I love being an ER doctor—but the patient load is crushing

I’ve been a full-time emergency room doctor at Calgary’s Foothills Medical Centre and South Health Campus for almost seven years. I love many things about my job: the adrenaline of never knowing what awaits me during a shift, the challenge of providing the right care to people with wide-ranging ailments, the reward of a job well-done when you know you’ve helped someone in need. I’ve always been the type of person who has to look at a train wreck or car accident. Those come to us every day in the emergency room.

I know this is the right career for me. But the work is incredibly demanding right now: the number and complexity of patients in the ER has never been higher, and we are crushed with demand. That’s why I was one of the 190 emergency room health-care providers in Calgary to recently sign an open letter asking the government to increase its support to our health-care system, because our careers as they are now are not sustainable. Family doctors and emergency room physicians and nurses in Calgary—and probably in many other urban centres in Canada—are overworked, understaffed and demoralized.

The job’s always been hectic, but it used to slow down overnight. The night team could catch up and clear the backlog of patients that accumulated through the day. That doesn’t happen anymore. The ER is just as busy at 3 a.m. as it is at 3 p.m. The rest of the hospital is skeleton-staffed at night, so the morning team starts by seeing the patients who have been waiting since the day prior. We are jammed all the time.

Patients typically wait for six hours, but I’ve seen people wait for as long as 15 hours on a busy day, growing sick and impatient in the emergency room chairs. We’re backlogged because our primary care system does not have enough staff and beds to take care of everybody. There are thousands of sick people without family doctors who have nowhere else to go. I’ve seen dozens of people sitting and lying on the floor, while lines of ambulances are waiting outside to carry more people in. Patients are screaming, crying, vomiting; the appearance of it is dehumanizing. Every shift, more people arrive than we can manage.

Our health-care systems nationwide are beyond capacity. We do not have enough hospital beds, we are dealing with a critical shortage of staff and there are 650,000 people who do not have a family doctor in Alberta alone. Recently, I saw an elderly lady who had been waiting for eight or nine hours in the hallway. She had abdominal pain. When we finally got her test results, they were very abnormal. She was dying. Fortunately, we were able to find her a room before she passed away 30 minutes later. I worry that this type of scenario is going to occur more as we struggle to accommodate high volumes of patients with limited space and staff to safely care for them.

During an average shift, I usually bounce around: sometimes I’ll intubate a cardiac arrest patient, then see someone who’s just had a stroke, then speak to someone who is depressed, then assess a patient with a cough for six months. I’ll stabilize people who overdosed on drugs while caring for patients with chronic illnesses like cancer or kidney failure. I’m responsible for them from when they first arrive until they leave the ER. Patients are living longer with serious illnesses because of modern medicine. But if they don’t have a family doctor they often rely on the emergency room for their ongoing care. Because of this, combined with ER staffing shortages and lack of hospital capacity, it takes more time to appropriately assess and treat patients than when I started. I am lucky if I can see 15 people a shift, compared to 20 or 30 earlier in my career. For the ER to not be swamped, it must be the last resort—lately, it seems like more people are seeing it as their only choice.

I also field more and more calls from paramedics bringing us overdosed patients who need immediate attention. People often come in unconscious after using opioids like fentanyl and heroin and require emergency resuscitation. We have to bump them ahead of the triage line because of the severity of their condition. I see many people with alcoholism come in with complications of that condition, such as withdrawal seizures. We treat their acute medical problems and encourage them to seek professional treatment for their addiction upon discharge. But because we cannot do proper follow-ups with them, we can only hope they don’t come back to us days later with the same problem. For many patients with addictions issues, the ER unfortunately becomes a second home.

All of this makes me worry that our primary care system is collapsing in a time when Canadians are becoming sicker. Not only is our population aging, but we have increased homelessness, poverty, mental illness, and addiction in our communities. It’s discouraging to constantly see people in so much pain and knowing that I can only do so much to help them.

We need to get back to a place where physicians, nurses and other health-care professionals enjoy their jobs again. I’m not sure how we will get there. We need more than just money: the provincial government has to improve access to primary care, recruit and retain more health-care professionals, and increase the number of emergency, inpatient and long-term care beds in the province. A system that can support more patients in the community would decrease the overcrowding in hospitals and emergency rooms across the province. That could increase our quality of life, and allow us to recruit new people in the field with a clear conscience that the work won’t be too much to handle.

My work is not to find all the policy solutions. I see myself more as a grunt in the fight against disease. I love what I do, and I find tremendous meaning in applying my skills to help people who really need it. But it’s important that work does not become too overbearing for me to pursue other personal projects. I love spending time outdoors adventuring with my family. Those are moments I want to protect: they allow me to bring my best self to work.

—As told to Alex Cyr