The Halifax Herald

ICU bottleneck delays patient’s tumour removal
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By DAVENE JEFFREY Staff Reporter
Tue. Apr 21 – 10:01 AM

Christopher Davis’s throat hurts to breathe and swallow. His voice is hoarse and he’s got a large tu­mour in his neck that is likely cancer.

The 39-year-old Dartmouth man has twice had surgery post­poned — once when he was in hospital, prepped and ready to go into the operating room.

“It’s just very frustrating,” said his wife, Debby MacDonald, during a telephone interview Monday afternoon.

On April 15, Mr. Davis was in hospital, ready to go under the knife at the Victoria General site of the Queen Elizabeth II Health Sciences Centre, when he was told the Halifax hospital had no room in the step-down unit for him and he was sent home.

The hospital gave the couple a chit to cover their parking and one worth $10 for the cafeteria.

A day or so later, his surgeon’s office tried to reschedule his op­eration for April 23, but again there was no room for Mr. Davis in the step-down unit, which is for patients who require less care than in the intensive care unit but more than a regular ward.

His next scheduled date is May 8, but Ms. MacDonald is worried that the tumour is growing and maybe spreading.

“Nobody will know until they actually cut him and take a look.” It’s pretty common for surger­ies to be cancelled because of no room in the step-down unit, said Dr. Jaap Bonjer, chief of surgery at the Capital district health au­thority.

“There’s no doubt we have a shortage of ICU capacity,” Dr. Bonjer said.

A shortage of intensive care nurses is one reason for the prob­lem. But medicine is changing, Dr. Bonjer said, and doctors are doing more complex surgeries and a lot of patients now are older and sicker.

The district has a long-term plan to deal with the shortage, but it requires money and time.

For now, staff try to schedule procedures to avoid any bottlenecks. But surprises often crop up, like emergencies or very ill patients transferred in from other hospitals, Dr. Bonjer said.

Still, the hospital is meeting national standards for cancer surgery waiting times, he said. That is not the case for orthopedic and cardiac cases, he said.

He said he understands patients’ frustration.

“We get frustrated as well,” the surgeon said.

“Cancelling (a surgery) is sometimes as much or more work than doing the surgery,” he said. “It’s very inefficient.”

He acknowledged the hospital often hands out parking and cafe­teria vouchers to patients and their families when surgeries are postponed at the last minute.

“We try to do what we can to soften the pain,” Dr. Bonjer said. In Mr. Davis’s case, something has been wrong with him for months.

At first, it seemed pretty minor. He had a pain that reached from his ear to his neck. Then in Octo­ber, he became hoarse, his wife recounted.
Figuring Mr. Davis had some sort of ear infection, their family doctor sent him to a specialist.

A CT scan revealed a growth that was affecting his vocal cord. On March 13, Mr. Davis went in for an ultrasound and a biopsy, but the location of the tumour prevented a sample of the growth from being taken.

“It looks like it is thyroid cancer, but we can’t tell for sure,” Ms. MacDonald said she was told. Cancer or not, the couple was told the growth has to go.

Mr. Davis’s family has a history of cancer. It killed his mother when he was 16 and his father has had two ribs removed because of the disease.

When the specialist the couple dealt with in Dartmouth couldn’t see Mr. Davis right away, he transferred the case to a colleague in Halifax who could book operating time immediately, Ms. MacDonald said.

They have been told that Mr. Davis will need a second operation to try and get the right vocal cord to work.

In the meantime, the worrying and waiting is making life more and more stressful.

The couple’s five-year-old daughter knows that her father needs to go into the hospital. She’s become clingy and is afraid to go to bed unless both of her parents are in the house.

Ms. MacDonald is a library support specialist with the Halifax regional school board. She’s had to take a leave of absence from her part-time job at Chapters to be home for her daughter. Mr. Davis is on long-term disability because of back problems.

The couple’s MLA, Marilyn More, is taking up their cause.

“We’re looking to bring this to the attention of the minister and the Health Department. This is a chap whose condition is deterio­rating on a daily basis and he needs a resolution to this immediately,” the MLA for Dartmouth South-Portland Valley said.

“Obviously the different aspects of treatment and care in hospital are not being co-ordinated to the point where they can use the resources that they have.”

Part of the master plan is to centralize particularly complex surgeries at the Halifax Infirmary and to expand the intensive care capacity there, Dr. Bonjer said. That plan includes building more operating and ICU rooms.

“That’s very costly and we don’t have any surplus funding available to us right now,” he said.

“In the meantime, we try to make the best use of the available resources