Saturday 18th April 2020
This is all total madness!
Wherever I look, I see the denial of the obvious. At my trust, we have the advice that Public Health England know best – their PPE advice is sufficient. But experience says the opposite. I saw a patient, elderly, in extremis – he of course tested positive a day later. There’s me in my surgical mask which we know full well won’t protect us and a plastic apron, as though that does any good. I have gloves but we know that the fomites will be covered for several hours. Everything my patient touches is contaminated – including me! My patient is breathing in oxygen at 15 litres a minute and his hands are touching his face, he is breathless and is tugging at the mask, touching his mouth and nose. He slips off the xray plate stuck behind his back as we attempt to xray his chest in resus. The heavily protected Intensive Care staff left as soon as they clapped eyes on him – of course he wouldn’t be one of those who required their assistance – he’s not going to survive. They turned their backs and left, not offering to help, not wanting to know more. Obvious. So there’s me left – to keep trying to help this poor man as he slips sideways, his weakness means he cannot sit upright. My bare arms reach to pull his shoulders towards me once again. My mask as we all know will not prevent me from inhaling his exhalations……..
I come away emotionally fraught knowing that in other circumstances we would have tried at least to rescue him from death, but this time, it is me who has to ask his wife to come in and spend time with her dying husband. I hear her distress and wish it were different. She was not allowed to accompany him in the ambulance, but at least, now he’s for ‘palliation’, she can be by his side.
I wish I didn’t feel so helpless. I feel it for him, for her, for our staff. I have to go away and cry. I am so upset at all this. It’s so wrong. I know that it would be futile to have him on a ventilator for days on end and that he cannot escape his fate. But I’m used to at least giving it a go. This is the kind of decision that I realise will be taken often in the coming days. There is no time to weigh up the pros and cons, to let the relatives down gently. The treatments we’ve become used to are no longer available.
For me and my health, this encounter has left me unprotected in a way that is staggering -at least I know that the fact I am female puts me in less of a risky position. But I worry. I cannot imagine that after this, there could be any possibility of NOT being infected. But I take this home with me now so what of my husband? How would I feel if he were to succumb? I would be as devastated as this poor wife was today.
I don’t know what to do. I can’t help wondering if it would have been better for all of us to be locked up with our patients and only allowed home when an antibody test somewhere in the future shows that we are no longer a risk.
I read absurd things – the canteen is now closed to seating as we are not the required social distance from one another. Yes, they will provide food but nowhere for us to eat it. What then? Should we go to our cars and eat alone? Everyone possible will work from home. I cannot be a remote doctor. No. I’m there on the front line, like the nurses, the cleaners, the porters – it has to be done. No choice. We’re the greatest threat to each other – people like me, who have close contact with the infected and the dying but are unprotected. The true front line. I cannot be two meters away from my patients, so why are we so worried about being two meters away from each other when people like me have little choice?
They’re crazy the lot of them. They’re just paying lip service but haven’t the gall to speak out. If they did, then none of us would be in this position. So our sacrifice will be measured with platitude as though we are heroes. We’re not, we’re sacrificial lambs. There is no choice. None. Our families are going to be in the same position. The inevitable will happen and they may take some comfort from the accolades the media will produce. But I won’t – not if I’m dead, or not if I’ve brought infection into my home and it kills the one I love.
We are canon fodder. I thought that phrase was over the top when I first heard it. Not any more – we are going over the top, like the soldiers who gave their lives in the first world war – dispensable – young men – more where they come from.
Bureaucrats – they speak from their backsides. From their computer screens in their suburban islands of fantasy. They don’t care. Statistics, number crunching, being seen to do good is their bread and butter.
I wrote this two weeks ago and I am still here with no signs of infection. I am lucky. My initial anger has dissipated. But since then I have been shouted at by a radiographer who thought I was getting too close to him; colleagues who are normally calm, behave with out of character irritability. We are nowhere near the peak of the pandemic in our area.
I am getting more used to the situation and am no longer afraid. My distress if there is any left, is felt most when trying to cope with the emotional strain of being in a dysfunctional hothouse of everybody else’s temper tantrums. It feels as though the patients are less central than they should be – our protection is to be considered the primary consideration. We are at risk, but surely we cannot forget that our patients are the reason we are here in the first place? Moral injury is another assault on our NHS conscience.
On Thursday, I was home for the clapping, but I had to come in because my tears flowed. I want to be like some of the places in the USA, where they stand at their doors at 8 pm and howl. They are in collective mourning. It is poignant to express grief for the many who are dying alone, including some of our caregivers, infected at the front line. I want to cry for those who are experiencing domestic abuse and for the children in such homes. I want to weep for those who have lost jobs and those who are homeless and for the many nameless victims of economic disaster in the rest of the world.
I am glad that it has slowed us all down, made us all reconsider the important facets of life. It is wonderful that pollution has decreased in many major cities and that the rate of global warming has slowed down, even if just a fraction. It has shown us what we can do without. These times are strange indeed but my hope is that it has given us all the shake up we need to re-discover our humanity – maybe we can then be kinder to one another and more accepting of our unique place in a very diverse world.