‘Burned out’: Saskatoon cancer doctors reveal reasons for departures

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After working nearly every day for 13 years, Dr. Christopher Giede doesn’t really know what to do with all of his free time. He plays the electric guitar and feeds his pet sheep, but he can’t stop worrying about his cancer patients.

Those concerns creep into his dreams: « Are his patients being cared for in his absence? Do they feel he abandoned them? »

In September, the 55-year old gynecologic oncologist went on medical leave.

« I’m physically unwell and can’t carry the load anymore, » Giede said, during an interview at his home near Saskatoon. « There has been a lot of psychological stress in the past couple years, and that has not helped with the physical stress. » 

The only other gynecologic oncologist in Saskatoon, Dr. Anita Agrawal, quit her job in December. She told CBC News that she was « burned out » and tired of asking for support. She accepted a job in Ontario. 

The situation in Saskatoon is being repeated in other smaller cities across Canada. 

Kingston, Ont., and Sherbrooke, Que., for example, have had a difficult time recruiting and retaining gynecologic oncologists, especially in the midst of a national shortage due to retirements, disability leaves, international competition, and growing demand from an increasing patient load, according to the Society of Gynecologic Oncologists of Canada.

Specialists are often drawn to departments in major centres with larger teams and more resources. In both Calgary and Winnipeg, for example, there are five gynecologic oncologists on staff and each is only on-call every fifth weekend. In Toronto, 21 specialists share the workload.

‘You feel in peril’

Saskatchewan is losing three of its four gynecologic oncologists by June of next year; two in Saskatoon and one in Regina.

Dr. Anita Agrawal says a lack of manpower and support made it difficult to maintain the level of care for patients that she wanted to provide. (University of Saskatchewan)

A gynecologic oncologist is a highly-trained specialist who treats ovarian, cervical, uterine, and vulvar cancers. 

It’s a unique specialty in that gynecologic oncologists not only perform complex surgeries, they also shepherd women through the entire treatment process with post-operative chemotherapy and care.

« We become very attached to our patients, and vice versa, they become attached to us, » Giede said.

Ovarian cancer patient Kimberly MacKinnon received treatment from both specialists, and isn’t comfortable with locums being flown in to Saskatoon from Ottawa to handle her case.

« How well do they know my case? It’s devastating, and frightening. You feel in peril, » she said.

Workload issues

In October, the Saskatchewan Cancer Agency sent patients a letter notifying them that Saskatoon was losing both of its specialists; Dr. Giede was on an indefinite leave and Dr. Agrawal was leaving her practice in early December.

A subsequent statement from the Saskatchewan Health Authority said the specialists were leaving for « personal reasons. »

That’s misleading, both doctors contend, because their reasons are work-related. 

Giede said they’ve been asking the health region to hire a third gynecologic oncologist and add other clinical support for at least six years. He warns that the province’s pledge to « aggressively recruit » replacements is ill-fated unless workload issues are resolved.  

‘It feels like someone opened a trap door beneath me, and let me fall through,’ said ovarian cancer patient Kimberly MacKinnon. She is upset about the departures of two gynecologic oncologists in Saskatoon whom she trusted. (CBC News)

Pleas for help

Each year, another 240 women are diagnosed with reproductive cancers in Saskatchewan. The wait time for a hysterectomy for cancer is roughly four weeks, on par with Ontario, according to health ministry data from both provinces.

The prairie province is in a chronic quandary over staffing enough specialists to avoid burn out. Its small population of 1.12 million people only warrants — in theory— a certain number of specialists in any field.

Yet, patients are spread over vast distances and timely access often requires service in both Saskatoon and Regina. Specialists need a certain critical mass to maintain a work-life balance.

When Giede accepted a job in 2005 as Saskatoon’s only gynecologic oncologist, he was on-call 24 hours a day, seven days a week. The arrival of a second gynecologic oncologist, Dr. Anita Agrawal, in 2008, provided some relief.

Still, the two doctors shared what they called a « one in two » ratio workload — meaning, each had to be on-call half of each month, on top of their normal clinical practice. If one took vacation, the other covered 24/7. 

Dr. Christopher Giede said treating gynecologic cancers is ‘intense work’ that requires respite. (Bonnie Allen/CBC News)

It wasn’t unusual for Giede to be called out of bed in the middle of the night to see a feverish chemo patient in the ER, catch a few hours sleep at the hospital, then perform a four-hour radical hysterectomy that day. 

« I could tell when we were both getting tired when we would argue over who was working more. And it was a silly argument because we were both working more than a full-time position, » Giede said. « We needed each other, and we need to work well or we would have collapsed long ago. »

As academic physicians, they were also expected to do research, teaching and administrative work.

‘You’re breaking bad news all the time’

The doctors started sending emails and letters requesting a third gynecologic oncologist in 2012. Their frustrations intensified when, that same year, the health region didn’t hire an eager young doctor who had been born and raised in Saskatoon and was seeking a job in the city.

« I love Saskatoon, and that was drawing me there, » Dr. Sarah Glaze told CBC News. She confirms she had multiple meetings with the university and health region, but with no job offer, she ultimately found work in Calgary.

Giede was particularly disappointed that health officials wouldn’t create a position for her, when it’s proven that homegrown doctors are more loyal.

Health officials argued that the number of patients didn’t justify adding a third specialist.

Magic number of 3

A recently published report on national best practices, called the Pan-Canadian Standards for Gynecologic Oncology, states that the magic number in any centre is a minimum of three gynecologic oncologists. That reduces surgeon fatigue and improves patient care.

« Physician burn-out is a huge problem, » said Dr. James Bentley, president of the Society of Gynecologic Oncologists of Canada. « If you’re down to two people for a long time, it’s very wearisome. We’re dealing with people who are sick, you’re breaking bad news all the time, long surgeries, complicated chemotherapy regimes. It’s not straightforward stuff. »

In Ontario, a hospital must meet that benchmark of three gynecologic oncologists on staff to be designated a Gynecologic Oncology Centre by Cancer Care Ontario.  

Dr. Christopher Giede feeds his pet sheep on his acreage south of Saskatoon. He’s on indefinite leave with disability benefits. (Bonnie Allen/CBC News)

Moncton, Halifax, and St. John’s all staff three gynecologic oncologists, but it has often proven challenging for those smaller centres, and others in Canada, to retain that number of specialists. 

There are 101 gynecologic oncologists operating in Canada, with about 85 clinical positions, as reported by the national society. Many of them only see patients part-time, and also work on research, teaching or administrative duties. 

In Giede’s case, he was expected to oversee resident physicians on top of a full patient load.

Aggressive recruitment

In 2015, the health region finally granted permission to hire a third specialist. However, Giede said, three years in a row, a potential candidate has rejected their job offer because of the work environment. 

Saskatchewan Health Minister Jim Reiter has directed the health authority « to do whatever they need to do to aggressively recruit » new gynecologic oncologists.

A job advertisement promises $467,000 – $587,000 annually, plus a $30,000 signing bonus with a three year return-of-service commitment.

The health authority is also offering to sponsor two gynecologic oncology fellowships, at roughly $200,000 each, in return for service in Saskatchewan — just as it did for Giede nearly two decades ago.

« When you have a homegrown doctor, there’s a stronger likelihood that they’ll stick around, » Reiter told CBC News. « Longer term, we think that’s going to help with retention. »  

Saskatchewan’s Health Minister Jim Reiter sat down face-to-face with Dr. Giede to listen to his concerns. (Mike Zartler/CBC News)

Giede said he is proof that the fellowship incentive is not enough, « if you then allow the person who you trained to get burned out. »

In a face-to-face meeting with Reiter, Giede made a pitch for a minimum of three gynecologic oncologists in both Saskatoon and Regina, as well as clinical associates, locum backfill, and first responder support from within the cancer agency.

The health minister confirmed that there is no plan to centralize services in just one city, and that a formal review of the program will take place shortly. Recommendations could lead to change in the program’s structure and staffing number.

‘We’ve been holding on’

This past summer, Giede’s neck pain flared up to the point he was popping anti-inflammatory pills, lying down at work, and heading straight to bed when he got home. 

Both Giede and Agrawal said they held on as long as they could, and didn’t plan their departures together.

« Our goal was to provide the best care that we could with all we had in us, despite the environment, » Agrawal said.

Giede will only return to the operating room if both his health, and the work environment, improve.

« Nobody wants a temporary fix. I’m confident that message has gotten out there. »

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The night the residential school burned to the ground — and the students cheered

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The first thing Jenny Spyglass remembers is the shouting. There was a fire, she was told, and she needed to get out — now.

It was 1948, and smoke was pouring out of the basement of the Thunderchild Indian Residential School.

The large dormitory room filled with girls getting ready for bed exploded into chaos. Seven-year-old Spyglass was given a thin blanket and was marched down the fire escape into a January night with temperatures reaching –35 C.

Flames quickly consumed the old wooden building. The large barrel of diesel and lubricating oil in the basement didn’t help. The fire was so large, it could be seen 65 kilometres away.

There were no casualties because they were all prepared.— Milton Tootoosis

It would be understandable if the students were frightened that night.

But instead of crying, many students started cheering.

Now 77, Spyglass, like other survivors, is convinced that boys at the school intentionally set the fire that burned the school to the ground.

And she’s glad they did.

Residential school survivor Jenny Spyglass says she’s glad the residential school burned down. (David Shield/CBC)

Stories of abuse, overcrowding and death

The story of the Thunderchild residential school is a familiar one.

Established in 1901 by the Roman Catholic Church just outside the village of Delmas, about 30 kilometres west of North Battleford in central Saskatchewan, the school was designed to house and educate First Nations children in the area.  

However, there were problems.

Milton Tootoosis, historian and headman of the Poundmaker First Nation, said many stories of abuse at Thunderchild came out during the Truth and Reconciliation Commission hearings.

The TRC spent six years documenting Canada’s residential school legacy — a government-funded, church-operated assimilation program from the 1870s to 1996 — and issued 94 recommendations, including several involving child-welfare reform.

Tootoosis’s parents went to the Thunderchild school in the 1940s. When he asked his father about the school, he would immediately fall silent.

« It’s a way they survived, » Tootoosis said. « They didn’t want their children to know what really went on in those schools, to protect them from the shock and likely the anger we would have experienced. »

The Thunderchild residential school operated from 1901 to 1948 near Delmas, Sask. (Provincial Archives of Saskatchewan)

Death rates were high in the overcrowded school, according to Shattering the Silence: The Hidden History of Residential Schools in Saskatchewan, a report written by the University of Regina’s faculty of education.

According to a paper prepared for the Law Commission of Canada, 15 per cent of the students at the school died in 1928, a rate of up to five times the provincial average for non-First Nations students.

A survivor and a brother lost

Spyglass was three years old when a black Jeep drove up to her family’s home on the Mosquito-Grizzly Bear’s Head-Lean Man First Nation.

Indian Agents and a priest « were pointing their fingers at me, and my mom started crying, » she said. « I should have had the feeling that something was wrong. »

She said the agents took her and threw her into the back of the vehicle. Dust caught in her throat as she bounced along the gravel road.

« I yelled and I screamed and I fought, » she said. « That didn’t help. »

She would spend the next three and a half years at the school. She said life there was hellish.

« It’s hard when I talk about it. Sometimes I can’t sleep. »

A group of parents camp near the Thunderchild school as they visit their children. (Provincial Archives of Saskatchewan)

One day at the school’s church, she saw her brothers sitting on the boys’ side of the aisle. She sprinted over to them for a hug. She hadn’t seen them in weeks. She said the nuns caught her and threw her into the school’s basement for the rest of the day.

« I thought they were going to leave me to die, » she said. « It was no use crying. They just left me. »

She said food at the school was inadequate.

« I didn’t like dry bread, dry bannock. That’s how we ate, » she said. « I didn’t know what a chocolate bar was — or an apple or an orange or a banana. »

Over the years, Spyglass said most of her brothers and sisters ran away from the school, except her older brother, Reggie. He died at the school after contracting tuberculosis.

« Reggie was my best friend, » she said. « Reggie was my playmate. He was everything to me. »

She said the strict conditions at the school made it impossible to mourn.

« I didn’t know how to grieve, » she said. « I didn’t know what to do. »

The original residential school building. (Provincial Archives of Saskatchewan)

The warning spread quickly

Spyglass and Tootoosis said the fire at the school was carefully planned by students.

Word quietly spread from student to student that night, telling everyone to get ready. Tootoosis said the boys were told to go to sleep with their clothes on and cover up with a blanket, so they would be ready once the fire started.

« There were no casualties because they were all prepared, » Tootoosis said.

According to an RCMP investigation report from the time, the fire started in a cupboard where custodians kept their tools. The nun who discovered the fire tried to throw water on it but was forced out by thick black smoke.

The provincial fire investigator believed the fire might have been set intentionally and asked RCMP to question four teenage boys. However, the boys claimed they had nothing to do with the fire, and the case was eventually dropped due to lack of evidence.

Once outside, Spyglass and some of the other children were taken to a garage to spend the night.

I hated school right through my teenage years. I would make an excuse to go to the washroom outside and from there I would take off.— Jenny Spyglass

In the morning, she was taken back to her home and her family.

« From far away, I saw a young man running towards us, » she said. « When I recognized it was my big brother Martin, I threw my little blanket away and my big brother carried me home. »

However, life wasn’t easy for Spyglass once she got home.

« All I did was cry, » she said. « I told my mom never to let me go anywhere. »

Finding culture and forgiveness

She began to attend a day school at the nearby Red Pheasant First Nation. Whenever she heard that the local Indian Agent was visiting her school, she would hide in the bushes, terrified she would be taken from her family again.

« I hated school right through my teenage years, » she said. « I would make an excuse to go to the washroom outside and from there I would take off. »

She dropped out of school after finishing Grade 10.

« I started drinking, and I didn’t like my life, » she said.

Jenny Spyglass and her husband Mervin Cox in the mid-1970s. (Submitted by Jenny Spyglass)

Eventually, she got married and had children. She started working at a school. She even got into politics, serving as a band councillor for 21 years and chief for four years — the first woman to hold that office in the North Battleford area.

However, it wasn’t until she discovered her culture that she was able to feel happy. After going to her first round dance, she bought a sewing machine and made her first dress.

« I was dancing, and I felt peace, » she said. « Those people that hurt me so much, I forgave them. »

These days, she works as an elder at many schools in the North Battleford area. She said it’s been an important part of her healing.

« I feel it within my heart, » she said. « I put my arms around them. I cry with them. »

Still, Spyglass doesn’t mourn the Thunderchild Indian Residential School. There’s no more than an empty field now where it once stood.

« They should have burned it a long time ago, » she said. « Maybe then my brother would be still alive. »

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