I’m a veteran ER doctor. I can’t believe what I’m seeing.

Dr. Kashif Pirzada has worked in ERs for 15 years and is witnessing the damage from overcrowding and understaffing. “Patients are extremely upset, and I would be too.”

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(Photo courtesy Dr. Pirzada)

Dr. Kashif Pirzada has been an ER doctor in Toronto for 15 years. In recent weeks and months, he’s witnessed the overcrowding and long wait times that patients have been forced to endure. And that was before a new wave of COVID-19. Exasperated with what he says is unclear messaging by provincial governments, he warns that COVID-19 is far from over—and hospital emergency rooms all over the country are bearing the brunt of the crisis. This is his story. 

—As told to Liza Agrba 

Believe it or not, I got into emergency medicine because I watched the show ER in high school. The idea of being someone who could make a difference in a critical scenario—to help people every single day you come into work—was really appealing to me. And that’s what keeps me coming back, despite all the problems we’re experiencing.

Right now, ERs are dangerously overcrowded. Every evening, I face people who have been waiting for six to eight hours, and have to simultaneously assuage their anger with the failure of the system and fix their problem. Being constantly on the defensive trying to explain what’s happening is profoundly demoralizing.

It’s not unusual to come into a shift these days and see that you’re down one third of your usual staffing complement. That means you can’t staff the beds that you have, and you see more and more patients in fewer spaces. When a wave happens, like right now, it starts knocking people out for sickness. They’re off for seven to 10 days with symptoms. And then you cross your fingers wondering who’s going to get long-term symptoms after that.

When we’re stretched too thin, paramedics can’t offload patients because there’s no one to take care of them, so we have 10 to 15 teams of paramedics practising what we call “hallway medicine” before someone can resume care. So you have basically a huge chunk of your active EMS staff sitting in a hallway in the hospital.

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The other thing is that people wait much longer to get help. When the patients do get to us, they’re understandably very upset. I can’t blame them. But we take the brunt of their feelings, and that leads to people burning out and wanting to leave the field. So all of it comes together into a perfect storm. There’s real moral injury from watching a system fail and collapse when much more could be done to shore it up. The system has never been the greatest with ER and specialist wait times, but it’s significantly worse now.

I recently saw someone who had a brain hemorrhage and needed surgery. Since we don’t do brain surgery at that particular hospital, usually we would quickly send them to a neighbouring hospital with an escort of our own staff. This time, we just didn’t have any staff to spare. We had to wait for a special team to do the transfer. They were delayed too, so this person ended up waiting to get urgent surgery. A few years ago, they wouldn’t have waited at all. This kind of thing is happening more and more. And not only are patients waiting—they’re waiting to see someone who’s already overworked that day.

I saw somebody with kidney stones last week. That is an excruciating condition. If we had more staff, we usually try to pick out these people, give them pain medication right away and line them up for a scan to find out where the kidney stone is. One patient waited for about eight hours before getting any pain medication. They were extremely upset, and I would have been too.

The problem is being exacerbated by a resurgence of COVID cases. It’s become obvious that COVID, unfortunately, didn’t end like we thought it would. It’s continuously mutating and trying to evade vaccines and our immunity, and we’re seeing the evidence of that in the hospital. It’s important to stress that vaccines are still preventing serious illness in most cases. But because we keep having waves, our health care system is under enormous strain.

We test for COVID all the time, and up until two weeks ago, almost all of the tests I’d send out came back negative. But in the last two weeks, I started seeing a major uptake in COVID cases—especially with very young and elderly patients. It’s causing a serious increase in patient volume and major delays in the emergency room.

The first COVID case I saw in the most recent wave was a woman in her 60s. She was triple vaccinated and didn’t present any respiratory symptoms.  She had been nauseous for a week and nobody knew why she wasn’t eating or drinking. Her blood work was a mess: she had inflammation all over her body, and then our COVID test came back positive. We had to admit her to the hospital and start her on antivirals, steroids and other medications that we give people with severe COVID to take down inflammation.

That symptom pattern has held true with many other new COVID cases, which indicates that the new subvariant—Omicron BA.5—is different than previous ones. Some people will present with just weakness. Others come with headaches, neck pain and vomiting.

Another case I saw was a woman with a joint condition that had been stable for 10 years. She came into the ER with COVID and a huge infection of one of her joints. COVID seemed to be the catalyst. Viral infections weakening you and leading to other infections is a well-known phenomenon.

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Not only are we seeing an uptick in COVID cases, but we have a reduced capacity for dealing with them. We’ve lost a significant number of experienced nurses over the pandemic—especially in the last six months. We’ve lost doctors too, but definitely more nurses. They’ve had it. The stress has been too much, and I can’t blame them.

It takes years to develop an emergency room nurse skillset, like how to pick someone out of a waiting room who’s going to deteriorate quickly. Losing each one of these nurses is a huge loss, and we’ve lost a ton.

Because of the staff shortages, a lot of people have not been getting leave time approved. A lot of these people end up quitting. That’s a common story among nursing and physician staff right now. Everyone is burning out.

I’ve found the issues to exist outside of the ER as well. Once we discharge patients, we rely on sending people out to specialists to deal with the conditions we find. But now specialists are overwhelmed, too. I saw one lady who had a suspicious breast lesion and couldn’t get in to see anyone for three to four weeks. Can you imagine wondering if you have cancer and not being able to get a biopsy or a scan for that long? In another case, someone had a new blood clot, and we couldn’t get them follow-up appointment for months.

We also get all these patients coming with long-term COVID symptoms: fatigue, heart palpitations, brain fog. The specialists we would send them to—neurologists, cardiologists—don’t have capacity to see people. We have nowhere to send them.

Seeing whole families get sick at the same time is definitely a big theme right now. The lack of awareness really frustrates me: people are happily sending their kids off to camp with no COVID precautions whatsoever, and then a whole group of kids get sick, some of whom end up in the emergency room.

I think the summer weather, with people doing activities outdoors, will keep the damage of this wave as low as possible. But what we’re seeing in the ER is probably a dress rehearsal for what’s coming our way in the fall and winter, so right now is a good time, policy-wise, to plan for that. That would entail making sure that all indoor spaces have excellent ventilation by upgrading HVAC and putting in HEPA filters, and improving messaging from the provincial government so the public knows when they need to mask.

Unfortunately, I think ERs will look like this for a long time unless we find a way to significantly beef up capacity. It’s going to be a longer road than we thought.