blurry screen, and don PPE. I go in to talk to Anne about her condition before I connect Jane. With the high flow oxygen + non rebreather mask we have on Anne to give as much support as we can, I have to yell so she can hear me.
"YOUR OXYGEN IS NOT GOOD. YOUR LUNGS ARE TIRING OUT. THERE IS NOTHING MORE WE CAN DO..... (and with a giant deep breath, I yell) ANNE. YOU'RE DYING."
Anne looks at me, deep into my eyes, and mouths "When?"

Today.
She points to her lips, and then to her belongings. I walk over and find hot pink lipstick in her bag. I bring the lipstick to her, and she pulls off her oxygen mask and says, in gasping breath:

"If I'm dying today, I'm dying beautifully, with my lipstick on. Hand me a mirror."
Moments later, her oxygen dropped, and so mask went back on, and Jane came through the screen to say goodbye to Anne. Through the hissing of the machines, and the ziplock bag covering the iPad, Anne couldn't hear her daughter. So, I yell-translated.
"JANE LOVES YOU. ALL OF THE GRANDKIDS LOVE YOU."

Anne looks up at the iPad and says "Jane. Don't fight over my pearls."
She closes her eyes. Jane asks me to stay with her mom, and wishes to remain on the iPad. We sit in silence for 30 minutes, until Anne takes her last breath.

This is one story. Of so many I re-live often. Of COVID robbing families of good byes.
Today, another 34 families went through this just from COVID. How may others went through this over the last 4 weeks since surgeries have been cancelled? How many deaths will be acceptable, @jkenney @JasonCoppingAB before we see a #FirebreakAB
*names changed to protect privacy. Events are very real.*

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More from @NeejaB

20 Nov
612. The number of days since AB first declared Public Health State of Emergency due to COVID. On almost all of those days, I've woken up, checked the census of internal medicine and COVID patients in my hospital.
95 days. Roughly the number of days we have been in the 4th wave in AB. A wave that may have peaked, but now has plateaued into what we are calling at the hospital "the new normal."
150%. The amount each of my internal med docs have worked over the last 21 months, above their usual contractual obligations, in order to staff the COVID and internal med surge teams. (Should out to @BisonGIM - #TeamGIM)
Read 4 tweets
7 Nov
State of affairs: Healthcare edition.

With every wave, there is the peak and then the steady decline, where for a moment or two, it feels like the pressure cooker has settled. Where we feel like maybe things are over and the worst is behind us. /1
The reality is that with each wave, the cumulative healthcare effects from March 2020 are more dire, with this current reality the worst we have faced as a province./2
COVID: cases have come down, and hospitalizations are down. All true. BUT any internal medicine service can tell you that our ward COVID patient numbers have plateued, unlike any other wave. Previously, we would see a fast decline as soon we saw cases go down./3
Read 13 tweets
12 Jul
Thread on healthcare system collapse. Warning: it's long.
Just finished handover for the acute inpatient GIM service I take over tomorrow, and several observations that may help explain further why this crisis is not like anything we have seen before, and why cutting nursing renumeration makes literally zero sense.
An average GIM service will have a mix of patients awaiting long term care/subacute care with a number of medically acute patients. For many years, the flow out of the hospital has relied on numerous factors, including availability of community and alternate level of care spaces.
Read 12 tweets
2 May
As I reflect on AB's cases, I can't help but get angry at the privilege and selfishness of so many.

I am talking first hand w/ relatives in India, where oxygen is being rationed, saturations of 75% are all of a sudden "acceptable."/1
Families are pooling funds together to purchase their own high flow machines. I am talking to the doctors, walking them through COVID management as many of them are not at all critical care or hospital trained.

People are dying in the waiting area, in the entry ways, at home/2
Our per capita case load in AB is higher than that of India. But we are fortunate because we have resources. Privilege of being able to social distance and isolate. To attempt to save our healthcare system from triage and crumble./3
Read 5 tweets

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