Voice from the ICU

Dr. Jeffrey Betcher writes about his experiences during the third wave in Regina’s ICUs, where he is critical care department head and area lead. He compares a typical day prior to COVID-19, to the preparations taken at the outset as cases began to mount. He traces the ebbs and flows of the pandemic, how events affected him personally and what he has done to cope with the challenges of his job.

By Dr. Jeffrey Betcher, Critical care department head and area lead, Regina.

A typical day in ICU in Regina varies with the units for which I am on service. There are three ICUs in Regina covered by two intensivists and supported by critical-care associates. There may also be a resident on rotation, but this is variable. Typically, the day begins with a brief walk through the unit to decide on potential transfers and to deal with anything that cannot be deferred to the ward round later in the day. The ward round that occurs midmorning in the surgical ICU and Pasqua ICU, and in the early afternoon in the medical ICU, is multidisciplinary involving nursing, physicians, respiratory therapists, a pharmacist, a dietician, and a social worker. Family presence during these rounds is also encouraged to enhance communication. Much of the time outside rounds is spent speaking with consultants and meeting with families for intense discussions about such things as goals of treatment and advance care planning.

At first the pandemic didn’t change the daily routine other than the precautions that needed to be taken with personal protective equipment (PPE) and the isolation of patients. The donning and doffing of PPE required more time when going into patient rooms, most of which occurs outside the time for multidisciplinary rounds. There were times, however, when discussions with family had to take place over the phone or virtually due to restrictions with isolation and visitation. I found it taxing and stressful to have goals of treatment discussions with families over the phone rather than face to face.

The most significant change early in the pandemic was the number of meetings and huddles that occurred daily, including weekends, and the challenge of planning to meet the demand of the initial predicted numbers of patients expected to require critical care. The planning happened on many levels and included nurses and health-care support staff. There was a significant amount of angst over how to provide sufficient coverage by intensivists and critical-care associates to meet the expected patient demand. Open discussion and contemplation resulted in the plan we now have in place. As the summer progressed without seeing the large number of predicted cases, there was a sense of relief.

Things changed significantly with the third wave and the rise of variants of concern (VOC). Regina was spared when other areas, including Saskatoon, saw a rise in cases late in 2020. The third wave with VOCs impacted the Regina ICUs hard with a large influx of patients that required the opening of multiple surge areas and the deployment of extra staff. On a personal level, the third wave was harder as the age demographic was much younger. Some of the patients had young children and, in some cases, had expectant wives. Sometimes, the entire family was in isolation and life-changing decisions had to be made over the phone. It affected me in a profound way as it did not allow for the usual face-to-face meetings where I could get to know more about the patients and their loved ones as I talked with them.

Multidisciplinary rounds took most of the day with little time left for other tasks. Decisions about opening new surge areas needed to be made. The decision was made to stand up a third intensivist so each ICU had an attending intensivist. Decisions of when to stand up, how long to stand up, and when to stand down extra physicians in the face of the ebb and flow of patients was difficult yet needed to be made. Fortunately, decisions like these are not made in isolation and there is support on many levels. It would not have been possible without the support of colleagues in many roles at many levels.

Support for each other has been very important throughout this time of uncertainty. The most stressful and anxiety provoking aspects of the pandemic have been not knowing exactly how it will play out and how to best plan for and anticipate how to handle the surges as they come. Everyone is in the same predicament; many teams have pulled together to work cooperatively to overcome this pandemic. It has brought about the building of relationships throughout the Saskatchewan Health Authority. I suppose you could say it has been the SHA’s “coming of age.”

On a personal level, my faith has been especially important to me in this time of uncertainty, and God has been faithful in guiding me in my leadership role. Another important outlet for me has been my hobby of scale model building. Retiring to my workshop to work on a project has given me a retreat from the pressures of the day where I can contemplate issues that have arisen or simply turn my attention away for a time of respite. I find it to be a creative outlet that is rejuvenating.

The public can be confident in the work that has been done to meet the surges. I would say to them that we have done this to be there for them when they need us, and I would ask that they continue to do their part in fighting the pandemic by obeying the public health orders, wearing masks, getting tested if symptomatic, and getting vaccinated at the first opportunity.

Dr. Betcher was raised in rural Manitoba and attended the University of Manitoba for his undergraduate medical degree. He completed a rotating internship at the Regina General Hospital and joined the medical staff in the Department of Anesthesiology in 1995. He completed an anesthesiology residency and critical-care training at McMaster University before settling into practice in Regina, where he has been for 26 years practising anesthesiology and critical-care medicine. The focus of his practice has shifted to critical care, where he has been the department head and area lead since 2014. ◆