My respected colleague has not only been there on the front lines delivering exceptional care, but has been part of planning how to look after as many patients as possible. He also has a flare for understatement. Please protect our most vulnerable until they can be vaccinated. https://twitter.com/ahs_media/status/1343225126515593219

I think we would all love to show you the inner workings of our ICU. Sadly, we cannot. It would violate our code of patient confidentiality. If you could see it, you would be as conflicted as we are.

For the uninitiated, there would be shock. Being placed in a coma, and on a ventilator is one of the most dehumanizing things I can imagine. You would soon realize that those who nurse our patients combat that reality by being some of the most compassionate souls I know.

You would meet our respiratory therapists, who have had to relearn everything they thought they already knew. COVID-19 is a new disease with new paradigms, but through every high risk intubation, they are right beside me ensuring things go smoothly.

You might bump into our physiotherapists, taking one of our patients for a walk around the unit while on a ventilator. Early mobility reduces delirium and strengthens our patients so the can get off ventilators faster.

Our pharmacists are an essential part of our team, ensuring that we pick the right antibiotics for the job and ensuring that harmful drug interactions do not occur. Our dietitians wage war against malnutrition and constantly make sure our patients don’t wither.

You would see three teams staffed by an attending physician , with nurse practitioners or resident physicians rounding on all the patients ensuring that all medical issues are covered and collaborating with the bedside nurses to solve problems and advance care.

You would also see our expansion into the operating room’s recovery area. It is a communal space where our sickest COVID patients are cared for. Everyone is nursed in the open, and they are all heavily sedated. You would see us team up and sequentially prone all of them.

You would be concerned about the lack of privacy, as are we, but it’s a trade off to ensure everyone has access to a critical care bed. We endeavour to transfer weaning patients back into the main unit as they recover and wake up.

You would be amazed at the camaraderie of the staff in the COVID unit. Everyone gowns up and helps each other out. The moral is impressive, but always tempered by the knowledge that some of our residents are slowly getting worse despite our best efforts.

What you would not see is our Rapid Response Team. They have always been roving the wards fixing problems before the require ICU involvement. A specially trained team of composed of an experienced ICU nurse and respiratory therapist solve common urgent calls independently.

They consult with an ICU physician when things fall out of their scope. They are our early warning system and a boon to patient care. However due to the sheer number of sick patients on the ward we have brought in a 4th ICU physician to handle all the consultations.

This system allows the doctors in the ICU to focus their attentions on their patients so details are not missed.

I am amazed at how much our system has expanded, and how graciously our staff has been to accommodate these workloads. I am grateful to our management and @AHS_media for organizing and resourcing us. It’s been a remarkable accomplishment.

But, (you knew this was coming) it can only be sustained for so long. Though we constantly plan for more beds, be know that care will be spread thinner as we do. The smiles quiver at the thought of what will confront us in the next two weeks. We know there will be another surge.

We know that January and February has always exacted a heavy mental health burden and the bitter irony is that this year will likely be worse. We are bracing for those consequences as well.

So, how do we make this better? Yes, quarantine measures are incredibly important and remain so, but let us also be kind to each other. Let us be disciplined in our excise routines, our daily walks, our acts of generosity. The days are getting longer, the vaccines are coming.

We will make it through this. And when we do, let’s learn from this and tackle the disparities at the root of this suffering.

I wish you a safe and healthy New Year.