Why we need to get it right: Inside the country’s hardest-hit ICUs

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What if the hospitals are overwhelmed? That has been the question haunting health authorities since the beginning of the COVID-19 pandemic more than a year ago. Now, a punishing third wave has pushed them to a breaking point. In the country’s critical-care units, patients, their families and medical staff are suffering the worst of the virus, and issuing dire warnings about the threat of deadlier and more contagious variants.

ICU, Regina General Hospital

When Warren Montgomery, 42, died this past Tuesday morning, it was so peaceful that his wife, Roshelle – allowed at the very end to be at his side – didn’t know he was gone until a nurse gently told her. The doctors had removed all the tubes and breathing apparatus, the symbols of their best efforts to save him from the virus that tore through his lungs and caused a devastating stroke that made any chance of recovery impossible. There was just enough time for his family back in Louisiana to say final virtual good-byes with the help of a nurse, enough time for his two young daughters in Regina to tell their dad over their mom’s phone that they loved him and missed him. Then it was just Ms. Montgomery, watching over him as if he were sleeping, granted the small blessing of a quiet death.

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The past few weeks, as her husband lay dying, were like no ending she’d ever imagined. The two had met online in 2010 and were married within the year; she fell in love with him because he was kind and warm and made her laugh. He was the type of guy people remembered after a first meeting. He’d started a company called the Big Easy Kitchen in Regina, hosting traditional backyard Louisiana crawfish boils, working as a guest chef at restaurants, and then packaging Cajun meat pies for local grocery stores when in-person events were cancelled. He had plans to grow the business once the pandemic was over. “I’m famous,” he’d joke when people greeted him on the street, and his wife would roll her eyes and tell him not to get a big head. But then he got sick, and people she didn’t know showed up with love and meals and donations for her and the girls, who are just nine and five. “He made friends very easily,” she says.

Ms. Montgomery was the first to get COVID-19 – a guilt she will have to learn to carry, she says. She has a marketing job at a company that sells PPE, among its products. The rules had been strict, she says, and everyone followed them. But this virus, especially its latest version, sneaks in with one co-worker, and comes home with you before you notice the cough and the headache. She tested positive on Easter weekend with the variant of concern from Britain, and then Mr. Montgomery and their eldest daughter (though not, inexplicably, their youngest) tested positive, too.

Ms. Montgomery says she shook so badly with fever she could barely walk. Her husband was struggling to breathe. He coughed so hard he threw up. She called 911, and the paramedics looked at him and said he should be okay – and after all, no one wanted to go to the hospital. But two days later, he was so short of air he couldn’t speak, and this time, he went right away by ambulance. In the hospital, Ms. Montgomery says, he was scared, coughing uncontrollably, and having panic attacks. “He just wanted to come home,” she says. “His biggest fear was the ICU.” She was already getting better herself and figured her husband was just a couple of days behind in recovery. She would text him upbeat messages: You got this. You are strong. Tomorrow will be better.

But it wasn’t. Mr. Montgomery’s coughing wouldn’t stop, so he had to be sedated. His lungs were failing. He was admitted to ICU and intubated, but no matter what the doctors tried, they couldn’t get his oxygen levels up. “They kept telling me he was on the max of everything,” Ms. Montgomery remembers. They would tell her, “Roshelle, he is really, really sick,” and she understood they were trying to prepare her. Then, last week, her phone rang, and they told her about the stroke, the result of a clot that started in his lung. The left side of his brain, the doctor explained, was gone. Even if he survived, he would never get off the feeding tube, never be close to the way he was. Warren, who had lived so large, would not want that, she says. So after talking with his family, she decided to take him off the machines. But on Tuesday, “he took that decision out of my hands.” The nurses called her at 6 a.m. to come quickly – he didn’t have long. And because he was dying, she could sit beside him, and be present with him, this one last time.

“I made sure he wasn’t alone,” she says.

She had 45 minutes, at the end. And 10 years of marriage. Not nearly long enough.

“He went to sleep, and my nightmare is going on.”

She is still in shock. “Nothing has sunk into me yet.” But this is what she wants everyone to know: They were careful, she says. They followed the rules. But she had pandemic fatigue, too – she just wanted the world to open up again, to get on with living. Now, she says, we all just need to hold on for a few more months while the vaccine rolls out. She has seen the inside of the ICU. “The people I saw are not in their 80s,” she says. They are young, with lots of years left, like Warren. “If you lived in my shoes, you would know what to do.”

ICU, Sunnybrook Hospital, Toronto

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Shelly Dev finds a lot of things about this wave of the pandemic terribly hard. It’s terribly hard to see younger people coming in sick. It’s terribly hard to see whole families showing up ill with COVID-19. It’s terribly hard to see her colleagues “kind of broken” by the strain of a year on the front line. It’s terribly hard to see the ICU filling up. It’s terribly hard to see dedicated nurses taking so much of the strain and getting so little of the credit. It’s terribly hard to see the virus taking such a heavy toll on the city’s most vulnerable.

One of the very hardest things is having no personal contact with patients’ families. Dr. Dev is forced to talk to them over the phone – a vastly different experience from talking to them by a parent’s or spouse’s bedside. Many of the patients themselves are too sick to speak. Even if they can, Dr. Dev has to talk to them from behind her armour of mask and PPE, which means her facial expressions aren’t visible. Hugs are out of the question.

She makes a point of talking to even the unconscious patients, assuming, but never knowing, they can hear her. “I will always say, ‘Hi, I’m Shelly. I’m your doctor.’”

COVID ICU, Vancouver General Hospital

It’s the I-love-yous that really break your heart, says Leah Macintyre, an ICU nurse at VGH. Early in the pandemic, she helped collect donated iPads for patients so they could talk to their families. But as it turned out, they were mostly used at one terrible stage of care: right before a patient was intubated, an indication their condition was truly serious and the outcome uncertain. And so, Ms. Macintyre would hold the iPad or phone while daughters and sons and husbands and wives and grandkids sang a chorus of I-love-yous. “It is the hardest conversation to hear,” she says.

Until it is the hardest one to have. At midnight on April 7, a co-worker called Ms. Macintyre at home. And suddenly, she was the one weeping and saying “I love you” on the phone while doctors in the ICU prepared to intubate her father, who was deteriorating quickly from COVID-19.

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Her parents, Sylvia and Al Macintyre, live on a farm near Langley, B.C. Looking back, Mr. Macintyre – a retired police officer – thinks maybe they got COVID-19 from a visit to a stable. On Easter Monday, Leah went to check on them, and found her dad sleeping on the couch and her mom in the bedroom upstairs. Both were having a hard time breathing. They went to the hospital that same day.

They both ended up in the ICU where Leah works. Her mom fared better, but her dad’s condition worsened, until doctors made the call to put him under and intubate him, to help his lungs. That’s when they called Leah, and she spoke to him on the phone. “My dad was frightened,” she recalls. “And my dad doesn’t get frightened.” Seeing him like that, she says, having both her parents so near the edge, “was devastating. You try to block it out until you have to process it later.”

All the hospital staff are exhausted, she says, and the surge in cases is draining them further. “It’s like being at the end of the marathon, and someone just took away the finish line.”

Under sedation, Mr. Macintyre began to recover. The doctors have since removed the tube, and he can breathe on his own again. They hope a round of steroids will heal the damage to his lungs. He was moved out of ICU and is due to go home today. His wife is there waiting for him; before she left hospital, a nurse wheeled her by his door so they could see each other, for an instant, at a distance.

Mr. Macintyre has his own “I love you” story – he spoke those words to Sylvia, his wife of 47 years, as she lay in the bed next to his, before he was intubated. “You’re saying it, and you don’t know if you are saying it for the last time.” He knows they both got very lucky. “We have learned our lesson,” he says. “No more mistakes.”

ER, Michael Garron Hospital, Toronto

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The staff at Michael Garron have made heroic efforts to cope with COVID-19. They have emptied offices to make more space, doubled the number of patients the ER can accommodate and increased the number of ER doctors by 50 percent. Will it be enough?

That’s the question troubling ER head Kyle Vojdani as more and more sick people come through the door. “We prepare for something that hopefully never comes,” he says, “and it seems we’re about to see it.”

Already, patients are being treated in hallways and in waiting rooms. Hospital staff are bone-weary. “Everyone is so thin and burnt,” he says. There’s a limit to their endurance, but work keeps piling up. Just to “prone” a COVID patient safely – turn them on their stomach so they can breathe more easily – can take up to 12 people. “It’s clearly escalating beyond our control,” says Dr. Vojdani. “I do worry.”

2nd floor, Regina General Hospital

This past Wednesday evening, Misbah Zakir gave birth to a healthy baby girl via caesarean section. In the ICU – on the same floor – her husband, Ali Syed, lay in an induced coma for the 22nd day, his lungs ravaged by COVID-19.

Mr. Syed, who in his late 40s, tested positive in late March. He caught the virus while carpooling back to in Regina after his shift at the Boundary Dam Power Station in Estevan. He’d come to Canada 15 years ago from Pakistan and sent money home so his sisters could go to university. “He is a good guy and fun to work with,” says Preston Benning, who shared 12-hour shifts with him in the plant’s control room and launched a fundraiser for his family when he got sick. With two young children and a baby on the way, Mr. Syed was training for a promotion to assistant operator.

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His friends say he was healthy, with no underlying illnesses. But at home, he began dozing off while talking and fainted from lack of oxygen, so Ms. Zakir called 911. Her husband walked to the ambulance, but in the hospital, he soon needed help breathing. He had a tracheostomy and was kept heavily sedated while doctors tried stop the damage the virus was doing to his lungs. His wife was also briefly hospitalized, but recovered before delivering her daughter.

“It was bad timing and bad luck,” says Abdul Mohammed, a friend who works with Mr. Syed. At the plant, Mr. Mohammed says, “we were so diligent” about following guidelines. Now, he says, “it’s not good news.” The doctors have suggested Mr. Syed’s lungs are beyond repair and he may need a transplant – meaning a long and uncertain journey for his young family.

For now, his friends are just hoping Mr. Syed will soon have the chance to meet his new daughter, Nusaybah.

ER, St. Joseph’s Health Centre, Toronto

Horrifying. That’s the word Joan Cheng keeps using for what’s happening in Canada’s hospitals as the third wave rolls through. Dr. Cheng took over as head of ER at St. Joe’s on March 1. Since then, she says, “I’ve been swallowed whole.” The patients coming in are younger and sicker, and while most of them are grateful, a few have lashed out with racist and sexist slurs. Doctors and nurses are burning out. Some have already quit because of the pressure.

Dr. Cheng would be angry or bitter about what has brought St. Joe’s to this awful place – the failure of governments to take adequate measures, despite all the warnings from scientific advisers – but her anger is being crowded out by another feeling: fear. With projections showing the worst is yet to come, says Dr. Cheng, “I am very, very scared, and that doesn’t happen a lot. We just don’t know what is around the corner.”

ICU, Pasqua Hospital, Regina

Jonnah Dela Cruz tries to visit her husband, Christian, almost every day, before she starts her late-afternoon shift as an assistant manager at Burger King and her nightly cleaning stint at a local business, which gets her home by midnight.

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She sits at his bedside wearing PPE and talks about how their three teenagers are helping out at home, what happened at work, the kindness of their friends. She prays out loud, hoping he can hear. Mr. Dela Cruz, 39, was put into a coma on March 16, after arriving at the hospital unable to breathe. COVID-19 swept through their family: Ms. Dela Cruz spent a few days in hospital, and their 17-year-old middle child was admitted overnight.

Mr. Dela Cruz, a hospital dietary aide, was hit hardest. “He is not here,” Ms. Dela Cruz says, wearily, “so I have to be everything.” She leans on her faith, as doctors slowly try to bring her husband out of sedation. Lately, he opens his eyes when he hears his wife’s voice. “I pray to the Lord and ask for his strength,” she says. “You can only do so much as a person.”

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ER, hospital in Toronto

For Kashif Pirzada, one of the hardest aspects of the pandemic is talking candidly to patients’ families. “We are going to put your relative on a ventilator,” he had to tell the family of one man. “There is a 50-per-cent chance you won’t see him again. You have to say what you need to say soon.” The patient was just 48 and got the virus from family members, many of whom work outside the home. When paramedics got to his apartment, he was purple from lack of oxygen.

The third wave of COVID-19 is hitting Dr. Pirzada’s hospital hard. On one recent shift, stretchers were lined up 10 or more deep in the ER. Two-thirds of the sick people coming through the door on their own had the virus. Many of the patients he sees now are in their fifties, forties and even thirties.

A year into this pandemic, he says, many still don’t comprehend how easily the virus can spread. He urges everyone to wear a mask, avoid indoor spaces if possible and get vaccinated as soon as they can. With vaccination rates rising and warmer weather coming, there’s reason for hope. But “the next few weeks are going to be very, very hard.”

ICU Pod A, Foothills Medical Centre, Calgary

While Adrian Bussoli, 68, lies unconscious, his lungs struggling to heal from a COVID-19 infection, his children are trying to save his business and the jobs of 10 employees. “My dad poured his life savings into it, and we don’t know if it’s going to survive,” says his son, Michael.

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Alberta Garment, whose main business was sewing gear for the oil industry, pivoted to medical masks and gowns during the pandemic. But two weeks ago, after a close contact was identified at work, Mr. Bussoli got tested. By Thursday, his wife, Sue, had organized a conference call with their three adult children to persuade him to go to the hospital. “He was in a fog, having a hard time answering questions,” Michael says.

Even then, his father was trying to send e-mails to his staff before agreeing to get in the car. He was admitted to the ICU almost immediately, his oxygen levels severely depleted. With both Mr. Bussoli and his co-owner sick with COVID-19, the company’s work has been paused.

Now, Michael and his siblings are isolating in their own families bubbles, trying to support their mom, who has so far tested negative, and relying on quick phone updates from the hospital about their dad’s condition – while also sorting out next steps for his company. As politicians weigh the cost of lockdowns, Michael urges them to remember: “The economy is built on people. We need to take care of the people.”

ER, hospital in Peel Region

When Gaibrie Stephen was in medical school, he took an ethics course. One of the questions put to students was: “Should doctors be forced to work during a pandemic?” He thought they probably should.

Now, he’s in the midst of one. The 27-year-old finished his medical residency last summer and now works in an ER in the hard-hit Peel Region. “Sometimes I come to work and every chart is fever, cough, fever, cough.” On one recent day, he treated a relatively young man whose chest X-rays came back all white – a sign of fluid, pus or scarring on the lungs.

Many patients are confused or breathless, and unable to talk. The sickest get put on a ventilator, a dangerous procedure, but often the only thing that might save them. And because of infection safeguards, they’re often all alone, with no family to sit with them. “I couldn’t even imagine,” he says, “how lonely it is to be so sick and to be alone.”

ER, hospital in Toronto

Lindsay Bisset used to see a pattern in the COVID patients she saw, most of them elderly. If they were on the upswing by Day 10, they were probably going to be okay. Now that the variants have arrived, the disease is less predictable, and many of its victims are younger. She recently treated a 27-year-old who caught the bug at work and lives with roommates. When he first came in, his oxygen saturation seemed okay. When he came back a couple of days later, it was much worse. All this makes her worry about what’s to come. “We are running out of beds,” she says. Even though many patients are being transported to other hospitals, “we are bursting at the seams.”

The disease is striking warehouse workers, factory workers and taxi drivers, she says. “These are the people who have kept us afloat for the past year, and we’re still not protecting them enough,” says Dr. Bisset. “It’s very hard not just to be angry all the time.” But she clings to hope. As she tells her three children, “It’s not always going to be like this. We will get to the other side one day.”

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