ICU staff battle patients' regret, denial and mistrust during Quebec's 4th wave

Eighteen months into the pandemic, Joanie Bolduc-Dionne never imagined some COVID-19 patients would question or fight with hospital staff about what medical treatments needed to be done to keep them alive.

"Either people are in denial or aggressive against the staff because they think we are exaggerating the situation or that things aren't as bad as we're telling them," said Bolduc-Dionne, the head nurse in the intensive care unit at Cit-de-la-Sant hospital in Laval.

She recalls a 30-year-old pregnant woman, who refused to be oxygenated even though her levels were plummeting.

She eventually had to be intubated and transferred to another hospital to receive specialized care called ECMO, a machine that removes the patient's blood so it can be oxygenated and then pumped back into their body because their lungs are too damaged.

Since the fourth wave of COVID-19 began at the end of August, the ICU is seeing an increase in younger patients in their 20s, 30s and 40s. Most are also unvaccinated.

Some of the patients tell staff, "'I didn't think it would happen to me, I didn't think it would get this bad,'" said Bolduc-Dionne. "They have regrets because they notice now it's too late and they are here."

The conversations around treatment can be tense.

"A lot of 'leave me alone, I'm OK'," said Dr. Joseph Dahine, an intensive care specialist.

It gets more difficult as the person deteriorates.

No one wants to be put on a ventilator, but most people understand they will die without it, said Dahine.

But during the fourth wave, he said staff are encountering patients who resist being intubated due to mistrust and scepticism.

"They don't trust that it's going to help them and we never used to see that," said Dahine, who thinks some of their doubts are rooted in misinformation and conspiracy theories. "It's just disheartening."

One of the more upsetting cases recently involved a 60-year-old patient, who died a few weeks ago.

Prior to catching this virus, he was fit and healthy. But he had listened to a podcast and decided not to get vaccinated, said Dahine.

The man's wife was fully vaccinated and worked in a vaccination clinic. Yet, not even she couldpersuade him to change his mind.

Delta variant more virulent

Since the fourth wave began, Bolduc-Dionne estimates between 85 to 90 per cent of their ICU patients are unvaccinated or not fully vaccinated.

Against the delta variant, which is highly contagious, one dose is not enough, she says.

That was the case for a 44-year-old patient who got his first dose at the end of August.

He caught the virus before he got his second jab.

By the time he showed up in the emergency department in early September, Dahine said he was in such bad shape, he had to be intubated immediately.

Three weeks later, he's still on a ventilator in the ICU. His condition is complicated by kidney failure, which requires dialysis, and a new bacterial infection.

The man's wife told Dahine she doesn't know how she'll raise their children alone if he dies.

"It's heartbreaking," the doctorsaid.

In previous COVID-19 waves, younger patients would typically begin to recover after a week or two on a ventilator.

But the delta variant seems to progress differently, said Dahine.

The patients show up sicker and, rather than showing signs of improvement, some patients suddenly go downhill around week three.

"Some of them have died actually," said Dahine.

One man never reached the ICU.

Last month, a 39-year-old man with COVID-19 rapidly deteriorated and died in the hospital's emergency room. He was unvaccinated.

Patients regret not getting jabbed

Clairefane Martine Delly works as a nurse on the COVID-19 floor at Cit-de-la-Sant.

Although there were quiet stretches during the summer, the rooms are once again full.

Some of the patients have told Delly they didn't think they would get sick or were scared about the vaccine's side effects.

"Most of the people who don't have the vaccination, they want to take it now," she said. "They change their mind."

A positive COVID-19 diagnosis can turn families upside down.

Recently, an unvaccinated couple in their 30s had to be hospitalized due to the virus. Their 10-year-old son also tested positive and was admitted to pediatrics.

That left their remaining child, who was five or six years old, alone.

The family had no relatives or close friends in the country to care for him.

Eventually, youth protection services found an acquaintance to take him in, but it was stressful for everyone, said Beverly-Nata Mus, head nurse for the COVID-19 dedicated unit on the hospital's third floor.

When the father was discharged last week, he told the staff he regretted waiting so long to get vaccinated and for waiting so long to come to the hospital after he started feeling really sick.

"During his hospitalization, he convinced his entourage to be vaccinated because he was proof of what could happen," said Mus.

Patients become the messengers

It's frustrating and hard on staff morale to see severely sick patients coming in with COVID-19 who could have avoided the ICU if they had gotten vaccinated, said Dahine.

If he could, he would invite anyone who doubts the suffering and distress the virus causes to come and see for themselves.

But he's reassured when he hears about patients or families who convince their loved ones to get vaccinated because of their experience.

"They become the messengers," said Dahine. "Yes, someone had to pay the price, but maybe we avoided several other people from ending up in the same situation."