May 2020: Doctors in a coronavirus ward in Germany. DPA/PA Images

Hospital doctor Frontline workers have given their all - a second surge would be devastating

Dr Rachel McNamara describes her experience of working on the frontline in the past few months. She says it’s hard not to view the easing of restrictions with anything but trepidation.

I REMEMBER FIRST hearing about the novel coronavirus in Wuhan in my living room, in the warm glow of post-Christmas merriment. It was something vague about a virus and a market in a city that I’d never heard of.

At that point, if you had told me that the five-minute news story tacked on to the end of World News would change the way in which we lived our lives, permanently, I would have suggested that it was time for you to put down the wine glass.

Nevertheless, an unease soon grew within me, stoked by each news report and article detailing the virus’s raging spread in China. In mid-January, I recall eying our newest patients lying end to the bitter end in the Emergency Department, and I remember thinking that it was just as well this virus was on the other side of the world because we couldn’t hope of ever dealing with a virus like that here.

And then it arrived

A few scarcely credible weeks passed and I remember sitting numbly in the meeting that confirmed all of the worst rumours about Covid-19. Department heads were bowed in disbelief. Nervous laughter was stifled by suffocating masks.

Phrases like “The greatest threat to human health of our generation” were being thrown about, and nobody was joking. Covid-19: a disease with no cure, a varied presentation, unpredictable course and death was coming, like a bat out of hell.

I remember driving home on that mid-March evening wondering what I should choose to worry about first. Should I worry about my professional life? I had seen our hospital staff struggling with workloads for the entirety of the 18 months that I had worked there.

Each week, despite our efforts, we seemed to break our own records of people on trolleys, outpatient waiting lists and outbreaks of infection.

It goes without saying that, from the occupational hazards of working in a consistently back-breaking environment, my own mental health, and that of my burnt-out colleagues, was already hanging …by a rope.

Should I worry about my family? Obviously, I now had to move out of my family home or face the guilt of infecting everyone. Should I worry about myself?! I had never found my own immune system to be particularly robust. What about the economy? I would consider myself lucky if I was even alive to endure the oncoming recession.

I expected chaos. I expected distress. I expected trolleys in the car park, drive-by intubations and patients’ families faxing through solicitors’ letters.

What I did not expect . . . was resilience.

I did not expect the gargantuan mobilisation of the HSE. I did not expect heroes emerging from the corners of libraries, from under administration desks and out from laboratory bunkers. Everyone was stepping up to the plate – and for once, they found it full and ripe and pouring adequate funding into our health service.

Rounds of circulars and scores of guidelines were produced. The protocol patrol was in overdrive. No sooner had one investigation and management plan been developed, a better version was clamouring to take its place.

There was a fervour to up-skill. Teaching sessions increased ten-fold. Everyone wanted to know as much as they could. Everyone was an innovator and everyone was an infectious disease expert (or so they would have led you to believe!).

Our ‘new normal’

Soon, the landscape of the hospital was unrecognisable. Patients awaiting long-term care were placed instantaneously. Medical teams were designated by ward to improve efficiency. Unprecedented inter-departmental communication meant we were working smarter as well as harder.

Staffing actually approached safe levels (when you take intermittent outbreaks out of the equation). The real beacon for change came in the form of a prehistoric Windows 95 desktop which, on retiring to its eternal home in the hospital skip, was to be replaced by a shiny new Vista model. This was truly doctoring in style.

There was immense sadness too, though. There was the wholly unnatural process of comforting a dying patient while wearing a mask, trying to exude as much comfort and care through eyes that no doubt spoke volumes of fear and desolation.

There were the days we realised our colleagues, whom we had laughed with at a distance the day before, were developing symptoms. We didn’t know how they would fare and we didn’t know if we would be next.

There was always the fear that a call would come, that told us someone we loved wasn’t going to make it. There was also the knowledge that we may be called upon to work through that pain.

While the emergency still hangs on the edge of a curve, the last three months has taught me to hope and above all; to expect more. When faced with a public health threat with an exotic name and the firm glare of the public, our health services, through the elimination of bureaucracy, nay-sayers and a limit on spending, were able to work faster, better and stronger.

For once, we were adequately resourced and facilitated to work effectively and innovate on the fly. Why quit now, when so many other ‘pandemics’ remain? The malady of mental ill-health, the cancer of crowded outpatient lists, the virus of vacant consultant posts?

It helps to be appreciated

Like anyone, I long for that day when the first item of the news bulletin is not a death toll or something pandemic-related. I long for a day when I can, with reasonable certainty, start to look forward, to anything….at all.

Though I long for a night out as much as the next person, it is hard to view the recent easing of restrictions with anything but trepidation. I see the reproductive number creeping over what would have been targeted, I hear street parties rage from where I rest on 24-hour shifts and I wonder if we are about to throw it all away.

I know not what physical and psychological reserves remain for a second surge, and I would rather not see us find out.

When Covid-19 relinquishes its grip on the world, however long that may take, what is left may pose an even greater challenge. Do our ‘health heroes’ deserve archaic rosters and unpaid overtime? Should we ‘feed the frontline’ with crippling registration and training fees? Will we ‘clap for carers’ with the echoing crack of a judge’s gavel?

There were things that could not have been predicted. There were failings. There were also a great many triumphs. There is no one saying that the way in which the pandemic was handled so far in our health service was without fault.

I cannot un-see the fear of patients and their families. I cannot un-feel the last time I hugged my mother before social distancing.

But I refuse to un-know how our health service and the public have the ability to back us, and arm us and inspire us to face any pandemic that comes along. Let us not slip back into the familiar bed of inertia that has had the HSE in lockdown for decades.

Dr Rachel McNamara is a member of the NCHD Committee of the Irish Medical Organisation and a Senior House Officer in an Irish hospital.

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