Daphne Bramham: 'Horror show' as B.C. specialist shortage leads to agonizing wait for woman's urgent cancer surgery

Opinion: The human resources crisis is at a tipping point not only for patients and their loved ones, but it’s devastating to health-care workers.

Daphne Bramham 5 minute read January 27, 2022

Kelly Ennis, 48, has ovarian cancer and urgently needs surgery. PNG

UPDATE: On Wednesday morning (Jan. 26), Kelly Ennis had emergency surgery to the ovarian cyst and two lymph nodes. Once she has recovered from the surgery, the next step is chemotherapy. Since the tumour was initially found in mid-December, it had grown by nearly five centimetres.

  Kelly Ennis looks like she is eight-months pregnant. At 48, that would be a minor miracle. Instead, it’s a tragedy.

Ennis has ovarian cancer. She got the bad news on Dec. 13 that she needs urgent surgery.

A CT scan revealed a irregularly shaped tumour about the size of a large orange, a “haze” in her omentum — the curtain of fatty tissue that hangs down from the stomach and liver and wraps around the intestines — as well as some fluid on the wall lining, and enlarged lymph nodes.

“I was told to expect a call within seven to 10 days,” the mother of three told me. “I thought that was great to be able to see someone so quickly. But with the holidays looming, I heard nothing.”

The timeline given Ennis fits the benchmark for optimal care — a referral to an oncologist within 10 working days, followed by surgery within two weeks of that consultation.

But it didn’t happen. Her mother, Dianne Davis, calls what happened next “a horror show,” adding that it is time the provincial government realizes that there is more going on than COVID.

Over the next few weeks, both Ennis and her gynaecologist’s receptionist repeatedly tried to contact the specialist. Emails, voice messages. No response.

Finally, on Jan. 5, Ennis was told that her file has been passed on to the B.C. Cancer Agency in Vancouver. Five days later, the cancer agency called Ennis to say that its gynaecological oncologists are swamped. Ennis was put on a waiting list.

By Jan. 14, Ennis had so much abdominal fluid that she could barely breath or walk. She was told to go to Vancouver General Hospital from her home in Surrey, not to any of the Fraser Health hospitals, because that is where the gynaecological oncologists from the cancer agency work.

Over two days, six litres of fluid were drained from her abdomen using a procedure that Ennis described as “painful” and “barbaric”.

Finally, on Jan. 19, she got a surgery date — Feb. 28 — nearly three months after her gynaecologist first made the urgent referral.

Within days, the fluid began accumulating again, which is not unusual for the kind of ovarian cancer that she has. But it is more than uncomfortable.

On Monday when we spoke, Ennis rated her pain at eight on a scale of one to 10. “The pain is unreal.”

Still, she empathized with the health-care workers.

“My heart goes out to doctors, nurses and support workers who are so overworked. There just isn’t enough support for them.”

On Tuesday, Ennis went back to emergency at VGH, unable to cope at home. Her condition has worsened to the point that the waiting is nearly over. She is scheduled for emergency surgery today.

Kelly Ennis has ovarian cancer and urgently needs surgery. But in mid-January, while she was waiting, her stomach filled with nearly six litres of fluid that had to be drained. On Jan. 25, she was back to emergency again because of fluid in her abdomen. Her cancer surgery isn’t scheduled until Feb. 28, not because of COVID, but because of a longstanding shortage of gynaecological oncologists. PNG

Ennis’ journey through the medical system began Dec. 4 in the emergency room at Delta Hospital, only a few days after B.C. reported its first case of the Omicron variant.

Many cancer surgeries have been cancelled due to COVID. But the pandemic didn’t delay Ennis’s original surgery date. It only amplified B.C.’s longstanding and acute shortage of gynaecological oncologists, according to Dr. Sarah Finlayson, head of the gynaecological oncology program at the University of B.C. and who practices at the B.C. Cancer Agency and Vancouver General Hospital.

“British Columbia has a human resources crisis,” she said in an interview. “We have approximately the equivalent of seven full-time gynaecological oncologists serving a population of five million people.”

She contrasts that with other Western Canadian provinces — Alberta has 12 for a population of 4.3 million, Saskatchewan has six for a population of 1.1 million, Manitoba has five for 1.3 million.

And here’s another contrast: Fraser Health Authority has a population of 1.9 million (including Ennis) and doesn’t have a single one.

Fraser Health’s response to questions was to refer me to the B.C. Cancer Agency and Vancouver Coastal Health.

It’s not that B.C. can’t attract these highly trained specialists, or even that there aren’t enough of them trained in Canada each year. UBC, for example, graduates one person in the subspecialty every year.

The problem is money, or will. Take your pick. But the result is the same.

Every week, 30 to 40 more women from across the province are referred to the specialists at the cancer agency.

Even though the population has grown by nearly three-quarters of a million in the past decade (and continues to grow during the pandemic), the government, health authorities and hospitals have neither funded a single new position for these specialists nor increased their operating time.

Finlayson doesn’t know why. It’s not because the authorities haven’t been told.

But here is her fear: “I think when we do things well — and we have been providing incredible care to women with gynaecological malignancies for years — you’re not the fire in the room.”

Now, the human resources crisis is at a tipping point not only for patients and their loved ones, but it’s devastating to health-care workers.

“We feel this critical lack of adequate staffing in our hearts,” Finlayson said. “We pride ourselves in our ability to provide world-class care, and when we don’t have capacity to do that for each and every woman, it makes us all feel terribly sad.”

It’s a terrible irony that it has taken a pandemic for Canadians to realize the great gaping holes in a health-care system that may not be completely rebuilt, but one that is certainly in need of substantial renovation.


Twitter: @bramham_daphne

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