Paul Johnston spent the early days of the COVID-19 pandemic pacing the floors, imagining the tumours in his patients’ bodies growing bigger without treatment.
What was the bigger risk? Their existing problems, or the unknown virus spreading around the world? That’s a question Johnston still ponders.
The St. John’s urologist, and chair of the Newfoundland and Labrador Medical Association’s fee-for-service committee, sat down with CBC reporter Mark Quinn for a frank conversation about decisions made during those early weeks and months.
The following conversation has been edited for clarity and length.
Q: What was it like being a surgeon in those years?
A: That was hard. That was really hard. You have two competing voices in your conscience. On the one hand, you’ve been trained to look after folks and you’ve dedicated, you know, decades to the process and you believe that what we need to do here is do the surgeries get these tumours out of these poor folks, right? They’re suffering.
But on the other hand, we have this new beast out there that is also dangerous and just even interacting with humans is a risk. It was a terrible time. It was beyond frustrating, I think would be the best way to to put it.
I think I drove my my wife and kids crazy just pacing the house, waiting for a chance to go take a tumour out, you know, lying awake at night. It was bad because you want to look after these folks and you can’, and you’re just thinking how hard it is for them. They’re at home and they have this thing in them that’s growing and it needs to come out. And every day the clock is ticking. So yeah, it sucked.
It must have affected outcomes, I guess in two ways. People didn’t get the surgeries they needed as quickly as possible … but were people found later and diagnosed later?
Research is starting to emerge on a number of different fronts. This was sort of an obvious risk that the medical community, the surgical community, knew, and research is starting to emerge that suggests that you are seeing patients who would ultimately get to the operating table with disease that was a little bit more advanced than it had been before.
Now, that sucks, but we have to weigh that against the risk of what would happen if we had simply carried on as before. What happens with the completely unchecked COVID-19 virus? We have this hindsight now and you’re starting to see these negative effects of the lockdowns manifest themselves.
But we have to remember at the time you’re looking at a situation that [was a] completely novel virus. [There was] nothing like this before in terms of the length of time of the incubation period, all of that. It was really hard to to figure out what to do. We hadn’t seen it before.
The other thing with patients that has been really hard is not just the the oncology effects, but the social effects. I know people struggled with the drink. I know a number of people who lost their jobs. People lost houses. I know patients of mine whose marriages collapsed because it was a very stressful time and you’re all over each other. So the echoes from the actual lockdown continue.
Featured VideoDr. Paul Johnston worked through the worst of the COVID-19 pandemic. Now, he says, we’re not out of the woods yet when it comes to wait times. Dr. Johnston sat down for a candid conversation with the CBC’s Mark Quinn.
I’m not suggesting that we should not have had some kind of public health measures. I mean, my God, I think that’s crazy. But it turns out that this was a very hard problem to navigate for patients. Because they’re a whole person, right? They’re not just their tumour.
One of the echoes, of course, is this big backlog in surgeries. In 2022, you were one of the people who spoke about the fact that there was a backlog of 6,000 surgeries at two hospitals in St. John’s alone.
Yeah, that was really hard. As the pandemic unfolded longer and longer, that backlog gets harder to ignore. And then you start getting to the point where you’re wondering if the competing risks are tipping over.
I mean, how do we know the answer to these questions? Really, I don’t know that it’s knowable in a real, true, mathematical, scientific sense.
But I guess my own conscience started saying, you know, I’m worried here now again. I’m just one voice, right? We have to look at the public health voice. There’s many people who have skin in the game. And it was hard. At that point I felt I had to speak up.
And I want to speak to you today because I want to talk about where we are now. We had that backlog. How are things going? Are we addressing that?
We are. I am. There’s no question that the administration, that the political players are trying to move the chess pieces on the table to get the surgeries done. And I can tell you from the [Newfoundland and Labrador Medical Association’s] perspective in looking at the numbers which we watch, you know, you can see that things like cancer cases, some of the more pressing stuff, the cardiac stuff — the the wait times are starting to come down. So the the efforts are bearing fruit.
But we’re not all the way there. There are still a whole bunch of people in this province who have a surgical problem that is not cancer or something otherwise urgent but is nonetheless really affecting them.
I’ve said it before, but there’s a lot of guys in their 30s, 40s, gals too, with mortgages to pay, mouths to feed, that because of what’s wrong with them, they can’t work … and this affects their family. This affects their, you know, their mental health, their participation in the community.
So those issues — I think I’m speaking in broad terms here, but from what the NLMA can see — those issues are the next that need to be addressed.
The things that have caused the backlog that we talked about a little bit are the pandemic, and there was that blizzard in 2020, and then of course the cyberattack. But the other issue, I think, is the demographics, yes?
This is perhaps really about when the oil money was flowing in this province about 15-20 years ago. [That] was the time to start investing in infrastructure, in personnel, technology, you name it, in anticipation of the baby boomers, you know, arriving at their health-care years.
And I’m certainly not blaming any particular administration or political stripe at all. But that process didn’t start to unfold. It never really did. And then all of a sudden COVID comes along and now you have basically two tidal waves now forming one large tsunami of patients who are now waiting longer than they should be.
And so it’s hard to solve it because you have to unwind things that didn’t happen in the past in terms of how many trained personnel [like] doctors, nurses, techs. These people don’t appear overnight. They need years of training to become good at what they do. We we can’t magically create five more ORs because those rooms are so sophisticated that it takes years, really, to build them. And then, of course, this province is chronically financially strapped.
So these are really complicated problems to solve. But there’s no question that the demographics added just another element here, making it even harder.
Download our free CBC News app to sign up for push alerts for CBC Newfoundland and Labrador. Click here to visit our landing page.