Shownotes Transcript
Scott Payne spent nearly two decades working undercover as a biker, a neo-Nazi, a drug dealer, and a killer. But his last big mission at the FBI was the wildest of all. I have never had to burn Bibles. I have never had to burn an American flag. And I damn sure was never with a group of people that stole a goat, sacrificed it in a pagan ritual, and drank its blood. And I did all that in about three days with these guys.
Listen to Agent Pale Horse, the second season of White Hot Hate, available now. This is a CBC Podcast. I'm Dr. Brian Goldman. This is White Coat Blackheart. Almost every shift I work in the ER these days, I'm apologizing to patients for the long wait to see me, to see a specialist, to be admitted, to get a bed upstairs.
It's happening at ERs right across Canada, and the reasons are frustratingly well-known. Not enough hospital and long-term care beds, not enough staff, inadequate home care, and more. You have so many stories to tell about long waits they could fill two seasons of our show. The one we have this week stands out because the patient, a woman who waited 40 hours in the ER at Kingston General Hospital, could have died. And because her husband, who happens to be a physician, was uniquely aware of that possibility.
Hi, my name is Christina Shahata. I am 51 years old and was diagnosed with metastatic breast cancer and recently spent over 40 hours in the emergency room waiting to get a bed. Hi, I'm Dr. Adam Shahata. I'm a family physician with additional training in anesthesia and I practice anesthesia and emergency medicine.
Christina Shahada, Dr. Adam Shahada, welcome to White Coat Black Art. Thank you. Thanks for having us. Christina, what was your health like immediately leading up to your stay in the emergency department? Ironically, I was feeling fine. I had just spent a lovely weekend with my sister and her kids, and Adam came home from working an on-call shift.
Christina had been diagnosed with metastatic breast cancer in December 2020. After a year of cancer treatment, she went into remission. Unfortunately, in the fall of 2024, the cancer recurred and she went back on chemotherapy. Christina picks up the story on February 9th, 2025, nine days following her third round of chemo. We were watching television and then all of a sudden I started to get the shivers and
Didn't have a fever at that time, was bundled under blankets. And just before we actually went to bed and went to sleep, Adam went to give me a kiss goodnight and noticed I was burning up. And that's when we took my temperature again and decided, okay, no, we have to go to the hospital.
One of the most serious side effects of chemo is that it drastically lowers your white blood count and therefore your body's ability to fight off bacterial infections in the bloodstream. Patients on chemo are warned to come to the hospital immediately if they have a temperature of 38.3 degrees Celsius or higher. Christina's temperature was 39.
So Adam, as you know, you're a husband and like me, you're a physician. What makes you decide that Christina needs to go to the emergency department when you got that temperature and it was 39.2? You know, we were thinking about it earlier in the day because she had felt a bit feverish. And when you're a cancer patient, you are to check your temperature every so often, you know, approximately, you know, once a day. Certainly, if you feel feverish, you should check. And so I
So I was really worried. We had been here when Christina, four years prior, had been on chemotherapy. There was a week where we had to take her three times to the hospital because she had a fever. So it was close to nine o'clock at night and it was a Sunday evening. And honestly, we really didn't feel like we wanted to go to the emergency department. And we knew that, of course, when you're there, there are lots of sick people around and things like that. And so I reluctantly said, okay, we should really go in.
You're a physician and you do emergency shifts as I do. So you know all about long waits in the emergency department and hallway medicine. So, you know, as you're thinking, I got to take you to the emergency department. Are you thinking at all about that? So I was quite concerned about the fact that, yes, she should go because we should rule out this very serious issue. But at the same time, there's a risk in going as well. So I was I was a little bit hesitant.
Christina, I'm guessing you're at this point a bit too sick to have an opinion, but did you have an opinion about whether you should go to Emerge? I actually did have an opinion. I was like, do we really have to go? Because honestly, I did not feel sick. I felt just almost normal. I didn't realize the state that I was in. And I
I was like packing things like my crochet and a book and making sure I had stuff to do while I was waiting in the emergency room. So Adam, when you get to the emergency department, you and Christina give the triage nurse something called a fever card. In really simple terms, explain what it is, what's it supposed to do?
It's a business card. Basically, on the one side, it says to the patient, you know, how often and when they should take her temperature and if they have a fever that they should go in. And on the other side, it says to the triage nurse, what steps to take when presented with this card, because not all emergency departments like this one have a cancer center. And so, for example, it says.
This patient is to be triaged as what's called a CTAS2, which is just one step under someone who is being actively resuscitated, like having CPR, for example. And then for the other parts, it says certain blood work that's supposed to happen. And then it also says that this patient is not to wait in the waiting room and that they are to be basically isolated and immediately taken back to a treatment area if possible.
So we're not blaming anybody. We know that there are system-wide problems, not just at the hospital where you brought Christina, but almost every hospital in the country. So what happened when you presented the card? You just told us what was supposed to happen. What actually did happen?
So what actually happened was the triage nurse, being a very experienced nurse, had said, well, as you can see, we're full. We are full up in the treatment area. What you can do is you can go and wait in your car if you would like, because if you don't want to be around the people here who are obviously sick because of the risk to Christina. It being February, it being very, very cold. And with this particular hospital, the parking that we had had was around the corner. This wasn't ideal for a number of reasons, not the least of which was
Had Christina's condition deteriorated, we would have had to call an ambulance to get her into an area as opposed to having doctors and nurses come from the treatment area to the waiting room to treat her. So like an ambulance from the car. That's right. Wow. You know, this is this is an unusual set of circumstances for me. So you decide to stay. They did blood work while she was in the waiting room.
They did. It took about 20 minutes to be triaged because there was somebody else ahead of us. It took about 45 minutes to an hour to get the actual blood work drawn. And then shortly after that, she was taken back to the treatment area. So what was the blood count? And tell me the significance of that.
The blood test results came back as a critical level and they called the eMERGE doc. And I remember asking because I happen to know this person and I said, what was her, what's called an absolute neutrophil count? And she said zero. And I said, oh, no, no, no, not like what was it? Was it low? It's not like what was the actual number? And she said, no, Adam, it's zero. She has no white blood cells that fight off infection. Wow. So that means that if she has a bacterial infection and she has a fever, then she's a sitting duck for the bacterial infection.
Exactly. I was really, really worried. Just a quick note here. The technical term for Christina's condition is febrile neutropenia. Basically, it means she has a fever and a low white blood count, in her case, zero white blood cells, which means her body cannot fight a bacterial infection if that's the cause of the fever. What actions took place as a direct result of that?
So immediately she was seen, she was taken back to the treatment area. She was seen by the physician right away. At that point, they knew already that she would need to be admitted and be worked up for this condition called febrile neutropenia. And they were trying to find a source of infection. So they were asking questions.
whether she had been around anyone who was sick, whether she had any breathing problems, whether she had any abdominal pain, things like that to see is there some kind of infection that they can localize, that they can find so that they can treat that appropriately. And then immediately after, regardless of whether or not they found anything there, they were going to start her on broad spectrum IV antibiotics.
And did they? They did. It took about two hours from that moment. So it took about three hours from the time we presented ourselves to the triage nurse until the IV antibiotics went in. And that was only at my very strong urging. There's a reason why Christina had to wait two hours to get on antibiotics. She has a porticath. It's a semi-permanent IV often used to give chemo.
It's surgically implanted, usually in the chest area. Since port-a-caths can get infected, Christina's doctors needed to get a sample from her port-a-cath site before starting her on the antibiotics. The delay had to do with difficulties getting the port-a-cath sample.
Christina, throughout all this, how are you feeling? Honestly, I was feeling fine. I didn't feel like I was sick. I didn't understand why Adam was so concerned. Even though I'm a doctor's wife, I didn't know what zero neutrophils meant. I was just crocheting and reading a book and waiting to see what was going to happen next because I was no longer feverish. My fever had already come down.
And I think that's part of the problem is Christina presents as a patient who looks well. Obviously, you can tell that she has cancer. She doesn't have hair, you know, this sort of thing, but she otherwise looks well.
So, Adam, you know, you and I are both physicians. We both work in the emergency department. And I'm guessing you don't want to be that kind of physician, you know, spouse of the patient or son of the patient or father of the patient where you're pushing, trying to push the staff to do what you know needs to be done for Christina. Were you just getting anxious, more and more anxious by the hour? What are you feeling? What are you thinking you need to do?
Very much so. I think the two sort of biggest points of tension were that initial stage of getting the antibiotics into Christina, you know, as quickly as possible, because I know the stats. I know that a delay in antibiotics can raise the mortality or the death from this very serious medical condition to up to 70%.
And I don't want to be that guy. I don't want to be that person that is really being pushy. I want to be understanding. I know what it's like on the other side of the gurney, as you always sort of sign off with. I know that there could be sicker patients. There could be other people that people are working very, very hard. And then the other part was a little bit later when there weren't any beds.
Christina was placed on a gurney in a part of the ER called the treatment area. It's not a hallway per se, but it's an open area where patients are continuously wheeled in and out at all hours of the day and night. She stayed there for 24 hours. What's that like as you watch the parade go by? It's intense. There's constant movement. There's constant noise. Lots of talking. Patients who are crying and begging for help.
and not necessarily really needing help. They're just frustrated with their situation. The noise level was very high, impossible to sleep. There's no privacy, really, because every noise that you make is heard by 10 other people. It's a lot going on, which makes it not the best place to recover from anything.
Adam, you were concerned that she could acquire a different kind of infection. Can you talk about that?
So there was the waiting room and obviously people are sort of around helter skelter. There are around 20 people or so that were there. Obviously, people are coughing. Obviously, there were people that were vomiting. There were people that were half on the floor and security was trying to assist them as best they could and things like that. But in the treatment area in particular, what I was worried about was this was a section and I've worked in this emergency department as a resident physician.
This particular area is more for ambulatory medicine, meaning that people come, they stay for a little bit, and then they go. So they're not segmented off rooms with walls and so on. It's a row of gurneys separated by curtains. And on one side, there was a patient who was elderly and couldn't unfortunately get up and take the 10 or so steps to the washroom and was defecating in a commode right beside us. And on the other side, there was someone that had a productive cough. And it was just, it was not, it was not a great scene. I was, I was really, really worried for Christina. Yeah.
And Christina, I, you know, I can kind of get this kind of juxtaposition of these two scenes that Adam is worried bordering on frantic and you're crocheting. And at some point the conversation comes up between the two of you about contacting your parents. Yes. So Adam just says, maybe we should call your parents and let them know. And I'm thinking it's 11 o'clock at night. We're not going to call my mom and dad at 11 o'clock at night because
and worry them and stress them out. And he's saying, well, what if something happens? And I'm like, what are you talking about? Because I didn't feel, like I said, I really didn't feel sick. Did he tell you what he was thinking about, what he was worried about? He sort of explained it, but I think he was probably trying to protect me as well from worrying. I think the way that I phrased it was, you know, she had said, what are you talking about? I said, well,
it's one thing to just go to the hospital and be discharged from the emergency department. It's another thing to come into the hospital for a period of time. And then it's a third thing to have what I know to be a very serious condition. And I said, what if something happens, not wanting to say, what if she died? Right? What if she came into the hospital, and I didn't get a chance to talk to her parents, and something happened? We'll be right back.
In the fall of 2001, while Americans were still grappling with the horror of September 11th, envelopes started showing up at media outlets and government buildings filled with a white, lethal powder. Anthrax. But what's strange is if you ask people now what happened with that story, almost no one knows. It's like the whole thing just disappeared. Who mailed those letters? Do you know?
From Wolf Entertainment, USG Audio, and CBC Podcasts, this is Aftermath, the hunt for the anthrax killer. Available now. Nobody taught me when to tell patients and their loved ones to summon the family. It's even harder when you're both loved one and healthcare provider, and you're struggling between needlessly worrying a family and depriving them of a chance to say goodbye.
You're listening to White Coat Blackheart. This week, Christina Shahada, a breast cancer patient, and her husband, Dr. Adam Shahada, a family doctor, describe what it was like for Christina to wait in an ER for 40 hours while at risk of a life-threatening infection. It happened at Kingston General Hospital. But as we said, waits that long happen all the time at hospitals right across Canada.
After spending 24 hours on a gurney separated from sick patients by curtains, Christina didn't get a bed upstairs on the ward. She did get a private room in the ER, but as you'll find out, it took some strong advocacy from Adam. Christina, you know, looking back on that whole experience, man, what do you think of that?
It's scary. It's scary on so many levels, but I think mostly I'm a doctor's wife, so I have a better understanding of how the medical system works and what some of these conditions are. I can't imagine somebody in my position who is a layperson, who has no idea, who's feeling fine, who is in the same circumstances, and
isn't able to advocate for themselves because they don't know what they need. Adam, how instrumental do you feel your efforts were in making that happen? It's really hard to gauge.
So I know that everyone there is doing the absolute best that they can. I would like to think that the charge nurse that I spoke with has an eye out on everyone, but I also know what their job is like. And having a well-appearing patient with someone who is just on routine IV antibiotics that doesn't need much else is just not the top of your list of things necessarily. So at the 24-hour mark, this is now at about 9 o'clock at night on a Monday, and I said, what's the status of her bed? Because I thought by now she would have gone upstairs. And she said,
And the charge nurse had said, well, your wife is due to get the next private room in the hospital. And I said,
okay, but it's Monday. And I know that in hospitals on Monday, we have discharges. That's just the nature of how hospitals work. So what happened to the beds that were made available from those discharges? And the information that I was told was ICU had downgraded a number of patients to make room in the ICU. Those patients had gone to a step down, which is in between a ward bed and the ICU. And those other patients had then taken the beds that were freed up from the discharges. So at that
At that point, I said, can she go to an isolation room, which is like a negative pressure room where everything is kept isolated? And she said, well, we have six of those in this hospital, in this emergency department. They're all being taken up by patients that have other illnesses that may be a risk to other people that may be contagious to other people. So those are all taken up. And I said, OK, what about just a room with walls and a door? And about a couple hours after that conversation took place, that's when she had that.
I have no idea if what I said made a difference, but Christina, Christina feels that it did make a difference. Oh, I think it made a huge difference because shortly after that conversation, I sent him home again because he was just getting frustrated and wasn't going to do anything.
And one of the nurses came in and said, I know your husband just left, but I wanted to let you know we've got a room for you. We're just waiting for it to be cleaned and a porter to take you over there. Your husband must love you very much. And that was the point where I knew things were better. And I, of course, called him to let him know right away that there was a room and they were just waiting for things to turn around.
Adam, what was supposed to happen and in how much or how little time? What does the book say someone with febrile neutropenia like Christina is supposed to be treated? So the book says that the standard of care for this condition is that you are triaged as early as you can be. You're triaged as that CTAS2, that very emergent situation we talked about.
that you have your blood work drawn as soon as possible. And that if it's confirmed that you have no white cells, that you should get IV antibiotics within an hour, within an hour of presentation. And then...
As soon as you can, they should go to the safest place that they can, which should be some kind of isolation room or equivalent. As it happened, Christina got IV antibiotics within three hours of presentation, and she was taken to just a regular room in the emergency department after about 24 hours, which had no garbage, no clock, just walls and a door, basically. And then she finally got a regular ward bed after about 40 hours or so.
So certainly much longer for all of the major steps compared to the standard of care. Yes. Adam, as we've said several times, you're not just a husband, you're a physician. You do this work. You've compared your experience to what was happening there. What's your take on how people with the best of intentions are trying to look after Christina?
I think the empathy is there. I think the professionalism and the skill is there. I think what we're seeing, Dr. Goldman, is, as you've seen, is that the system is simply at its absolute wits end, it's at its breaking point. So, you know, for the past several decades now, we've had shortages of beds and things like that. And the emergency department has become a catch-all social safety net for everyone to go to, whether it's from another part of the hospital or from outside of the hospital.
and the system, both the nurses and the doctors and the other allied health professionals, have been doing more and more with less and less as time has gone on.
And I just feel like this is the symptom that really shows that, that if someone in Christina's situation coming with the privilege that she has, the advocacy that she has on there, and I truly believe that if something different could have been done, these physicians and nurses would have absolutely done it. But they were just up against a brick wall. And it was just a simple fact that there wasn't anything else at that time that could have been done, which then tells us that we'd really need to do something and change the system.
Christina, how did you do in hospital? How long were you there and how long until you were able to go home? Went home on Wednesday. 72 hours. Went home on Wednesday, but it would have been a lot longer if Adam hadn't kept coming home.
because there was trouble with my port-a-cath and he kept making suggestions about how to get that fixed. And I wasn't on the list to go to the IVR. Interventional radiology. They're the ones that fix port-a-caths at many hospitals. Although I, you know, I recently found out that there are anesthesia assistants in some hospitals who do that as well. Oh, wow. So if he hadn't been there the whole time, I probably would have been in the hospital until the following weekend. Yeah.
which would have meant I was taking up a bed that I didn't need to be taking up a bed anymore. Because by that point, my neutrophils were up and I could go home to where I would be safer.
And the interesting thing, Christina, is that your delay in getting out of hospital means that the next person that needs the bed is also waiting in the emergency department. So you got to see the whole issue from both sides. Yes, exactly. And that I find very concerning. And I know everybody...
Christina and Adam said a couple of things that stand out. Christina experienced delays getting admitted to hospital and delays getting discharged from hospital. Both are caused by gaps in the system that need to be addressed.
The other notable thing is that when you're admitted to hospital, it helps to have a partner who knows their way around the wards. There's one final bit of my conversation with Adam and Christina that we want to share. Adam talked about notifying Christina's parents, but there's one more family member worth mentioning, their 13-year-old daughter.
How much of your experience have you shared with her? She knows what's going on with me. She has a fairly good understanding of the situation that I'm currently in with my cancer having come back. It's kind of obvious when you don't have hair, it's very obvious something is going on.
We do what we can to make sure that she's not overly affected by my situation. So we make sure that she is participating in school activities, that she has doing her extracurricular activities with air cadets, where she is one, the second team in her region and marksmanship, which was fantastic. So we try and,
to limit how much my situation affects her. I actually woke up Amelia before we left for the emergency department. She had already gone to bed. And I'd said, listen, here's your cell phone because we don't let her have her cell phone in her room. If I need to, I will call you, but go back to sleep. I'll be back in the morning, but you may need to stay in the hospital for a little bit. We'll see. Okay. So I didn't want her to wake up and not know where anyone was. And then I had called my mom to come in from out of town so that she could come and take care of things.
But I remember at one point my mom, seeing how frustrated I was and calling the hospital and calling Christina about trying to get things going about different things, had said, you know, maybe she shouldn't necessarily know everything that's going on or she might lose faith in the medical system, might lose faith in physicians.
And I remember having a conversation with my mother saying, you know, she's the daughter of a physician. I think that she needs to know that as skilled and trained as we are, we don't have always the power to do all of the things that we need to do or would like to do. And we work in teams. And also part of this has to be on politicians. And the reason why it's so important that stories like this need to be heard is so that we can put pressure on our politicians to change the system and make it better.
And I know, Adam, you reached out to the world on social media. Christina, I don't know how private a person you are. What made you want to share this story with the world? Honestly, I was not really prepared to share this story with the world. Adam is more of the social media person and, I guess, celebrity in our family.
And when he told me what he did, I said, it's good. People should know what's going on with the system. Yeah.
You know, I want to thank the two of you, Christina Shahada, Dr. Adam Shahada, for telling your story. And, you know, I think it will resonate right across the country, especially people listening in provinces where they've spent 10, 20 hours in the waiting room or on a gurney in a hallway in the emergency department to know they're not alone. Thank you. Thanks very much for having us.
We reached out to Kingston Health Sciences Centre. They sent us a statement that reads in part, Like many hospitals across the country, Kingston Health Sciences Centre has experienced a sustained increase in patient volumes and continues to operate at high capacity. Despite these challenges, our teams are committed to providing timely, high-quality, safe care to every patient. Our priority remains to deliver the best possible care to the communities we serve.
That's our show this week. If you'd like to comment, our email address is whitecoat at cbc.ca. White Coat Black Art was produced this week by senior producer Colleen Ross, with help from Jennifer Warren, Stephanie Dubois, and Samir Chhabra. Our digital producer is Ruby Buiza. I'm Brian Goldman, and I'm proud to bring you medicine from the Canadian side of the gurney. See you next week. For more CBC Podcasts, go to cbc.ca slash podcasts.