We caught up with Dr. Michael Mikhaeil (BSc ’12) to ask a few questions of this former Health Sciences alumnus who has been working on the front line of the pandemic and will soon be “rounding out his tour of Ontario universities” by heading to complete a Master of Science in Quality Improvement and Patient Safety at the University of Toronto.
Tell us a bit about what you’ve been up to since you graduated from Laurier’s first Health Sciences cohort in 2012
After my time at Laurier, I went on to Queen's University for medical school, then Western University where I completed a residency in Internal Medicine, and I am currently at McMaster University completing a fellowship in Critical Care Medicine. My plans for next year include working in Internal Medicine and Critical Care, while completing a Master’s degree in Quality Improvement and Patient Safety at the University of Toronto.
My current role as a fellow in the Intensive Care Units (ICUs) in Hamilton includes managing critically ill patients in medical, surgical, trauma and neurological ICUs, leading daily bedside rounds, teaching junior residents and trainees, and covering on-call duties for the ICUs after hours. I am chief resident for the critical care program, which includes a lot of curriculum development and planning, advocacy for the ICU fellows in the program and, especially over the last year of the pandemic, a lot of leadership and administrative duties with planning redeployment schedules and resources for non-ICU staff being redeployed to the ICU.
In my spare time, I enjoy playing pick-up basketball, and am an avid Raptors fan (despite this disappointing last season... but I trust in Masai). I love watching movies to decompress and you can always count on me to be binge-watching the latest show or documentary on Netflix. Pre-pandemic, I loved travelling and open-water scuba diving, as well as checking out the local restaurant scene at whatever city my travels may take me to, and I am very excited to get back to that.
I was part of the first cohort of the Health Sciences program at Laurier, and I consider myself super lucky to have been a part of that special class. We had some fantastic opportunities to lead initiatives and get involved. My favorite memories are the times spent with the lifelong friends I made over these formative years, as well as being an orientation week ice-breaker.
What's something you learned while studying at Laurier that is still helping you today?
I learned a lot during my years at Laurier – in and out of the classroom – but I think by far what stands out are the lessons I learned in the Social Determinants of Health course, taught by Dr. Robb Travers at the time.
Over the course of a term in my third year of undergraduate studies, Dr. Travers shed light on the key social determinants that have an effect on health, and how so much of a person's and a society's health may not necessarily be due to individual choices at all.
This was the first time I had viewed people's health through this lens. It explained why certain people get sick and others don't, when the biological or strictly pathophysiological factors we are comfortable assessing could not explain it. The lessons I learned from this course have stuck with me, and have helped me to have a deeper understanding of the health issues of my patients. It has helped me have empathy for the patients I see with morbid obesity and terribly controlled diabetes and associated organ dysfunction, the life-long smokers with end-stage malignancies and lung disease, or the people who inject drugs and have substance use disorders and present with infections of their spine and heart valves.
This course has helped me to take a step back and assess root causes of a lot of these issues that I see daily in my patients, and understand that so often it has less to do with individual choices that they made, but rather factors that they have very little control over, and the crucial impact of effective public health policy in breaking this cycle.
What's one thing you wish more folks understood about what it has been like working in healthcare during the pandemic?
The last 18 months have been difficult for everyone. Whether in healthcare or not, it seems many people have suffered or are struggling in one way or another. I consider myself lucky to still have been able to maintain a stable job and have a steady income flow during a time of such uncertainty for so many. The effects of the pandemic are also felt differently even among different healthcare professionals, so I can only speak to my experience in about a dozen ICUs throughout Ontario during this period. I think the overarching theme of the first few months of the pandemic can be classified by a general sense of anxiety. It seemed everyone was on edge all the time. From nurses, to respiratory therapists, to physicians, to administrative clerks. Walking into the hospital made people uneasy. A lot of it had to do with fear of the unknown. It seemed the state of the knowledge about what the right thing to do was, what the optimal personal protective equipment was, or even how best to treat a patient with COVID-19, was changing every day. This left a lot of uncertainty in the way things were operating day to day in the ICUs and the anxiety was palpable. Even things that were previously routine and mundane, such as taking a patient to a scan, or performing a procedure, now required second and third thoughts and meticulous planning to ensure all precautions were being taken to protect patients and staff.
As one can imagine, this was a mentally draining experience day to day. This was all occurring while, fortunately, relatively speaking, numbers of COVID patients were manageable. Certainly, during this first wave, the total numbers in ICUs were much less than what some models had predicted. This leads into what is now the second and third waves of COVID patients during this pandemic, with the third wave being what we are likely (hopefully!!) currently in the tail end of. This phase, to me, is characterized by burnout. Thankfully, a lot of the uncertainties of before have been rectified. While evidence is always being updated, we are much more prepared to deal with the masses of COVID patients, we know which personal protective equipment to wear in different situations, we know which therapies likely work and which don't for COVID patients, and we know when the best time is to intervene for patients, take over their work of breathing, and put them on life support when needed.
But we have certainly seen the mental, emotional and physical fatigue being borne out over the last 12 months among healthcare workers. It stems from the difficulty in dealing with this terrible disease, and seeing the effects it has on individuals' lives and the lives of their families and, especially with some of the latest variants, seeing this happen in patients who are younger than before. Unlike the first wave, I am able to see my parents, or even myself – younger, healthier, functional people – in some of my patients this time around. There is also a struggle in seeing the same syndrome over and over again. Myself and colleagues sometimes joke about how at times, or some nights, we are puzzled at where all the other acute illnesses people used to present with have gone. There is almost a monotony of mostly seeing COVID patients day after day.
Finally, and I think this is what has taken its toll on me the most, is that COVID, especially when severe enough to put a patient in the ICU and on life support, is not a disease that resolves quickly. It lasts days and more often weeks, and depending on different patient factors, many don't survive. It wears on you to be updating families daily and having very little or no improvement in their loved one's status day to day. To be clear, we are used to dealing with illness and death, that comes with the job, and there is a sense of satisfaction when you are there to support families and patients through some of their worst days. But certainly it has never been to this extent, at this magnitude, or at this pace. We are in the business of making people better, and improving their quality of life through our interventions, but with COVID it seems this is sometimes not possible, or certainly not possible to do quickly, and this can lead to some emotional fatigue. While there may sometimes be empty beds in the ICU, often the shortage has to do with staffing (i.e. an empty bed cannot be used if we don't have a nurse that evening), and staffing shortages have been a large-scale issue for some time now, exacerbated by the pandemic. It takes a very large team to care for just one patient with COVID in the ICU, and each patient is often in our units for weeks at a time. This has been a massive undertaking, and a huge strain on the system when you think of the volumes of COVID alone, in addition to everything else that is urgent/emergent that is continued to be dealt with in the ICU.
What has been a constant inspiration for me, however, is how well the healthcare team has come together during these trying and uncertain times. We have found a way to very quickly learn about a new disease, develop treatments and a vaccine for it, learn to handle it, navigate issues around it, expand our capacity immensely and help patients. When I think of how the healthcare teams across the province that I have worked in have handled it all, it is nothing short of awe-inspiring.
What's your top piece of advice for other Laurier alumni working in health care today?
My main advice to Laurier alumni working in healthcare is to try and be grateful for the privileged position that we are in, and to be cognizant around developing compassion fatigue with the patients we treat. Personally, when I think about my days at Laurier, how hard we worked, and how much we dreamed of these days, just to get to this point to be able to say we work in healthcare. During the early mornings and late nights, and the demands of everyday work now, it is easy to forget that.
I think it is helpful and important to pause and reflect at how far we've come, and how privileged and lucky we are to have received the education we had at Laurier and now to be working in the healthcare field, especially during such a historic time that will certainly be spoken of for decades to come.
Related to this, I urge Laurier alumni in healthcare, especially ones on the front lines of this pandemic, who have essentially been working nonstop, with little breaks and no opportunities for vacation for a year and a half, to fight the urge to lose their empathy. I know firsthand how easy it is to fall into the trap of emotional and mental fatigue, as you see similar patients with the same disease, day in and day out, and have to recite the same heartbreaking spiel to another family whose loved one is sick with COVID, but remember it can always be worse. As hard as our days can be, the patient and their family are always experiencing a worse day, and I think constantly reminding myself of this sentiment has allowed me to maintain some perspective and maintain a sense of empathy and compassion for my patients throughout this pandemic.