Wednesday, 02 December 2020

Hopes and Heroes

Greetings from the settlement of Gracehill, Northern Ireland. It has been said that we are living through an unprecedented period. That it is of historic proportions is undoubted. The village church here in Gracehill has never before closed its doors maintaining services despite periods of war, famine and rebellion and yet for the last few months the doors have remained shut. No aspect of our personal or civic life has been unaffected and I think it is clear that many of the results of this period remain to be seen. We have all had to react to events, look at new ways of living and working and plan for the 'new normal'.

I am a general practitioner (GP) and also the clinical director of an out of hours medical care provider. In early January this year while clearing a store at my practice I came across a box marked 'PPE'. Opening it up I discovered some personal protective equipment; masks, gowns, visors and the like that had been in storage since the H1N1 swine flu pandemic 10 years ago. Thinking it would entertain my colleagues I donned the whole kit and joined them for their tea break. Little did I think that a very few weeks later no one would be laughing and PPE would become an essential part of our everyday lives.

The first case of the coronavirus known as Covid-19 was recorded in the UK in late January with the first case in Northern Ireland being confirmed just over four weeks later. In preparation for what was clearly a significant and developing health emergency there was a rare sense of unity and a real focus to ensure that we were as ready as we could be to cope. The media were full of shocking stories and images from China, then Italy and next London! There was a palpable sense of anxiety and foreboding and yet it was an uplifting and exhilarating time as the normal bureaucracy was set aside and everyone worked together in the race to prepare. Our National Health Service was completely transformed. Hospitals main focus became emergency departments, respiratory wards and intensive care units. In the community, general practice was reconfigured to try to maintain essential services but also manage Covid patients while protecting staff and other patients. Attendance at the practice moved to a system of 'by invitation only' following telephone triage of patients by clinical staff. Any patient who needed to be seen in person but who had symptoms suggestive of Covid infection was referred to one of the specially established 'community covid centres' where GPs and staff with appropriate training and equipment could assess them.

GPs across Northern Ireland were issued with hospital type 'scrubs' to wear which looked and felt a bit like maroon pyjamas. This and PPE quickly became the norm.

The Prime Minister, Boris Johnston, announced the UK wide lockdown on the 23rd of March. The levels of infection were rising in Northern Ireland at this point but had not reached the same extent as the rest of the UK and in retrospect the lockdown here at an earlier stage probably did result in us having the lowest death rate to date in the UK. On the 27th of March it was confirmed that the Prime Minister was suffering from Covid-19. From television appearances it was clear that he was unwell and he was subsequently admitted to hospital on the 2nd of April and then to intensive care on the 6th of April. This was a salutary moment for anyone who doubted the virulence of Covid-19. If the Prime Minister could get this ill then clearly everyone was at risk and confidence was shaken. As one of my patients said, 'It is a bit like Winston Churchill being kidnapped by the Nazis at the height of the Battle of Britain!'

News of the provision of additional morgue capacity and extra graves being prepared did little to lighten the mood but it did galvanise a sense of community and a feeling that we are all in this together and everywhere acts of kindness were evident. Often I witnessed people caring for their neighbours and looking out for others to an unusual degree. Nationally the focus tended to be on the NHS as exemplified by the weekly 'clap for carers' across the whole country at 8pm on Thursday evenings. Our local community Covid centre was inundated with gifts for staff, including flowers, food of all descriptions and cosmetic products. Some of our staff even had strangers step in and pay their bill at supermarket checkouts! Patients regularly enquired after our wellbeing and thanked us for our efforts. Banners appeared acclaiming 'NHS heroes!' Time will tell who the heroes are but for me, heroes are people who demonstrate courage. Obviously that can take the form of a single selfless act in the face of huge risk but often it is about commitment and perseverance in the face of difficulty and danger. 'Staying at your post', knowingly and repeatedly putting oneself in harm's way in the service of others. It was inspiring and uplifting to hear the media stories of many 'heroes' but personally I was humbled by the example of so many staff and carers who look after our vulnerable and elderly people both in care homes and in their own homes. Despite being some of the most poorly paid and overworked people these carers, often with inadequate protective equipment, continued to provide essential care despite risks to their own health. They are the heroes who I hope will not be forgotten in future.

A number of patients from our practice died with confirmed Covid-19 infection and also a number died following suspected infection and just like the national situation these were mainly elderly patients or those with an underlying illness. However, every death was a life cut shorter than it might have been and yet again I was humbled by the fortitude and dignity with which families bore their grief especially when the usual traditions and funeral arrangements were impossible.

There were lighter moments too of course. One afternoon when I was on duty at the Covid centre we were asked to do an emergency home visit to an elderly farmer who had hearing difficulties and lived alone. He had apparently become increasingly short of breath over the previous 24 hours to the extent that he could no longer walk. The emergency Covid vehicle was dispatched and we eventually arrived at the isolated farmyard. Wearing our 'maroon pyjamas' we donned our PPE and managing not to upset the farm dog too much, we made our way into the house where we found our patient. After he got over his surprise at our appearance he explained that in fact he had been knocked over by a sheep the previous day and had hit his chest which was now sore and causing him breathing difficulty. He also appeared to have broken his leg! Despite this we still felt it was better to deal with sheep rather than the coronavirus!
From a practice perspective the use of PPE was also interesting. Children were sometimes frightened by the use of masks and visors. Home visits in the early days, in Northern Ireland required a lot of explanation, as to appear wearing a mask on somebody's doorstep here could be misconstrued!

Personally the last months and the lockdown have not been the trial for me that it has been for so many others. It has been a pleasure having my two older sons home from university and they, my wife and I have all been busy in health related jobs. Fortunately, we have all remained well apart from my third and youngest son who managed to break his foot - he should have been in school!

As I write this in mid-June we are thinking about the future and about what the new normal might look like. Policy and practice has changed significantly over the last number of months and we have all learned new skills and new ways of working. Much of this is beneficial and was simply an acceleration of long-term aspirations. However, as I reflect on the last few months I do hope that a few more universal lessons will be learned.

Almost 400 years ago John Donne famously wrote 'No man is an island' and he went on to say 'Any man's death diminishes me, because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee.'
In recent times we have become careless of our environment and of each other. We have forgotten the humility of our forefathers. We are concerned about our individual rights rather than our community responsibilities.

I hope the sadness and sacrifices of these last months will lead to a renewed focus, that we will review our understanding of what is really of value, that we will hold on to all the good things that we have learned and that we will remember that the world is a very small place, it really is a 'global village'. We have certainly all had a wake-up call but the response of so many has been a source of great hope and in the words of retired US Navy Admiral William H. McRaven, 'The only thing more contagious than a virus is hope.'

david johnston
Br David Johnston

Gracehill

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