Cardiac Care

Dr. David Forrest (00:11) Reality is that without a catheterization lab north of the Malahat, 60 % of the residents of Vancouver Island are denied access to the best therapy for a heart attack. So this is why it's desperately needed, and this is why over the decades we have been particularly frustrated in internal medicine and critical care, because our patients can't access this. We've watched patients die. We see the ravages of inappropriate or ineffective therapies for heart attacks, which result in damage to the heart muscle and heart failure. Barney Ellis-Perry (00:53) Welcome to Harbouring Hope, a podcast brought to you by the Nanaimo District Hospital Foundation. I'm Barney Ellis-Perry, CEO of the Foundation and your host for this series. We're on an exciting journey with our dedicated donors who you will hear from throughout this series as they share why it is in our nature to give and their collective vision for improving health across Central and North Vancouver Island. In each episode, we'll take you behind the scenes at the Nanaimo Regional General Hospital, Oceanside Health Centre and other facilities supported by our Foundation to explore the many departments, innovations and dedicated professionals who keep our health care system running from doctors and nurses to administrative leaders and patients with lived experience. We'll hear powerful stories that reveal both the challenges and the triumphs within our hospital walls. Most importantly, we'll shine a light on the critical role our community plays because behind every success story is a network of generous supporters helping to make it all possible. Today, we will meet critical care physician, Dr. David Forrest, as well as past patient and current donor, Pat Morris, who herself has experienced the highs and lows of cardiac care on Vancouver Island, along with her late husband, Mike. Let's start with Dr. David Forrest. Firstly, we'd love to know a little bit about your background and why are we so lucky to have a man with your talents here in Nanaimo? Dr. David Forrest (02:14) My name is David Forrest. I'm an infectious disease and critical care medicine physician at Nanaimo Regional General Hospital and president of the Medical Staff Association. I came to Nanaimo 21 years ago. And I have to say largely because of the opportunities that I saw in terms of work and the potential for growth in the community and the desperate need for establishment of better tertiary level services here. And so it was a real opportunity to foster development of services here to serve the population of the central and north Vancouver Island. Barney Ellis-Perry (02:48) In his 21 years here, Dr. Forrest has done a lot to help build Nanaimo and Central Island medical infrastructure. I'll let him tell you about it. Dr. David Forrest (02:57) I've done here in infectious diseases and building a program I think has provided service not just in the Nanaimo but across the central North Island. The Infectious Disease Group provides in-hospital and outpatient services once weekly, once every two weeks in either Campbell River or Comox. And I visit Campbell River, Comox and Port Alberni regularly to provide HIV care. So our focus from an infectious disease standpoint has been very much on improving services and providing service for residents of not just Nanaimo, but central and North Vancouver Island. Barney Ellis-Perry (03:30) And you've had great success with infectious disease and I sort of feel like you're now turning your sights to cardiology in some respects as you are a very vocal proponent for what we need to build in terms of our future cardiac capacity in central North Island. I have to ask though, how did we get here? Like you've been in this game for 21 years. The need for cardiology services has been only growing over those 21 years and from your perspective, know, how did we get into the situation we're in? Before Dr. Forrest answers my question, let me tell you a little bit about what I mean by the situation we're in. As you heard throughout this series, while NRGH is an amazing hospital for Nanaimo, we are lacking what some would consider essential services, such as access to cardiac services like a cath lab. This means that individuals seeking care for cardiac-related illnesses are likely to be sent to Victoria for care. And if you're from Central or North Island, you're aware of how challenging this can be, especially in an emergency situation. Dr. David Forrest (04:28) You know, for years I did general internal medicine here. and I continue to practice as a critical care physician. And a good part of what we do in internal medicine and in ICU is management of acute cardiology, acutely ill patients who have heart disease, most particularly heart attacks or unstable angina. And so over the years, it's been very apparent to me the desperate need for access to cardiac services, most particularly interventional services. By that I mean cardiac catheter. catheterization and indeed that has been recognized for decades. When the first CEO of the Vancouver Island Health Authority which preceded Island Health in 2006 came to Nanaimo, he acknowledged the need for development tertiary level services here and most particularly cardiac services and in fact promised that there would be a catheterization lab built within 10 years in Nanaimo. That was in 2006. And obviously it has been almost 20 years since then and nothing unfortunately has happened. So I'm well aware of the need for improved services for Central North Island from a cardiac standpoint. Barney Ellis-Perry (05:45) Not only are our physicians identifying this need, our community is as well. In fact, the foundation has over $3 million that has been promised by donors for a cath lab, even without a campaign. I asked Dr. Forrest if this level of public support is higher than in the past. He says yes, and to help us understand, I asked him to give us a cardiology 101 lesson. Dr. David Forrest (06:05) Absolutely, and I think it's important to understand why development of cardiac catheterization services is so important locally. The primary treatment if you have a heart attack is a process called angioplasty. So a heart attack is caused by there's a narrowing in at least one of the blood vessels that supplies the heart with blood and a clot forms there which completely blocks blood flow and that's what causes a heart attack. People develop angina because of poor blood flow through that narrowed area before they develop a heart attack. But a heart attack is caused by a clot forming at that narrowed area. And since the 1990s, now for over 30 years, from the last century, there's clear evidence that the best treatment for someone who's had a heart attack is to open up that blood vessel as quickly as possible. And that requires a procedure called an angiogram. where a little catheter is put in usually through the wrist up to the heart and dye is shot down the blood vessels to identify the narrowed area and then that area is opened up with a balloon and a little stent is put in to hold it open. And that treatment is the best therapy for a heart attack. In order to get angioplasty done in the context of a heart attack you have to be close to a facility that can provide that service. you have to be available to be in a cath lab within about 90 minutes. And that means that since the only service that's available for Vancouver Island is in Victoria, residents north of Duncan cannot access that service. Now, after you've had a heart attack, you still go for an angiogram, you still have an angioplasty done, and that service is still provided in Victoria. But the reality is that without a catheterization lab north of the Malahat, 60 % of the residents of Vancouver Island are denied access to the best therapy for a heart attack. Not just in terms of convenience then, but it's also about outcomes. This reduces risk of death, it improves the preservation of heart muscle and therefore prevents things like heart failure. So it is the most effective therapy and the evidence is very clear for that. So this is why it's desperately needed and this is... why over the decades we have been particularly frustrated in internal medicine and critical care because our patients can't access this. We've watched patients die. We see the ravages of inappropriate or ineffective therapies for heart attacks which result in damage to the heart muscle and heart failure. And that impairs people's function, reduces their quality of life, oftentimes means they can't work. Barney Ellis-Perry (08:50) This feels like a good time to introduce you to Pat Morris, a former patient of Cardiac Services and a current foundation donor. Pat lost her husband Mike in 2015 due to cardiac issues and shortly after that started experiencing them herself. Let's meet her now. I'd love you to share a little bit with us about your journey and your husband's journey in having to go to Victoria for cardiac care. And you live in Nanaimo and obviously that's not your first choice. So I'd love to hear more about your experiences. Pat Morris (09:19) It's very traumatic and it's very traumatic for your family as well. The first experience with our hearts was Mike in 2003. He got into NRGH and of course they treated him very, very well here. He was on oxygen and nitroglycerin drip and he was in there for five days and by this time I was getting a little anxious and he had a male nurse and he was just absolutely excellent. And so he and I talked and we said we would like, especially, would like Mike to go to Victoria. And the doctor said, well, ⁓ Mike, it isn't an emergency. And he doesn't know when Mike would go, because they would take you down here, there, and everywhere, I guess. I don't know. Stress, stress, stress for us, you know. And so anyways, it was the very next morning. I phoned ⁓ at 6 in the morning. He leaves. This is the sixth day that he was in NRGH. He arrived, of course, in Victoria and we were in the waiting room and we were in the waiting room and we were in the waiting room. So consequently, ⁓ he doesn't come out of surgery for quite a while. I get to see him for about five minutes and he has had one stint and he's had a couple of blockages. So, so much for an emergency and the hesitation for sending him. I was impressed. Oh, that hospital down there is absolutely out of this world. It was in 2003. It was also out of this world when 2015, when I went down. So anyways, it hasn't changed very much, but it's wonderful. Barney Ellis-Perry (10:57) Mike went on to live for another 12 years until January 2015. While talking to Pat, I could hear the gratitude in her voice that she was able to have those many more years with her husband, Mike. However, a week later, Pat started having some issues with her heart. She was picked up by an ambulance and brought to the Victoria Hospital. Pat Morris (11:14) They take me in and the next thing I know I'm sitting or I'm well I'm laying I guess in a looks like a puppy hole with boxes cardboard boxes all around me not you know not very professional anyway beside me is a television and on the television is my heart and all of these little blips are going boop boop all around my heart trying to find out where my problem was. Well after a very long time I had to look away. had to look away. The next day the doctor someone told me that they found the blockage was 90 % blocked I think and they put a stent in and I was ready to go home. This is the next morning. That was nine years ago. But I must remind you that this was a week after Mike died that I had my procedure. So consequently I can imagine my family, know, here's another one going to Victoria. This is, it's ridiculous. It's just, it's just absolutely. Barney Ellis-Perry (12:13) Well, the global standard of care. When you've had an incident to what they call door to needle, when you've had an incident and to getting to a cath lab, which is what you and Mike both experienced, the global standard is 90 minutes. And here on Vancouver Island and central North Vancouver Island, we're one of the largest communities in Canada and large parts of North America that do not have 90 minute access to a cath lab. And so the concept of you having to go a week after your husband's passing to go to Victoria to get a cath lab and over 52 % of the people in Victoria at the Cath Lab are from Central North Island is the reason that we're fighting really hard and the community here at Nanaimo is fighting really hard to get a Cath Lab to serve all of the people living north of the Malahat, all 460,000 people. We really have to get that Cath Lab here. One of the areas that the foundation is working on with Island Health, we're basically looking to build all the infrastructure to support a cath lab. Like we're very determined to get a cath lab. And in the meantime, we have to build up the structures in order to attract the cardiologists we need. We only have two now, two and a half. We need to get to six and we need to have cardiac rehab. We need to have other cardiac services here. we've been, last year we were very fortunate to raise quite a lot of over half a million dollars for cardiac equipment and to support the diagnostic and treatment of cardiac issues here in Central Island. But we're now trying to build the rehab center. We're trying to build more offices for cardiologists to attract them. And, you know, eventually we're going to get a promise for a cath lab. We're going to try and figure out how we get one in the interim basis. You know, while we're very focused on getting a patient tower here in Central Island, that we'll have a cath lab in it. The government is committed to that. But that's 10 years away till we open the doors. So we need to do something now. And the foundation is working really hard to try and rattle all the cages to make it happen. Pat Morris (14:04) Well, it's amazing how a lot of people don't know about it. Unless they have someone that has had the experience to go down, I don't think they really realize what a mess we're in here. At the times I had to take Mike up to the hospital, there were four hours, six hours, one was an eight hours. I mean, he could have died then, you know? Barney Ellis-Perry (14:27) That story is troubling, but more common than you think. In fact, 52 % of the patients at the cath lab in Victoria are from North and Central Island. As for building a cath lab here in Nanaimo, it's easier said than done. Let's go back to Dr. Forrest. Dr. David Forrest (14:40) I think it's important to understand, however, that cardiac catheterization services can't happen on their own. In order to provide cardiac catheterization services, you need a full cardiology program. You need heart specialists who are able to provide the care. I think we do a very good job in critical care here in Nanaimo, as well as the internal medicine group, as they do across central North Vancouver Island. But really, we need the value added of subspecialists. in heart disease cardiologists to provide the expert care. Barney Ellis-Perry (15:14) course, you talked really well about the long-term health outcomes if people don't have the primary angioplasty, et cetera. But also there's that emotional toll that it takes. People not able to access that care in Nanaimo. And it takes a real toll on people. The other aspect that you mentioned is the real human stories behind it and having to see people die here unnecessarily. mean, we both heard of a story a couple of weeks ago. A gentleman, I think, was 54 years old. presents with a heart attack at six in the morning. Victoria did accept him to go down. They called the helicopter. By the time the helicopter got here, he was prepared. he was pronounced dead on arrival. And that's insane. He's left behind a wife and three children and a life here. it just, that wouldn't have happened if we'd had the cath lab here. And I love how you talked about us sort of building the roadmap that we're looking at to develop the infrastructure to attract the doctors that we need, because we're in this complete chicken and egg. And I'm really hopeful that as soon as we can get a solid commitment to opening the doors of a cath lab in. maybe three years, hopefully sooner, that we can really lean in on recruitment. Because right now, how do we recruit when we don't have that? You know, the Foundation invested significantly last year in a lot of equipment for the heart centers, both in the hospital and across the street. We have invested in training for some of the heart center staff, but we also would like to build what we call the Nanaimo Cardiology Center as a space for six doctors, they'll of build it they will come. And cardiac rehab, we don't have cardiac rehab for Central North Island. So we are really looking to partner with Island Health as soon as we can get a solid commitment to bring donor support to the table and build the infrastructure for this tertiary care level of cardiology that we all want to see here in the island. From your perspective, what would you like to see our listeners do in terms of advocacy, personal care in general? How do you tell people to help us achieve our goals here? Dr. David Forrest (17:13) Well, I think first off, you mentioned, the community clearly is very motivated to support this. And that is great. I think that there is increasing understanding of the importance of the community, the importance to the community of having access to cardiac catheterization services. You mentioned a roadmap to developments of a catheterization laboratory. The medical staff position is that we need that catheterization laboratory. We need a commitment to it. in a short timeframe. By that I mean three years. And we have been absolutely clear that that is kind of a bottom line for us as a medical staff association and we feel for the community's sake and I believe the community is behind that. And the reason that that's so critical that it be in a short timeframe is that we cannot build the cardiology program that is needed as a say to support catheterization services without that commitment. I want to emphasize again what you mentioned Barney, the commitment of the community to this. You and I know that as residents of the Regional District of Nanaimo, we have been paying a considerable amount of money through our property taxes to fund this sort of infrastructure. And we know that the Regional District has made available significant funds, frankly enough funds probably to build a catheterization laboratory. There is clear community commitment to the development of cardiac services. It angers me frankly that the provincial government and NDP MLAs have all promised, have all committed to providing catheterization services in Nanaimo and a new tower, but catheterization services here. And yet since the NDP has been in power, the new government, they have failed to make that commitment budgetarily. And that's a problem. Because as I say, without that commitment, we cannot build a program. Without building a program, we can't realize a catheterization lab. And people will continue not to have access to primary angioplasty when they have a heart attack. They will have worse outcomes. There will be deaths. There will be people that we watch that do well after thrombolysis, after getting clot busting drug, and then die of a brain hemorrhage. We will continue to see these bad outcomes. We will continue to see the emotional distress, inconvenience and morbidity that caused by having transport patients to Victoria for services that should be available in Nanaimo. We've waited 21 years, 20 years for these services and promises have been made. They've never been fulfilled. And from our perspective, that no longer is acceptable. We need to see change. So what do we need from the community? You, the community, has already made a huge commitment to the development of these services. And I think it's critical that we continue to support the efforts of Fair Care Alliance and frankly of our local politicians in ensuring that that financial and other support is there. What can you do? You can advocate. You can advocate with your member legislative assembly. You can advocate publicly. You can continue to contribute and talk to Aircare Alliance and to people like Barney who have been very strong advocates for the development of these services and the infrastructure that's required for them. So I think that advocacy from the community is critical. We need to hold our politicians to account. They made promises during the campaign. We need to see them fulfill. Barney Ellis-Perry (20:51) I couldn't have said it better myself. We have to advocate. Like you say, our MLAs need to hear from everybody in this community. So thank you, Dr. Forrest, thank you for being this brave warrior for 21 years. I hope we get another 21 years of your warriorship and we really appreciate you taking time to be with us today. Thank you so much. Of course. And thank you to you, our listeners, for listening to season one of Harbouring Hope. Having these conversations with our donors, medical professionals and staff throughout the hospital has really reinforced something for me that I probably wasn't aware of when I took this job three years ago. The incredible need to equalize healthcare between South Vancouver Island and Central North Vancouver Island has become a personal passion project for myself. It's more than a job. It's very much a mission. And it's been thrilling to have so many people come alongside the foundation. We've seen attendance at all of our activities swell. We've seen the numbers of donors supporting the foundation grow exponentially. And we've seen the financial impact of that support just go off like a rocket ship. We have tripled our fundraising thanks to the support of the community. One of the greatest things we can do the foundation is to rally the community, is to rally people who care, is to create awareness and to bring the capital, the financial resources of our community in order to bring pressure on the government. Because one question I get asked is, when you raise money, do you let the government off the hook? What I've come to realize is it's actually the opposite. When we raise money for programs and as we are building out the required tertiary care programs, such as cardiology, neurology, maternity, GI and others, We create the infrastructure. We only do that in partnership with Island Health because then they are committed to the staffing and the ongoing operations of those clinics. So with every dollar we raise, we're actually bringing new money for healthcare to our community for the future. It's clear that we have an enormous amount of work to do. Your support makes a real difference. Whether you share these stories, volunteer your time, or make a donation, you're a part of the work we do. Together, we're building a healthier future for everyone in our region. So thank you for listening. I really hope we get to spend some time together in season two. To learn more about the Nanaimo and District Hospital Foundation, please visit nanimohospitalfoundation.com. I'm your host, Barney Elsperry. If you are a current or future partner of the foundation, thank you. With your unwavering support, we are delivering a new standard of care for all who call this amazing region home. Together, it's in our nature to give. Dr. David Forrest (23:39) Another Everything Podcasts production. Barney Ellis-Perry (23:43) Visit everything. Dr. David Forrest (23:44) A division of Patterson Media. Pat Morris (23:48) The reason why I contribute to the Nanaimo District Hospital Foundation is because through them I got my heart back.