Each day when Paula Abramczyk starts her shift as an ICU social worker, she has at least "a dozen calls" to return from anxious loved ones.
The intensive care unit's 22 beds are full with the sickest COVID-19 patients at Humber River Hospital in northwest Toronto, an area hit hard by the pandemic.
Over her 30 years at the hospital — 20 of them in ICU — she says she's never been as frantically busy as she is during the third wave of COVID-19.
"So I worked in the ICU through SARS [in 2003], and that was bad. But this is something that's unbelievable. You can't even imagine that it's happening. It's extremely busy and it's constant," Abramczyk told host Dr. Brian Goldman. "And it's been like that for the last year, but particularly since the third wave started, it's just tenfold."
Like other social workers in the thick of the crisis, these days her job is to help COVID-19 patients and their families get through some of the worst days of their lives.
Because there are new ICU admissions each day, along with transfers to and from other hospitals, "there's a new slew of people all the time," Abramczyk said.
The neighbourhood has a high concentration of essential workers living in close quarters with their families. "I guess the hardest part here, it's … that we see multiple family members in our hospital, in our ICU and dying with COVID."
That's what Abramczyk's client, Chinda Vilaisavanh, is grappling with right now. On April 5, a few days after her 99-year-old mother was taken to hospital in an ambulance for what turned out to be COVID-19, her brother was found dead of the disease in the home he shared with their mother and younger sister, who struggles with mental illness.
Vilaisavanh is now grieving the loss of her brother; her mother, who died on April 25; and an older sister, who lived in another apartment in the same building and also succumbed to COVID-19, on April 28. Her younger sister recovered from her own bout of COVID-19 but is still in the hospital's mental health ward, in part because of the way this tragedy unfolded.
"She was living there with his dead body and did not take medication for however many days," Vilaisavanh said.
From keeping her abreast of her mom and sisters' conditions to pointing her to resources to help make arrangements for funeral services, Vilaisavanh has relied on Abramczyk at every step.
"She's been everything, you know, everything that I need to know, she has been there helping all the way — information, where to call, what to do. Without her I would be lost," said Vilaisavanh, who lives in Brampton, Ont.
Abramczyk said building relationships and quickly establishing trust are essential in her job. "That's really important in supporting somebody through this journey. And when the patient dies, it's also about supporting [family] through that process. It's supporting them through financial need because a lot of people don't have the finances in this neighbourhood to pay for funerals."
'Never a dry eye'
Her work also includes facilitating those all-important video calls between patients and their loved ones, who usually can't visit in person. "What we do is we have [what's] called integrated bedside terminals, and we can video chat — kind of like Skype or FaceTime," she said.
"And often we get them on the screen before they're intubated so they can say goodbye, because they don't know if they'll ever see them again."
Abramczyk said there's "never a dry eye" in the room, particularly when the patient has young children.
She was also heartbroken recently to see a pair of young-adult siblings left without parents.
"We had a gentleman die in November here of COVID, [who had] two kids, 22 and 20. And then only a few weeks ago, the mom came into hospital with COVID and she died," Abramczyk said. "Now this 22-year-old is saying, you know, what do I do?"
He now bears the weight of providing for both himself and his sister, she said, and is grappling with questions about how to pay the rent and funeral bills and whether to stay in school. As the family's social worker, Abramczyk was able to connect them with resources and help guide them through their initial steps forward.
Social workers are supporting patients outside of the ICU as well, along with their families. Venese James, whose brother, Horace Brown, is in the regular COVID-19 ward at Humber River Hospital, has been working with social worker Leslie Shafran throughout his stay.
"I think, you know, she was sent as an angel just to help me out because, you know, the stress for me is very high," James said.
A big part of Shafran's role with James's brother is to get him onside with the fact that he needs to be there and help him get comfortable with the care his doctors recommend. On Thursday, for example, Brown was "really edgy."
"He heard that he needed a blood transfusion, and he was refusing it all along, so I asked her if she could go and just, you know, give him all the positive reasons why he needed it," James said. "She went, and I think she sat with him and … gave him some warm blankets and stuff and just a little bit of TLC." After that, he felt more settled and accepted the treatment, she said.
'Must grieve to move forward'
For those whose loved ones don't recover, it's critical to make space for the grieving process, Abramczyk said.
"A lot of people think, 'Oh, I'll be fine.' And then six months later, the world crashes. That's because they haven't grieved. People must grieve to move forward."
Chinda Vilaisavanh said she hasn't yet been able to attend to her own grief, given she had to make funeral arrangements for three family members in the space of five days.
"I just don't have time here right now just to sit down and think about much but what to do, what to do next and what needs to be done."
– Paula Abramczyk
My goal is to make the journey a little bit easier for them to manage.
What is on her mind is her desire for their story to remind people to continue to take the virus seriously. "I believe that some people still think it's a hoax, or not real. It is real. COVID is real and it is deadly," she said.
By working in an ICU, Abramczyk said she's had to come to grips with the fact that she can't control the outcome.
"I can't change what's going to happen. My goal is to make the journey a little bit easier for them to manage."
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