MOUNT HOPE:

LIFE AND DEATH AT THE HOSPITAL - Pg. 4

Even Leslie Vincent is frightened by the possibilities of the pandemic — which is frightening all on its own. Hospitals are grave places, after all, and Leslie Vincent has worked in them (as a cancer nurse, no less) for 30 years, ever since she began her nursing studies at McGill University at the age of 16. “When you’re a nurse,” Ms. Vincent says, “and you’re helping someone who’s dying to get in and out of bed every day, you feel their weakness. You experience them getting weaker every day.” But these difficulties never stop her. She can’t change the fact that people die, but she can do something about how they die. This approach had helped her to the top of Mount Sinai, where she’s senior vice-president of nursing — 1,200 employees, a budget of $115-million, a salary pushing a quarter of a million dollars a year. Not that the money matters that much to her: She still brings her lunch to work. She is still the chief nurse of the hospital.

During the SARS epidemic that made Mount Sinai world-famous, Ms. Vincent had to tell her employees that the hospital was taking in its own staff as SARS patients. It was one of the hardest days of her entire career. So it is a matter of some note when Leslie Vincent, the salt of the nursing earth, is scared by the thought of a flu pandemic. The problem is that the bird flu is so confounding, she’s not sure this time any of them can make a difference. It’s not just the million practical details of preparing a hospital for an inevitable pandemic — whether there are enough ventilators (probably not), how the infected should be admitted (a flow-chart job no one wants), the gruesome issue of morgue overflow, or even the basic question of how to decide when a pandemic has actually begun.

Susan Poutanen, a microbiologist and infectious-disease consultant who is the vice-chairman of the flu committee, reminds everyone that they have already decided that rather than “relying on the Ministry of Health’s stockpiles of Tamiflu, given the quantity that would be available to us from the ministry, it would be prudent for us to consider stockpiling our own” — i.e., the government’s 12.4 million doses, which would treat a million people, aren’t enough, so it’s every hospital, business and essential service for itself. It’s a reasonable precaution: If hospital workers get sick, we’re all finished. So the committee plans to distribute the pills, as a prophylaxis to prevent the disease, to everyone in the hospital — patients possibly included. Still, to be even 80 per cent effective, Tamiflu has to be taken every day through the first and second “waves” of the infection — six to 12 weeks or longer.

Ms. Vincent, ever rational, is laying out the cost scenarios. The current retail cost of Tamiflu is $4.20 a pill. Roche, the Swiss manufacturer, will let the hospital stockpile it for $2.50. Over the course of 90 days for the 5,000 people associated with Mount Sinai, that’s just north of $1-million. If she includes patients — a move Dr. Low opposes, which the committee is still debating — the number rises to more than $4-million. But the cost is only the white picket fence at the bottom of the garden pathway that leads up to the real house of horrors. Is it even a good idea for everyone to be on Tamiflu? Some studies show that the H5N1 virus (the avian form of influenza) can develop resistance. “Is there any modelling” — this is Tony Mazzulli, a microbiologist sitting at the end of the table — “of what would happen when that many people then stop taking the drug? Are you going to extend the period of the influenza?” Allison McGeer’s voice squawks out of a speaker in the middle of the table. Dr. McGeer is an infectious-disease expert at the hospital, as famous as Dr. Low: She actually contracted SARS working in the hospital. She’s at the airport, waiting for a plane. Her opinion, along with Dr. Low’s, is the group’s gold standard.

< Previous Page | Next Page >