As an emergency doctor I am dealing with COVID-19 patients almost every day. Don't worry - this is not another post complaining about the lack of masks or "PPE." It is simply an account of what I am experiencing.
I work in a very busy North London hospital. The department is usually buzzing with organised chaos. The "blue call" phone ringing to prepare us for a very sick patient arriving. Elderly patients arriving in the dozens for anything from emergency interventions to much needed TLC. Appendicitis, kidney stones, heart attacks, heart failure. If the diagnosis exists it is in one of the cubicles.
Hospitals often function in quite a segregated fashion. Patients arrive and are seen by the emergency team who stabilise them and refer on to the appropriate speciality. Now it is all about everyone pulling together to make whatever needs to happen, happen. Every speciality is on the "shop-floor" ready to pitch in with their expertise, the moment it is needed. I have done portering duties when required. Only a couple of days ago I was on a ward disinfecting bays to assist the domestics who work tirelessly but simple can't keep up with the demand. A screen which lists each patient in the department has a column to highlight their working diagnosis. Instead of the variety of diagnoses listed above, 80% of the column is filled with "COVID-19."
I wear a mask, the patient wears a mask. I stand at a distance from the patient as I take the history. As we communicate the dialogue is often interrupted with "sorry?" as our masks muffle our diction. The concept of rapport no longer seeming possible. We rarely examine the chest as our stethoscopes travel from patient to patient and are high risk for transmitting the virus. We take a short history, closely monitor observations and wait for the characteristic low lymphocyte count to show in the blood tests and peripheral patchy shadowing on the chest x-ray. Very relevant to my work as a perfumer - the recurrent complaint of loss of smell and/or taste. The treatment options limited to supplementary oxygen, antibiotics and then referral to intensive care if more invasive forms of ventilation are required.
As a doctor one of the biggest challenges is remembering that diagnoses other than COVID-19 still exist in the current climate. There comes a point where your mind flips in to a COVID/Non-COVID autopilot. There is then of course the risk of missing something which is totally unrelated to COVID-19 or that has made someone more susceptible to the virus. Our departments have transformed in to unfamiliar environments. Its sort of the same feeling as knowing your lines perfectly in rehearsals for a show and then forgetting them the second rehearsals move to the stage.
The public support for the NHS has been incredible. I sometimes feel guilty about that to be honest. I use the comparison to the fire service who don't get to choose how big the fire they are prepared to put out is. I am of course only talking about my own experience but I am not suffering. As I have said previously, I have a job which saves me from isolation and I still have an income. We are probably a cohort who though hugely appreciate the crates of food we are given everyday - don't benefit from them as much as others in less privileged positions would. Yes, we are exposed daily to a potentially life threatening virus but in many ways we now know what to expect. Even prior to the pandemic NHS staff are exposed frequently to anything from infectious diseases to violent patients. Perhaps this pandemic has actually put a spotlight on what NHS workers have been doing all along. Please don't see this as a criticism, merely a reflection.
From a personal perspective the lock-down has made me reflect on my own way of life. I have nothing other than what I have and that is enough. The luxuries I thought nothing of indulging in seem totally irrelevant and I am taking great pleasure in smaller things. Having time to develop new scents. The 45 minute walk to the hospital each day. More frequent and considerate communication with friends.
I often talk about "moments" when discussing scent. This is a moment in time that most of us will never forget and probably won't want a frequent reminder of when it is over. Particularly for those who have lost loved ones. For those of us who come out of it largely unscathed, there is a lot to learn. A city which can often be cold and excessively fast-paced has taken a moment to stop and reset. London has discovered village values and long may they live.
Please, if possible, give us demographics of your Covid+ patients i.e. race, age, sex, comorbidities
gracias….Muy interesante soy medico de primer contacto, agradeciendo esa reflexión.
Thank you for these beautiful reflections, bringing a different perspective to what’s going on in our world – expanding the horizons of what would be resourcing to remember. I’m aware too that our sense of smell is closely related to our memories, and I’m curious about what smells (and memories) you may take with you on this most unusual of journeys.
May God bless and protect you and your fellow brave Doctors and nurses, thank you for your honest Words, , we can’t imagine what you guys go through every day. Asking god protection in these scary time. Proud of all of you 😘😍
Thank you Nadeem, wonderfully put.
I’m a registered nurse in Northampton
Very well said Dr , you brought tears into my eyes , you words are from the heart and god bless you and keep you safe
My prayer are with all of the front line workers wherever they are and in particular the NHS staff
Thanks for taking the time to put these thoughts down and for the work you are doing, stay safe and well.