February 2, 2021 • 57 mins
It’s undeniable at this point – we were unprepared for a pandemic. But how can we protect our most valuable assets, medical professionals, in this time of crisis? This week’s episode of Contakt World dives into the hot button issues of race, hospital capacities, pandemic plans and the determinants of public health – specifically through the lens of Dr. Paul Bajwa, an emergency physician who’s practiced in Florida and also Canada. Join our hosts Justin Beck, Catherine Delcin and Deepti Pahwa, as they speak with Bajwa, who breaks down the approach emergency physicians take toward treating the disease, and discusses larger implications of how it affects the whole healthcare system in America, Canada and beyond. We also hear from Meliza Rangel, a nurse who tragically lost her father to COVID. As always, we’ll talk about how to help our local health departments – and encourage innovation and technology integration – all while remaining empathetic, plus keeping an eye toward health equity for all.
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Episode Transcript
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Speaker 1 (00:02):
L A County is one of those counties have been
hit extremely hard because their patient population is so large
and their capacity so small that they have actually told
some of their e M S personnel that if a
patient has known to be COVID and they have a
lot of coal morbidities and they appear extremely sick, to
consider not transporting them to the hospital. That's Dr Paul Bagba,
(00:27):
an emergency medicine physician who shares firsthand how the system
in the US was never prepared to handle such an
overwhelming public health disaster. In our conversation with Dr Bogeba,
we discussed the silent yet widespread effect the pandemic is
having on our frontline workers. The mental health and well
being of our doctors, nurses, and medical practitioners seems to
(00:48):
go unnoticed, and yet despite this undeniable emotional and physical strain,
they're the ones we turn to for help while demanding perfection.
It's really an impossible proposition. On the other end of
that phone call to our emergency services is meliitsa rangel,
a loving daughter, a protective mother, and a practicing nurse.
Melita shares the devastating story of how her father paid
(01:11):
the ultimate price while protecting her from the disease, and
all because of an overwhelmed and broken system. And yet
for someone experiencing such loss, Melita understands the heavy weight
and burden placed on our healthcare workers and speaks with
empathy when sharing her story. So my sisters called the
MS so they can pick up my father. And then
(01:31):
maybe two hours passed and E M S never came.
My sisters called E M S again and E M
S told him that there was no space, that they
couldn't pick it up, so they canceled the ambulance services
from my father. At that point, my sister came immediately
to pick up my dad. She put on full ppe
and rushed into the hospital. That was the only option
(01:53):
we had. I'm Justin Beck, founder and CEO of Contact World.
I'm here with my co host Katherine Nelson and DT Pava,
and over the coming months, we'll be talking to scientists, researchers, celebrities, experts,
anyone who's been affected by COVID and getting to the
bottom of how we can improve public health together. We
(02:16):
may not have all the answers, but you deserve to
understand what goes on in your neighborhood and the decisions
that will affect you and your family's health. Welcome to
Contact World. We're here to share two stories with you today.
This is a bit of a heavy episode, but we
need to bring attention to these topics. The show is
about truth, So one day, when we look back at
(02:39):
the overall carnage of this pandemic, the emotional and mental
toll this has had on society as a whole is
really underestimated. I mean, I haven't seen friends or socialized
since March, but I sometimes remind myself how relatively easy
I have it. But to think of being a frontline
worker and what's become a normal day in a clinical
(03:00):
environment is another story altogether. I mean, we're going to
see post traumatic stress disorder. These heroes haven't even had
the time to mentally unpack what's happening to them. What
do you two think about the mental anguish and stress
of the pandemic and how it's affected our hospitals and
clinical environments. So, you know, justin I feel that even
(03:21):
before we making to think about mental health or even
you know, move beyond the current crisis, we all need
to first reckon with the skill or what has been
experienced right our front line health care workers among the
most vulnerable populations at this point in time, and as
research shows that the risks to the well being of
these health care workers are not even very understood, forget
(03:43):
about trying to solve for those issues. I think the
key thing with mental health right now is do we
have the ability to self check? Do we have that
moment where we're able to check in with ourselves and
make sure everything is okay. And when you're working, you know,
as a physician in a hospital or you're a nurse
and you're there around people that are dying and suffering
(04:04):
and hurting, perhaps you're so busy helping everyone else you
don't have that ability to stop and make sure that
you're mentally at well. I was thinking the other day
about how we put a cap on over the road
truckers and how much time that they can spend on
the road, or we put a cap on how many
(04:24):
transcontinental or trans oceanic flights a pilot might take because
of the impact that their decision making might have on
lives of people. Right you can't put a trucker on
the road for fourteen hours a day because he might crash.
But we don't put health or mental wellness or well
(04:45):
being programs in place for our frontline workers. And they're
in the same decision making capacity matters of life and death,
and they are working seven days a week, in some
instances too many hours a day. They inevitably are going
to make bad decisions or they're going to miss things
because it's impossible for a human to endure the anguish
(05:08):
that they're going through the amount of time they're working,
and then you multiply that by the pain of decision
making that they have to go through every day, sometimes
literally denying people critical care. It's unbelievable. Yeah, true, justin
what you're saying is, you know, it's so sad to
see that how little we have been prepared in terms
of providing care to people who are responsible for caring
(05:31):
for us, and that came through during this pandemic. Why
don't we have ancillary services or frequent visits to psychologists
for these health care workers. That's something very basic they
should be having access to. Right. I agree with both
of you, but I struggle to say that we should
limit the time that they spend because there are shortages.
It's a tough thing to say, But do we want
(05:54):
to turn people away from the hospital because there's no
doctor on the shift. It's almost like we're in cry, says,
and we need them so much, but then at the
same time we want them to be clear and level
headed enough to make the right decisions. It's a horrible situation,
it really is. There is a need for better preparation,
and when we talk about better preparation, you know we
(06:15):
are not prepared for such emergencies, right. I believe this
gives us a perfect platform to think about such issues.
So if at all something like this happens again, we
do not face the situation. We don't have to make
that compromise that we're making today. You know, in hindsight
is and I think that we're not talking about pivoting
the way that we're handling it now. But what we
(06:37):
need to do is we know we need to better
resource health agencies and we need to change the way
we've thought about clinical care based on what we're putting
these doctors through. You know, a few years down the road,
when they really have a chance to think about what
they've gone through, we're probably going to see unprecedented amounts
of PTSD suicides from frontline how workers. We're not going
(07:01):
to know what the real long term impact of this
is until we're looking back at it, and you're right,
what we need to do is take a very honest
look at the way we've managed this, the way that
we've been prepared for it or unprepared for it, and
we have to be ready to change things drastically in
some cases. I agree. Begins with the conversation and deep
(07:22):
te I know this episode focuses a lot on your
interview with Dr Paul Bargeois. Tell us about that conversation
and kind of set it up as far as what
a listener can expect to learn from him. Sure. So,
Dr Bagua is actually an emergency physician who has worked
in Florida before and also now in Canada, and what
(07:46):
we really talked about was more on the healthcare workers side,
is to what they face in terms of extreme COVID
footigue and how that comes with their own risks and
rising levels of anxiety and fational exhaustion that they go through.
They have to make heart decisions and decide who needs
the care and these services the most. Thank you Dr
(08:19):
Bada for joining us today. It's great to have you
here and to have an opportunity to hear from the
front lines on how as an emergency physician you were
experiencing and treating COVID nineteen directly, as well as we
will talk a bit about, you know, your own experiences
with the inequities of the health system in the US
(08:39):
and globally and what you see while working firsthand with
the patients. So let's first talk about your choice to
work as a physician. Why medicine? What inspired you? Thank
you first for having me on the show. I guess
your question is a question that they asked pretty much
all physicians when they enter MAD school, was why medicine?
(09:01):
You know, most physicians have a story behind it, So
I'll give you a bit of a story. When I
was growing up, I actually wanted to be a police officer.
I thought was the most rewarding thing. I would see
police officers on the road, and as I was going
through school, I was on a call with one of
my friends who was a police officer, and it would
ended up being a medical call, and I noticed that
(09:22):
they're kind of almost first responders, just like emergency medicine is,
and that kind of opened my eyes up into medicine,
and I decided to do an elective away in India
and they put me in the emergency room the first
day that I was there, and I had a child
that had his hand caught in a sugarcane wheel. I
(09:43):
couldn't really do anything to help him. His hand was
very badly damaged. But I remember I literally just went
over and I sat with him and I put my
arm around him, and I think at that point I
realized that medicine might be the path for me because
he was, you know, obviously crying, but that in there
and soothing him really drove me towards medicine. Wow, what
(10:04):
a story. One of the next questions I had was,
you know why emergency medicine. I mean, of course, you
know kind of mentioned that and touch that, but do
you see there is more to it than just being
a physician that you really wanted to serve in the
emergency medicine area. When I was going through medical school,
I appreciated all the different fields, but nothing really hit
(10:25):
home for me until I did emergency medicine. When patients
enter a hospital, that is the first place to go.
No one knows what's going on with the patient. You
were the first one to see them, and so I
enjoyed that aspect. I enjoyed that aspect of being the
first person to see the patient, being the first person
to diagnose something, because it really starts there. That initial
(10:46):
contact is what drove me to emergency medicine. So, as
you trained to become a doctor, did you personally ever
see you know, over the years, any health iniquities you
were also India, you said, right, So, I mean I
would say not just in the US, but also globally
where the challenges that came up through the system, you know,
specifically in caring for the underserved communities and specifically who
(11:09):
gets scared. Did you see that? So? You know, I
think each country has their deficits, but I definitely see
a disparity in healthcare in every single country that I've
been in a hospital where I've spent some time with.
One of the main things across the board that I've
noticed is the preventative care for the underprivilege to prevent
(11:31):
long term diseases. And by that, I mean, you know,
if you break your hand, you're going to be seen
no matter where you go, Right, that is an acute
problem that will be treated. But if you have long
standing hypertension or high blood pressure, that may not be
seen in a lot of countries, and a lot of
people may not have access to manage that or to
(11:52):
get to a physician. So I think the biggest disparity
that I've noticed across the board, no matter where I went,
is to event these preventable diseases, especially in the under privilege.
The way to fix that is to get access out there,
to get access to a family doctor or primary doctor. Right,
I mean, you talk about preventive care. That's very interesting.
(12:14):
I mean in various episodes that we've had so far,
Dinner Towers and Peter Hotels, where we have often talked
about how health and economic crisis stemming from COVID situation
at this point in time has only magnified the systemic
barriers to health and how they're particularly worse for these
much groups. But it has been existing, and there are
certain areas which have been completely overlooked, you know, for years,
(12:37):
and I believe these complexities demand for accountability, transparency, and
also solutions that transcend health and health care programs as
they've been designed, you know traditionally. Do you have a
take on that, Yeah, So, absolutely. I think, you know,
COVID nineteen has definitely brought to light the disparities and
healthcare and especially the under privileged communities. Initially, when there's
(12:59):
these came out, I I had a theory and I'm
sure a lot of physicians did as well, that there
we're going to be risk factors that when you look
back at the thousands and hundreds and millions of patients
have been affected, who has been affected the most? And
there have been some small studies that have come out
of the States and globally that African Americans, people with obesity,
people with smoking, you know, are the ones that are
(13:21):
affected most. And some of these things like smoking smoking cessation.
Preventing smoking is a very simple task that you can,
you know, start with public health, and some countries have
done it much better than others. Obesity, especially in the
United States, is a big concern. But these things have
been really brought to light with the disease and it's important.
(13:43):
It's important that we just don't throw them to the
wayside when this disease is controlled. So I think it's
a great point that you bring up. COVID nineteen definitely
has brought to light a lot of the disparities in healthcare.
So talking about COOD, Dr Bashua, you contracted COVID yourself too,
How was it managing your own care while also being
(14:03):
in the same home with your family and your wife
and your kids. And I believe your wife is also
an emergency physician. She is, she's a family physician. But
when I had COVID nineteen, physicians make the worst patience,
by the way, and I think you you'll you'll find
that across the board, we never think anything's wrong with us.
I was practicing an emergency room. I was on a
(14:24):
regular shift. It was a Saturday night. COVID had just
been kind of on the news for the last two
or three weeks. This was back in March of last year.
And I went home and I was pretty tired because
I just brod six ships in a row. And Sunday morning,
I woke up completely fine. Monday, again, I felt a
little bit tired, and I just thought it was from
the weekend. And Monday night, I woke up at midnight
(14:45):
and immediately I knew something was wrong. I hadn't felt
kind of this way in a long long time. I
think the last time I probably felt this way was
when I had the flu, which must have been five
or six years ago, and I had diffused body aches.
I had a pretty pretty bad had ache, enough that
I could barely open my eyes, and so immediately I
went to the spare bedroom and I texted my boss
(15:08):
at one am and I said, listen, I think something's wrong.
I'm gonna come in for a test in the morning.
And at that point, the disease was so new in
Canada that the testing wasn't there, so the testing was
so backlogged. They initially thought my test was going to
come back in three or four days. It actually took
eight days to come back, and when the test did
(15:29):
come back, it came back negative. Luckily, I had was
off for six or seven days, so before going back
to work, I called my boss and said, list of
my test isn't back yet. My disease course, luckily, was
only two or three days, and the body aches, the
headaches completely went away, and I had no respitory symptoms, thankfully,
(15:49):
and so I got to repeat tests the prior quarterback
to work, and my original test came back negative, but
my repeat test came back positive, which means that my
first test was a false test and so luckily my
disease course was very short compared to a lot of
the other people on some of my colleagues as well,
and I was out for about three weeks until I
(16:10):
had a negative swab to get back to work. You
bring an important point that it took you eight days
to get tests back just quarantin NG and this confusing
around things and also talks a little bit about the
unpreparedness that you will have been going through. We'll touch
that topic a little later, but what I also caught
on was that he came back after six shifts like
it's been tough. Right. As an emergency physician, we all
(16:33):
know your work is very important at any point in time,
but specifically during COVID nineteen kindamic, you were saving a
lot of lives. And during the panda maybe we've been
also reading that there's been like chaos in many hospitals globally,
and this comes with rising levels of anxiety and emotional exhaustion,
and I find it as a pity. You know, I
(16:54):
was just doing some research that to date, no research
has focused on the emergency physician ex hidents during the pandemic.
I saw only a few publications coming from China where
they kind of did some studies on you know how
emergency physicians you don't really take the distress. So as
you faced, you know, you are faced with an unpresident
(17:14):
search of critically ill patients showing up at the hospital
without warning. What was your personal experience dealing with it?
You know, working in the emergency room, you do see
the worst, the worst. You're the person that's supposed to
diagnose the life threatening conditions, So that in itself is
hard enough to begin with. And now you throw a
disease in that process where you have to put on
(17:36):
personal protective equipment, which takes time. You have to sift
through the cases that you think are either COVID or
there's something else. It adds another layer of complexity to
your job. And if you do that for a month
or two months, that may be okay. But people get
COVID fatigue and physicians get COVID fatigue, and you start
(17:58):
missing them in cases that you normally would catch. So
it is very hard on the emergency room physician and
any physician in the hospital, the surgeons, the pediatricians, the O, B, G,
y n s. They also have to contemplate is this
patient COVID positive. It is taxing not only on the
physicians in the hospital, but the nurses, the text, the
(18:19):
CT people, the radiology people, even you know, the ancillary
staff that's there. And then you brought up another great
point as to the hospital capacity. Right, so now you
are adding another burden on the hospital system. And I
don't care which country you go to, the amount of
hospital space is not proportionate to the patient population. Right.
(18:41):
We need more hospitals everywhere we go. But the places
that are really really hard hit are the ones that
their population size is large and their hospital capacity is
not equivalent to that. And you look at the news
any day, what are the countries have been hit the hardest,
You know, Brazil, the United States? Right, these are the
countries you can see the dispairy there. So it's not
(19:03):
only taxing, I would say, on your physician, but it's
also taxing on the hospital itself. I was reading more
about Italy living in Switzerland. You know, I have more
contexts in Europe, but also you know a bit in
the US that multiple patients will just show up, and
you know that would mean that you would have to
kind of give care at the same point in time.
To multiple people, and and it's evident, you know, like
(19:23):
you're saying that critically ill patients have been far greater
in number than the life saving equipment itself. Right, the
vent leads the hospital beds, montree equipment and all of
these things, and then compounding appropriate ppe s that you're
talking about, for instance, and you do talk about the preparedness, right,
you know, the hospital space is less than what it
should be. What do you think there could have been
(19:45):
around better preparedness and response? If we just turn back time,
what could have been done which could have made this
a little bit better as a situation. You know, preparedness,
especially when we've never dealt with anything like this before,
is relative. And in the emergency room we have a
special department called the disaster preparedness and by that I
(20:06):
mean we treat for environmental disasters or chemical disasters. There's
never been any type of training for a pandemic disaster,
or even for the hospital for that matter. So looking
back at it, how could we have prepared for this?
It shows that the hospitals one are not ready for
the capacity for patients. And that's what we can see it,
(20:28):
which is pretty evident. Number Two, we weren't ready as
far as personal protective equipment. But I think the biggest
thing would be to look at our everyday operations as
a hospital and as physicians. How do we treat people
who have normal conditions, yet we have to be aware
(20:48):
about COVID. How do we treat the heart attacks and
the strokes? What do we have to do differently? Right?
So I think moving forward, we have to think outside
the box to prepare for these things. And mainly I
think the big thing is getting the hospital capacities up
to par to deal with all the patients. And I
(21:08):
think a lot of countries already doing that, especially here
in Canada. And you talked interestingly also about the stuff
and you know a lot of the physicians within the
hospital itself, and would you like to talk a bit
about emotions, stress, anxiety, moral injury and even the department
culture change during the pandemic? Right? I mean, how do
you keep all those healthcare support functions and stuff motivated
(21:32):
to keep going. It's a tough job. It's a very
tough job, you know. It's I think the emotions is
the biggest factor that we all have to I think
control and also deal with. I think it's something that
we have to talk about. I'll give you an example. Recently,
I had a patient who was presumed to be COVID
positive was not breathing too well, and I had to
(21:54):
put a breathing tube down to help them breathe. And
when I came out of the room, we have a
system where the nurse is watch us, and we watch
the nurses as we take off our protective equipment as
to not to contaminate everything. And I was taking off
my equipment and my unit secretary came to me and said, hey,
the patient's husband is on the phone, which, by the way,
(22:15):
I think we should also talk about that patients families
are not allowed in the hospital, which is a big anxiety,
especially for the patient, but also for the families. Imagine
sending your family member in and you have no idea
what's going on. So, as I was taking off my equipment,
I forgot to take off my mask, which technically is contaminated,
and I went to the seat and I put it
(22:36):
onto the desk and my nurse, who's one of my
outstanding nurses, asked me to dispose it properly, and I didn't,
and I kind of brushed her away in a sense
that hey, let me deal with this patient's family, which is,
you know, obviously concerned, but I should have dealt with
her concerns as well. So there's this aspect of emotions
are running high with everyone, but it's such a stressful
(22:59):
time not only to the families, but to the physicians,
to the nurses. So you have to be mindful of
a lot of the emotions that are going on in
the hospital, especially when people are extremely sick. I think
that's the hardest aspect to deal with is you're not
sure you know who's feeling angry or who's feeling upset,
but you have to be there pretty much for everyone.
(23:20):
In the context of what you're saying in your story,
I was just reading that the burnout rate of doctors
practicing emergency medicine and specific is estimated to be about
eighty six percent according to a recent survey by Canadian
Association of Emergency Physicians, And also recently one doctor's death
in Quebec, Canada, where you know, she committed suicide, and
(23:42):
that sent shock ways in the Canada's medical community. The
point I want to just kind of bring in here
is it's not just we are poorly prepared in terms
of infrastructure. We're also poorly prepared and little aware of
the potential devastation of the health care communities worldwide. Right,
what's your take on that. When I was working in
(24:03):
Florida and I was part of the administrative staff of
the hospital that worked at I brought up this exact topic.
I said, we need more support for physicians dealing with
kind of the everyday emotions that they have. There was
no support system if a physician felt suppressed or angry,
There was no wordy for them to go to write.
The hospital had no ancillary staff for them. We don't
(24:25):
have that here as well, right, So it's a huge problem.
Imagine going to an emergence room and your physician has
worked eight days or nine days in a row, and
they are back after six hours of work. Do you
really want them taking care of you? Is there a
chance that they missed something? Absolutely? So, there is very
little support for physicians as far as their emotions, and
(24:47):
it's a big problem because it definitely affects performance and
anything you do. You look at sports players, you look
at anything, it's the same. Right, you need that support,
especially in high stress situations, and so there is disparity,
and I believe the numbers that you've looked up, I
think they're probably at that number. Would you like to
share some of the toughest moments that you've faced as
(25:08):
as as an ear physician during COVID times where you
felt helpless, powerless and you wanted to help patient that
you could not help. Do you have any moments of
grief in any story to share? Yeah, I'll actually have.
I have two stories. One is COVID related, one is
not COVID related, one of which was not my story,
but I felt for the physician because I trained with
(25:31):
him and he's a good friend of mine. And he
went off to l A County to be in attending
and he's been there for about six or seven years,
and he called me a month ago and he seemed
very down. In l A County is one of those
counties have been hit extremely hard because their patient population
is so large and their capacity so small that they
have actually told some of their e M. S personnel
(25:54):
that if a patient has known to be COVID and
they have a lot of comorbidities and they appear extremely sick,
to consider not transporting them to the hospital because their
hospitals are so full, and and they obviously have to
talk to the physician who was there at the hospital
and give the vitals in the scenario. But I remember
(26:16):
my colleague who called me after his night shift. He
said that he got a call from the paramedics that
it was his neighbor that they called in, and he
his neighbor actually was picked up and on the way
that the hospital passed away. And so you know, it's
one of those things that as emergency physicians, you see
death all the time and you almost get immune to it.
(26:38):
You kind of brushed it off. But I could feel
the pain in his voice, and it was one of
those things that initially you feel the pain, but then
it just becomes numb. And I had a similar case
which was not a COVID case. The actually just happened yesterday.
I had a patient who was a thirty four year
old who was a mom of two who actually saw
(27:00):
my wife as a doctor, and she was complaining of
donald pain and my wife ended up getting an ultrasound
and the ultrasound was concerning for a possible new type
of cancer, and she was sent into the emergency room
because we needed to do a CT scan and when
we did the CT scan, we confirmed the diagnosis. But
because of COVID, the time for her to get referred
(27:23):
to oncology is going to take some time. And I
remember just sitting with her and I I cried with her,
you know, because this is something that shouldn't you shouldn't
have to wait for. You shouldn't have to wait for
seeing an oncologist and getting treatment started just because the
virus is out there in a thirty or four year
old mom with two kids. It's something I head home
(27:44):
and it's just one of those things that in a
normal world without a pandemic, this would have been dealt
with much faster. Moving on a bit into to come
as an ear doctor, are you also seeing any spike
in other non related COVID cases? Is that putting a
(28:06):
strain on the hospitals as well? Absolutely? You know that
we have right now in Ontario where I work, stay
at home order at least for thirty days. And you know,
when you have a pandemic like this, the diseases that
should be brought to light are not brought to light.
So for example, people who have adal pain are scared
to come to the hospital because of COVID nineteen, and
when they do come in, they have the most severe
(28:28):
problems that should have been dealt with a month ago
or two months ago. I recently had a case of
a person who had right lower quadrant pain and they
clearly had appendicitis, and they sat at home for four
days and now they're a penicetis ruptured and now they're
in the hospital for a couple of days because that
rupture causes them to become septic. So these common diseases, appendicitis,
(28:49):
heart attacks, strokes, gall bladder problems, these should be dealt
with because their emergent and people choose not to come,
which is rightfully so, because are scared of COVID nineteen
and the government has told them stay at home. So
it's a very big problem because common diseases are being
missed and common diseases are going to the extremes, so
(29:12):
it's more of a burden when they come in this late.
I want to hand we talk about these diseases and
where people are not even coming to the hospitals because
they want to feel safe, as well as we talk
about healthcare workers and physicians who are you know, kind
of doing so much more to just get through the day,
you know, and at the same time, I want to
have your perception about general population, you know, how they
(29:34):
are reacting to the measures in place globally, you know,
to contain this virus. You know who could be actually
influential in getting these numbers down, like wearing masks, you know,
keeping distances, etcetera. You obviously do understand disease more than
any other man on the street does. But how do
you respond to, you know, people not really taking care
(29:54):
on these measures. Yeah, you know, it's hard because I
came from a place called Florida, which a lot of
people in that state have not taken this disease seriously.
You have extremes in that state of the very very
old people who are very susceptible disease, and a lot
of young people, especially in Southeast Florida, who don't think
that the disease is actually true or there it's not
(30:16):
going to affect them. And then you have people that
are kind of in between that do wear masks that
sometimes comply with the regulations. One of the reasons why
I came to Canada was because the Canadian belief do
what's right for others, put others in front of yourself,
and I really appreciated that about my family and friends
(30:37):
that were up here, and I wanted to be more
like that. It's hard because it's hard to get everyone
on board on the same page. And even as simple
as mask wearing, that is probably one of the most
simplest things that anyone can do, or even social distancing,
right distance someone by six ft. It truly doesn't sound hard,
but no one does it because I think it's in
(30:59):
human nature to try to do the opposite. If I
were to pick and I know there's a lot of
weapons now against COVID nineteen. We have social distancing, we
have mask wearing, we even have vaccines. Out of all
those things, I think the biggest thing you could do
is social distance. If I didn't have the vaccine, I
would social distance, and if I couldn't social distance, I
would wear a mask, and finally I would get the vaccine.
(31:21):
I think that is probably the last restore because it's
going to take time for the vaccine to roll out.
There's a lot of people out there that don't believe
one in this virus and number two in the prevention
of this virus. But you can see the numbers on
the news, and you know, I don't joke with people,
but I say, if you really don't believe this, come
to an emergency room and let me show you a
(31:43):
lot you're talking about is really the personal accountability and
social responsibility. But I imagine you guys a healthcare workers
on frontline, especially on top of that with COVID, you
have an extra challenge being at a higher risk of
contracting the disease. I mean, I've seen some pictures wearing
face eels and moon suits and all that gear to
protect yourself. And we are such a visual society. If
(32:06):
we if we haven't seen those struggles of health care workers,
we believe you know, it's not happening, right. So I
take your point to that and do take pictures from
there and maybe post it. I think it's going to
really work, because we need a behavior change in people.
In my opinion, let's stave deeper a bit into healthcare
systems in the US versus Canada. I mean, you've worked
(32:28):
in both the places, and one of my questions was
that why did you make a choice to move to Canada,
which you kind of answered, but also what has been
your experience so far working within the two different health
care systems. So I trained in a stakehold Connecticut and
then I moved to Florida for about six years. There's
a lot of major differences between the two countries on
(32:49):
healthcare in general. One of the biggest differences is access
to healthcare. If you make healthcare part of your taxes,
which Canada as. It's a big difference in the preventable diseases,
like we talked about hypertension, diabetes, high cholesterol in years
to come. That prevents people from being hospitalized. And that's
(33:13):
what has made I think Canada so great that everyone
starting from birth has access to healthcare. In the United States,
not everyone has access to healthcare, so you see the
most disastrous outcomes because people don't have management to eye
blood pressure. You see the strokes, you see the bad
heart attacks, and don't get me wrong, you see them
(33:34):
here as well. But it's gratifying to see people know
their medical history, know what medications there on, no the
last time they saw a doctor. So I think preventive
healthcare is one thing. Now. One thing that America is
great at is if you want to have a procedure done,
say you have hurt your d and you tore your
a c L and you want surgery tomorrow, you will
(33:55):
get surgery tomorrow. You have to find orthopedic surgeon and
your insurance resent and they'll do the surgery. Because a
c L surgery is not a mergent here in Canada,
you may have to wait a couple of months. And
I personally have not heard my a c L, so
I'm not that picture. But if I were to, I
would say I'm okay with waiting. I'm okay with waiting
(34:16):
four or five months because someone out there needs more
emergent treatment. That's kind of that sacrifice for the greater good.
But I have an analogy for US healthcare in a
sense that it's like Amazon. Right you clicked the order
on Amazon, it's there in forty eight hours. If you
want something done in the United States, you will get
it done in the United States, but you may have
to wait in a lot of socialized healthcare settings, and
(34:38):
it's a trade off. Some people don't want to wait
for that and some people are willing to wait for that.
That's a great point to touch on access to healthcare,
and here living in Switzerland, I mean, it's one of
the best examples of that as well. I mean it's
really very much silar to what you're saying in Canada
as well, perhaps the most talked about topic right now,
and would love to get your views on it. I'm
sure you've been asked a hundred times what do you
(35:00):
think about vaccines and do you think of them as
a promise? So? I think vaccines in general have done
a great good in global healthcare. If you look at
diseases like measles and momps, we've done such a great
job with those, and I think that vaccine children has
gone a long way. You look at the Gates Foundation
(35:21):
and what they have done. As far as the COVID
nineteen vaccine, because it's so new, we really don't know
how far it's going to go. We have trials, but
I think in the long term it's probably gonna be
close to what they have advertised, and I think it's
going to be another tool to battle COVID nineteen. Do
(35:43):
I think it's going to be the end all, be
all treatment. I don't think so. I think we have
come to a new realization that viruses are prevented by
distancing and by wearing masks. But I think getting the
vaccine is absolutely going to help in reducing the transmission
of COVID nineteen will absolutely stop the transmission. I do
(36:05):
not think it's going to stop the transmission. I think
eventually a lot of us will get immune to it,
either via the vaccine itself or via herd immunity. But
I think we've come to a realization that we need
to do other things besides vaccines to prevent disease, washing
our hands, wearing masks. This may be a new norm
that we're we're going into. Um it's I guess the
(36:27):
only time will tell. But back to your question support vaccines. Yes,
there have been side effects to some vaccines. As you know,
some vaccines can cause these terrible diseases like GM beret
and Bell's palsy. But in the realm of all the
people that have been vaccinated in the world, this is
a small, small percentage, and I think for the greater good,
(36:50):
vaccines have done a great service to all of humanity. Right,
And I do agree that you know, vaccines is not
the only solution. We have to continue wedding masks and
dick tists and preventive measures need to be done as well.
But in specific to where you are in terms of Canada,
you know, how has been the reaction response there and
throughout how does that look like? Yeah, so you know,
(37:11):
every government is different. Here, we have just recently started
it back in late December, so now it is mid January.
So like a lot of the other countries, we are
vaccinating first the most susceptible populations, which is the elderly people,
you know, compromise, the residents at long term care, the
workers in long term care, and then the high risk
(37:32):
healthcare workers, which would be the I c U doctors,
the emergency medicine doctors, the nursing staff, the ancillery staff
in those areas, the pharmacists. You know, if you look
at all the research throughout the world, these are the
populations that have been affected the most. But I think
Canada overall is doing a great job with what they have.
Obviously everyone needs more vaccines, but prioritizing the vaccines and
(37:55):
distribution of the vaccines, I think Canada is doing a
great job so far in that context. Maybe one of
the last questions I have for you is a little
bit long term, and what we're starting to see is
also a mental health crisis. People are tired of this.
Of course, it's taken a toll on people, So what's
(38:15):
your take on that, and if there's any advice that
you could give to people that would be created as well.
I have not seen this much mental health illness in
my career. My career so far has been a boy
eight years after residency, and in this past year I've
probably seen more mental health complaints and patients than I
have in the first seven years of my career. This
(38:38):
is again a stressful time in all of our lives,
whether it's not even a health care worker, whether it's
a frontline worker, or whether you know, if you're just
staying at home, it's very stressful. So I think this
has shed a lot of light on mental health and
mental health issues. It has probably worse than people who
already have mental health issues, and I think there should
(38:59):
be a big I know candidate here. We have recently
passed and lecture that brings more availability and mental health
to the public, and I think other countries should be
doing the same to follow, because this is going to
be a big problem as we recover from COVID nineteen.
This is a time where you should be helping your neighbors.
You should be lending a hand and calling a neighbor,
(39:21):
calling a friend, and being there for others. It's going
to be stressful for years to come. It's one of
those times that we'll never see again. We'll talk to
our kids about this, and this is a time where
we should be there for each other. Dr Bawa, thanks
for sharing your experiences as someone who has lived this
COVID nineteen experience in terms of physical, emotional and psychological challenges.
(39:44):
You know of working through this pandemic, and you, along
with all healthcare workers on the front lines, they have
experienced significant losses, trauma, grief, and a burden that is
really hard to put in words. So all we can
say is you've been doing a tremendous job and absolutely
deserved all I respect. So thank you. I appreciate you
(40:05):
having me. Thank you so much. Transitioning from Dr bog
Bob an e er physician and hero faced with impossible
decisions day to day whose mental health and well being
are compromised because the health care system is on the
brink of collapse at any given time, and like so
many others, she doesn't have the luxury of taking a break.
(40:27):
We hear from Melizza Rangel and the tragedies she's experienced firsthand,
including the loss of her father. I want to warn
you there is no sugarcoating nous. Melissa was a patient,
a family member who lost her father, and a nurse
who truly empathized with her caregivers all at once. I
(40:49):
want to start with you sharing some fond memories of
your family and your dad. You know, growing up, my
dad was our everything to us, not just I don't
literally say our everything, because he was our father, but
he was our mechanic, our plumber, are you know, our worlder,
our honeymoon. He was a person that was always there
(41:11):
for us. Um My dad was always, you know, the
person that motivated as the most, and even though he
was disabled, he he really was very involved in everything
that we did. And he was a positive influencer in
our lives. And that's something that that I hold dearly
(41:32):
with my heart because it's a something that I don't
ever want to forget. Yes, of course, of course. Now
I want to talk about your experience with COVID, your
personal experience. Can you share with us how it all
started your COVID symptoms. My COVID symptoms started in June.
(41:55):
I had learned that I had got exposed, right, so
I immediately isolated my self. I was feeling very tired,
I wasn't really feeling very hungry. I noticed I was
heavily sweating. Within maybe like three days, I developed a
lot of facial pain. So I did develop a fever.
It was about a hundred and one. Soon after, maybe
(42:19):
like within two days, I noticed that just walking to
the restroom, I was very short of breath. So at
that point, you know, I decided to get a note
to a pulse oxyometer so that I could actually take
my oxygen levels and see where I was at. On
the twentieth, I went to the hospital and one of
(42:40):
the things they did was a they gave me antibiotics.
They gave me steroidse which we're gonna help me with
my lungs. I believe they even gave me a rosa shot.
And then they sent me home and they're like, Okay,
you're still good, Just you know, try to relax. So
were they saying you have COVID or were they just
treating the symptoms not knowing that it was COVID. At
(43:01):
that time, I still hadn't gotten my results. So when
you went to the hospital, one of the main things
they did is that if you had any sort of
symptoms that were related to COVID, you were automatically put
with people that had COVID. So I was like, let's say,
if I would have been negative at that point, I
would have been exposed because of the fact that they
(43:23):
had to separate anybody had the symptoms and put all
those individuals together. So I was in the room with
a whole bunch of other people that had symptoms. Yeah,
that's kind of scary to think of, because you don't
know who's really sick and who's not, And as you've said,
you could be exposing yourself to the virus just by
being there when you're trying to get better. So after
(43:46):
I went to a hospital, I went twice right, because
I kept developing the shortness of breath. Do you feel
because you're young, They didn't take it as seriously maybe
I don't have like um pre existing conditions, so I'm
guessing it was more of a your oxygen is still okay,
you should be fine, which I understand because at that
(44:09):
point there was no rooms, and everybody that was not
hospital was because they were in critical condition. You know,
you have to meet a criteria to get admitted. So
on the third time that I ended up going to
the hospital was because I blacked up. I tried to
go to the restroom. I felt my body shot it
down and I screamed for help. That's the last thing
(44:30):
I remember. And then the next thing, well, my father
was there China to help me, of course, and rush
me to the hospital. I couldn't walk. I felt like
I was suffocating. I was just coughing and coughing, And
you know, the biggest thing on my head was I
just exposed my father. I was very scared, but at
the same time, my dask like, why wouldn't I do it?
(44:53):
You're my daughter? Wow? So um, he's my hero. That's
the love of father has as kids. Yes, so do
you know whether any MC service was called for you
or not? Or do you not remember because you were
passing out? No, my dad didn't call because he knew
that everything was very packed and we had already been
(45:15):
here in the news. There was ambulitis with actual patients
waiting in the ambulances. He just rushed me straight into
the hospital. I mean, my oxygen was in the low eighties.
If I walked and went into the seventies, Like I
was pretty signotic. I felt like if I took any
steps or if I walked, and I was going to die.
(45:36):
It's not something that I wish on anybody. It was
a very horrible feeling. Yeah, I can't even imagine. So
your dad makes the ultimate sacrifice and takes you to
the hospital. Tell us about your experience this time around
at the hospital. When we got to the hospital, they
(45:58):
were a little bit more organized. I remember the first
time I went, there was just a crowd of people outside,
you know, waiting to even go into the e er
or you know, waiting to go in through the COVID side. Um.
When we got there, the lady in the front I
remember that she uh asked my dad what was wrong,
because he's the one that got off, and he's like,
(46:19):
my daughter can't breathe. He's like, we need a wheelchair,
and they they said, well, you grab it, right, So
my dad grabbed the wheelchair. He's the one that wheeled
me into the hospital. Once I was there, they checked
my oxygen levels and at that point they're like, okay,
you can't really walk and I was like, no, I
(46:41):
I can't breathe. And that's where they admitted me. When
I got there, it didn't take that long I want
to say, maybe like thirty minutes max. Before they put
me in a room. And was that room by yourself
or with other people? When I was in the r
I was by myself for two days, and after two
(47:01):
days I shared a room with an older lady who
had COVID and she was passing. Wow, that must have
been tough. How do you feel about the care that
you receive or lack of care if you feel that
way at the hospital. When I was at the hospital,
(47:23):
I I had this one episode where I really needed
to go to the restroom. But at the same time,
we keep hearing code blue, like maybe every thirty minutes, right,
And what does code blue mean? Again? Code blue means
that somebody is unresponsive, they're crashing, they're dying. I mean,
you're pretty much trying to save somebody from dying. Being
(47:47):
a nurse, I know that somebody is going into cardiac
arrest anytime I hear called blue, so I knew what
that was. That day, I can see the nurses running
back and forth and I really needed to go to
the restroom. The thing is that when you have COVID
you're stuck to your bed, your bed bound. Any step
(48:08):
that I took, even if it was to go to
the restroom, I felt like I was going to pass
out and die. I felt really horrible. I was scared
to like pass out in the restroom and just suffocate.
I was terrified. I am not gonna lie. It was
something that was very scary. It was a horrible experience.
(48:28):
I remember calling the cob bell so that the nurses
could come, and they never came. I waited an hour.
I called again and they're like, it's because we're having
a lot of emergencies, which honestly I understood because I
kept hearing all the coding. I tried to hold it
at least I want to say, three hours without going
(48:50):
to the restroom until I just couldn't anymore. So I
grabbed whatever I could and I had to use that
to go to the restroom on my own, in my
bed um and trying not to dirty anything because at
that point, like I just couldn't hold it anymore. Eventually
the nurse got there and she said, I am so sorry.
At that point I couldn't be mad because I saw
(49:13):
her face. She wanted to cry. Like the workload that
she had was too much for her, and I remember
her telling me it's because I have like thirty patients.
So me putting myself in her position, I'm like, if
I have all patients that are bad abound, there's no
way I could provide the proper care for any of them.
(49:34):
I just told her not to worry about it. I
feel bad because I had pretty much made a mess.
There was no way that I wanted to put any
more stress on somebody that's trying their best to help
somebody when I know they don't have the resources to
do it. Wow, you have such a great heart, because
you know a lot of people would not be thinking
about somebody else and feeling empathy at that moment, and
(49:57):
they would just be frustrated. I am a nur, so
I know that they were suffering just as much as
we were. So I was there for about I want
to say, a week and a half, and because we're
all on oxygen and none of us could shower, we
weren't allowed to shower. So when I made a mess,
I asked her, you know, I know it that you
(50:18):
have a lot going on, and I know that you
cannot help me. I'm like, but can you at least
bring me a new basin with water and soap. I
told her I would like to like clean myself, like
you know, at least do a bed bath on my own,
and that is what I did. Um, I did a
bed bath on my own, and she did bring me
the like the little tampoo and everything so that I
could try to do it on my own. So eventually
(50:41):
you started to get better, right, yes, any time that
I tried to breathe, like you breathe in and you're
taking that guple there, but when you have COVID, it's
like you try to breathe and it's just stuck and
it doesn't go into your lungs. And that's how I felt.
Twenty four hours after I had last uh, I actually
was able to take my first breath by myself, and
(51:05):
I was shocked. I'm like, Okay, this is actually working.
So tell us about the progression of you getting better
and what was happening on the opposite end of the
spectrum with your father. So when I was getting better,
my dad started to get worse. He started developing a
cough and then my son would call us and he's like, oh,
(51:27):
his oxygen's eighties um where he started dropping even more
and then his blood sugar started rising and at that
point it's like, okay, we need to take him to
the hospital. So my sisters called the MS so they
can pick up my father. And then maybe two hours
passed and E M S never came. My sisters called
e M S again and e MS told him that
(51:48):
there was no space, that they couldn't pick it up,
so they canceled the ambulance services for my father. At
that point, my sister came immediately to pick up my dad.
She full ppe and rushed him to the hospital. That
was the only option we had. Wow. So when he
got to the hospital, do you know how long before
(52:10):
his symptoms got worse. He was in the e er
for three days, and his symptoms started getting worse the
day that he was supposed to be released. My dad
was never able to get pastma right away like I was,
because there wasn't anymore. I tried to donate myself, but
(52:31):
because I had just had COVID, They're like, you don't
even have anti bodies yet, it takes a while for
your body to develop them. I wanted to see my
dad old, and I knew that he had diabetes, and
I knew he had had retention, so I knew at
one point this was gonna probably kill him. But I
didn't think that COVID, which was a virus that appeared
(52:54):
out of nowhere right, was actually gonna take what we
cared for the most, which was my father. It really
broke my heart over all, the fact that we couldn't
be there to hold his hand, and we couldn't be
there at all with him. It still seems very surreal,
like it seems like it's all alive, like it's fake,
but it isn't. A lot of people are like COVID, Joe,
(53:17):
COVID is, It's not real. I had COVID and I
had no symptoms. Okay, well, some people really don't have
symptoms and they are lucky and they are fortunate. But
for those who have gone through COVID and have experienced loss,
it is something that you don't wish on anybody. It
is something very hurtful and it's very real, and it's
(53:37):
something that I hope that a lot of people really
really really make sure that they're doing everything in order
to not get sick. And just if you know when
you leave home, you know Hug, Hug those people you know,
Hug your parents, Hug your families because you don't know
if you're gonna see them next or if you're never
(53:58):
going to see them again. At this point, this is
what has come down to, and as sad as it is,
it's what's going on right now. I'm so sorry about
your loss. I am sorry about your experience. I'm sorry
that you missed opportunity to receive the care that you
deserve in the first world country. And you know, I
understand you have empathy for the nurses, but you know,
(54:21):
at the same time, it's heart wrenching to hear that
you weren't able to be taking care of the way
you should have been taken care of. My favorite thing
when you were talking about your dad is how your
face lit up. You're sharing your memories of him. How
would you like for us to remember your father? My dad?
(54:41):
He um, he was the best. He was the best.
I just want everybody to remember him as a person
that always um gave us a hot twenty body, strangers
or a strangers, anybody on this read. He would actually
(55:01):
stop and you know, try to help those in need,
even though we didn't help much. My dad did a
lot of things for a lot of people, and I did.
What I wanted to remember the most was how he
always had a smile. Can you imagine having a family
(55:26):
member denied ambulance service? What about being in the shoes
of an e er physician who has to decide where
to allocate limited resources and your decision means the death
of somebody else's family member. How about having a heart
so strong that you can actually separate your personal loss
and suffering from the pain that your caregiver's experience. As
(55:50):
we heard from Melizza, folks, things will get better, but
we have to be serious about these lessons. Our health
care system was not built to weather this storm arm
even if we're supposed to be the shining city on
the hill. To continue shining, we need to continue the
progress towards health equity and meet this moment wide eyed.
(56:11):
We need to improve resources to our local health agencies,
as we continue to say, and we have to have
a better plan for our frontline heroes to cope with
the decisions and the trauma that they've endured and will
inevitably continue to endure during this pandemic. At the risk
of sounding like a broken record, I want to remind
you of something. As hard as it is to wear
(56:32):
a mask to separate from your friends and loved ones,
and as much as your life has been disrupted from
this pandemic, every decision you make is life or death.
I'm not trying to sensationalize this. The decisions that you
make today, if they don't affect your own family or you,
they affect someone like Melitza or Dr Boshbab, So please
(56:53):
consider their stories and the impact of your decisions. Thank
you so much for joining us again. We'll keep bringing
truth no matter how hard it is, and we'll see
you soon. Listen to Contact World of podcast on the
(57:14):
I Heart Radio app or wherever you get your podcasts.
H
L A County is one of those counties have been
hit extremely hard because their patient population is so large
and their capacity so small that they have actually told
some of their e M S personnel that if a
patient has known to be COVID and they have a
lot of coal morbidities and they appear extremely sick, to
consider not transporting them to the hospital. That's Dr Paul Bagba,
(00:27):
an emergency medicine physician who shares firsthand how the system
in the US was never prepared to handle such an
overwhelming public health disaster. In our conversation with Dr Bogeba,
we discussed the silent yet widespread effect the pandemic is
having on our frontline workers. The mental health and well
being of our doctors, nurses, and medical practitioners seems to
(00:48):
go unnoticed, and yet despite this undeniable emotional and physical strain,
they're the ones we turn to for help while demanding perfection.
It's really an impossible proposition. On the other end of
that phone call to our emergency services is meliitsa rangel,
a loving daughter, a protective mother, and a practicing nurse.
Melita shares the devastating story of how her father paid
(01:11):
the ultimate price while protecting her from the disease, and
all because of an overwhelmed and broken system. And yet
for someone experiencing such loss, Melita understands the heavy weight
and burden placed on our healthcare workers and speaks with
empathy when sharing her story. So my sisters called the
MS so they can pick up my father. And then
(01:31):
maybe two hours passed and E M S never came.
My sisters called E M S again and E M
S told him that there was no space, that they
couldn't pick it up, so they canceled the ambulance services
from my father. At that point, my sister came immediately
to pick up my dad. She put on full ppe
and rushed into the hospital. That was the only option
(01:53):
we had. I'm Justin Beck, founder and CEO of Contact World.
I'm here with my co host Katherine Nelson and DT Pava,
and over the coming months, we'll be talking to scientists, researchers, celebrities, experts,
anyone who's been affected by COVID and getting to the
bottom of how we can improve public health together. We
(02:16):
may not have all the answers, but you deserve to
understand what goes on in your neighborhood and the decisions
that will affect you and your family's health. Welcome to
Contact World. We're here to share two stories with you today.
This is a bit of a heavy episode, but we
need to bring attention to these topics. The show is
about truth, So one day, when we look back at
(02:39):
the overall carnage of this pandemic, the emotional and mental
toll this has had on society as a whole is
really underestimated. I mean, I haven't seen friends or socialized
since March, but I sometimes remind myself how relatively easy
I have it. But to think of being a frontline
worker and what's become a normal day in a clinical
(03:00):
environment is another story altogether. I mean, we're going to
see post traumatic stress disorder. These heroes haven't even had
the time to mentally unpack what's happening to them. What
do you two think about the mental anguish and stress
of the pandemic and how it's affected our hospitals and
clinical environments. So, you know, justin I feel that even
(03:21):
before we making to think about mental health or even
you know, move beyond the current crisis, we all need
to first reckon with the skill or what has been
experienced right our front line health care workers among the
most vulnerable populations at this point in time, and as
research shows that the risks to the well being of
these health care workers are not even very understood, forget
(03:43):
about trying to solve for those issues. I think the
key thing with mental health right now is do we
have the ability to self check? Do we have that
moment where we're able to check in with ourselves and
make sure everything is okay. And when you're working, you know,
as a physician in a hospital or you're a nurse
and you're there around people that are dying and suffering
(04:04):
and hurting, perhaps you're so busy helping everyone else you
don't have that ability to stop and make sure that
you're mentally at well. I was thinking the other day
about how we put a cap on over the road
truckers and how much time that they can spend on
the road, or we put a cap on how many
(04:24):
transcontinental or trans oceanic flights a pilot might take because
of the impact that their decision making might have on
lives of people. Right you can't put a trucker on
the road for fourteen hours a day because he might crash.
But we don't put health or mental wellness or well
(04:45):
being programs in place for our frontline workers. And they're
in the same decision making capacity matters of life and death,
and they are working seven days a week, in some
instances too many hours a day. They inevitably are going
to make bad decisions or they're going to miss things
because it's impossible for a human to endure the anguish
(05:08):
that they're going through the amount of time they're working,
and then you multiply that by the pain of decision
making that they have to go through every day, sometimes
literally denying people critical care. It's unbelievable. Yeah, true, justin
what you're saying is, you know, it's so sad to
see that how little we have been prepared in terms
of providing care to people who are responsible for caring
(05:31):
for us, and that came through during this pandemic. Why
don't we have ancillary services or frequent visits to psychologists
for these health care workers. That's something very basic they
should be having access to. Right. I agree with both
of you, but I struggle to say that we should
limit the time that they spend because there are shortages.
It's a tough thing to say, But do we want
(05:54):
to turn people away from the hospital because there's no
doctor on the shift. It's almost like we're in cry, says,
and we need them so much, but then at the
same time we want them to be clear and level
headed enough to make the right decisions. It's a horrible situation,
it really is. There is a need for better preparation,
and when we talk about better preparation, you know we
(06:15):
are not prepared for such emergencies, right. I believe this
gives us a perfect platform to think about such issues.
So if at all something like this happens again, we
do not face the situation. We don't have to make
that compromise that we're making today. You know, in hindsight
is and I think that we're not talking about pivoting
the way that we're handling it now. But what we
(06:37):
need to do is we know we need to better
resource health agencies and we need to change the way
we've thought about clinical care based on what we're putting
these doctors through. You know, a few years down the road,
when they really have a chance to think about what
they've gone through, we're probably going to see unprecedented amounts
of PTSD suicides from frontline how workers. We're not going
(07:01):
to know what the real long term impact of this
is until we're looking back at it, and you're right,
what we need to do is take a very honest
look at the way we've managed this, the way that
we've been prepared for it or unprepared for it, and
we have to be ready to change things drastically in
some cases. I agree. Begins with the conversation and deep
(07:22):
te I know this episode focuses a lot on your
interview with Dr Paul Bargeois. Tell us about that conversation
and kind of set it up as far as what
a listener can expect to learn from him. Sure. So,
Dr Bagua is actually an emergency physician who has worked
in Florida before and also now in Canada, and what
(07:46):
we really talked about was more on the healthcare workers side,
is to what they face in terms of extreme COVID
footigue and how that comes with their own risks and
rising levels of anxiety and fational exhaustion that they go through.
They have to make heart decisions and decide who needs
the care and these services the most. Thank you Dr
(08:19):
Bada for joining us today. It's great to have you
here and to have an opportunity to hear from the
front lines on how as an emergency physician you were
experiencing and treating COVID nineteen directly, as well as we
will talk a bit about, you know, your own experiences
with the inequities of the health system in the US
(08:39):
and globally and what you see while working firsthand with
the patients. So let's first talk about your choice to
work as a physician. Why medicine? What inspired you? Thank
you first for having me on the show. I guess
your question is a question that they asked pretty much
all physicians when they enter MAD school, was why medicine?
(09:01):
You know, most physicians have a story behind it, So
I'll give you a bit of a story. When I
was growing up, I actually wanted to be a police officer.
I thought was the most rewarding thing. I would see
police officers on the road, and as I was going
through school, I was on a call with one of
my friends who was a police officer, and it would
ended up being a medical call, and I noticed that
(09:22):
they're kind of almost first responders, just like emergency medicine is,
and that kind of opened my eyes up into medicine,
and I decided to do an elective away in India
and they put me in the emergency room the first
day that I was there, and I had a child
that had his hand caught in a sugarcane wheel. I
(09:43):
couldn't really do anything to help him. His hand was
very badly damaged. But I remember I literally just went
over and I sat with him and I put my
arm around him, and I think at that point I
realized that medicine might be the path for me because
he was, you know, obviously crying, but that in there
and soothing him really drove me towards medicine. Wow, what
(10:04):
a story. One of the next questions I had was,
you know why emergency medicine. I mean, of course, you
know kind of mentioned that and touch that, but do
you see there is more to it than just being
a physician that you really wanted to serve in the
emergency medicine area. When I was going through medical school,
I appreciated all the different fields, but nothing really hit
(10:25):
home for me until I did emergency medicine. When patients
enter a hospital, that is the first place to go.
No one knows what's going on with the patient. You
were the first one to see them, and so I
enjoyed that aspect. I enjoyed that aspect of being the
first person to see the patient, being the first person
to diagnose something, because it really starts there. That initial
(10:46):
contact is what drove me to emergency medicine. So, as
you trained to become a doctor, did you personally ever
see you know, over the years, any health iniquities you
were also India, you said, right, So, I mean I
would say not just in the US, but also globally
where the challenges that came up through the system, you know,
specifically in caring for the underserved communities and specifically who
(11:09):
gets scared. Did you see that? So? You know, I
think each country has their deficits, but I definitely see
a disparity in healthcare in every single country that I've
been in a hospital where I've spent some time with.
One of the main things across the board that I've
noticed is the preventative care for the underprivilege to prevent
(11:31):
long term diseases. And by that, I mean, you know,
if you break your hand, you're going to be seen
no matter where you go, Right, that is an acute
problem that will be treated. But if you have long
standing hypertension or high blood pressure, that may not be
seen in a lot of countries, and a lot of
people may not have access to manage that or to
(11:52):
get to a physician. So I think the biggest disparity
that I've noticed across the board, no matter where I went,
is to event these preventable diseases, especially in the under privilege.
The way to fix that is to get access out there,
to get access to a family doctor or primary doctor. Right,
I mean, you talk about preventive care. That's very interesting.
(12:14):
I mean in various episodes that we've had so far,
Dinner Towers and Peter Hotels, where we have often talked
about how health and economic crisis stemming from COVID situation
at this point in time has only magnified the systemic
barriers to health and how they're particularly worse for these
much groups. But it has been existing, and there are
certain areas which have been completely overlooked, you know, for years,
(12:37):
and I believe these complexities demand for accountability, transparency, and
also solutions that transcend health and health care programs as
they've been designed, you know traditionally. Do you have a
take on that, Yeah, So, absolutely. I think, you know,
COVID nineteen has definitely brought to light the disparities and
healthcare and especially the under privileged communities. Initially, when there's
(12:59):
these came out, I I had a theory and I'm
sure a lot of physicians did as well, that there
we're going to be risk factors that when you look
back at the thousands and hundreds and millions of patients
have been affected, who has been affected the most? And
there have been some small studies that have come out
of the States and globally that African Americans, people with obesity,
people with smoking, you know, are the ones that are
(13:21):
affected most. And some of these things like smoking smoking cessation.
Preventing smoking is a very simple task that you can,
you know, start with public health, and some countries have
done it much better than others. Obesity, especially in the
United States, is a big concern. But these things have
been really brought to light with the disease and it's important.
(13:43):
It's important that we just don't throw them to the
wayside when this disease is controlled. So I think it's
a great point that you bring up. COVID nineteen definitely
has brought to light a lot of the disparities in healthcare.
So talking about COOD, Dr Bashua, you contracted COVID yourself too,
How was it managing your own care while also being
(14:03):
in the same home with your family and your wife
and your kids. And I believe your wife is also
an emergency physician. She is, she's a family physician. But
when I had COVID nineteen, physicians make the worst patience,
by the way, and I think you you'll you'll find
that across the board, we never think anything's wrong with us.
I was practicing an emergency room. I was on a
(14:24):
regular shift. It was a Saturday night. COVID had just
been kind of on the news for the last two
or three weeks. This was back in March of last year.
And I went home and I was pretty tired because
I just brod six ships in a row. And Sunday morning,
I woke up completely fine. Monday, again, I felt a
little bit tired, and I just thought it was from
the weekend. And Monday night, I woke up at midnight
(14:45):
and immediately I knew something was wrong. I hadn't felt
kind of this way in a long long time. I
think the last time I probably felt this way was
when I had the flu, which must have been five
or six years ago, and I had diffused body aches.
I had a pretty pretty bad had ache, enough that
I could barely open my eyes, and so immediately I
went to the spare bedroom and I texted my boss
(15:08):
at one am and I said, listen, I think something's wrong.
I'm gonna come in for a test in the morning.
And at that point, the disease was so new in
Canada that the testing wasn't there, so the testing was
so backlogged. They initially thought my test was going to
come back in three or four days. It actually took
eight days to come back, and when the test did
(15:29):
come back, it came back negative. Luckily, I had was
off for six or seven days, so before going back
to work, I called my boss and said, list of
my test isn't back yet. My disease course, luckily, was
only two or three days, and the body aches, the
headaches completely went away, and I had no respitory symptoms, thankfully,
(15:49):
and so I got to repeat tests the prior quarterback
to work, and my original test came back negative, but
my repeat test came back positive, which means that my
first test was a false test and so luckily my
disease course was very short compared to a lot of
the other people on some of my colleagues as well,
and I was out for about three weeks until I
(16:10):
had a negative swab to get back to work. You
bring an important point that it took you eight days
to get tests back just quarantin NG and this confusing
around things and also talks a little bit about the
unpreparedness that you will have been going through. We'll touch
that topic a little later, but what I also caught
on was that he came back after six shifts like
it's been tough. Right. As an emergency physician, we all
(16:33):
know your work is very important at any point in time,
but specifically during COVID nineteen kindamic, you were saving a
lot of lives. And during the panda maybe we've been
also reading that there's been like chaos in many hospitals globally,
and this comes with rising levels of anxiety and emotional exhaustion,
and I find it as a pity. You know, I
(16:54):
was just doing some research that to date, no research
has focused on the emergency physician ex hidents during the pandemic.
I saw only a few publications coming from China where
they kind of did some studies on you know how
emergency physicians you don't really take the distress. So as
you faced, you know, you are faced with an unpresident
(17:14):
search of critically ill patients showing up at the hospital
without warning. What was your personal experience dealing with it?
You know, working in the emergency room, you do see
the worst, the worst. You're the person that's supposed to
diagnose the life threatening conditions, So that in itself is
hard enough to begin with. And now you throw a
disease in that process where you have to put on
(17:36):
personal protective equipment, which takes time. You have to sift
through the cases that you think are either COVID or
there's something else. It adds another layer of complexity to
your job. And if you do that for a month
or two months, that may be okay. But people get
COVID fatigue and physicians get COVID fatigue, and you start
(17:58):
missing them in cases that you normally would catch. So
it is very hard on the emergency room physician and
any physician in the hospital, the surgeons, the pediatricians, the O, B, G,
y n s. They also have to contemplate is this
patient COVID positive. It is taxing not only on the
physicians in the hospital, but the nurses, the text, the
(18:19):
CT people, the radiology people, even you know, the ancillary
staff that's there. And then you brought up another great
point as to the hospital capacity. Right, so now you
are adding another burden on the hospital system. And I
don't care which country you go to, the amount of
hospital space is not proportionate to the patient population. Right.
(18:41):
We need more hospitals everywhere we go. But the places
that are really really hard hit are the ones that
their population size is large and their hospital capacity is
not equivalent to that. And you look at the news
any day, what are the countries have been hit the hardest,
You know, Brazil, the United States? Right, these are the
countries you can see the dispairy there. So it's not
(19:03):
only taxing, I would say, on your physician, but it's
also taxing on the hospital itself. I was reading more
about Italy living in Switzerland. You know, I have more
contexts in Europe, but also you know a bit in
the US that multiple patients will just show up, and
you know that would mean that you would have to
kind of give care at the same point in time.
To multiple people, and and it's evident, you know, like
(19:23):
you're saying that critically ill patients have been far greater
in number than the life saving equipment itself. Right, the
vent leads the hospital beds, montree equipment and all of
these things, and then compounding appropriate ppe s that you're
talking about, for instance, and you do talk about the preparedness, right,
you know, the hospital space is less than what it
should be. What do you think there could have been
(19:45):
around better preparedness and response? If we just turn back time,
what could have been done which could have made this
a little bit better as a situation. You know, preparedness,
especially when we've never dealt with anything like this before,
is relative. And in the emergency room we have a
special department called the disaster preparedness and by that I
(20:06):
mean we treat for environmental disasters or chemical disasters. There's
never been any type of training for a pandemic disaster,
or even for the hospital for that matter. So looking
back at it, how could we have prepared for this?
It shows that the hospitals one are not ready for
the capacity for patients. And that's what we can see it,
(20:28):
which is pretty evident. Number Two, we weren't ready as
far as personal protective equipment. But I think the biggest
thing would be to look at our everyday operations as
a hospital and as physicians. How do we treat people
who have normal conditions, yet we have to be aware
(20:48):
about COVID. How do we treat the heart attacks and
the strokes? What do we have to do differently? Right?
So I think moving forward, we have to think outside
the box to prepare for these things. And mainly I
think the big thing is getting the hospital capacities up
to par to deal with all the patients. And I
(21:08):
think a lot of countries already doing that, especially here
in Canada. And you talked interestingly also about the stuff
and you know a lot of the physicians within the
hospital itself, and would you like to talk a bit
about emotions, stress, anxiety, moral injury and even the department
culture change during the pandemic? Right? I mean, how do
you keep all those healthcare support functions and stuff motivated
(21:32):
to keep going. It's a tough job. It's a very
tough job, you know. It's I think the emotions is
the biggest factor that we all have to I think
control and also deal with. I think it's something that
we have to talk about. I'll give you an example. Recently,
I had a patient who was presumed to be COVID
positive was not breathing too well, and I had to
(21:54):
put a breathing tube down to help them breathe. And
when I came out of the room, we have a
system where the nurse is watch us, and we watch
the nurses as we take off our protective equipment as
to not to contaminate everything. And I was taking off
my equipment and my unit secretary came to me and said, hey,
the patient's husband is on the phone, which, by the way,
(22:15):
I think we should also talk about that patients families
are not allowed in the hospital, which is a big anxiety,
especially for the patient, but also for the families. Imagine
sending your family member in and you have no idea
what's going on. So, as I was taking off my equipment,
I forgot to take off my mask, which technically is contaminated,
and I went to the seat and I put it
(22:36):
onto the desk and my nurse, who's one of my
outstanding nurses, asked me to dispose it properly, and I didn't,
and I kind of brushed her away in a sense
that hey, let me deal with this patient's family, which is,
you know, obviously concerned, but I should have dealt with
her concerns as well. So there's this aspect of emotions
are running high with everyone, but it's such a stressful
(22:59):
time not only to the families, but to the physicians,
to the nurses. So you have to be mindful of
a lot of the emotions that are going on in
the hospital, especially when people are extremely sick. I think
that's the hardest aspect to deal with is you're not
sure you know who's feeling angry or who's feeling upset,
but you have to be there pretty much for everyone.
(23:20):
In the context of what you're saying in your story,
I was just reading that the burnout rate of doctors
practicing emergency medicine and specific is estimated to be about
eighty six percent according to a recent survey by Canadian
Association of Emergency Physicians, And also recently one doctor's death
in Quebec, Canada, where you know, she committed suicide, and
(23:42):
that sent shock ways in the Canada's medical community. The
point I want to just kind of bring in here
is it's not just we are poorly prepared in terms
of infrastructure. We're also poorly prepared and little aware of
the potential devastation of the health care communities worldwide. Right,
what's your take on that. When I was working in
(24:03):
Florida and I was part of the administrative staff of
the hospital that worked at I brought up this exact topic.
I said, we need more support for physicians dealing with
kind of the everyday emotions that they have. There was
no support system if a physician felt suppressed or angry,
There was no wordy for them to go to write.
The hospital had no ancillary staff for them. We don't
(24:25):
have that here as well, right, So it's a huge problem.
Imagine going to an emergence room and your physician has
worked eight days or nine days in a row, and
they are back after six hours of work. Do you
really want them taking care of you? Is there a
chance that they missed something? Absolutely? So, there is very
little support for physicians as far as their emotions, and
(24:47):
it's a big problem because it definitely affects performance and
anything you do. You look at sports players, you look
at anything, it's the same. Right, you need that support,
especially in high stress situations, and so there is disparity,
and I believe the numbers that you've looked up, I
think they're probably at that number. Would you like to
share some of the toughest moments that you've faced as
(25:08):
as as an ear physician during COVID times where you
felt helpless, powerless and you wanted to help patient that
you could not help. Do you have any moments of
grief in any story to share? Yeah, I'll actually have.
I have two stories. One is COVID related, one is
not COVID related, one of which was not my story,
but I felt for the physician because I trained with
(25:31):
him and he's a good friend of mine. And he
went off to l A County to be in attending
and he's been there for about six or seven years,
and he called me a month ago and he seemed
very down. In l A County is one of those
counties have been hit extremely hard because their patient population
is so large and their capacity so small that they
have actually told some of their e M. S personnel
(25:54):
that if a patient has known to be COVID and
they have a lot of comorbidities and they appear extremely sick,
to consider not transporting them to the hospital because their
hospitals are so full, and and they obviously have to
talk to the physician who was there at the hospital
and give the vitals in the scenario. But I remember
(26:16):
my colleague who called me after his night shift. He
said that he got a call from the paramedics that
it was his neighbor that they called in, and he
his neighbor actually was picked up and on the way
that the hospital passed away. And so you know, it's
one of those things that as emergency physicians, you see
death all the time and you almost get immune to it.
(26:38):
You kind of brushed it off. But I could feel
the pain in his voice, and it was one of
those things that initially you feel the pain, but then
it just becomes numb. And I had a similar case
which was not a COVID case. The actually just happened yesterday.
I had a patient who was a thirty four year
old who was a mom of two who actually saw
(27:00):
my wife as a doctor, and she was complaining of
donald pain and my wife ended up getting an ultrasound
and the ultrasound was concerning for a possible new type
of cancer, and she was sent into the emergency room
because we needed to do a CT scan and when
we did the CT scan, we confirmed the diagnosis. But
because of COVID, the time for her to get referred
(27:23):
to oncology is going to take some time. And I
remember just sitting with her and I I cried with her,
you know, because this is something that shouldn't you shouldn't
have to wait for. You shouldn't have to wait for
seeing an oncologist and getting treatment started just because the
virus is out there in a thirty or four year
old mom with two kids. It's something I head home
(27:44):
and it's just one of those things that in a
normal world without a pandemic, this would have been dealt
with much faster. Moving on a bit into to come
as an ear doctor, are you also seeing any spike
in other non related COVID cases? Is that putting a
(28:06):
strain on the hospitals as well? Absolutely? You know that
we have right now in Ontario where I work, stay
at home order at least for thirty days. And you know,
when you have a pandemic like this, the diseases that
should be brought to light are not brought to light.
So for example, people who have adal pain are scared
to come to the hospital because of COVID nineteen, and
when they do come in, they have the most severe
(28:28):
problems that should have been dealt with a month ago
or two months ago. I recently had a case of
a person who had right lower quadrant pain and they
clearly had appendicitis, and they sat at home for four
days and now they're a penicetis ruptured and now they're
in the hospital for a couple of days because that
rupture causes them to become septic. So these common diseases, appendicitis,
(28:49):
heart attacks, strokes, gall bladder problems, these should be dealt
with because their emergent and people choose not to come,
which is rightfully so, because are scared of COVID nineteen
and the government has told them stay at home. So
it's a very big problem because common diseases are being
missed and common diseases are going to the extremes, so
(29:12):
it's more of a burden when they come in this late.
I want to hand we talk about these diseases and
where people are not even coming to the hospitals because
they want to feel safe, as well as we talk
about healthcare workers and physicians who are you know, kind
of doing so much more to just get through the day,
you know, and at the same time, I want to
have your perception about general population, you know, how they
(29:34):
are reacting to the measures in place globally, you know,
to contain this virus. You know who could be actually
influential in getting these numbers down, like wearing masks, you know,
keeping distances, etcetera. You obviously do understand disease more than
any other man on the street does. But how do
you respond to, you know, people not really taking care
(29:54):
on these measures. Yeah, you know, it's hard because I
came from a place called Florida, which a lot of
people in that state have not taken this disease seriously.
You have extremes in that state of the very very
old people who are very susceptible disease, and a lot
of young people, especially in Southeast Florida, who don't think
that the disease is actually true or there it's not
(30:16):
going to affect them. And then you have people that
are kind of in between that do wear masks that
sometimes comply with the regulations. One of the reasons why
I came to Canada was because the Canadian belief do
what's right for others, put others in front of yourself,
and I really appreciated that about my family and friends
(30:37):
that were up here, and I wanted to be more
like that. It's hard because it's hard to get everyone
on board on the same page. And even as simple
as mask wearing, that is probably one of the most
simplest things that anyone can do, or even social distancing,
right distance someone by six ft. It truly doesn't sound hard,
but no one does it because I think it's in
(30:59):
human nature to try to do the opposite. If I
were to pick and I know there's a lot of
weapons now against COVID nineteen. We have social distancing, we
have mask wearing, we even have vaccines. Out of all
those things, I think the biggest thing you could do
is social distance. If I didn't have the vaccine, I
would social distance, and if I couldn't social distance, I
would wear a mask, and finally I would get the vaccine.
(31:21):
I think that is probably the last restore because it's
going to take time for the vaccine to roll out.
There's a lot of people out there that don't believe
one in this virus and number two in the prevention
of this virus. But you can see the numbers on
the news, and you know, I don't joke with people,
but I say, if you really don't believe this, come
to an emergency room and let me show you a
(31:43):
lot you're talking about is really the personal accountability and
social responsibility. But I imagine you guys a healthcare workers
on frontline, especially on top of that with COVID, you
have an extra challenge being at a higher risk of
contracting the disease. I mean, I've seen some pictures wearing
face eels and moon suits and all that gear to
protect yourself. And we are such a visual society. If
(32:06):
we if we haven't seen those struggles of health care workers,
we believe you know, it's not happening, right. So I
take your point to that and do take pictures from
there and maybe post it. I think it's going to
really work, because we need a behavior change in people.
In my opinion, let's stave deeper a bit into healthcare
systems in the US versus Canada. I mean, you've worked
(32:28):
in both the places, and one of my questions was
that why did you make a choice to move to Canada,
which you kind of answered, but also what has been
your experience so far working within the two different health
care systems. So I trained in a stakehold Connecticut and
then I moved to Florida for about six years. There's
a lot of major differences between the two countries on
(32:49):
healthcare in general. One of the biggest differences is access
to healthcare. If you make healthcare part of your taxes,
which Canada as. It's a big difference in the preventable diseases,
like we talked about hypertension, diabetes, high cholesterol in years
to come. That prevents people from being hospitalized. And that's
(33:13):
what has made I think Canada so great that everyone
starting from birth has access to healthcare. In the United States,
not everyone has access to healthcare, so you see the
most disastrous outcomes because people don't have management to eye
blood pressure. You see the strokes, you see the bad
heart attacks, and don't get me wrong, you see them
(33:34):
here as well. But it's gratifying to see people know
their medical history, know what medications there on, no the
last time they saw a doctor. So I think preventive
healthcare is one thing. Now. One thing that America is
great at is if you want to have a procedure done,
say you have hurt your d and you tore your
a c L and you want surgery tomorrow, you will
(33:55):
get surgery tomorrow. You have to find orthopedic surgeon and
your insurance resent and they'll do the surgery. Because a
c L surgery is not a mergent here in Canada,
you may have to wait a couple of months. And
I personally have not heard my a c L, so
I'm not that picture. But if I were to, I
would say I'm okay with waiting. I'm okay with waiting
(34:16):
four or five months because someone out there needs more
emergent treatment. That's kind of that sacrifice for the greater good.
But I have an analogy for US healthcare in a
sense that it's like Amazon. Right you clicked the order
on Amazon, it's there in forty eight hours. If you
want something done in the United States, you will get
it done in the United States, but you may have
to wait in a lot of socialized healthcare settings, and
(34:38):
it's a trade off. Some people don't want to wait
for that and some people are willing to wait for that.
That's a great point to touch on access to healthcare,
and here living in Switzerland, I mean, it's one of
the best examples of that as well. I mean it's
really very much silar to what you're saying in Canada
as well, perhaps the most talked about topic right now,
and would love to get your views on it. I'm
sure you've been asked a hundred times what do you
(35:00):
think about vaccines and do you think of them as
a promise? So? I think vaccines in general have done
a great good in global healthcare. If you look at
diseases like measles and momps, we've done such a great
job with those, and I think that vaccine children has
gone a long way. You look at the Gates Foundation
(35:21):
and what they have done. As far as the COVID
nineteen vaccine, because it's so new, we really don't know
how far it's going to go. We have trials, but
I think in the long term it's probably gonna be
close to what they have advertised, and I think it's
going to be another tool to battle COVID nineteen. Do
(35:43):
I think it's going to be the end all, be
all treatment. I don't think so. I think we have
come to a new realization that viruses are prevented by
distancing and by wearing masks. But I think getting the
vaccine is absolutely going to help in reducing the transmission
of COVID nineteen will absolutely stop the transmission. I do
(36:05):
not think it's going to stop the transmission. I think
eventually a lot of us will get immune to it,
either via the vaccine itself or via herd immunity. But
I think we've come to a realization that we need
to do other things besides vaccines to prevent disease, washing
our hands, wearing masks. This may be a new norm
that we're we're going into. Um it's I guess the
(36:27):
only time will tell. But back to your question support vaccines. Yes,
there have been side effects to some vaccines. As you know,
some vaccines can cause these terrible diseases like GM beret
and Bell's palsy. But in the realm of all the
people that have been vaccinated in the world, this is
a small, small percentage, and I think for the greater good,
(36:50):
vaccines have done a great service to all of humanity. Right,
And I do agree that you know, vaccines is not
the only solution. We have to continue wedding masks and
dick tists and preventive measures need to be done as well.
But in specific to where you are in terms of Canada,
you know, how has been the reaction response there and
throughout how does that look like? Yeah, so you know,
(37:11):
every government is different. Here, we have just recently started
it back in late December, so now it is mid January.
So like a lot of the other countries, we are
vaccinating first the most susceptible populations, which is the elderly people,
you know, compromise, the residents at long term care, the
workers in long term care, and then the high risk
(37:32):
healthcare workers, which would be the I c U doctors,
the emergency medicine doctors, the nursing staff, the ancillery staff
in those areas, the pharmacists. You know, if you look
at all the research throughout the world, these are the
populations that have been affected the most. But I think
Canada overall is doing a great job with what they have.
Obviously everyone needs more vaccines, but prioritizing the vaccines and
(37:55):
distribution of the vaccines, I think Canada is doing a
great job so far in that context. Maybe one of
the last questions I have for you is a little
bit long term, and what we're starting to see is
also a mental health crisis. People are tired of this.
Of course, it's taken a toll on people, So what's
(38:15):
your take on that, and if there's any advice that
you could give to people that would be created as well.
I have not seen this much mental health illness in
my career. My career so far has been a boy
eight years after residency, and in this past year I've
probably seen more mental health complaints and patients than I
have in the first seven years of my career. This
(38:38):
is again a stressful time in all of our lives,
whether it's not even a health care worker, whether it's
a frontline worker, or whether you know, if you're just
staying at home, it's very stressful. So I think this
has shed a lot of light on mental health and
mental health issues. It has probably worse than people who
already have mental health issues, and I think there should
(38:59):
be a big I know candidate here. We have recently
passed and lecture that brings more availability and mental health
to the public, and I think other countries should be
doing the same to follow, because this is going to
be a big problem as we recover from COVID nineteen.
This is a time where you should be helping your neighbors.
You should be lending a hand and calling a neighbor,
(39:21):
calling a friend, and being there for others. It's going
to be stressful for years to come. It's one of
those times that we'll never see again. We'll talk to
our kids about this, and this is a time where
we should be there for each other. Dr Bawa, thanks
for sharing your experiences as someone who has lived this
COVID nineteen experience in terms of physical, emotional and psychological challenges.
(39:44):
You know of working through this pandemic, and you, along
with all healthcare workers on the front lines, they have
experienced significant losses, trauma, grief, and a burden that is
really hard to put in words. So all we can
say is you've been doing a tremendous job and absolutely
deserved all I respect. So thank you. I appreciate you
(40:05):
having me. Thank you so much. Transitioning from Dr bog
Bob an e er physician and hero faced with impossible
decisions day to day whose mental health and well being
are compromised because the health care system is on the
brink of collapse at any given time, and like so
many others, she doesn't have the luxury of taking a break.
(40:27):
We hear from Melizza Rangel and the tragedies she's experienced firsthand,
including the loss of her father. I want to warn
you there is no sugarcoating nous. Melissa was a patient,
a family member who lost her father, and a nurse
who truly empathized with her caregivers all at once. I
(40:49):
want to start with you sharing some fond memories of
your family and your dad. You know, growing up, my
dad was our everything to us, not just I don't
literally say our everything, because he was our father, but
he was our mechanic, our plumber, are you know, our worlder,
our honeymoon. He was a person that was always there
(41:11):
for us. Um My dad was always, you know, the
person that motivated as the most, and even though he
was disabled, he he really was very involved in everything
that we did. And he was a positive influencer in
our lives. And that's something that that I hold dearly
(41:32):
with my heart because it's a something that I don't
ever want to forget. Yes, of course, of course. Now
I want to talk about your experience with COVID, your
personal experience. Can you share with us how it all
started your COVID symptoms. My COVID symptoms started in June.
(41:55):
I had learned that I had got exposed, right, so
I immediately isolated my self. I was feeling very tired,
I wasn't really feeling very hungry. I noticed I was
heavily sweating. Within maybe like three days, I developed a
lot of facial pain. So I did develop a fever.
It was about a hundred and one. Soon after, maybe
(42:19):
like within two days, I noticed that just walking to
the restroom, I was very short of breath. So at
that point, you know, I decided to get a note
to a pulse oxyometer so that I could actually take
my oxygen levels and see where I was at. On
the twentieth, I went to the hospital and one of
(42:40):
the things they did was a they gave me antibiotics.
They gave me steroidse which we're gonna help me with
my lungs. I believe they even gave me a rosa shot.
And then they sent me home and they're like, Okay,
you're still good, Just you know, try to relax. So
were they saying you have COVID or were they just
treating the symptoms not knowing that it was COVID. At
(43:01):
that time, I still hadn't gotten my results. So when
you went to the hospital, one of the main things
they did is that if you had any sort of
symptoms that were related to COVID, you were automatically put
with people that had COVID. So I was like, let's say,
if I would have been negative at that point, I
would have been exposed because of the fact that they
(43:23):
had to separate anybody had the symptoms and put all
those individuals together. So I was in the room with
a whole bunch of other people that had symptoms. Yeah,
that's kind of scary to think of, because you don't
know who's really sick and who's not, And as you've said,
you could be exposing yourself to the virus just by
being there when you're trying to get better. So after
(43:46):
I went to a hospital, I went twice right, because
I kept developing the shortness of breath. Do you feel
because you're young, They didn't take it as seriously maybe
I don't have like um pre existing conditions, so I'm
guessing it was more of a your oxygen is still okay,
you should be fine, which I understand because at that
(44:09):
point there was no rooms, and everybody that was not
hospital was because they were in critical condition. You know,
you have to meet a criteria to get admitted. So
on the third time that I ended up going to
the hospital was because I blacked up. I tried to
go to the restroom. I felt my body shot it
down and I screamed for help. That's the last thing
(44:30):
I remember. And then the next thing, well, my father
was there China to help me, of course, and rush
me to the hospital. I couldn't walk. I felt like
I was suffocating. I was just coughing and coughing, And
you know, the biggest thing on my head was I
just exposed my father. I was very scared, but at
the same time, my dask like, why wouldn't I do it?
(44:53):
You're my daughter? Wow? So um, he's my hero. That's
the love of father has as kids. Yes, so do
you know whether any MC service was called for you
or not? Or do you not remember because you were
passing out? No, my dad didn't call because he knew
that everything was very packed and we had already been
(45:15):
here in the news. There was ambulitis with actual patients
waiting in the ambulances. He just rushed me straight into
the hospital. I mean, my oxygen was in the low eighties.
If I walked and went into the seventies, Like I
was pretty signotic. I felt like if I took any
steps or if I walked, and I was going to die.
(45:36):
It's not something that I wish on anybody. It was
a very horrible feeling. Yeah, I can't even imagine. So
your dad makes the ultimate sacrifice and takes you to
the hospital. Tell us about your experience this time around
at the hospital. When we got to the hospital, they
(45:58):
were a little bit more organized. I remember the first
time I went, there was just a crowd of people outside,
you know, waiting to even go into the e er
or you know, waiting to go in through the COVID side. Um.
When we got there, the lady in the front I
remember that she uh asked my dad what was wrong,
because he's the one that got off, and he's like,
(46:19):
my daughter can't breathe. He's like, we need a wheelchair,
and they they said, well, you grab it, right, So
my dad grabbed the wheelchair. He's the one that wheeled
me into the hospital. Once I was there, they checked
my oxygen levels and at that point they're like, okay,
you can't really walk and I was like, no, I
(46:41):
I can't breathe. And that's where they admitted me. When
I got there, it didn't take that long I want
to say, maybe like thirty minutes max. Before they put
me in a room. And was that room by yourself
or with other people? When I was in the r
I was by myself for two days, and after two
(47:01):
days I shared a room with an older lady who
had COVID and she was passing. Wow, that must have
been tough. How do you feel about the care that
you receive or lack of care if you feel that
way at the hospital. When I was at the hospital,
(47:23):
I I had this one episode where I really needed
to go to the restroom. But at the same time,
we keep hearing code blue, like maybe every thirty minutes, right,
And what does code blue mean? Again? Code blue means
that somebody is unresponsive, they're crashing, they're dying. I mean,
you're pretty much trying to save somebody from dying. Being
(47:47):
a nurse, I know that somebody is going into cardiac
arrest anytime I hear called blue, so I knew what
that was. That day, I can see the nurses running
back and forth and I really needed to go to
the restroom. The thing is that when you have COVID
you're stuck to your bed, your bed bound. Any step
(48:08):
that I took, even if it was to go to
the restroom, I felt like I was going to pass
out and die. I felt really horrible. I was scared
to like pass out in the restroom and just suffocate.
I was terrified. I am not gonna lie. It was
something that was very scary. It was a horrible experience.
(48:28):
I remember calling the cob bell so that the nurses
could come, and they never came. I waited an hour.
I called again and they're like, it's because we're having
a lot of emergencies, which honestly I understood because I
kept hearing all the coding. I tried to hold it
at least I want to say, three hours without going
(48:50):
to the restroom until I just couldn't anymore. So I
grabbed whatever I could and I had to use that
to go to the restroom on my own, in my
bed um and trying not to dirty anything because at
that point, like I just couldn't hold it anymore. Eventually
the nurse got there and she said, I am so sorry.
At that point I couldn't be mad because I saw
(49:13):
her face. She wanted to cry. Like the workload that
she had was too much for her, and I remember
her telling me it's because I have like thirty patients.
So me putting myself in her position, I'm like, if
I have all patients that are bad abound, there's no
way I could provide the proper care for any of them.
(49:34):
I just told her not to worry about it. I
feel bad because I had pretty much made a mess.
There was no way that I wanted to put any
more stress on somebody that's trying their best to help
somebody when I know they don't have the resources to
do it. Wow, you have such a great heart, because
you know a lot of people would not be thinking
about somebody else and feeling empathy at that moment, and
(49:57):
they would just be frustrated. I am a nur, so
I know that they were suffering just as much as
we were. So I was there for about I want
to say, a week and a half, and because we're
all on oxygen and none of us could shower, we
weren't allowed to shower. So when I made a mess,
I asked her, you know, I know it that you
(50:18):
have a lot going on, and I know that you
cannot help me. I'm like, but can you at least
bring me a new basin with water and soap. I
told her I would like to like clean myself, like
you know, at least do a bed bath on my own,
and that is what I did. Um, I did a
bed bath on my own, and she did bring me
the like the little tampoo and everything so that I
could try to do it on my own. So eventually
(50:41):
you started to get better, right, yes, any time that
I tried to breathe, like you breathe in and you're
taking that guple there, but when you have COVID, it's
like you try to breathe and it's just stuck and
it doesn't go into your lungs. And that's how I felt.
Twenty four hours after I had last uh, I actually
was able to take my first breath by myself, and
(51:05):
I was shocked. I'm like, Okay, this is actually working.
So tell us about the progression of you getting better
and what was happening on the opposite end of the
spectrum with your father. So when I was getting better,
my dad started to get worse. He started developing a
cough and then my son would call us and he's like, oh,
(51:27):
his oxygen's eighties um where he started dropping even more
and then his blood sugar started rising and at that
point it's like, okay, we need to take him to
the hospital. So my sisters called the MS so they
can pick up my father. And then maybe two hours
passed and E M S never came. My sisters called
e M S again and e MS told him that
(51:48):
there was no space, that they couldn't pick it up,
so they canceled the ambulance services for my father. At
that point, my sister came immediately to pick up my dad.
She full ppe and rushed him to the hospital. That
was the only option we had. Wow. So when he
got to the hospital, do you know how long before
(52:10):
his symptoms got worse. He was in the e er
for three days, and his symptoms started getting worse the
day that he was supposed to be released. My dad
was never able to get pastma right away like I was,
because there wasn't anymore. I tried to donate myself, but
(52:31):
because I had just had COVID, They're like, you don't
even have anti bodies yet, it takes a while for
your body to develop them. I wanted to see my
dad old, and I knew that he had diabetes, and
I knew he had had retention, so I knew at
one point this was gonna probably kill him. But I
didn't think that COVID, which was a virus that appeared
(52:54):
out of nowhere right, was actually gonna take what we
cared for the most, which was my father. It really
broke my heart over all, the fact that we couldn't
be there to hold his hand, and we couldn't be
there at all with him. It still seems very surreal,
like it seems like it's all alive, like it's fake,
but it isn't. A lot of people are like COVID, Joe,
(53:17):
COVID is, It's not real. I had COVID and I
had no symptoms. Okay, well, some people really don't have
symptoms and they are lucky and they are fortunate. But
for those who have gone through COVID and have experienced loss,
it is something that you don't wish on anybody. It
is something very hurtful and it's very real, and it's
(53:37):
something that I hope that a lot of people really
really really make sure that they're doing everything in order
to not get sick. And just if you know when
you leave home, you know Hug, Hug those people you know,
Hug your parents, Hug your families because you don't know
if you're gonna see them next or if you're never
(53:58):
going to see them again. At this point, this is
what has come down to, and as sad as it is,
it's what's going on right now. I'm so sorry about
your loss. I am sorry about your experience. I'm sorry
that you missed opportunity to receive the care that you
deserve in the first world country. And you know, I
understand you have empathy for the nurses, but you know,
(54:21):
at the same time, it's heart wrenching to hear that
you weren't able to be taking care of the way
you should have been taken care of. My favorite thing
when you were talking about your dad is how your
face lit up. You're sharing your memories of him. How
would you like for us to remember your father? My dad?
(54:41):
He um, he was the best. He was the best.
I just want everybody to remember him as a person
that always um gave us a hot twenty body, strangers
or a strangers, anybody on this read. He would actually
(55:01):
stop and you know, try to help those in need,
even though we didn't help much. My dad did a
lot of things for a lot of people, and I did.
What I wanted to remember the most was how he
always had a smile. Can you imagine having a family
(55:26):
member denied ambulance service? What about being in the shoes
of an e er physician who has to decide where
to allocate limited resources and your decision means the death
of somebody else's family member. How about having a heart
so strong that you can actually separate your personal loss
and suffering from the pain that your caregiver's experience. As
(55:50):
we heard from Melizza, folks, things will get better, but
we have to be serious about these lessons. Our health
care system was not built to weather this storm arm
even if we're supposed to be the shining city on
the hill. To continue shining, we need to continue the
progress towards health equity and meet this moment wide eyed.
(56:11):
We need to improve resources to our local health agencies,
as we continue to say, and we have to have
a better plan for our frontline heroes to cope with
the decisions and the trauma that they've endured and will
inevitably continue to endure during this pandemic. At the risk
of sounding like a broken record, I want to remind
you of something. As hard as it is to wear
(56:32):
a mask to separate from your friends and loved ones,
and as much as your life has been disrupted from
this pandemic, every decision you make is life or death.
I'm not trying to sensationalize this. The decisions that you
make today, if they don't affect your own family or you,
they affect someone like Melitza or Dr Boshbab, So please
(56:53):
consider their stories and the impact of your decisions. Thank
you so much for joining us again. We'll keep bringing
truth no matter how hard it is, and we'll see
you soon. Listen to Contact World of podcast on the
(57:14):
I Heart Radio app or wherever you get your podcasts.
H
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