A surgeon speaks frankly about delayed procedures and other tough calls during pandemic

Paul Johnston spent the early days of the COVID-19 pandemic pacing the floors, imagining the tumours in his patients' bodies growing bigger without treatment.

What was the bigger risk? Their existing problems, or the unknown virus spreading around the world? That's a question Johnston still ponders.

The St. John's urologist, and board chair of the Newfoundland and Labrador Medical Association, sat down with CBC reporter Mark Quinn for a frank conversation about decisions made during those early weeks and months. 

The following conversation has been edited for clarity and length.

Q: What was it like being a surgeon in those years?

A: That was hard. That was really hard. You have two competing voices in your conscience. On the one hand, you've been trained to look after folks and you've dedicated, you know, decades to the process and you believe that what we need to do here is do the surgeries get these tumours out of these poor folks, right? They're suffering.

But on the other hand, we have this new beast out there that is also dangerous and just even interacting with humans is a risk. It was a terrible time. It was beyond frustrating, I think would be the best way to to put it.

I think I drove my my wife and kids crazy just pacing the house, waiting for a chance to go take a tumour out, you know, lying awake at night. It was bad because you want to look after these folks and you can', and you're just thinking how hard it is for them. They're at home and they have this thing in them that's growing and it needs to come out. And every day the clock is ticking. So yeah, it sucked.

It must have affected outcomes, I guess in two ways. People didn't get the surgeries they needed as quickly as possible … but were people found later and diagnosed later? 

Research is starting to emerge on a number of different fronts. This was sort of an obvious risk that the medical community, the surgical community, knew, and research is starting to emerge that suggests that you are seeing patients who would ultimately get to the operating table with disease that was a little bit more advanced than it had been before.

Now, that sucks, but we have to weigh that against the risk of what would happen if we had simply carried on as before. What happens with the completely unchecked COVID-19 virus? We have this hindsight now and you're starting to see these negative effects of the lockdowns manifest themselves.

But we have to remember at the time you're looking at a situation that [was a] completely novel virus. [There was] nothing like this before in terms of the length of time of the incubation period, all of that. It was really hard to to figure out what to do. We hadn't seen it before.

The other thing with patients that has been really hard is not just the the oncology effects, but the social effects. I know people struggled with the drink. I know a number of people who lost their jobs. People lost houses. I know patients of mine whose marriages collapsed because it was a very stressful time and you're all over each other. So the echoes from the actual lockdown continue.

I'm not suggesting that we should not have had some kind of public health measures. I mean, my God, I think that's crazy. But it turns out that this was a very hard problem to navigate for patients. Because they're a whole person, right? They're not just their tumour.