SARS Crisis of 2003

SARS more than 15 years after

West Park SARS team in 2003

It was a time of fear and unknown. In 2003, a new illness appeared on the other side of the world and rapidly spread to a handful of cities around the globe. Touching down in Toronto, the SARS crisis would become of one of the greatest international healthcare challenges in decades and envelope West Park in unimaginable ways.

Because of West Park’s national and international reputation in respiratory care, the Centre was first called upon to help.

Within six hours of a request from the provincial government, West Park turned a decommissioned TB unit into Ontario’s first dedicated SARS unit. That evening, patients began arriving - all fellow healthcare workers from Scarborough Grace Hospital struck by this mysterious illness.

West Park staff, many from TB services, volunteered to work on a quickly created unit with some of the sickest patients in the world, struggling with an unknown illness that left death in its wake.

“It was terrifying, daunting, to say the least,” said Dr. Peter Derkach, then Chief of Staff at West Park. “It took staff at all levels to organize this. It took administration. It took the nursing staff. It took the respiratory therapists – it took everybody – to get involved and step up to the plate and in a matter of a few hours set up new beds and have everything prepared.”

Dr. Derkach went home one last time before entering the unit. He packed a bag, kissed his wife and kids goodbye, not sure how long he would be gone. The days turned into weeks. When he finally did head home, it was only a brief respite.

“Even when I did go home I was basically isolated to the recreation room of our home and I didn’t use the same dishes, I didn’t hug my children or my wife. So I remained isolated for longer than a month, even at home, not knowing whether I could transmit the disease,” said Dr. Derkach.

Dr. Monica Avendaño was at a conference in Ottawa when West Park established the SARS unit. Once she returned, she also threw herself into the cause, staying more than two weeks straight on the unit.

“The patients were very sick so (the work) was day and night.  And the other thing is that I was afraid to go home and infect my family.  So it was not easy,” said Dr. Avendaño.

Every day, they would congregate in the nursing station to discuss the cases. Then they would begin rounds.

Team performed "like an orchestra"

For housekeeper Bernadette King, the sheer physical exhaustion is what she remembers most. “It was non-stop,” said King. But she knew she was part of something special, and was impressed by the team of volunteers that was assembled.  “It was like an orchestra. Everybody knew their part and they played it well,” said King.

Between each patient, they would have to change their full protection gear - including gowns, gloves, masks and face shields. They developed new cleaning procedures on the fly – using a bucket of water only once in a room, and replacing mops between rooms.  What would normally take an hour or two, stretched into full, exhausting days.

All the protective gear meant the isolation even extended within the unit.

“The worst thing I think was not so much the work but the fact that we had no contact – human contact,” said Dr. Avendaño. “We didn’t see faces. We didn’t touch anybody. We didn’t hug anybody – well we hugged a few patients because they were scared, but it was nothing – the human interaction was totally cut off.”

It made for challenging interactions. For instance, one patient celebrated her 30th birthday. The kitchen sent up a muffin and a birthday candle. Everyone gathered around her bed and sang happy birthday through their masks – and feverishly fanned the candle to try to blow it out.

Another patient brought her guitar but was too sick to play, and was convinced she was going to die. To comfort her, Dr. Avendaño picked up the guitar and sang her a song while wearing gloves and mask. “You’re not going to die,” said Dr. Avendaño. “So now stop crying and that’s it.”

Also troubling was all the unknowns about the illness. How did it spread? How long was incubation? What treatment would work? No one knew for sure.

“I don’t bungee jump and I don’t skydive,” said Dr. Derkach, “but this is the closest that I’ve come to doing something fairly dangerous - not knowing how it’s transmitted, not having any treatment for it and knowing that people could die.”

West Park loses one of its own

While all the 14 SARS patients eventually recovered, the illness ultimately took one West Park casualty. Tecla Lin, a well-loved part-time nurse who had worked on many West Park units before volunteering for the SARS team, succumbed to the illness.

“She was a very pleasant woman who was always in a very good mood, always very cooperative and patients liked her,” said Dr. Derkach. “We liked her.  She was just so good natured.”

Tecla LinLin shared so much joy, said King. Whenever the housekeeper started working on her unit, Lin would welcome King with such genuine delight and say how pleased she was to be working together. “I was never greeted like that by anybody before, or ever since,” said King.

Dr. Avendaño also remembers Lin as a very caring person. The evening before Lin became sick, the two sat down together in the nursing station. “She says to me – You look tired, I’m going to make you some tea.” So they shared some tea and conversation before heading back to care for patients.

The next day, Dr. Avendaño received a call telling her Lin had become ill and was showing the first symptoms of SARS. She thought back to the night before and the casual sharing of tea.

“Oh my god at that point I thought: This is it,” said Dr. Avendaño. “So what I did is I went to the room and I grabbed a piece of paper and I wrote to my children. I said: I’ve been exposed. I might get infected. This might kill me. And if it does, don’t cry too much. I did it because I’m a physician and I’m a doctor and my duty is to look after sick people.  And therefore you should be at peace with yourself – proud that mama died because of this – but I hope I won’t get it.”

King had her own close call. Within the first week she got sprayed in the face with blood and urine from a patient. “I panicked, but Dr. Avendaño calmed me right down, cleaned me up, and we kept going.” There really wasn’t time to be scared. Patient lives were at stake and there was always more work.

In the end, everything changed. New procedures like emphasizing hand hygiene became the norm. And those who volunteered on the unit say they were never the same. They bonded like troops on the front lines, and shared an experience few can say they have ever faced.

“I think that it was a privilege to be part of this experience,” said Dr. Avendaño. “For the first and probably only time you were the complete doctor like in the last century.”

Dr. Derkach also acknowledged the critical role all West Park staff played, including those who kept the other units operational. “We were extremely grateful to our staff for stepping up to the plate and even the staff that weren’t involved on the unit but everybody had to hold the fort,” he said. “And it gave us a great deal of satisfaction to know that we had the courage that we did and that we supported each other to the extreme length that we did.”

BBC SARS radio series features West Park

On the 10th anniversary of SARS, the BBC World Service has run a two-part radio series called Sacrifice: The Story of SARS about the illness and the havoc it created in a handful of cities around the world, including Toronto.

Host Dr. Kevin Fong visited West Park in 2013 and interviewed West Park’s Dr. Peter Derkach and Dr. Monica Avendaño, the two physicians who worked in the SARS unit here.

Listen to the series here

Part 1
Part 2

The second story includes more focus on Toronto and West Park in particular, which Dr. Fong describes as an epicentre in the fight against SARS.