Pandemic has lengthened wait times for surgery in Quebec, leaving hundreds of patients in limbo

At the end of last year, Juliana Dopazo could no longer bear the arthritis pain in her left shoulder.

She had difficulty lifting her arm, and the discomfort was so intense she couldn't sleep at night.

"Even the mattress, pushing against the shoulder, it was horrible," said Dopazo, 74.

Her doctor agreed she needed surgery and put her on a waiting list at Charles-Le Moyne Hospital on Montreal's South Shore.

Dopazo expected to be operated on last spring, but the first wave of COVID-19 delayed all but the most urgent operations, creating a backlog.

Hip and knee replacements and hundreds of elective surgeries like Dopazo's were postponed indefinitely.

Dopazo said her doctor cannot tell her when her operation will be scheduled.

Painkillers help her get through the day, but she's worried about the toll on her health. She's now up to six extra-strength Tylenol, two Oxycodone and one anti-inflammatory every day.

"This is no good," said Dopazo. "My kidneys and my liver are going to give up."

Nursing shortage

Unfortunately, wait times for orthopedic procedures are about double what they were pre-COVID, said Dr. Thien Vu Mac, the head of orthopedics at Charles-Le Moyne.

In September 2019, Mac said, there were 507 people on the hospital's waiting list for orthopedic procedures. About six per cent of them had waited longer than six months.

Fast forward a year, and the waiting list has grown to 723. According to Mac, nearly one-quarter of those patients have waited longer than six months.

"It's getting worse and worse because we're adding patients on the waiting list and we can't reduce the waiting list much," said Mac.

In Mac's view, the biggest obstacle to catching up is a shortage of nurses.

Of the hospital's 10 operating rooms, only six or seven are running, because there isn't enough personnel, he said.

Exhausted after the first wave of COVID-19, some operating room nurses left for other departments or hospitals, according to Mac.

For the nurses who remain, it means more overtime as well as shifts in the evenings and on weekends.

"We can't pull on the elastic band too much," said Mac. "I think it's at the point [where] it's going to rupture if it hasn't already ruptured. There's not much room to pull there."

It takes about a year to train an OR nurse, but the retention rate is about 50 per cent, said Mac.

New candidates are being recruited, but it will take time to train them.

The other challenge that's preventing orthopedics from chipping away at the backlog is how the hospital prioritizes surgery time.

In the Montérégie, Charles Le-Moyne is the hospital patients are referred to for specialties such as neurosurgery and thoracic and vascular surgery.

"Our patients that don't have life-threatening conditions, they cannot compete with cancer, so we're always at the bottom of the prioritization system," he said.

He knows some of his patients are suffering and he is frustrated he doesn't have answers for them.

"They have pain, they get depressed. Some of them lose their job or their business, even their couples," said Mac. "We have to prescribe them painkillers."

"Some are crying in our office and it's very hard."

COVID cases taking up hospital beds

No one can predict how bad the second wave of the virus will be in Quebec, but for the last few weeks, hospitalizations have increased at a worrisome pace.

So-called red zones in Montreal, Quebec City and the Chaudière-Appalaches have been under stricter public health rules in order to keep case numbers down and avoid overtaxing the health care system.

As of August, the Ministry of Health said about 92,000 people are awaiting surgery. The province does not want to add to that backlog and has pledged it will keep operating rooms open.

But Dr. Mac is afraid the surgery waiting list will only get worse if the province's measures can't bring the number of COVID-19 cases under control.

Charles-Le Moyne hospital has an agreement with Clinique DIX30, a private, for-profit medical clinic which does minor day surgeries.

It takes some of the pressure off but, Mac said, more complex cases require a hospital stay, so a bed has to be available.

If the hospital has to make room for more COVID-19 patients, more beds will need to be set aside for those patients, leaving fewer beds for surgery, he said.

Concerned about the ballooning wait lists in some regions, Dr. Jean-François Joncas, president of Quebec's Orthopedic Association, sent a letter to health minister Christian Dubé last week.

He encouraged the ministry to make it clear to hospital administrators that certain slow-growing, less urgent cancers can be postponed to make room for elective surgeries.

Once the province gets through the second wave of COVID-19, he has asked for a meeting with the ministry to come up with a plan to tackle the backlog

He'd like to see more agreements with private clinics for day surgeries.

"We can't build more hospitals," said Joncas.

In places where the waiting lists are longer, he'd like the operating room schedule opened up to include more evenings and weekends to get elective surgeries done.

'I feel trapped'

Juliana Dopazo hopes she'll be called by her surgeon soon.

She recently stopped taking the anti-inflammatory she was prescribed when she noticed it was giving her headaches and she felt a worrisome pressure behind her eyes.

She'd like to get off the painkillers too.

Dopazo looked into having the surgery done at a Montreal hospital instead, but was told to stay where she is.

She also considered having the surgery done in the United States where her sister lives, but the potential cost and long travel time dissuaded her.

"I feel trapped," she said.