IceStorm 98 Study

Dr. Ruth Wilson was in Toronto on the Wednesday night. Her husband was at home in Kingston with their five children. She got on an early train that left Toronto at about 6:10 a.m. and had no knowledge that anything had happened. She had been in Ottawa the previous week and "had seen some of the ice there so I'd sort of been feeling a little smug that it wasn't happening to us". While on the train, shortly after 8:00 a.m., when they were around Port Hope or Trenton, "all the cell phones started going off in the train". People who were travelling to Kingston for early meetings were on the train and it was generally their Toronto offices calling them to say that the Kingston people had called to cancel the meeting "because something had happened in Kingston about ice". Her seat mate received one of those calls. They both looked out the train window, saw no ice, so didn't take it too seriously. Just after Napanee, they started to see the ice on the trees and trees down but still it was pretty and interesting. There was the odd tree they would point out to each other but they didn't really appreciate the magnitude of it.

When Dr. Wilson got off the train, the station "was absolutely packed with people". That was because the train from Ottawa had been seriously delayed. "And that's the famous train where people said they were treated as if they were on the Titanic. That train had yet to arrive in the Kingston station and there were all kinds of people waiting to get on it." Many of her medical colleagues were in the station ready to get a train to Toronto for equally early meetings. One of them told her that about 75% of the power was out in Kingston. She still couldn't quite believe it.

She phoned home but didn't get an answer because, as it turned out, her family was outside looking at the devastation. She finally saw a taxi and raced up to ask if he could take her home. "He grumbled quite a bit and said 'We're in an emergency situation' but he did agree to." She lives downtown on Willingdon Avenue, which was a very hard-hit area. The cab driver could not get down her street so he dropped her off on Johnson Street at the north end of Willingdon so she walked the two short blocks to her house, avoiding the power lines and the trees that were down.

When she got to the house, the children were all " gingerly" outside, as was her husband, looking. All their power lines had been ripped down. Fortunately, their car was fine but one of their neighbour's cars had a tree through the roof.

Dr. Wilson says that she thinks almost everyone was thinking in that first little while that things would be back to normal soon but, both from what she had seen in Ottawa and what she had seen from driving in, "I had the sense that this was going to be a longer haul". She and her husband proceeded to get the family organized and the family has done a lot of camping. They went out and bought non-perishable foods, propane for their barbecue, lots of candles, flashlights. She remembers a brief moment of panic when Canadian Tire didn't have any propane so she and her husband drove out to the Canadian Tire in Bayridge and were able to get some, although it was going very fast. "And I felt a little bit like a hoarder or somebody who was...but, anyway...that's what we decided to do."

Sometime around the end of the afternoon on Thursday, Dr. Wilson phoned in to work at the Family Medicine Centre to let them know she was back from Toronto. Her staff told her not to go in, that they were sending everybody home and canceling patients. But they also told her that the Hotel Dieu Hospital had been looking for her. It had already been decided to cancel the O.R.s and it was at that point that she learned they were planning to open a shelter for the frail elderly.

She and her husband went two doors down to check on some elderly neighbours. They don't know them well but he's in a wheel chair, so they went to knock on the door. It turned out that the wife was just on her way to check on some even more elderly neighbours. It was getting dark at this point so the three of them went into the other neighbour's home. "My heart sank because the two of them are quite old and they were sitting there in the dark and there was the smell of urine and they both seemed very confused and cold. They had heard, [somehow], that the Hotel Dieu was opening up as a shelter and they were waiting for a bus to come and pick them up because that had been organized. Somebody had called them, I think. Anyway, the bus wasn't coming so my husband and I decided that we would drive them down.... Actually, just as we got our car there, the bus came so we helped them onto the bus. And then my husband and I (my husband's also a doctor) looked at each other and thought, 'we should get down to the hospital' because we'd seen what this couple was like and we knew that there was going to be a need for medical care at the hospital."

They had dinner at a neighbour's house (just across the back fence from them) who for some reason had power. The neighbour cooked up a big dinner for all of her kids and all of Dr. Wilson's family. Then she and her husband, along with some of the teen-aged kids from the two families, headed down to the hospital. They arrived at about 7:00 p.m. and things were "just starting to gear up".

Dr. Wilson is the Head of the Department of Family Medicine and is also the Chair of the Medical Advisory Committee at the Hotel Dieu Hospital, which means she is responsible for advising the Board on the quality of medical care.

She immediately recognized that there would be a need for medical care at all of the shelters that were opening up in town. There were medical students who had turned up to volunteer. Her husband, Dr. Ian Casson, Dr. Mike O'Connor (the head of emergency medicine) and Nancy Sears of the Community Care Access Centre got in touch with the medical students and organized teams of students to provide a 24-hour role at the shelters. Volunteer nurses were then attached to them.

They also realized that the emergency department was getting very busy, not with emergencies particularly but with people who were at the shelter and had forgotten medication or who were panicky or worried or confused. The emergency physicians and nurses decided to open up 24 hours a day. This was Dr. O'Connor's decision.

They also realized they were going to have an influx of people with medical needs. The beds at the Dieu had been closed in April of 1997 so they no longer had a cafeteria or kitchen. They only had a small coffee shop. So the Dieu quickly started to open beds.

Dr. Wilson's job was to get medical help into the hospital because Hotel Dieu no longer has a 24-hour system and no longer has a doctor in the hospital overnight, something she felt the public was not aware of. Most of their work is now with outpatients and some live-in psychiatry patients so there is no medical infrastructure.

The first night, they started with "just the doctors who appeared out of the woodwork and volunteered, and that was great to see them". As Dr. Wilson says, "it was a funny kind of disaster" because nobody knew how long it would last. At one point, she remembered that they have, at Hotel Dieu, a disaster fan-out telephone tree that has been in place for a long time and is updated every six months. It says at the top, "When the Surgeon-in-Chief declares an emergency, he will phone the head of Family Medicine and then she will phone all the people. And a small part of me kind of kept waiting for the Surgeon-in-Chief to call me. Well, then I looked around and realized the Surgeon-in-Chief wasn't there. I wasn't even sure who the Surgeon-in-Chief was. And probably I was the top banana and probably I should do this." She points out, however, that that plan was for the kind of medical emergency where you have a train wreck and you have 40 emergency cases arriving at one time. This was a different situation. "We had a thing that's going to go on for days and was not an all-at-once kind of emergency."

So, on Friday morning, they started calling all the family doctors in town for two purposes. "One, to see if they would like to come and volunteer, and a good number of them did. We had a double shift of volunteer doctors on call starting immediately for the duration. And they were not all family doctors, some of them were specialists." With a laugh, she points out that the kind of needs these people had were for general medical care, which is what family doctors are trained to do, "the kind that specialists aren't particularly trained to do". People had rashes, or couldn't sleep, or had a cough, or forgot their meds. "To their credit, some of the specialists came and volunteered to do that kind of work."

Also on Friday, Dr. Wilson started going back and forth between K.G.H. and Hotel Dieu. "From a medical point of view, we have a very close relationship with K.G.H. in that all of the members of the medical staff are appointed both at Hotel Dieu and at K.G.H. And our Medical Advisory Committee which advises the two Boards is actually the same people, but one week I'll chair and the next week the K.G.H. person, Dr. John Marshall, will chair." So she went over every day during the storm to hear what K.G.H. was doing and worked together with them. K.G.H. had a couple of important needs. One was the need to preserve their beds for the tertiary care role that they always play. "So if somebody has a stroke or a bad M.I. … they needed to make sure their I.C.U. was open and the beds were available because the medical needs continued during the ice storm willy-nilly." Because they needed to have their beds clear, it meant they had to quickly discharge patients who were able to be discharged but they couldn't go home, of course. So Hotel Dieu started to help K.G.H. decant some of its patients.

At the same time, they started to become more aware that there were medically fragile people in the community, "not just the kind of frail elderly neighbours that I described, but people who had medical devices that depended on electricity, like their oxygen concentrators, their dialysis machines, their continuous positive airway pressure machine...a whole variety of people who live in the community and depend on electricity to stay in the community. And those people were starting to come."

The other panic they had on Friday was that there were a couple of nursing homes that looked like they were going to be without power and Hotel Dieu thought they might have to take those people, who need a high level of care, in as well.

On Friday night Dr. Wilson's family all went over to their neighbour's house for dinner again. The kids had spent a lot of the day with the neighbours while she was at the hospital. "We had a cold night that night. From the family point of view, we sat around the fireplace...".

"The other thing that I had decided personally was certainly the hospital needed 24-hour care but I couldn't look after my own health and the hospital's needs 24 hours a day. So we set up a sort of medical administrator call system, too. And I asked that it not be me during the night."

On Saturday, she went back down again to the hospital. The decision was made that day for the Dieu to change its role from taking in everybody including the frail elderly to just medically needy people (the electricity dependant types) and making sure they had room for the nursing homes. At this point they were up to around 350 guests, so this involved a system of going around and triaging everybody from a medical/nursing/social work point of view to figure out where they could go. "That was a very lengthy process. And we didn't do it perfectly, meaning that we probably made the decision that some people could go to a regular community shelter who shouldn't have. But, I think, by and large we were able to figure out where people could go if they didn't need to be at the Dieu because, keep in mind, we were still expecting a large influx of nursing home patients." Volunteer family doctors, volunteer nurses and some social work staff were involved in doing triage. Some medical students also helped two teams in assessing people.

The pharmacy at the hospital was opened full-time on Friday and was very active on Saturday. They gave drugs free of charge to people who had arrived without their medication. Medical students, a volunteer doctor, volunteer runners and a pharmacist did that.

On the Friday, the other thing that was clear to Dr. Wilson when she went to the K.G.H. meeting was that it was necessary to keep the primary care medical system in the City up and running "because, if we didn't, then the hospitals were going to get all the burden of regular coughs, colds and earaches that normally go to the family doctor's office rather than to the hospital. But if people can't get a hold of their family doctor, that was all going to land on the hospitals, too."

In her role as Head of Family Medicine, she wanted to make sure that family doctors were available. So they canvassed them to see who had power (and most didn't). Many of them had vaccines that had to be looked after (and here she mentions Dr. Ian Gemmill of the public health unit). There's a fairly large group of doctors in town called the Willow Group who were out of power and they ended up moving into the Family Medicine building and sharing space so they could see their patients.

So Saturday was very busy with the large number of guests and the need to change the role and move them elsewhere. That night, Dr. Wilson's neighbours who had had power, lost their power. So they all went to the neighbours' mother who had a condo on Ontario St. There were 10 or 11 kids in this group (her kids, the neighbours' kids and friends of friends) all went and had a swim there and pizza. "I remember feeling very drained at that point. Very tired. And worried."

"The other big thing that happened Saturday from an anxiety point of view for me was I had gone over to K.G.H. about noon and we were talking about preserving the tertiary care role, getting primary care up and running, and while I was in the middle of that meeting at K.G.H. I got a call from the Dieu that they had just been at a meeting at City Hall and that the power grid for the City was damaged to the extent that it would take 3 or 4 weeks to repair. Now, at this point, I didn't really know what that meant, what a power grid was.... So we really started to worry about our delivery system if we were without power for that long." She felt discouraged and worried. She recalls somebody else's response to this news as: "My first thought is 'where can we get a whole lot of buses because we're going to have to send people out of Kingston because we cannot cope with this if it goes on like that'".

Another personal thing that happened for her was that on Friday night another neighbour had "jury-rigged" her furnace by plugging in her furnace to the neighbours who still had power so her family got heat Friday night. They hadn't had it on Thursday night. Then, on Saturday, these neighbours lost their power so she and her family lost their heat again.

Dr. Wilson usually goes to church on Sundays but their church didn't hold a service that Sunday. She says with a laugh, "I probably could have used going."

She went down to the hospital again on Sunday and they were starting to move people out to St. Mary's, K.P.H. and Penrose. Some people started to get power back that day and were able to go home. So their census at Hotel Dieu started to go down. The situation at Fairmont Home, who they had been anticipating taking in, also stabilized on Sunday or Monday.

She also made the decision on Sunday to open up the hospital again on Monday. They had had to cancel their clinics and "that was bad because people needed to have their casts off or their sutures out and weren't able to get in. And I felt again that it was really important that the primary care level be opened." So they phoned around again to staff, some of whom still could not get in due to their personal situation. She had volunteer staff from the Family Medicine Centre who turned up and took on the job of phoning all the doctors.

"Actually, when I think back on my role, I did very little actual work. I wore a stethoscope around my neck but I hardly saw any patients and I talk about calling all these doctors but I hardly made any calls myself. But it was mostly thinking about what needed to be done and finding people to help me do it."

They were down to about 240 people on the Sunday and it was still a very uncertain situation city-wide as to when the power was going to come back on.

Her family was still without power on Sunday night and they spent the time playing cards by candlelight, sort of huddled around.

(She went to Queen's a few times to have a shower.)

Her recollection is that by Monday they were starting to see the beginning of the end. Her own power at her house came back on Monday "and that made a big difference" to her morale and the kids' morale. On Monday night, her family went out to dinner at the Lone Star Restaurant as a celebration that they'd "made it".

She mentions that her family does a lot of camping. Last summer they had "a really challenging canoe trip in Algonquin Park that included one day of all-day rain that was really cold and we headed home and did five portages in one day." Her kids range in age from 7 to 16. One of her kids, at their celebration dinner, said, "Well, Mom, the whole ice storm wasn't as bad as the canoe trip."

She feels that the ice storm "divided the world into those who could cope and those who couldn't, and the doctors among them. Some of the doctors were coping down here and helping out and other doctors, when I would phone them and said 'could you help us', they said 'well, I'm without power'." She laughs. "Yes, I know. So are the rest of us." As she says, regarding people's reactions, "There were the helpers and the helped. And we all received help. That's always good."

Her kids chopped wood and cleared brush. She remembers that one of the neighbours wanted to pay them for it and they were thrilled. They heated water on the Coleman stove and her 7-year-old took coffee around to some of the neighbours and she really enjoyed doing that. "There are some good memories." Her kids also went down and volunteered at the hospital.

By Thursday, they were back to normal at the hospital. They started to open the clinics as quickly as possible. K.G.H. took as many clinic appointments from the Dieu as they could at Fraser Armstrong because K.G.H. hadn't been disrupted in the same way. The Dieu had "guests" all over the place and couldn't get the clinics up and running until about Tuesday.

The decision to close the shelter was made by a management group headed by Hugh Graham. Dr. Wilson, who was not part of this decision-making, had the impression that they were able to have all of their guests adequately looked after before they closed.

"For me, personally, it was a wonderful experience.... The joys were working together with a whole bunch of people who were so willing to do whatever needed to be done. Medical student volunteers, community volunteers. When the R.M.C. people came, that gave us a big help.... I remember them in their uniforms. [she laughs] I didn't actually know what they were doing but they seemed to be doing something. It was just nice to see those really energetic young people doing things. And practically nothing that I asked for was denied. It was the opposite. It was people coming to me, 'Do you need this? Can I do this?' It was great."

Most of Dr. Wilson's in-hospital work is done at the K.G.H. (in obstetrics) and "it was a real pleasure to get to know the managers and administrators [at Hotel Dieu] and work together as a team. And the Sisters, I got to know all of them."

The main problem, from a medical point of view, was that they discovered that they didn't have a good database for how to get hold of doctors. It was a problem if a doctor was on call (this is mainly related to K.G.H.). In some cases it was hard to contact them because their phones weren't working or some of their beepers went down for a while. And some of the doctors weren't at their homes. They had people willing to drive out to the doctors' homes to find them but if the doctor had moved to a hotel or something, they couldn't find them. "So I think we learned from a medical staff point of view that the first principle in an emergency is 'don't wait to be called but you call in and say where you are'. Let us know. Communicate."

The second thing, from a disaster planning point of view was that all of their planning had been done around a "point disaster" idea and they had not thought of how to deal with this sort of emergency. One of the lessons that her medical colleagues learned was, as a specialist said to her, "You know, Ruth, when I was in training, all these people who are now our 'guests' in the hospital who live at home, they all would have been in the hospital twenty years ago." It was an eye-opener for doctors to realize how many people are now being cared for in the community.

Ian Gemmill (public health) phoned Dr. Wilson at one point to tell her that there were a number of elderly people who had been phoning and were unable to get a hold of their family doctor. They wanted to stay home and needed a house call. So she put together a list of seven or eight doctors who would be willing to make house calls for those people who couldn't get in touch with their own doctors.

She did get a call from one of her own patients who, for some reason, reached her at the hospital. "A delightful, delightful woman (Clara Brook, I'm sure she wouldn't mind having her name mentioned) who is 94, I believe, and was living alone. And she called me and said, 'They all want me to go to a shelter.' She said, 'I'm fine. I have my blankets, I have my soup, I have people checking on me. Would you please, as my doctor, tell these people I don't need to go to a shelter.'" Dr. Wilson thought that sounded reasonable and was sure that if it became unreasonable then Ms. Brook would have changed her mind.

She had a little bit of contact with the media. There was a brief flurry of excitement on the Wednesday when they thought that Prime Minister Chretien was going to the Dieu.
"And Marcel Masse came instead and he did walk by and shake my hand and the media kind of followed him. But that was it." She had considered asking the media to make an announcement on the Saturday asking doctors to report in but decided not to because they didn't want to panic the population. A bulletin did go out asking health care workers to identify themselves, if they could volunteer.

She remembers that on the Monday at noon they had a meeting of all the medical staff, about 200 of them, and she and John Marshall (Chief of Staff at K.G.H.) outlined the need they had for medical volunteers. She felt more secure after this knowing that she wasn't on her own.

She was very impressed with the medical students, who took it upon themselves to become involved and who organized their own shifts, both at the hospitals and the City shelters. Mike O'Connor would know more about this. They also had family doctors who volunteered to help out in the Emergency Department. "Again, these were people who were not paid. They just came in and volunteered." Secretaries also went in and did not expect to be paid.

Dr. Wilson laughingly recounts a cute story of a write-up done in the family practice magazine (sort of a throw-away journal) about the ice storm and their role in it. Her picture was in it but with the incorrect name of Dr. Rita Wilson. Her friends across the country read this and she received several faxes and phone calls saying something like, "You have lied to us. All these years we thought you were a dynamo and it turns out you're not - you have a twin."

In conclusion, she remarks "that it was interesting to see how you organize in a vacuum and how some of your structures work really well and others didn't." The hospitals were surprised at themselves on the Monday that they had gone through the week-end with very little communication between the hospitals except that she had gone over. There had also been a conference call on the Saturday when Hotel Dieu changed their role. They didn't use their centre-wide structure but used their institutional structure instead, likely because the hospitals each have a management structure and a line of responsibility. By Monday, they started working even more cooperatively.