Table 1

Key quotes demonstrating themes

ThemeParticipant infoQuote
Disruption and loss of ED shift workParticipant 353 (F) (line 137)“I think it was easier in a way for people to pick up those [shifts] because the whole rest of their lives were put on hold. So all the things that would normally be reasons why you couldn’t pick up a shift, like a particular teaching session, or a meeting, or some other engagement, suddenly your calendar was completely clear so you didn’t have all those other engagements and I think people were anxious to find a way that they could do something helpful”.
Participant 527 (F) (line 130)“So we had about 6 people off at the beginning because they travelled for March break. And some of them couldn’t return early, some of them did choose to return early, but they were all on 14-day isolation, so they couldn’t work for the 14 days. They ended up trying to do some other admin roles when it was able, not everybody was”.
Participant 531 (F) (line 283)“One of my [emergency physician] colleagues, she had a babysitter that was hired for the summer taking care of her kids and now the babysitter for whatever reason, learned that the physician was actually an emergency doctor in contact with COVID patients and she bailed out”.
Stress of COVID-19 uncertainty and information bombardmentParticipant 447 (F) (line 562)“I think the toughest part for the first month and a half was really the uncertainty, the not having a good grasp. I mean you’ve been working for 10, 12 years, you know what you need to do, you’re comfortable in your work. Now it’s like okay, our work is changing almost every day, we don’t know what’s going to happen, we don’t know if we’re going to run out of PPE, I’m not sure what this disease looks like, so it was really a lot of the unknown and already you can see a change”.
Participant 268 (F) (line 209)“I don’t think I could have ever pictured that I would have a dangerous job and it kind of felt dangerous for a little bit because you have so little control over how things are going to go. I don’t know. I think I picked a field of work where we deal with the unexpected all the time but the unexpected in a pandemic when somebody is coming in with respiratory distress can make it difficult because you have to gown up or down with all of your PPE and you may not have the time to do that.(…) Initially, you don’t really think about it because it’s just what you have to do but as time goes it just weights a little bit heavier and you wish ‘I just wish things could go back to normal’ or ‘I don’t know how good I had it before’. It does play a little bit on the mental psyche”.
Participant 89 (F) (line 657)“I mean I think the hardest time was right at the beginning when it was really scary, and things were—there was just this huge workload, like the firehose of information to process and the boatload of emails to reply to. I wasn’t sleeping very much. I think even if I hadn’t been so busy though, I wouldn’t have been sleeping very much because you know, you’re sitting there scrolling through Twitter trying to understand what’s happening and just kind of that adrenaline rush”.
Increased team bondingParticipant 524 (M) (line 258)“So yeah, initially those first three weeks, boom. We’re excited, we’re in it together. Somebody misses a shift, they’ll go oh! I’ll take your shift! Right? Because I want to be there, I’m in the trenches ready to go”.
Participant 353 (F) (line 253)“Well I really loved the sense of collaboration in terms of working with other units and other teams in the hospital. We do a lot of work that can be siloed, I could have a particular idea and take it to somebody, and by the time it filtered through all the various committees and all the different hands it has to pass through, it could take 2 years to get to its final stage. And we were turning things over and having meetings and bringing people together and reaching consensus and agreement, like almost in real time. So, it was satisfying in that way to see those silos come down and people actually make things happen”.
Concern for patients' isolation, miscommunication and disconnection from careParticipant 128 (F) (line 289)“[Low ED volumes] means people are staying home with their appendicitis until it perforated. That means they’re staying home with their MI, and then coming in with heart failure a week later when you couldn’t tell if they had heart failure or if they had COVID at presentation. People are completing their stroke. These sorts of things, people are… there have been… this drop, emergency department visits in the province went down by 50%. That’s not because people are not getting sick”.
Participant 333 (F) (line 575)“When we intubate a COVID patient, (…) we often give the phone to the person, because they don’t have visitors, to talk to their loved ones, and we know that this could be the last time that they talk to them. So, we’re witnessing this very personal, intense moment and it’s kind of soul crushing so… most of medicine is not personalized. But suddenly you are taken into a very personal part of someone’s life that you could probably relate to, what if it was you talking or somebody you love talking?”
Participant 268 (F) (line 350)There’s been probably a lot of times when I’ve discharged the patient home and they just didn’t understand some of the stuff that I explain and it would be lost in translation (…) Then later on a family member will call and be like ‘can you just summarize what happened because my mom or dad didn’t really understand’ and you’re like ‘oh shoot’”.
Greater personal life stressParticipant 41 (F) (line 519)“[My elderly parents] basically said ‘we would rather get COVID from you and die than continue with this. So we will take that risk so that we will have more normal interactions and that we feel that we’re happier human beings and quality of life is better’. But that’s a hard conversation to have. Like I’m tearing up just now, just thinking about it (chuckles), (holds back tears) Um, so… that scares me. Bringing it home”.
Participant 128 (F) (line 524)“I think when this whole thing first hit, and provincial lockdown occurred through late March, I was really anxious, I was really nervous, I was worrying a lot, I felt a lot of tension, I was having trouble falling asleep, I was having… I was… actually, I was anxious enough that I had chest pain (chuckles).(…) you know the feeling you get in your chest if you’re about to cry because somebody said something really upsetting to you or really hurtful? Almost that feeling when you would think about, ‘oh my god’ there’s just this… and I realize I was really, really worried and there was no way I… and we can’t make it safe”.
Emotional distress: humanity not heroismParticipant 531 (F) (line 238“I’m more afraid about the long-term consequences. To be honest, there have been days where I have been like, ‘Do I really still want to do this for the rest [of my life?]’ (…) I never felt at any point like a hero. On the opposite, we’re kind of like, we feel so useless to be honest. Most of the time we’re powerless and those people just, being at the end of their life dying without anything we can do. It’s almost — I mean at the beginning it was kind of nice, now it’s almost like, I’m almost angry at this term to be honest”.
Participant 490 (M) (line 619)“Yeah, a desire for human connection. I got off call this morning for example, off night call, and we hand over among colleagues all the cases on the board and it was an hour after my shift was done that we were still there, because you know, we were just craving human connection. And connection with the people that we would normally connect with. So we’re standing around all masked up at the hospital and it’s like, ‘what have you been doing?’ ‘Hey, what about politics this?’ ‘Have you read the news of that?’ And ‘hey you know I got married 2 weeks ago?’ Which by the way, I got married 2 weeks ago, which is another challenge (laughs) that I didn’t tell you about”.
Participant 585 (F) (line 391)“So, in my hospital when we want to bring info up, it has to go up all through that top, and then it has to be uniformized—it has to be the same for all the hospitals—so they try to change things to bring them down to all the hospitals. But in the same group we have very different hospitals: we have big regional hospitals and small, remote hospitals. So it cannot be the same for everyone. That’s why it takes so much time so have that protocol going down. And yeah, it’s all barriers, it’s frustrating”.
  • F, female; M, male; PPE, personal protective equipment.