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Like so many nights throughout the pandemic, Linda Flockhart couldn't sleep. So, she got up and went to work. She arrives in the dark, when most of the city is still quiet, on yet another day in the province-wide lockdown. Same old, same old.
"There are so many concerns right now that my brain is just constantly whirring," says Linda, Clinical Director of the Peter Munk Cardiac Centre and the Toronto General Hospital (TGH) ICUs.
"Does our team have the resources and tools to do their jobs? It's my job to ensure they do."
The first coffee of the day is a must, it will power her through the virtual meetings, which start on this day in early Mayat 7:00 a.m. and go until darkness descends again. Through each of the waves that have engulfed the province, ICU capacity has been the critical concern, and as the person responsible for keeping these units running, and its people supported, Linda shoulders a heavy burden.
Even as we learn more and more about how to treat patients with COVID-19, UHN's ICUs are still seeing only the most critically ill patients. Death is a common occurrence, and its impact on the staff is only one of the many things Linda worries about.
"Our people have really stepped up through this crisis," says Linda. "With the onset of each wave I've watched everyone just bring their best over and over again.
"It's hard not to wonder does everyone have the capacity to rise again? I think helping people let go of perfection will be the next big thing, as we may have to focus on providing essential care only, if we are faced with a surge of ICU patients.
"All of this has been so tough on our teams, and even as they show up, time and time again, I want so much more for them than this."
The first meeting of the day is with the Ontario Health buying group. Linda has been tasked with working with this group to ensure all the hospitals across the province have what they need. With the looming threat of overwhelmed ICUs, this team is constantly assessing the needs of the system as a whole.
Depending on the patient population, hospitals are looking for everything from dialysis equipment, to IV pumps, ventilators, cardiac monitors and beds. As many as 1000 beds are ready to be mobilized if needed.
For anyone not intimately involved in the supply side of things, it might come as a surprise to discover the challenges of both getting supply, storing it, and then shipping it as needed. The logistics could be overwhelming at the best of times, let alone during a pandemic that requires constant monitoring and shifting of tactics in order to stay ahead of it.
Checking in with the various hospitals yields some requests but Linda worries that the ones they are not hearing from are already overwhelmed. It's clear everyone on the line is concerned about their ability to support an imminent surge in ICU needs, but after more than year of near constant strategizing, this group knows what needs to be done.
"I'm so grateful to have been given the opportunity to work with our provincial partners," says Linda. "I had no idea the scope of the work happening behind the scenes.
"Having the full context of the provincial picture has really allowed me to understand UHN's role in all this. It would be easy to just look inward at our own challenges but working to ensure the safety of all Ontarians is truly rewarding."
The group signs off rather cheerily, perhaps because there were no fires to put out today.
The next few hours are spent connecting with all the teams in Linda's portfolio. Various huddles ensure Linda is aware of any pressing concerns and gives her the chance to pass on important information and most recent developments.
On this day, Linda has an opportunity to recognize a special leader in the Medical Surgical Intensive Care Unit (MSICU). Denise Morris, Nurse Manager of the MSICU has been named a "Nursing Hero" by
Hospital News and Linda is surprising her with the news. Any opportunity to recognize her staff is a joyful moment, but Linda is particularly pleased by this award.
"When MedSurg ICU first started getting COVID patients I couldn't sleep," says Linda. "I worried constantly about whether they were safe.
"None of us knew what they were going in to and now, I watch as they manage all this with so much confidence and such a sense of commitment to their patients, and to each other. I could not be more proud of this team."
There is clapping, and speeches, flowers and even some tears before Linda leaves the team and heads back to her next set of meetings. Enjoying a good moment with her team provides a bounce in her step, and another coffee doesn't hurt either as she heads off to a meeting with HR to discuss staffing needs.
Recruiting more nurses has become an urgent concern for every hospital across the region, and as ICU needs expand, Linda is anxious about getting new hires in the door and trained appropriately. The nurses have been working without relief for so long now, she is worried about their mental and physical health and how everyone will be when COVID finally relaxes its grip on the system.
"I worry about all of them," says Linda. "I do my best to have some laughs, otherwise we'd be in danger of heading down some pretty dark rabbit holes.
"We have amazing people here, doing incredible work under very stressful conditions, and we need to remember they are more than just workers, we have to take their full lives into consideration when we try to support them."
Meetings continue all afternoon with a wide range of individuals and groups throughout the network. Only the quickest bathroom breaks are allowed as the day marches on. Caffeine and walking on her desk treadmill keep Linda's energy up through back-to-back meetings until the sun is finally setting.
As darkness descends, it's time to head home. The work isn't done – it's never done – but Linda is committed to trying to achieve some small balance by leaving the office after a 10-hour day. Like all her colleagues, there will still be work to do from home but at least she can have dinner with her son and play with her new puppy.
"I did it, I got a pandemic puppy," says Linda. "He's been a godsend really.
"When you think of how dark things can be, you need to have some light and laughter. Right now, he's getting me through."
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