Tues 24th March 2020:
Today I took the decision to close my private skin surgery service and which I do from a local private clinic. The only other time I have paused this since I set it up in 2010, was when I went to Canada in 2017 and after 9 months I came back to a busy time where loyal patients had wanted to wait for my return. In the interests of patient safety and in line with government and Public Health England's advice, I didn't want to wait any longer to decide over this. None of the surgery I do in this service is urgent-my role is rather more that of Dr Pimplepopper, as I am locally becoming known as! I have to lend me energies to the urgent skin cancer in my NHS job, and await news of deployment. All my booked patients are understanding and seeminly relieved at the decision, and I hope to pick things back up when it is safe to do so again.
While I’ve been operating full skin cancer removal lists at work and so up close to patients I have been remaining always aware of my unknown personal risks after cancer in my chest which required chemo and radiotherapy as well as a stem cell transplant, I have had to self risk assess and have again remained ahead of the advice curve and have been trying to champion the need for Personal Protective Equipment (PPE) for all of us in dermatology. And all the while being so aware that it is in short supply so why would anyone in dermatology be considered above anyone in itu? It’s a sad reality, but putting some doctors and their contact risk above other doctors is why doctors, and nurses, are dying. It may be easier to consider that known covid patients being admitted or treated, or sadly dying, are the ones to protect from. But what about those without symptoms who are shedding it every time they walk into our outpatient dept, our operating room, every time droplets from patients coughing, or from the aerosol generating particles (AGP) produced every time we cauterise bleeding vessels during our surgery, enter my operating room environment (and in dermatology these rooms are smaller and the ventilation requirements are less compared to proper operating theatres) I still think we are as at much risk as anyone. My husband and family have been urging me for weeks not to work directly with covid patients, concerned that I may be more vulnerable after my lungs and chest were the focus of my previous cancer and treatment.
My manager had submitted a referral to occupational health as she and my team appear to have the same concerns. I was a bit timid to even express my husband's concerns to my manager about my previous illness, and I'm a bit resistant, almost embarrassed, to be presenting myself as a risky worker, when all I want to do is help however I may be needed. I don't want to be seen as the one who didn't put herself forward, the one who couldn't didn't help her comraces. I feel well, I’m careful with my protection, and have been for longer and more seriously, than several of my dermatology colleagues, as I assumed a slightly higher risk to myself, and I’m definitely doing procedures which bring a bit more risk to my working day, and we don’t have all the right gear. Yes I’ve been fit mask tested and will now get on with using the new mask, but I need to think about a visor, long sleeves, donning and doffing (putting on and taking off ppe) carefully. As a department we have started taking patients' temperatures on arrival, the staff wearing a plastic apron, gloves and a surgical mask during the daily grind, and I've just made sure of taking all the precautions I can in the op room for myself and my assisting nurse. Noone is really telling us to do this in dermatology outpatients, but why wouldn't we? We still need to take individual responsibility to protect ourselves and our patients-we still can't see with our eyes where this assailant is, so why wait to be told?
I attended a webinar tonight on covid by an itu consultant in Edinburgh with my friend and surgical colleague-more for my own education on it, and not because I think I’m going to managing these patients, given the hovering suggestion that I may not be selected to go on the front line. I am so privileged in my job to treat the generations above me, who have taught me so much, and could teach all our generations so much more, including in this health war. So many elderly male patients of mine who have talked about their time fighting in a world war, have been nothing short of heroic, in whatever roles they had to adopt, whether serving frontline in the trenches, in the air, on the sea, or unseen working with intelligence and in the planning and administrative roles behind the visible scenes, at all levels of rank. I always comment, with deep gratitude, on their blazer pins which many still so proudly adorn on themselves, as this small symbolic reminder to themselves and to those who recognise the significance of this 5p piece sized badge, is the one reminder of what they did to bring us to the place we all have the privilege to be in now.
However many others have told me how they couldn’t join the army/airforce/navy due to a health condition (we specifically ask if they served when we are treating their skin cancers, as a war veterans agency exists which compensates former servicemen for their time served in hot countries in the war and if they have subsequently suffered a skin cancer. It is the least I can do to inform them of a potential opportunity for a monetary bonus for what they did for us). I have learnt that those who weren’t allowed to sign up, without exception, still feel guilt and disappointment even in their 8th and 9th decades, and so many years after the war ended. And now I have an inkling of what they felt like to not have the opportunity to serve at the country’s greatest time of need. But better to live a coward than die a hero as they say. Maybe so for some, but not for all. This would never have been said to me when I had cancer. When facing mortality then had a different meaning, because I wasn't volunteering myself to get cancer, I was only working hard, with all the help I could get, to fight the assailant.
Would I be a coward, or would I be sensible if I were not to step forward, or not be stepped forward, to help in this war fight against covid? I still can't consider not being in it, and still intend to play my part, whatever role I am summoned to have. I reflect again on our war veterans. Many talk with such pride and commeraderie, whilst others remain silent and have lived with post-traumatic stress ever since. Everyone's experience of the same event have been so different. I imagine the same with this millenial world event.
I learn a lot from the webinar. I don’t like that people are getting hypoxic after 5 days and by staying at home at the moment many are presenting to hospital late and in a more serious condition. I fear again for my family. I’m 2 hours away. My dad is on the high risk list given that he is 76 with hypertension and copd. I pray he nor my mum come within a sniff of this virus. I order a pulse oximeter during the webinar and send it to my parents -this way they can measure their oxygen levels at home with a finger probe and know if there’s a problem quickly and not to wait to get to hospital. I pray hard again that none of this advice I’m giving them ever needs to be employed. I also write a message to my younger brother, a hero to me, perhaps because his distance is more painful for all of us than for him right now, and our ability to reach him is so limited. I try to encourage him to keep in touch, I tell him that we may need him and he may need us. I ask him that now we all segregated by force, and with no knowledge of where I’ll be posted in the coming days to weeks, I hoped he would keep himself safe, and be reassured and be reassuring to us, that he is ok, that we are ok. I know my brother, although in the film industry, doesn't watch much TV, and this is where we are all getting the covid info as it emerges.
I don't expect a reply, and I don't get one. Not to that message anyway. But again I just have to hope he has heard me. I am also worried about him looking after himself well through all this, and the knowledge that I can't have the same level of interaction with him as I have with the rest of my family, is hard, but it won't stop me letting him know what's important as things emerge. He is so precious to all of us.
By Dr Sam Anthony
Survivor of a career in medicine, a career break from medicine, cancer, and blogging..join me in my quest to make us happier healthier individuals and doctors