Uncertainty, Resilience and Hope
Healthcare In The Time Of Covid
Author: Cristiana Theodoli1
21/4/20
That feeling.
It sits in the pit of our stomachs. It's a feeling we are very well used to in the Emergency Department (ED). It's the feeling you get when you have a standby call for the young asthmatic or a severe burn; a late gestation cardiac arrest or a major trauma. It's the anticipation of something awful that's about to happen. Usually this anticipation lasts 5 or 10 minutes - then the patient arrives, you put your head down, start working, and the world around you disappears. In the time of Covid-19 this sense of anticipation is constant.
To a certain extent in the Emergency Department we are used to being over capacity, understaffed and overwhelmed. We have built a resilience over the past few years working under significant pressure. The chaos of a high workload, though always tiring and stressful, is what we know, what we do, what we deal with all the time.
Now that we have adapted to keep everyone safe while we await the influx of critically ill Covid-19 patients we are at times eerily quiet. Many people avoid coming to ED, aware of the challenges the NHS is facing. Others are referred straight to their specialities instead of having to come through us. As an urban ED in the city centre, party-related presentations make up a large number of our evening and weekend patients and with bars, pubs and nightclubs on lockdown these have mostly come to a halt.
But while it is a different kind of workload and the volume of patients we see is somewhat lower than usual, the proportion of critically ill patients feels higher, the protocols more time consuming and the emotional demand much, much deeper.
On any given shift the same sentiments are echoed across the department as we check on each other. From domestics to doctors, porters to nurses, radiographers to healthcare support workers. We worry about our patients, unable to see their families as they get admitted into the hospital. We worry about our own families, many of whom are in high risk categories and shielding. We worry about our colleagues, facing the same invisible challenges.
As we enter the fifth week of lockdown and getting used to a new way of working, the cloud hanging over us is slowly starting to lift, yet many of us still can't sleep. When we manage to get some rest we dream of work. I noticed last week, after a particularly emotional shift, that I started grinding my teeth when trying to drift off. Soon, I hope, this will pass too. Humanity's resilience is clear to see when looking back at history and I take some comfort in knowing that, like seasons change, this period will eventually come to an end too.
What I personally find most challenging is the care for vulnerable and end of life patients, both those presenting with Covid-19 symptoms or other conditions. Knowing these patients are being admitted at a time when families won't be able to visit or spend time with them is heartbreaking.
Our health board has a policy of allowing one family member to stay with vulnerable or end of life patients but this isn't always possible when relatives are themselves vulnerable, unwell, or at high risk. While as a department we always try and make sure these patients aren't alone, it is not the same as having their tribe there. I think of my family, back home in Italy, far away and inaccessible and I feel for the families here, close by, yet unable to provide comfort and support to their loved ones.
I also struggle with the young Covid-19 patients who are in a serious condition. The 30, 40, 50-year-old patients in resus, gasping for breath and unable to maintain their oxygen saturations make the virus all the more real. Today it's them, tomorrow it could be my friends, neighbours, colleagues or even myself. As they get whisked away to intensive care I can't but feel for them and their families, fearing what's to come and with no way of reassuring each other. We carry this emotional load with us every day.
We work with Covid-19 patients every day, dealing with unprecedented ethical and emotional challenges, and I know I speak for the whole department when I say we are extremely grateful for the public support and recognition. There is also a general feeling of guilt for the free food we keep getting sent while we still earn a wage when many have been laid off due to the crisis. While we get free food and early access to supermarkets there are also just as many non-NHS key workers out there who continue working hard to ensure people are safe and fed.
From supermarket staff keeping us fed to home carers looking after our loved ones, from freight drivers keeping us stocked up to teachers looking after vulnerable kids, from train and bus drivers getting us to work to journalists keeping us informed and keeping the government accountable – all key workers are at increased risk of being exposed to the virus and all deserve the recognition and support that we get in the NHS.
I also feel lucky that as key workers we get to leave the confines of our flats and houses and maintain a sense of normality. We get to spend time with others outside of our household as we see our friends and colleagues at work. We are able to share our fears and worries with our team, and knowing that everyone else shares the same concerns helps us cope with the unknown. Many of us report feeling better at work, where our minds are occupied, and though facing Covid-19 head on we can at least feel like we are actively doing something to help.
As we adapt and get used to the challenges of living and working during a pandemic I am restless yet hopeful. I look forward to the day we can get back to our normal lives and “open the door a crack wide enough for the entire world to pass through” (Gabriel Garcia Marquez, Love in the Time of Cholera).
Cristiana x