Pearls and Irritations

Caring for COVID-19 patients in a Sydney hospital through the city’s latest outbreak, a doctor reflects on the impact the pandemic is having on our healthcare system and the people who work in it.

I cannot

I cannot be more resilient
I cannot manage anything else
I cannot be too honest
I cannot watch the news anymore
I cannot imagine
I cannot sleep
I cannot let my team down
I cannot think about more than one day at a time
I cannot keep going

A calling

Someone asked me last week if I would have chosen this path if I knew I had been signing up for this.

I was exhausted, slumped over a desk with my head in my hands when I took a deep breath through my surgical mask to answer.

“It pains me to say it but I still would have done this. I cannot imagine doing anything else,” I sighed. “It is still a privilege to do what we do.”

I was almost rolling my eyes at myself, cringing at expressing something so cliché, but amidst much uncertainty I knew this to be fact. I was resigned to it. Does this privilege come with a price? How would I feel if any health care worker across our state, our nation, could not withstand the immense pressure they were under right now.

The answer? Devastated. Angry. Crushed.

Colleagues

It is not everyone, and it is not all the time, but the majority pull together when needed. This period has seen more collaboration and sharing of information, experience, and expressions of support across multiple hospitals than ever before in my career.

We humbly exchange successes and failures over Zoom, Skype, Microsoft Teams — if we remember to unmute ourselves.

We gather outside where we can physically distance and remove our masks to enjoy a coffee and a quick chat in patches of sun or shade.

These brief, shared moments of light and darkness feel precious. They help one go on.

Communication

Everyone I know is struggling with communication at the moment.

You do not say much. You frantically text in your breaks, letting typos fly while emojis do the talking. Sad face. Tired face. Laughing crying face.

Sometimes you speak but the words are all jumbled. Sometimes there is random, hysterical laughter which is almost as contagious as the virus itself. The next moment, you are confronted with the fear of a patient or their loved ones, who cannot visit or help them. It is unimaginable.

Some health workers are looking after patients from parts of Sydney they have never heard of, let alone been. This provides important insights into how different pockets of society function.

While coronavirus has forced people to isolate in their own communities, in their echo chambers, we providing healthcare are not able to do that. I hope we will be the better for it.

Compromise

Conflict and compromise occur in hospitals daily. From the front door to the top floor. Consensus in meetings is akin to reaching Nirvana — unattainable for most. This is not unique to the health sector.

The discomfort of being faced with this possibility that we might have to compromise on the care we provide is palpable. Of course, we are privileged that this is not something we are faced with every day.

Complain

I should not complain because we will not face anything like China, Italy, the US or UK have faced from this virus.

I should not complain because so many colleagues return home to loved ones including unvaccinated children, or to care for elderly relatives.

I should not complain when the nursing and junior medical staff constitute the majority who are providing “around the clock” care for coronavirus patients in our hospitals.

It is hard, maybe impossible, to use words to describe the gut-wrenching anguish many feel on their way home. The vague nausea of exhaustion and dry lip-smacking, for titrating water and coffee intake with the challenge of doffing personal protective equipment (PPE) to use the bathroom is a fine balance indeed.

Then a slowly typed text to family or friend that you are off the ward and on your way home. This journey is one of processing what you have done today, often fixating on what you missed or should have done better.

Assaulted on the outside by the noise of news, modelling and mayhem, I often switch to music, embrace the endorphins of singing. A small smile may creep up when “Danger Zone” by Kenny Loggins comes on seemingly by chance.

Then the work façade is replaced by the home façade. What can you say and share? Who can you be vulnerable with? The energy taken to shift between these fronts can be almost as hard as the work itself.

Clean

Most hospitals are using terminology like “hot” and “cold” zones, or even “dirty” and “clean”, in an attempt to clearly communicate areas where coronavirus patients may be transported and where certain PPE is necessary. We are familiar with these terms which are often used in surgical procedures where sterile zones are needed, but no one thinks the term “dirty” is really acceptable.

It helps focus the mind on the stigma of this and other diseases. Remember when you could cough without someone turning to glare at you?

If you are not working in coronavirus care, you cannot possibly know how good showering can be.

Perhaps if you have reached the summit of Mount Everest you can appreciate the sensation I describe. From the anxious, painstaking peeling off of one’s gear to the fearless frolicking in warm water, scrubbing from head to toe once, then again. Maybe just one more time. It is a strangely joyful climax at the end of a long, hard… day.

Celebration

When life returns back to something we recognise as “normal”, it will be a great relief.

But it should not be a relaxation into past oversights, assumptions and errors. The coronavirus pandemic has exposed some of the biggest disparities across Sydney in the way we interact with healthcare and the media.

It has also exposed crucial access limitations for rural communities. I feel confident that we as healthcare workers can embrace these lessons when we recover. I hope others will follow our lead.

I can

I can help patients and their families at this difficult time
I can swallow some of my frustrations
I can listen
I can lean on colleagues, friends and family
I can ask for help
I can feel good about my work
I can feel proud of my team
I can be grateful
I can face tomorrow