Dr. Bri Budlovsky, a physician in the Emergency Departments at Royal Jubilee and Victoria General hospitals shares her perspective on what it has been like in our hospitals and what it has meant to be a care provider during COVID-19.
Our hospitals and caregivers made extreme sacrifices to keep our community safe
Dr. Budlovsky: A number of physicians moved out of their homes for a period of time, renting apartments, staying in hotels, or creating makeshift suites in their houses so they could effectively quarantine themselves away from their family members as to not inadvertently expose them. There were a number of families that sent their children away to live with either friends or family members that could avoid community exposure and isolate more readily than those working on the front lines. Most of us showered at work, changing into travel clothes before heading home in our designated “COVID car” if we had the luxury of owning more than one vehicle. We would use a separate entrance to get into our homes with Lysol wipes in hand before heading into the shower again, bagging up our travel clothes to wash them immediately before saying hello to our families. A lot of us also lost child care either because our child care providers didn’t want to be exposed to us or because we didn’t want to expose them. I for one changed my shifts all to night shifts so that my husband and I could spell off on child care and didn’t have to rely on family so that we wouldn’t inadvertently expose them to the virus.
Our care teams went through lots of changes in-hospital including information sharing, new PPE regulations, physical hospital renovations etc.
Dr. Budlovsky: In the early days of the pandemic we received over one hundred emails a day with snippets of information about new research, data and new guidelines which eventually developed into a better, more central process to get information. We were also receiving practice Personal Protective Equipment (PPE) sessions where we tried to put on our many layers of PPE without contaminating ourselves. Most of us had more than one respirator fitting, as there were threats of PPE shortages and so we wanted to ensure that we had a backup should they run out of our best fitting mask size. The ER department physically changed dramatically as well with lightning speed renovations done to erect walls and doors to create hot (higher risk of possibly having COVID) and cold zones (lower risk). We also divided physicians into those who would be considered higher risk for severe disease and lower risk, privately of course based on their age and medical conditions.
Our hospitals and staff managed an unprecedented spike in admissions
Dr. Budlovsky: People were afraid to come in to the hospital for help. At the same time, unfortunately most GP or family doctor offices and walk-in clinics were closed to in-person visits. This change in access to care made many people delay their visit to the hospital even if they needed us. To understand the increase in admissions during COVID, I ran a visit report. During a 14-day period last year, the Royal Jubilee Hospital saw 1,300 patients in the ER, the lowest number being 78 patients in one day. For the same time period this year, we saw 2,300 patients, the lowest number being 131 patients in a day and the highest being 190 in a day. This works out to about nine or ten patients per shift last year versus 24 this year. It was only really a matter of time before we started seeing patients facing some of the consequences of delaying their care including people suffering from heart attacks and strokes coming in days after symptom onset, or people who had respiratory illness who were afraid to come in (whether they were afraid that they would contract COVID in the hospital or they didn’t want to expose anybody if they in fact had COVID). And then of course even further along, a surge in mental health issues due to anxiety, social isolation, changes in routine, and lack of access to outpatient care. And now time has progressed and there is far less surprises about COVID both with its management and now with the numbers dropping we’re finally starting to take a bit of a breath. While the variants are obviously still a cause for concern, we know the vaccinations work and the rates are incredible and I think that we’re all feeling very excited about how the uptake has been so incredible here in British Columbia thanks to our leadership and our sort of community thought for for each other.
From banging pots and pans to helping equip the new High Acuity Unit, our community’s and our VHF donor support was felt inside the hospital
Dr. Budlovsky: Early on it was it was pretty magical. It was tears every night for most of us. It was really quite overwhelming to feel the recognition from our community. It was not only just pots and pans at seven o’clock, but people would come by the hospitals every night and banged them outside of the ER and we would go out there, and there was a police parade there, a bagpipe marching band, delivery of meals that was all so incredibly moving. It really sustained us when we were feeling frightened and trying to anticipate what might happen. It showed us were all in this together. We feel appreciated and seeing our community members follow mask guidelines and seeing the rates of vaccination in our community rise, it all feels like a thank you as well.
It would be great if we could have a High Acuity Unit (HAU), a place for patients who are not well enough to be on a regular medical ward but are still getting checked on a number of times a day. During the pandemic in particular, the HAU is even more valuable because COVID can cause very low oxygen level (hypoxia). Early on, we were seeing people come in with oxygen levels extraordinarily low and saw that we needed to intubate or put people on ventilators. As time wore on and we had some experience and data to put behind our decision making, we realized that these people tended to do better with positive pressure ventilation or external mask ventilation as opposed to a tube and that is best managed in an HAU and the ICU because it’s so specialized and our caregivers have the right training there. The HAU allowed us to care for more critical patients with more space which was absolutely invaluable. It also doesn’t just focus on our need now, but will help us plan for potential need on a provincial basis as well. We’re so grateful for this new space and so proud of our community and the generosity of donors who made it possible.
Our hospitals are now seeing an increase in mental health and substance use patients
Dr. Budlovsky: We’re seeing an increase in people seeking mental health and substance use care. Some of the increase is just the march of time and the growth of our population and unfortunately rates of substance addiction and abuse but certainly COVID has had its effect. It changed people’s routine, changed access to care, increased isolation and interpersonal stress. It has led to quite a surge in young people not going to school, not being able to socialize in normal ways. COVID has had a big impact and we see it in the ER. The Victoria Hospitals Foundation’s new campaign Equipped to Heal and the resources it will help fund is just an invaluable resource moving forward. Unfortunately this issue is not going to go away without work and so having the resources to be able to help people to this higher capacity will be huge for our patients. Thank you to all who are supporting the Foundation’s newest campaign.
Dr. Bri Budlovsky is an ER physician working in Emergency Medicine at the Royal Jubilee and Victoria General Hospitals, and also runs a private cosmetic practice. Dr. Budlovsky received her Bachelor of Science with Honours from McGill University, and her MD from UBC Vancouver. She completed her specialty in Emergency Medicine at the University of British Columbia and is a fellow of the Royal College of Physicians and Surgeons of Canada. She obtained a degree in Medical Education with the University of Dundee, and is a Clinical Instructor with the UBC Faculty of Medicine.
Doctor Bri established a large social media following during the early stages of the pandemic (@doctorbri). She was recognized by VIATECH as a COVID-Hero for her efforts in combating fallacies and misinformation via social media, and for keeping people up to date on the local response. Dr. Bri aims to educate her followers, debunk common myths and train critical thinking, so that they can make medical (and aesthetic) decisions from an informed stance. She prides herself in being clear, accessible and honest in her recommendations, and stands out in the local medical community for her transparent and collaborative approach to the field of aesthetics and trusted relationship as an expert within the local community. Above all, Bri is a healthcare hero – truly an inspiration to the community for her selflessness as she leads a front line team during this pandemic. She is adored by many inside and outside of the hospital walls, including her Victoria Hospitals Foundation colleagues.
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