Inside intensive care: what Toronto hospital staff learned about COVID-19

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Ray Gentle was feeling bad and resting at home when he collapsed.

“I got up, tried to walk,” he said.

But he was going nowhere.

“Short of breath, my lungs collapsed on me. And I almost fell back to where I was, “he added.

“I was hyperventilating, sweating like a pig. I was just losing it. ”



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His wife called 911 and an ambulance transported him to the Humber River Hospital in Toronto. Based on his symptoms – shortness of breath and fever – the staff immediately suspected COVID-19, and they were right.










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“I have no idea how I came into contact with this virus,” the father of three, 55, told Global News from his hospital bed, where he was lying down and on oxygen. for more than a week.

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“I was inside, I was not in the audience or anything at all. I couldn’t believe it. “

As cities and provinces begin to lift restrictions on slowing the spread of the new coronavirus, front-line hospital staff say their fight is far from over – fighting an invisible enemy they do not know. still not fully understand.

“It is a very intelligent virus,” said Dr. Jamie Spiegelman, specialist in internal medicine and critical care. “We don’t know exactly how it works, where it goes, how it infests our bodies. It’s unpredictable. ”

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The Toronto hospital where Gentle ended up was literally designed for that – its construction and design was inspired by the 2003 SARS epidemic.

“As we built it, we were very aware of SARS and very aware of the kinds of things you could do to make it a healthier and safer environment in the event of a pandemic,” said the President and CEO. general of the hospital. Barbara Collins.

The 656-bed hospital has a state-of-the-art ventilation system with “100% fresh air” (no recirculation). Eighty-five percent of its rooms are single use with private bathroom and 80 are equipped with negative pressure.

“Our corridors are wider, our doors are wider, our building has a larger area (167,225 square meters), which allows a” social distancing “, which we did not know when we designed this building”, Collins told me.

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But even armed with these benefits, frontline hospital staff are concerned. In the past seven weeks, they have seen firsthand what COVID-19 can do.

“The elderly are definitely getting sicker than the younger ones, but we’ve seen random young people get really sick: a 23-year-old woman, we have two guys upstairs in their forties who are seriously ill on the ventilators” , Dr. Said Spiegelman.

“It doesn’t discriminate whether you are rich or poor, old or young – if you get this disease, it is a bad disease if your body reacts badly to it. “



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In the hospital emergency department, we meet our guide of the day.

Dr. Susan Tory is an internal medicine physician and “hospitalist” – a relatively new and little-known position in some hospitals, responsible for the care of hospital patients who are ill but in stable condition. This includes most of the approximately 80 COVID-19 patients in the hospital.

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“Over an average day shift, we may have 14 to 16 referrals from an emergency room doctor; I would say at least half of these people are suspected of COVID, “she said.

Dr. Susan Tory prepares to enter the hospital room of a patient with COVID-19.

Dr. Susan Tory prepares to enter the hospital room of a patient with COVID-19.


Jeff Semple / World News


Dr. Tory’s first stop: Checking a newly admitted COVID-19 patient – a man in his sixties who recently tested positive and isolated himself at home until he began to have difficulty breathe. He was found passed out on the floor of his apartment.

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“It looks like the patient is a pretty stoic guy and he’s trying to avoid coming to the hospital as much as possible,” she said after speaking with her daughter over the phone. “But his family asked him to come and get help.”

Now that he has been admitted to the hospital, his family members can no longer see him. In this pandemic, they are not allowed to visit.










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” It’s difficult. There are patients who experience many very serious illnesses. And in times of high stress, each member of the family just wants to be there holding their hand. And they cannot. “

In their absence, Dr. Tory takes his hand and spends time talking to him, while closely monitoring his condition. She and her colleagues saw how quickly COVID-19 can get worse. “The problem with these patients that has been very delicate is that things can change very quickly. “

Dr. Susan Tory chats with a COVID-19 patient at the Humber River Hospital in Toronto.

Dr. Susan Tory chats with a COVID-19 patient at the Humber River Hospital in Toronto.


Jeff Semple / World News


Right at the end of the corridor, this is exactly what is happening: a 62-year-old woman, who arrived hours ago uncomfortably, now has trouble breathing.

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Dr. Spiegelman said it is quickly becoming a familiar pattern: patients suffer from flu-like symptoms up to 10 days before their lungs quickly become inflamed and filled with fluid.

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“It’s pretty consistent and actually quite scary,” he said. “The virus gives itself nine days to be able to be contagious to others before a person becomes really, really sick. “

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To save the really sick people, the doctors perform a high risk procedure. The team is preparing to intubate the 62-year-old woman who has trouble breathing.

Doctors intubate a patient with COVID-19 at the Humber River Hospital on April 24, 2020.

Doctors intubate a patient with COVID-19 at the Humber River Hospital on April 24, 2020.


Jeff Semple / World News


“She doesn’t have enough oxygen. I’m afraid she’ll get tired and stop breathing, “said Dr. Spiegelman.

Intubation involves inserting a ventilation tube into the patient’s mouth and into the airways leading to the lungs. It involves risks for both the patient and the medical staff; while COVID-19 is spread by respiratory droplets, usually when an infected person coughs or sneezes, the intubation generates contaminated aerosol particles. After the procedure, doctors assume that the virus is airborne inside the room for 30 minutes.

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“Normally, before the COVID era, if someone were to be intubated, we would put on our masks and rush into the room,” said critical care specialist Dr. Keren Mandelzweig.

“Now we have to do things very differently. “










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For their own safety, hospital staff redesigned the playbook by deploying additional layers of PPE (Personal Protective Equipment).

“It takes twice as long to do anything because we have to put on all the protective gear,” said Dr. Spiegelman, his voice muffled by his N95 mask and plastic face shield.

Dr. Jamie Spiegelman says it takes twice as long to prepare for an intubation procedure because of the extra layers of personal protective equipment.

Dr. Jamie Spiegelman says it takes twice as long to prepare for an intubation procedure because of the extra layers of personal protective equipment.


Jeff Semple / World News


Fewer staff are allowed to enter the patient’s room, while others are kept outside in the event of a problem. And this time something happened.

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A few minutes after the procedure started, one of the doctors started shouting, “Guys, we need a rescue cart!” A rescue cart is essentially a unit of shelving on wheels, which usually contains the equipment necessary to treat a person with cardiac arrest.

Fewer staff are allowed to enter the patient's room, while others are kept outside in the event of a problem.

Fewer staff are allowed to enter the patient’s room, while others are kept outside in the event of a problem.


Jeff Semple / World News


In this case, the ventilation tube did not fit properly in the patient’s airways. Her oxygen level dropped. And, for about 10 seconds, her heart stopped.

A staff member came running down the hall with the rescue cart, which was thrown inside. An alarm has started to sound. A small crowd of medical personnel gathered in front of the room, staring anxiously at the door window. The doctors inside performed chest compressions. And, in the end, they saved his life.

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“I have probably intubated thousands of patients. COVID-19 is a completely different type of intubation, “said Dr. Spiegelman, explaining that COVID-19 patients have an unusually low” supply “of oxygen. Once doctors have removed a patient’s oxygen mask to insert the airway tube, they need to move quickly.

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“Most patients, if you give them oxygen, they are good for at least a few minutes, and their oxygen saturation does not decrease. These COVID-19 patients, within a second or two or after removing their oxygen, their oxygen saturation will drop from about 90% to 30 or 20% in a few seconds.

“It makes it much more difficult to intubate these patients. You should put the breathing tube on as soon as possible. “

The 62-year-old patient remains in critical condition. Studies in other countries with COVID-19 suggest that most patients placed on a ventilator do not survive. But hospital staff gave him a chance to fight.

“All you want to do is help these people, our patients,” said intensive care specialist Dr. Keren Mandelzweig. “But just watching them desaturate so quickly, and not being able to do everything we can all the time to help them, is really frustrating. It’s terrible. “










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Dr. Tory ended the day and invites us to come home and meet his family: husband Jamie and two daughters, Piper, six, and Reese, three.

When the pandemic started, the family debated whether to live elsewhere for a period of time. “People are worried about getting sick and they are afraid to take it home,” she said. “It comes to my mind constantly, just to be as careful as possible. “

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She is also worried about carrying the emotional burden of the pandemic through her front door. “You just have to find a way to try to get rid of it when you get home. It is not always possible. “

It is helpful, she says, to talk about it with friends and family, including her father: John Tory, Mayor of Toronto.

“I’m proud of what Susan does, and I’m proud of who she is,” Mayor Tory told Global News via Skype. “And who she is is much more important: she is a compassionate, caring and loving person, who applies the attributes of her personality to take care of people as a doctor.”

Dr. Susan Tory is the daughter of John Tory, Mayor of Toronto.

Dr. Susan Tory is the daughter of John Tory, Mayor of Toronto.


Susan Tory


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For the past six weeks, Mayor Tory has spoken regularly with his family on the FaceTime video. Once a week, he stands on the sidewalk in front of their house and delivers treats to his granddaughters.

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“I can tell you this: I cannot wait for the day when I visit my grandchildren,” he said. “I do this thing where I stand on the porch 10 feet away and talk to them, but I can’t hug them. I just feel a little hollow from the visit. “

“So I’m waiting for the day – that I’ll have a hand, with others, so that I hope to do it as soon as possible – when we can hug people. “

Toronto mayor John Tory practices

Toronto mayor John Tory practices “social distancing” by standing in front of his daughter’s house to offer treats to her granddaughters.


Susan Tory


But when he misses his grandchildren, he worries about his daughter.

“I think mostly of her because she is in an environment where she is exposed to this virus all the time, and I worry about it,” he said. “The fact that my daughter on the frontline as a doctor also helps me when I can turn to her, ask her a few questions about it.”

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The mayor and Dr. Tory are both fighting the same battle from different front lines – Dr. Tory cares for the sick in Toronto, while his father tries to keep others from getting infected. The city has closed parks and fined those who ignore the province’s ban on more than five people.

Dr. Tory is now seeing first-hand the results of his father’s foreclosure: a surprising number of empty hospital beds with far fewer COVID-19 patients than they feared.

They also see a sharp drop in the number of other non-COVID patients. Emergency traffic is down 40%.

“It is this strange calm that exists where we have a lot of capacity,” she said. “You don’t see the same volume, which makes you wonder: what’s going on outside these doors? “

One likely explanation is that people drive less – Toronto’s May 1 traffic volume was down 45-65%. But hospital officials also fear that the sick will simply stay at home.

“People can have worrisome symptoms and they’re just sitting on it because they don’t want to go to the hospital, because the hospital is one place for all COVID patients,” said Dr. Michael Gardam , chief of staff at Humber. River hospital. “And so they avoid it. And that will catch up with us. It will catch them. ”

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They are already seeing examples. During our visit to the Humber River Hospital, an elderly woman was admitted. She told Dr. Tory that she had been “rotten” – with aches and pains – for weeks, but was hesitant to come to the hospital.

Her test results revealed that she did not have COVID-19. But she tested positive for acute leukemia.

Dr. Tory registers an elderly patient at the Humber River Hospital. Doctors discovered that she had acute leukemia.

Dr. Tory registers an elderly patient at Humber River Hospital. Doctors discovered that she had acute leukemia.


Jeff Semple / World News


“This case weighed on me because it was a woman who was at an advanced stage – she was 90 years old – but she was living independently and suddenly had this disease,” said Dr. Tory.

With visiting restrictions, Dr. Tory had to report the news to his family by phone. She brought the patient a glass of water, held his hand, and listened as he spoke about his beloved dogs.

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The next day, she died.










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“Myself and all the other frontline providers came home and cried,” said Dr. Tory. “We are human at the end of the day. We are emotional and it’s okay. I am lucky to have the support of my family. “

Families around the world have been separated by this virus. And a few brave men are fighting, putting their own health at risk, to ensure that we can all be safely assembled soon.

See the link »

© 2020 Global News, a division of Corus Entertainment Inc.



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