Wednesday, 02 December 2020

From the front line

Greetings from a partially eased lockdown: I write in the middle of May and the situation may be different by the time you read this. I hope my brothers and sisters are safe and well despite restrictions.

Most of you will know that I am a doctor and have been a consultant in Emergency Medicine (casualty) for the past 26 years. I currently work in Whitehaven on the Cumbrian coast. As Covid-19 began to spread our work dramatically changed: attendances were half their usual daily numbers or less. However, for each patient, whatever their symptoms, you needed to put on a basic surgical mask (like the ones you see people wearing in the shops), a disposable apron and gloves. The mask causes fear amongst young children and is very difficult for those with hearing problems who rely on lip reading to some degree. No one could come in with the patients apart from one parent with a child. That also caused difficulties as there was no collateral history for some patients and this is more difficult to ascertain over the telephone.

We were able to divide the department into separate areas and for those suspected of Covid-19 were seen in a separate contained area and each cubicle was thoroughly cleaned by a special team after each use. In this area a more substantial mask was used and at times the visor or goggles and for very serious cases a gown or white disposable suit under the apron. This got very warm and I find I can only wear the mask for a couple of hours.

Each time you take off the apron, gloves and mask you need to wash your hands. Even for a patient with a small limb injury you may need several sets of this PPE (personal protective equipment) and so several hand washes. This also happened each time I needed to review a patient with a junior colleague.

I want to share with you a Monday evening shift several weeks ago and tell you about five patients I saw in the Covid-19 or hot zone in the department.

The first man almost certainly had Covid-19. His wife had died the Thursday before and he had typical symptoms. He also had multiple other medical problems and would not have been a candidate for going to the intensive care unit and being put onto a ventilator. Wearing a mask, I had to discuss this with him and also talk about a ‘do not attempt cardiopulmonary resuscitation’ decision: he would have had all other care offered to him. ‘I’ve just got to take my chance then’ he said to me as my gloved hand held his. He died a few days later and the staff in our department were angry at this case as the couple’s grandson in his early twenties had been visiting and they felt he’d led to the death of his grandparents within a week of each other.

The next man was of similar age but had no underlying health problems. We lobbied hard for him to go to the intensive care unit and he eventually did but died of the disease about ten days later. All he was worried about was a medallion on the chain around his neck that he had been given when helping with a natural disaster several years before and we had managed to misplace as the chain was removed for his chest x-ray. Small things do matter.

The other three patients all had cancer. One lady was obviously very ill from her cancer and whether she had Covid-19 or not was immaterial: she died later that night with no family around her. Another patient, a man, was also very ill and again the virus did not matter as he also died within a few days. The third patient was a lady with a slow growing tumour. She probably had the virus but survived to leave hospital.

A grim evening as four out of the five patients did not survive to leave hospital. A few weeks later I went to review a patient with a junior colleague. She possibly had bowel obstruction. We did a scan and indeed this was the diagnosis and the cause was almost certainly cancer. It was very difficult explaining this through a mask. I gripped her hand tightly with my gloved hand as she held back the tears. She was a couple of years younger than me and related to one of our staff (West Cumbria is a small area and so often patients are related to staff). The tears did eventually flow and when her son brought up a case for her hospital stay it was again difficult as we could not let him see his mother: both myself and the sister found this testing in a deserted waiting room.

People have been overwhelmingly kind. We have had many gifts, some even left on my doorstep. They have been varied, from all manner of food and cold drinks to hand cream and hair products, useful after repeated showering. At home on a Thursday I go outside to clap and think of those working in care homes and the relatives of residents who cannot visit, and those working in shops and doing home deliveries: they too are ‘heroes’. If at work we try to go out to clap and are often greeted by various members of the emergency services – ambulances if present, police, fire, coastguard and blood bikes all with flashing lights on their vehicles.

Team work has been particularly important and also personally a great help as if I did not go to work I would not see many people as I live alone. The team members are not only the obvious ones of doctors and nurses, but our receptionists who need to decide if the patient needs the hot area, ambulance staff, police, porters and cleaners and many more. The cleaners are very important as they often need to clean a room quickly for another waiting patient.

No-one knows how long this situation will go on. Will it be a grandma’s step with one step forwards and two steps back if easing of lockdown leads to a surge of cases? It is difficult not to be able to attend church worship in person but the radio and television help as does streamed worship for those who can access it. Please stay safe and follow the guidance. If you have a serious illness or injury please attend your local emergency department, calling 999 if needed, and you will be welcomed and treated for your problem. Enjoy your exercise and take time to notice the wildlife; the wild flowers seem all the more vibrant this year.

claire summers
Yours in Christ,
Sr Claire Summers
(Diaspora)

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