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A State of Emergency

I’ve been an ER doctor for 39 years, and my department has never been closer to collapse. We’re not alone.

A few months ago, a middle-aged woman in seemingly fine health came to my ER, feeling under the weather. She had called her family doctor, but he was booked up and couldn’t see her for six weeks. I treated her instead, and when I pulled up her records, I saw a recent scan ordered by that same doctor, the results of which she hadn’t yet learned: cancer, already too advanced to cure. It wasn’t just one tumour; they were everywhere. It was up to me to tell her she had a handful of months, at most, and she should start getting her affairs in order.

There was nothing else to do but hold her as she cried. She asked me what would happen to her spouse—who is older than her and dependent on her—when she was gone. More than anything, I wanted to say I could get her another year, or two or five. Instead, she heard the hardest news of her life from a stranger wearing a mask and a shield, in an exam room steps from the noise of gridlocked hallways and a packed waiting room.

For 39 years, I’ve worked as an ER physician at Great War Memorial hospital in Perth, Ontario, part of the Perth and Smiths Falls District Hospital. After all that time, I’ve become intimately acquainted with life’s fragility—how any of us can be here one moment and gone the next. That’s part of the job. But medicine shouldn’t be so ugly and upfront and harsh. Patients shouldn’t have this kind of news delivered in an overcrowded, underfunded emergency department by a person they’ve never met. More and more often, however, these heartbreaking, infuriating scenes are playing out in my hospital and in countless others across the country. Why? In part because the pandemic delayed checkups and put routine scans on the backburner. More patients discovered how sick they were, or that they were sick at all, during visits to ERs that were already struggling and in no condition to substitute for day-to-day health-care providers.

Yet we can’t simply blame this crisis on COVID—that’s the easy way out. Canadian health care, both primary and emergency, has been buckling for decades, and I’ve had a front-row seat to its slow collapse. For the past 21 years, I’ve been public affairs co-chair of the Canadian Association of Emergency Physicians, the professional association for Canada’s emergency doctors. I’ve always seen our emergency department in Perth as a microcosm of Canada. Everything that happens here is also happening in the roughly 850 emergency departments nationwide: overcrowding, staff shortages, violence, abuse, burnout, patients warehoused in the ER because they can’t get a bed. What happens in Perth happens everywhere, and what’s happening in Perth has never been as bad as it is today.

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On newsstands now: 

Inside Canada's urgent-care crisis

I’ve been an ER doctor for 39 years, and my department has never been this close to collapse. We’re overcrowded, underfunded and short-staffed. And we’re not alone.  

Also in this issue:

• Uncovering a Calgary schoolteacher's legacy of abuse 
• The Interview: Gabor Mate on the mind-body connection 
• The Leonard Cohen you didn't know 

Check it out