Inside a packed B.C. Children's Hospital: How kids, parents and staff are coping amidst virus surge

Michelle Bastin’s three-year-old son Elliott had problems breathing for about a week when she brought him to B.C. Children’s Hospital, but the family had to wait nearly eight hours to see a doctor in the jam-packed facility.

“We came here because his breathing was very laboured, his fever was really bad, and energy-wise he was not doing well at all,” recalled Bastin, as her son lay against her on a bed in the ED, or emergency department, an intravenous tube attached to his left arm and heartbeat-monitoring electrodes stuck to his chest.

“You’re stressed out and no one wants to come to emergency, but you kind of make that decision thinking, ‘I don’t have any other options.’ So you have to do what you have to do. But waiting, you just get concerned.”

When they arrived at B.C. Children’s at 2 a.m. on Nov. 24, a trauma patient was understandably being given first priority by the stretched-thin staff. But sitting indefinitely in the waiting room can be torture for worried parents, especially for Bastin, who had twice taken her son to the ED in a different hospital but his symptoms persisted.

After 6½ hours, Elliott was brought to an examination room, and about an hour later finally saw a doctor. Tests showed his oxygen level was at 86 per cent of what it should be, his heart was beating too fast, and he was likely suffering from serious asthma, his mother said.

While the hospital, like most others in the country, had an obvious shortage of medical staff, Bastin described the people who treated her son as wonderful and patient.

Waiting times at B.C. Children’s have been as long as 12 hours, mirroring the situation in many emergency departments across Canada, driven by an early season of viral infections, in particular respiratory syncytial virus, known as RSV, and influenza. Exacerbating this is an increase in COVID cases, as well as a health-care workforce that is short-staffed and burnt-out by the pandemic.

The ED is usually the busiest in the winter, when kids catch viruses at schools and daycares, seeing an average of 140 patients daily. But over the past week or so, that number has jumped to 150 to 190 children a day, said Dr. Garth Meckler, the hospital’s head of pediatric emergency medicine.

“Honestly, even with all of the challenges that you’ve heard with staffing and increased numbers of people seeking care, I feel, and my colleagues feel, like we are still able to meet the needs of the sickest kids,” said Meckler.

It’s the kids who are less sick who face the longest waiting times. Meckler recognizes that is frustrating for their parents. “We’re empathetic because most of us (staff) are parents as well. And we know that the most important thing to us is our children’s health and when they suffer, we suffer.”

Meckler, dressed in blue scrubs, spoke with Postmedia during a tour of the hospital to witness how staff and patients are handling this unprecedented surge, which could continue for several months until flu season is over.

While her son is recovering well, Bastin is disappointed with those who oversee and fund the health-care system. The previously calm woman began to cry, asking why there was not better planning when governments knew the flu season was coming and there were warning signs this year could be harsh.

And she’s bewildered that health-care workers who toiled through the COVID pandemic are now working long hours again during this national flu epidemic.

“The health-care system has been through so much with COVID, and it’s just absolutely unacceptable that it’s still continuing on,” the Langley mother said. “We should be kissing the feet of all the health-care providers that just got us through the last two years, instead it seems like it’s going the opposite.”

Health Minister Adrian Dix told reporters his government “knew it was going to be a hard season” and made adjustments, such as last month creating a secondary emergency room at B.C. Children’s for less-serious patients.

The NDP government’s handling of this crisis, though, has been criticized.

While Green Leader Sonia Furstenau applauded Dix’s pledge on Sunday to speed up accreditation for foreign doctors, she said steps are needed to address the emergency room chaos right now.

“Currently, the most pressing issue is the level of illness amongst children in B.C., and the dire conditions in pediatric hospitals,” she said.

On Monday, Premier David Eby pledged a new medical school would open in 2026 at Simon Fraser University and graduate much-needed, additional doctors by 2030. But the opposition Liberals said this promise was years behind schedule and will do nothing to immediately help the health care system, which the party alleges is “nearing a point of total collapse.”

Dix told reporters his ministry has also crafted a new salary deal for family doctors and given pharmacists greater powers. “We’re very concerned too, and that’s why we’re taking the steps we are taking,” he added.

With the increase in influenza and RSV, especially among children, Dix urged people to get vaccinated against COVID to reduce the chances of getting that virus as well.

If ED congestion worsens, Dix said, other steps can be taken to increase capacity in hospitals, such as delaying non-urgent surgeries — although he said that is also disruptive for patients.

“That’s a step that you take only when you need to, and we’re not at that point yet,” he said.

But some surgeries have been cancelled at B.C. Children’s, including for a six-month-old Colwood baby with a congenital heart defect.

In a recent interview, Sarah Bell, the hospital’s chief operating officer, said about 18 procedures had been postponed so far, but added they would never include oncology or other critical surgeries, and some had already been rebooked or completed.

Meckler, a pediatrician at Children’s for a decade, stressed that children who genuinely need urgent care should not hesitate to come to the ED.

But it would take pressure off the system if those who are less sick went to a doctor’s office or urgent-care centre instead, as they are the ones who face the longest waits because they will be bumped by sicker patients.

“When you walk into an ED, you don’t get a number and go sequentially,” he explained.

The good-natured doctor understands parents are upset when they have to wait, but asks for their patience until demand on the system eases.

“When the waiting room is full, there are (extra) chairs, families are asking when they’ll be seen, there are more interruptions — sometimes the frustration is taken out on health-care workers. And vice versa, I’m sure. I think it does increase the stress of the workplace,” Meckler said.

“But in terms of this unprecedented volume, fortunately we’re still in a situation where the critically ill children are able to be served in a timely way.”

Neelam Naicker’s five-year-old daughter Jaiya is an example of that. When they came to the ED on a busy weekday afternoon, Jaiya, who’d had a fever for five days and was lethargic, was escorted into an examination room almost immediately.

That’s because of her history with the hospital: She was born prematurely at 24 weeks gestation, and as a result spent months in the neonatal ward, has undergone four major surgeries and is small for her age.

“Amazingly, they saw us quite quickly. We were anticipating to sit here for 48 hours from what I saw online,” said Naicker, who had packed snacks, toys and medicine in anticipation of the wait.

As her daughter rested nearby in an ED exam-room bed, Naicker said Jaiya received wonderful treatment from the staff.

But the Delta mom was shocked when they arrived at the hospital to find every seat in the waiting room full, and expressed sympathy for parents trying to comfort their sick children.

“When they’re so little and they’re so sick, how can you make them feel comfortable? I think about moms who don’t have an extra stroller or maybe they took the bus here,” said Naicker.

“Being a mom and seeing your kids sick or in pain and having to wait that long, it’s heartbreaking.”

The hospital has made new efforts to try to ease the burden on the ED, such as limiting transfer patients from being sent there for admitting and holding, and instead funnelling them directly to the appropriate unit. And anesthesiologists have started administering sleep medication to children with broken bones in an extra space in the operating room, rather than in the ED where it has typically been done.

“Everyone is doing their best to think outside the box,” Meckler said.

The staff at Children’s are “a pretty tired” but resilient group who persevered through the COVID pandemic and now a flu epidemic, despite a number of unfilled vacancies in the hospital, said Bell, the COO.

“Over the last three years, we’ve seen people really stretch and really come together and work very hard to keep the system afloat,” she said, adding staff who previously worked in the ED and recent retirees have come back to help out.

Pediatric hospitals in other areas of Canada, Australia and New Zealand were hit earlier in the flu season, and Children’s is speaking with people at those hospitals to develop longer-term strategies, which must include recruiting more staff, she said.

Bell, who has been with the hospital for more than 15 years, said this is the busiest she has ever seen it.

“In terms of unprecedented volumes in our ED, and then, of course, the impacts to our in-patient units as children need to be admitted, and that coupled with the challenges that we’re all having in health human resources, and being able to staff with our very specialized team members to care for the kids,” Bell said.

How long ED patients have to wait fluctuates at the hospital, based on volume and the severity of cases, so Bell advises parents of non-critically-injured kids to check waiting times online before coming. “I saw it go from 12 hours to about one and a half in a very short period of time,” she said.

“It’s understandable that It’s distressing for families, and we’re doing everything we can to communicate to families when to bring their children to the ED.”

The hospital’s website also gives advice on when to come to the ED, such as children working hard to breathe, those with a fever who are difficult to wake up, or with a head injury accompanied by loss of consciousness. The list indicates when not to come to the ED as well, although Meckler acknowledges it can be difficult for parents without medical backgrounds to make these determinations.

On the day we visited the ED, a sea of sad faces greeted us in the crammed waiting room: A little girl on her father’s knee wore no shirt, presumably because she was too hot; two bored little boys pushed cars along the back of the chairs; parents, many rocking strollers, anxiously looked up every time a person walked into the room from the ward.

On the worst days, there were 40 or more people crowded into the small space, and that is why the hospital opened the overflow emergency area last week. It is primarily for kids with cough and fever, who are determined by triage nurses to be breathing OK, and are not anticipated to need blood tests, X-rays or lab work, Meckler said.

The Sunny Bear clinic, named after the hospital’s mascot, will run 10 a.m. to 10 p.m. when doctors and nurses can be found to work there, but will not operate when there isn’t enough staff. It can handle about 50 patients a day.

When patients are escorted to the overflow area — a model Children’s used during the 2009 H1N1 outbreak — nurse Cheryl Stevenson assesses them and puts them in one of the six exam rooms for a physician to see.

“It’s to help get the emergency out of the red zone,” she said. “It’s basically been fairly simple stuff, and just making sure that the kids are OK, giving them Tylenol, Advil, Benadryl.”

She teaches parents about viruses compared to other illnesses, and what to look out for after their children are discharged.

“We’ve had really positive feedback from the parents. They’ve been really happy. They’re like, ‘This is so nice that we can come in and we were able to get seen,'” Stevenson said.

How long Sunny Bear will remain open to reduce strain on the overcrowded ED isn’t clear. Epidemiologists predict the flu season is still on the rise, so more cases are anticipated for months, Meckler said.

“These waves typically should be starting to settle down by the end of the winter, and before spring is our hope.”

lculbert@postmedia.com

— with files from Katie DeRosa, kderosa@postmedia.com

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